{"id":7362,"date":"2020-08-06T09:52:28","date_gmt":"2020-08-06T14:52:28","guid":{"rendered":"https:\/\/cornflowerblue-rail-980953.hostingersite.com\/?p=7362"},"modified":"2020-08-06T09:54:04","modified_gmt":"2020-08-06T14:54:04","slug":"whats-new-in-msk-imaging-turkish-august-2020","status":"publish","type":"post","link":"https:\/\/staging-hub.acoredu.com\/tr\/whats-new-in-msk-imaging-turkish-august-2020\/","title":{"rendered":"What’s new in MSK Imaging (Turkish) – August 2020"},"content":{"rendered":"
\u00d6n \u00c7apraz Ba\u011f\u0131 Y\u0131rt\u0131lmalar\u0131nda, Menisk\u00fcs Ramp Lezyonlar\u0131n\u0131 Saptamada Manyetik Rezonans G\u00f6r\u00fcnt\u00fclemenin Diyagnostik Performans\u0131: Sistematik Derleme ve Meta-analiz<\/strong><\/span><\/h5>\n

Koo B, Lee SH, Yun SJ, Song JG. Diagnostic performance of magnetic resonance imaging for detecting meniscal ramp lesions in patients with anterior cruciate ligament tears: a systematic review and meta-analysis. The American Journal of Sports Medicine. 2019 Nov 4:0363546519880528.<\/p>\n

https:\/\/pubmed.ncbi.nlm.nih.gov\/31684739\/<\/a><\/p>\n

Giri\u015f:<\/strong> Ramp lezyonu, medial menisk\u00fcs (MM) arka boynuzda periferik meniskokaps\u00fcler ba\u011flar\u0131n y\u0131rt\u0131lmas\u0131, bozulmas\u0131 veya ayr\u0131lmas\u0131d\u0131r. Ramp lezyon onar\u0131m\u0131 yap\u0131lmadan \u00d6\u00c7B rekonstr\u00fcksiyonu uygulanmas\u0131, eklem kinemati\u011fini d\u00fczeltemeyebilir. Ramp lezyonlar\u0131 anterior translasyona, eksternal rotasyonel laksiteye (diz instabilitesi), medial menisk\u00fcs y\u0131rt\u0131\u011f\u0131n\u0131n arka boynuza uzamas\u0131na ve hem menisk\u00fcs hem de artik\u00fcler k\u0131k\u0131rda\u011f\u0131n h\u0131zl\u0131 dejenerasyonuna neden olur. Ramp lezyonlar\u0131n\u0131n tespitinde manyetik rezonans g\u00f6r\u00fcnt\u00fclemenin (MRG) tan\u0131sal do\u011frulu\u011fu geni\u015f bir skalaya sahiptir.<\/p>\n

Sorular:<\/strong> \u00d6\u00c7B y\u0131rt\u0131\u011f\u0131 olan hastalarda ramp lezyonunun tan\u0131s\u0131nda MRG’nin duyarl\u0131l\u0131\u011f\u0131 ve \u00f6zg\u00fcll\u00fc\u011f\u00fc nedir?<\/p>\n

Dizayn:<\/strong> Sistematik derleme ve meta-analiz.<\/p>\n

Kat\u0131l\u0131mc\u0131lar: <\/strong>\u00d6\u00c7B y\u0131rt\u0131\u011f\u0131 ve rekonstr\u00fcks\u00fcyonu bulunan 883 hasta (8 makaleden 9 \u00e7al\u0131\u015fma).<\/p>\n

D\u0131\u015flama Kriterleri: <\/strong>(1) vaka raporu veya vaka serisi; (2) derleme makaleler, k\u0131lavuzlar, konsens\u00fcs beyanlar\u0131, mektuplar, ba\u015fyaz\u0131lar ve konferans \u00f6zetleri; (3) ara\u015ft\u0131rma konusuyla ilgili olmayan \u00e7al\u0131\u015fmalar; (4) canl\u0131 insan \u00fczerinde yap\u0131lmayan \u00e7al\u0131\u015fmalar (hayvan ve kadavra \u00e7al\u0131\u015fmalar\u0131) ve (5) 2×2 tablosu i\u00e7in yetersiz veri i\u00e7eren \u00e7al\u0131\u015fmalar.<\/p>\n

Y\u00f6ntem:<\/strong> PubMed, EMBASE ve Cochrane Library literat\u00fcr taramalar\u0131, PRISMA DTA (Tan\u0131sal Do\u011fruluk \u00c7al\u0131\u015fmalar\u0131n\u0131n Sistematik \u0130ncelemeleri ve Meta-Analizleri i\u00e7in Tercih Edilen Raporlama \u00d6\u011feleri) raporunun revize edilmi\u015f k\u0131lavuzlar\u0131na dayan\u0131larak ger\u00e7ekle\u015ftirilmi\u015ftir. \u0130ndeks test olarak MRG\u2019yi ve ramp lezyonu i\u00e7in referans y\u00f6ntem olarak artroskopiyi kullanan tan\u0131sal performans \u00e7al\u0131\u015fmalar\u0131 dahil edildi. Tan\u0131sal performans\u0131 de\u011ferlendirmek i\u00e7in iki de\u011fi\u015fkenli ve hiyerar\u015fik ROC modellemesi kullan\u0131ld\u0131. Potansiyel heterojenite kaynaklar\u0131n\u0131 belirlemek i\u00e7in meta-regresyon analizleri yap\u0131ld\u0131.<\/p>\n

Sonu\u00e7:<\/strong> Ramp lezyonu i\u00e7in MRG ortalama duyarl\u0131l\u0131\u011f\u0131 0.71 (%95 CI, 0.59-0.81), \u00f6zg\u00fcll\u00fc\u011f\u00fc 0.94 (%95 CI, 0.88-0.97) ve hiyerar\u015fik ROC analizinde e\u011fri alt\u0131ndaki alan 0.90 (%95 CI, 0.87)-0.92) olarak belirlendi. Potansiyel ortak de\u011fi\u015fkenler aras\u0131nda; m\u0131knat\u0131s kuvveti (P <.01), hasta diz pozisyonu (P = .04) ve MRG yorumlay\u0131c\u0131s\u0131 (P = .04) duyarl\u0131l\u0131k a\u00e7\u0131s\u0131ndan heterojenlik ile ili\u015fkilendirilmi\u015fken, m\u0131knat\u0131s kuvveti ayn\u0131 zamanda (P = .03) \u00f6zg\u00fcnl\u00fck a\u00e7\u0131s\u0131ndan heterojenlik ile ili\u015fkili bulundu.<\/p>\n

\u00c7\u0131kar\u0131m:<\/strong> MRG, ramp lezyonunu te\u015fhis etmek i\u00e7in orta d\u00fczeyde duyarl\u0131l\u0131k g\u00f6sterirken, \u00fcst d\u00fczeyde \u00f6zg\u00fcll\u00fck g\u00f6stermi\u015ftir. MRG’de \u015f\u00fcpheli olup olmad\u0131\u011f\u0131na bak\u0131lmaks\u0131z\u0131n ramp lezyonunun varl\u0131\u011f\u0131 i\u00e7in rutin artroskopik de\u011ferlendirme \u00f6nerilir. Ramp lezyonlar\u0131n\u0131 tespit i\u00e7in i\u00e7in y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fckl\u00fc ve do\u011fru diz pozisyonuyla ger\u00e7ekle\u015ftirilen MRG\u2019leri i\u00e7eren daha detayl\u0131 klinikoradyolojik \u00e7al\u0131\u015fmalara ihtiya\u00e7 vard\u0131r.<\/p>\n

