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Yayın Accidental injection of autologous fat into the breast implant: a case report highlighting radiological findings(SPRINGER, 2017) Celik, Levent; Cubuk, Rahmi; Arslan, Gozde; Atasoy, Mehmet Mahir; Celik, LeventAutologous fat grafting is a popular technique for breast augmentation and improving breast contour depressions. It is a technique that involves using the patient's own adipose tissue to be applied on a subcutaneous area to increase total fat volume. Intraimplant fat is an unexpected finding after autologous fat grafting. A 51-year-old asymptomatic female who underwent breast augmentation with silicone implants and secondary breast augmentation with autologous fat grafting presented with unidentified cluster of radiolucencies superimposed to left implant on screening mammogram. Corresponding MRI revealed intraimplant fat intensities. This case represents a previously unreported intraimplant injection of fat with resultant intracapsular rupture and highlights the radiological findings of intracapsular implant rupture.Yayın Background parenchymal enhancement: is it just an innocent effect of estrogen on the breast?(AVES, 2017) Arslan, Gozde; Celik, Levent; Cubuk, Rahmi; Celik, Levent; Atasoy, Mehmet MahirPURPOSE We aimed to retrospectively analyze whether background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) correlates with menarche, menopause, reproductive period, menstrual cycle, gravidity-parity, family history of breast cancer, and the Breast Imaging-Reporting and Data System (BI-RADS) category of the patient. METHODS The study included 126 pre- and 78 postmenopausal women who underwent breast MRI in our institute between 2011 and 2016. Patients had filled a questionnaire form before the MRI. Two radiologists blinded to patient history graded the BPEs and the results were compared and analyzed. RESULTS The BPE was correlated with patient age and the day of menstrual cycle (P < 0.01 for both). No correlation was found with menarche age, menopause age, total number of reproductive years, and family history of breast cancer. In the moderate BPE group, only 1 out of 35 patients and in the marked BPE group only 1 out of 13 patients were postmenopausal and had BI-RADS scores of 4 and 5, respectively. CONCLUSION Increased symmetrical BPE is mainly due to current hormonal status in the premenopausal women. High-grade BPE, whether symmetrical or not, is rarely seen in postmenopausal women; hence, these patients should be further investigated or closely followed up.Yayın Comparison of Internal Mammary Artery and Lateral Thoracic Artery Width in Patients with Benign and Malignant Breast Tumors(AVES, 2017) Arslan, Gozde; Celik, Levent; Cubuk, Rahmi; Celik, Levent; Atasoy, Mehmet MahirObjective: The main objective of this study was to analyze the differences in ipsilateral and contralateral internal mammary artery (IMA) and lateral thoracic artery (LTA) width in patients with malignant and benign breast tumor. Materials and Methods: A total of 104 female patients, of which 41 had benign and 63 had malignant tumors, were included in the study. The diameters of the IMA and LTA were measured from the widest point in T1-weighted post-contrast images. Breast magnetic resonance images were evaluated by a breast radiologist. Results: The ipsilateral IMA diameter of cases in the malignant group was found to be statistically significantly higher when compared with the benign group. In the benign group, the ipsilateral IMA diameter being an average of 0.43 +/- 0.87 mm larger than the contralateral IMA diameter was found to be statistically significant, whereas in the malignant cases, the ipsilateral IMA diameter being an average of 0.78 +/- 1.08 mm larger than the contralateral IMA diameter was found to be statistically significant. Also, in benign cases, the ipsilateral LTA diameter being an average of 0.31 +/- 0.70 mm larger than the contralateral LTA diameter was found to be statistically significant, whereas in malignant cases, the ipsilateral LTA diameter being an average of 0.29 +/- 0.68 mm larger than the contralateral LTA diameter was found to be statistically significant. Conclusion: The IMA and LTA