Oral Presentations S2 • Turkish Society of Magnetic Resonance 23Rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Oral Presentations S2 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

DOI 10.5152/eurasianjmed.2018.02052018

O - 01 Materials and Methods: Between January 2017 and January 2018, 89 patients without abdominal MR imaging findings who underwent abdomi- ASSESSMENT OF PANCREATIC nal 3 T diffusion weighted imaging, (b=0, b=600 s/mm2) were retrospec- ULTRASONOGRAPHY AND MRI tively included. ADC mean values of the spleen were measured at MR Workstation. Measurements were performed with 25 mm2 ROIs at the FINDINGS IN RELATION TO GLUCOSE splenic hilus level. The average of four ADC mean measurements was TOLERANCE TEST IN PATIENTS WITH calculated to reduce random variability in the measurements. Pearsons correlation coefficient test was used to evaluate the relationship between BETA THALASSEMIA MAJOR age and ADC mean values. YASEMIN ALTINTAS Results: Twenty-four of the patients included in the study were males and 65 Private Adana Middle East Hospital, Adana, Turkey were females. The mean age was 45.9 years (range, 19-76 years). The mean ADC value was 0.9+0.13x10-3 mm2/s (range, 0.66-1.2x10-3 mm2/sn). There was Abstract a negative correlation between age and ADC mean values (r=-0.526, p=0.001). Objective: The most important cause of mortality is heart failure due Conclusion: There was a negative correlation between age and ADC mean to iron accumulation in beta thalassemia major and MRI have come into values. It may be necessary to consider age when assessing spleen s ADC values. routine use in evaluation of the iron load. Objective of this study was to evaluate the correlation of ultrasonografi and MRI of the pancrease with Keywords: Apparent diffusion coefficient, spleen, age glucose tolerance test. Materials and Methods: This study sixty patients were included. Oral glucose tolerance test (OGTT) was performed in all the cases. O - 03 Pancreas echogenicity was divided into three grades. Grade I, grade DIAGNOSTIC PERFORMANCE OF II and grade III. Pancreas MRI images were acquired using T2* GRE sequence parameters. MULTIPARAMETRIC MR IMAGING Results: OGTT impairment was defined in 5 cases, from the patient AT 3.0 TESLA IN DISCRIMINATING group and 1 case from the controls. Patient group, pancreas echogenicity PROSTATE CANCER FROM was found as grade I in 21 cases (35%), grade II in 27 cases (45%) and PROSTATITIS: HISTOPATHOLOGIC grade III in 12 cases (20%). Control group, pancreas echogenicity was found as grade I in 29 cases (96.7%) and grade II in 1 case (3.3%). T2* CORRELATION values were between 1.0 and 35.8 ms in the patient group and between ELIF PEKER1, DIDEM YASEMIN SONMEZ1, HABIP ESER AKKAYA2, 23.4 and 53.1 ms in the controls. SERHAT HAYME1, GUL AYSE ERDEN1, MEMET ILHAN ERDEN1 Conclusion: In this study, increased echogenicity was observed by 65% 1Ankara University School of Medicine, Ankara, Turkey and a statistically significant correlation was found between the pancreatic 2Karaman State Hospital, Konya, Turkey echogenicity increase and blood-glucose values. In this study, a significant negative correlation was found between T2* abnormality and fasting Abstract blood glucose. Glucose mechanism shows a correlation with pancreatic Objective: Aim of this study is to evaluate the diagnostic performance of US and T2* MRI values. Pancreatic changes in beta thalassemia major multiparametric magnetic resonance imaging (mpMRI) in differentiating patients can be evaluated with US and MRI. prostatitis foci from prostate cancer (PCa). Keywords: Beta thalassemia major, iron load, diabetes mellitus, pancreatic Materials and Methods: This retrospective study included 81 biopsy-proven US and T2* MRI lesions (37 PCa and 44 prostatitis). SI on DWI (b=1000 and 2000 s/mm2), normalised T2-signal intensity (nT2SI) and apparent diffusion coefficient (ADC) values, SI at the end of the dynamic curves, peak SI, mean enhance- O - 02 ment percentage, mean peak time, and washout percentage obtained from dynamic contrast-enhanced imaging (DCEI) were evaluated. THE RELATIONSHIP BETWEEN Results: nT2SI (3.2 vs. 3.8, p=0.003) and ADC values (0.685 vs. 0.874x10-3 AGE AND APPARENT DIFFUSION mm2/s, p<0.001) were significantly lower in the PCa group than the prostatitis COEFFICIENT VALUES IN NORMAL group. The washout percentage was significantly different between prostatitis SPLENIC PARENCHYMA group than the PCA (4% vs. 12%, respectively, p=0.003). ADC values alone showed higher specificity and and sensitivity (75% and 80.5%, respectively) than HALE COLAKOGLU ER all of the single and most of the combined criteria. Department of Radiology, Gaziantep University School of Medicine, Conclusion: mpMRI of the prostate gland can be used to differentiate Gaziantep, Turkey between, prostatitis, PCa and normal tissue. SI on DWI (b=2000 s/mm2), ADC values, nT2SI, and washout percentage were identified as MRI Abstract criteria for discriminating prostatitis from PCa. the ADC values alone, Objective: To evaluate the correlation between age and apparent diffu- demonstrated higher sensitivity and specificity when compared with all of sion coefficient values in normal spleen. the single and most of the combined criteria. Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S3

Keywords: Prostate, prostate cancer, prostatitis, multiparametric MRI, Abstract diffusion MRI, T2 weighted imaging Objective: In this study, assesment of cardiac and hepatic iron overload in thalasemia major patients with cardiac magnetic resonance imaging (MRI) T2* study was aimed. O - 04 Materials and Methods: 13 thalasemia major patient (7 female, 6 male) was “T2-HYPOINTENSE DOT SIGN” included in this retrospective study. With General Electric DiscoveryTM MR750W 3 Tesla MRI scanner; myocard and liver iron overload was HIGHLY SUGGESTIVE CLUE FOR THE assessed with T2* sequance. Cardiac T2* time was measured at mid-sep- DIAGNOSIS OF OVARIAN TORSION: A tum;<20 msec was accepted significant for siderosis. If T2* time was 10-20 NOVEL SIGN msec, considered moderate siderosis;if T2* time was<10 msec, considered severe cardiac siderosis. Liver iron overload was categorised normal if T2* TUMAY BEKI1, AHMET VEYSEL POLAT2 time was >11.4 msec; categorised mild if T2*time was 3.8-11.4 msec; cat- 1 Zonguldak Atatürk State Hospital, Zonguldak, Turkey egorised moderate if T2* time was 1.8-3.8 msec; categorised severe if T2* 2 Ondokuz Mayıs University School of Medicine, Samsun, Turkey time was<1.8 msec. Age, serum iron and ferritin levels, frequency of trans- fusion, chelation theraphy, co-morbid disease informations of patients was Abstract obtained and recorded from hospital information system (HIS). Objective: Early and accurate diagnosis is crucial for preserving the viabil- Results: The age of the patients ranged between 9 and 59 years. Cardiac ity of the ovaries and for the appropriate management of patients with siderosis was detected in 4 patients (30.1%) within 13 total patients. 1 ovarian torsion. In this study, we aimed to investigate the reliability of patient had modarate cardiac siderosis, 3 patients had severe cardiac sid- “T2-Hypointense Dot Sign” in the diagnosis of ovarian torsion. We also erosis. Except one patient, there was liver iron overload in all patients. 4 aimed to compare the diagnostic capability of this sing with whirlpool sign (30.1%) patients had mild iron overload, 6 (46.1%) patients had moderate in the detection of ovarian torsion. iron overload, 1 patient (7.1%) had severe iron overload. In 13 patients, 12 patient had iron chelation theraphy. In 3 patients, serum ferritin level was Materials and Methods: The pelvic MRI images of 31 patients with surgi- <1000 ng/ mL. In this 3 patients, mild and moderate liver iron overload was cally proven ovarian torsion were accepted to analysis. Thirty patients with detected, but there was no cardiac siderosis. Between serum ferritin levels adnexal neoplasm and 15 patients with tuboovarian abscess comprised and liver T2* time, there was no statistically significant correlation (p=0.12) the control group. The MRI images of 76 patients were retrospectively Between serum ferritin levels and cardiac T2* time, there was a strong evaluated by two independent radiologists for the presence of T2 hypoin- negative correlation (r=-0.762, p<0.05). There was no statistically significant tense dot sign and whirlpool sign with using three point scale (0=definitely correlation between cardiac T2* time and liver T2* time (p=0.24). negative, 1=inconclusive, 2=definitely positive). Conclusion: Cardiac T2* imaging is a successful and non-invasive modality, Results: T2 hypointense dot sign was more reliable than the whirlpool which can demonstrate cardiac siderosis; even before the myocardial dys- sign in the detection of ovarian torsion with the occurrence rate of 93.5% function emerged. In same session, measuring cardiac and liver T2* time and 58%, respectively. Both signs were definitely negative in patients with simultaneously, in tranfusion dependent thalasemia major patiens can lead adnexal neoplasm and tuboovarian abscess. “T2 hypointense dot sign” was to the detection of iron overload before clinical manifestations and guide definitely positive and definitely negative in 29 and two patients, respec- early onset of chelation theraphy. tively. The whirlpool sign was inconclusive and definitely negative in four and nine patients, respectively. Nevertheless, T2 hypointense dot sign was Keywords: Cardiac iron overload, thalassemia major, cardiac MRI evident four and seven patients with inconclusive and definitely negative results for whirlpool sign, respectively. O - 06 Conclusion: The presence of ipsilateral “T2 hypointense dot sign” could be valuable clue for the accurate and early diagnosis of ovarian torsion on NON INVASIVE ASSESSMENT OF non-contrast MRI. RENAL VASCULATURE USING Keywords: Ovarian torsion, MRI, T2-Hypointense dot sign INHANCE (3D INFLOW INVERSION RECOVERY) SEQUENCE OBTAINED O - 05 WITH 3.0 T MR IN CASES OF RENOVASCULAR HYPERTENSION ASSESMENT OF CARDIAC AND 1 1 HEPATIC IRON OVERLOAD IN YAVUZ METIN , NURGUL ORHAN METIN , EDA BEYKOZ CETIN1, ALI KUPELI2, MAKSUDE ESRA THALASEMIA MAJOR PATIENTS WITH KADIOGLU1, OGUZHAN OZDEMIR1 CARDIAC MAGNETIC RESONANCE 1Department of Radiology, Recep Tayyip Erdoğan University School of IMAGING Medicine, Rize, Turkey 2Department of Radiology, Muş State Hospital, Muş, Turkey MURAT BAYAV, NILGUN IŞIKSALAN OZBULBUL, DIDEM BAYAV Abstract Department of Radiology, Eskişehir Osmangazi University School of Objective: To evaluate the diagnostic performance of inhance (3D inflow Medicine, Eskişehir, Turkey inversion recovery) MRA in the depiction of the renal vasculature and S4 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 in the detection of main renal artery diseases in cases of renovascular systematic biopsy benignity. PI-RADSv2 scoring system was used to grade hypertension. the lesions. US-guided fusion biopsies combined with MRI findings of PI-RADS 3 and 4 lesions were performed separately. Materials and Methods: Unenhanced-MRA (inhance MRA) was performed in 73 patients (31 women, 42 men; mean [±SD] age, 54±17 Results: A total of 22 biopsies with PIRADS 2 (n=1), PIRADS 3 (n=11) years) with clinical suspicion of renovascular hypertension. All exami- and PIRADS 4 (n=10) lesions were performed in 16 patients. Of the nations were performed with a 3.0 T MR system (GE Discovery 750 lesions, 14 were in peripheral zone, 5 in transitional and 3 in central T). Inhance-MRA was performed using a respiratory-triggered 3D fat zone. Prostate adenocarcinoma was detected in 8 of 10 lesions scored saturated fast imaging employing steady state adquisition with inversion with PI-RADS 4 (Picture 1), and 1 of 11 lesions scored with PI-RADS 3. recovery pulses. Three radiologist independently evaluated the main The sensitivity of PI-RADSv2 for malignant lesion detection was 88,8%, renal artery, first order segmental branches and secondary order arteries specificity was 84,6%, accuracy was 86,3%. The negative predictive value within the renal parenchyma with the ‘inhance’ sequences, retrospectively. (NPV) and positive predictive value (PPV) were calculated as 91,6 % and Each reader graded the MR image quality on a 4-point confidence scale 80 %, respectively. based on the vessel signal intensity, sharpness and complete delineation of vessel borders. Also the pathologies of the main renal artery (stenosis, Conclusion: High incidence of malignant results in lesions scoring occlusion) were evaluated. After the independent reviews, a consensus PI-RADS 4 in prostate MRI suggests that these patients should be direct- was reached to resolve discrepancies. The consensus data was used as the ed to biopsy. Fusion biopsy improves accuracy rates, avoids unnecessary reference for the unenhanced-MRA reading. systematic biopsies and complications. When the appropriate sequences were used in 1.5T MRI system, the rate of detection of non-malignant Results: More than one renal artery was found in 24 patients. There was lesions was found to be high. Thus, the complications that may occur early division in 15 patients. Three patients had both extra renal artery and secondary to the extra invasive procedures are also prevented. early division variations. All of the variations could be detected correctly by all readers. In five patients, all readers detected stenosis at main renal arteries. Keywords: PI-RADS v2, 1.5 Tesla Prostat MRI, Fusion biopsy In two patients, two readers found renal artery stenosis while one reader interpreted it as normal. In a patient two readers reported as normal while one found renal artery stenosis. MR image quality score was found signifi- O - 08 cantly higher in imaging main renal artery for all readers, compared to first order branch and parenchymal branch (p<0.001).Intraclass correlation coef- CONTRIBUTION OF THE DIFFUSION ficient was found high for evaluating main renal artery disease (ICC=0.82) and the presence of vascular variations (ICC=0.96). WEIGHTED MAGNETIC RESONANCE Conclusion: Inhance 3D Inflow Inversion Recovery sequence is a reliable IMAGING ON TYPING OF LIVER CYST diagnostic method to depict renal vasculature without using contrast material HYDATIC in a very short time. The normality, stenosis and variations in the main renal 1 2 arteries can be easily detected by this method. This method can be used safely OZLEM ARMAY , CEYDA TURAN BEKTAS , 2 as an alternative to enhanced techniques in patients with renal insufficiency. AYTUL HANDE YARDIMCI 1 Keywords: Inhance inflow inversion recovery, magnetic resonance, renal Bitlis State Hospital, Bitlis, Turkey 2İstanbul Training and Research Hospital, İstanbul, Turkey artery disease Abstract Objective: The purpose of this study is to provide classification of dif- O - 07 ferent types of hepatic hydatid cysts by measuring the mean apparent 1.5 TESLA PROSTAT MRI PI-RADS diffusion coefficient (ADC) using diffusion-weighted magnetic resonance imaging (DWI). V2 RESULTS, CORRELATION WITH Materials and Methods: The total of 60 patients (42 female,18 male) FUSION BIOPSY and 79 lesions included in the research conducted in İstanbul Research PINAR GULERYUZ KIZIL1, ALMILA COSKUN BILGE1, and Training Hospital between January 2014 and May 2015, had been EMRE CAN CELEBIOGLU1, UTKU LOKMAN2, diagnosed with hepatic cyst lesions for various reasons according to the NEFISE CAGLA TARHAN1 hospitals archived records of abdominal MRI, and therefore had their diagnosis pathologically or serologically confirmed. ADC and EADC maps 1Department of Radiology, TOBB ETU Hospital, Ankara, Turkey were obtained with values of b0 and b400 s/mm2 and ADC and EADC 2 Department of Urology, TOBB ETU Hospital, Ankara, Turkey mean valuses were calculated for each lesions. Then the average value calculated for each cyst types are compared quantitatively. Abstract Results: In our study for ADC values, we determined that statistically Objective: Prostate cancer is the most common type of cancer in men. there was significant difference between types 1 and 4, between type 2 Magnetic resonance imaging (MRI) now plays an important role in the and type 4, type 3 and type 4 (p=0.001). When we compared EADC detection, localization and staging of prostate cancer. In this study, we values we found that WHO type 4 lesions EADC values were obviously aimed to correlate the lesions reported as especially PI-RADS 3 and lower than who type 1, 2 and 5 lesions (p=0.001).In addition, we divided PI-RADS 4 with fusion biopsy at 1.5T prostate MRI. our patients lesions into two groups, active (types 1-2-3) and inactive Materials and Methods: Dynamic multiparametric imaging was per- (types 4-5). When we compared each groups mean ADC and EADC formed with 1.5T MRI (Magnetom Symphony, Siemens) system in 16 values, we determined the difference between active and inactive groups. patients (age range 45-77, age average 62) with high PSA values or rapid When compared to inactive groups, lesions ADC values of active types PSA elevation with touché findings, family history or previously reported were higher and EADC values were lower as shown by statistics. Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S5

Conclusion: Our study shows that ADC and EADC values may be useful 1Department of Radiology, Ege University School of Medicine, İzmir, Turkey for differentiaton of type 4 lesions from other classes, and seperation of 2Department of Biostatistics, Ege University School of Medicine, İzmir, active and inactive groups. Turkey

Keywords: Hydatid cyst, diffusion weighted magnetic resonance imaging, Abstract apparent diffusion coefficient Objective: To evaluate the diagnostic performance of magnetic resonance imaging (MRI) in pregnant patients with suspected acute appendicitis and to assess its role in identifying other causes of abdominal pain in this O - 09 population. COMPARISON OF APPARENT Materials and Methods: A retrospective database search from 2011 through 2018 for MRI exams of pregnant patients due to abdominal pain DIFFUSION COEFFICIENT VALUES was performed. Sixty-one patients (median age:30 years) were identified. BETWEEN MALIGNANT LESIONS AND MRI exams were reviewed and the patients’ electronic medical record NORMAL UTERINE CERVIX WITH 3T for surgical, pathological, and clinical follow up were investigated. Cases were evaluated for presence of appendicitis, visualization of the appen- MRI dix, and non-appendiceal causes of pain. Kappa statistic and McNemar FUNDA DINC ELIBOL1, SEZEN BOZKURT KODEOGLU2 test were used to determine agreement between MRI and pathological examinations. Subjective analysis of image quality of MRI sequences was 1 Department of Radiology, Muğla Sıtkı Koçman University Training and performed in cases with proven appendicitis. Research Hospital, Muğla, Turkey 2Department of Gynecology and Obstetrics, Muğla Sıtkı Koçman University Results: Seven (11.5%) of 61 MRI exams were consistent with acute Training and Research Hospital, Muğla, Turkey appendicitis and were proven on pathology. One patient who underwent appendectomy was found to have appendicitis which could not be identi- Abstract fied by MRI. The sensitivity and specificity of MRI were 87.5% and 100%, Objective: The aim of the study was to measure and compare apparent dif- respectively. Radiological and pathological agreement was found to be fusion coefficient (ADC) values of uterine cervix between cervical neoplasms excellent (Kappa:0.92). Non-appendiceal causes for the patient’s abdomi- and normal cervical tissues with 3-Tesla magnetic resonance imaging (MRI). nal pain were seen in 32 (52.4%) scans. In 13 cases (21.3%), appendix could not be visualized on MRI. Of these, none had a final diagnosis of Materials and Methods: From April 2017 to February 2018, eleven con- appendicitis. For the subjective analysis of image quality of each separately secutive female patients having Diffusion-weighted MRI (DWI) with a diagnosis viewed MRI sequence in detecting appendicitis, there was no statistical cervix neoplasia were included in this retrospective case-control study. The significant difference (p>0.05). control group consisted of age-matched patients with normal cervical smear and having pelvic DWI due to other pathologies expect cervical pathologies Conclusion: MRI shows a high diagnostic value in the assessment of and genital malignities. All examinations were performed by using a 3-T MR pregnant patients with suspected appendicitis and provides a variety of with 2 different b values (b=50, 800 s/mm2). A total of 22 patients (cervical diagnoses of acute abdominal pain. neoplasia group n=11 and control group n=11) ADC measurements were Keywords: Pregnancy, abdominal pain, appendicitis, MRI performed on the axial ADC map three-times by the same radiologist. Results: The mean age of total patients, neoplasia group, and the control group was 50.9 (between 33-58), 51 and 50.8, respectively. There O-11 was no statistically significant difference in mean age between the two groups (p>0.05). Neoplasms were 6 squamous cell carcinoma, 1 adeno- IS MRI BE PREFERRED IN PEDIATRIC carcinoma, 1 clear cell carcinoma, 1 carcinoma in situ, 2 LSIL. The means of cervix ADC values of age-match groups were 0.79±0.32 mm2/s and PRESEPTAL AND POSTSEPTAL 1.51±0.11 mm2/s, respectively. There were statistically significant differ- PERIORBITAL INFECTION ences between groups in term of cervical ADC values (p=0.00). DIFFERENTIAL DIAGNOSIS? Conclusion: In pelvic DWI lower ADC values of uterine cervix indicate FIGEN PALABIYIK1, NIGAR ERKOC1, ERCAN INCI1, neoplasm of the cervix. Further study with large patient population is NEVIN HATIPOGLU2 necessary to find out a cut-off value 1Department of Radiology, University of Health Sciences, Bakırköy Dr. Sadi Keywords: 3T, ADC, uterine cervix cancer, DWI Konuk Training and Research Hospital, İstanbul, Turkey 2Department of Pediatrics, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey O - 010 Objective: In children who referred to hospital with periorbital swelling to ABDOMINAL PAIN IN PREGNANCY: differentiate preseptal cellulitis and orbital infection requiring emergency diagnosis and treatment, clinically is difficult so radiologic imaging is used. In THE ROLE OF MAGNETIC children orbita CT with contrast is preferred because it does not require RESONANCE IMAGING IN THE anesthesia and is easy to use in emergency conditions. However orbital DIAGNOSIS OF ACUTE APPENDICITIS infections and intracranial complications are evaluated better with orbital MRI. We purposed to evaluate difference between radiological findings of EZGI GULER1, TIMUR KOSE2, MAHMUT KUSBECI1, orbita CT and MRI and the contributions of these findings to the treatment MUSTAFA HARMAN1, NEVRA ELMAS1 in pediatric patients who had periorbital infection diagnosis in hospital. S6 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Materials and Methods: We evaluated 106 patients who referred to O - 013 hospital with periorbital swelling. The study is included 28 patients of these who performed CT and MRI. The findings of orbital CT and MRI CAN WE PREDICT THE TIMING OF of the cases were evaluated according to the Chandler classification used HEPATOSPECIFIC CONTRAST AGENT for periorbital infections. APPEARANCE IN THE BILE DUCT Results: 13 (46.4%) of cases were male, 15 (53.6%) of cases were female and mean age was 8.43. While 22 (78.5%) of all cases was detected paranasal BEFORE MRI? sinusitis.There was no difference between two imagings in the diagnosis of ERDEM YILMAZ1, OSMAN KOSTEK2 preseptal cellulitis,in diagnosis of orbital cellulitis that MRI was found signifi- 1Department of Radiology, Trakya University School of Medicine, Edirne, cantly superior (p<0.05). No significant difference between two imagings in Turkey diagnosis subperiostal abscess but in evaluation of abscess size there was sig- 2Department of Medical Oncology, Trakya University School of Medicine, nificant difference and MRI evaluate subperiostal abscess size larger than CT. Edirne, Turkey Conclusion: CT is often used to distinguish between emergency presep- Abstract tal and postseptal periorbital infections in children. However orbita MRI is more effective modality in assessing orbital extension and subperiosteal Objective: Gd-EOB-DTPA is highly effective in diagnosis of bile duct abscess size. pathologies. However, in some patients, Gd-EOB-DTPA is seen in the bile ducts at 5 min, and in some patients it is not observed at 120 min. Keywords: MRI, differential diagnosis, pediatric, periorbital infection The purpose of this study is to predict the Gd-EOB-DTPA appearance time (Gd-AppTime) in bile ducts with ALBI, APRI, FIB4 scores and liver function (albumin, bilirubin) and transaminase levels before examination. O - 012 Materials and Methods: Thirty-five patients were screened. 2 patients ROLE OF MRCP IN EVALUATION were removed from the study because of hepaticojejenostomy. 33 patients were analysed for Gd-AppTime in intrahepatic bile ducts, com- OF PATIENTS WITH POST- mon hepatic duct, proximal and distal common bile duct, gallbladder and CHOLECYSTECTOMY SYNDROME duodenum. Possible correlation between ALBI, APRI, FIB4 scores, liver function (albumin, bilirubin), and transaminase levels were investigated DILAN ECE GEYLAN DURGUN, MURAT UCAR, NESRIN with Gd-AppTime. ERDOGAN, ALI CAN YALCIN, NIL TOKGOZ Results: Thirty-three patients (19K, 14E) were included in the study. The Department of Radiology, Gazi University School of Medicine, Ankara, Turkey mean age was 52±13 (min:20, max: 84). There was no significant correlation between age and Gd-AppTime (p>0.05). ALBI score correlated Abstract positively with Gd-AppTime in proximal common bile duct (r=0.373, p=0.03), but correlated negatively with albumin (r=-0.366, p=0.04). Objective: The recurrence or new development of upper abdominal On the other side, Gd-AppTime in distal common bile duct showed a symptoms and signs (right upper quadrant pain, indigestion, abnormal liver negative correlation only with the albumin (r=-0.394, p=0.02). There function tests, hyperbilirubinemia etc.) after cholecystectomy operation was a significant correlation between total examination time with ALBI is called as post-cholecystectomy syndrome (PCS). Its prevalence among (r=0.504, p=0.003) and albumin (r=-0.428, p=0.01). cholecystectomised patients is about %10-15. The aim of this study was to assess the role of magnetic resonance cholangiopancreatography (MRCP) Conclusion: Changes in liver function affect the Gd-AppTime and dura- in the evaluation of patients with PCS. tion of the examination. We believe that this relationship can be seen more strongly with larger population studies. Materials and Methods: A retrospective study over a period of 7 years (between January 2011 and January 2018) was performed with 379 Keywords: Hepatospecific contrast agents, MRI, imaging time patients who have cholecystectomy history and recurrent upper abdominal symptoms. Clinical data from hospital’s electronic medical record system and MRCP images of patients were retrieved and evaluated. The definitive diagnosis was confirmed by patient history, physical examination, O - 014 laboratory tests, US, MRCP and ERCP all together and it was compared to MRCP diagnosis in order to asses accuracy of MRCP alone in PCS. THE ACCURACY OF 3T MAGNETIC RESONANCE Results: The patients group consisted of 57 early PCS and 322 late PCS. Among the late PCS group the most common diagnosis was choledocolithia- CHOLANGIOPANCREATOGRAPHY IN sis (32%). Twelve patients were diagnosed with malignancy, 8 of them had SUSPECTED CHOLEDOCOLITHIASIS cholangiocellular carcinoma. Among the early PCS group the most common 1 1 diagnosis was postoperative collection (30%) followed by operation related IBRAHIM ONDER YENICERI , NESAT CULLU , biliary tree injury (24.5%). MRCP yielded an overall sensitivity of 98%, speci- BURAK OZSEKER2, EMINE NESE YENICERI3 ficity of 92%, accuracy of 94% for the diagnosis of causes of PCS. 1Department of Radiology, Muğla Sıtkı Koçman University School of Conclusion: MRCP is a noninvasive, useful and reliable method in the Medicine, Muğla, Turkey 2 diagnosis of causes of PCS and should be recommended for a better Department of Internal Diseases, Muğla Sıtkı Koçman University School management of these patients. of Medicine, Muğla, Turkey 3Department of Family Medicine, Muğla Sıtkı Koçman University School of Keywords: Cholecystectomy, choledocolithiasis, MRCP Medicine, Muğla, Turkey Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S7

Abstract Results: Criteria of tumor response to treatment assessed with respect to RECIST criteria. The mean diameter and volume of hemangiomas showed Objective: The purpose of this study was to investigate interobserver a significant decrease following treatment (p<0.05). Though comparison agreement during MRCP evaluation and the sensitivity and specificity of of pre- and post-interventional T1 and T2 signals were statistically signifi- MRCP obtained with 3T scanners in cases of suspected bile duct obstruc- cant ADC values were not. tion. Conclusion: In the treatment of hepatic giant cavernous hemangiomas, Materials and Methods: Totally 37 patients who had MRCP and ERCP the results of the MA procedure are confounding. The most appropri- were included. Choledochal pathology was divided into two groups ate sequence showing the ablation zone for diameter and volumetric regarding the presence of stones as “there is stone or not”. MRCP were measurements in MR scans is T2w FSE scans. ADC values do not pro- performed with 3 Tesla system using respiratory triggered HASTE tech- vide a clear benefit in the quantitative assessment of residual liver tis- nique in axial and coronal plane and with T2 SPACE sequence in coronal sue. Significant regression is observed in lesion dimensions according to plane. Sensitivity, specificity, negative predictive value (NPV), and positive RECIST criteria. predictive value (PPV) were calculated separately for each observer. Cohen kappa analysis was performed for the correlation between the Keywords: Cavernous hemangioma, microwave ablation, MR, liver observers. The average of both observers was calculated for comparison with other studies. Results: The mean age of the 37 patients who constituted the study O - 016 population was 63.51 (14-91). The mean time between MRCP and ECRP was 5.46 days (1-15 days). Median choledoc diamater was 5 mm (3-8 DIAGNOSTIC PERFORMANCE mm) in 7 normal subjects and 11.65 mm (6-23 mm) in 30 choledocolitha- OF MR IMAGING FINDINGS sis. Agreement between the observers was analysed and Cohen’s kappa AND DIFFUSION WEIGHTED value was evaluated as 0.84. For two observers, sensitivity of MRCP was 93% where as specificity was 75% for the first observer and 62% for the MRI IN THE DIFFERENTIATION second. OF ENDOMETRIOMAS FROM Conclusion: In this study we found a high level of interobserver agree- HEMORRHAGIC OVARIAN CYSTS ment in evaluating MRCP. MRCP has a high sensitivity in detecting choledocolithiasis in 3T scanners. AYTUL HANDE YARDIMCI, ORHAN KAYA, CEYDA TURAN BEKTAS, BURAK KOCAK, MEHMET SEMIH CAKIR, Keywords: 3T MRI, choledocolithiasis, MRCP, ERCP MELIS BAYKARA ULUSAN, OZGUR KILICKESMEZ İstanbul Training and Research Hospital, İstanbul, Turkey

