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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 Automated Aortic Supravalvular Sinus Detection in Conventional Computed Tomography Image(IEEE, 2013) Unay, Devrim; Harmankaya, Ibrahim; Oksuz, Ilkay; Kadipasaoglu, Kamuran; Cubuk, Rahmi; Celik, LeventValvular diseases are those where one or more of the cardiac valves are affected. Treatment of valvular diseases often involves replacement or restoration of the affected valve(s). In such a surgical procedure, the medical expert performing the procedure can largely benefit from a patient-specific and dynamic valvular model containing information complementary to the 2D/3D static images. To this end, in this study a novel automated supravalvular sinus detection method (to be used as a first step in aortic valve segmentation) on conventional contrast-enhanced ECG-gated multislice CT data and its evaluation on expert annotated 31 real cases are presented. Results demonstrate a highly accurate detection performance with average error rate inferior to 1.12 mm.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 AN EFFICIENT ALGORITHM FOR AUTOMATIC TUMOR DETECTION IN CONTRAST ENHANCED BREAST MRI BY USING ARTIFICIAL NEURAL NETWORK (NEUBREA)(ACAD SCIENCES CZECH REPUBLIC, INST COMPUTER SCIENCE, 2013) Bayram, Bulent; Koca, Hilmi K.; Narin, Burcu; Cavdaroglu, G. Cigdem; Celik, Levent; Acar, Ugur; Cubuk, RahmiThe advances in image processing technology contribute to the interpretation of medical images and early diagnosis. Moreover various studies can be found in medical journals dedicated to Artificial Neural Networks (ANN). In the presented study, a method was developed to learn and detect benign and malignant tumor types in contrast-enhanced breast magnetic resonance images (MRI). The backpropagation algorithm was taken as the ANN learning algorithm. The algorithm (NEUBREA) was developed in C# programming language by using Fast Artificial Neural Network Library (FANN). Having been diagnosed by radiologists, 7 cases of malignant tumor, 8 cases of benign tumor, and 3 normal cases were used as a training set. The results were tested on 34 cases that had been diagnosed by radiologists. After the comparison of the results, the overall accuracy of algorithm was defined as 92%.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 Lumbar Disc and Facet Degeneration: Correlation with Age and Facet Orientation(AVES YAYINCILIK, IBRAHIM KARA, 2009) Cubuk, Rahmi; Kozakcioglu, Meral; Tasali, Nuri; Atalay, Ayce; Celik, LeventObjectives: The influence of age on orientation of the facet joint remains controversial. We aimed to examine facet joint degeneration, orientation and their relationships with disc degeneration in a group of patients in different age groups. Patients and Methods: The study included 106 patients with low back pain and/or leg symptoms who had undergone magnetic resonance imaging of L1-S1 lumbar segments. For evaluation of osteoarthritis of the facet joints grading described by Weishaupt et al. and for evaluation of disc degenerations grading by Pfirmann et al. were used. Results: Orientation of the facet joints were similar among age groups. Age was not correlated with facet joint orientation. Facet joint orientation was not correlated with facet or disc degeneration in neither female nor male patients. Age was positively correlated with facet degeneration at all spinal levels. At all levels except L3-4 level, facet joint degeneration was more prominent in male subjects. Conclusion: This study have demonstrated that facet joint orientation is similar among different age groups. The finding of greater prevalence and degree of facet arthrosis in men at all lumbar levels is in accordance with some recent studies. Our study supported the notion that disc degeneration precedes facet arthrosis.Yayın Non-invasive evaluation of the coronary venous system in patients with chronic systolic heart failure by 64-detector computed tomography(ROYAL SOC MEDICINE PRESS LTD, 2011) Cubuk, Rahmi; Aydin, Alper; Tasali, Nuni; Yilmazer, Serdar; Celik, Levent; Dagdeviren, Bahadir; Guney, SefikBackground: Imaging coronary venous systems to guide transcatheter cardiac interventions are becoming increasingly important, particularly