diameters in benign and malignant cases were found to be higher in comparison with contralateral breast, independent of the size of the lesion.Yayın Complication of non-US guided procedure of aquafilling breast gel(SOC ROMANA ULTRASONOGRAFE MEDICINA BIOLOGIE-SRUMB, 2017) Arslan, Gozde; Celik, Levent; Atasoy, Mehmet Mahir; Celik, Levent; Cubuk, Rahmi…Yayın Diagnostic accuracy of metastatic axillary lymph nodes in breast MRI(SPRINGER INTERNATIONAL PUBLISHING AG, 2016) Arslan, Gozde; Altintoprak, Kubra Murzoglu; Yirgin, Inci Kizildag; Atasoy, Mehmet Mahir; Celik, LeventPurpose: The most important prognostic variable for early stage breast cancer is the status of axillary lymph nodes. The aim of this study was to evaluate the diagnostic accuracy of preoperative magnetic resonance imaging (MRI) for metastatic axillary lymph node in breast cancer cases with post-operative sentinel lymph node biopsy (SLNB) results. Materials and methods: Women aged between 21 and 73 years who were diagnosed with malignant mass lesion of the breast between 2013 and 2015 were included in this study. The preoperative MR images of patients with diagnosis of breast cancer was evaluated to determine axillary lymph node status. Axillary lymph node size, long axis to short axis ratio, lymph node contours, cortical thickness to anteroposterior diameter ratio, the presence of a fatty hilum and contrast enhancement patterns (homogenous or heterogenous) was noted. Additionally, the presence of comet tail sign which a tail extending from an enhancing breast lesion into the parenchyma and might represent ductal infiltration on post-contrast series was also noted. All data obtained from this evaluation was compared with postoperative SLNB results. Results: Metastatic nodes were found to have a longer short axis when compared to reactive nodes (p = 0.042; p < 0.05). The long axis to short axis ratio was notably lower in metastatic nodes when compared to reactive nodes. Cortical thickness was higher in metastatic nodes when compared to reactive nodes (p = 0.024; p < 0.05). Comet sign was observed in 15 of metastatic nodes (73.3 %) and in one (5 %) reactive node. This difference was statistically significant (p = 0.001; p < 0.01). While fatty hilum was seen in 40 % of metastatic nodes (n = 6), it was seen in all (n = 20) reactive nodes. This difference was statistically significant (p = 0.001; p < 0.01). Conclusions: MRI is a non invasive sensitive and specific imaging modality for evaluating the axilla. We have shown that with the help of comet tail sign and status of fatty hilum contrast enhanced MRI has the highest sensitivity of 84.7 % for detecting axillary lymph node metastases (Singletary et al. in Semin Surg Oncol 21(1):53-59, 2003).Yayın Diffusion Weighted MR Imaging of Breast and Correlation of Prognostic Factors in Breast Cancer(AVES, 2016) Yirgin, Inci Kizildag; Arslan, Gozde; Ozturk, Enis; Yirgin, Hakan; Tasdemir, Nihat; Gemici, Aysegul Akdogan; Kabul, Fatma Celik; Kaya, EyupBackground: Through Diffusion Weighted Imaging (DWI), information related to early molecular changes, changes in the permeability of cell membranes, and early morphologic and physiologic changes such as cell swelling can be obtained. Aims: We investigated the correlation between the prognostic factors of breast cancer and apparent diffusion coefficient (ADC) in DWI sequences of malignant lesions. Study Design: Retrospective cross-sectional study. Methods: Patients who were referred to our clinic between September 2012 and September 2013, who underwent dynamic breast MRI before or after biopsy and whose biopsy results were determined as malignant, were included in our study. Before the dynamic analysis, DWI sequences were taken. ADC relationship with all prognostic factors was investigated. Pearson correlation test was used to compare the numerical data, while Spearman correlation and Fisher exact tests were used to compare the categorical data. The advanced relationships were evaluated with linear regression analysis and univariate analysis. The efficiency of the parameters was evaluated using ROC analysis. The significance level (P) was accepted as 0.05. Results: In total, 41 female patients with an average age of 