O - 015 Abstract EVALUATION OF MICROWAVE Objective: To evaluate magnetic resonance imaging (MRI) feature of endometriomas and to determine sensitivity and specificity of the ABLATION TREATMENT EFFICIENCY Diffusion Weighted MRI in helping to distinguish endometriomas from OF LIVER GIANT CAVERNOUS other hemorrhagic adnexal cystic lesions. HEMANGIOMAS WITH MRI Materials and Methods: Seventy-one patients who underwent surgery MEHMET SEMIH CAKIR, MELIS BAYKARA ULUSAN, for histopathologically confirmed endometrioma and twenty-five patients ILHAN NAHIT MUTLU, CEYDA TURAN BEKTAS, with hemorrhagic cyst were included in the this study. The following MRI AYTUL HANDE YARDIMCI, OZGUR KILICKESMEZ findings were reviewed in 96 patients (87 lesions in 71 patients with endometrioma and 25 lesions in 25 patients with hemorrhagic cyst): lesion İstanbul Training and Research Hospital, İstanbul, Turkey size, morphological appearance, T2-weighted (T2W) signal intensity, T1-weighted (T1W) signal intensity, DWI signals with apparent diffusion Abstract coefficient (ADC) calculated for b=600 s/mm, b=800 s/mm (2), T2 dark Objective: Microwave ablation (MA) is a newly developed interventional spot and T2 shading sign in cystic lesions. Sensitivity, specificity, and positive method as an alternative to endovascular embolization used as a classical and negative predictive values of the T2 dark spot and T1 hyperintencity method in the treatment of hepatic cavernous hemangiomas. The pur- and T2 shading sign in distinguishing endometriomas from hemorrhagic pose of this study was to evaluate the role of MR imaging in the assess- lesions were calculated. ADC values were measured 50-100 mm2 ROI ment of treatment response of liver hemangiomas after MA therapy. in the ADC map. Materials and Methods: All patients who underwent MA therapy for Results: In the endometrioma group, T2A shading and T2 dark spot find- cavernous hemangioma who had pre- and post-interventional MR exami- ings were significantly higher; T1A hypointensity was significantly higher in nations at our hospital between 10/2016 and 04/2017 were included. A the hemorrhagic cyst group. We observed significantly lower ADC values retrospective analysis of the institutional imaging database identified 10 in endometriomas compared with hemorrhagic ovarian cysts in all b val- patients (5 men, 5 women, mean age: 47.9 years). ues. Sensitivity, specificity, positive predictive value, and negative predictive value of ADC values of 2 x10-3 mm2 /sn for differentiating endometrio- Measurements of diameter and volume of lesions were performed on mas from other hemorrhagic cystic ovarian masses were 88.9%, 96.5%, axial T2w FSE images with fat saturation. ADC values of normal liver 96% and 98.88% respectively. parenchyma and of the hepatic hemangiomas were calculated using diffusion weighted images. Results were calculated and compared using paired Conclusion: We suggest that DWI should be included in the routine MRI pro- t-test with a significance level of 0.05. tocol for the evaluation of endometriomas from hemorrhagic ovarian cysts. It S8 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 may help in the better disease evaluation in substantiation with clues from the unnecessary operations, screening should be done optimally. The purpose symptomatology as well as signal intensity on the conventional MRI. of this study was to investigate the superiority of Diffuse weighted imaging (DWI) sequences and computed tomography (CT) findigns in detecting Keywords: DWI and ADC, endometrioma, hemorrhagic ovarian cyst, MRI small liver metastases, in addition to determine early diagnosis and oper- ability criteria in pancreatic cancer. O - 017 Materials and Methods: 79 pancreatic masses with adenocarcinoma and pancreatic neuroendocrine tumor (panNET) according to pathol- MRI FINDINGS OF PREGNANT PATIENTS ogy results were evaluated retrospectively between 2009-2017 years. Laparoscopy, operation, biopsy and follow-up correlations were investi- WITH ACUTE ABDOMINAL PAIN gated with CT and DWI MRI findings. ATAKAN ARSLAN, CANAN TUNCER ALTAY, ISIL BASARA Results: The distribution of ADC values did not show a statistically sig- AKIN, MUSTAFA SECIL nificant difference (p=0.976) in measurements between primer Adeno Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey ca and PanNET. Similarly, there was no statistically significant difference in ADC measurements from the metastases of both groups (p=0.140). Abstract In a total of 8 patients more number of metastases were detected in DWI than in CT (38.10%). In 3 patients with no metastases detected Objective: Ultrasonography (US) is the basic imaging method in preg- on CT, 1 metastasis was detected on DWI MRI. In 3 patients DWI MRI nancy. US may not be thoroughly evaluated pelvic region in the advanced showed single metastasis but they were not observed in CT. stage of pregnancy. Magnetic resonance imaging(MRI) is the main diagnostic tool for the evaluation of the pregnant women with acute abdominal Conclusion: One of the functional imaging modalities, DWI generally pain. The purpose of this study to evaluate MRI findings of pregnant improves staging in terms of diagnosis of pancreatic adenocarcinoma and patients with acute abdominal pain. PanNET lesions and determination of liver metastases. Functional radiologic imaging should therefore be used as a part of MR imaging modalities, Materials and Methods: The study group comprised 24 patients (mean age, and liver metastases in pancreas CA. Thus, liver metastases not detected 30.7±6.1) in whom abdominal MRI was performed for acute abdominal pain. in CT can be detected with DWI MRI, preventing unnecessary operations These patients were consecutively referred to our department for abdominal and thus increase in morbidity and mortality. MR imaging and evaluated between January 2010 and January 2018, retrospectively. Abdominal MRI examinations were obtained with fast T2-weighted Keywords: MRI, DWI, pancreatic cancer, liver metastases, CT images (WIs), and T1-Wis. No contrast material was administered. Chi-square test was performed using SPSS V.24 for statistical analysis. Results: MRI has revealed normal findings in 9 patients, renal mass in 1 O - 019 patient, isolated pelvic fluid in 1 patient, acute appendicitis in 4 patients, ovarian torsion in 1 patient, benign ovarian or uterine mass in 3 patients, compli- COMPLIANCE WITH THE TECHNICAL cated over cyst in 2 patients, endometrioma in 1 patient and acute hepatitis STANDARDS PROPOSED BY PI-RADS in 1 patient. There were no statistically significant differences between acute V2 GUIDELINE IN PERFORMING abdomen etiologies in terms of patient age and gestational age (p>0.05). MULTIPARAMETRIC PROSTATE Conclusion: Acute abdominal pain during pregnancy requires rapid and effective diagnosis because of the necessity of urgent surgical intervention MAGNETIC RESONANCE IMAGING and it can cause high mortality and morbidity in case of delayed diagnosis. IN UNIVERSITY AND TRAINING MRI is main diagnostic method used in the evaluation of acute abdominal HOSPITALS IN TURKEY: PRELIMINARY pain in pregnant patients. RESULTS Keywords: Pregnancy, MRI, acute abdominal pain MEHMET COSKUN1, ALI FIRAT SARP2, SEBNEM KARASU1, MUSTAFA FAZIL GELAL1, ISMAIL BARIS TURKBEY3 O - 018 1Department of Radiology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey DIFFUSION WEIGHTED MAGNETIC 2Department Of Radiology, Osmangazi University School of Medicine, Eskisehir, Turkey RESONANCE IMAGING FINDINGS IN 3Molecular Imaging Program, National Cancer Institute, National Institutes DETERMINING OF LIVER METASTASES of Health, Bethesda, MD, USA IN PANCREAS CANCER Abstract MELIKE RUSEN METIN1, SINEM SIGIT IKIZ2 Objective: Prostate imaging reporting and data system version 2 1Ankara Atatürk Training and Research Hospital, Ankara, Turkey (PIRADSv2) aims global standardization for acquisition and interpretation 2Nicosia Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Cyprus of multiparametric magnetic resonance imaging (mpMRI). The purpose of this study was to determine adherence to PIRADSv2 parameters in Abstract academic centers in Turkey. Objective: Pancreatic cancer (ca) is one of the most common, curable, Materials and Methods: Eighty four tertiary referral academic hos- and poorly prognostic tumors of the present day. A screening test that pitals in Turkey were asked to report their technical parameters of provides early diagnosis has not been established yet. In order to prevent their prostate mpMRI protocols. A total of 6, 9, 8 and 9 acquisition Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S9 parameters for axial T2W, diffusion weighed imaging (DWI), dynamic Keywords: Abdominal imaging, CT, MR, pancreatitis, revised Atlanta clas- contrast enhancement (DCE) and other technical standards were sification queried, respectively. Results: Forty two of 84 centers reported to perform prostate mpMRI (n=26 located in one of the biggest 3 cities [İstanbul, Ankara, O - 021 İzmir]) either at 1.5 (n=28) or 3 (n=14) Tesla. Two (4.8%) centers reported use of endorectal coil. There was only one center (2.4%) ASSESSMENT OF THE HEPATIC that had complete adherence to all parameters of PIRADSv2. For VASCULAR STRUCTURES: DYNAMIC axial T2, adherence to voxel dimension on frequency, phase encod- ing steps, maximum 3mm slice thickness (ST) were 7.1% (3), 40.5% ENHANCED MRI VERSUS DYNAMIC (17), 73.8 (31), respectively. For DWI, adherence to minimal b value ENHANCED CT IN HEALTHY LIVER (b≥1400), maximal 4mm ST were 61.9% (26), 83.3%(35), respec- AND DISEASED LIVER tively. Among 40 centers performing DCE, 24 centers use temporal resolution<10sec, whereas 8 centers use temporal resolution<7 AYSEGUL SAGIR KAHRAMAN1, BAYRAM KAHRAMAN2, sec. Repetition time was the most commonly compliant parameter LEYLA KARACA1, ZEYNEP MARAS OZDEMIR1 (38/40) for DCE. The mean image acquisition time for axial T2, DWI 1Department of Radiology, İnönü University School of Medicine, Malatya, Turkey and DCE were 234, 301 and 233sec respectively. 2Department of Radiology, Malatya Park Hospital, Malatya, Turkey Conclusion: The adherence to technical parameters of PIRADSv2 was Abstract lower than expected in academic centers in Turkey. Objective: We aimed to examine the relative usefulness and accuracy of Keywords: PIRADSV2, Multiparametric, Prostate, MRI, Parameter MRI in assessing hepatic vascular structures as compared to CT in healthy liver and diseased liver. O - 020 Materials and Methods: We prospectively assessed 48 donor candidates and 60 adult patients with liver disease who underwent dynamic enhanced IMAGING OF ACUTE PANCREATITIS: MRI and dynamic enhanced CT concurrently. The results of CT were compared against MRI firstly for all subjects totally and than for donors UPDATE OF THE REVISED ATLANTA and patients separately. Additionally results of qualitative and quantitative CLASSIFICATON MRI findings were also compared between donors and patients. FULDEM MUTLU1, AYDIN SEREF KOKSAL2, BILAL TOKA2 Results: For all subjects included in this study, demonstration of each vascular structure was significantly better at CT, except for right portal 1İstanbul Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey vein (RPV) and right inferior hepatic vein (RIHV) that were demonstrated 2Sakarya University Training and Research Hospital, Sakarya, Turkey equally at CT and MRI. The furthest inferior performances of MRI were in visualizing segment IV artery and RIHV. For both CT and MRI, the demon- Abstract stration of venous structures was significantly better in donors, except for left hepatic artery that was demonstrated better in patients. The qualita- Objective: To familarise the radiologist with the Revised Atlanta classifi- tive and quantitative MRI findings were not significantly different between cation system of acute pancreatitis with the help of pictorial review and healthy subjects and patients with liver disease. encourage them to use it in their everyday practice. Conclusion: A detailed study of hepatic vascular structures is crucially signifi- Materials and Methods: 213 patients who got the diagnosis of acute cant in many clinical conditions in particular, in partial liver resection, cadaveric pancreatitis between 2015 to 2017 years in Sakarya University Hospital liver transplantation, living-donor liver transplantation, and in interventional were taken to our study. We evaluated the morphology of the pancreas, treatment of hepatic primary or secondary tumours. Although CT remains interstitial oedematous and necrotisan,severity of the pancreas and local the initial modality of choice in evaluating hepatic vascular anatomy, MRI complications. We also evaluated laboratory tests, APACHE, Ranson, appears diagnostically equivalent and/or close and should be considered pri- BISAP, SIRS, PANCODE and CTSI scores. mary single imaging modality particularly if there is any contraindication to ct. Results: We evaluated 213 acute pancreatic patients. %86.7were inter- Keywords: Chronic liver disease, magnetic resonance imaging, computed stitial oedematous pancreatitis, %13.1 were necrotisan pancreatitis. tomography According to Revised Atlanta criterisation; %69.1 minimal severe, % 29.2 medium severe and %9.7 was highly severe pancreatitis. We also evaluate Ranson, BISAP, SIRS and APACHE scores. O - 022 Conclusion: The Revised Atlanta classification helps in standardizing the terminologies used in acute pancreatitis across a wide range of speciali- DIAGNOSTIC VALUE OF ties. It helps in precise documentation and reporting of the cases of acute CONVENTIONAL ENTEROCLYSIS AND pancreatitis and makes the role of the radiologist in dispensable. It also helps in stratifying the patients based on severity leading to effective man- FOLLOW-UP MR ENTEROGRAPHY agement and treatment planning. Imaging findings along with the duration IN ADVANCED STAGE AND of onset of symptoms help in clearly identfying the different type of col- COMPLICATED CROHN DISEASE lections. This further enhances the importance of the radiologist in the multi-disciplinary management of acute pancreatitis. DENIZ ESIN TEKCAN SANLI1, EMEL ESMERER2, UGUR KORMAN3 S10 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

1Department of Radiology, Kahramanmaraş Necip Fazıl State Hospital, respectively). There was no significant difference between the two groups Kahramanmaraş, Turkey in CA-125 values and hyperintense nodule presence (p>0.05). 2Department of Radiology, Hakkari State Hospital, Hakkari, Turkey 3Department of Radiology, İstanbul University Cerrahpaşa School of Conclusion: In this study; JZ thickness was found to be thicker in the Medicine, İstanbul, Turkey endometriosis patients than in the control group. The difference between JZ max-min greater than 4 mm was observed in endometriosis patients. Abstract Keywords: Junctional zone, endometriosis, MRI Objective: To determinene the type, stage, complication and activation signs of Crohns disease with both Enteroclysis (ECL) and Magnetic Resonance Enterography (MRE), and to assess the complementary role for the clinician to identify the treatment modalities. O - 024 Materials and Methods: In this study, we performed primary radiologic THE EFFECT OF AGING ON ADC diagnostic imaging with conventional enteroclysis in 110 patients with VALUES OF UTERINE CERVIX pre-diagnosis of Crohns disease and 107 cases with clinical findings of reactivation and/or complications with follow-up and treatment with FUNDA DINC ELIBOL, SEZEN BOZKURT KOSEOGLU Crohns disease. Follow-up MR review was performed for complicated or Department of Radiology, Muğla Sıtkı Koçman University Training and advanced stage CH according to conventional ECL findings. Research Hospital, Muğla, Turkey Results: ECL was superior in determining the type and stage of the Abstract disease while MRE was more indicative of the activation findings and complications of the disease. Objective: The aim of the study was to evaluate whether a change of apparent diffusion coefficient (ADC) values with aging in the uterine cer- Conclusion: ECL and MRE combination is the optimal imaging method vix with 3-Tesla magnetic resonance imaging (MRI) or not. that guides the clinician in selecting the medical/surgical treatment to be applied to the patient, complementing each other in determining activa- Materials and Methods: We searched female patients age between 18 tion findings, the type-stage and complications of the disease by revealing to 70 having lower abdominal diffusion-weighed MRI (DWI) in radiology the mural-extramural and intraabdominal involvement. database from December 2017 to February 2018. Patients having gynecologic malignancies were not included the study. All DWI examinations Keywords: Crohn disease, enteroclysis, magnetic resonance enterography were performed by using a 3-T MR with 2 different b values (b=50, 800 s/mm2). The ADC values of the cervix were measured on the axial ADC map three-times by the same radiologist who didnt know the age of the O - 023 patients. All patients divided into three groups according to their ages: group 1 age between 18-39, group 2 age between 40-49 and group 3 ENDOMETRIUM-MYOMETRIUM age between 50-70. The mean of measured ADC values and standard JUNCTIONAL ZONE THICKNESS IN deviations were calculated for each patient. To evaluate the correlation ENDOMETRIOMA PATIENTS between the age of the patient and ADC value Pearson-correlation analysis was performed. AGAH BARAN1, ANIL INCEDERE2, OMER ERBIL DOGAN2, Results: A total of 96 women age between 18-70 (mean 41,31) were 1 MUSTAFA SECIL included the study. In age over 49 the mean of ADC value was 0.95±0.17 1Department of Radiology, Dokuz Eylül University Hospital, İzmir, Turkey mm2/s and in age, under 50 years the mean of ADC values was over 2Department of Gynecology and Obstetrics, Dokuz Eylül University Hospital, 1.26±0.19 mm2/s. There were statistically significant differences between İzmir, Turkey groups in term of cervical ADC values (p=0.00). There was a negative correlation between age and ADC values. Abstract Conclusion: In previous studies, ADC values have been shown to be Objective: Junctional zone (JZ) is known as a transition zone between the decreased due to hypercellularity. In this study, we found a negative cor- endometrium and the external myometrium. In this study, we aimed to inves- relation between aging and ADC values. This may indicate that hypercellu- tigate JZ thickness in endometriosis patients comparing with the control group. larity may occur with aging. When we are evaluating the ADC values of Materials and Methods: MR images of 53 premenopausal patients operated cervix we must take into account of patients age. between May 2012 and October 2017 due to endometrioma/endometrio- Keywords: DWI, ADC, aging, uterine cervix sis (Group 1, n=22) or other benign ovarian causes (Group 2, n=31) were retrospectively evaluated. On sagittal T2W images, two measurements were performed at the thickest (maximum) and the thinnest (minimum) levels of JZ. The difference between the two was calculated (‘JZdif’). Groups were O - 025 composed according to the presence of the hyperintense nodule, JZ greater than 8 mm and ‘JZdif’ greater than 4 mm. The two groups were evaluated EVALUATION OF MRI FINDINGS IN statistically by Chi-square and Mann-Whitney U Tests. LIRADS-TIV LESIONS ACCORDING TO Results: The mean JZ min thickness was 4.77 mm in Group 1 and 4.52 MORPHOLOGIC CHARACTERISTICS mm in Group 2; the mean max thickness was 8.00 mm and 5.52, respec- ISIL BASARA AKIN, HAKAN ABDULLAH OZGUL, tively. The ‘JZdif’ value was 3.22 mm in Group 1 and 1.00 mm in Group 2). Statistically significant difference was found in the thickness of JZ CANAN ALTAY, FUNDA BARLIK OBUZ (>8mm) and JZ difference (>4mm) groups (p values 0.012 and 0.017, Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S11

Abstract muscle were compared with SI values of ASII in out of phase images using Pearson correlation and T-test. Objective: Hepatocellular carcinoma (HCC) is the most common epithelial primer malignant tumor of liver. In the world it is the most Results: Adenomas SI values of FIESTA sequence were showed poor common fifth tumor and third death cause. Incidence is high in Asia and negative correlation (-0.036) with ASII values of out of phase images, Africa where HBV and HCV prevalence is prominent. In Turkey the eti- whereas correlations of adenoma/spleen SI with ASII were strongest ologies are HBV, HCV and alcoholic liver disease respectively. Magnetic negative (-0.264), adenoma/psoas SI with ASII were poorest negative resonance imaging (MRI) is an effective diagnostic method. American (-0.011). All SI measurements of FIESTA sequence were well corraleted College of Radiology reported LIRADS in 2011 and revised in 2017 in with each other. We also detected poor positive correlation (+0.102) order to be able to produce a common report language for cirrhotic between SI of adrenal adenomas using FIESTA and SI obtained in out patients detection. In recent classification, HCC lesions with thrombus of phase images. at least in one vein are classified as LIRADS-TIV lesions. Herein we Conclusion: Although FIESTA sequence showed poor correlation with aimed to evaluate MRI findings in LIRADS-TIV lesions according to out of phase MRI in detection of typical adrenal adenomas containing morphologic features. intracellular lipid, the best correlation was observed in using spleen SI/ Materials and Methods: MRI images of 20 patients with HCC between adenoma SI ratio and adenomas were apperaed as hypointense in FIESTA March 2017–March 2018 were evaluated. Venous invasions were classi- sequnece. However larger comperative studies including cases with lipid fied in 4 level (Level 1- one vein near to lesion, Level 2- right-left portal poor adenomas and non adenomas are required to evaluate diagnostic veins, Level 3- main portal vein, Level 4- Confluence-extrahepatic value of the results. veins). Level 1-2 was Group 1, Level 3-4 was Group 2. Lesions were Keywords: Adrenal adenoma, FIESTA sequence, magnetic resonance evaluated according to distribution (focal-infiltrative), microscopic imaging fat-necrosis and washout. Qui-Square Test was applied, p<0.05 was statistical significant. Results: Mean diameter was 10.75±64.73mm. Most common ethol- O - 027 ogy was HBV. There was no statistical significance between two groups according to distribution, necrosis-washout. However microscopic fat CORRELATION OF HEPATIC ARTERIAL content was statistically significant between groups (p<0.05). AND PORTAL VENOUS ANATOMY Conclusion: Metastatic features are manifest in LIRADS-TIV lesions and WITH BILE DUCT VARIATIONS LIRADS-TIV forms contraindication in terms of transplantation. Venous thrombus is low in lesions with microscopic fat content, which is a well MELAHAT KUL, DIGDEM KURU OZ, AYSE ERDEN differentiation criterion. MRI is effective method in detection. Studies of Department of Radiology, Ankara University School of Medicine, Ibni Sina LIRADS-TIV tumors will be able to clarify the characteristics of larger Hospital, Ankara, Turkey series of patients. Abstract Keywords: Hepatocelular carcinoma, LIRAD-TIV, magneticresonance imaging Objective: To correlate hepatic arterial (HA) and portal venous (PV) anatomy with variations of bile duct (BD) confluence. Materials and Methods: A total of 225 liver donors, who underwent O - 026 dynamic-enhanced CT at our institution from July 2011-March 2017, were retrospectively reviewed. Hepatic artery and PV anatomy were IMAGING OF ADRENAL ADENOMAS categorized according to classifications of Michel and Cheng et al., respec- USING FIESTA BALANCED STEADY tively. Bile duct variations were evaluated on MRCP images according to Mc Sweeney classification. Hepatic vascular anatomy was correlated with STATE FREE PRECESSION PULS BD variations using chi- square test. SEQUENCE Results: The study population consisted of 159 patients. The most GOKHAN PEKINDIL, FATMA CAN observed HA variations were type 3 in 16 and type 2 in 10 patients. Type 1 PV was detected in 132, type 2 PV in 4 and type 3 PV in 23 patients. A Department of Radiology, Celal Bayar University School of Medicine, Manisa, Turkey normal BD anatomy and variations were observed in 79 and 80 patients, Abstract respectively. Bile duct anatomy showed no significant correlation between both HA and PV anatomy (p>0.05). A positive correlation was found Objective: Although FIESTA sequence is routinely used in anatomic evalu- between segment 4 artery arising from right HA and presence of diverse ation of upper abdominal imaging, we recently showed in a previous study BD variations. Segment 4 artery originating from left HA was significantly that it could be revealed intracellular lipid content in cases such as liver associated with normal BD anatomy (p=0.046). hepatosteatosis. In this study, imaging findings of adrenal adenomas which have intracellular lipid content will be presented using FIESTA sequence Conclusion: Preoperative assessment of hepatic vascular and BD anato- first time in the literature. my in liver donors is essential for safe liver transplantation. However, due to their thin caliber in MRCP, detection of BD variations can be challeng- Materials and Methods: Fifty cases with adrenal adenoma which had ing. In such cases, the presence of segment 4 artery originating from right adrenal signal intensity index (ASII) over 20% in out of phase MR imaging HA might be indicative of BD variation and should lead to more cautious using 1.5 T machine were retrospectively measured SI mean values using biliary assessment. appopriate 3 ROIs in adrenal adenoma, liver, spleen and psoas muscle in coronal FIESTA slices. SI values of Adrenal adenom, liver, spleen and psoas Keywords: Liver donor, hepatic artery, portal vein, bile duct variations S12 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

O - 028 Abstract THE VALUE OF IMAGING FINDINGS Objective: Intravoxel incoherent motion is a diffusion weighted imaging method which can characterize the relation between signal intensity and FOR PREDICTING HEPATOCELLULAR b value. Regarding to this bieksponential model, IVIM would seperate the CARCINOMA (HCC) RECURRENCE diffusion of water molecules from microcapillary perfusion of tissues. AFTER LIVING DONOR LIVER This technique may estimate the perfusion of tissues without intravenous contrast application. To investigate the value of an intravoxel incoherent TRANSPLANTATION (LDLT) motion (IVIM) diffusion perfusion model for differentiation between SADIK SERVER1, KROUROSH YAGHOUTI1, adrenal adenomas and adrenal metastasis. EMEL KAYA AUMANN1, TOLGA SAHIN2, NAGIHAN INAN1, Materials and Methods: We retrospectively evaluated thirty five adrenal UNAL AYDIN3, N. CEM BALCI1, YAMAN TOKAT3 lesions. Twenty five lesions were incidentally detected adenomas. Ten 1Department of Radiology, İstanbul Bilim University Sisli Florence Nightingale lesions were adrenal metastasis from primary oncologic malignancies. Hospital, İstanbul, Turkey Fourteen lesions were bilateral. Mean age of all subjects was 61 years 2Department of Gastroenterelogy, İstanbul Bilim University Sisli Florence (range 43-81). All patients were examined by 1.5T MRI (Siemens, Nightingale Hospital, İstanbul, Turkey Magnetom Symphony, Erlangen, Germany) with the use of four-channel 3Department of Liver Transplantation, İstanbul Bilim University Sisli Florence phased array body coil. In addition to routine pre- and postcontrast Nightingale Hospital, İstanbul, Turkey sequences, IVIM (16 dif ferent b factors of 0, 50, 100, 150, 200, 300, 400, 2 Abstract 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300 s/mm ) and conventional DWI (3 different b factors of 50, 400, 800 s/mm2) were obtained using a Objective: HCC recurrence rate after LDLT remains a significant prob- free breath single-shot echo planar spin echo (EPI) sequence. The ADC lem in clinical practise. Although many potential risk factors have been maps reconstructed from conventional DWI (ADCcon). The mean D described, a reliable preoperative method to estimate this risk has not (true diffusion coefficent), D* (pseudo-diffusion coefficient associated been established. The purpose of this study was to determine the utility with blood flow) and f (perfusion fraction) values also calculated from of imaging findings in predicting HCC recurrence after LDLT. IVIM. Quantitatively, both ADCcon, D, D* and f values were compared Materials and Methods: Eighty patients with 135 HCCs who were underwent between adenoma and metastase groups by Mann-Whitney U test. CT and/or MRI included in this study. Twelve patients with 37 HCCs (group Results: The f and D values were statistically higher in metastasis group 1) had recurrence, while 68 patients with 98 HCCs (group II) had remained (p<0.05). ADC and D* values of metastatic lesions were significantly disease free. Following radiologic findings were evaluated by two radiologists: lower than those of adenomas (p<0.05). number of HCCs, largest tumor diameter, tumor margins, tumor internal homogeneity, arterial enhancement pattern, the presence or absence of Conclusion: IVIM parameters such as f, ADC and D* values can provide tumor capsule, periportal LAP, bulging (tumor causing liver capsul expansion), significant diagnostic information about differentiation of adrenal adeno- and beak sign (the acute angle between the tumor and liver parenchyma). mas and adrenal metastasis, based on different perfusion characteristics. Results: Number of HCCs were significantly higher and the distance from Keywords: Adrenal, metastasis, adenoma, intravoxel incoherent motion tumor to portal vein were significantly shorter in group 1 than those of group II. A tumor capsule was seen in 56,8% in group 1, and 78,6% in group II; LAP was seen in 56,8% in group 1, and 7,1% in group II, beak sign O - 030 was seen in 29,7% in group 1, and 2.2% in group II. The bulging sign was more frequently seen in group 1. EFFECTIVENESS OF CT AND MRI Conclusion: Patient with beak sign in their pretransplant imaging exami- METHODS IN EVALUATING LIVER nations might benefit from histologic confirmation of the tumor through STEATOSIS OF LIVING LIVER biopsy and subsequent bridge treatment such as TARE or TACE prior to liver transplantation. DONORS Keywords: Liver transplantation, beak sign, HCC DIGDEM KURU OZ, AYSEGUL GURSOY CORUH, ILHAN ERDEN, AYSE ERDEN Department of Radiology, Ankara University School of Medicine, Ankara, O - 029 Turkey DIFFERENTIATION OF ADRENAL Abstract ADENOMAS FROM ADRENAL Objective: To investigate the efficacy of CT and MRI methods in quantify- METASTASIS WITH INTRAVOXEL ing liver fat. INCOHERENT MOTION MODEL Materials and Methods: Sixty-five patients who underwent CT and MR examinations as living donor candidates for liver transplantation from 1 1 BEDRIYE KOYUNCU SOKMEN , AYSEGUL OZ , January 2017 to March 2018 were studied. Patients without histopathol- 1 1 1 SOHEIL SABET , SADIK SERVER , SEZGI BURCIN BARLAS , ogy were excluded. Patients body mass index (BMI) was noted. The liver 2 1 DOGUKAN SOKMEN , NAGIHAN INAN attenuation index (LAI) obtained by ROI analysis from the liver and spleen 1Department of Radiology, İstanbul Bilim University Sisli Florence Nightingale parenchyma on non-contrast CT examination were calculated. In MR, Hospital, İstanbul, Turkey the parenchyma fat signal fraction was obtained by ROI analysis from the 2Department of Urology, Memorial Bahçelievler Hospital, İstanbul, Turkey in-out phase images and the proton density fat fraction (PDFF) map. MRI Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S13 and CT results were compared with pre- and / or intraoperative biopsy of inter-observer harmony, there was a perfect compliance between the results. Spearman correlation coefficient and ROC (receiver operating two observers (κ=0.901). characteristic) analysis were used for statistical analysis. Sensitivity, specific- Conclusion: Abdomen MRI obtained without using contrast agent ity, positive predictive value, negative predictive value and 95% confidence Computed Tomography and ultrasonography shows high diagnostic suc- interval were calculated. cess in acute abdomen cases and high compliance between observers. Results: A total of 30 patients (19 males, 11 females, mean age 34.7 Although the cost is high, there are advantages that can be evaluated years (range 19-55 years) were included in the study. The mean BMI of without using contrast agent, not containing ionizing radiation and not the patients was 26.9 (range 20-38). There was a significant correlation requiring Radiology Specialist. between, CT LAI, the parenchyma fat signal fraction and histopathologic results (r=-0.712, 0.508, 0.649, respectively). According to the presence Keywords: MRI, abdomen, emergency or absence of steatosis, patients were divided into two groups. Cut-off values for CT, dual-echo technique and PDFF were determined as 6.25, 3.2, and 2.95, respectively. The area under curve was measured as 0.847, 0.831, 0.855, respectively. Sensitivity, specificity, positive predictive value O - 032 (95% confidence interval), negative predictive value and accuracy were CORRELATION OF GD-EOB- 0.833, 0.722, 0.667 (0.471-0.821), 0.867 and 0.77, respectively, for CT and 0.833, 0.778, 0.714 (0.519-0.856), 0.875 and 0.80 respectively, for, DTPA ENHANCED DYNAMIC MRI dual-echo technique and 0.909, 0.688, 0.667 (0.460-0.828), 0. 917 and WITH HISTOPATHOLOGICAL 0.78 respectively, for PDFF. DIFFERENTIATION IN Conclusion: Significant correlation of dual-echo technique, PDFF and CT HEPATOCELLULAR CARCINOMA outcomes with histopathology suggests that these noninvasive effective methods can be used as biopsy alternatives when living donor liver fat is HUSEYIN TUGSAN BALLI1, FERHAT CAN PISKIN1, KIVILCIM graded. ERDOGAN2, YUSUF CAN1, KAIRGELDY AIKIMBAEV1 Keywords: Liver donors, fat quantification, CT, MR 1Department of Radiology, Cukurova University School of Medicine, Adana, Turkey 2Department of Pathology, Cukurova University School of Medicine, Adana, O - 031 Turkey EVALUATION OF ACUTE ABDOMEN Abstract WITH RAPID SEQUENCE MR Objective: To evaluate the relationship between histological differentiation of the tumor and enhancement pattern in dynamic MRI (DMRI) with ALI HAYDAR BAYKAN, SUKRU SAHIN, IBRAHIM INAN, gadoxetine acid disodium (Gd-EOB-DTPA) in patients with hepatocellular SAFIYE KAFADAR, SUKRU MEHMET ERTURK carcinoma (HCC). Department of Radiology, Adıyaman Universty School of Medicine, Materials and Methods: Between April 2015 and February 2018 Adıyaman, Turkey Gd-EOB-DTPA DMRI of 32 patients with histopathologically proved HCC were evaluated retrospectively. Tumors’ morphological features, Abstract distribution, AFP values and enhancement pattern were qualitatively Objective: Acute abdominal pain is a clinical chart for which patients apply analyzed. The relative signal intensity ratio (RIR) and enhancement to emergency services and which often results in the need for surgical ratio (ER) were examined quantitatively by measuring signal intensi- treatment. ties of hepatic parenchyma and tumor in post-contrast hepatobiliary phase in DMRI. Contrast-enhanced abdominal computed tomography (CT) and ultrasonography are frequently used as first-step imaging methods in these cases. Results: Thirty-two patients (median age 64.5) were evaluated. HCCs were diagnosed as well (n=14), moderately (n=9) and poorly differ- In this study, it was aimed to compare the diagnostic performance of entiated (n=9) according to histopathological evaluation. AFP values nonenhanced abdominal MR imaging in cases with acute abdomen pain, were significantly higher in poorly differentiated tumors (p=0.030). evaluation of compliance between observers and comparison with ultra- There was no correlation between the enhancement pattern of the sonography and computed tomography. tumor, morphological features and tumor distribution with the his- Materials and Methods: Patients admitted to our emergency department tological differentiation (p=0.319, p=0.565, p=0.293, respectively). with acute abdomen pain between January 2016-February 2018 were There was statistically significant relationship between signal intensity included in the study. Data obtained from computed tomography and/or of the tumor and histopathological differentiation in hepatobiliary ultrasonography examinations were recorded retrospectively. phase (p=0.027). However, there was no significant correlation between post-contrast RIR and ER with tumor histological differen- MRI images were independently evaluated by two Radiology specialists tiation (p=0.065, p=0.160, respectively). and the results were recorded. Conclusion: In Gd-EOB-DTPA-enhanced dynamic MRI, the contrast Results: 12 of the 25 cases included in the study were male (48%) and 13 enhancement in the hepatobiliary phase is an effective parameter for pre- were female (52%). The average age was 44.32±21.87. In 13 cases (52%) dicting histologic differentiation in patients with hepatocellular carcinoma. the treatment was surgical and 12 (48%) cases were conservative. MR sensitivity was 100% for the first observer, 92% for the second observer, Keywords: Hepatocellular carcinoma, histopathologic differentiation, BT sensitivity was 90%, ultrasound sensitivity was 61.5%. In the evaluation Gd-EOB-DTPA S14 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