Yorum: <\/strong>Ara\u015ft\u0131rmac\u0131lar\u0131 \u00d6\u00c7B yaralanmas\u0131nda MM y\u0131rt\u0131klar\u0131n\u0131 konu alan bu geni\u015f kapsaml\u0131 \u00e7al\u0131\u015fmay\u0131 yay\u0131nlad\u0131klar\u0131ndan dolay\u0131 tebrik ediyoruz. Artroskopinin meniskoskaps\u00fcler yaralanmalarda, \u00f6zellikle retrospektif bak\u0131da, alt\u0131n standart olarak kabul edilen bir de\u011ferlendirme metodu olmad\u0131\u011f\u0131 ak\u0131lda tutulmal\u0131d\u0131r. Bunun yan\u0131 s\u0131ra \u00d6\u00c7B yaralanmas\u0131nda medial menisk\u00fcste k\u00f6\u015fe frakt\u00fcr\u00fc veya longitudinal y\u0131rt\u0131k \u00e7ok s\u0131k kar\u015f\u0131la\u015f\u0131lan durumlard\u0131r. Bu t\u00fcrden y\u0131rt\u0131klarla ili\u015fkilendirilen meniskoskaps\u00fcler zedelenme veya ayr\u0131lmalar\u0131 MRG ile ay\u0131rt etmek olduk\u00e7a zordur. Ek olarak, \u00d6\u00c7B rekonstr\u00fcksiyonu artroskopisi; pratikte erken rekonstr\u00fcksiyondan veya ba\u015fka \u00f6ng\u00f6r\u00fclemeyen sebeplerden dolay\u0131 ortaya \u00e7\u0131kan olumsuz etkenler nedeniyle s\u0131kl\u0131kla ertelendi\u011fi i\u00e7in, rutin klinik uygulamalarda kullan\u0131m i\u00e7in ge\u00e7erli olmayabilir.<\/p>\n

\u00a0<\/strong><\/p>\n

\u00c7ocuk Servikal Omurga Yaralanmalar\u0131n\u0131n Epidemiyolojisi ve G\u00f6r\u00fcnt\u00fcleme S\u0131n\u0131fland\u0131rmas\u0131: Seviye-1 Travma Merkezinde 12 Y\u0131ll\u0131k Deneyim<\/strong><\/span><\/h5>\n

Beckmann NM, Chinapuvvula NR, Zhang X, West OC. Epidemiology and imaging classification of pediatric cervical spine injuries: 12-year experience at a Level 1 Trauma Center. American Journal of Roentgenology. 2020 Jun;214(6):1359-68.<\/p>\n

https:\/\/www.ajronline.org\/doi\/abs\/10.2214\/AJR.19.22095<\/a><\/p>\n

Sorular:<\/strong> \u00c7ocukluk \u00e7a\u011f\u0131nda k\u00fcnt travma sonucu servikal omurga yaralanmalar\u0131n\u0131n oran\u0131 nedir? Bu populasyonda servikal omurga yaralanma \u00e7e\u015fitleri nelerdir?<\/p>\n

Dizayn:<\/strong> Retrospektif \u00e7al\u0131\u015fma.<\/p>\n

Kat\u0131l\u0131mc\u0131lar: <\/strong>2006 Temmuz ve 2018 Haziran aras\u0131ndaki travma kay\u0131tlar\u0131nda 16 ya\u015f ve alt\u0131 servikal omurga yaralanmas\u0131 tan\u0131s\u0131 konmu\u015f 235 hasta.<\/p>\n

D\u0131\u015flama kriterleri: <\/strong>Kesitsel g\u00f6r\u00fcnt\u00fcleri (BT veya MRG) olmayan hastalar ve servikal omurgada penetran travmas\u0131 olan hastalar \u00e7al\u0131\u015fmaya dahil edilmedi.<\/p>\n

Y\u00f6ntem: <\/strong>BT ve\/veya MR g\u00f6r\u00fcnt\u00fcleri 13 y\u0131ll\u0131k tecr\u00fcbeye sahip bir kas-iskelet radyologu taraf\u0131ndan de\u011ferlendirildi ve yaralanma seviyesi ile yaralanma tipi kaydedildi. E\u011fer hastalar\u0131n ba\u015fvuru an\u0131nda \u00e7ekilen direk grafisi mevcutsa grafi raporlar\u0131 da analiz edilerek BT veya MR g\u00f6r\u00fcnt\u00fclerindeki yaralanma bulgular\u0131 ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131.<\/p>\n

Sonu\u00e7: <\/strong>\u0130zole \u00fcst servikal omurga yaralanma s\u0131kl\u0131\u011f\u0131 3 ya\u015f alt\u0131 hastalarda %73, 3-8 ya\u015f aral\u0131\u011f\u0131ndaki hastalarda %48, 8 ya\u015f \u00fcst\u00fc hastalarda %29 olarak belirlendi. Oksipital kondil frakt\u00fcrlerinin %71\u2019i, dens frakt\u00fcrlerinin ise %26’s\u0131 av\u00fclsiyon tip frakt\u00fcrd\u00fc. Tip-II dens frakt\u00fcrleri yaln\u0131zca 8 ya\u015f \u00fcst\u00fc hastalarda bulundu. Tip-I ve tip-III dens frakt\u00fcrleri neredeyse sadece 8 ya\u015f ve alt\u0131ndaki hastalarda g\u00f6zlendi. AO-Omurga s\u0131n\u0131flamas\u0131na g\u00f6re A, B ve C olarak grupland\u0131r\u0131lan yaralanmalar, subaksiyal yaralanmalar\u0131n s\u0131ras\u0131yla %65.6, %17.2 ve %17.2’sini olu\u015fturuyordu.<\/p>\n

\u00c7\u0131kar\u0131m: <\/strong>Pediyatrik hastalarda, s\u0131kl\u0131kla avulsiyon frakt\u00fcrleri ile ili\u015fkililendirilen bir distraksiyon yaralanmas\u0131 olma e\u011filimi g\u00f6steren \u00fcst servikal omurga yaralanma oranlar\u0131 y\u00fcksektir. Pediyatri hastalar\u0131nda yaralanma paternleri ya\u015fa g\u00f6re \u00f6nemli farkl\u0131l\u0131klar g\u00f6sterir; 3 ya\u015f\u0131ndan k\u00fc\u00e7\u00fck hastalar \u00f6zellikle distraksiyon tipi yaralanmalara meyillidir.<\/p>\n

Yorum: <\/strong>\u00c7al\u0131\u015fma i\u00e7in te\u015fekk\u00fcrler. G\u00f6rece daha b\u00fcy\u00fck bir pediatrik kafa boyutu ve daha g\u00fc\u00e7l\u00fc servikal ligamentlerin varl\u0131\u011f\u0131, \u00fcst servikal yaralanmalar\u0131n ve tipik av\u00fclsiyon frakt\u00fcrlerinin neden daha s\u0131k ger\u00e7ekle\u015fti\u011fini a\u00e7\u0131klamaktad\u0131r<\/p>\n