49.4 years (age interval 21-77) and 44 lesions were included into the study. In the Pearson correlation test, no statistically significant difference was determined between ADC and the patient's age and tumor size. In the Spearman correlation test, a statistically significant difference was determined between nuclear grade (NG) and ADC (r=-0.424, p=0.04); no statistically significant correlation was observed between the other prognostic factors with each other and ADC values. In the linear regression analysis, the relationship of NG with ADC was found to be more significant alone than when comparing all parameters (corrected r2=0.196, p=0.005). Further evaluations between the NG and ADC correlation were carried out with ROC analysis. A statistically significant difference was determined when NG 1 separately was compared with NG 2 and 3 (p=0.03). A statistically significant difference was also determined (p=0.05) in the comparison of NG 1 with only NG 3. No statistically significant difference was determined when NG 2 separately was compared with NG 1 and NG 3 and when NG 3 separately was compared with NG 1 and 2 (p=0.431, p=0.097), Conclusion: We found that ADC values obtained by breast DWI showed a higher correlation with the NG of breast cancer, which is an important factor in the patient's treatment. Predictions can be made about NG by analyzing the ADC values. Additional studies are needed, however, and the ADC value of the lesion can be used as a prognostic factor proving the aggressiveness.Yayın Effects of Smoking and Hemoglobin Values on Femoral Bone Marrow Resonance Signal Intensity(YERKURE TANITIM & YAYINCILIK HIZMETLERI A S, 2017) Arslan, Gozde; Sanel, Selim; Cubuk, Rahmi; Gemici, Aysegul Akogan; Inci, ErcanObjective: The aim of our study is to evaluate the correlation of residual-reconverted red bone marrow areas of distal femoral metaphysis with the age, gender, weight and hemoglobin (hgb) values and smoking. Material and Methods: 150 non smoking and 62 smoking patients were included in the study. The residual red bone marrow areas in the distal femoral metaphysis in MRI (Magnetic Resonance Imaging) images were examined by two radiologists. The size of the residual red bone marrow area and the age, gender, weight and hemoglobin values of the patients were compared by using the Oneway Anova Test, Tukey HSD Test, Fisher's Exact Test and Pearson Chi-Square Test. Results: In our study, residual red marrow areas were detected higher in smoking male and female patients when compared to non-smoking patients (p=0.004; p<0.01), (p=0.026; p<0.05). Residual red marrow areas were more common in female patients when compared to male patients (p=0.004; p<0.01). We haven't seen significant effect of weight, hemoglobin values and age on these areas (p>0.05). Conclusion: We have determined correlation between reconverted-residual red marrow areas, female sex and smoking behavior. In the correlation existing group; we are not in favor of mentioning these areas on MRI reports of the knee. But they should be phrased in reports considering the probability of malignancy if they are hypointense compared to adjacent muscle groups on T1-weighted sequences; if they are extensive involved in bone tissue; if they show epiphyseal extension or if there is accompanying soft tissue mass.Yayın Internal Mammary Artery Anastomoses in Patients without Breast Lesions (BIRADS 1) and in Patients with Malignant Breast Lesions (BIRADS 6) on Magnetic Resonance Imaging (MRI)(INT SCIENTIFIC INFORMATION INC, 2017) Arslan, Gozde; Celik, Levent; Cubuk, Rahmi; Celik, Levent; Atasoy, Mehmet MahirBackground: We aimed to compare the frequency of IMA (internal mammarian artery) anastomoses in right and left breasts in patients without breast lesions and in patients with malignant breast lesions. Material/Methods: A total of 100 patients with no breast lesions and a total of 100 patients with malignant breast lesions were included in the study. The anastomoses of IMA of right and left breasts were evaluated on MIP and post-contrast T1-weighted magnetic resonance imaging (MRI) sequences. Breast MRI scans were read by a radiologist. Results: In patients with no breast lesions, IMA anastomoses were found