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    Can subcoracoid effusion be a more specific finding for subscapularis tear among rotator cuff pathologies on magnetic resonance imaging?
    (Mosby-Elsevier, 2023) Bahadir, Batuhan; Sarikaya, Baran; Kaya, İbrahim; Oklaz, Burak; Sarikaya, Pelin Zeynep Bekin; Kanatli, Ulunay
    Hypothesis and Background: Magnetic resonance imaging (MRI) is a well-known, noninvasive diagnostic method for rotator cuff tendon pathologies that are not very sensitive for subscapularis tendon tears. Subcoracoid effusion (SE) is an easily recognizable radiologic sign on MRI. In this study, we aimed to examine the relationship of SE with rotator cuff tear and to investigate whether SE could be a supportive finding in the diagnosis of subscapularis tear in preoperative MRI. Our hypothesis was that SE was a more specific finding of subscapularis tear than other rotator cuff tears. Methods: The data of patients who underwent shoulder arthroscopy in our clinic between 2017 and 2021 were analyzed retrospectively. Four groups were included in the study: patients with a rotator cuff tear accompanied by a subscapularis tear (group 1, n = 273), patients with isolated subscapularis tear (group 2, n = 57), patients with rotator cuff tear with intact subscapularis tendon (group 3, n = 190), and patients without any rotator cuff pathology (group 4, n = 263). Arthroscopic video records and MRIs of all patients were evaluated retrospectively. Subscapularis tendon tears were classified according to the Lafosse classification. Results: There was a statistically significant difference between the groups in terms of the presence of SE on MRI (P = .001). The presence of SE in group 1 and group 2 was statistically significantly higher than that in both group 3 and group 4 (P = .001), and there was no significant difference between group 3 and group 4 (P > .05). A significant relationship was found between Lafosse classification and SE (P = .001). When the diagnostic powers of the detection of SSC tear and the presence of SE on MRI for SSC tear were compared, Kappa values were 0.615 (P = .001) and 0.701 (P = .001), and overall diagnostic accuracy rates were 80.3% and 85.5%, respectively. Conclusion: We conclude that SE is a more specific finding for subscapularis tears than other rotator cuff pathologies. We suggest that SE on MRI should also be considered in patients with a rotator cuff tear in whom a subscapularis tear was not detected in preoperative MRI and that the subscapularis tendon should be carefully evaluated during surgery in cases where the effusion is positive. (c) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
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    Deficits in peripheric and central olfactory measurements in smokers: evaluated by cranial MRI
    (Springer, 2023) Sarikaya, Pelin Zeynep Bekin; Muluk, Nuray Bayar; Baser, Selcuk; Ozdemir, Adnan; Yilmazsoy, Yunus
    Objectives Cigarette smoking remains a serious health problem all over the world. We investigated the peripheral and central olfactory pathways in young male smokers to determine whether there is a relationship between the amount of cigarettes smoked and duration of smoking and the dimensions of the olfactory areas. Methods In this retrospective study, cranial Magnetic Resonance Imaging (MRI) images of adult male smokers aged <= 40 years (n = 51) and 50 healthy male adults were analyzed. The olfactory bulbus (OB) volumes and olfactory sulcus (OS) depths, insular gyrus, and corpus amygdala areas were measured via cranial MRI. In the smoker group, the number of cigarettes smoked and duration of smoking were noted and the Brinkmann index was calculated. Results OB volume, OS depth, and the insular gyrus areas of the smokers were lower than in the control group (p < 0.05). There were no differences between the groups in terms of the corpus amygdala measurements (p > 0.05). No significant correlations were found between the number of cigarettes smoked daily, smoking duration, and the Brinkmann index and the peripheral and central olfactory measurements in our study (p > 0.05). Conclusions In smokers, OB volumes, the OS, and the central areas decrease bilaterally, regardless of smoking duration and number of cigarettes smoked daily. This could be related to inflammatory mediators that may be harmful to the olfactory neuroepithelium, gray matter atrophy in the brain, or endothelial damage related to smoking and its effects on blood support to the brain and olfactory regions.