 <\/p>\n

Asemptomatik Sa\u011fl\u0131kl\u0131 Kontrol Grubuna Kar\u015f\u0131 Lateral Epikondilit Olgular\u0131nda Ultrasonografik De\u011ferlendirmenin Klinik De\u011feri<\/strong><\/span><\/h5>\n

Krogh TP, Fredberg U, Ammitzboll C, Ellingsen T. Clinical Value of Ultrasonographic Assessment in Lateral Epicondylitis Versus Asymptomatic Healthy Controls. The American Journal of Sports Medicine. 2020 Jun 2:0363546520921949.<\/p>\n

https:\/\/pubmed.ncbi.nlm.nih.gov\/32484714\/<\/a><\/p>\n

Giri\u015f:<\/strong> Tenis\u00e7i dirse\u011fi olarak da bilinen lateral epikondilit (LE), ortak ekstans\u00f6r tendonun a\u015f\u0131r\u0131 kullan\u0131m sendromudur. Artan ortak ekstans\u00f6r tendon kal\u0131nl\u0131\u011f\u0131 LE’de g\u00f6zlenen tendinopatik de\u011fi\u015fikliklerin bir par\u00e7as\u0131d\u0131r. Ultrasonografi (US) LE’nin de\u011ferlendirilmesinde s\u0131kl\u0131kla kullan\u0131lmas\u0131na ra\u011fmen klinik r\u00f6l\u00fcn\u00fc destekleyen yeterli d\u00f6k\u00fcmantasyon bulunmamaktad\u0131r.<\/p>\n

Sorular: <\/strong>Ultrasonagrafi tek ba\u015f\u0131na LE tan\u0131s\u0131nda kullan\u0131labilir mi? Ortak ekstans\u00f6r tendonun renkli Doppler bulgular\u0131 LE i\u00e7in patognomonik midir? Kemik spur varl\u0131\u011f\u0131 ve LE geli\u015fimi aras\u0131nda bir ba\u011flant\u0131 var m\u0131d\u0131r?<\/p>\n

Dizayn\u00a0: <\/strong>Kesitsel, g\u00f6zlemsel ve kar\u015f\u0131la\u015ft\u0131rmal\u0131 \u00e7al\u0131\u015fma.<\/p>\n

Kat\u0131l\u0131mc\u0131lar\u00a0: <\/strong>Sa\u011fl\u0131kl\u0131 dirseklere sahip 264 kat\u0131l\u0131mc\u0131 ve kronik LE\u2019si bulunan 60 hasta.<\/p>\n

LE hastalar\u0131 i\u00e7in d\u0131\u015flama kriterleri\u00a0: <\/strong>18 ya\u015f\u0131ndan k\u00fc\u00e7\u00fckler, son 3 ayda glukokortikoid enjeksiyonu \u00f6yk\u00fcs\u00fc ve \u00f6nceden ge\u00e7irilmi\u015f LE ameliyat\u0131 tarifleyenler, inflamatuar hastal\u0131klar (\u00f6rn., romatoid artrit, psoriatik artrit veya inflamatuar ba\u011f\u0131rsak hastal\u0131\u011f\u0131), boyun a\u011fr\u0131s\u0131, ipsilateral (ayn\u0131 tarafta) omuz a\u011fr\u0131s\u0131 ve kronik yayg\u0131n a\u011fr\u0131 sendromlar\u0131 bulunanlar.<\/p>\n

Sa\u011fl\u0131kl\u0131 dirse\u011fi olan grup i\u00e7in d\u0131\u015flama kriterleri\u00a0:<\/strong> 20 ya\u015f\u0131ndan k\u00fc\u00e7\u00fckler ve lateral dirsekte a\u011fr\u0131 ge\u00e7mi\u015fi bulunanlar.<\/p>\n

Y\u00f6ntem\u00a0: <\/strong>Tendon kal\u0131nl\u0131\u011f\u0131, renkli Doppler aktivitesi ve kemik spur varl\u0131\u011f\u0131 US ile de\u011ferlendirildi. Hasta \u00f6zelliklerine ek olarak Hasta Bazl\u0131 Tenis\u00e7i Dirse\u011fi De\u011ferlendirme (PRTEE) skoru, a\u011fr\u0131 ve sakatl\u0131k kaydedildi.<\/p>\n

Sonu\u00e7\u00a0: <\/strong>Kullan\u0131lan \u00f6l\u00e7\u00fcm tekni\u011fine ba\u011fl\u0131 olarak, ortalama LE tendon kal\u0131nl\u0131\u011f\u0131 kontralateral tarafla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda 0,53 mm (% 10,2) veya 0,70 mm (% 14,5)\u00a0; genel populasyonla k\u0131yasland\u0131\u011f\u0131nda 0,40 mm (% 7,9) veya 0,41 mm (% 8,5) artm\u0131\u015ft\u0131r. Ortalama renkli Doppler aktivitesi (skala, 0-4) LE bulunan kolda 3.47, asemptomatik kontralateral kolda 0.13 ve genel pop\u00fclasyonda 0.26 bulundu. LE vakalar\u0131n\u0131n %78\u2019inde kemik spur g\u00f6zlenmesine kar\u015f\u0131n bu oran kontralateral kolda %45 ve genel populasyonda %50 olarak \u00f6l\u00e7\u00fcld\u00fc.<\/p>\n

\u00c7\u0131kar\u0131m\u00a0: <\/strong>Ultrasonografi tek ba\u015f\u0131na bir tan\u0131 arac\u0131 olarak kullan\u0131lamaz. Daha ziyade LE hastalar\u0131ndaki do\u011fal tendon kal\u0131nl\u0131\u011f\u0131ndaki belirgin varyasyonlar ve tendon kal\u0131nl\u0131\u011f\u0131ndaki k\u00fc\u00e7\u00fck art\u0131\u015flar g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda genel de\u011ferlendirmelere yard\u0131mc\u0131 bir ek de\u011ferlendirme arac\u0131 olarak kullan\u0131labilir. Kontralateral dirsekte (asemptomatikse) genel pop\u00fclasyona g\u00f6re tendon kal\u0131nl\u0131\u011f\u0131 ortalama de\u011ferleri daha iyi bulunmu\u015ftur. Renkli Doppler aktivitesi devam eden tendinopatinin bir g\u00f6stergesidir ve LE te\u015fhisini destekler, ancak patognomonik de\u011fildir. LE \u015f\u00fcphesi olan bir hastada Doppler aktivitesinin olmamas\u0131, di\u011fer tan\u0131 olas\u0131l\u0131klar\u0131n\u0131 art\u0131rmal\u0131d\u0131r. Genel pop\u00fclasyonda y\u00fcksek prevalans\u0131 g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, kemik spurun tan\u0131mlanmas\u0131 klinik olarak \u00e7ok anlaml\u0131 olmayabilir. A\u011fr\u0131, sakatl\u0131k, PRTEE ve hastal\u0131k s\u00fcresi, US tekniklerinden hi\u00e7biriyle ili\u015fkili bulunmad\u0131.<\/p>\n