in 45% of cases, and in patients with malignant breast lesions, IMA anastomoses were found in 58% cases. In four patients with malignant lesions, ipsilateral IMA was rudimentary, and the lesion was feeding from the contralateral IMA. Conclusions: No statistically significant difference was found between patients without any breast lesions and patients with malignant breast lesions with respect to the frequency of IMA anastomoses in right and left breasts. The frequencies were higher than expected in both groups.Yayın Knowledge and experience of radiologists working in Istanbul on radiographic contrast medium anaphylaxis(AMER INST MATHEMATICAL SCIENCES-AIMS, 2017) Arslan, Gozde; Balci, Ayla; Cubuk, Rahmi; Cetinkaya, FeyzullahRadiologists are among the physicians with the highest probability of encountering cases with anaphylaxis. Therefore, they should be familiar with the recent developments in the diagnosis and treatment of anaphylaxis. In this study, we aimed to investigate the level of knowledge of the radiologists about the current diagnostic criteria and management of anaphylaxis in addition to their personal experiences on radiographic contrast medium (RCM) induced systemic reactions. Radiologists working in Istanbul were randomly selected and asked to fill out a 16-item questionnaire related to their experience on radiographic contrast medium anaphylaxis and knowledge about current anaphylaxis diagnosis and management guidelines. The study group consisted of 106 physicians 11 (10.4%) of whom have reported that they had encountered anaphylaxis due to radiographic contrast medium during their own practice. They have also reported two cases of mortality due to RCM. Most of the physicians were familiar with the signs and symptoms of anaphylaxis and about two thirds of them chose epinephrine as the first-line medication for treatment of anaphylaxis. Radiologists may encounter patients with RCM-induced anaphylaxis. Therefore they should be aware of the diagnosis and management of anaphylaxis.Yayın Sonographically Unusual Breast Carcinomas, 2 Case Reports(INT SCIENTIFIC INFORMATION INC, 2016) Arslan, Gozde; Celik, LeventBackground: For infiltrative breast lesions; sonography might not always be as helpful as mammography and MRI (magnetic resonance imaging). For higher sensitivity and specificity, these 3 imaging methods should be carried out together. Radiologists should be aware of the patient's history and complaints. Patients who have a specific history like a long-term drug treatment or a palpable tumour should be approached differently. Case Report: We would like to present 2 cases with atypical sonographic findings. The first case is an infiltrative breast cancer with occult sonography findings in a patient with a history of a long-term immunosuppressive drug treatment due to kidney transplantation and the second case is a malignant breast tumour which is hyperechogenic on sonography. Conclusions: Overall breast sonography should always be correlated with mammography in patients over 40 years old and the images should be interpreted along with the patient's history and clinical status.Yayın Understanding the signs of malignant breast tumours on magnetic resonance imaging(BMC, 2017) Arslan, Gozde; Yirgin, Inci Kizildag; Altintoprak, Kubra Murzoglu; Cubuk, Rahmi; Celik, Levent; Yilmaz, Birnur…Yayın Unexpected Finding on Mammography and MRI due to Accumulation of Iron Oxide Particles Used for Sentinel Lymph Node Detection(AVES, 2019) Arslan, Gozde; Yilmaz, Cem; Celik, Levent; Cubuk, Rahmi; Tasali, NuriWe present a case with imaging artefacts on mammography and Magnetic Resonance Imaging (MRI) caused by iron oxide particles. After being diagnosed with the medullary cancer of the breast, the female patient had a breast conserving surgery on right breast. Iron oxide particles were used for the detection of the sentinel lymph node during operation. On follow ups, a de novo density on mammography, which was initially thought to be a new tumour, was found. MR images proved that the lesion is an artefact caused by iron oxide accumulation. Our aim in this case study is to underline and discuss the imaging artefacts caused by these particles and raise awareness.