O - 033 Abstract The aim of this study was to evaluate some rarely localized uterine DIFUSSION WEIGHTED IMAGING fibroids and their magnetic resonance imaging findings with case OF HEPATOCELLULER CARCINOMA: samples. In this retrospective study, 65 cases diagnosed as leiomyomas via pelvic MR examination were collected from recorded data RELATIONSHIP BETWEEN IMAGING between January 2014 and August 2017. Locations, sizes and MR CHARACTERISTICS, APPARENT signal features of 5 patients’ masses were noted. Symptoms and DIFFUSION COEFFICIENTS complaints of the patients were recorded and discussed. The mean age of the patients was 45±6.16 years (37-53). An extra-uterine, AND HISTOPATHOLOGICAL and a giant fibroid and leiomyomas of the urinary bladder, uterine GRADE cervix, uterine isthmus were investigated. All patients underwent a laparotomy or laparoscopy, and the diagnosis was confirmed HUSEYIN TUGSAN BALLI1, YUSUF CAN1, KIVILCIM histopathologically. Pelvic fibroids based on their location, size and ERDOGAN2, FERHAT CAN PISKIN1, KAIRGELDY AIKIMBAEV1 compression features lead to different symptoms and, diagnosis may 1Department of Radiology, Cukurova University School of Medicine, Adana, sometimes be difficult. In this instance, the additional and problem- Turkey solving role of MRI should be kept in mind. 2Department of Pathology, Cukurova University School of Medicine, Adana, Turkey Keywords: Fibroid tumors, leiomyoma, magnetic resonance imaging

Abstract Objective: To define correlation between histopathological grade of O - 035 hepatocellular carcinoma (HCC) and diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC). MAGNETIC RESONANCE FINDINGS IN Materials and Methods: We retrospectively evaluated pathologically OVARIAN TORSION confirmed 33 patients with HCCs who underwent hepatic multipa- AHMET AKCAY, FURKAN UFUK, DUYGU HEREK rametric dynamic MRI on 3.0-T platform, between September 2016 and January 2018. HCCs were diagnosed as well (n=13), moderately Department of Radiology, Pamukkale University School of Medicine, Denizli, (n=11) and poorly (n=9) differentiated according to histopathological Turkey assessment. Two abdomen imaging experienced radiologists reviewed Abstract all the images and noted the signal intensity (SI) of each tumor on DWI images with b-values of 800 s/mm2. The mean ADC values Objective: To evaluate the magnetic resonance imaging (MRI) findings were measured for each tumor. The relationships between SI values, of patients with ovarian torsion and compare these findings with ovarian ADC values on DWI, and histopathological differentiation of HCC salvageability. were analyzed. Materials and Methods: Patients who were diagnosed with ovarian torsion Results: All HCC nodules showed hyperintensity with comparison and underwent MRI were retrospectively investigated. A total of only 10 to the surrounding hepatic parenchyma on DWI. There was no patients (mean age, 26.7; SD,±10; age range, 14-42), with surgical confirmation significant correlation between ADC values (p=0.143) and SI values of ovarian torsion, were included to the study. All patients underwent conven- on DWI (p=0.765) with histopathological grade. Alfa fetoprotein tional MRI and 6 patients also underwent diffusion-weighted imaging (DWI) 2 (AFP) values exhibited correlation with histopathologic grade of the using a b-value of 600 s/mm . Quantitative and qualitative analysis of both the tumor with higher measured values in poorly differentiated group torsed and contralateral normal ovary were performed. (p=0.009). Presence of macrovascular invasion, pseudo-capsule and Results: Of the 10 patients, 5 torsed ovaries could be salvaged in necrotic component, number or distribution of lesions showed no a viable state. The mean size of the torsed ovaries was found to relationship with tumor grade. increased more than 100% when compared to the contralateral Conclusion: Quantitative analysis of SI and ADC values did not show normal ovary (60.8+19.3 mm vs. 25.8+3.4 mm). Peripheral rim of correlation with histopathological grade in hepatocellular carcinoma. high signal intensity on T1 weighted imaging with fat saturation was However, AFP values might be useful to define tumor biology with found in 8 of the 10 patients. Of these 8 patients, 5 ovaries were respect to pathological differentiation. found to be non-salvageable. Swirling of the vascular pedicle and free fluid around torsed ovaries was present in all cases. Torsion causes Keywords: Hepatocellular carcinoma, histopathological differentiation, were ovarian fibroma in one case, endometrioma in two cases and > diffusion weighted imaging 4 cm ovarian cyst in two cases. In other cases, there were no lesions. Average apparent diffusion coefficient (ADC) values in torsed ovaries were found to be lower than the contralateral normal ovary (1.6 x O - 034 10-3 mm2/sn vs 2.1 x 10-3 mm2/sn). Conclusion: Swirling of the vascular pedicle, free fluid around torsed PELVIC LEIOMYOMAS IN RARE ovaries and increased ovarian size by more than 2 times compared LOCALIZATIONS AND MAGNETIC to the contralateral ovary are significant findings for ovarian torsion RESONANCE IMAGING FINDINGS and these findings should be carefully investigated in patients with suspected torsion. NAMIK KEMAL ALTINBAS Keywords: Ovarian torsion, magnetic resonance imaging, emergency Ankara University School of Medicine, Ankara, Turkey medicine, ovarian viability Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S15

O - 037 Abstract EVALUATION OF COCHLEAR NERVE Objective: Temporomandibular joint (TMJ) pain affects 5-12% of the population. Among the pain-related disorders in the musculoskeletal sys- SCALE WITH MRI IN PATIENTS tem, it is the second most common cause after back pain. WITH IDIOPATHIC UNILATERAL Computerized tomography (CT) is the best imaging method to show SENSORINEURAL HEARING LOSS bone cortex and sclerosis in radiological evaluation while magnetic resonance imaging (MRI) is the standard imaging method to identify internal HAKKI CANER INAN1, ONUR TAYDAS2 derangement related with joint disc. In this study, the performance of MRI 1Department of Ear, Nose and Throat, Erzincan Mengücek Gazi Training was compared to CT which is adopted the gold standard in showing bone and Research Hospital, Erzincan, Turkey changes in TMJ. 2Department of Radiology, Erzincan Mengücek Gazi Training and Research Hospital, Erzincan, Turkey Materials and Methods: Between April 2013 and August 2017, the patients who had both TMJ CT and MRI were included. The patients who were Abstract under 15, had acute trauma-traumatic dislocation, congenital anomalies, history of head and neck tumors and radiotherapy were excluded. Joint Objective: Sensorineural hearing loss is the result of pathologies in the inner ear, retrocochlear region, vestibulocochlear nerve or intracra- degeneration was staged using condylar-eminence sclerosis, subchondral nial region. Imaging is applied to these patients to exclude congenital, cyst, condylar erosion, osteophyte, deformation and ankylosis criteria. infectious, inflammatory or tumoral pathologies. In recent years, it has Results: Degeneration was not seen in 47 of 108 joints that provided the become possible to evaluate the cochlear nerve with magnetic reso- inclusion criteria. 34 joints were in stage 1, 19 were in stage 2, 8 were in nance imaging (MRI), especially through the “constructive interference stage 3, on CT evaluation. All stage 2 and 3 joints were detected on MRI in steady state (CISS)” sequence. The aim of this study was to evaluate however 26/34 (76.5%) stage 1 joints were defined with MRI. the cochlear nerve diameter in patients with unilateral sensorineural hearing loss and to compare the diameters of the normal side with the Sensitivity and specificity of magnetic resonance imaging were 86.9% and hearing loss side. 97.9%, respectively, when computerized tomography was accepted as the gold standard. Magnetic resonance imaging could not detect 23.5% of Materials and Methods: A total of 21 patients with idiopathic unilateral early stage (Stage 1) degenerative cases. sensorineural hearing loss were included in the study. MRI and audiogram were performed on all patients. Both cochlear nerve diameters were Conclusion: Magnetic resonance imaging was quite successful in showing measured on axial thin-section CISS sequence images. bone degeneration, but early stage bone changes could be missed. Results: The patients comprised 10 males and 11 females with a mean Keywords: CT, MRI, internal derangement, bone degeneration, osteoar- age of 52±11 years. Hearing loss was determined in the right ear in 5 thritis, temporomandibular joint patients, and in the left ear in 16. The average cochlear nerve diameter on the side with hearing loss was 0.13 mm and 0.19 mm on the unaffected side. There was a statistically significant difference between the two sides O - 040 (p<0.001). A CHALLENGING DIAGNOSIS ON Conclusion: In patients with unilateral sensorineural hearing loss, MRI allows anatomically detailed assessment of the cochlear nerve, MRI: ORBITAL IGG4-RELATED DISEASE as well as excluding possible organic pathologies. Demonstration of AND LYMPHOMA decreased cochlear nerve diameter in idiopathic sensorineural hearing loss will contribute to elucidating the etiology of this disease in ELIF BULUT, KADER KARLI OGUZ the future. Department of Radiology, Hacettepe University School of Medicine, Ankara, Keywords: Cochlear nerve, sensorineural hearing loss, magnetic reso- Turkey nance imaging Abstract Objective: To investigate MRI features that may help to differentiate O - 038 between orbital IgG4-related disease and lymphoma. Materials and Methods: We retrospectively examined initial MRI stud- DOES THE PERFORMANCE OF ies (3 and 1.5 Tesla) of 9 patients with orbital IgG4-related disease (F/M: MAGNETIC RESONANCE IMAGING 5/4) and 9 patients with orbital non-Hodgkin lymphoma (F/M: 4/5). The REACH TO COMPUTERIZED median age of the patients at the time of MRI was 51 (7-69) and 40 (6-62) years, respectively. Orbital lesions were evaluated with respect to TOMOGRAPHY IN SHOWING location, T1 and T2 signal intensity, contrast enhancement and diffusion BONE CHANGES IN THE characteristics. T2 signal intensity ratio (SIR) of lesions to temporal cortex, ADC ratio of lesions to cortex and pons were also calculated. Fisher’s TEMPOROMANDIBULAR JOINT? exact and Wilcoxon signed rank tests were performed to compare MRI MEHMET COSKUN, NEZAHAT KARACA ERDOGAN, findings between groups. Results with p-values ≤ 0.05 were considered ATILLA HIKMET CILENGIR, MUHSIN ENGIN ULUC to be statistically significant. Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Results: Orbital involvement was unilateral in 8 patients in each group. Research Hospital, İzmir, Turkey The most frequent locations were lateral and/or superior extraconal S16 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 space in lymphoma (n=7), medial extraconal space and/or medial rectus O - 042 muscle in IgG4-related disease (n=4). There was no significant difference in terms of T1 and T2 signal intensity, contrast enhancement pattern and SINONASAL SCHWANNOMAS:A CASE T2 SIR between groups. The mean ADC values were 1.25±0.29 (×10-3 SERIES AND REVIEW mm2/s) in IgG4-related lesions and 0.56±0.16 (×10-3 mm2/s) in lymphoma lesions. ADC values and ADC ratios were found significantly different EMIN DEMIREL, CIGDEM OZER GOKASLAN between groups (p=0.01). Department of Radiology, Afyon Kocatepe University School of Medicine, Conclusion: Although there is a considerable overlap in conventional MRI Afyoni Turkey findings of orbital IgG4-related disease and lymphoma, ADC values and Abstract ADC ratios could be used to help differentiation. Schwannomas, also known as neurilemmomas or perineural ﬁbroblastoma), Keywords: MRI, orbita, IgG4-related disease, lymphoma are slow growing benign tumors and originate from the Schwann cells in the sheath of the myelinated nerve fibres ﬁrst described by Verocay in 1908. These tumors can occur any location in the body but are compara- O - 041 tively common (25-45%) in the head and neck region but involvement of the sinonasal region and pterygopalatine fossa is rare (4%). MRI PREVALENCE OF These lesions are typically asymptomatic until they grow large enough EXTRAMEDULLARY HEMATOPIESIS to perform a mass effect on ambient structures, by means of that producing clinical symptoms. Primarily the patients experience nonspecific OF THE PARANASAL nasal symptoms (such as rhinorrhea,epistaxis and nasal obstruction) the SINUSES IN CHILDREN WITH physician try to conservative praxis means fail to improve the symptoms. HAEMOGLOBINOPATHIES Sinonasal anatomy cause the early clinical diagnosis of such tumors difficult until the sinonasal schwannomas are quite large. TANER ARPACI Keywords: Sinonasal Schwannoma, MRI, head and neck radiology Acıbadem University Vocational School of Health Services, Acıbadem Adana Hospital, Adana, Turkey Abstract O - 046 Objective: Extramedullary hematopoiesis (EMH) develops in chronic CRANIOCEREBRAL METASTASES IN anemies like thalassemia and sickle cell disease (SCD) as response to increased need for erithrocyte production. It most commonly occurs CHILDREN WITH NEUROBLASTOMA: in liver, spleen and paravertebral regions. It is rare in head and neck A SERIES OF 8 CASES but has been reported in paranasal sinuses (PNS), thyroid and lacrimal MESUT SIVRI, HAVVA AKMAZ UNLU, NAZLI GULSUM AKYEL, glands. Maxillary sinus is the most commonly involved PNS. Purpose AYSE GUL ALIMLI of this study was to investigate magnetic resonance imaging (MRI) prevalence of EMH of PNS in pediatric patients with haemoglobin- Department of Radiology, University Of Health Sciences, Ankara Child opathies. Health And Diseases Hematology Oncology Training And Research Hospital, Ankara, Turkey Materials and Methods: Medical records of 110 pediatric patients (69 Abstract thalassemia, 41 SCD) who were followed up for haemoglobinopathies between January 2010-March 2018 in our instution were evaluated. Neuroblastoma is the third commonest childhood tumour after leukaemia Thirty patients (16 thalassemia, 14 SCD) who underwent MRI of the and brain malignancies.that occur anywhere along the sympathetic chain, the brain, neck and PNS for any reason were included in the study (13 girl, vast majority arise from the adrenal gland. Craniocerebral neuroblastoma 17 boy; age range 3-19; median age 14 years). MRI studies were retro- metastases may involve the calvaria, orbits, skull base, dura, brain, ventricles spectively reviewed. and leptomeninges.. Although neuroblastoma is common, involvement of the craniocerebral metastases, imaging findings and follow-up views are rarely Results: Four (13%) of 30 patients demonstrated EMH of PNS (2 girl, 2 reported in the literature. Generally, over the past several years, they pre- boy; age range, 4-17; median age, 11 years). Three (18%) of 16 patients sented as a case report. The aim of this study is to present imaging findings of with thalassemia and 1 (7%) of 14 patients with SCD revealed EMH of craniocerebral metastases in children with neuroblastoma in a series of 8 cases. PNS. Three (75%) of 4 were detected in maxillary sinus and one (25%) Keywords: CNS, neuroblastoma, metastas, MRI was in sphenoid sinus. Conclusion: Patients with thalassemia demonstrated higher prevalence of EMH of PNS which was more frequently observed in maxillary sinus O - 049 and defined as homogeneous soft tissue mass expanding the sinus wall, filling the sinus cavity and demonstrating signal intensity consistent with RADIOMICS APPLICATIONS ON red bone marrow hyperplasia on MRI. It should not be confused with MAGNETIC RESONANCE IMAGES: PNS tumors. Correct diagnosis prevents biopsy and other invasive procedures. HOW I DO IT? Keywords: Paranasal sinus, extramedullary hematopoiesis, thalassemia, ILKER OZGUR KOSKA sickle cell disease, magnetic resonance imaging Ege University School of Medicine, İzmir, Turkey Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S17

Abstract O - 051 Objective: Radiomics is rising its popularity among imaging community. DWI FOR SOLITARY PULMONARY It is a way of quantifiying the pixel values which reflect the underlying tissue architecture revealed by imaging modalities. Statistical, model NODULE ASSESSMENT based or wavelet transformations and shape features by geometric ERDEM FATIHOGLU1, SUZAN BIRI2, SONAY AYDIN1, model descriptors can be used for analysis. Then by combining this ELIF ERGUN1, PINAR KOSAR1 data with clinical or other relevant patient data, some computer based pattern recognition algorithms are applied in order to classify them 1Ankara Training and Research Hospital, Ankara, Turkey 2 under correct pathological label. Our aim is to demonstrate steps of Koru Hospital, Ankara, Turkey this process. Abstract Materials and Methods: Although it seems somewhat sophisticated The aim of this study is to assess magnetic resonance imaging for the unfamiliar, it is not a so complicated process. Either by using Objective: Matlab and writing a few lines of code or by using software packages (MRI), diffusion-weighted imaging (DWI), T2 weighted image (T2WI) such as MaZda or Weka which are commercial products or freeware, and apparent diffusion coefficient (ADC) maps thresholds value before analysis of our data is an easy task. We demonstrated the process computed tomography (CT) -guided transthorasic biopsy in solitary pul- step by step from region of interest selection to preprocessing and monary nodules (SPN) by describing tumoral cell density. feature extraction and finally classification by means of Bayesian or Materials and Methods: Patients who had SPN were prospectively evalu- kNN calssifier or neural networks on magnetic resonance images of ated with MRI (T1WI, T2WI) and DWI (b=0, b=500, b=1000). ADC maps brain tumors. were created for each patient. Before the biopsy, lesion muscle ratios (LMR) Results: The steps applied are demonstrated by screen shots of Matlab at T2WI, ADC value, lesion spinal cord ratio at each b values were noted. based processing. The measurements were correlated with the histopathological results. Conclusion: In the new artificial intelligence era, radiomics methods are Results: 53 patients included in the study, 30.2% (n:16) were female strong tools for decision support purposes. Familiarity with these meth- and 69.8% (n:37) were male. 17 lesions (32.1%) are benign and 36 ods may lead to more frequent usage of them by radiologists. lesions(67,9%) are malignant. The age varies between 40-82 years, with a mean of 61.7±9.1 years. The SPN diameters were between 10 - 30 Keywords: Radiomics, artificial intelligence, texture analysis mm, and the median was 24 mm. LSR0 and LMR values were not statistically significant in detecting malignancy. LSR500 >0.53 value can predict malignancy with 100% sensitivity and 70.6% specificity. LSR1000 > 0.53 O - 050 can predict malignancy with 88,9% sensitivity and 88,2% specificity. Setting the cut-off value at 0.9×10-3, ADC values had a sensitivity of 72,2 % and PATTERN RECOGNITION METHODS a specificity of 88,2% for predicting malignancy. FOR RADIOMICS APPLICATIONS OF Conclusion: For SPN follow up, a new following up protocol can be MRI IMAGES established using DWI and ADC mapping, safely. Particularly, patients with benign nodules with low cell density can be followed up without invasive ILKER OZGUR KOSKA interventional procedures. Ege University School of Medicine, İzmir, Turkey Keywords: Solitary pulmonary nodule, diffusion weighted imaging, benign-malign pulmonary nodule differentiation Abstract Objective: Radiomics deals with the images as they are pieces of data and applies pattern recognition methods in order to classify them with O - 052 correct labels. Supervised or unsupervised methods may be applied. With this study, our aim was introducing the most used pattern classifi- A PHANTOM STUDY AT 3-TESLA: cation methods and provide some familiarity to them for non-technical staff. FAT QUANTIFICATION WITH 3D-CAIPIRINHA-DIXON VS. Materials and Methods: Bayesian classification, kNN, artificial neural networks and support vector machine methods are introduced in an 3D-STANDART-DIXON intuitive way. URAL KOC1, OKTAY ALGIN2, MUSTAFA TAHTACI3, Results: Aim of getting some familarity to these methods were provided BETUL OZBEK2 by application of them to magnetic resonance image texture features and 1 step by step examples Erzincan Mengücek Training and Research Hospital, Erzincan, Turkey 2Ankara Atatürk Training and Research Hospital, Ankara, Turkey Conclusion: Machine learning methods are gaining importance and cur- 3Ankara Yıldırım Beyazıt University School of Medicine, Ankara, rently ongoing extensive research by them dominates innovative aspect Turkey of imaging science. Getting some familarity with them will provide both understanding the publications on that area more clearly and opportunity Abstract for joining the community applying these methods. Objective: To evaluate the impact of 3D-CAIPIRINHA-DIXON on the Keywords: Machine learning, pattern classificaiton, magnetic resonance detection and the quantification of fat content and to compare with texture 3D-STANDART-DIXON based on phantoms at 3.0T. S18 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Materials and Methods: Nine fat-water phantoms were constructed with without specific agent or herb; Group 3: Meso-2,3-Dimercaptosuccinic variation in fat content. All phantoms were examined on a 3T MR unit acid (DMSA); Group 4: N-acetylcysteine (NAC); Group 5: Coriandrum (Magnetom Skyra, Siemens Healthcare, Ger-many) with a 30-channel coil Sativum extract (Cilantro) and Group 6: Deferoxamine. All GBCAs were setup (with 18-channel body and 12-channel from the spine coils). All administrated from lateral tail vein two times a week with a high dose phantoms were imaged using both techniques (3D-DIXON with and with- protocol (2.5mmol/kg, Gadodiamide: Omniscan (R), GE Healthcare, out CAIPIRINHA (TR/TE−4.21/1.34 ms; spatial resolution−1.4×1.4×1.5 Waukesha, WI) and a total of 15mmol were given to Group 2, 3, 4, 5 and mm3). One radiologist placed a circular regions-of-interest (ROI) 5 cm2 6. DMSA, NAC and Cilantro were given to group 3, 4 and 5 with oral within phantoms on these images. The ROIs were copied at the same gavage 100 mg/kg, 150 mg/kg and 200 mg/kg per day, respectively for 15 position in the relevant slice for both Dixon sequences. 72 measurements days following the first GBCA injections. Deferoxamine was administrated had been done. Signal intensities and signal to noise ratios (SNRs) were to rats of Group 6 intraperitoneally (IP) 100 mg/kg per day. All rats were calculated as mean signal divided by the standard deviation of noise and sacrificed under high dose anesthesia after 3 weeks. One hemisphere of mean signal ratio of noise. cerebrum and cerebellum, blood and right kidney from each rat were Results: The mean signal intensity indexes were not significantly different extracted and each tissue homogenate was sent to Inductively Coupled between the tech-niques with and without CAIPIRINHA (35.24±31.40; Plasma Mass Spectrometry (ICP-MS) which is the gold standard method 34.72±31.16). SNR did statistically significantly differ between the tech- in the quantitative analysis of gadolinium levels. niques (p<0.001). SNR had lower values with CAIPIRINHA technique Results: Kruskal Wallis test revealed insignificant difference in total body, versus non-acceleration technique. Fat fraction SI and SNR values had no brain and right kidney weight in the whole study group. The lowest statistical significance between acceleration and non-acceleration tech- brain gadolinium levels were detected in Group 4 with a median value niques (p>0.316, p>0.456; respectively). of 397.70 ng/gr. However, it was not statistically significant compared to Conclusion: 3D-CAIPIRINHA-DIXON sequence (with PAT factor: Group 2 (p=0.831). The study groups did not demonstrated significant 6) can be used for isotropic fat imaging with higher-resolution and difference in terms of blood gadolinium levels. Kidney gadolinium levels improved/uniform fat suppression. At an acquisition time of 14 seconds, were both higher in Group 4 and 5 which was about twice as much of 3D-CAIPIRINHA-DIXON can be obtained in considerably less time than than that of Group 2 (p=0.033). Group 4 and 5 provided a statistically standard fat-saturated sequences. significant gadolinium boost in kidneys compared to group 3 and group 6. Deferoxamine did not decrease gadolinium in brain-blood nor significantly Keywords: Caipirinha, dixon, phantom study, 3D, dixon, 3-tesla increased in kidneys. Conclusion: The rats exposed to both Gadodiamide and NAC have revealed the lowest brain gadolinium levels. However, we were O - 053 not able to find a significant difference. This might be due to high dose GBCA protocol and low clearance time that we used as the N-ACETYLCYSTEINE AND methodology. It is well known that the gadolinium clearance is sup- CORIANDRUM SATIVUM LEAF plied by the renal excretion following GBCA injection. Interestingly, EXTRACT MAY REDIRECT our preliminary study has shown that NAC and Cilantro increased kidney gadolinium levels compared to Group 2 and other treat- GADOLINIUM TO KIDNEYS: ment groups. Despite lack of urine analysis, these findings prove the PROMISING AGENTS AGAINST potential promising role of NAC and Cilantro in the redistribution GADOLINIUM RETENTION IN BRAIN of gadolinium. TURKER ACAR1, EGEMEN KAYA2, DENIZ YORUK3, Keywords: Gadolinium deposition, gadodiamide, brain, kidney, NESLIHAN DUZENLI4, RECEP SELIM SENTURK4, N-acetylcysteine, coriandrum sativum CENK CAN4, LOKMAN OZTURK3 1Department of Radiology, University of Health Sciences Bozyaka Training and Research Hospital, İzmir, Turkey O - 054 2Department of Physiology, Ege University School of Medicine, İzmir, Turkey 3Department of Anatomy, Ege University School of Medicine, İzmir, WHO SHOULD PROVIDE SEDATION Turkey FOR CHILDEREN IN MRI ROOM? 4Department of Pharmacology, Ege University School of Medicine, İzmir, Turkey THE COMPRASION OF DIFFERENT Abstract HEALTHCARE PROVIDERS 2 1 Objective: Gadolinium based contrast agents (GBCA) have been shown BASAK ALTIPARMAK , FUNDA DINC ELIBOL , 2 2 to accumulate in brain despite normal kidney functions and this discov- MELIKE KORKMAZ TOKER , ALI IHSAN UYSAL ery drastically changed contrast media administration in the globe. As 1Department of Radiology, Muğla Sıtkı Koçman University Training and gadolinium is a heavy metal in the group of lanthanide, we hypothesized Research Hospital, Muğla, Turkey that drugs or herbs which were used previously to treat heavy metal or 2Department of Anaesthesiology and Reanimation, Muğla Sıtkı Koçman iron exposed rodents can similarly be used in GBCA administered rats. University Training and Research Hospital, Muğla, Turkey Therefore, in this preliminary study we aimed to reduce gadolinium levels in rodents after repetitive IV GBCA administration using several agents Abstract which were shown to have heavy metal or iron chelating properties. Objective: Magnetic resonance imaging (MRI) is a non-invasive diagnostic Materials and Methods: Six group (n=6) of Wistar albino male rats were procedure which has distinct advantage over other imaging modalities. enrolled. Groups were arranged as Group 1: Control; Group 2: only GBCA One of the most important factors for a successful MRI study is ability of Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S19 the patient to lie motionless. However, this becomes almost impossible for gastrointestinal system(GIS) malignancy, which appeared in 31 (36.2%) small children. In such conditions, a propor anesthetic sedation can deter- cases and hematological malignancy which appeared in 28 (32.5%) cases. mine the quality of diagnostic image. In this study, we aimed to analyze the The malignity incidence was found statistically high in women %60.5(n:54) experiences of different healthcare providers during anesthetic sedation than men %39.5(n:32) (p=.006). There was no statistical difference in the for children in MRI room. retroaortic LRVV and circumaortic LRVV groups in terms of age, gender, malignancy frequency and types. Materials and Methods: After the institutional ethical committee approval, the patients who had sedation for MRI study in the last 5 years Conclusion: LRVV appears to be associated with high incidence of malig- were detected from hospital database. The records were divided into nancy, especially GIS and hematologic malignancy, compared to the popu- two; children sedated by an anesthesiologist were enrolled in group 1, lation. Further investigations are needed to understand the relationship and children sedated by nonanesthesiology doctors (radiologists, paedia- between left renal vein variations and malignancy development. tricians, emergency physicians) or nurses were enrolled in group 2. The Keywords: Variation, renal vein, retroaortic, circumaortic, cancer, com- demographic variables of the children, sedation drugs, and complications puted tomography were recorded. Results: The demographic variables were similar. The anesthesiologist had commonly prefered propofol in anesthetic agent combinations, however O - 056 nonanesthesiology doctors and nurses had usually prefered midazolam. The most frequent complication was agitation in both groups (n=22), EFFICIENCY OF DIFFUSION whereas it was significantly high in group 2 (p=0.03). The other frequent complications were bronchospasm (n=14) and respiratory depression WEIGHTED MRI ON (n=13). One cardiovascular collapse case which was sedated by a radiolo- DIFFERENTIATION OF SOLITARY gist was detected in group 2. PULMONARY NODULES Conclusion: Although anesthetic sedation for children in MRI rooms pro- ILYAS DUNDAR1, MESUT OZGOKCE1, IBRAHIM vides advantages for radiologists, it carries potential risks. All healthcare AKBUDAK3, HANIFI YILDIZ2, SUMEYRA DEMIRKOL providers, regardless of their practice venue, should be experienced and ALAGOZ1, HUSEYIN AKDENIZ1 trained. 1Department of Radiology, Yüzüncü Yıl University School of Medicine, Van, Keywords: Childeren, sedation, anesthetic Turkey 2Department of Chest Diseases, Yüzüncü Yıl University School of Medicine, Van, Turkey O - 055 3Batman Region State Hospital, Batman, Turkey IS THERE A RELATIONSHIP BETWEEN Abstract LEFT RENAL VEIN VARIATIONS AND Objective: In this study we aimed to investigate the efficiency of Apparent Diffusion Coefficient (ADC) scores on Diffusion Weighted Imaging MALIGNANCY DEVELOPMENT? (DWI) in MRI for malignant-benign differentiation of solitary pulmonary TAHA YUSUF KUZAN1, BEYZA NUR KUZAN1, nodules (SPN) detected and followed up. TUGBA AKIN TELLI2, RABIA ERGELEN1, DAVUT TUNEY1 Materials and Methods: The DWI (b0-b200-b400-b800) of 37 patients 1Department of Radiology, Marmara University School of Medicine, (28 male (75.7%), 9 female (24.3%); mean age, 58.7±13.7; age range, İstanbul, Turkey 25–85) that SPN was detected with conventional methods was evalu- 2Department f Oncology, Marmara University School of Medicine, İstanbul, ated including ADC map in 1.5 Tesla MRI between 2015-2017. The Turkey ADC scores of nodules (5-30 mm in diameter) detected from images was calculated. Measurements were performed by the same radiologist Abstract who does not know the diagnosis. 19 (51.4%) patients were diagnosed with benign and 18 (48.6 %) with malignant lesions. All malign nodules Objective: Left renal venous variation (LRVV) can be observed 2.6– and 9 of benign nodules were diagnosed histopathologically. The other 10.2% of population depending on the method of investigation. There benign nodules were correlated with follow up, morphology, PET-CT and is no comprehensive information in the literature on the relationship dynamic contrast enhanced (DCE) MRI. The independent t test and the between LRVV and cancer development. The purpose of this study is ROC curve were used to calculate the difference between the scores of to analyse the association between LRVV and malignancy development. malignant and benign nodules. Materials and Methods: A total of 371 patients with a LRVV on abdomi- Results: On DWI, the mean score of malignant nodules 1.13±0.3(0.3-1.7) nal MRI or CT examination at Marmara University Pendik Training and was significantly lower than benign nodules (1.83±0.49(1-2.7) (p<0.01), Research Hospital between January 2015 and December 2016 were ret- with an area under the ROC curve of 0.867±0.63 (95% CI, 0.744-0.990). rospectively evaluated in this study. To investigate the association between When a score of 1,35 was considered as a threshold, the sensitivity and LRVV and malignancy, clinical and demographic data were recorded by specificity were %84.2 and %78.8 respectively. means of Hospital Information System. Conclusion: The signal intensity of pulmonary nodules may be useful for Results: Of the 371 patients, retroaortic LRVV were found in 277(74.6%) malignant and benign differentiation on DWI. In addition when the mor- cases, while circumaortic LRVV were found in remaining 94(25.4%) cases. phologies, DCE and the SUV-max values of the nodules is correlated, it The patients’ mean age was 46.2±19.2 years (range, 4-92 years) and the will have a high diagnostic value. female to male ratio was 3 to 2 (female=223, male=148). Of the cases with LRVV, 86 (23.1%) had malignancy, the most common of which were Keywords: Pulmonary nodule, DWI, ADC S20 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