Yorum\u00a0: <\/strong>Bu ilgin\u00e7 ara\u015ft\u0131rma i\u00e7in sizlere te\u015fekk\u00fcr ederiz. Pratikte, aktif tendon iltihab\u0131 tan\u0131s\u0131nda sonografik palpasyonda hassasiyet b\u00fcy\u00fck rol oynamaktad\u0131r. Asemptomatik kemik proliferasyonu veya tendon kal\u0131nla\u015fmas\u0131n\u0131n, genellikle rastlant\u0131sal oldu\u011fu kabul edilmelidir.<\/p>\n

<\/h1>\n

 <\/p>\n

Her Ye\u015fil Tof\u00fcs De\u011fildir: Minimum Aten\u00fcasyon Optimizasyonu ve Kalay Filtre Kullan\u0131m\u0131n\u0131n Ayak ve Ayak Bile\u011fi \u00c7ift Enerjili Bilgisayarl\u0131 Tomografisinde G\u00f6r\u00fclen K\u00fcmele\u015fmi\u015f Artefaktlar\u0131 Azaltmadaki \u00d6nemi,<\/span><\/strong><\/h5>\n

Park EH, Yoo WH, Song YS, Byon JH, Pak J, Choi Y. Not All Green Is Tophi: The Importance of Optimizing Minimum Attenuation and Using a Tin Filter to Minimize Clumpy Artifacts on Foot and Ankle Dual-Energy CT. American Journal of Roentgenology. 2020 Jun;214(6):1335-42.<\/p>\n

https:\/\/www.ajronline.org\/doi\/full\/10.2214\/AJR.19.22222<\/a><\/p>\n

Giri\u015f: <\/strong>\u00c7ift enerjili bilgisayarl\u0131 tomografi (DEBT), kimyasal bile\u015fimlerine g\u00f6re \u00fcrik asit kristallerini kalsiyumdan ay\u0131rt ederek, gut hastal\u0131\u011f\u0131n\u0131n erken tedavisini m\u00fcmk\u00fcn k\u0131lan umut verici sonu\u00e7lar g\u00f6stermi\u015ftir. Kronik gut hastal\u0131\u011f\u0131ndaki tof\u00fcs\u00fcn toplam hacmi DEBT ile \u00f6l\u00e7\u00fclerek, tof\u00fcs\u00fcn kantitatif de\u011ferlendirilmesi ve hasta takibinde tedavi yan\u0131t\u0131n\u0131n analizi m\u00fcmk\u00fcn olabilir. DEBT baz\u0131 durumlarda saf olmayan materyali ye\u015fil renk olarak kodlar. Bir milimetreden k\u00fc\u00e7\u00fck ye\u015fil pikselle\u015fmelerin olu\u015fturdu\u011fu bir k\u00fcme olan bu artefaktlar, \u201csubmilimetrik artefakt k\u00fcmesi\u201d veya \u201ck\u00fcmele\u015fmi\u015f artefaktlar\u201d gibi farkl\u0131 terimlerle tan\u0131mlanm\u0131\u015ft\u0131r. Bu artefaktlar tendon ve ligamentlar \u00fczerinde k\u00fcmeler halinde g\u00f6r\u00fcnmektedir. Bu y\u00fczden \u015fekilleri ve yerleri a\u00e7\u0131s\u0131ndan tof\u00fcslere benzeyen bu yap\u0131lar hastal\u0131k te\u015fhisi ve tan\u0131s\u0131n\u0131 zorla\u015ft\u0131rmakla birlikte yanl\u0131\u015f pozitifliklere de sebebiyet verebilir.<\/p>\n

Soru:<\/strong> K\u00fcmele\u015fmi\u015f artefaktlar\u0131n s\u0131kl\u0131\u011f\u0131 nedir ve nerede bulunur? K\u00fcmele\u015fmi\u015f artefaktlar\u0131n gut hastal\u0131\u011f\u0131 olarak yanl\u0131\u015f tan\u0131 alma oran\u0131 nedir? Aten\u00fcasyon de\u011ferini art\u0131rmak ve tomografide se\u00e7ici bir foton kalkan\u0131 kullanmak bu artefakt\u0131 \u00f6nlemede etkili olur mu?<\/p>\n

Dizayn:<\/strong> Retrospektif\u00a0 ara\u015ft\u0131rma<\/p>\n

Kat\u0131l\u0131mc\u0131lar: <\/strong>Chonbuk Ulusal \u00dcniversite Hastanesinde ayak ve ayak bile\u011fi \u00e7ift enerjili bilgisayarl\u0131 tomografisi (DEBT) \u00e7ekilen 40 hasta.<\/p>\n

D\u0131\u015flama Kriterleri:<\/strong> Tek enerjili bilgisayar tomografisi (TEBT), gut hastal\u0131\u011f\u0131 \u00f6yk\u00fcs\u00fc, gut hastal\u0131\u011f\u0131n\u0131 ekarte etmek i\u00e7in yap\u0131lan BT, 16 ya\u015f \u00f6ncesi bireyler, bir romatolog taraf\u0131ndan gut hastal\u0131\u011f\u0131 sebepli oldu\u011fundan s\u00fcphelenilen a\u011fr\u0131 varl\u0131\u011f\u0131, taranm\u0131\u015f alanda \u00f6nceden var olan metal protezler, standard gri \u00f6l\u00e7ekli BT g\u00f6r\u00fcnt\u00fclerinde y\u00fcksek aten\u00fcasyon g\u00f6steren ve DEBT rekonstr\u00fcksiyonunda da ye\u015fil pikselle\u015fme olarak ay\u0131rt edilen alanlar<\/p>\n

Y\u00f6ntem:<\/strong> Set 1\u2019deki g\u00f6r\u00fcnt\u00fcler DEBT ile kalay filtre kullan\u0131lmadan elde edilmi\u015ftir. Set 2\u2019deki g\u00f6r\u00fcnt\u00fcler DEBT\u2019de kalay filtre kullan\u0131larak elde edilmi\u015ftir. Hem Set 1 hem de Set 2\u2019deki g\u00f6r\u00fcnt\u00fcler rastlant\u0131sal olarak minimum 130 HU ve 150 HU olacak \u015fekilde atanm\u0131\u015ft\u0131r. \u00dc\u00e7 radyolog birbirinden ba\u011f\u0131ms\u0131z \u015fekilde t\u00fcm g\u00f6r\u00fcnt\u00fcleri; ye\u015fil renk pikselle\u015fmenin varl\u0131\u011f\u0131, hacmi ve yeri \u00fczerinden de\u011ferlendirmi\u015f ve bulgular\u0131n\u0131 4 \u00f6l\u00e7ekli bir g\u00fcven \u00f6l\u00e7e\u011fi, s\u0131kl\u0131k ve hacme g\u00f6re not etmi\u015ftir. Yanl\u0131\u015f tan\u0131 oran\u0131 ve puan\u0131,Wilcoxon ve McNemar testleri kullan\u0131larak kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r.<\/p>\n