in heart failure patients who are selected for cardiac resynchronization therapy (CRT). Failure of left ventricular (LV) lead placement during the procedure has been attributed to the inability to insert catheters into the coronary sinus and the lack of suitable side branches. Purpose: To comparatively assess the value of a 64-detector MDCT examination in visualizing the cardiac veins and evaluating the morphological characteristics of the coronary venous system in patients with and without chronic systolic heart failure (SHF). Material and Methods: A 64-detector MDCT examination of the heart was performed in 26 consecutive patients (five women, 21 men; mean age 57.80 +/- 12.05 years; range 27-81 years) with chronic SHF. The morphological characteristics of the coronary venous system, such as the diameter, the distances between the venous tributaries, the angle and the tortuosity, were evaluated. The group was compared with a subgroup of 52 subjects without SHF (LV ejection fraction >40%) matched for age, sex, and the risk factors for coronary artery disease. Results: The coronary sinus (CS), great cardiac vein (GCV), anterior interventricular vein (AIV), and posterior interventricular vein (PIV) were visualized in all 78 individuals. The posterior vein of the left ventricle (PVLV) (63/78), left marginal vein (LMV) (72/78), and the small cardiac vein (SCV) (50/78) were visualized in SHF and control patients (p = NS). The lengths between venous tributaries were higher (p > 0.05) and more dilated (P < 0.001 for CS, GCV, AIV, PVLV, LMV; p = 0.001 for PIV) in the cases with SHF compared with the control population. The angle between the CS-GCV axis and the venous branches was wider (p = 0.02 for LMV and Ply, p = 0.001 for PVLV) and did not have any correlation with the LV diameter in cases with SHF. There was no difference between the SHF and control groups in terms of the tortuosity of PVLV and LMV (p = NS). Conclusion: The study demonstrated an increase in the diameters, lengths, and angulations with the CS-GCV axis of the coronary veins in cases with SHF. A 64-detector MDCT is a feasible tool for non-invasive evaluation of the coronary venous system and may provide considerable information regarding numbers and morphology of coronary veins before percutaneous transcatheter cardiac therapy.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.Yayın Vacuum-assisted stereotactic biopsy for isolated BI-RADS 4 microcalcifications: evaluation with histopathology and midterm follow-up results(AVES, 2015) Atasoy, Mehmet Mahir; Tasali, Nuri; Cubuk, Rahmi; Narin, Burcu; Deveci, Uğur; Yener, Nese; Celik, Levent; Deveci, UğurPURPOSE The aim of this study was to evaluate the 10-gauge vacuum-assisted stereotactic biopsy (VASB) of isolated Breast Imaging Reporting and Data System (BI-RADS) 4 microcalcifications, using histology and follow-up results. METHODS From January 2011 to June 2013, VASB was performed on 132 lesions, and 66 microcalcification-only lesions of BI-RADS 4 were included into our study. VASB was performed using lateral decubitis stereotaxy for all patients. Pathologic results of VASB and further surgical biopsies were reviewed retrospectively. Patients who were diagnosed to have benign lesions by VASB were referred for follow-up. VASB and surgical histopathology results were compared to determine the underestimation ratios. RESULTS Fifteen out of 66 lesions from 63 patients (median age, 47 years; range, 34-88 years) were identified as malignant by VASB. Pathological results after surgery revealed three cases of invasive ductal carcinoma among the 12 VASB-diagnosed ductal carcinoma in situ (DCIS) lesions, for a DCIS underestimation rate of 25%. The atypical ductal hyperplasia underestimation rate was 0% for the three lesions. The follow-up period was at least 10 months, with an average of 22.7 months for all patients and 21.2 months for patients with VASB-diagnosed benign lesions. None of the patients had malignancy during the follow-ups. The false-negative rate was 0% in the follow-up of 48 patients. CONCLUSION VASB should be the standard method of choice for BI-RADS 4 microcalcifications. This method obviates the need for a surgical procedure in 73% of BI-RADS 4 microcalcification-only patients.