O - 057 CARDIAC MRI IN DIFFERENT lated by the formula by Bloch et al. (3) CARDIOMYOPATHY TYPES SI=Mz,eq(1-2e^(-TI/T1)) ZEYNEP AKBULUT, HASAN YIGIT, SONAY AYDIN, SI/Mz,eq=1-2 e^(-TI/T1) PINAR KOSAR 1-(SI/Mz,eq)=2* e^(-TI/T1) Ankara Training and Research Hospital, Ankara, Turkey 1-(SI/Mz,eq)/2=e^(-TI/T1) Abstract ((Mz,eq-SI)/Mz,eq))/2=e(-TI/T1) Objective: Cardiomyopathies are classified into four main types: hyper- SI of the nulled myocardium is equal to 0 trophic, dilated, restrictive cardiomyopathies and arrythmogenic right ½=e(-TI/T1) ventricular cardiomyopathy. Cardiac MRI is a leading method to diagnose cardiomyopathies. We aim to determine normal ranges of T1 and T2 ln(1/2)=-TI/T1 relaxation times. Also, we intend to define the efficacy of T1/T2 mapping -0.69315=-TI/T1 to detect and differentiate cardiomyopathy subtypes. TI=T1*0.69315 Materials and Methods: 78 patients were included. The patients are classified into eight subgroup: 1-ischemic cardiomyopathy(3), 2-hyper- According to this formula TI can be calculated by multiplying T1 value with trophic cardiomyopathy (21), 3-dilated cardiomyopathy(6), 4- restric- a constant number of 0.69315. tive cardiomyopathy(6), 5-myocarditis(15), 6-noncompacted cardio- The aim of this study is to investigate different MOLLI schemes in order myopathy(8), 7-unclassified cardiomyopathy(9), 8-Cardiomyopathy to estimate null point of the myocardium. without CMRI sign(10). 30 healthy volunteers consist of the control group. Materials and Methods: Seven patients were scanned at 1.5 T (Aera, Siemens Healthcare GmbH, Erlangen, Germany) scanner with an addi- Results: In patients group, T1 values are higher than the control tional single mid slice MOLLI 3(2)3(2)5 sequence after TI Scout images. group. In dilated cardiomyopathy subgroup, T1 values are higher than Analysis was performed with region of interest placed conservatively the control group for both homogenius myocard and myocard with a within the septum. lesion. In hypertrophic cardiomyopathy subgroup, T1 values are higher than the control group. In ischemic cardiomyopathy and myocarditis Results: Mean TI estimate by T1 maps and TI scout and TI estimate subgroups, both T1 and T2 values are higher than the control group. selected for LGE showed positive correlation with each other (spearman: In restrictive cardiomyopathy subgroup, T1 values are higher than the 0.986, p:0.000 and pearson: 0.986, p:0.000). Mean difference between TI control group for both normal myocard and myocard with a lesion. estimate selected for LGE and MOLLI 3(2)3(2)5 was 9±5. Both T1 and T2 values are higher than control group in myocard with Conclusion: As a result, T1 mapping has been increasingly used for cardiac a lesion. imaging in the last years. With MOLLI 3(2)3(2)5 null point of the myocar- Conclusion: To conclude; both T1 and T2 mapping are sufficient for dis- dium can be calculated instead of estimating. tinguishing normal and pathologic myocard. T1 values are more successful. Keywords: T1 mapping, myocardium, null point, LGE, TI scout Especially, using the native T1 and T2 mapping methods in combination, enables evaluating the myocard without using any contrast agent. Keywords: Cardiomyopathy, T1, T2, MRI, mapping O - 059 THE MR IMAGING OF 6 CARDIAC O - 058 AMYLOIDOSIS AND REVIEW OF THE CAN T1 MAPPING BE USED INSTEAD IMAGING LITERATURE OF TI SCOUT FOR NULLING THE KARABEKIR ERCAN MYOCARDIUM Ankara Atatürk Training and Research Hospital, Ankara, Turkey ELIF PEKER, ZEHRA AKKAYA, BASAK GULPINAR, Abstract AYSEGUL GURSOY CORUH, MEMET ILHAN ERDEN The imaging findings of 6 cardiac amyloidosis cases were evaulated Ankara University School of Medicine, Ankara, Turkey with the MR imaging literature knowledge. The movement of left ventricle (LV), the thickness of LV myocardium, T1 map values of LV, Abstract and enhancement patterns after IV Gadoliniumand tagging feature of LV were assessed. They were clinically prediagnosed as cardiac amyloi- Objective: Late gadolinium enhancement (LGE) imaging is the accepted dosis by the cardiology department after echocardiographic and elec- application of cardiac MR imaging used to characterise myocardial tissue archi- trocardiographic evaluation. The laboratory findings of 6 cases were tecture. TI scout images are used to `estimate´ the most appropriate inversion normal. There were no pathological diagnosis as a limiation. Cardiac recovery time (TI) to null the signal intensity of normal myocardium in order MRI may be taken as an important diagnostic imaging modality in the to maximise the contrast between healthy and diseased myocardium. The diagnosis of amyloidosis. performance of LGE images is mostly effected by the IR time selected. Our findings were also similar with the findings of the literature T1 mapping is a novel emerging technique for quantitative myocardium characterisation (2). Signal intensity on a determined time can be calcu- Keywords: Amyloidois, cardiac MRI, imaging findings Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S21

O - 060 University of Health Sciences, Okmeydanı Training and Research Hospital, İstanbul, Turkey SONOELASTOGRAPHIC EVALUATION Abstract OF THE SCIATIC NERVE IN PATIENTS Objective: Chondromalacia is a common disease, also a normal outcome WITH UNILATERAL LUMBAR DISC of aging. Individuals with this condition are often referred to the physician HERNIATION with unexplained knee pain. The underlying problem cannot be identified most of the time so the sufferers go back with anti-inflammatory UMUT ORKUN CELEBI1, VEYSEL BURULDAY1, MEHMET FAIK 2 3 4 medications. Besides chondromalacia is identified with conventional MR OZVEREN , ADIL DOGAN , MEHMET HUSEYIN AKGUL imaging that is performed for many different reasons. Clinical diagnosis 1Department of Radiology, Kırıkkale University School of Medicine, and its confirmation with imaging findings, in other words, their link seems Kırıkkale, Turkey improvable. 2Department of Neurosurgery, Kırıkkale University School of Medicine, Kırıkkale, Turkey Materials and Methods: A total of 38 people including 26 female and 3Department of Radiology, Kahramanmaraş Sütçü Imam University School 12 male were included in the study. Subjects with additional pathology of Medicine, Kahramanmaraş, Turkey that could be the cause of knee pain were excluded from the study for 4Department of Neurosurgery, Kirikkale Yüksek Ihtisas Hospital, Kırıkkale, objectively evaluating the source of pain. Patients in pediatric age were Turkey also excluded from the study as maturation, patellar cartilage thickness, and signal intensity could be confusing. Visual analogue scale (VAS) and Abstract Kujala front knee pain score (AKPS) were recorded for clinical correla- Objective: The aim of this study was to compare MRI results, strain elastogra- tion. MR findings were assessed using a 1.5 Tesla MR device and knee phy and shear wave elastography (SWE) findings of the sciatic nerve in patients coils. Axial, coronal and sagittal proton weighted (PW) and coronal T1 with unilateral lumbar disc herniation (LDH) and healthy control subjects weighted sequences were obtained. The cross-sectional thickness was 4-5 mm without gaps. Chondromalacia classification system (MR grade), mean Materials and Methods: The study group included patients with com- patellar thickness (MPT) were measured to evaluate the MR findings, and plaints of unilateral sciatica for 3-12 months, with foraminal stenosis due the patellar cartilage score (PCS) was defined to evaluate these two data to one level of LDH (L4-L5 or L5-S1). An age and gender-matched control together. PCS was defined as mean cartilage thickness / MR grade + 1. (+ group was formed of healthy subjects. LDH was diagnosed, and foraminal 1 is aimed to avoid division by zero) Pearson correlation coefficient was level assessment was based on the MRI-based description recommended calculated for correlation evaluation. by the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neurology. 1.5 Tesla MRI unit was Results: Correlation coefficients are shown on the table. used to visualize nerve roots and herniation. The foraminal stenosis was Conclusion: When the correlation coefficients were compared, AKPS assessed according to the Wildermuth staging. Sonoelastographic evalua- was found to be more valuable than VAS in evaluating the clinical correlations were performed on both the axial and longitudinal planes from the tions. This scoring is used to assess the pathology of anterior knee pain bilateral gluteal region using a 5-9 MHz multifrequency convex probe. and is a more specific method. The most valuable finding in identifying Results: There were 40 patients (20 male, 20 female) with a mean age of patellar cartilage pathologies was PCS, in which the cartilage thickness 43.1±12.7 years in the study group, and 40 healthy subjects (22 male, 18 and the signal intensity are evaluated together. We would like to inform female) with a mean age of 42.9±10.7 years in the control group (p>0.05). that more objective results can be obtained after evaluating the cartilage While blue (32.5%) and blue-green (47.5%) color codes were the most thickness in addition to MR classification in patellar disease. commonly observed in the involved side of LDH patients, green-yellow Keywords: Patellar chondromalacia, MR findings, clinical correlation color codes were the most commonly observed in the non-involved side of LDH patients and both sides of healthy control subjects (p<0.05). The sciatic nerve stiffness assessed on both the axial and longitudinal planes of the involved side was significantly higher than that of non-involved side in O - 062 the patient group and of both sides in the control group (p<0.001) QUANTITATIVE ASSESMENT OF Conclusion: Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. SE and SWE seem to be a conve- PATELLAR CARTILAGE FOR EARLY nient and informative imaging tool to evaluate LDH in daily practice CHONDROMALASIA BY USING T2 Keywords: Sciatic nerve, ultrasound, peripheral nerve, strain elastography, MAPPING AT 3T shear wave elastography, low back pain ONDER TURNA1, ISIL FAZILET TURNA2, YUSUF CELIK3 1Department of Radiology, Biruni University School of Medicine, İstanbul, Turkey O - 061 2Department of Physical Medicine and Rehabilitation, Acıbadem University Atakent Hospital, İstanbul, Turkey EVALUATION OF CORRELATION 3Department of Biostatistics, Biruni University School of Medicine, İstanbul, Turkey BETWEEN THE CLINICAL AND MRI FINDINGS OF PATELLAR Abstract CHONDROMALACIA:INITIAL RESULTS Objective: The aim of the study was to evaluate the quantitative assessment of patellar cartilage for early chondromalasia by using T2 mapping DENIZ OZEL, CAGLAR KIR at 3T magnetic resonance imaging (MRI). S22 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Materials and Methods: Thirty patients (22 women, 8 men; mean age in ON area sizes between pre-HBO and post-HBO MRI images at the end of 47.67±9.557) with chondromalasia of ICRS (International Cartilage Repair the treatment. Studies with longer follow-up imaging and with larger sample Society) grade ≤2 and 69 normal subjects (43 women, 26 men; mean age sizes may be more helpful in demonstrating the effect of HBO on ON. 40.04±13.05) were examined by using a 3T MRI with an 15-channel knee Keywords: Knee, secondary ostonecrosis, hyperbaric oxygen therapy, coil. Chondromalasia was graded based on PD TSE images. T2 maps were magnetic resonance imaging calculated from a T2 star sequence. Medial and lateral facets of each patellar cartilage were divided into three zones. M1, M2, M3; for medial facet and L3, L2, L1; for lateral facet from medial to lateral. Region of interest (ROI) of 0.5 mm2 for each zones and a single ROI for entire cartilage were drawn O - 064 to analyse mean T2 relaxation times (ms) and compare for both groups. ROC curves and AUCs (Area Under Curve) were performed to evaluate WHICH IS THE MOST AFFECTED MUSCLE the diagnostic value of quantitative assesment of patellar cartilage for early IN LOMBER DISC DEGENERATION? chondromalasia diagnosis. P<0.05 was considered significant. MULTIFIDUS OR ERECTOR SPINA? Results: Mean T2 relaxation times (ms) of entire cartilage/M1/M2/M3/ L3/L2/L1 zones of chondromalasia patients were significantly higher than PIRIL ERBAY OZTURK, NILUFER AYLANC the ones of normal subjects (21.98/21.66/23.97/23.61/23.85/23.64/25.23 Çanakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey and 19.71/18.38/19.34/18.41/18.91/21.22/20.98, respectively). The best predictive accuracies for diagnosis of early chondromalasia was obtained Abstract at M3 [(AUC: 0.734; %95 CI: 0.620–0.848) (p<0.001)]and L3 [(AUC: Objective: The aim of the study is to evaluate the relationship between 0.724; %95CI: 0.612–0.836), (p<0.001)]. the lumbar disc hernias and fatty degeneration of the paravertebral mus- Conclusion: T2 mapping might be a useful method for the detection of culature, especially erector spina and multifidus. early chondromalasia at the patella. Materials and Methods: Lumbar MR images of 392 patients with back pain Keywords: Cartilage, chondromalasia, patella, T2 mapping complaints were retrospectively reviewed. Cases between the age of 18 and 64, LDH was detected in 205 patients as case group and 187 patients without LDH as the control group. In the case and control groups, the erector O - 063 spina and multifidus muscles were compared in terms of fatty degeneration. Also, fatty degeneration rates of these muscles were examined according to MRI CORRELATION IN SECONDARY age and gender characteristics and LDH levels in the groups. KNEE OSTEONECROSIS PATIENTS Results: There was no statistically significant difference between the cases (42.0±12.4) and controls (41.3±12.4)in terms of the mean age (p=0.465). In WITH CLINICAL BENEFIT FROM cases with no significant statistical difference about gender (0.465), herniation HIPERBARIC OXYGEN THERAPY was detected in the lower lumbar level, in L4-5 and L5-S1, higher than the MUZEYYEN KALKAN1, GAMZE TURK1, ALI KOC1, LDH detected in upper levels. In the case and control groups, the degree of fatty degeneration in the erector spina and multifidus in the patients older than MEHMET EMIN AKCIN1 40 years, was higher than the younger ones (p<0.05). In patients with upper 1Department of Radiology, University of Health Sciences Kayseri Training lumbar level herniation moderate degeneration was observed in both muscle and Research Hospital, Kayseri, Turkey groups, whereas in patients with lower lumbar level hernia, degeneration was 2 Department of Undersea and Hypervaric Medicine, University of Health observed mildly in the multifidus and moderately in the erector spina similarly Sciences Kayseri Training and Research Hospital, Kayseri, Turkey to patients with herniation in all levels. Abstract Conclusion: Low back pain can be seen in patients both with LDH or without LDH. In particular, the degree of fatty degeneration in multifidus Objective: The purpose of this study was to examine the MRI findings and erector spina muscles must be taken into consideration as it can vary in secondary knee osteonecrosis (ON) patients with clinical benefit from according to the level of disc herniation. In a diagnostic process or follow hyperbaric oxygen therapy (HBO). up treatment, indicating the detailed grading of degeneration in radiology Materials and Methods: Eleven symptomatic secondary knee ON patients reports will contribute to the rehabilitation process of the patients and (18 knees) who had no surgery and had clinical benefit from HBO between therefore to the treatment management. 2016-2018 were included in this study. Knee joint was divided into medial Keywords: Lomber disc herniation, multifidus, erector spina, MRI and lateral femorotibial compartments. ON areas were calculated in axial and coronal planes in pre and post-HBO fat saturated T2W images, and compared. Statistical analysis was done by Wilcoxon test. O - 065 Results: Of 11 patients 3 were male and 8 were female. Mean age was 29±6.2. Most common involvement sites were lateral femoral condyle SUBSCAPULAR TENDON RUPTURE (n:17, 94.4%) and medial femoral condyles (n:13, 72.2%). Tibia was less commonly affected with medial tibial involvement in 5 patients and lateral AND SUBCORACOID IMPINGEMENT tibial involvement in 4 patients. ON area measurements showed no sta- SYNDROME:A MAGNETIC tistical difference between pre and post-HBO fat saturated T2W images RESONANCE IMAGING STUDY in coronal and axial planes. Conclusion: HBO enables clinical benefit in symptomatic secondary knee GULCIN DURUKAN GUNAYDIN, AHMET ASLAN osteonecrosis patients. However, there was no statistically significant difference İstanbul Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S23

Abstract Results: Eighteen patients were included in the study. Tumors were classified to 3 groups as malignant (angiomatoid fibrous histiocytoma, epithe- Objective: We aimed to investigate the diagnostic value of coracohumeral lioid angiosarcoma, clear cell sarcoma, Hyalinizing spindle cell tumor with anatomic measurements and other associated pathologies that may be giant rozette), benign (granuloma annulare, hibernoma, intramuscular helpful in the subscapular tendon rupture and subcoracoid compression myxoma, intraneural perineuroma, pleomorphic hyalinizing angiectatic syndrome on shoulder magnetic resonance imaging (MRI) examination. tumor, cellular myxoma, solitary fibrous tumor, benign parosteal osteo- Materials and Methods: 982 shoulder MRI examinations between chondromatous proliferation) and infection (mycobacterium fortuitum, December 2016 and July 2017 were reviewed retrospectively. 51 patients aspergilloma, cyst hydatid). Of 50% malignant lesions had necrosis, het- diagnosed with subscapular tendon rupture (study group) and 50 patients erogeneity and invasion were 67%, hemorrhage was 33%. All malignant without subscapular tendon pathology (control group) on MRI, were ran- lesions located intramuscular region and none of them include fat tissue. domly selected from among patients who had MRI examinations due to Benign lesions had no necrosis and hemorrhage. Only cyst hydatid had shoulder pain between the same dates. Gender and age matched control specific MRI findings. There was no statistical significance in terms of age group were included in the study. Patients and control groups were evaluated and size between benign-malignant tumors. comparatively for coracohumeral distance (CHD), coracoid overlap(CO), Conclusion: Although MRI is the most common method in diagnosis coracoglenoid angle(CGA), coracoglenoid distance and acromiohumeral dis- there is no specific MRI feature in STTs. However, MRI has prominent tance, subscapularis, supraspinatus, infraspinatus and biceps muscles patholo- contribution in lesion localization, invasion degree, content of lesion and gies, coracoid type and tuberculum cysts by a single operator relation of lesions with surrounding tissue. Results: For each group (control and study) 20 (39.2%) of the patients Keywords: Magnetic resonance imaging, rare, soft tissue tumors were male and 31 (60.8%) were female. The average age of the patients was 59.3 years(34-75 years). A statistically significant difference was found in the patients with transvers CHD, sagittal CHD, CGA and AHD values when compared to the control group (p<0.001). Concomitant supraspinatus, O - 067 infraspinatus and biceps tendinosis and rupture were found in the patient EVALUATION OF SLAP TYPE 5 group more than the control group (p<0.001). Also a statistically significant difference was found in the patient group compared to the control group in LESIONS WITH OBLIQUE SAGITTAL the protruded coracoid type and greater tuberosity cysts (p<0.005). MR-ARTROGRAPHY Conclusion: Coracohumeral distance and coracoglenoid angle measure- GOKHAN ONGEN, GOKHAN GOKALP ments in routine shoulder MRI examination are important parameters for subcoracoid impingement syndrome. In addition, ancillary findings such Department of Radiology, Uludağ University School of Medicine, Bursa, Turkey as biceps tendinosis, rupture and tuberculum cysts help to diagnose the subscapular tendon tears. Abstract Keywords: Subscapular tendon rupture, subcoracoid impingement syn- Objective: The aim of this study is to compare conventional drome MR-artrography sequences and thin slice oblique sagittal sequence oriented to the labrum in detecting Bankart and SLAP type 5 lesions. Materials and Methods: Consequent patients undergone MR-artrography O - 066 and surgery with shoulder instability between January 2013 and MRI FINDINGS OF RARE SOFT TISSUE January 2018 were analyzed retrospectively. Demographic data and MR-artrography images were retrieved from PACS archives. Conventional TUMORS sequences (T1-wieghted fat-saturation coronal and axial images with 3 ISIL BASARA AKIN1, BURCIN CEVIK TUNA2, ALI BALCI1 mm slice thickness) and oblique sagittal sequence oriented to the labrum with 1 mm slice thickness) were evaluated. MR-artrography was accom- 1Department of Radiology, Dokuz Eylül University School Of Medicine, plished by an experienced musculoskeleteal radiologist. Results were com- İzmir, Turkey pared with surgical outcomes. Sensitivity, specificity and positive predictive 2 Department of Pathology, Dokuz Eylül University School Of Medicine, values (PPV) were calculated for both sequences. İzmir, Turkey Results: Bankart lesion (40 patients) and SLAP type 5 lesions (16 patients) Abstract were detected in 45 patients (40 patients male, 5 patients female; mean age 36.2 years). Sensitivity, specificity and PPV of conventional sequences Objective: Soft tissue supports fat, muscle, nerves, subcutaneous and in detecting Bankart lesion were 95%, 25% and 92%, respectively. These synovial structures. Percentages of benign and malignant soft tissue values for detecting SLAP type 5 lesion were 47%, 92.6% and 80%. tumors (STT) are 0.3% and <%1 respectively. STTs are local aggressive Sensitivity, specificity and PPV of oblique sagittal sequences in detecting with high metastatic potential. The purpose of this study is to evaluate Bankart lesion were 75%, 100% and 100%, respectively. These values for magnetic resonance imaging (MRI) findings of rare STTs found in our detecting SLAP type 5 lesion were 82%, 100% and 100%. archives. Conclusion: While oblique sagittal MR-artrography sequence has lower Materials and Methods: Between 2010 January- 2017 December, sensitivity in detecting Bankart lesions when compared with conventional patients who were diagnosed as STTs with MRI were included to study. sequences, it has high accuracy in demonstrating anterior to superior Tumors were classified according to pathology, MRI findings (homogenei- extension of these lesions. For this reason, it has an important role in the ty-heterogeneity, T1-T2 signal), localization, fat, cyst, necrosis, hemorrhage evaluation of SLAP type 5 lesions. contents and invasion. SPSS V.16 was used in statistical analysis; Chi-square and Mann-Whitney U tests were performed as descriptive tests. Keywords: SLAP, Bankart lesion, MR-artrography S24 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