Ana Bulgular<\/strong>: Set 1\u2019de, minimum aten\u00fcasyonlar\u0131 130 HU ve 150 HU olarak ayarlanm\u0131\u015f tomografide, k\u00fcmele\u015fmi\u015f artefaktlar\u0131n s\u0131kl\u0131\u011f\u0131 s\u0131ras\u0131yla 81% ve 68% olarak saptanm\u0131\u015ft\u0131r. Set 2\u2019de, minimum aten\u00fcasyon 130 HU olarak ayarland\u0131\u011f\u0131nda, k\u00fcmele\u015fmi\u015f artefaktlar\u0131n s\u0131kl\u0131\u011f\u0131 44% olarak saptanm\u0131\u015fken; 150 HU olarak ayarland\u0131\u011f\u0131nda, k\u00fcmele\u015fmi\u015f artefakt g\u00f6r\u00fclmemi\u015ftir.<\/p>\n

Sonu\u00e7<\/strong>: K\u00fcmele\u015fmi\u015f artefaktlar kalay filtresiz DEBT incelemesinde s\u0131kl\u0131kla g\u00f6r\u00fclmektedir. Minimum aten\u00fcasyonu 150 HU de\u011ferinden daha y\u00fcksek olarak ayarlamak ve kalay filtre eklemek k\u00fcmele\u015fmi\u015f artefaktlar\u0131n s\u0131kl\u0131\u011f\u0131n\u0131 azaltm\u0131\u015ft\u0131r.<\/p>\n

<\/h1>\n

 <\/p>\n

Ba\u015flang\u0131\u00e7 MR G\u00f6r\u00fcnt\u00fclemesinde, Kemik \u0130li\u011fi \u00d6demi G\u00f6r\u00fclen Hastalarda T1 Sinyal De\u011fi\u015fikli\u011fi\u00a0 Olmadan Osteomiyelitin \u00d6ng\u00f6r\u00fclmesi<\/span><\/strong><\/h5>\n

Sax AJ, Halpern EJ, Zoga AC, Roedl JB, Belair JA, Morrison WB Predicting osteomyelitis in patients whose initial MRI demonstrated bone marrow edema without corresponding T1 signal marrow replacement. Skeletal Radiology. 2020 Mar 4:1-9.<\/p>\n

https:\/\/pubmed.ncbi.nlm.nih.gov\/32130445\/<\/a><\/p>\n

Giri\u015f<\/strong>: Osteomiyelit, uygun \u00e7ekim teknikleri kullan\u0131larak (\u00fclsere yak\u0131n alanlarda) s\u0131v\u0131ya duyarl\u0131 sekanslardaki kemik ili\u011fi \u00f6demi ve T1 a\u011f\u0131rl\u0131kl\u0131 g\u00f6r\u00fcnt\u00fclerde ya\u011f sinyalinde g\u00f6r\u00fclen de\u011fi\u015fiklikler ile tespit edilebilir. Ancak, vakalar\u0131n bir k\u0131sm\u0131nda \u00fclsere yak\u0131n alanlarda s\u0131v\u0131ya duyarl\u0131 sekanslarda kemik ili\u011fi \u00f6demi izlenirken T1 a\u011f\u0131rl\u0131kl\u0131 g\u00f6r\u00fcnt\u00fclerde normal sinyal kaydedilmektedir. Bu durum “erken osteomiyelit” veya “reaktif hiperemi” olarak yorumlanabilir.<\/p>\n

Sorular:<\/strong> Normal T1 sinyaline sahip diyabetik ayak \u00fclseri bulunan hastalarda, y\u00fcksek osteomyelit riski olu\u015fturan MRI bulgular\u0131 nelerdir?<\/p>\n

Dizayn:<\/strong> Retrospektif \u00e7al\u0131\u015fma<\/p>\n

Kat\u0131l\u0131mc\u0131lar:<\/strong> Diyabetik ayak zemininde osteomiyelit s\u00fcphesi mevcut 60 hastan\u0131n MR g\u00f6r\u00fcnt\u00fcleri<\/p>\n

D\u0131\u015flama Kriterleri<\/strong>: Metal ve di\u011fer artefaktlar ve kemik ili\u011fi \u00f6deminin de\u011ferlendirilmesini engelleyebilecek yak\u0131n zamanda yap\u0131lm\u0131\u015f cerrahi i\u015flemler<\/p>\n

Metod:<\/strong> \u00dclser boyutlar\u0131 ve derinlikleri \u00f6l\u00e7\u00fclm\u00fc\u015ft\u00fcr. T2\/STIR sekanslar\u0131nda kemik ili\u011fi ROI\/eklem s\u0131v\u0131s\u0131 ROI oran\u0131 elde edilmi\u015ftir. Osteomiyelite ilerleme, takip eden MR incelemelerde T1 a\u011f\u0131rl\u0131kl\u0131 serilerde normal kemik ili\u011fi sinyal kayb\u0131 ile karakterize edilmi\u015ftir.<\/p>\n

Ana bulgular<\/strong>: \u0130ncelenen 60 MR aras\u0131ndan 34 tanesi osteomiyelite ilerlemi\u015ftir. Kemik ili\u011fi ROI\/eklem s\u0131v\u0131s\u0131 oranlar\u0131 osteomiyelit grup i\u00e7in ortalama olarak %65 ve osteomiyelit harici grup i\u00e7in %45 olarak saptanm\u0131\u015ft\u0131r (p<0.001). ROI oran\u0131 >% 53olanlar, 6.5 kat artm\u0131\u015f osteomiyelit riskine sahiptir ( p<0.001). Kemi\u011fe yak\u0131nl\u0131k ortalamas\u0131 osteomiyelit grubu i\u00e7in 6 mm ve osteomyelit harici grup i\u00e7in 9 mm\u2019dir (p=0.02). 3 cm2<\/sup>den b\u00fcy\u00fck \u00fclserlerde, osteomiyelit riskinde 2 kat art\u0131\u015f g\u00f6r\u00fclm\u00fc\u015ft\u00fcr(p=0.04).<\/p>\n

Sonu\u00e7:<\/strong> T2\/STIR g\u00f6r\u00fcnt\u00fclerinde artan kemik ili\u011fi ROI\/eklem s\u0131v\u0131s\u0131 ROI oran\u0131, osteomyelitin g\u00f6r\u00fclmesinde en \u00f6nemli risk fakt\u00f6r\u00fcd\u00fcr. \u00dclser boyutu ve derinli\u011fi ise daha zay\u0131f belirteyicilerdir.<\/p>\n

Yorum<\/strong>: \u0130lgi \u00e7ekici bir \u00e7al\u0131\u015fma. Pratikte, MR g\u00f6r\u00fcnt\u00fclemesinde T1 ve T2 kortikal hipointensite kayb\u0131 ile kortikal y\u0131k\u0131ma daha \u00e7ok odaklan\u0131yoruz. E\u011fer gadolinyum da uygulanm\u0131\u015fsa, kortikal kontrastlanma da olduk\u00e7a g\u00fcvenilir bir g\u00f6stergedir. Bence T1\u2019de izlenen kemik ili\u011fi hipointensitesi, bu \u00e7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131 ile benzer \u015fekilde, MRG\u2019de izlenen ge\u00e7 d\u00f6nem bir bulgudur.<\/p>\n

