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Öğe Anatomic variations of the colon detected on abdominal CT scans(2004) Unal B.; Kara S.; Aktaş A.; Bilgili Y.PURPOSE: The frequency of anatomic variations of the colon detected on abdominal CT scans was examined. MATERIALS AND METHODS: 296 consequtive abdominal tomography were evaluated prospectively for the presence of retrorenal colon, retrogastric (pancreaticogastric interposition or retrosplenic) colon, high positioned colon, interposition of the colon between the psoas muscle and the kidney and hepatodiaphragmatic interposition (anterior or posterior). RESULTS: We observed 2 retrogastric colon [1 pancreaticogastric (0.3%), 1 retrosplenic (0.3%)], 7 retrorenal colon (1.2%) being bilateral in two cases, 2 interposition of colon between the psoas muscle and the kidney (0.7%), 1 posterior (0.3%) and 6 anterolateral hepatodiaphragmatic interposition (2.1%) and 12 high positioned cecum (4.2%) (in 4 of them cecum was totally subhepatic in location). Terminal ileum was lying in Morrison's pouch and anterior to renal hilus in two of the cases with subhepatic cecum. CONCLUSION: Anatomic variations of the colon probably result due to mild embryologic abnormalities of bowel rotation and fixation, short transvers mesocolon, intraperitoneal ascending or descending colon, increased intraperitoneal pressure or decreased retroperitoneal fat. Pancreaticogastric interposition occurs in approximately 0.2%, partial retrorenal colon in 9-10%, complete retrorenal colon 1%, interposition between psoas muscle and kidney in 0.7-1.7%, anterolateral hepatodiaphragmatic interposition in 1.3-3% of individuals. When located in lesser sac it simulates several pathologies of this area. On intravenous urography images it may cause mass effect. In percutaneous interventions and surgical procedures colon may be perforated. For these reasons tomography images should be evaluated for the presence of these anatomic variations.Öğe Column of bertin: Normal sonographic findings(2005) Ünal B.; Aktaş A.; Bilgili Y.; Yilmaz E.Introduction: We aimed to describe the normal and pathologic sonographic (US) findings of column of Bertin (CB). Materials and methods: The study was performed on sixty-six patients who had CB on CT. CB was found to be suspicious in 22 cases; with either hypoechoic, heterogeneous, bulging contour, increased vascularity or cystic areas on US. Patient underwent US and CT imaging following their initial CT and US examinations, respectively. On CT images, isodens and homogeneous texture, enhancement equal to renal cortex were accepted as normal findings. The thickness of CB on axial (AT) and longitudinal (LT) sonography images and the thickness of renal parenchyme (PT) on longitudinal images were measured. The ratio of AT to PT and LT to PT were calculated. Echogenity, vascularity, and contours of CB were evaluated on sonography. The data evaluated with Pearson and t tests. Results: CB was bilateral in 39, and double in 9 cases. Totally 136 CB were evaluated. In two sonographically suspicious CB, renal cell carcinoma (pathologically confirmed) and Bosniak type 2 cysts were detected. In LT, AT, LT/PT and AT/PT were 14.0+3.1 mm (maximum: 23.4mm), 13.2±2.9 mm (maximum: 21.8 mm), 1.1±0.19 (maximum: 1.56) and 1.0±0.17 (maximum: 1.67) in normal cases, 28 mm, 26 mm, 2.15 and 2 mm, in case with renal cell carcinoma. The correlation between thickness of CB and parenchyme was significant (AT-PT r=0.555, p<0.001, and LT-PT r=0.614, p<0.001). Peripheral vascularities were observed in all, central minute vascular focuses in 24 (18%), hypoechogenity in 12 (9.0%), bulging exterior contour in 9 (6%) CB. Conclusion: Increased vascularity, hypoechogenity, increased thickness of CB and thickness to parenchyme ratio are suspicious sonographic findings which may necessitate CT examination.Öğe Superior mesenteric artery syndrome: CT and ultrasonography findings(2005) Ünal B.; Aktaş A.; Kemal G.; Bilgili Y.; Güliter S.; Daphan Ç.; Aydinuraz K.Purpose: The purpose of the study was to describe-computed tomography (CT) and ultrasonography findings in superior mesenteric artery syndrome (SMAS). Materials and methods: The study was performed on 89 CT examinations. Ultrasonography was performed on 32 and barium study was performed an four of these subjects. Group A consisted of cases with one or more of the following complaints: postprandial epigastric pain, weight loss and vomiting. Group B consisted of the remaining cases. Cases who had all of the above-mentioned clinical findings and duodenal dilatation, to-and-fro barium movement and SMA indentation in barium study were diagnosed as having SMAS. Body mass index (BMI, kg/m2) was calculated. The distance between SMA and aorta, at the location where the duodenum passes from, was measured on CT and ultrasonography. The angle between SMA and aorta was measured on ultrasonography images. Group and gender differences were analyzed with t-test, the relationship between clinical and CT findings was analyzed with Mann Whitney U test and the relations between BMI-CT and CT-ultrasonography measurements were analyzed with Pearson coefficients. Results: Of 13 cases in Group A, 3 were diagnosed as SMAS. Eight of the cases showed gastric and/or duodenal dilatation. In 6 cases, antrum had an abnormally high location at portal hilus. In Group A, the SMA-aorta distance was 6.6 ± 1.5 mm and the SMA-aorta angle was 18.7 ± 10.7°. In Group B, these values were 16.0 ± 5.6 mm and 50.9 ± 25.4°, respectively (p<0.001). Cut-off values between SMAS and Group B were 8 mm (100% sensitivity and specificity), and 22° (42.8% sensitivity, 100% specificity). CT and ultrasonography measurements (p<0.001) and SMA-aorta distance and BMI (p=0.004) were significantly correlated. The SMA-aorta distance was significantly shorter in females (p=0.036). Conclusion: Gastric and/or duodenal dilatation and a diminished SMA-aorta distance have a significant correlation with clinical symptoms of SMAS that include postprandial pain, vomiting and weight loss. © Turkish Society of Radiology 2005.Öğe Transient arterial enhancement in a hepatic peritumoral fat-spared area(2005) Ünal B.; Bilgili Y.; Kara S.; Erdal H.H.Early-enhancing areas that are perfusion abnormalities rather than tumor deposit are sometimes encountered on arterial dominant-phase images in multisection dynamic magnetic resonance imaging. Focal sparing in diffusely fatty liver is also a well recognized entity. However, both conditions occasionally create problems in the diagnosis of hepatic mass lesions. Familiarity with these abnormalities on ultrasonography and multisection dynamic magnetic resonance images is important to prevent misinterpretation of these pseudolesions as real masses. In addition, focal sparing can be the only clue for a space occupying lesion in the liver. We present here the ultrasonography and magnetic resonance imaging findings of a case with liver metastasis from pancreas cancer which caused a wedge-shaped fat-spared enhancing area on dynamic magnetic resonance imaging. © Turkish Society of Radiology 2005.