O - 068 Abstract EVALUATION OF SPINAL-PARASPINAL Objective: Pelvic congestion syndrome (PCS) is the frequent condition that causes chronic pelvic pain in the reproductive women. MRI-defined PARAMETERS TO DETERMINE pelvic venous congestion (PVC) sign is the important finding of PCS. The SEGMENTATION OF THE VERTEBRAE aim of this study is to compare the prevalence of PVC sign on sacroiliac and hip MRI in the reproductive women. NUR HURSOY, ELIF PEKER, HABIP ESER AKKAYA, SENA UNAL, EZGI ANAMURLUOGLU, BILGESU ARIKAN, Materials and Methods: The study was performed with the retrospec- MEMET ILHAN ERDEN tive basis and between January 2010 and December 2017, a total of 727 MRI examinations (401 sacroiliac joint MRI and 326 hip joint MRI) were Ankara University School of Medicine, Ankara, Turkey included into the study. Incidental findings of musculoskeletal and genitourinary disorders were recorded. Besides 727 MRI examinations, after Abstract removing patients with the disorders that may cause pain, remaining 539 Objective: The purpose of the study is to compare the usefullness of (322 sacroiliac and 217 hip) MRI examinations were analyzed separately. parameters used for vertebra segmentation in lumbar MR examinations. Results: Four hundred one patients with sacroiliac MRI examination had Materials and Methods: The lomber MR examinations of 143 patients 120 (29.9%) PVC sign and 326 patients with hip MRI examinations had were retrospectively evaluated. First images were evaluated for morphol- 54 (16.6%) PVC sign (p<0.001, chi-square test). After removing patients ogy and for the presence of transitional vertebrae, then counted from C2 with the disorders that may cause pain; 322 patients with sacroiliac MRI vertebra to determine the exact segment of the vertebra. examination had 102 (31.7%) PVC sign and 217 patients with hip MRI examinations had 38 (17.5%) PVC sign (p<0.001, chi-square test). No sig- Secondly, 14 parameters were evaluated in all cases: 1) Morphological nificant differences were found between patients with acute sacroiliitis and characteristics - Vertebra corpus shape - Intervertebral disc shape patients without acute sacroiliitis in terms of PVC prevalence (p>0.05). (ODriscoll classification) -Lumbosacral angle - Dimensions of vertebra There were also no significant differences between other comparable -Last costovertebral joint -Last facet joint 2) Levels of anatomic markers incidental findings. -Iliolumbar ligament Conus medullaris Celiac artery -Superior mesenteric The fact that a significantly increased PVC prevalence in artery Right renal artery -Aort bifurcation -Vena fava inferior confluence Conclusion: patients with sacroiliac MRI may be attributed to that PCS may simulate -Dural sac end-point clinically sacroiliitis. Results: Transitional vertebrae was detected in 13 patients. Percentage of Keywords: Sacroiliitis, pelvic congestion syndrome, pelvic venous conges- errors made according to morphology was 11%. Levels and distribution tion differences of anatomic markers are shown in Table 1. In normal cases, the L5 vertebra is always rectangular, and the S1 vertebra is always trapezoi- dal. In the case of sacralisation, the difference between the end-plates of the transitional vertebra was significantly smaller than that of the actual S1, O-070 which is closer to the shaped rectangle, ie the true L5 vertebra (p=0.037). The S1-2 disc appears significantly more frequently in type 3 characteris- MULTIPLE FACES OF LUNATE tics (p=0.013) than in the true L5-S1 disc. The mean of the lumbosacral ZEHRA AKKAYA, ELIF PEKER, BASAK GULPINAR, angle is higher, although not statistically significant, in the case of variations. AYSEGUL GURSOY CORUH, GULDEN SAHIN Therefore, if this angle increases, correlation with other findings can be made in terms of variation. The iliolumbar ligament is at the L5 vertebra Department of Radiology, Ankara University School of Medicine, Ankara, level in all normal cases that can be evaluated. Turkey Conclusion: Correct identification of vertebral levels is not always pos- Abstract sible according to morphology. However, helpful parameters can be used Objective: Although the presence of an articular facet on lunate for to determine exact segmentation of the vertebrae. hamate makes a type 2 morphology, correct assessment of lunate shape Keywords: Vertebrae, lumbalisation, sacralisation may be difficult since small facets are not always conspicuous on radiographs or routine MR images. The purpose of this study was to determine more precise parameters to assess lunate types and further evaluate their possible effects on triangular fibrocartilage (TFC), hamate and lunate O-069 articular surfaces. INCREASED PREVALENCE OF Materials and Methods: Anteroposterior radiographs and T2-3D iso- PELVIC VENOUS CONGESTION SIGN metric DESS MRIs at 3.0 T MR of 118 cases with neutral ulnar variance were retrospectively analysed for articular cartilage effacement, presence ON SACROILIAC MRI IN WOMEN of signs of hamatolunate degeneration and MRI findings at central part WITH CLINICALLY SUSPECTED of TFC. The distance between cortices of lunate-hamate and capitate SACROILIITIS (C)-triquetrum (T) were measured on MRIs and radiographs and the LH/CT ratios were calculated. For statistical analyses a p value <0.05 was AHMET PEKER, GOZDE TOKATLI, ALI BALCI, considered as significant. ISIL BASARA AKIN, CANAN ALTAY Results: 72% of cases were female and 28% were male with a mean age Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, of 38.5 (±13.5). The incidences of type 1 and type 2 lunates were 74.6% Turkey and 25.4% respectively. There were no statistical significance with respect Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S25 to lunate types and gender. Findings regarding hamatolunate degeneration O-073 were significantly higher in type 2 lunate group (p=0.003), however the LH/CT ratios showed no such correlation. When LH/CT ratios at MRI THE CONTRIBUTION OF 3 TESLA MRI were analysed, a cut-off value of 0.907 showed high sensitivity and speci- TO THE PREOPERATIVE ASSESSMENT ficity in determining type 2 lunate with significantly more accuracy than radiographic ratios (p<0.001). TFC pathologies showed no correlation OF BREAST CANCER with regard to lunate types (p=0.935). SENA UNAL1, EBRU DUSUNCELI ATMAN2, ELIF PEKER2, Conclusion: A ratio of 0.907 for LH/CT in MRI may be a helpful tool ILHAN ERDEN2, UMMAN SANLIDILEK2 in determining the lunate type where type 2 morphology is significantly 1Department of Radiology, Erzurum District Training and Research Hospital, more associated with hamatolunate arthrosis. TFC changes and lunate Erzurum, Turkey morphology showed no correlation. 2Department of Radiology, Ankara University School of Medicine, Ankara, Keywords: Hamatolunate degeneration, MRI, TFC, type 2 lunate Turkey Abstract O-072 Objective: To define the contribution of MRI to preoperative assessment of newly diagnosed breast cancer patients. DETERMINATION OF Materials and Methods: In this study 31 breast cancer patients whose MORPHOLOGICAL CHARACTERISTICS diagnosis had been proven histopatologically and examined with breast OF PRIMARY BREAST CANCER BY MRI were evaluated retrospectively. The size and the kinetic properties of the tumor, additional foci in the same breast, the existence of tumor FOCUS DIFFUSION-WEIGHTED MRI: in the other breast, extension to the chest wall and axillary lymph node COMPARISON WITH CONVENTIONAL metastasis were noted. These findings were compared with postoperative DIFFUSION WEIGHTED IMAGES AND histopathological findings. DYNAMIC CONTRAST-ENHANCED Results: In 10 patients multifocal disease was identified but only in 3 MRI patients it was proven pathologically. In 1 patient MRI couldn’t identify the additional foci (sensitivity 66.6%, specificity 71.4%, positive predictive YAVUZ METIN, NURGUL ORHAN METIN, value (PPV) 20%, negative predictive value (NPV) 95.2%). In 2 patients OGUZHAN OZDEMIR, FILIZ TASCI, MAKSUDE ESRA MRI found multicentric foci and they were confirmed with pathology. Out KADIOGLU, EDA BEYKOZ CETIN of 6 patients with suspicious findings in the contralateral breast, 1 patient was diagnosed as cancer (sensitivity 100%, specificity 28%, PPV 16%, NPV Department of Radiology, Recep Tayyip Erdoğan University School of 100%). 13 patients were evaluated as positive for axillary lymph node Medicine, Rize, Turkey involvement. One of them didn’t have axillary lymph node metastasis in Abstract the pathology specimens. In 1 patient MRI couldn’t identify the axillary lymph node metastasis (sensitivity 92.3%, specificity 94.4%, PPV 92.3%, Objective: In this study, we aimed to compare the diagnostic accuracy and NPV 94.4%). Compared to histopathological measurements, we obtained effectiveness of focus diffusion weighted imaging (f-DWI), conventional a high reliability ratio (88%) for the lesion sizes. diffusion weighted imaging (c-DWI), and dynamic-contrast enhanced magnetic resonance imaging (DCE-MRI) in determining the morphological Conclusion: MRI can be used to exclude additional foci in patients who characteristics of primary breast cancer. have high risks for multifocal and contralateral disease. MRI may reveal false positive results and therefore the diagnosis must be proven with Materials and Methods: c-DWI, f-DWI and DCE-MRI of newly diagnosed 155 pathology before surgery. breast cancer patient’s images were evaluated retrospectively. Morphological features of the lesions and image quality were compared between all three Keywords: Breast cancer, breast MRI, preoperative assessment imaging protocols by two radiologists. Also apparent diffusion coefficient (ADC) values of the lesions were compared between f-DWI and c-DWI. Results: Evaluation by the two readers of all primary breast cancers for O-074 the mean ADC values were 82.5 and 88 for f-DWI, and 92.5 and 94.5 by c-DWI, respectively and the difference was statistically significant (p< MAGNETIC RESONANS IMAGING 0.001). The least distorted images were obtained in DCE MR images FEATURES OF TRIPLE NEGATIVE compared to c-DWI and f-DWI for both readers. The highest distor- sion scores were obtained in c-DWI. Sharpness was rated as significantly BREAST CANCER higher for f- DWI and DCE MR images compared to c-DWI by all read- GULTEN SEZGIN, EMINE MERVE HOROZ, MERVE GURSOY ers (p<0.001). Also, perceived SNR scores were significantly higher for BULUT, MELDA APAYDIN f-DWI and DCE MR images than c-DWI for both readers (p<0.001). Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Conclusion: f-DWI allows higher quality images than conventional one. Research Hospital, İzmir, Turkey This allows the morphological features to be identified at similar accuracy to dynamic contrast-enhanced images with high resolution. Abstract Keywords: Diffusion-weighted imaging, focus, high resolution, magnetic Objective: To discuss the magnetic resonans imaging (MRI) features of resonance imaging triple negative breast cancer (TNBC) S26 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Materials and Methods: Thirty-two patients with TNBC evaluated by Conclusion: These findings suggest that MD values of breast invasive MRI between 2010-2017 were identified via a radiology information sys- tumours may be further assessed as potential predictors of molecular tem. Unifocal mass, rim enhancement and intratumoural T2 hiperintensity subtypes of breast cancer. were evaluated. The scans were obtained on a 1,5-Tesla Optima 360 MR unit (General Electric Medical Systems, Milwaukee, WI, USA). Standard Keywords: Diffusion tensor imaging, breast cancer, HER2 sequences were obtained which included T2 fat-supressed images, T1-weighted non-contrast images, dynamic contrast enhanced images, subtracted images and maximum intensity projection images. O-076 Results: The mean age of patients was 51.3±12.4 years (range: 31-83 years). Sixteen of patients (50%) were invasive ductal carcinoma, 4 (12.5%) BACKGROUND PARENCHYMAL were invasive ductal carcinoma with ductal carcinoma in situ, 3 (9.4%) were ENHANCEMENT AND BREAST invasive ductal and invasive lobular carcinoma and 9 (27.1%) were the other DENSITY ON BREAST MRI: carcinomas (medullary, metaplastic, apocrine, adenoid cystic and saliva-like carcinoma). Unifocal mass was seen in 84.4% (27/32) of the patients. Non- CORRELATION WITH TUMOUR mass like enhancement was seen in 3 (9.1%) patients and satellite malignant CHARACTERISTICS lesion was seen in 2 (6.5%) patients. Rim enhancement was seen in 60.3% (17/27), intratumoural T2 hiperintensity was seen in %68.75 (22/32) of the AYSEGUL AKDOGAN GEMICI, SAFIYE TOKGOZ OZAL, patients. Enhancement kinetic curve was washout pattern in 30 (93.5%) ERCAN INCI patients, and progressive pattern in 2 (6.5%) patients. Bakırköy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey Conclusion: Triple negative breast cancers are receptor-negative and Abstract 11-20 percent of all breast cancers. Our study supports that TNBCs are most commonly seen as unifocal mass. Rim enhancement and intratu- Objective:To investigate the relationship between background paren- moural T2 hiperintensity were the other common MRI features and this chymal enhancement (BPE) and breast density (BD) at breast MRI and finding was compatible with literature histopathological features of invasive breast cancers. Keywords: Triple-negative breast cancer, mri findings, enhancement Materials and Methods: A total of 112 women with unilateral invasive breast cancer who preoperatively underwent contrast enhanced breast MRI were included in the study. MRI studies were performed within the O-075 second week of the menstrual cycle to reduce the enhancement of normal breast parenchyma. Two radiologists rated BD and BPE at breast MRI ASSOCIATION OF BREAST CANCER according to BI-RADS criteria in consensus. The relationship between BD SUBTYPES AND 3.0 TESLA DIFFUSION and BPE was investigated, and compared with tumor subtype, ki 67 level TENSOR MR IMAGING PARAMETERS and histologic grade of invasive breast cancers according to the level of BD and BPE. SAFIYE TOKGOZ OZAL, AYSEGUL AKDOGAN GEMICI, ERCAN INCI Results: BPE was associated with breast density (p<0.01). Both breast density and BPE were not associated with molecular subtypes (p=0.309 Bakırköy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey and p=0.603). Women with high breast density tended to have increased Abstract rate of Her 2 positive tumours (p<0.01). No significant differences between BPE and reseptor positivity were found (p=0.315). Also no Objective: To investigate relationship of breast cancer subtypes and the association between the histological tumour characteristics and BPE was mean diffusivity (MD), fractional anisotropy (FA) measured by diffusion observed. tensor imaging (DTI). Materials and Methods: This retrospective study included 102 patients Conclusion: We conclude that, in women with invasive breast cancer, (age 51,37 ± 11,47 years) who underwent pre-operative contrast- there is an association between breast density and BPE on breast MRI. enhanced 3T breast MRI and DTI, from september 2015 to february There is no correlation with BPE and reseptor positivity while high BD is 2018. Patients were histopathologically confirmed invasive breast cancer. associated with Her 2 positivity of the invasive breast cancer which is not Histologic analysis parameters included tumor size, expression of estro- suggested in the current literature. gen receptor (ER), human epidermal growth factor receptor 2 (HER2). Keywords: Breast cancer, MRI, background parenchymal enhancement, Breast cancer is divided into the following molecular subtype: estrogen breast density receptor positive and HER2 negative (luminal A, n=46); estrogen receptor positive and HER2 positive (luminal B, n=24); estrogen receptor negative and HER2 positive (HER2 enriched, n=13); estrogen receptor negative and HER2 negative (triple negative, n=18). Comparisons were O-077 made using Kolmogorov Smirnov and Kruskal Wallis H tests. THE ROLE OF MRI FINDINGS WITH Results: A statistically significant difference was found between MD values of four subtypes of breast cancer. According to the binary comparisons to DIFFUSION-WEIGHTED IMAGING find the group that makes the difference; MD measurements in Luminal IN THE DIFFERENTIATING PURE A and HER2 enriched subtypes were significantly different (p=0,038; p<0,01). There was no statistically significant relationship between breast MUCINOUS CARCINOMAS FROM cancer subtypes and FA measurements (p>0.05). FIBROADENOMAS Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S27

RAVZA YILMAZ, GULCIN AKKAVAK PALAZ ALI, Materials and Methods: Among the June 2016-February 2018, in the YUNUS EMRE AKPINAR, ZUHAL BAYRAMOGLU, Harran University Faculty of Medicine Radiology department with 3 SELMAN EMIRIKCI, MUSTAFA TUKENMEZ T MRI (Magnetom Skyra, Siemens Healthcare, Erlangen, Germany) breast MR images who had US reports, evaluated respectively. The İstanbul University İstanbul School of Medicine, İstanbul, Turkey patients who had breast masses without histopathologic evaluation or Abstract BI-RADS 6 excluded from the study. 40 patients with histopathological data choosed up for the study. The US reports and MR images Objective: Although mucinous carcinoma is a rare breast cancer, distinc- evaluated according to American College of Radiology BI-RADS Atlas tion from fibroadenomas may sometimes be challenging. The purpose Fifth Edition Quick Reference criteria. US findings examined with of this study to differantiate pure mucinous carcinomas (P-MCs) from regard to shape, orientation, margin, posterior features, architectural fibroadenomas (FAs) on magnetic resonance imaging (MRI) using breast distortion, vascularity, ductal changes and US BI-RADS; MRI findings imaging reporting and data system (BI-RADS) descriptors (5th edition) evaluated according to backround parenchymal enhancement, shape, and apparent diffusion coefficient (ADC) value. margin, internal enhancement characteristics, architectural distortion Materials and Methods: The study included 14 patients with patho- and kinetic curve assesment. logically proven P-MCs and 16 patients with biopsy-proven FAs that was Results: There are 31 patients with benign and 9 with malign histo- hyperintense on T2-weighted images between 2011 and 2017. All imaging pathological features. Shape, orientation, margin, posterior features, studies were evaluated using the BI-RADS lexicon. Besides hyperintense architectural distortion and BI-RADS in US were compatiable with signal on T2-weighted image, enhancing internal septation, the mean ADC pathology results (p<0.05). Vascularization of mass in US showed close values of masses and normal parenchyma were also evaluated. relationship with the pathology (p=0.086). In MRI shape, margin and Results: Irregular margins were observed more frequently in P-MCs architectural distortion showed significant relationship with the pathol- (0/16, %0 vs. 6/14, %43 p<0,05) P-MCs also showed nonmass enhance- ogy (p<0.05), kinetic curve assesment showed close relationship with ment along with mass, septal enhancement, rim enhancement while none the pathology(p=0.079). But background parenchymal enhancement and of FAs showed.(respectively; 4/14, %43; 4/14, %43; 7/14,%50, p<0,05) internal enhancement characteristics have no significant relationship with FAs showed circumscribed margins more frequently. (16/16, %100 vs. the pathology (p>0.05). 6/14, %43, p<0,05). There was no statistically significant relation of mean Conclusion: The results of our first morphological and kinetic analysis ADC values between P-MCs and FA. (1,709±0,389 vs 1,757±0,213 m2/s) with 3 Tesla dynamic breast MRI and US findings show a significant rela- However P-MCs and FAs both showed significantly higher mean ADC tionship with pathology. values compared with the parenchma. (p<0,05) Rim enhancement was significantly higher in P-MCs. (7/14, %50 vs 0/16, %0, p<0,05) Keywords: 3 Tesla, breast, MRI Conclusion: P-MCs were most commonly very hyperintense masses with irregular margin and rim enhancement on MRI. Also nonmass enhancement along with mass, septal enhancement can be used to O-079 differantiate P-MCs from fibroadenoma. These findings may separete DOES STRONG BACKGROUND P-MCs from FA, however ADC values had no discriminatory power for P-MCs versus FAs. PARENCHYMAL ENHANCEMENT ON MRI AFFECT THE TUMOR SIZE Keywords: Pure mucinous carcinoma, fibroadenoma, ADC, breast imaging ESTIMATION WITH MRI IN BREAST CANCER PATIENTS? HULYA ASLAN, AYSIN POURBAGHER O-078 Department of Radiology, Başkent University School of Medicine, Ankara, CORRELATION OF DYNAMIC 3 TESLA Turkey MAGNETIC RESONANCE IMAGING Abstract AND ULTRASONOGRAPHY FINDINGS Objective: The purpose of this study was to evaluate whether the level of background parenchymal enhancement (BPE) would affect the correct WITH HISTOPATHOLOGICAL tumor size estimation on MRI or not. RESULTS, OUR FIRST 3 TESLA Materials and Methods: From January 2016 to February 2018, 49 EXPERIENCE patients having breast Magnetic Resonance Imaging (MRI) prior to surgery and primarily surgically treated breast carcinoma were included in the SUNAY SIBEL KARAYOL, DILEK SEN DOKUMACI study. The patients were divided into two groups based on the level of Department of Radiology, Harran University School of Medicine, Şanlıurfa, BPE with consensus (mild/strong BPE). The Bias (d) was defined as the Turkey difference between the tumor sizes measured by MRI and histopathology. Two readers independently measured the tumor sizes on MRI manually. Abstract Then the mean bias was compared between the two groups. Objective: The aim of this study is histopathological comparison with Results: 49 patients were included in the study with a mean age of 53.46 the identification of the findings of dynamic magnetic resonance imaging years. 28 of the patients had mild and 21 of the patients had strong BPE. (MRI) and ultrasound (US) findings in breast masses. Mean tumor size was 19.20±6.79 at histopathology. For reader 1 the S28 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 mean (b) was 3.12±2.14 and 3.36±3.16 (mild and strong BPE groups, RAVZA YILMAZ, RANA GUNOZ COMERT, respectively). For reader 2 the mean (d) was 3.43±2.68 and 3.57±3.22 GULCIN AKKAVAK PALAZ ALI, MUSTAFA TUKENMEZ, (mild and strong BPE groups, respectively). When we compared the mean ABDULLAH IGCI (d) among the patients with mild and strong BPE, it did not show any significant difference for both of the readers (p values were 0.78 and 0.43 İstanbul University, İstanbul School of Medicine, İstanbul, Turkey for readers 1 and 2, respectively). Abstract Conclusion: The level of BPE may not affect the correct tumor size Objective: Fat necrosis is a relatively common benign entity in the breast. estimation on MRI. The reason is unknown in many cases; most likely the underlying cause Keywords: Background parenchymal enhancement, breast carcinoma, MRI may be trauma. Our aim is to evaluate the contribution of magnetic resonance (MR) imaging to clinically uncertain fat necrosis cases and to describe MR imaging features of this type of fat necrosis of the breast. O-080 Materials and Methods: Present study included 16 cases where diagnosis could not be made with certainly on ultrasonography and mamography. CORRELATION BETWEEN MRI AND Fat necrosis detected with MR imaging was histopathologically proven HISTOPATHOLOGICAL FINDINGS OF using US-guided biopsies. SPICULATED BREAST CANCERS Results: Traumatic fat necrosis presented as mass in all patients on MR imaging. Lesions were superficially evaluated in five patients (31%). The shapes of GOKHAN GOKALP, GOKHAN ONGEN the masses were mostly irregular 8/16 (50%) and round 5/16 (31%). In 10 Department of Radiology, Uludağ University School of Medicine, Bursa, patients (63%), fat signal was observed in the mass. Edema was seen around Turkey the mass in 4 patients (25%). The internal enhancement pattern of masses was heterogenous 9/16 (56%), homogenous 5/16 (31%). Complete enhance- Abstract ment of fat necrosis was seen as the same as partial in 8 patients (50%). Objective: To compare the relationship between MRI and histopathologi- Architectural distortion were seen in 5 patients (31%) on MR imaging. cal findings of spiculated and non-spiculated breast cancer. Conclusion: MR imaging has a wide spectrum of findings for fat necrosis and Materials and Methods: Between January 2014 and January 2018, 90 the appearance is the result of the amount of the inflammatory reaction, the women who had undergone image guide-biopsy with 50 spiculated and liquefied fat, and the fibrosis. MR imaging is an informative tool for evaluating 40 non-spiculated masses were separated accoding to BI-RADS criteria and diagnosing fat necrosis especially in cases that clinic uncertain and mam- on mammography. Estrogen receptor (ER), progesterone receptor (PR), mography and ultrasonography are suspicious for malignacy. HER2 and Ki67 were used as markers to identify molecular subtypes of Keywords: Fat necrosis, breast, imaging, magnetic resonance imaging, trauma breast cancer. Pearson chi-square test was employed to measure statistical significance of correlations. Results: There was no difference for age between two groups (p=0.331). O-082 The size of the masses were not different between the two groups (p=0.244). More hypointense signal features were detected in T2-weighted IDIOPATHIC GRANULOMATOUS images for the spiculated masses (p=0.004). There was no difference MASTITIS DYNAMIC BREAST MRI between the two groups in terms of multifocal or multicentric involvement, non-mass type enhancement, peripheral rim enhancement and AND DIFFUSION-WEIGHTED axillary lymph node involvement in the MRI (p=0.237, p=0.622, p=0.096, MRI FINDINGS: CLINICAL AND p=0.295 and p=0.764, respectively). ER and PR positivity were higher in RADIOLOGICAL CORRELATION the spiculated masses (p=0.027 and p=0.03, respectively). For the Ki67 index and HER2 positivity, statistically significant a difference were not HAZAL SELVI OZTOPRAK, SEVGUL KOSE found between two groups (p=0.571 and p=0.596, respectively). Department of Radiology, Çukurova University School of Medicine, Adana, Turkey Conclusion: ER and PR positivity are more common in the spiculated masses. This could be helpful to predict the course of the disease as well Abstract as the effectiveness of the treatment. Objective: Idiopathic granulomatous mastitis is a rare disease that simu- Keywords: Breast, cancer, spiculated, MRI, histopathological lates breast cancer clinically and radiologically. We aimed to determine the relationship between dynamic breast MR imaging and diffusion-weighted imaging findings and recurrence or residual disease prevalence in patients with pathologically diagnosed idiopathic granulomatous mastitis with core O-081 needle biopsy and to compare ADC values with contralateral healthy breast parenchyma in the same patients. THE CONTRIBUTION OF MAGNETIC Materials and Methods: In our study, 17 female patients (mean age RESONANCE IMAGING IN THE 36+8; 27-57 years) with pathologically diagnosed granulomatous mastitis DIAGNOSIS OF FAT NECROSIS between 2016 and 2018 were included. This retrospective study was THAT CLINICALLY UNCLEAR AND approved by Cukurova University Department of Radiology that imaging with 3 Tesla (3T) whole body MR system (Philips Achieva) 8 channel CONVENTIONAL RADIOLOGIC breast coil. Idiopathic granulomatous mastitis ADC values were compared FEATURES ARE UNCLEAR CASES with contralateral healthy breast ADC values. On dynamic contrast imag- Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S29 ing, lesion type, shape, contrast distribution and contrast pattern, pres- Keywords: Breast cancer, thomosynthesis, ultrasonography, MRI, molecu- ence of reactive lymph nodes and presence of residual or recurrence in lar subtype the follow-up of the patient and family history were evaluated. Results: Diffusion weighted images showed significant decrease in ADC values compared to healthy breast tissue (p: 0,02). On dynamic contrast- O-084 enhanced MRI 5% of patients had mass like contrast enhancement, 52% of patient had segmental and 41% had diffuse contrast enhancement. %70 LACTATION EFFECT ON FINDINGS of patients had reactive lymph nodes. Recurrence or residual disease was OF CONTRAST-ENHANCED AND observed in eight patients (47%) after treatment. There was no significant DIFFUSION-WEIGHTED MAGNETIC difference between contrast distribution, residual disease and presence of reactive lymph nodes with ADC values. RESONANCE IMAGING IN PATIENTS Conclusion: Idiopathic granulomatous mastitis generally has non-mass con- WITH IDIOPATHIC GRANULOMATOUS trast enhancement and limited diffusion. No significant correlation was found MASTITIS between the contrast enhancement pattern and ADC value with residual dis- AYSEGUL ALTUNKESER1, FATMA ZEYNEP ARSLAN1, ease or recurrence after treatment, family history, and lymph node presence. MEHMET ALI ERYILMAZ2, MUSLU KAZIM KOREZ3 Keywords: Breast, MRI, benign disease, ADC 1Department of Radiology, Health Sciences University Konya Training and Research Hospital, Konya, Turkey 2Department of General Surgery, Health Sciences University Konya Training O-083 and Research Hospital, Konya, Turkey 3Department of Biostatistics, Selçuk University School of Science, Konya, Turkey COMPARISION OF MALIGNANT Abstract BREAST LESION SIZES ACCORDING Objective: Idiopathic granulomatous mastitis (IGM) is a benign chronic TO MOLECULAR SUBTYPES inflammatory disease of the breast, yet the etiopathogenesis is not

1 1 3 clearly understood. Lactation is considered as one of the most important ISIL BASARA AKIN , ATAKAN ARSLAN , MERIH GURAY DURAK , risk factors. We investigated the effect of lactation on the findings of 2 1 1 SULEYMAN OZKAN AKSOY , ALI BALCI , PINAR BALCI contrast-enhanced (CE)and diffusion-weighted magnetic resonance imag- 1Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey ing (DW-MRI) in IGM and aimed to identify the most observed findings. 2Department of General Surgery, Dokuz Eylül University School of Medicine, Materials and Methods: CE and DW-MRI of 40 patients with lactation history İzmir, Turkey in the last 5 years and of 35 patients reporting no lactation history had been 3Department of Pathology, Dokuz Eylül University School of Medicine, İzmir, Turkey reevaluated retrospectively. Morphological features, enhancement pattern and kinetics of lesions were assessed based on BI-RADS. The presence of diffusion Abstract restriction was evaluated and apparent diffusion coefficient (ADC) values were obtained. MRI findings depending lactation status were compared. Objective: Breast cancer is the most common cancer diagnosed in the women. The tumor size plays an important role in determining the treat- Results: Non-mass contrast enhancement (NMCE) (p<0.02), clustered ment method. The purpose of this study to compare preoperative tumor ring pattern (p<0.008) and fistula formation (p<0.035) were more fre- size measurements using digital breast thomosynthesis (DBT), ultraso- quently seen in patients with a lactation history than in patients reporting nography (US), magnetic resonance imaging (MRI) with the size of the no lactation history. Mass and NMCE combination and abscess formation were the most common MRI findings. NMCE was regional and heteroge- pathologic specimen according to molecular subtypes. neous and most of enhancement kinetics had type 2 contrast enhance- Materials and Methods: 52 patients with primary breast cancer were ment curve. Diffusion restriction was present in all of the lesions and the analyzed retrospectively between 2017 January and 2018 January. Patients mean ADC values were 0.93±0.25x10-3 mm2/s. were divided into four groups by molecular subtypes as “Luminal A”, Conclusion: Lactation status increases the incidence of NMCE, clustered “Luminal B”, “Triple (-)” and “Her2 enriched”. Size of the pathologic speci- ring pattern and fistula formation on MRI. men was chosen as the sizing reference. Wilcoxon sign rank test was used to evaluate the correlation between size of the pathologic specimen and Keywords: Idiopathic granulomatous mastitis, contrast-enhanced mag- tumor size for every imaging method. netic resonance imaging, diffusion-weighted imaging, lactation Results: Although there was no significant correlation between specimen size and the tumor sizes of DBT and US; MRI showed significant correlation for “Luminal A” molecular subtype of breast cancer. For “Triple (-)” O-085 PROBLEM SOLVING BREAST MRI and “Her2 enriched” subtypes, there was significant correlation between IS REALLY PROBLEM SOLVING? sizes of the specimen and US, DBT and MRI. Although, for “Luminal B” subtype, there was no correlation between specimen and MRI tumor size; ISIL BASARA AKIN, HANDE MELIKE HALAC, ALI BALCI, DBT and US showed significant correlation. PINAR BALCI Conclusion: In breast cancer, the size of tumor at the time of diagnosis is Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey decisive for optimal treatment planning. Breast tumors have different imag- Abstract ing findings according to molecular subtypes. In optimal treatment planning, for measuring the closest size to actual size of tumor, appropriate imaging Objective: Magnetic resonance imaging (MRI) is used as problem solving method which is suitable for molecular subtypes should be chosen. method for BI-RADS 0 lesions that are diagnosed with mammography S30 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