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    Diagnostic Dilemma: Which Clinical Tests Are Most Accurate for Diagnosing Supraspinatus Muscle Tears and Tendinosis When Compared to Magnetic Resonance Imaging?
    (Springernature, 2022) Batur, Elif Balevi; Sarikaya, Pelin Zeynep Bekin; Kaygisiz, Mustafa Emin; Gezer, Ilknur Albayrak; Levendoglu, Funda
    Background: The study aims to investigate the diagnostic accuracy of five clinical shoulder tests in the diagnosis of supraspinatus tears and tendinosis when compared to magnetic resonance imaging (MRI). Methods: A total of 116 shoulders of 106 consecutive patients who experienced shoulder pain were assessed for this cross-sectional diagnostic accuracy study. Patients were assessed with the most commonly used clinical shoulder tests, including the Jobe test (empty can), Neer test, drop arm test, Hawkins test, and full can test to identify supraspinatus tears and tendinosis. MRI examinations were performed on a 1.5 Tesla MRI system, and images were assessed by a blinded radiologist. The primary outcomes were to determine the sensitivity, specificity, and accuracy of the five clinical tests and to establish their correlation with MRI for supraspinatus tears and tendinosis. Results: The Hawkins test had a higher sensitivity and accuracy when diagnosing tears (sensitivity 89.66% [95% CI, 78.83-96.11] and accuracy 56.03% [95% CI, 46.51-65.23], respectively) and higher sensitivity in tendinosis (79.07% [95% CI, 63.96-89.96]). The drop arm test had a lower sensitivity but higher specificity in both tendinosis and tears (sensitivity 0% [95% CI, 0-8.22] and 12.07% [95% CI, 4.99-23.29], respectively, and specificity 87.67% [95% CI, 77.88-94.21] and 96.5% [95% CI, 88.09-99.58], respectively). The Neer test had a higher positive predictive value (PPV) of 37.21% in diagnosing tendinosis. When compared to the Hawkins test, the combination of the clinical tests had no statistically significant contribution to sensitivity and diagnostic accuracy. Conclusion: The Hawkins test had higher accuracy in diagnosing tears and was the most sensitive in diagnosing supraspinatus tendinosis and tears when compared to the MRI findings. The Neer test may also be another reliable tool for the diagnosis of tendinosis due to its higher PPV.
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    Is There a Relationship between Optic Nerve and Chiasm Measurements with HbA1c Levels in Diabetic Patients?
    (Thieme Medical Publ Inc, 2023) Sarikaya, Pelin Zeynep Bekin; Muluk, Nuray Bayar; Ozdemirl, Adnan; Gungunes, Askin
    Objectives We investigated the optic nerve (ON) and chiasm (OC) in magnetic resonance (MR) in diabetic patients by comparing them with hemoglobin A1c (HbA1c) levels.Methods In this retrospective study, cranial MRIs of 42 adults (19 males and 23 females) with diabetes mellitus (DM) (group1) and 40 healthy controls (19 males and 21 females) (group 2) were included. In both groups, bilateral ON widths and OC area, width, and height were measured. In the DM group, HbA1c values were also obtained at the time of MRI or within the same month.Results In the DM group, the mean of the HbA1c values was 8.31 & PLUSMN; 2.51%. There were no significant differences between ON diameter; and OC area, width and height of the DM and control groups ( p > 0.05). In each of the DM and control groups, ON diameter was not different between the right and left sides ( p > 0.05). In DM groups, correlation tests showed that there were positive correlations between right and left ON diameters, OC area and OC width, and OC height ( p < 0.05). In males, ON diameters were higher than those in females bilaterally ( p < 0.05). In patients with higher HbA1c values, OC width was smaller ( p < 0.05).Conclusion A significant correlation of OC width and HbA1c levels suggests that uncontrolled DM causes ON atrophy. Our study represents a thorough assessment of OC measures using standard brain MRI to evaluate optic degeneration in DM patients and shows that the OC width measurement is suitable and reliable. This simple method can be obtained from clinically available scans.