 <\/p>\n

Faz D\u0131\u015f\u0131 Kimyasal Kayma G\u00f6r\u00fcnt\u00fclemesinde Anormal Sinyal Art\u0131\u015f\u0131: Kemik \u0130li\u011fi Mineralizasyonu Belirtisi Mi?<\/span><\/strong><\/h5>\n

van Vucht N, Santiago R, Pressney I, Saifuddin A. Anomalous signal intensity increase on out-of-phase chemical shift imaging: a manifestation of marrow mineralisation?. Skeletal Radiology. 2020 Mar 20:1-7.<\/p>\n

https:\/\/europepmc.org\/article\/med\/32198527<\/a><\/p>\n

Giri\u015f: <\/strong>Faz i\u00e7i (F\u0130) ve faz d\u0131\u015f\u0131 (FD) kimyasal kayma g\u00f6r\u00fcnt\u00fclemeleri (KKG), net verifiye edilemeyen kemik ili\u011fi lezyonlar\u0131n\u0131 a\u00e7\u0131klamada kabul g\u00f6rm\u00fc\u015f bir teknik haline gelmi\u015ftir. Ya\u011f i\u00e7eren kemik ili\u011finin non-neoplastik s\u00fcre\u00e7lerinde, FD sekans\u0131nda sinyal intensitesi (SI), 1.5 Tesla incelemede >20% veya 3 Tesla incelemede >25% d\u00fc\u015fer. Bazen, FD sekanslar\u0131nda SI art\u0131\u015f\u0131 da g\u00f6r\u00fclebilir.<\/p>\n

Soru:<\/strong> FD sekanslar\u0131ndaki SI art\u0131\u015f\u0131n\u0131n sebepleri nelerdir?<\/p>\n

Dizayn:<\/strong> Prospektif \u00c7al\u0131\u015fma<\/p>\n

Kat\u0131l\u0131mc\u0131lar:<\/strong> Kemik t\u00fcm\u00f6r\u00fc \u015f\u00fcphesi de\u011ferlendirmesi i\u00e7in sevk edilmi\u015f 184 hasta<\/p>\n

D\u0131\u015flama Kriterleri:<\/strong> Yok<\/p>\n

Metodlar:<\/strong> 184 vakada, FD\u2019deki SI de\u011fi\u015fimleri hesaplanm\u0131\u015ft\u0131r. F\u0130 sekanslar\u0131na k\u0131yasla FD\u2019de belirgin olarak SI de\u011feri artan hastalar\u0131n, mevcut BT ve direk grafileri kemik ili\u011findeki skeloruzu ve matriks mineralizasyonunu saptamak amac\u0131yla analiz edilmi\u015ftir.<\/p>\n

Bulgular:<\/strong> 184 hasta aras\u0131nda, 40 hastan\u0131n (34.35%) FD sekanslar\u0131 anormal SI art\u0131\u015f\u0131 g\u00f6stermi\u015ftir. BT g\u00f6r\u00fcnt\u00fclemelerin (27 vakada mevcut) 20\u2019sinde med\u00fcller skleroz ve 2\u2019sinde matriks mineralizasyonu izlenmi\u015ftir. Direk grafilerde ise 6 vakada matriks mineralizasyonu saptanm\u0131\u015ft\u0131r. 2 vakan\u0131n MR g\u00f6r\u00fcnt\u00fclemesinde kondral kalsifikasyon ile uyumlu punktat sinyal kayb\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Tipik g\u00f6r\u00fcnt\u00fcleme \u00f6zellikleri ve histolojilerine dayanarak, 17.5% vaka non-neoplastik, 45% vaka iyi huylu neoplasm, ve 37.5% vaka k\u00f6t\u00fc huylu neoplasm olarak s\u0131n\u0131fland\u0131r\u0131lm\u0131\u015ft\u0131r.<\/p>\n

Sonu\u00e7:<\/strong> KKG ile fokal kemik ili\u011fi lezyonlar\u0131 de\u011ferlendirmesinde, FD sekanslar\u0131ndaki anormal SI art\u0131\u015f\u0131 vakalar\u0131n yakla\u015f\u0131k \u00fc\u00e7te birinde g\u00f6r\u00fclebilmektedir. Bu vakalar\u0131n 75%\u2019inden daha fazlas\u0131nda, BT ve direk grafiler difuz kemik ili\u011fi sklerozu veya matriks mineralizasyonu g\u00f6sterir.<\/p>\n

Yorum:<\/strong> Harika bilgiler. Fizi\u011fe geri d\u00f6necek olursak, FD g\u00f6r\u00fcnt\u00fcleme hemoraji veya hemosiderin g\u00f6r\u00fclen b\u00f6lgelerde de sinyal art\u0131\u015f\u0131 g\u00f6sterecektir. Bu nedenle orak h\u00fccreli anemi, tenosinovyal dev h\u00fccreli\u00a0t\u00fcm\u00f6r\u00a0(TSDHT) ve hemartroz gibi kemik ili\u011fi hemosiderozu g\u00f6r\u00fclen vakalarda; sinyal art\u0131\u015f\u0131 g\u00f6r\u00fclmesi beklenir.<\/p>\n

 <\/p>\n

\u0130yi Huylu Periferik Sinir K\u0131l\u0131f\u0131 T\u00fcm\u00f6rlerinde Ameliyat \u00d6ncesi De\u011ferlendirme \u0130\u00e7in Dif\u00fczyon Tens\u00f6r G\u00f6r\u00fcnt\u00fcleme ve Traktografi<\/strong><\/span><\/h5>\n

Gersing AS, Cervantes B, Knebel C, Schwaiger BJ, Kirschke JS, Weidlich D, Claudi C, Peeters JM, Pfeiffer D, Rummeny EJ, Karampinos DC. Diffusion tensor imaging and tractography for preoperative assessment of benign peripheral nerve sheath tumors. European Journal of Radiology. 2020 Jun 6:109110.<\/p>\n

https:\/\/europepmc.org\/article\/med\/32559592<\/a><\/p>\n

\u00d6n Bilgi:<\/strong> N\u00f6rofibroma tespit edilmesi halinde, t\u00fcm\u00f6r\u00fcn tamamen ortadan kald\u0131r\u0131lmas\u0131 etkilenen sinirin tamam\u0131n\u0131n rezeksiyonu ile m\u00fcmk\u00fcn olabilir. Bu durum sinir fonksiyonunda kayba sebep olaca\u011f\u0131ndan; rezeksiyon ve bunun sonucunda olu\u015fabilecek komplikasyonlar de\u011ferlendirilmeli, n\u00f6rofibroman\u0131n bir i\u011fsi h\u00fccreli sarkom olan malign periferik sinir k\u0131l\u0131f\u0131 t\u00fcm\u00f6r\u00fcne (MPNST) d\u00f6n\u00fc\u015fme riski iyi analiz edilmelidir. \u00d6te yandan schwannomalarda kanserle\u015fme e\u011filimi d\u00fc\u015f\u00fckt\u00fcr ve e\u011fer schwannomalar cerrahi eri\u015fim yolunda eksantrik olarak konumlanm\u0131\u015f ise operasyon s\u0131ras\u0131nda fasik\u00fcller rahatl\u0131kla korunabilir. Bu y\u00fczden, iyatrojenik hasara yol a\u00e7madan tam rezeksiyon yapabilmek i\u00e7in fasik\u00fcllerin tam konumu hakk\u0131nda detayl\u0131 bilgi sahibi olmak \u00e7ok \u00f6nemlidir.<\/p>\n