(MG) or ultrasonography (US) and for screening patients with family his- Conclusion: Lobular carcinomas may present as masses with irregular tory. Our purpose was to evaluate the diagnostic capacity of breast MRI shape, speculated contours, non-mass enhancement and clustered- as a problem-solving and screening method. conglomerated lesions. Despite wash out is less common in lobular carcinoma in our patients Type 3 pattern was the most common kinetic Materials and Methods: In this retrospective study, 535 women included property. This can be due to accompanying ductal component. Most that had family history or were evaluated as BI-RADS 0 in MG and US and of the lesions showed restricted diffusion. Non-mass enhancement underwent breast MRI between July 2015 and July 2017. Patients were clas- was more frequent with LCIS and speculated border was with ductal sified into two groups according to MG an US findings. BI-RADS 0 patients component. Despite we found restricted diffusion in most of the [patients with BI-RADS 0 lesions, asymmetric fibroglandular tissue (AFT) and lesions, lacking of this property does not exclude the diagnosis.MRI has dense breast tissue] were included to group 1 and patients with family story an effective role with its high sensitivity in diagnosis of invasive lobular were included to group 2. MRI findings of groups were evaluated. carcinoma and LCIS. Results: Number of patients in group 1 was 398 [217 (40.6%) AFT, 80 Keywords: Invasive lobular carcinoma, MRI findings (15%) BIRADS 0 lesion and 101 (18.9%) dense breast tissue] and in group 2 was 249 (46.5%). Fifty [8 (1.5%) malignant, 42 (7.9%) benign] patients were redirected surgery as a result of MRI. Forty of 80 patients with BI-RADS 0 lesions were directed for surgery. According to MRI findings O-087 there was no statistical significance in both groups. However, p value of statistics was 0.07 and near to statistical significance. CAN ADC BE A PROMISING MAKER OVER CURRENT BREAST MRI Conclusion: MRI is a problem solving method in patients with BI-RADS 0 on MG-US and with intense family history. Although there was no sta- PARAMETERS FOR EVALUATING tistical significance in our study, for objective evaluation in patients with BREAST MASSES? suspicious findings MRI is still a valuable diagnostic method. MESUT OZGOKCE1, NURI HAVAN2, FERHAT YUCE1, Keywords: Breast MRI, family history, BI-RADS 0 FATMA DURMAZ1 1Department of Radiology, Van Yüzüncü Yıl University School of Medicine, Van, Turkey O-086 2Kartal Koşuyolu Yüksek Ihtisas Training and Research Hospital, İstanbul, Turkey MAGNETIC RESONANCE IMAGING FINDINGS IN LOBULAR PATHOLOGIES Abstract OF BREAST Objective: The purpose of our study was to show the correlation between three of the breast magnetic resonance imaging (MRI) diagnostic LEMAN GUNBEY KARABEKMEZ1, MELTEM YILDIRIM parameters and the histopatology of breast masses and invastigate the EROL1, MELTEM CETIN 2 limitations of the MRI parameters for improving the diagnostic accuracy of the breast MRI. 1Yıldırım Beyazıt University School of Medicine, Ankara, Turkey 2Katip Celebi University School of Medicine, İzmir, Turkey Materials and Methods: 49 female patients in whom breast mass diagnosis were made and MRI was performed as a further examination Abstract technique were enrolled to this study. The morphological properties, Objective: In this study; it is aimed to discuss magnetic resonance imag- enhancement kinetics and apparent diffusion coefficient (ADC) values ing (MRI) findings of lobular type breast cancer and in situ cancer, which of the solid lesions were compared withtheir histopathological results are relatively more difficult to diagnose among breast malignancies, and prospectively. whose diagnostic accuracy is increased with magnetic resonance imaging Results: 51 lesions that were diagnosed by biopsy were included in the (MRI) in particular. study; 23 (45.1%) of these lesions were malignant and 28 (54.9%) of these Materials and Methods: We searched the 195 patients who have MRI lesions were benign. Five of 28 benign lesions (17.9%) had irregular con- and histopathological examination. Among these patients 14 with lobular tour and contours of the other 23 lesions (88.88%) were smooth. In 23 pathological diagnosis were reviewed for MRI findings. Lesions’ sizes, malignant lesions, two lesions (8.7%) had smooth border and macrolobu- morphological, dynamic enhancement properties and diffusion weighted lar shape, and contours of the other 21lesions (91.3 %) were spicular and imaging findings were evaluated. irregular. Contrast enhanced MRI was performed in 47 lesions and the Results: In the pathological evaluation:11 patients had invasive lobular accuracy of type 3 enhancement was 92% and the accuracy of type 1 was carcinoma; with some of them have invasive ductal carcinoma, lobular 100%. The ADC values of 51 lesions demonstrated a good correlation carcinoma in situ (LCIS) or Ductal carcinoma in situ (DCIS), 2 patients with the histopathology; only in one patient the ADC value calculated as had LCIS and 1 patient had lobular type mastitis. Morphological findings: 1.1x10-³ mm²/s was assessed in the benign group but the histopathology 4 irregular shaper mass, 2 speculated bordered mass, 1 microlobulated was reported as invasive ductal carcinoma (IDC) in correlation with the contour, 3 ring like enhancement, 3 non-mass enhancement, 2 conglom- morphology. erating multiple masses, 1 ring like enhancing mass. Contrast enhance- Conclusion: We believe that the combination of ADC value, lesion mor- ment patterns: 4 lesions Type2,8 lesions Type3, 1 lesion Type 1, 1 patient phological property and contrast kinetics features can provide a higher showed Type 3 (at invasive component) and Type 2 (at in situ compo- diagnostic accuracy in breast MRI. nent). When the diffusion weighted imaging properties were evaluated: 9 patients had restricted diffusion whereas 5 did not. Keywords: Breast, imaging, magnetic resonance Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S31 O-088 ment approaches are present for both lesions. T1 mapping without contrast administration (native T1 mapping) is a new MRI technique which BIRADS CATEGORIZATION AND is used for the detection of fibrosis in different studies. In this study we HISTOPATHOLOGIC CORRELATION aim to evaluate the role of native T1 mapping in the differentiation of fibroadenomas from phyllodes tumors of the breast. OF LESIONS DEFINED IN BREAST MRI Materials and Methods: Twelve patients with histopathologically proven FADIME GUVEN, SUAT EREN, AKIN LEVENT diagnosis of fibroadenomas (FA) (n=8) and phyllodes tumor of the breast Atatürk University School of Medicine, Erzurum, Turkey (PT) (n=4) were included in this study so far. Breast MRI with native T1 mapping was performed to all patients using 1.5T MR scanner before the Abstract biopsy procedure (Siemens Aera, Siemens Healthcare, Germany). Images were analyzed in offline workstation and freehand ROIs belong the FA Objective: In this study, it is aimed to compare BIRADS categorization of and PT groups were acquired. Different T1 relaxation times of both imaging features of lesions identified in mammary MRI with histopatho- groups were compared statistically. logic data. Results: Mean age of the study population was 46.7±5.6 years. Mean Materials and Methods: 120 breast MRI cases carried out in our centre calculated T1 relaxation times for FA and PT groups were 948±236 and between November 2017 and February 2018 were included in the study. 1658±563 respectively. PT group had significantly higher T1 relaxations Findings detected on MRI were recorded. Later, the results of the biopsied times compared to FA group (p<0.001). cases were correlated with the imaging findings. MRI images were obtained by means of 3 T MR (Magneto or Magnetom Avanto Skyrun A: Healtcare Conclusion: According to our preliminary results, native T1 mapping Siemens, Erlangen, Germany). T1 and T2 weighted axial, fat-suppressed T2 is proved to be useful in distinguishing fibroadenomas from phyllodes sagittal, dynamic series and diffusion weighted images were obtained. tumors of the breast. We think that different T1 relaxation times belong to FAs and PTs reflect the diverse histologic natures of those entities Results: A total of 120 cases were retrospectively reviewed. Of these, which have different portion of fibrous tissue components. Further stud- histopathologic results of the MRI findings of 55 patients with histopatho- ies with larger patient series are required to confirm our findings. logical examination were correlated. Additional focus investigations in 13 cases were aimed due to 13 BIRADS-6 lesions. In 5 cases, multifocal- Keywords: T1 mapping, fibroadenoma, phyllodes tumor multicentric breast Ca was detected. In 2 cases, additional focuses were detected on the opposite breast. There was only one focus in 6 cases, no additional focus was detected. Invasive ductal carcinoma in 11 cases, inva- O-090 sive lobular carcinoma in 2, and mixed type carcinoma in 1 were detected in 14 cases of BIRADS-5 lesions detected in MRI. Invasive ductal carci- IS THERE A RELATIONSHIP BETWEEN noma in 12 cases and inflammation-mastitis in 8 cases were detected in MIGRAINE DISEASE AND SKULL BASE 31 cases of BIRADS 4 lesions. Histopathological findings of no malignancy were reported in the remaining 11 cases. ANGLES? Conclusion: Breast MRI is an important modality in directing the treat- NESE ASAL, MEHMET HAMDI SAHAN ment approach when used in appropriate indications. Especially in deter- Department of Radiology, Kırıkkale University School of Medicine, Kırıkkale, mining multifocality-multicentricity, sensitivity and specificity of detecting Turkey chest wall invasion is high. It can also be used for screening purposes in high risk groups.However, it should be kept in mind that if there is no Abstract appropriate indication, it may lead to unnecessary anxiety and interven- Objective: The aim of the study was to determine whether there were tional procedures. variability in the skull base according to magnetic resonance images in Keywords: Breast MRI, BIRADS, Breast carcinoma migraine patients. Materials and Methods: A total of 130 magnetic resonans images, including 65 migraine and 65 control groups were retrospectively in the O-089 age range 18-50 years. Migraine patients were selected from patients who were diagnosed migraine according to the diagnostic criteria of the ROLE OF NATIVE T1 MAPPING International Headache Society (International Headache Society 2013). IN THE DIFFERENTIATION OF The study included all migraine patients and no distinction was made between subgroups. Modified basal angle, clivo-axial angle in migraine FIBROADENOMAS FROM PHYLLODES and control groups were measured by a radiologist in magnetic resonans TUMOR OF THE BREAST; images. The independent t test was used to compare between the groups. PRELIMINARY RESULTS The level of significance was set at p<0.05. In addition, basilar invagination (according to McGregor and Chamberlain line) was evaluated. MEHMET GOKTEPELI, AHMET YALCIN, ONUR TAYDAS Results: The migraine group was 13 male, 52 female (mean age of male Department of Radiology, Erzincan University School of Medicine, Erzincan, 30.38±11.5, mean age of female 32.54±9). The control group con- Turkey sisted of 15 males and 50 females (mean age of male 34.4±8.6, mean age of female 33.14±9.7). In the migraine group; the modified baseline Abstract angle average was 123.78±6.06°, and the clivo-axial angle average was Objective: Fibroadenomas and phyllodes tumors of the breast are two 142.65±8.73°. In the control group; the modified baseline angle average different entities that have to be distinguished, because different treat- was 121.6±5.5°, and the clivo-axial angle average was 153.66±6.35°. S32 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Significant differences were detected between the groups. There was no Abstract difference between the genders for both groups. In the migraine group; according to McGregor line in 3 patients and McGregor and Chamberlain Objective: MRI is successful in showing the anatomy probable line in 2 patients, basilar invagination was observed. Basilar invagination pathologies of central nervous system. However, it can be inadequate was not detected in the control group. in revealing physiologic and metabolic changes. Further MRI techniques, perfusion and permeability MRI, are the key to overcome Conclusion: Changes in the skull base angles (modified basal angle and the limitations. We intend to detect the efficacy of permeability and clivo-axial angle) are observed in migraine patients according to magnetic resonance images. perfusion MRI techniques. And also, we want to enlarge the usage of permeability MRI Keywords: Magnetic resonans imaging, migraine, skull base Materials and Methods: The patients who had a pathology result as primary brain glioma, at least one perfusion and permeability MRI study, performed before the surgery are included. Population consists of 38 O-091 patients. The permeability MRI (Ktrans, Ve), perfusion MRI values (CBV, MAGNETIC RESONANCE CBF), and pathology results are noted. The patients are classified into two SPECTROSCOPY FEATURES OF THE main groups:high and low grade. VISUAL PATHWAYS IN PATIENTS Results: High grade group consists of 22 patients, low grade group 16 patients. Patients’ age varies between 9-79years, with a mean of 46.8 WITH GLAUCOMA years. Mean CBV and CBF, median Ktrans and Ve is higher in high grade DIRENC OZLEM AKSOY1, JULIDE CANAN UMURHAN group. All parameters tend to elevate with grade, and have positive cor- AKKAN2, ALPAY ALKAN1, AYSE ARALASMAK1, HAFIZE relation. CBV >2.25, with a sensitivity and specificity of 100%, CBF >2.02, OTCU1, ISMAIL YURTSEVER1 with a sensitivity and specificity of 100%, Ktrans>0.043, with a sensitivity of 81.82%, and specificity of 100%, and Ve>0.255, with a sensitivity and 1 Department of Radiology, Bezmialem Vakıf University School of Medicine, specificity of 100% can predict high grade. İstanbul, Turkey 2Department of Ophthalmology, Bezmialem Vakıf University School of Conclusion: To conclude, perfusion and permeability MRI, can be used Medicine, İstanbul, Turkey safely for discriminating high and low-grade gliomas, and predicting glioma grades. Abstract Keywords: Permeability, MRI, glioma, grading Objective: Our aim is to investigate any metabolic changes on MRS throughout the visual pathway of the brain in patients with Glaucoma between patient and control group and correlate the results with clinical findings. Materials and Methods: 87 cases were enrolled; 30 healthy controls, 25 glau- O-094 coma, 16 glaucoma suspect (GS) and 16 ocular hypertension (OHT) patients. ANALYSIS OF ADVANCED A single voxel MRS on TE; 30 ms was performed by placing VOI on the Corpus Geniculatum Laterale (CGL) and primary visual cortex (VC). We enrolled NEURORADIOLOGICAL IMAGES BY peak values of metabolites as NAA, Cr, Cho and Ins on MRS. Thereafter, we SPM8 AND VBM correlated MRS results with age, intraocular pressure (IOP), retinal nerve fiber length (RNFL), mean deviation (MD) and cup disk ratio (CD). ILKER OZGUR KOSKA Results: NAA values obtained from CGL in glaucoma and GS cases were Ege University School of Medicine, İzmir, Turkey lower than the healthy control group. Cho values at CGL in glaucoma are Abstract lower than GS and control. There was a negative correlation between NAA values of VC and CD in glaucoma cases. Additionally, there was a negative Objective: Radiology is the seeing eye of medicine and should lead the correlation between age and RNFL in both glaucoma and GS cases. innovation. Radiologists are facing to technology more than any other branch of medicine. Unfortunately either due to non familarity or lack of Conclusion: MRS may reveal neurodegeneration in LGB and VC in interest, use of advanced softwares is generally exception among radiolo- patients with glaucoma. Depiction of metabolic changes throughout the gists. Our aim was introducing SPM and VBM which allow us voxelwise visual pathways via MRS will guide the treatment planning and follow-up analysis of images to our collegues willing to get familarity. in glaucoma and glaucoma suspect cases. Keywords: Glaucoma, visual pathway, magnetic resonance spectroscopy, Materials and Methods: Voxelwise analysis of two or more groups of corpus geniculatum laterale, visual cortex either structural MPRAGE or DTI or fMRI data were demonstrated step by step by screenshots of the process. Results: Familarity to apply voxelwise analysis methods and resources to O-092 construct the environment for such analysis are provided. PERMEABILITY MRI IN GLIOMA Conclusion: Leading the innovation and pushing thel lead further away should be one of the skills of the radiologist in order to survive in the era GRADING of field competitions and artificial intelligence thread. We should make SONAY AYDIN, ELIF ERGUN, PINAR KOSAR friends with technology and opportunities it offers. Ankara Training and Research Hospital, Ankara, Turkey Keywords: Voxelwise, spm, vbm, group analysis Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S33 O-095 flow, closed. It was compared with postoperative results in cases we reported as closed. Arachnoid cysts were classified according to MRI STUDIO, VOLBRAIN AND localization. MRICLOUD: FREE RESOURCES FOR Results: The mean age of patients was 12.2 years (age range 2-44). A PROCESSING BRAIN MRI total of 106 examinations of 63 patients were evaluated. Flow pattern in 1 patient was not evaluated optimally due to motion artifact. It was ILKER OZGUR KOSKA excluded from study. In 13 patients, cystocisternostomy stoma was noted as closed. Ege University School of Medicine, İzmir, Turkey Conclusion: 3D SPACE T2 and 3D CISS sequence in cases with cystocis- Abstract ternostomy are effective for evaluation of flow patency. Objective: Changes in volume of certain structures of brain in health Keywords: Cystocisternostomy, 3D SPACE T2, 3D CISS, magnetic reso- and disease may be measured and analysed. Also construction and visu- nance imaging, cerebrospinal fluid alisation of fiber tracts and obtaining quantitative data such as fractional anisotropy or mean diffusivity may add some benefits to our research. Our aim was providing the ways to free resources and demonstrating how to use them efficiently. O-097 Materials and Methods: MRI studio which allows construction of fiber DIAGNOSTIC VALUE OF APPARENT tracts or determine numeric values such as FA or MD or provide visuali- DIFFUSION COEFFICIENT (ADC) IN sation tools obtained from group analysis of data and allow them to be projected onto anatomical images is introduced and a pipeline for analysis DISTINGUISHING HAEMANGIOMAS is demonstrated. Also obtaining volume information of various cortical, FROM MALIGNANT VERTEBRAL subcortical and white matter structures via Volubrain and MRI cloud is LESIONS demonstrated. BEYZA NUR KUZAN, TAHA YUSUF KUZAN, Results: New opportunities for research on MRI of brain in health and disease by free resources is demonstrated step by step with accompany- RABIA ERGELEN, GAZANFER EKINCI ing screenshots. Marmara University School of Medicine, İstanbul, Turkey

Conclusion: Volbrain, MRIcloud and MRI studio are free applications Abstract which provide important tools for neuroradiological research Objective: The aim of the study was to assess the values of ADC in Keywords: Volubrain, MRI studio, brain volumes, fiber tracts vertebral haemangiomas and malign vertebral deposit in correlation with conventional MRI sequences. Materials and Methods: A total of 81 patients with vertebral O-096 metastasis in 33 and vertebral haemangioma in 48 on abdominal MRI at our unity between January 2016 and Agust 2017 were ret- FLOW EVALUATION WITH 3D SPACE rospectively evaluated in this study. All imaging procedures were T2 AND 3D CISS SEQUENCES IN performed at 1.5T and 3T MRI scanners. The vertebral lesions cat- CASES WITH CYSTOCISTERNOSTOMY egorized as an malign deposit or haemangioma on conventional MRI sequences. To investigate the association between ADC values and IN 3T MRI lesion types, ADC values of malign deposits and the haemangioma AYDAN ARSLAN1, MURAT BASARIR2, MEMET OZEK2, were compared between the two groups. Mann-Whitney U test ALP DINCER1 between the two groups were performed. Discriminative values of ADC for haemangioma and malign deposit were assessed using 1Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School ROC curves analysis. of Medicine, İstanbul, Turkey 2Department of Neurosurgery, Acıbadem Mehmet Ali Aydınlar University Results: Mean ADC values were higher in the haemangioma group School of Medicine, İstanbul, Turkey (1.22906×10-6mm2/s±29.34) than the malignant group (0,42994×10- 6mm2/s±29,03) (p<0.01). There was a statistically significant dif- Abstract ference between mean ADC of haemangiomas and malign lesions in 1,5T and 3T MR, respectively (p<0.01, p<0.01). There was no Objective: This study aimed to evaluate stoma and flow patency with statistically significant difference in the mean ADC of vertebral hae- 3D SPACE T2 and 3D CISS sequences in cases with cystocisternostomy mangiomas on 1,5T and 3T MRI (p=0.85). Similiarly, there was no in 3T MRI. statistically significant difference in the mean ADC of malign deposit Materials and Methods: Sixty two patients (23 female, 39 male) on 1,5 T and 3T MRI (p=0.85). The best cutoff values for mean ADC with endoscopic cystocisternostomy who underwent 3T MRI units were 0,956×10-6mm2/s. The AUC was 0.95 with 83.3% sensitivity and to determine flow patency between 2007 and January 2018 were 93.9% specificity. reviewed retrospectively. The examination was evaluated together Conclusion: First, there is statically mean ADC difference in the haeman- with the patients previous examinations. Primarily,flow and function giomas and malign deposit. Second, there is no difference haemangiomas in cystocisternostomy stoma, preoperative and postoperative arach- and malign deposit mean ADC values on 1.5T or 3T MRI. noid cyst volume difference and postoperative complications were evaluated. Findings were classified as open and functional, minimal Keywords: Haemangioma, ADC, malign deposit S34 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

O-098 with postnatal (1st year) imaging findings. Exclusion criteria were non- diagnostic image quality of the fbMRIs. The mean gestational age of the UNUSUAL CEREBELLOPONTINE fetuses was 28.4 weeks at the time of the fetal MRI. The images were ANGLE MASS: MRI FINDINGS GUIDE retrospectively analyzed by two experienced radiologists in consensus. Results: Twenty-six cases were included in this study. For postnatal imag- NESRIN ERDOGAN, MURAT UCAR, NIL TOKGOZ ing 19 of them had TFUS, 6 had brain CT, and 5 had brain MRI. 3 cases Department of Radiology, Gazi University School of Medicine, Ankara, Turkey had normal pre and postnatal brain imaging findings. 15 cases had central nervous system anomalies (CNS) in the fbMRI and normal postnatal brain Abstract imaging findings. CNS anomalies in the fbMRI and postnatal brain imaging Objective: Imaging is necessary to make differential diagnosis of cerebel- were the same for 6 cases. 2 cases had additional anomalies in the post- lopontine angle masses (CPA), describe extent of lesions and effect to natal brain imaging. The most common pathologies on the fbMRIs were cranial nerves, planning to surgery. Menengiomas and vestibular schwan- ventriculomegaly (VM) (n=12), mega cisterna magna (n=3), and choroid nomas are most common lesions. However some rare masses, only plexus cysts (n=2). Of the 12 cases with VM, 10 had normal postnatal account for less than 1% each, like cavernoma, metastasis, chordoma, imaging findings. vascular lesions like aneurysm or paraganglioma can occur that location. Conclusion: Although fbMRI is a well-established and widely used valu- The aims of this presentation are characterization and differentiation able prenatal imaging, it has shortcomings. Therefore, the clinicians should of unusual CPA masses with computer tomography (CT) and magnetic be notified about the potential cases that have postnatal follow-up imaging resonance imaging (MRI). indication. Materials and Methods: CPA is subarachnoid space, centered by internal Keywords: Fetal brain magnetic resonance imaging, central nervous sys- auditory canal contains cranial nerves (from 5. cranial nerve to 9. Cranial tem anomalies, postnatal brain imaging, transfontanel ultrasound nerve) and associated vessels. CPA lesions cause similar symptoms according to effect of cranial nerves and vascular structures related to mass effect, so preoperative diagnosis is possible only by imaging and unusual lesions are challenging to diagnose. O-0100 Results: CT and MRI are the modalities of choice for diagnosis of CPA 3T MR ANGIOGRAPHIC EVALUATION lesions. It is important to begin with assessment of its intra or extra-axial OF WILLIS POLYGON VARIATIONS origin to narrow the differential diagnosis. CT attenuation, adjacent bone reaction, signals characteristics at conventional and advanced MRI tech- USING VOLUME RENDERED-3D niques and contrast enhancement are key imaging features to differentiate IMAGES these lesions. After that we need to describe to origin location of masses, skull base or cistern. DILEK SEN DOKUMACI, SUNAY SIBEL KARAYOL Department of Radiology, Harran University School of Medicine, Şanlıurfa, Conclusion: Radiologist plays major role to diagnose CPA masses, espe- Turkey cially unusual ones. Contrast enhancement, shape, and origins with CT, conventional MRI and data from advanced technique like diffusion-weight- Abstract ed imaging (DWI) and perfusion imaging, it is easy to evaluate CPA lesions. Objective: To evaluate the Willis polygon variations using 3T MR angiog- Keywords: Cerebellopontin angle, cisternography, internal auditory canal raphy volume-rendered 3D (VR-3D) images. Materials and Methods: We retrospectively reviewed the cranial MR angiography (CMRA) images of 153 patients who were referred to our O-099 radiology clinic between January 2017 and February 2018 for various ini- COMPARISON OF FETAL BRAIN MRI tial diagnosis such as headache, stroke. The axial images obtained with the TOF-3D-multislab method were transferred to a separate workstation. AND POSTNATAL BRAIN IMAGING Volume-rendered 3D (VR-3D) images were created for each patient on FINDINGS: WHERE DID WE GO this workstation using 3D software (Synapse, Fuji Medical Systems, Tokyo, Japan). These images and axial slices were analyzed for variations as pos- WRONG? terior communicating artery (PcoA) hypoplasia / aplasia, anterior cerebral UMIT AKSOY OZCAN, SILA ULUS, DENIZ MUTLU, artery (ACA) A1 segment hypoplasia / aplasia, fetal posterior cerebral EZGI AYDIN, CEM DEMIRKIRAN, ALP DINCER artery (FPCA), infundibular dilatation of PcoA, anterior communicating artery (AcoA) variations and other rare variations. Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey Results: The mean age of the patients was 36.65±21.70 (aged 1-79), 70 Abstract (45.8%) were female and 83 (54.2%) were male. Initial diagnosis included headache in 50%, stroke in 26%, epilepsy in 5.2%, aneurysm in 2.6% and Objective: To compare fetal brain magnetic resonance imaging (fbMRI) ptosis and vasculitis in lesser proportions. 75 patients (49.01%) had a com- with the postnatal brain imaging findings (transfontanel ultrasound plete Willis polygon. 22.3% of the patients had unilateral and 22.9% had (TFUS), MRI, computed tomography (CT)) and to demonstrate the bilateral hypoplasic / aplasic PcoA. Unilateral hypoplasic / aplasic A1 was strengths and shortcomings of fbMRI in the clinical management of the observed in 14.3% of the patients. FPCA was unilateral with 12.4% and neonatal period. bilateral with 5.2%. In addition, infundibular dilation of PcoA in 4 patients, Materials and Methods: In this retrospective institutional review board H-shape AcoA in 3 patients, Y-shaped AcoA in 1 patient and fenestration (IRB) approved clinical study, we analyzed fbMRIs and included fetuses in different localizations in 4 patients were detected. Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S35