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    Radiological Evaluation of the Effect of Laryngopharyngeal Reflux on the Thickness of Inferior Turbinate, Maxillary Sinus Mucosa and Nasal Septal Body
    (Springer India, 2024) Tas, Burak Mustafa; Sarikaya, Pelin Zeynep Bekin; Sencan, Ziya; Comert, Ela; Muluk, Nuray Bayar
    Background We investigated the relationship between Laryngopharyngeal Reflux (LPR) and maxillary sinus mucosal thickness (MSMT), inferior turbinate mucosal thickness (ITMT), inferior turbinate width (ITW) and nasal septal body thickness (NSBT), which can be signs of chronic rhinosinusitis and allergic rhinitis.Methods The study, which included 87 patients, was designed as two groups. While 42 of the patients were included in the Laryngopharyngeal Reflux group, 45 were included in the control group. Age and gender information of the patients were noted. MSMT, ITMT, ITW and NSBT values were measured in patients who had Paranasal Sinus Computed Tomography. MSMT, ITMT and ITW were measured as right and left. Both groups were evaluated in terms of these values.Results Right ITMT, bilateral ITW and MSMT values were found to be significantly higher in the LPR group than in the control group (p < 0.05). MSMT values were higher in males (p < 0.05). The left-ITT and NSBT values were not significantly different between the LPR group and the control group, but both values were higher in the LPR group than in the control group (p > 0.05). In the LPR group, there were positive correlations between ITMT and ITW values of the right side; and left side separately (p < 0.05).Conclusion It has been shown that Laryngopharyngeal Reflux increases maxillary sinus mucosal thickness, inferior turbinate thickness and width, and nasal septal body thickness, which can be signs of chronic rhinosinusitis and allergic rhinitis. The negative effects of LPR on nasal and paranasal mucosa and structures were demonstrated in this study.
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    Relationship Between Nasal Septal Deviation Angles and Turbinates: A Computed Tomography Study
    (Springernature, 2023) Sarikaya, Pelin Zeynep Bekin; Muluk, Nuray Bayar
    BackgroundThis study aimed to evaluate inferior turbinate hypertrophy caused by nasal septum deviation, nasal septal deviation (SD) angles, and age differences with the help of paranasal computed tomography (CT) and to investigate the relationship between these parameters. MethodologyThe paranasal sinus CT images of 100 patients (50 males and 50 females) were retrieved from the hospital's picture archiving and communication system. In this retrospective study, patients were examined in two groups. There were 50 patients aged >35 years in group 1 and 50 patients aged <35 years in group 2. The SD side was determined using a coronal image and was mentioned as the ipsilateral side. The contralateral side of the SD side was mentioned as the contralateral side. Additionally, the SD curve angle (SDCA), superior SD angle (SSDA), and diameters and mucosal thicknesses of the inferior turbinates were measured. Concomitant ipsilateral sinusitis and ipsilateral concha bullosa (in the middle concha) were also noted as present or absent.ResultsIn our study, the SDCA values of the >= 35-year age group were significantly higher than those of the <35-year age group (p < 0.05). Furthermore, the SSDA values of the >= 35-year age group were significantly lower than those of the <35-year age group (p < 0.05). In each of the age groups, ipsilateral inferior turbinate mucosal thickness and ipsilateral inferior turbinate diameter values were significantly higher than those of the contralateral sides (p < 0.05). Ipsilateral concha bullosa was present in 30.0% of the <35-year age group and 18.0% of the >= 35-year age group. Ipsilateral sinusitis was present in 34.0% of the <35-year age group and 52.0% of the >= 35-year age group.ConclusionsSD and inferior turbinate hypertrophies should be evaluated together and measured with paranasal CT to provide more efficient nasal aeration. Studies with larger patient series are needed to elucidate the etiology.