Sorular:<\/strong> 3D dif\u00fczyon a\u011f\u0131rl\u0131kl\u0131 (DW) sokanslarla olu\u015fturulmu\u015f\u00a0 fiber traktografi ve dif\u00fczyon analizlerinin, iyi huylu periferik sinir k\u0131l\u0131f\u0131 t\u00fcm\u00f6rlerinin ameliyat \u00f6ncesi de\u011ferlendirmesinde tan\u0131 de\u011feri nedir?<\/p>\n

Dizayn<\/strong>: Prospektif \u00e7al\u0131\u015fma, 2016 Ekim ay\u0131ndan 2018 Ocak ay\u0131na kadar.<\/p>\n

Kat\u0131l\u0131mc\u0131lar: <\/strong>Toplamda 22 hasta (ortalama ya\u015f 50.9\u202f\u00b1\u202f18.6 y\u0131l, 13 kad\u0131n) i\u00e7inden 18 schwannoma ve 11 n\u00f6rofibroma incelendi. T\u00fcm vakalarda, t\u00fcm\u00f6r rezeksiyonu veya ekzisyonel biyopsi ile histopatolojik tan\u0131 koyuldu.<\/p>\n

D\u0131\u015flama Kriterleri: <\/strong>Periferik sinirler ile alakal\u0131 olmayan lezyonlar bu \u00e7al\u0131\u015fmadan \u00e7\u0131kar\u0131lm\u0131\u015ft\u0131r (1 sarkom and 2 miksoma).<\/p>\n

Y\u00f6ntem: <\/strong>Histolojik olarak do\u011frulanm\u0131\u015f schwannoma hastal\u0131\u011f\u0131 (N<\/em>\u202f=\u202f18)\u00a0 ve n\u00f6rofibromas\u0131 olan (N<\/em>\u202f=\u202f11)\u00a0 22 hastaya ya\u011f bask\u0131l\u0131 3D DW turbo spin eko sekans\u0131 dahil 3Tesla MR incelemesi ger\u00e7ekle\u015ftirildi. Dif\u00fczyon tens\u00f6r parametreleri hesapland\u0131 ve sinir liflleri belirlendi. De\u011ferlendirme, k\u00f6r olarak 2 radyolog ve bir ortopedist taraf\u0131ndan yap\u0131ld\u0131. T\u00fcm\u00f6r\u00fcn mikroyap\u0131s\u0131n\u0131 daha iyi de\u011ferlendirmek i\u00e7in ortalama dif\u00fczyon g\u00fcc\u00fc hesapland\u0131. Operasyon \u00f6ncesi fasik\u00fcl g\u00f6r\u00fcnt\u00fclemesi puanland\u0131r\u0131larak, anatomik lokasyon ve t\u00fcm\u00f6r\u00fc saran fasik\u00fcl miktar\u0131na g\u00f6re s\u0131n\u0131fland\u0131rma yap\u0131ld\u0131. G\u00f6r\u00fcnt\u00fcleme sonu\u00e7lar\u0131 ile operasyon s\u0131ras\u0131ndaki bulgular aras\u0131ndaki uyum de\u011ferlendirildi.<\/p>\n

Ana Sonu\u00e7lar: <\/strong>Dif\u00fczyon Tens\u00f6r G\u00f6r\u00fcnt\u00fclemenin %78,3\u2019\u00fcnde, fasik\u00fcl g\u00f6r\u00fcnt\u00fcleme iyi veya \u00e7ok iyi olarak puanland\u0131r\u0131lm\u0131\u015ft\u0131r. Traktografi incelemesi, schwannoma\u2019n\u0131n (94.8 %) norafibromadan (0 %, P\u202f<\u202f0.01) daha fazla eksantrik olarak konumland\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir. Fasik\u00fcller schwannoma\u2019da \u00e7o\u011funlukla kesintisizken(87.5 %), n\u00f6rofibromada fasik\u00fcllerin hi\u00e7biri kesintisiz olarak bulunmamaktad\u0131r (0 %, P\u202f=\u202f0.014). T\u00fcm\u00f6r etraf\u0131ndaki fasik\u00fcl yollar\u0131na ili\u015fkin g\u00f6r\u00fcnt\u00fcleme \u00f6zellikleri ve cerrahi bulgular\u00a0 aras\u0131nda \u00f6nemli \u00f6l\u00e7\u00fcde uyum saptanm\u0131\u015ft\u0131r (\u03ba\u202f=\u202f0.78). Schwannoma\u2019n\u0131n ortalama dif\u00fczyon g\u00fcc\u00fc (1.5\u202f\u00b1\u202f0.2\u202f\u00d7\u202f10 \u22123\u202fmm 2\/s) n\u00f6rofibroman\u0131nkinden \u00f6nemli miktarda d\u00fc\u015f\u00fckt\u00fcr (1.8\u202f\u00b1\u202f0.2\u202f\u00d7\u202f10 \u22123\u202fmm 2\/s; P\u202f<\u202f0.001).\u00a0 Youden endeksi ise 1.7\u202f\u00d7\u202f10 \u22123\u202fmm 2\/s\u2019de optimal limit g\u00f6stermektedir (duyarl\u0131l\u0131k: 0.91; \u00f6zg\u00fcll\u00fck: 0.78; J\u202f=\u202f0.69).<\/p>\n

Sonu\u00e7: <\/strong>Ameliyat \u00f6ncesi dif\u00fczyon tens\u00f6r g\u00f6r\u00fcnt\u00fcleme, schwannoma ve n\u00f6rofibroma ayr\u0131m\u0131n\u0131 ve ameliyat \u00f6ncesi planlamada t\u00fcm\u00f6r\u00fcn sinir fasik\u00fcllerine g\u00f6re konumunun belirlenebilmesini sa\u011flad\u0131.<\/p>\n

Yorum<\/strong>: \u00c7al\u0131\u015fman\u0131z i\u00e7in te\u015fekk\u00fcrler. \u00d6rneklem k\u00fc\u00e7\u00fck fakat sinir k\u0131l\u0131f\u0131 t\u00fcm\u00f6rleri aras\u0131ndaki farklar\u0131 iyi bir \u015fekilde g\u00f6steriyor. Hat\u0131rlanmas\u0131 gereken bir di\u011fer nokta ise segmental schwannomatosis, rezeksiyonun yap\u0131labilmesini zor veya imk\u00e2ns\u0131z duruma getirmektedir. Ayr\u0131ca schwannoma veya norafibroma ile ili\u015fkili olan fasik\u00fcller zaten i\u015flevsiz durumda oldu\u011fundan rezeksiyonlar\u0131 \u00f6nemli bir fonksiyon kayb\u0131na sebep olmamaktad\u0131r. Bu konuda daha b\u00fcy\u00fck \u00e7al\u0131\u015fmalar bekliyoruz.<\/p>\n