Conclusion: CMRA images are widely evaluated with 3D MIP images. showed the fatty infiltration of muscles at different levels. The aim of this VR-3D images along with CMRA images can be used to evaluate Willis study was to compare the paravertebral muscle volumes at convex and polygon variations. concave sides and to analyze the relationship between the Cobb angles and the paravertebral muscle volumes among patients with type I ASI. Keywords: 3T MRI, Willis polygon, volume rendered Materials and Methods: The magnetic Resonance Imaging (MRI) studies of the 24 patients having a diagnosis of type I ASI with a Cobb angle O-0101 lower than 25 ° from January 2015 to January 2018 were retrospectively included in the study. Measurements were done at at the level of the api- MRI FEATURES AND ASSOCIATED cal vertebra, upper end vertebra, and lower end vertebra. ANOMALIES OF TETHERED CORD Results: 12 of the patients demonstrated thoracic convexity to the right and SYNDROME 12 of the patients showed thoracic convexity to the left. The mean Cobb angle of the major thoracic curve was 22,21°.When the mean paravertebral MESUT SIVRI1, MEHMET SEDAT DURMAZ2 muscle volumes at convex and concave sides were compared, it only showed significant difference at lower end vertebra level (p=0.01). There was a 1Department of Radiology, Health Sciences University Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey negatively (r=-0.31, p≤0.05) correlation between the Cobb angle and the 2Department of Radiology, Konya Health Sciences University Training and paravertebral muscle volume at concave side. There was also a good positive Research Hospital, Konya, Turkey correlation at the lower end vertebra level on convex side (r=0.78, p≤0.05). Conclusion: Our results suggested that muscle volumes could be affected Abstract among patients with type I ASI. Objective: Tethered cord syndrome (TCS) is a congenital childhood dis- Keywords: Magnetic resonance imaging, paraspinal muscles, scoliosis ease, which can also be seen in adults. If it is isolated, named as the primer, if accompanied by other anomalies, named as the secondary TCS. The aim of this study was to describe magnetic resonance imaging findings and accompanying anomalies with TCS of 240 patients. O-0103 Materials and Methods: MRI examination and associated anomalies of 1P36 DELETION SYNDROME: 240 patients with TCS were evaluated retrospectively between 2012 and 2017. Pediatric and adult age groups were assessed separately also. NEURORADIOLOGIC FINDINGS Results: There were 114 pediatric and 126 adult patients. The female SAFAK PARLAK1, EKIM GUMELER1, GULEN EDA UTINE2, to male ratio was 2,2 (74 male, 166 female). The mean age was 25 KADER KARLI OGUZ1 years. The most frequent localization level of the conus was L4 (22%). 1Department of Radiology, Hacettepe University School of Medicine, Syringohydromyelia was found in 91 patients (37%), diastematomyelia in Ankara, Turkey 85 patients (35%), lipoma in 29 patients (12%), myelomeningocele in 25 2Department of Pediatric Genetics, Hacettepe University School of Medicine, patients (%10), lipomeningomyelocele in 3 patients (1%), dermal sinus in Ankara, Turkey 24 patients (10%), perinoeural cysts in 18 patients (7%), hemivertebrae in 16 patients (7%) and butterfly vertebra in patients (4%). Abstract Conclusion: TCS is a complex syndrome may be associated with spinal Objective: 1p36 deletion syndrome is the most common subtelomeric abnormalities. MR is very useful in the evaluation of the TCS, identify chromosomal deletion syndrome, with an estimated incidence of 1/5000- accompanied lesions and evaluate associated bony dysraphisms. 1/10000 at birth. Beside skeletal, genitourinary, gastrointestinal and cardiac anomalies patients often have severe neurological deficits. Diagnosis is Keywords: Magnetic resonance imaging, spinal dysraphism, tetheret cord syndrome suggested by clinical findings like characteristic facial appearance, global developmental delay and confirmed by detection of deletion of the most distal band of the short arm of chromosome 1(1p36). In previous studies O-0102 polymicrogyria and periventricular nodular heterotopia have been linked to critical regions within 1p36. In this study we present the neuroradio- PARAVERTEBRAL MUSCLE VOLUMES logic analysis of our cases of 1p36 deletion syndrome. WITH TYPE I ADOLESCENT Materials and Methods: We evaluated retrospectively MR examinations IDIOPATHIC SCOLIOSIS PATIENTS of patients with 1p36 deletion syndrome confirmed with genetic analysis who were followed up and treated by our Pediatric Genetic Department. SERMIN TOK UMAY1, HULYA ASLAN2 Results: The study group consisted of 9 patients (F/M: 7/2) with a mean 1Department of Radiology, Dumlupınar University School of Medicine Evliya age of 17 months (min/max: 0.5/51months).We detected hypoplasia of Celebi Training and Research Hospital, Kütahya, Turkey 2Department of Radiology, Başkent University Faculty of Medicine Adana the corpus callosum in all patients, abnormal multifocal T2 patchy signal in Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey cerebral white matter in 7 patients (77%), ventriculomegaly in 7 patients (77%), enlargement of subarachnoid space in 5 patients (55%), delayed Abstract myelination in 2 patients (22%), cerebral atrophy in 1 patient and basioc- cipital hypoplasia in 1 patient. 2 patients (22%) had bilateral frontoparietal Objective: Adolescent idiopathic scoliosis (AIS) is the most common and perisylvian polymicrogyria. abnormality effecting spine in pediatric patients. Muscle imbalance has been suggested as a factor affecting the static and dynamic mechanical Conclusion: Neuroimaging reveals bilateral polymicrogyria, hypoplasia of the properties. Previous studies including patients with high Cobb angles corpus callosum, ventriculomegaly and abnormal patchy T2 hyperintensities S36 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 in the cerebral white matter. In patients with characteristic facial appearance, 1Department of Radiology, Ondokuz Mayıs University School of Medicine, global developmental delay, neurological deficits and bilateral polymicrogyria, Samsun, Turkey 1p36 deletion syndrome should be included in differential diagnosis. 2Department of Pulmonary Medicine, Ondokuz Mayıs University School of Medicine, Samsun, Turkey Keywords: 1p36 deletion syndrome, magnetic resonance imaging, poly- 3Boğaziçi University, Institute of Biomedical Engineering, İstanbul, Turkey microgyria Abstract Objective: Previous diffusion tensor imaging (DTI) studies showed axonal O-0104 and myelin damage in multiple white matter (WM) fibers in patients with severe obstructive sleep apnea (OSA). However, it is not clear whether PERFUSION MRI OF PRIMARY there are WM changes in OSA people with moderate disease. The aim CENTRAL NERVOUS SYSTEM of this study is to investigate microstructural WM abnormality using DTI LYMPHOMAS; WHAT PERFUSION in untreated and newly diagnosed moderate OSA patients. GRAPHICS TELL US? Materials and Methods: The study included in 21 moderate OSA patients (5 females, 16 males, mean age: 44.3±7.6 yr, mean AHI: 21.3 HAKAN CEBECI, YAHYA PAKSOY events / hour) and 21 age and sex matched controls, (16 males, mean age: 45.1±8.1 y). Following DTI, tract-based spatial statistics (TBSS) were Department of Radiology, Selçuk University School of Medicine, Konya, Turkey used to investigate differences in fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD) Abstract between the moderate OSA patients and control group. Objective: Differentiation of malignant brain tumors using MRI is still a Results: Compared with the control group, TBSS showed significant challenging problem in routine clinical practice. Primary central nervous ADC reduction in corpus callosum, corona radiata, internal / external system lymphomas (PCNSL) and glioblastomas (GB) may show similar capsule, and superior longitudinal fasci- ulus in patients with moderate imaging features in conventional MRI. Perfusion MRI is adjunctive tool for OSA (p<0.05). Compared with the control group, in addition to ADC evaluating brain tumors. DSC perfusion MRI is the mostly used perfusion reductions in white matter in moderate OSA patients, FA decrement and MRI technique for brain tumor characterization. Diagnostic utility of con- RD increment were detecded in extensive white matter tracts including trast leakage patterns in DSC perfusion MRI is shown in brain neoplasms. cerebral peduncle, posteior thalamic radiations, fornix, superiorfronto- The aim of this study was to analyze rCBV values of PCNSLs and GBs and, occipital fasciculus and sagittal stratum. Additionally FA reductions were also evaluate perfusion graphics in DSC perfusion MRI. also observed on middle cerebellar peduncle, tapetum and corticospinal tract (p<0.05). There was no difference in AD values between the con- Materials and Methods: A retrospective study was performed includ- trol group and moderate OSA patients (p>0.05). ing 21 patients with 26 brain tumor lesions. Mean rCBV of tumor core and peritumoral region in 13 PCNSL and 13 GB lesions were evalu- Conclusion: In our study, we showed an injury in the white matter tracts ated. Perfusion graphics were generated from ROIs placed in solid and/ that regulate memory, attention, respiratory, autonomic, cognitive, and or enhancing part of tumor and peritumoral T2 hyperintense region. emotional functions in the patients with moderate OSA. The results of Perfusion curves were classified as returning to baseline, T1 dominant this study showing the increase in RD values without any AD change sas- contrast leakage and T2* dominant contrast leakage. The curve types sociated with loss of myelin integrity in moderate OSA patients suggests were compared with histology. that myelin is more affected than axons and susceptible to hypoxia in moderate OSA patients. Results: Mean rCBV of tumor core in PCNSLs and GBs were 1.59 and 3.11 respectively. Mean rCBVof peritumoral areas in PCNSLs and GBs Keywords: Obstructive sleep apnea, diffusion tensor imaging, tract-based spatial were 0.67 and 0.98 respectively. Nine lesions showed T1 dominant leak- statistics, fractional anisotropy, apparent diffusion coefficient, radial diffusivity age, 4 lesions showed a curve patern of returning to baseline, and 13 lesions showed T2* dominant leakage. Conclusion: Tumor core and peritumoral regions show higher rCBV val- O-0106 ues in GBs. T1 dominant leakage is predominantly seen in PCNSLs. This may be a useful sign for differentiation PCNSLs from GBs. DIAGNOSTIC CONTRIBUTION OF Keywords: Perfusion, glioblastoma, lymphoma SUSCEPTIBILITY-WEIGHTED IMAGING IN CENTRAL NERVOUS SYSTEM SUPERFICIAL SIDEROSIS O-0105 BUNYAMIN GUNEY1, YUSUF KENAN CETINOGLU2, MICROSTRUCTURAL WHITE MATTER IBRAHIM ONDER YENICERI1, NESAT CULLU1 ABNORMALITIES IN PATIENTS WITH 1Department of Radiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey MODERATE OBSTRUCTIVE SLEEP 2Department of Radiology, İzmir Katip Celebi University Atatürk Training and APNEA: A DIFFUSION TENSOR IMAGING Research Hospital, İzmir, Turkey STUDY USING TBSS ANALYSES Abstract KERIM ASLAN1, AYGUL GUZEL2, HEDIYE PINAR GUNBEY1, Objective: Superficial siderosis (SS) is a rare condition defined as hemo- ONUR OZYURT3, LUTFI INCESU1 siderin deposition along the leptomeninges in the superficial layers of the Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S37 brain as a result of recurrent subarachnoid hemorrhage. This study aimed and 0.029, respectively) in the group 2. In the analysis of the differ- to investigate the contribution of SWI to the diagnosis of SS and to deter- ences between group 1 and 2 we found increase of FA in the right ILF mine underlying causes of it. (p=0.053), and AD in the right FWM (p=0.021). Materials and Methods: T2-weighted turbo spin-echo (TSE) and SWI Conclusion: We concluded that in comparison of two CT regimens in images of 16 patients with SS were evaluated retrospectively. Distribution, NSCLC, WM changes like axonal degeneration and de-/dysmyelination involvement pattern, the possible etiological cause of SS were reviewed may be more prominent in the fasciculi involving executive and cognitive on both T2-weighted TSE and SWI images. Diagnostic performance of functions in patients who received Cisplatin. T2-weighted TSE and SWI images were compared in the light of literature. Keywords: Cancer chemotherapy protocols, carboplatin, cisplatin, diffu- Results: SS pattern was diffuse in 14, focal in 2 patients. The localization sion tensor imaging, lung neoplasia of SS was limited in posterior fossa in 6, supratentorial compartment in 9 patients. One patient had involvement on both sides. A total of 16 patients, the cause of SS was found as vascular pathologies in 4, cerebral amyloid angiopathy (CAA) in 5, prior brain surgery in 2, brain metastasis O-0108 in 1, methotrexate treatment in 1, and neurocysticercosis in 1. The cause CAN UNENHANCED MRI BE of SS in two patients was not found. SS along with the leptomeninges in 616(37.5%) and parenchymal microhemorrhages in all CAA patients AN ALTERNATIVE FOLLOWING (31.2%) were only seen on SWI images. SWI also showed one devel- INCIDENTALLY DISCOVERED opmental venous anomaly and one cavernous malformation in separate patients which have not been seen in T2-weighted TSE images. MENINGIOMA Conclusion: SWI is an essential MRI technique for determining the pres- IBRAHIM ONDER YENICERI, NESAT CULLU, ence of SS and its spread. It may also be useful in detecting microhemor- BUNYAMIN GUNEY rhage and additional vascular anomalies. Department of Radiology, Muğla Sıtkı Koçman University School of Keywords: Susceptibility weighted imaging, superficial siderosis, MRI, Medicine, Muğla, Turkey Hemorrhage Abstract Objective: Incidentally discovered small meningiomas are usually followed. O-0107 Contrast enhanced CT and MRI are generally used in imaging for meningiomas. In the last time, There are some concerns about the use of gadolinium- EVALUATION OF TOXIC EFFECTS based contrast agents. The purpose of this study is to investigate whether there is a difference in measurement between contrast enhanced T1W and OF CHEMOTHERAPY IN NON-SMALL the T2W series in MRI. Contrast-enhanced MRI images of 30 consecutive CELL LUNG CANCER ON CEREBRAL meningioma patients (20 female, 10 male, 33-85 years, mean 64.1 years) WHITE MATTER USING DIFFUSION were evaluated by two independent radiologists. Meningioma sizes were measured as three dimensions by each observer in contrast T1A and T2E TENSOR IMAGING (DTI) sequences. The average volume was calculated from the three-dimensional SINEM AYDIN1, HACI MEHMET TURK2, TARIK DEMIR3, measurement with the formula AxBxCx0.52. Interobserver (contrast ALPAY ALKAN1, HAFIZE OTCU1, EZGI COBAN3 enhanced T1W and T2W) and intersequensiel correlations were performed for each observer from the calculated volumes. 1Department Radiology, Bezmialem Vakif University School of Medicine İstanbul, Turkey 2Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Results: Two observers were found to have an average meningioma size İstanbul, Turkey of 10.43 cm3 (0.15-148). The p value was 0.995 (p <0.01) between con- 3Department of Medical Oncology, Bezmialem Vakif University School of Medicine, trast enhanced T1W and T2W series for the first observer and 0.997 (p İstanbul, Turkey <0.01) between contrast enhanced T1W and T2A series for the second observer. The interobserver r value for both T2W series and T1W series Abstract were calculated to be 0.994. Correlations were quite good. Objective: Examination of cerebral white matter alterations caused by Conclusion: If the use of gadolinium is concerned, even if the renal func- chemotherapy (CT) in non-small cell lung cancer patients using DTI. tion is borderline or abnormal, kidney functions are normal even in cases Materials and Methods: Patients are divided into three groups according to of meningioma planned for follow-up (previously known), unenhanced the received chemotherapy regimen: patients who took Cisplatin (group1), imaging follow-ups can be discussed as an alternative if side effects of using Carboplatin (group 2), and the other medications (group 3). Patients were multiple contrasts are to be avoided scanned with a 1.5T MR equipment. Regions of interest along the following localizations were drawn bilaterally for evaluation of FA and ADC: inferior Keywords: Meningioma, follow-up, unenhanced MRI longitudinal fasciculus (ILF), superior longitudinal fasciculus, forceps minor (FM), anterior thalamic radiation, anterior corona radiata, external capsule, inferior fronto-occipital fasciculus, genu and splenium of corpus callosum, O-0109 cerebral white matter in frontal (FWM) and parieto-occipital regions (PWM). AD, MD and RD indices were calculated using eigenvalues. PATTERNS OF HEMORRHAGE OF Results: In the analysis of pre-and postCT DTI data of the group 1, there RADIATION NECROIS IN BRAIN was a significant increase in FA value of the right ILF. (p=0.028). There EKIM GUMELER, EMRE UNAL, RAHSAN GOCMEN was significant change in FA and RD values of the right FM (p=0.025 and p=0.017, respectively), and AD and MD values of right FWM (p=0.006 Hacettepe University School of Medicine, Ankara, Turkey S38 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Abstract Materials and Methods: 131 healthy fullterm infants prospectively examined with CS through the anterior fontanelle on coronal and sagit- Objective: To investigate the patterns of hemorrhage encountered on tal images by two radiologists. 46 fullterm infants brain retrospectively susceptibility-weighted imaging (SWI) in patients with radiation necrosis examined with MRI by a neuroradiologist. (RN) affecting brain parenchyma. Results: The mean value of the genu, body, splenium and AP diameter Materials and Methods: SWI images of patients who were diagnosed with RN of CC was 4,8 mm, 3 mm, 4.4 mm, 43.54 mm on CS and 4.5 mm, 2.9 between 2010 to 2017 were included in the study. The patients had received mm and 4.3 mm, 42.39 mm on brain MRI, respectively. The mean value radiotherapy due to brain or head/neck tumors. The diagnosis of RN was of the BP, BV, third, right and left LV was 87.2 mm, 24.57 mm, 2.35 mm, made based on histopathological findings or by the lesion course on follow-up 1.48, 1.48 on CS and 87.76 mm, 22.65 mm, 2.4 mm, 1.8 mm, 1.9 mm on imaging. Only SWI sequence was used for detecting hemorrhage. MRI, respectively. Results: Twenty-six lesions were detected in 21 patients. The indications Conclusion: Routine morphometric measurements have not compared for radiotherapy were brain metastasis (n=8), high grade glial tumor with CS and MRI yet. In our study, both techniques significantly permit (n=5), low grade glial tumor (n=4), head/neck malignancies (n=3), and safe and multiple serial scans to evaluate intracranial structures (p<0.001). squamous cell carcinoma of the scalp (n=1). The mean time interval between RN and radiotherapy was 15.5 months (range, 3-84 months). Keywords: Cranial sonography, brain MRI, morphometric measurement The mean follow-up was 20.4 months (range, 1-84 months) following the diagnosis of RN. Petechial hemorrhages were found extending from center to periphery of the lesion with ring appearance on SWI images O-0111 in twenty-two lesions (85%). In the remaining four lesions we detected nonspecific nodular foci of hemorrhage. SPINAL FRACTURE Conclusion: Differentiation of RN from tumor progression could be CHARACTERISTICS IN challenging. We found a unique hemorrhage pattern on SWI images ANKYLOSAN SPONDYLIT AND THE that could be characteristic for RN. We consider that this pattern of CONTRIBUTION OF MR IMAGING hemorrhage occurs as a consequence of perivenular petechial hemorrhages which are reported to be encountered in patients with RN in the FATMA CAN, FATIH DUZGUN, GULGUN YILMAZ OVALI, literature. However, further studies investigating the imaging differences SEBNEM ORGUC, YUKSEL PABUSCU between the patients with RN and histologically proven tumor recur- Department of Radiology, Manisa Celal Bayar University School of rence, are warranted to support our results. Medicine, Manisa, Turkey Keywords: Radiation necrosis, hemorrhage, brain Abstract Objective: Susceptibility to weak trauma has increased due to severe O-0110 ankylosis that occure at the spine in Ankylosing spondylitis. The trauma affects the anterior-medial and posterior vertebral column due to MORPHOMETRIC STUDY OF the change of mechanical load distribution on the spine. We aimed to describe the fracture patterns and the contribution magnetic resonance BRAIN STRUCTURES IN FULL- imaging of ankylosing spondylitis trauma cases in our study. TERM NEONATES BY CRANIAL Materials and Methods: Computed tomography (CT) and magnetic SONOGRAPHY AND MAGNETIC resonance (MR) images of 16 ankylosing spondylitis patients which with RESONANCE IMAGING archived recorded trauma history were evaluated. Localization of fractures, affected bones and joints were classified. Spinal cord injury, pres- 1 2 BILAL EGEMEN CIFCI , GOKCEN COBAN , ence of epidural hemorrhage, and ligament rupture associated with frac- CENK ERASLAN2 tures were evaluated on MR images. Data were analyzed using SPSS 18. 1 Department of Radiology, İzmir Atatürk Training and Research Hospital, Results: In 16 male patients, the most frequent cervical region (43%), the İzmir, Turkey second most affected thoracic region (31%), 43% of the cases were listesis 2Department of Radiology, Ege University School of Medicine, İzmir, Turkey developed and 75% had the entire anterior-mid-posterior vertebral column. Fractures of the facet joints were most detected in the posterior column Abstract fractures (68%). It was seen that 5 of 8 cases with vertebra corpus fracture Objective: Cranial sonography (CS) was introduced into neonatology in were in the cervical region. In cases of compression fracture, the cervical and the 1970s, the non-invasive nature of ultrasonography makes it an ideal thoracic regions are affected by 94% more. CT and MR examinations were imaging technique. The ability to be performed at bed side without dis- performed in 50% of the cases. 37% cord pressure, 31% myelopathy, 37% turbing infants and other is produce images without radiation. Structural ligament damage and 25% epidural hemorrhage were determined. brain abnormalities and intracranial findings in premature infants are rou- Conclusion: Fractures affecting the Vertebra corpus in Ankylosing spon- tinely evaluated on CS. However, routine morphometric measurements dylitis, extending into the posterior elements and take in the whole ver- are uncertain in full-term healthy infants. The aim of this study was to tebral column. Ankylosing spondylitis fractures are instable, and therefore evaluate and compare the normal morphometric measurements of third, CT imaging is important to define the localization of the fractures, MR right and left lateral ventricles (LV), biventricular (BV) diameter, diameter imaging is important to define spinal cord injury and epidural hematoma. of the genu, body, splenium of corpus callosum (CC), anteroposterior (AP) diameter of CC and bipariatal (BP) diameter with CS and magnetic Keywords: Ankylosing spondylitis, trauma, computed tomography, mag- resonance imaging (MRI). netic resonans imaging Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S39

O-0112 Abstract THE MESENCEPHALONE INDEX Objective: Since the end of the 1980s, gadolinium-based contras agents (GBCAs), which are commonly used as contrast agents in magnetic reso- CONTRIBUTION TO DIFFERENTIAL nance (MR) imaging systems, have been reported to cause accumulation DIAGNOSIS OF PARKINSONISM in tissues, primarily the kidneys. Although linear nonionic (Gadodiamide) SUBGROUPS GBCAs were reported to play a role in multiple organ toxicity, it has been reported in recent studies that macrocyclic ionic (Gadoteric acid) GBCAs CEMIL OKTAY1, S. SIBEL OZKAYNAK2, ESMA ESEROGLU also cause toxicity in tissues. Under the light of this information, we aimed AKSU3, KAMIL KARAALI1 in this study to investigate histopathological and immunohistochemical effects of linear nonionic and macrocyclic ionic GBCAs on the spinal 1Department of Radiology, Akdeniz University Hospital, Antalya, Turkey cord connecting the central nervous system and the peripheral nervous 2Department of Neurology, Akdeniz University Hospital, Antalya, Turkey system. 3Department of Public Health, Gazi University School of Medicine, Ankara, Turkey Materials and Methods: In the study, 32 male Sprague dawley rats were Abstract used and were divided into four groups. No attempt was made to the Objective: Early distinction between parkinsonian disorder subgroups is healthy control group (Group 1). Serum physiologic 0.2 ml/kg was applied important because of differences in prognosis and treatment response. on the serum physiologic group (Group 2). After applying the contrast An accurate method for the diagnosis is needed. The purpose of our agent to the Gadodiamide group (Group 3) and Gadoteric acid group study was to assess morphologic changes of brainstem in the evaluation (Group 4) for five weeks with 0.2 ml/kg for four days a week from the of parkinsonian disorders. tail vein, the groups were left untreated for five weeks. At the end of the tenth week, the rats were anesthetized, and samples were taken from Materials and Methods: MRI of 14 patients with possible PSP, 43 patients the spinal cord. Measurements of gray-white ore areas in hematoxylin with PD, 8 patients with probable MSA-P, and 45 age-matched controls and eosin-stained spinal cord incisions after fixation (10% formalin) and were recruited in this retrospective study. Diagnoses were confirmed clin- routine histological follow-up were performed by two blinded histopa- ically. The pons area (P), mesencephalon area (M), middle peduncle width thologists who were not at the tissue tracing stage. The data obtained (MCP), superior peduncle width (SCP), and peduncle angle (PA) were by measurement of 40 different fields in each incision were evaluated by measured from T1-MPRAGE images. In additon to this the P/M ratio, one-way ANOVA and Duncan test. p<0.05 was considered significant for MCP/SCP ratio, the previously defined MR Parkinsonism Index [PI=(P/M). all measurements. (MCP/SCP)] and also index that we termed the Akdeniz Index was calculated [AKI=(P/M).(PA/180)]. Two blinded radiologists evaluated all MR Results: Control group neurons and oligodendrocytes cells were observed images. Interrater and interobserver variations were also measured. to be in normal structure. Perikaryons of neurons and oligodendrocytes cells were observed to be normal in the serum physiological group Results: There was a statistically significant difference among the three samples. In the samples of Gadodiamide and Gadoteric acid groups, peri- groups. Further statistical evaluations showed that significant difference was karyons and oligodendrocytes were present in typical structure and no due to results of PSP and PD patients. M and SCP were significantly smaller pathology was found. in PSP patients than PD patients otherwise P/M ratio, MCP/SCP ratio and PA were significantly larger in patients with PSP. PI and AKI indices were signifi- Conclusion: Repeated use of GBCAs does not cause pathological findings cantly higher in the PSP group than in the PH and MSA groups. When PI and in the spinal cord tissue of rats. These findings do not differ according to the chemical composition of the contrast material (linear or macrocycles). AKI were compared, similar sensitivity and specificity values were obtained. Keywords: Gadolinium-based contras agent, linear, macrocycles, spinal cord Conclusion: AKI ande PI can help distinguish patients with PSP from those with PD. However, because of the easy of measurement and the higher agreement between measurements, we believe that the use of AKI is appropriate. O-0114 Keywords: Parkinsonian disorders, PSP, progressive supranuclear palsy POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME O-0113 FOLLOWING BONE MARROW TRANSPLANTATION HISTOPATHOLOGICAL AND GULHAN ERTAN IMMUNOHISTOCHEMICAL ANALYSIS Department of Radiology, Medipol University School of Medicine, İstanbul, OF THE EFFECTS OF MAGNETIC Turkey RESONANCE CONTRAST AGENTS ON THE SPINAL CORD TISSUE OF RATS Abstract Objective: Following bone marrow transplantation (BMT), severe 1 2 FATMA BEYAZAL CELIKER , TOLGA MERCANTEPE , neurological complications are significant causes of morbidity and ARZU TURAN1 mortality. In children, hematologic diseases (esp. Acute leukemia), 1Department of Radiology, Recep Tayyip Erdoğan University School of renal disorders, and cytotoxic drugs increase posterior reversible Medicine, Rize, Turkey encephalopathy syndrome (PRES) prevalence. The limited literature 2Department of Histology and Embryology, Recep Tayyip Erdoğan University of PRES in pediatric allogenic BMT patients reports a prevalence of School of Medicine, Rize, Turkey 5.2%. S40 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

The aim of our study is to determine the prevalence of (PRES) in mm in the patients with T2 hyperintens white matter lesions. The patients with neurological complications following BMT performed diameter of temporal horn was detected 2,3 mm in normal patients. in our hospital and correlate this entity with clinical and radiological Nonspesific T2 hyperintense white matter lesions might be a sign of findings. early aging of the brain. Materials and Methods: We retrospectively evaluated cranial CT and Keywords: Aging, T2 hyperintense white matter lesions, cranial magnetic MR images 24/150 pediatric patients with neurological complications resonance imaging who received BMT in our hospital between January 2014-February 2018. Results: In 8 out of 24 patients with post-BMT neurological complica- O-0116 tions, (7 males and 1 female; average=15.2 years) PRES neuroradiological findings were present. In Table 1, clinical and MRI findings are THE USEFULNESS OF summarized. In literature, seizure symptoms are more frequent in the SUSCEPTIBILITY WEIGHTED pediatric group of PRES cases. In our cohort symptoms of seizure were diagnosed in 5 of 8 post-BMT cases along with severe headache IMAGING FOR THE DIAGNOSIS in 3 of 8. Hypertension with correlating MRI finding was present in AND EVALUATION OF THIS 7 of 8 cases. In the first 400 days following BMT, the prevalence was SEQUENCE WITH THE OTHER reported as 20%. In our study, PRES was clinically and radiologically diagnosed in 7 cases in the first 100 days and in 1 case on the 120th SEQUENCES day after BMT. In cranial MRIs, holohemispheric involvement was SEMA AKSOY1, SAFIYE TOKGOZ OZAL2 observed in 3 of 24 patients, parieto-occipital in 5 of 24, cerebellar in 1 3 of 24, and brain-stem in 1 of 24. Hemorrhage was present in 2 of Private Hospital 34, İstanbul, Turkey 2 24. Contrast enhancement in 2 of 24. There was no diffusion restric- Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Turkey tion excluding cytotoxic edema in all our cases, in keeping with the Abstract reported literature cases. Objective: My aim is to search the role of the susceptibility weighted Conclusion: In hemato-oncologic diseases, especially when hypertension, imaging (swI). I also searched the role of the other sequences. change in consciousness, or seizure is present, PRES should be considered, and appropriate supportive care should not be delayed to prevent perma- Materials and Methods: There were 108 cranial imaging (Siemes Era, nent neurological sequelae. Erlangen, Germany) of the patients with the ages of 0-92. Keywords: Bone marrow transplantation, PRES, seizure Results: There were 8 new lesion with hemorrhage or calcification. I cannot detect 3 of them in the other sequences. Four of them (grater than 4 mm) were detected in the b0 of diffusion weighted O-0115 imaging and T2 wighted imaging. One lesion (a capiilary telangiecta- sia) was only detected swi and T1 imaging after contrast material. COMPARISION OF THE DIAMETER Conclusion: Swi is useful for the detection of the lesions with calcification OF TEMPORAL HORN OF LATERAL or hemorrhage especially lesser than 4 mm. VENTRICULE IN THE PATIENTS Keywords: Swi, cranial magnetic resonance imaging, diffusion WITH T2 HYPERINTENSE WHITE MATTER LESIONS TO NORMAL O-0117 PATIENTS SEMA AKSOY ROLE OF PERITUMORAL APPARENT DIFFUSION COEFFICIENT VALUES Private Hospital 34, İstanbul, Turkey IN DIFFERENTIAL DIAGNOSIS OF Abstract GLIOBLASTOMA FROM SOLITARY Objective: Our aim is to compare temporal horn of lateral ventricule of METASTASIS the patients with nonspecific T2 hyperintense white matter lesions to the normal patients. MUSTAFA MAHMUT BARIS, AHMET PEKER, NURI KARABAY Materials and Methods: There were 40 patients (28 female and 12 male patients between the ages of 30-49) with cranial magnetic resonance Dokuz Eylül University School of Medicine, İzmir, Turkey imaging (Siemens; Era, Erlangen, Germany). Their neurological examinations were normal. Abstract Results: There were T2 hyperintense white matter lesions in the cranial Objective: It is often difficult to differentiate a solitary brain metastasis from glioblastoma based on conventional magnetic resonance imaging of 23 patients. Seventeen patients had no abnormal lesion in the (MR) imaging characteristics alone. On the other hand, some features gray and white matter. like peritumoral edema volume and mass effect can be used in differ- Conclusion: The diameter of temporal horns were calculated as the ential diagnosis. Pathological researches showed that there are malign average of two horns. The mean value of temporal horn was 2,6 tumor cells in peritumoral edema of glioblastom, while there is none Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S41 in peritumoral edema of metastasis. Based on this information, we was 0.79. Values were found respectively 0.808, 0.75, 0.76 between LC-MM; can expect that “apparent diffusion coefficient” (ADC) values may 0.589, 0.83, 0.40 between LC-BC; 0.634, 0.50, 0.92 between GIS-MM; 0.818, differ in peritumoral area of glioblastoma and metastasis. The pur- 0.83, 0.69 between GIS-BC and 0.884, 0.95, 0.75 between MM-BC. pose of our study to evaluate the effect of peritumoral ADC values Conclusion: In terms of differential diagnosis of the ITSS percentages in differential diagnosis. measured in the SWI sequence, the diagnostic performance was very Materials and Methods: We retrospectively reviewed MR images good between MM-BC, good between MM-LC, GIS-LC and GIS-BC, and of patients with glioblastoma (n=26) or metastasis (n=18). Only poor between LC-BC and GIS-MM. Percentages of ITSS has high sensitiv- patients with intra-axial supratentorial solitary metastatic lesion were ity and specificity values to make a differential diagnosis between GIS-LC, included to metastasis group. ADC values measured in peritumoral GIS-BC, MM-BC and MM-LC area (adjacent to tumor border) in three different location using Keywords: SWI, malign melanoma, brain metastases, hemorrhage region of interest (ROI) in 1 cm diameter and mean values were calculated. Additionally, cerebrospinal fluid (CSF) ADC values were measured with same ROI for correction. Statistical analyses were performed with SPSS 15. O-0119 Results: Mean peritumoral ADC values were found 1.1x10-3 mm2/sn in ABSENT NIGROSOME 1: DIAGNOSTIC glioblastoma group and 1.4x10-3 mm2/sn in metastasis group. Mean corrected values (peritumoral ADC/CSF ADC) were 0.38 in glioblastoma ACCURACY IN PARKINSON DISEASE group and 0.11 in metastasis group. There was statistically significant dif- AYSE NUR SIRIN OZCAN1, EBRU BILGE DIRIK2 ference between two groups in corrected ADC values (p=0.001). 1Department of Radiology, Ankara Atatürk Training and Research Hospital, Conclusion: Measurement of peritumoral ADC values may contribute Ankara, Turkey to the differential diagnosis of solitary brain metastasis from glioblastoma. 2Department of Neurology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey Keywords: Apparent diffusion coefficient, glioblastoma, metastasis, differential diagnosis Abstract Objective: Newly recognised anatomic structure called nigrosome 1 include intense dopaminerjic neurons and absent in Parkinson disease O-0118 (PD) bilaterally or unilaterally was depicted especially in 7 Tesla MRI researchs. We aim to demonstrate diagnostic accurancy of absent nigro- ASSESSMENT OF HEMORRHAGE some 1 on substantia nigra in PD at 3 Tesla. AND PARAMAGNETICAL SUBSTANCE Materials and Methods: 46 subject including 26 healty control and 21 ACCUMULATION IN BRAIN parkinson disease enrolled to the study. All subject underwent MRI scan METASTASES BY SUSCEPTIBILITY include susceptibility weighted imaging (SWI) in addition to conventional WEIGHTED IMAGING (SWI) sequences. SWI sequence was obtained parallel to the fourth ventricle. Results: All healty control subject except one subject was showed nigro- ABDURRAHMAN GOLBASI, ISMAIL SALK some 1 bilaterally. In PD group 1 patient showed bilateral nigrosome 14 Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey showed controlateral absent nigrosome and in 6 patient showed absent nigrosome bilaterally. Absent nigrosome 1 showed high sensitivity and Abstract specificity in PD diagnosis (p<0.05). Objective: It has been reported that differential diagnosis of cerebral Conclusion: Altough PD diagnosis was based on clinical findings newly metastases can be made by evaluating intratumoral susceptibility signals recognised anatomic structure nigrosome 1 could be used in PD diagnosis (ITSS) in susceptibility weighted imaging (SWI). In our study, we aimed to in controversial cases. make a differential diagnosis of cerebral metastases by measuring the ITSS in the SWI sequence. Keywords: Nigrosome, parkinson disease, SWI Materials and Methods: In our study, MRI images were acquired from 77 patients between October 2012 and October 2017 with intracerebral metastases (23 patients with breast carcinoma (BC), 4 patients with malig- O-0120 nant melanoma (MM), 42 patients with lung cancer (LC) and 8 patients A COMPARATIVE STUDY ON with gastrointestinal adenocancer (GIS)) at 1.5 T MRI in our unit. On contrast-enhanced T1 weighted images, all enhancing lesions were carefully MAGNETIC RESOANCE VENOGRAPHY delineated and the outline transferred to the coresponding SWI images. On WITH T2SPACE SEQUENCE MRI SWI images, the number of the pixels containing ITSS and the number of the pixels of entire lesion were recorded. The reference value to determine KARABEKIR ERCAN, BURAK YAGDIRAN pixels containing ITSS was the average intensity value of the lateral ventricle. Ankara Atatürk Training and Research Hospital, Ankara, Turkey Subsequently, the ITSS percentages of all metastases were calculated. Abstract Results: ITSS percentages in metastases were found 22.52% in LC, 47.61% in GIS, 11.85% in BC and 60.75% in MM. When the diagnostic value of ITSS Objective: The relationship between MR venography MRI using TOF percentages were compared in between tumor types, the area under the (time of flight) sequence and T2Space sequence MRI technique was curve between LC-GIS was 0.734, the sensitivity was 0.61 and the specificity investigated in this study. S42 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Materials and Methods: 37 patients with the clinical preliminary nar and 4 of them were band heterotopia group, 1 had both nodular diagnosis of sinus vein thrombosis who applied to the radiology and laminar koponent. There were additional anomalies in 5 of the clinic evaluated 55 intracranial sinus veins. The hypoplasia of the vein, patients. 2 of them had polymicrogri-pachygly, 2 of them had schizen- hypoplastic vessel diameters, determine to the thrombotic vessel and cephaly and corpus callosum agenesis and only one had corpus cal- thrombosed vessel diameters were investigated by two radiologists. losum agenesis. Six of the heterotopic gray matter foci were located Statistical analysis was performed using SPSS after the data were in the periventricular white matter, 11 in the subepandimal wall, and collected. 4 in the subepandimal wall and periventricular white matter. Nine of the cases had both hemispheres and 12 had single hemispheres. Results: There was no significant difference between two tests with McNemar test in vessel hypoplasia study. The hypoplastic vessel Conclusion: Heterotopes may be clinically asymptomatic; but may cause diameters were analysed by Student-T test and no statistical differ- epilepsy, developmental delay, and mental retardation. These patients ence was found (p=0.519). There was no significant difference in the need to be recognized by radiologists. analysis of dependent groups by the McNemar test in the thrombo- Keywords: Heterotopia, MRI, gray matter sis detection study (p=0.375). There was no significant difference between the two tests with Wilcoxon test to finding thrombosed veins.There was no significant difference between the T2Space and MR venogram tests in the measurement of thrombosed vessel diam- O-0129 eters. There was significant correlation between two tests (p=0.001). PRELIMINARY STUDY: WHAT IS T1 Conclusion: There was no significant difference between T2Space TIME MEASUREMENT IN PATIENTS sequence and MR venogram obtained with TOF MRI technique in the hypoplastic vein, the detection of the thrombotic vein and thrombotic and WITH NORMAL CONVENTIONAL non-thrombotic vessel diameters. There was no superiority between two CORONARY ANGIOGRAPHIC MRI sequences. According to the obtained results, both MRI technique EXAMINATION BUT ISCHEMIC can be used instead of each other. SYMPTOMS? Keywords: Sinus vein thrombosis, T2space, venography, MRI SAFIYE SANEM DERELI BULUT1, FUAT NURILI3, BURAK OZTURKERI2, YASAR BUKTE1 O-0128 1Department of Radiology, University of Health Sciences University Umraniye Research and Training Hospital, İstanbul, Turkey EVALUATION OF GRAY MATTER 2Department of Cardiology, University of Health Sciences University Umraniye Research and Training Hospital, İstanbul, Turkey HETEROTOPIES WITH MRI IN THE 3Department of Radiology, Memorial Sloan-Kettering Cancer Center, PEDIATRIC AGE GROUPS İstanbul, Turkey Abstract HUSEYIN ALPER KIZILOGLU, RECEP SADE, MECIT KANTARCI Objective: To evaluate the possible changes in myocardium with native T1 mapping method in patients with normal coronary angiog- Atatürk University School of Medicine, Erzurum, Turkey raphy examination but with chest pain and positive exercise stress Abstract tests. Objective: Gray matter heterotopes are neuronalmigration disorder Materials and Methods: Cardiac MR examinations were performed in that describe the abnormal location of cortical neurons. We aimed to 1.5 tesla MR machine (OPTIMA MR 450, GE) for 20 patients with isch- determine gray matter heterotopes causing epilepsy, developmental emic symptoms but normal conventional coronary angiography between retardation and mental retardation in children by magnetic resonance December 2016 and June 2017. Myocardial T1 maps were acquired by imaging (MRI) examination, and classification possible additional mal- SMART T1 (saturation method using adaptive recovery times for cardiac formations. T1 mapping) in short-axis orientations. Native T1 times were evaluated manually. Patients with any additional (amyloidosis, DM, hemochromatosis, Materials and Methods: In our center, brain MRIs of the cochleas evaluated cardiomyopathies) disease that may affect myocardial native T1 time of with the pre-diagnosis of epilepsy, mental retardation and developmental study were excluded. The age range of the patient is between 22-56 years retardation between 2013-2017. Conventional MRI images were obtained and the average age is 40 years. with a 1.5 T or 3-T MR device (MagnetomAvantoorMagnetomSkyra: Siemens Healtcare, Erlangen, Germany). Patients were studied by obtain- Results: On short axis images obtained from the apical, midventricular, ing spin echo T1AG, T2AG and FLAIR (fluid attenuated inversion recov- and basal levels, it was noted that the T1 time was significantly higher ery) AG images on axillary, coronal and sagittal planes with coils suitable than normal myocardium as a result of manual measurements made to for the imaging table. General anesthesia was applied to some age groups 17 cardiac segments. for imaging. Conclusion: Patients with positive exercise stress tests and chest Results: A total of 400 cases pre-diagnosed with epilepsy, mental pain but with normal conventional coronary angiography examina- retardation and developmental delay were reviewed. Gray matter tion shows myocardial tissue T1 time prolongation. In these patients, heterotopy was detected in 21 cases (5%). 10 of them were male, even if fibrosis with late myocardial enhancement is not observed 11 of them were female. The cases were between 1-18 years of age in myocardium, early treatment and close monitoring should be (mean age 6.5 years). 13 of them were nodular, 3 of them were lami- applied. Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S43 O-0130 heterogeneity is associated with the focal dimension of the foci and at the same time the sequence may be an important diagnostic tool in the INVESTIGATION OF EFFECTIVENESS diagnosis of venous anomalies. IN DETERMINING HEMORRHAGE, Keywords: Pediatric neuroimaging, susceptibility weighted imaging, para- CALCIFICATION AND VASCULAR magnetism, diamagnetism ANOMALIES IN MRI OF CHILD BRAIN WITH ADDING SUSCEPTIBILITY O-0131 WEIGHTED IMAGING TO CONVENTIONAL SEQUENCES QUANTITATIVE ANALYSIS OF HEALTHY LIVER AND KIDNEY USING KEMAL CAGLAR TUNA, FATMA CEREN SARIOGLU, MUHAMMET SALMAN, YASIN ERTUG CEKDEMIR, A NATIVE T1 MAPPING IN CHILDREN HANDAN GULERYUZ SERCIN OZKOK, AHMET ASLAN, MINE ASLAN, AYSENUR Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, BUZ Turkey Department of Radiology, İstanbul Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey Abstract Objective: To investigate the efficacy of adding SWI sequence to con- Abstract ventional sequences in pediatric brain imaging to demonstrate calcific or Objective: T1 mapping is a technique to quantify tissue T1 relaxation time hemorrhagic focus and abnormal venous structures, the usage areas of for assessing fibrosis of organs. The purpose of this study is to determine SWI in pediatric patients, the characteristics of SWI signals, sequence- native T1 relaxation times of liver and kidney in healthy children with specific artifacts and pitfalls. MOLLI T1 magnetic resonance imaging(MRI). Materials and Methods: We retrospectively examine the images of Materials and Methods: Healthy subjects referred for abdominal pediatric patients who had pathologic signal foci on SWI sequence, with MRI were examined with MOLLI T1 sequence. Native T1-maps different pre-diagnosis MRI between 31.07.2017 and 22.01.2018. The were acquired in a single axial slice through liver and coronal slice foci are classified as homogeneous paramagnetic, primer paramagnetic, through kidneys. Reference values were recorded with region of homogeneous diamagnetic and primer diamagnetic. Classification of interest measurements by two radiologists for assessing interob- lesions as calcification or hemorrhage was made in the context of CT server reliability. and conventional MR images, medical history and clinical information including laboratory, pathology results. These foci have been investi- Results: Mean native T1 values for liver were 709.47±126.54 and gated in conventional sequences. The focus higher than 100 HU on CT 691.43±80.02 msec, for right kidney cortex(RKC) were 1111.33±170.19 were accepted as gold standard for calcification. Descriptive statistical and 1178.63±192.71 msec, for right kidney medulla (RKM) were methods were used to classify the data. Chi-square test was used for 146786±177.58 and 1441.88±258.64 msec, for left kidney cortex agreement of conventional sequences and SWI. Chi-square test was (LKC) were 1174.81±207.18 and 1501.54±254.64 msec, for left kid- used to compare the calcific foci observed on CT with conventional ney medulla (LKM) were 1508.57±182.99 and 1166.04±180.14 msec, sequences and SWI. In the chi-square test, values below P <0.05 were respectively. Interobserver reliability was good for liver measurements considered to be statistically significant. (ICC: 0.512), were moderate for RKC and LKC and LKM (ICC: 0.772, 0.705, and 0.684, respectively), and excellent for LKM (ICC:0.89) with Results: On SWI images 287 hypointense focuses were found. 135 of statistically significant differences (p<0.05 for all parameters). There these foci were classified as diamagnetic or calcification, 149 as para- were no significant correlation between age, body mass index (BMI) magnetic or hemorrhagic focus, and 13 as vascular anomaly. There are and T1 relaxation times. 6 signal changes on T1 WI, 11 signal on T2 WI and 7 signal on FLAIR the presence of foci that support calcification. Totaly 13 (approx. 9.6%) Conclusion: T1 mapping is a reliable method for assessing pediatric liver of the 135 diamagnetic focus were appeared in conventional sequences. and kidney parenchyma without using a contrast media and may be used There are 19 signal changes on T1 WI, 20 signal on T2 WI and 15 signal as a diagnostic tool to distinguish between normal variants and pathologi- on FLAIR the presence of foci that support hemorrhagi. Twenty-five cal conditions. (approx. 16.7%) were selected on conventional sequences from a total Keywords: T1 mapping, children, liver, kidney, pediatric T1 mapping of 149 signal changes. Only one of the vascular anomalies observed in thirteen patients on the conventional sequences was showed. There are 143 calcification focus on CT images. On SWI this was 135. Eight calcified foci could not be distinguished on SWI. A Chi-square test was O-0132 used to compare the efficacy of SAG-added conventional sequences in detecting calcification with the efficacy of conventional sequences only ASSESSMENT OF BRAIN DIFFUSION- in detecting calcification, and the p value was found to be 0.001. The WEIGHTED IMAGES AT 3 TESLA MRI signal is more heterogeneous proportional to the increasing dimension IN CHILDREN WITH NEPHROTIC on phase images. SYNDROME, PRELIMINARY RESULTS Conclusion: We observed that on SWI calcification or bleeding products have significant determined, because of the nature of hemorrhagi focus DILEK SEN DOKUMACI1, SUNAY SIBEL KARAYOL1, FERIT may be heterogeneous, involve some artifacts and have been shown DOGAN2, KENAN YILMAZ3 S44 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