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    Supraorbital ethmoid cells (SOECs), anterior ethmoid artery notch and ethmoid roof relation in PNSCT
    (Elsevier Sci Ltd, 2023) Ozdemir, Adnan; Muluk, Nuray Bayar; Sarikaya, Pelin Zeynep Bekin; Yilmazsoy, Yunus
    Objectives: We investigated supraorbital ethmoid cell (SOEC) presence and types in paranasal sinus computed tomography (PNSCT).Methods: The PNSCT images of 188 adult patients (93 males and 95 females) were evaluated as SOEC group (n = 87 sides), and non-SOEC group (n = 289 sides, control). In both groups, anterior ethmoid artery (AEA) notch-ethmoid roof distance and presence of AEA canal were evaluated. In the SOEC group, SOEC types (type 1 to 3) and SOEC angle are also examined.Results: SOEC was detected in 87 sides (23.13 %). SOEC type 2 was the most detected type (71.3 %). AEA notch-ethmoid roof distance of the SOEC group was significantly higher than those in the non-SOEC group. AEA notch-ethmoid roof distance of the SOEC Type 3 group was significantly higher than SOEC Type 2 group. AEA notch-ethmoid roof distance was 3.74 +/- 1.81 mm in the SOEC group and 0.68 +/- 1.16 mm in the non-SOEC group. When SOEC types were considered, this distance was 5.29 +/- 2.66 mm in type 3, 3.35 +/- 1.35 mm in type 2 and 3.48 +/- 0.92 mm in type 1. In higher SOEC types, SOEC angle; and AEA notch-ethmoid roof distance increased.Conclusion: In more pneumatized SOEC presence, SOEC angle increase, and AEA notch-ethmoid roof distance increases, AEA runs inferiorly in the ethmoid cells and freely below the skull base; and is more susceptible to injury. The surgeons should be more careful not to damage AEA in the FESS when detecting well-pneumatized SOECs (SOEC Type 3).
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    Temporal CT Evaluation of the Relationships between Basic Anatomical Structures and the Round Window: Importance for the Cochlear Implant Surgery
    (Thieme Medical Publ Inc, 2024) Asal, Nese; Muluk, Nuray Bayar; Sarikaya, Pelin Zeynep Bekin
    Objectives In the present study, we investigated the round window (RW) and neighboring anatomical structures using temporal computed tomography (CT) which are important for cochlear implant (CI) electrodes. Methods In this retrospective study, the temporal CT images of 112 adult patients (45 males and 67 females) were evaluated. We classified mastoid pneumatization, and measured RW diameter, RW-carotid canal (CC) distance, RW-facial nerve mastoid segment (FNMS) distance, RW-pyramidal eminence distance, RW-jugular bulb (JB) distance, and RW-internal acoustic canal (IAC) distance. Additionally, RW-cochlea angle and RW-facial nerve angle were also measured. Results RW diameters in males were significantly higher than those in females bilaterally ( p < 0.05). RW-CC distance and RW-JB distance were both smaller than 10mm. RW-IAC distance was 2.54 to 2.68mm, and RW-FNMS distance was 4.20 to 4.40mm. RW-cochlea angle ranged from 39.62 to 41.91degrees and RW-FN angle ranged from 17.28 to 18.40degrees. Males showed better mastoid pneumatization values ( p < 0.05). In higher RW diameters, RW-JB distance decreased, and in pneumatized mastoids, RW-JB distance increased. RW-JB distance and RW-CC distance were detected to increase together ( p < 0.05). Conclusion RW is crucial anatomic structure for CI surgeries. RW diameters are between 1.21 and 1.35mm and lower in the females. Males exhibited better mastoid pneumatization values than the females, and CC and JB distances from RW were farther in well-pneumatized mastoids. Future studies should include comprehensive clinical and surgical findings.