 <\/p>\n

Ayak Bile\u011fi Ekleminde K\u0131k\u0131rdak Hasar\u0131 Tespiti \u0130\u00e7in Flat-Panel Bilgisayarl\u0131 Tomografi Artrografisi: In Vivo \u0130lk Sonu\u00e7lar<\/strong><\/span><\/h5>\n

Sarah P, David C, Roman G, Vanessa P, Daphn\u00e9 G, Pierre C, Le Corroller T. Flat-panel CT arthrography for cartilage defect detection in the ankle joint: first results in vivo. Skeletal radiology. 2020 Mar 7:1-7.<\/p>\n

https:\/\/link.springer.com\/article\/10.1007\/s00256-020-03398-9<\/a><\/p>\n

\u00d6n Bilgi:<\/strong> Direkt MR artrografi, standart MR g\u00f6r\u00fcnt\u00fcleme ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda kondral hasar\u0131n tespitinde daha iyi sonu\u00e7lar vermekte olup eklem k\u0131k\u0131rda\u011f\u0131nda lezyon \u015f\u00fcphesi olan hastalarda kullan\u0131m\u0131 dikkate al\u0131nmal\u0131d\u0131r. MDBT artrografi, eklem k\u0131k\u0131rda\u011f\u0131 de\u011ferlendirilmesinde \u00f6zellikle de hiyalin k\u0131k\u0131rda\u011f\u0131n\u0131n ince oldu\u011fu ayak bile\u011fi ekleminde tercih edilen y\u00f6ntemdir. Son zamanlarda, Flat-Panel Bilgisayarl\u0131 Tomografi(FPBT) artrografisinin in vitro ve ex vivo ortamlarda MDCT artrografisine e\u015f de\u011fer uygulanabilirlik ve g\u00f6r\u00fcnt\u00fc kalitesine sahip oldu\u011fu g\u00f6sterilmi\u015ftir.<\/p>\n

Sorular: <\/strong>FPBT artrografisinin MR artrografiye ve MDBT artrografiye g\u00f6re ayak bile\u011fi eklemindeki k\u0131k\u0131rdak hasar\u0131 tespitinde tan\u0131sal performans\u0131 nedir?<\/p>\n

Dizayn<\/strong>: Prospektif \u00e7al\u0131\u015fma.<\/p>\n

Kat\u0131l\u0131mc\u0131lar<\/strong>: Temmuz 2015 ve Nisan 2017 aras\u0131nda, ayak bile\u011finde eklem k\u0131k\u0131rda\u011f\u0131 lezyonu \u015f\u00fcphesiyle ba\u015fvuran 27 hastaya, ayn\u0131 g\u00fcn i\u00e7erisinde ameliyat \u00f6ncesi tetkik amac\u0131yla FPCT, MDCT ve MR artrografi uygulanm\u0131\u015ft\u0131r.<\/p>\n

D\u0131\u015flama Kriterleri: <\/strong>Ayak bile\u011fi artroskopisi veya a\u00e7\u0131k ameliyat ge\u00e7mi\u015fi olanlar ve kontrast madde enjeksiyonu ile kesitsel g\u00f6r\u00fcnt\u00fcleme aras\u0131ndaki zaman fark\u0131 30 dakikadan fazla olanlar.<\/strong><\/p>\n

Y\u00f6ntem: <\/strong>Eklem k\u0131k\u0131rda\u011f\u0131 lezyonu \u015f\u00fcphesi olan 27 hastaya, seyreltilmi\u015f gadolinyum ve iyobitridol enjeksiyonuyla ayak bile\u011fi artrografisi uygulanarak FPBT, MDBT ve 1.5 T MR g\u00f6r\u00fcnt\u00fclemeleri elde edildi. FPBT, MDBT ve MR artrografi tetkikleri k\u00f6r ve ba\u011f\u0131ms\u0131z olarak iki kas-iskelet radyolo\u011fu taraf\u0131ndan de\u011ferlendirildi. Her ayak bile\u011finde sekiz adet eklem k\u0131k\u0131rda\u011f\u0131 b\u00f6lgesi ayr\u0131 ayr\u0131 incelendi:medial talar y\u00fczey, lateral talar y\u00fczey, medial talar troklea, lateral talar troklea, tibial malleol, tibial medial plafond, tibial lateral plafond ve fibular malleol. 216 kondral alana y\u00f6nelik FPBT ve MR bulgular\u0131 MDBT ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131.<\/p>\n

Ana Sonu\u00e7lar: <\/strong>K\u0131k\u0131rdak hasar\u0131 tespitinde FPBT %97 duyarl\u0131l\u0131k, %95 \u00f6zg\u00fcnl\u00fck ve %96 do\u011fruluk; MR artrografi %69 duyarl\u0131l\u0131k, %94 \u00f6zg\u00fcnl\u00fck ve %87 do\u011fruluk g\u00f6sterdi. FPBT, MDBT artrografiyle neredeyse m\u00fckemmel uyum g\u00f6sterirken MR artrografide orta dereceli uyum izlendi. FPBT\u2019nin (2.9\/3) ortalama tan\u0131sal g\u00fcvenilirli\u011fi MR (2.3\/3) ve MDBT (2.7\/3) artrografisinden daha y\u00fcksek bulundu.<\/p>\n

Sonu\u00e7: <\/strong>Ayak bile\u011fi ekleminde k\u0131k\u0131rdak hasar\u0131 tespitinde FPBT, 1.5 T MR artrografisinden daha y\u00fcksek do\u011fruluk g\u00f6stermi\u015f olup bu ama\u00e7la kullan\u0131m\u0131 dikkate al\u0131nmal\u0131d\u0131r.<\/p>\n

Yorum: <\/strong>\u00c7al\u0131\u015fman\u0131z i\u00e7in te\u015fekk\u00fcrler. Ayak bile\u011fine y\u00f6nelik MR artrografinin pratikte kullan\u0131m\u0131 azalm\u0131\u015f olup, eklem k\u0131k\u0131rda\u011f\u0131n\u0131 de\u011ferlendirmek i\u00e7in y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fckl\u00fc 1.5T \u00e7ekimler veya 1.5T ve 3T taray\u0131c\u0131larda 3D g\u00f6r\u00fcnt\u00fcleme tetkikleri tercih edilmektedir. E\u011fer MR \u00e7ekimlerinde; 2D g\u00f6r\u00fcnt\u00fclemede 3mm\u2019lik kesitlerle ve 256 (veya daha y\u00fcksek) matriks de\u011ferinde veya 3D T2W g\u00f6r\u00fcnt\u00fclemede 0.65-0.7mm voksel aral\u0131\u011f\u0131nda tutularak g\u00f6r\u00fcnt\u00fc kalitesi optimize edilirse, BT\u2019nin radyasyon etkisinden ka\u00e7\u0131nmak amac\u0131yla tercih edilebilir.<\/p>\n","protected":false},"excerpt":{"rendered":"\u00d6n \u00c7apraz Ba\u011f\u0131 Y\u0131rt\u0131lmalar\u0131nda, Menisk\u00fcs Ramp Lezyonlar\u0131n\u0131 Saptamada Manyetik Rezonans G\u00f6r\u00fcnt\u00fclemenin Diyagnostik Performans\u0131: Sistematik Derleme […]","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-7362","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-tr"],"yoast_head":"\nWhat's new in MSK Imaging (Turkish) - 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