1Department of Radiology, Harran University School of Medicine, Şanlıurfa, 20 patients (43.5%) and CT images were obtained in 9 patients (19.6%). Turkey Along with the findings of MRCP and CT, ERCP were performed under 2Department of Radiology, Sanlıurfa Children’s Hospital, Şanlıurfa, Turkey an intention to treat in eleven patients (23.9%). Seventeen patients 3 Department of Pediatric Nephrology, Şanlıurfa Children’s Hospital, (36.9%) were followed up with USG and recovered in a short time, and Şanlıurfa, Turkey no further imaging was performed. Upper abdomen MR-MRCP and CT images revealed 75.9% pancreatic thickening, 48.3% parenchymal Abstract heterogeneity-T2AG signal increase. Additionally images showed peripan- Objective: To compare ADC values obtained from different regions of creatic dirty fat tissue in 72.4%, peripancreatic collection in 58.6%, and brain parenchyma in normal children with children with nephrotic syn- intraabdominal ascites in 48.2% of the patients. MRCP and CT findings drome (NOS) via brain diffusion-weighted images. explained the stones in the biliary tract and/or pancreatic duct in 24.1%, dilated biliary ducts in 27,6%, and dilated pancreatic ducts in 34.5% of the Materials and Methods: This prospective study was planned from January patients. Pseudocyst formation occurred in 2 patients (6.9%). 2017 to July 2017 with 15 children with a mean age of 10.8±2.3 (7-15) who were diagnosed with nephrotic syndrome at the pediatric nephrol- Conclusion: The comprehensive assessment of pancreatitis is based on ogy clinic and 15 healthy children of the same age group that accepted as clinical, laboratory and imaging evaluation. MRI is an excellent noninvasive a control group. We performed non-contrast brain MR and diffusion MR modality to detect and to stage the severity of inflammatory processes. examinations with 3T MRI scanner (Magnetom Skyra, Siemens Healthcare, The development of complications of pancreatitis such as hemorrhage, Erlangen, Germany) in both groups. Brain MRI scans were evaluated for pseudocysts, abscesses, and venous thrombosis are well-demonstrated by parenchymal lesions. The diffusion images obtained with b0 and b1000s/ MRI which is an inalienable radiological modality by the clinicians. mm2 were analyzed with 0.25 cm² ROIs for ADC measurements bilaterally Keywords: Pancreatitis, MR cholangiography, children from perirolandic white matter, anterior and posterior centrum semiovale, anterior and posterior corona radiata, periatrial white matter, internal capsule anterior and posterior limbs, corpus callosum genu and splenium, mesencephalon, dorsal and ventral pons, caudate nucleus, putamen, thalamus, O-0134 cerebellar white matter and dentate nuclei. ADC values were compared for differences between the NOS group and the control group. COEXISTENCE OF PERSISTENT Results: There was a significant difference between the ADC values FALCINE SINUS AND VARIOUS measured from right internal capsule, left perirolandic white matter, left CLINICORADIOLOGICAL thalamus, left cerebellar dentate nuclei (p<0.05 for all). The ADC values CONDITIONS: MRI FINDINGS in these regions were lower in the patient group. MEHMET H. ATALAR1, BULENT YILDIZ1, R NURI SENER2 Conclusion: Nephrotic syndrome, as a primary renal pathology, may also cause diffusion changes in some areas of the brain parenchyma. Further 1Department of Radiology, Cumhuriyet University School of Medicine, Sivas, research with more patients is needed to better define this issue. Turkey 2Department of Radiology, Ege University School of Medicine, İzmir, Turkey Keywords: Nephrotic syndrome, 3T MRI, DWI Abstract Falcine sinus is a rare variation of the venous pathway between the O-0133 dural layers of the falx cerebri, and it is a normal anatomic structure that typically closes before birth. Persistent falcine sinus (PFS) extremely rarely THE UPPER ABDOMEN MR-MR occurs in isolation from sinus thrombosis and congenital anomalies. PFS is CHOLANGIOGRAPHY AND CT associated with absent or hypoplastic straight sinus. PFS has been widely reported in pediatric patients. In the literature, it has been reported FINDINGS OF THE CHILDREN WHO that persistent falcine sinus may coexist with various conditions including HAD PANCREATITIS atretic parietal encephalocele, galen vein malformations, arteriovenous malformations, corpus callosum agenesis, osteogenesis imperfecta, acro- AYSEL UNLUSOY AKSU, BETUL EMINE DERINKUYU cephalosyndactyly, dysplastic or absent tentorium cerebelli, bilateral giant Dr. Sami Ulus Children Hospital, Ankara, Turkey parietal foramen, and Chiari type II malformation. In this presentation, we aimed to report the MRI findings of 16 patients with various pathological Abstract conditions accompanying the rarely encountered PFS. Five patients had atretic parietal encephalocele, 3 had arteriovenous malformation, 1 had Objective: The study aims to evaluate the imaging findings of children total corpus callosum anomaly, 1 had osteogenesis imperfecta, 1 had clo- with pancreatitis, especially MR cholangiography. verleaf skull anomaly, 1 had cerebellar hypoplasia, 1 had Apert syndrome, Materials and Methods: The upper abdomen MR-MRCP and CT images 1 had focal gray matter heterotopia, and 1 had Chiari type II malformation. of the children who had pancreatitis between 2008-2018 in the pediatric One patient had isolated PFS. The patients had an age range of 1 month gastroenterology clinic of Dr. Sami Ulus Children’s Hospital were retro- to 15 years. Nine patients were male and 7 were female. Five patients spectively reviewed. underwent MR venography examination in addition to conventional MRI. MR imaging, particularly with the help of sagittal images, greatly helps for Results: The mean age of the 46 patients who were diagnosed with making the diagnosis of PFS, and it can also detect most of the underlying pancreatitis was 10,5 years (2-17,5) and 52,1% were male. 22.2% of the malformations. It should be remembered that PFS may coexist with many patients had recurrent episodes of pancreatitis (≥2). The most common different clinical conditions. etiologies were 39% idiopathic, 13% stone, 10,9% infection, 10,9% congenital anomaly, 6,5% drug, 6,5% trauma, 6,5% dyslipidemia, 6.5% other Keywords: Anomalies, brain, magnetic resonance imaging, persistent were noted. Upper abdominal MR-MR cholangiography was performed in falcine sinus Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S45

O-0138 Materials and Methods: Sixty-four patients who underwent MRI both with unenhanced steady-state free precession (SSFP) and contrast- “PULMONARY VEIN SIGN” IN enhanced 3-dimensional gradient echo (3D-GRE) sequences for sus- PATIENTS WITH SUSPECTED pected PE constituted the study population. The PVS was defined as the presence of > 2 cm hypointense filling defect in a pulmonary vein. Two PULMONARY EMBOLISM ON observers who were unaware of the patients clinical findings and final MAGNETIC RESONANCE IMAGING diagnosis (PE +/-) assessed images for the presence of PVS by consensus. Diagnostic performance of PVS was calculated using patients final diag- 1 2 1 FURKAN UFUK , FURKAN KAYA , PINAR CAKMAK , ERGIN noses for PE as reference. In addition, presence of pleural effusion and 1 1 SAĞTAŞ , AHMET BAKI YAĞCI atelectasis-linear bands were investigated. 1 Department of Radiology, Pamukkale University School of Medicine, Results: Forty-one patients (64%) had a final diagnosis of PE. The PVS Denizli, Turkey was detected in one patient (2.4%) on 3D-GRE and 6 patients (14.6%) on 2Department of Radiology, Afyon Kocatepe University School of Medicine, SSFP. Sensitivity, specificity, accuracy, positive and negative predictive values Afyonkarahisar, Turkey of PVS on SSFP were 15%; 95.8%, 45.3%, 85.7%, and 40.3%, respectively. Abstract A statistically significant correlation was found between atelectasis-linear bands and presence of PE (p=0.011, r=0.313) . Objective: In pulmonary embolism (PE), hypodense filling defect in pulmonary veins due to decreased perfusion on computed tomography Conclusion: We suggest that presence of PVS and atelectasis-linear band on MRI may contribute the diagnosis of PE in patients with suspected PE, angiography was defined as “pulmonary vein sign (PVS)“. Herein, we especially in unenhanced MR images. aimed to evaluate PVS for PE diagnosis in magnetic resonance imaging (MRI) sequences. Keywords: Pulmonary vein sign, embolism, MRI Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S46

Poster Presentations Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S47

P - 01 Abstract Lipoma is the most common soft tissue tumor of body. It is usually located ROLE OF ARFI IN DIFFERENTIAL in proximal extremities, trunk, shoulders etc. Paratesticular localisation is very DIAGNOSIS OF ENDOMETRIUM rare, there is only a few cases in the literature. The most common paratesticu- PATHOLOGIES lar mass is hernia and spermatic cord lipoma is usually diagnosed incidentally during hernia operation. In some cases spermatic cord lipoma may be the 1 1 2 HALIME CEVIK , BIRNUR YILMAZ , TEVFIK BERK BILDACI , only finding without accompanying hernia during the surgery. Spermatic 2 GULDENIZ DESTELI cord lipoma can be diagnosed with ultrasound and magnetic resonas imaging 1 Okan University School of Medicine Hospital, İstanbul, Turkey (MRI). In ultrasound examination, like most fatty lesions, lipomas are usually 2 Başkent University School of Medicine İstanbul Hospital, İstanbul, Turkey hyperechoic which is neither sensitive nor specific. Other benign masses like hernia or malign lesions like sarcoma, can also be echogenic. MR imaging can Objective: To show contribution of ARFI in distinguishing endometrium be helpful in diagnosis, showing high signal intensity similar to subcutaneous cancer and other pathologies from each other and in detecting myome- fat. Especially in coronal and sagittal views, it has a well demarcated superior trium invasion, in cases with bleeding complaints. wall and there is no connection with the peritoneum. While inguinal hernias Materials and Methods: Our study was prospectively performed with containing mesenteric fat extend to ward mesentery medially or laterally 45 cases of hysterectomy decision in 41-91 years (mean 58.3 years) age to the inferior epigastric vessels without distinct superior wall. Cord lipoma range. Pathology revealed 14 cases of endometrial atrophy, 11 cases of may cause inguianl hernia symptoms and patient may end up with unneces- secretory and proliferative phase, 10 cases of polyp, 6 cases of endome- sary hernia surgery. So MRI has significant role to diagnose spermatic cord trial hyperplasia and 4 cases of endometrium cancer. Independent sample lipoma. Lipoma is the most common paratesticular neoplasm and although it T test was used for comparison of ARFI values. can occur other places with in the scrotum, it most often originate from the spermatic cord. We present here a case of spermatic cord lipoma presented Results: Minimum, mean and maximum ARFI values were found to be as a palpable mass lesion in the scrotum with MRI findings. 2.72 m/s, 3.09 m/s and 3.45 m/s for atrophy, 3.37 m/s, 3.80 m/s and 4.22 m/s for endometrial proliferation, 2.60 m/s 3.02 m/s and 3.43 m/s for Keywords: Inguinal swelling, spermatic cord lipoma, scrotal MRI polyp, 3.68 m/s, 4.02 m/s, 4.36 m/s for hyperplasia and 2.57 m/s, 2.98 m/s and 3.4,0 m/s for cancer, respectively. There is a statistically significant difference between the mean of the minimum, mean and maximum P - 03 ARFI values of the two groups with atrophy and proliferation and with hyperplasia and polyp (p<0.05). There is a statistically significant differ- GIANT UTERINE LEIOMYOMA ence between average of the minimum, mean and maximum ARFI values TORSION AND ASSOCIATED UTERINE of the two groups in which endometrial hyperplasia and atrophy were detected (p<0.01). There is a statistically significant difference between TORSION: MRI FINDINGS the average of the minimum and mean ARFI values of the two groups FURKAN UFUK, HUSEYIN GOKHAN YAVAS with endometrial polyp and proliferation (p<0.05). There was no statisti- Pamukkale University School of Medicine, Denizli, Turkey cally significant difference between the average of minimum, mean and maximum ARFI values of dual groups of polyps and atrophy, cancer and Abstract atrophy, hyperplasia and proliferative endometrium, cancer and polyp, Uterine torsion is an unusual cause of acute abdominal pain and it can cancer and hyperplasia in endometrium. No statistically significant differ- be seen in pregnancy but torsion of non-pregnant uterus is a very rare ence was detected in the average of minimum, mean and maximum ARFI condition. It may cause irreversible ischemic changes and life-threatening values of cases with and without endometrial cancer. conditions. To prevent these complications, early and correct diagnosis Conclusion: As a result, the ARFI contributes to the differential diagnosis is of great importance. Computed tomography and magnetic resonance of benign pathologies such as hyperplasia, polyps and atrophic endometri- imaging are successful methods for prompt diagnosis in suspected cases. um causing bleeding like cancer in the postmenopausal period. However, Also, these methods can guide the surgeon. The aim of this study was to it is insufficient in differentiating cancer, atrophy and other pathologies evaluate the clinical and imaging findings of a non-pregnant patient diag- from each other. nosed with uterine torsion. Keywords: Endometrial cancer, ARFI, elastography, ultrasonography Keywords: Myoma, torsion abnormality, uterine neoplasms, magnetic resonance imaging, computed tomography

P - 02 P - 04 A RARE CAUSE OF INGUINAL SWELLING; SPERMATIC CORD AN UNUSUAL CASE: LIPOMA TRANSDIAPHRAGMATIC RUPTURE OF HEPATIC HYDATID CYST DILAN ECE GEYLAN, NESRIN ERDOGAN, BERRAK BARUTCU, ALI YUSUF ONER KEVSER ESMERAY CIFCI, AYTUL HANDE YARDIMCI, CEYDA TURAN BEKTAS, ESMA AKTUFAN Department of Radiology, Gazi University School of Medicine, Ankara, Turkey İstanbul Training and Research Hospital, İstanbul, Turkey S48 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Abstract was also considered. Transvaginal and transabdominal ultrasonography showed heterogeneous formation without flow to color Doppler in left We present a rare case of right sided huge hydatic cyst with transdia- tubal topography with intrauterine live embryo. In addition, hemorrhagic phragmatic rupture to the right hemithorax. In this case with huge multipl free fluid was observed in the pelvic region. Magnetic resonance imaging hepatic hydatid cysts, acute respiratory complaints had developed. Thorax revealed a heterogeneous formation in the left adnexal region, a gravid CT and contrast enhanced abdomen MRI showed right athelectasis and consolidation in lung basal segments and right sided extensive pleural uterus with a live embryo and some internal cystic focal spots. A prompt effusion and air images in the cyst. The huge cyst at the dome of the laparotomy revealed a ruptured left ampullary pregnancy, and salpingec- liver was transdiaphragmatically ruptured to the right hemitoraks and tomy was performed. Although rare, heterotopic pregnancy should be the small defect on cyst wall and diaphragma was seen. There are few considered in the differential diagnosis of abdominal pain in pregnancy. similar examples in the literature. Blunt trauma and large diameters of Every physician treating women of reproductive age should bear in mind the cyst are the risk factors for rupture, it can also be spontaneously. the possibility of heterotopic pregnancy not only in patients with predis- Transdiaphragmatic rupture of hydatid cyst can cause anaphilactic shock posing risk factors but also in those without them. or ordinary respiratuar complaints. In such cases, percutaneous drainage Keywords: Heterotopic pregnancy, abdominal pain, intraabdominal hem- with oral albendazole is a successful treatment option. orrhage Keywords: Transdiaphragmatic, rupture, hydatid cyst P - 07 P - 05 A RARE CASE: ZINNER’S SYNDROME DIFFUSE LARGE B-CELL LYMPHOMA: NEVIN KOREMEZLI KESKIN1, HAKAN KELES1, MASSIVE ABDOMINAL INVOLVEMENT OZER BARAN2 EMIN DEMIREL, ERANIL ASLAN, IBRAHIM SULKU, 1Department of Radiology, Karabük Training and Research Hospital, CIGDEM OZER GOKASLAN Karabük, Turkey 2Department of Urology, Karabük University Training and Research Hospital, Department of Radiology, Afyon Kocatepe University School of Medicine, Karabük, Turkey Afyonkarahisar, Turkey Abstract Abstract Introduction: Zinner’s syndrome is a rare condition which consist of semi- Diffuse large B cell lymphoma (DLBCL), a subtype of non-Hodgkin’s nal vesicle cysts, ipsilateral renal agenesis and ejaculatory duct obstruction. lymphoma (NHL)accounting for 30%-40% of adult NHLs, according to In this case report, we aimed to present the imaging findings of 40-year- the World Health Organization’s (WHO) classification.The patient was a old male with Zinner’s syndrome. 48-year-old man who had chief complaint weight loss and anorexia. He was admitted to the hospital due to fatigue, night sweating and cough. Case Report: A 40-year-old man with nonspecific complaints was referred Imaging findings are bilateral renal medulla involvement, extensive retro- for routine ultrasonography by the urology clinic. Ultrasonography peritoneal lymph nodes, widespread paroaortic involvement that envelop- revealed absence of left kidney and cystic dilatations in left seminal ing left ureter. The massive involvement consist of perisplenic, periportal, vesicle. Renal agenesis was confirmed with contrast-enhanced magnetic paracaval and bilaterally iliac region. resonance imaging (MRI). MRI showed cystic tortuous dilatations in the Keywords: Diffuse large cell B-lymphoma, renal involvement, MRI region of left seminal vesicle appearing intermediate signal intensity on T1-weighted image and hyperintense on T2-weighted image. Cystic dilatations did not show pathologic contrast enhancement. In addition to the P - 06 findings, a mildly dilated tubular structure, extending from the left main iliac artery to the aortic bifurcation was observed. It was considered as THE CASE OF HETEROTOPIC ectopic-atretic ureter. The spermiogram and laboratory test results were PREGNANCY AFTER IN VITRO normal. FERTILIZATION Discussion: Zinners syndrome is distal mesonephric duct and ureteral bud developmental disorder. Other genitourinary anomalies such as CEMAL AYDOGAN, SUKRU OGUZ, DILARA ATASOY, ectopic-atretic ureter or megaureter may be associated. Seminal vesicle DENIZ OZTURK KOCAKGOL, AYSEGUL CANSU cysts may increase in size due to the atresia of the ejaculatory duct, fluid Department of Radiology, Karadeniz Technical University, Trabzon, Turkey content may become intense over time and become symptomatic, for example, intraabdominal mass, prostatitis, incontinence, hematospermia, Abstract infertility, carcinoma. In our case, ectopic-atretic ureter is observed as an Heterotopic pregnancy is a life-threatening complication of pregnancy additional anomaly. defined as coexistent intrauterine and ectopic gestation. Its diagnosis is Conclusion: USG and MRI are important imaging modalities for assessing frequently overlooked and delayed. A 28-year-old woman experienced the urogenital system.The absence of ionizing radiation and good soft tis- acute abdominal pain in pregnancy achieved by in vitro fertilization. Since sue contrast are the most important advantages of MRI. all previous checkups indicated a normal course of pregnancy, the ectopic pregnancy was not suspected on admission. However, due to persistent Keywords: Zinners syndrome, seminal vesicle cysts, Ipsilateral renal lower quadrant pain and decrease in hemoglobin level, this diagnosis agenesis Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S49 P - 08 netic resonance imaging (MRI) findings of a case of bladder leiomyoma in a 69-year-old male patient. GASTROINTESTINAL STROMAL Materials and Methods: A 69-year-old male patient with burning in urine TUMOR: CT AND MRI FINDINGS was examined by 1.5 Tesla MRI (Magnetom Avanto, Siemens Healthcare) UMMUGULSUM BAYRAKTUTAN, HAYRI OGUL, for abdominal imaging. ALPER KIZILOGLU, RECEP SADE, MECIT KANTARCI, Results: We present a hypointense mass lesion on T1 and T2 weighted AKIN LEVENT images with having lobulated contours and homogeneous contrast Department of Radiology, Atatürk University School of Medicine, Erzurum, enhancement on the right anterosuperior wall of the bladder. The case Turkey was diagnosed as bladder leiomyoma histopathologically after biopsy. Abstract Conclusion: Bladder leiomyomas typically occur in the fourth and fifth decades. The most common symptoms are urinary problems such as Objective: Gastrointestinal stromal tumors (GIST) are the most com- obstruction and irritation. Some small leiomyomas are asymptomatic. mon mesenchymal neoplasms of the gastrointestinal tract. GIST is often Tumor primarily shows an intravesical growth pattern (63%), but both seen in the stomach less frequently in the extra duodenal small intes- extravesical growth (30%) and intramural growth (7%) are uncommon. tines, colon and rectum. It is rarely seen in esophagus and duodenum. Non-degenerative leiomyomas on both T1- and T2-weighted images on We aimed to present multislice computerized tomography (MSCT) and magnetic resonance imaging can be seen as low-signal intensity nodules magnetic resonance imaging (MRI) findings of the GIST in a 36-year-old with smooth surface. Submucosal localization with intact mucosa is a male patient. characteristic feature of leiomyoma. Conversely, transitional cell carci- Materials and Methods: Abdominal imaging studies were performed noma affects mucosa. Definitive diagnosis requires histopathology by in a 36-year-old male patient with abdominal pain and vomiting com- urethro-cystoscopy. plaint with MDCT (320 detector-row CT, Aquilion ONE Vision; Toshiba Keywords: Bladder leiomyoma, MDCT, MRI Medical Systems Corporation, Otawara, Japan) and 1.5 Tesla MRI device (Magnetom Avanto, Siemens Healthcare). Results: In our case, there was an intraperitoneal mass with cen- P - 010 trally cystic-necrotic characteristics, heterogeneous peripheral contrast enhancement and lobulated contour in the right side of the abdomen. It SKROTAL LEIOMYOMA: MRI FINDINGS was approximately 12x10 cm in dimensions. Case was histopathologically UMMUGULSUM BAYRAKTUTAN, SERHAT KAYA, diagnosed as GIST after biopsy. HAYRI OGUL, RECEP SADE, MECIT KANTARCI, AKIN LEVENT Conclusion: GIST is mesenchymal tumors originating from interstitial Department of Radiology, Atatürk University School of Medicine, Erzurum, Kajal cells, which can develop throughout the entire gastrointestinal tract, Turkey from the esophagus to the anus, and in areas other than the gastrointestinal tract, such as the omentum, mesenteric, and retroperitoneum. It Abstract usually occurs on average at the age of 60 after the 4th decade. The GISTs Objective: Leiomyomas are benign neoplasms that can develop from located in the stomach and rectum are smaller in size and the colon and any organ and structure, including smooth muscle. Scrotal leiomyomas small bowel tumors are more advanced sarcomas. The most common are very rare tumors. We aimed to present magnetic resonance imag- metastatic regions are the liver and peritoneum. Imaging techniques that ing (MRI) findings of a case of scrotal leiomyoma in a 44-year-old male can be used include CT, MRI, FDG PET. GISTs are mostly hypervascular patient. lesions and show intense peripheral contrast fixation after contrast medium administration. It may also include cystic degenerated areas, areas Materials and Methods: A 44-year-old male patient with painless scro- of calcification and haemorrhage. Biopsy and immunohistochemical evalu- tal mass was examined by 1.5 Tesla MRI (Magnetom Avanto, Siemens ation are necessary for definitive diagnosis. Treatment is surgical resection. Healthcare) for scrotal imaging. Keywords: Gastrointestinal stromal tumor, MDCT, MRI Results: In our case, there was an extratesticular mass in the left hemiscrotum. It was 21x17 mm in size, hypointense on T1 and T2 weighted images and showing relatively homogeneous contrast enhancement. P - 09 The case was diagnosed as leiomyoma histopathologically as a result of surgical excision. BLADDER LEIOMYOMA: MRI FINDINGS Conclusion: In contrast to testicular tumors, most extratesticular solid UMMUGULSUM BAYRAKTUTAN, HAYRI OGUL, masses are benign. Paratesticular tumors may arise from epididymis, RECEP SADE, MECIT KANTARCI, AKIN LEVENT tunica albuginea, spermatic cord, and scrotal smooth muscle. Skrotal leiomyoma usually occurs between the fourth and sixth decades of Department of Radiology, Atatürk University School of Medicine, Erzurum, life and presents with a clinically painless scrotal mass. On magnetic Turkey resonance imaging, both T1- and T2-weighted images show low-signal Abstract intensity nodules with smooth surface. A fibrous pseudotumor should also be considered in the differential diagnosis. The treatment is surgical Objective: Leiomyoma in the urinary bladder is a rare benign disease. excision. However, it is the most common benign bladder tumor. While it is more common in women, men can also be affected. We aimed to present mag- Keywords: Scrotal leiomyoma, MRI S50 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 P - 011 P - 013 TESTICULAR ABSCESS: MRI FINDINGS PRIMARY HEPATIC TERATOMA: A UMMUGULSUM BAYRAKTUTAN, ALPER KIZILOGLU, RARE CAUSE OF CYSTIC LIVER MASS HAYRI OGUL, RECEP SADE, MECIT KANTARCI, IN AN INFANT AKIN LEVENT ASLI IRMAK BIRANCI, HILAL SAHIN, YELIZ PEKCEVIK, Department of Radiology, Atatürk University School of Medicine, Erzurum, AYSUN CAKIR, TUGCE HANCIOGLU Turkey University of Health Sciences, İzmir Tepecik Training and Research Hospital, Abstract İzmir, Turkey Objective: Intratesticular abscess is a rare clinical entity. We aimed to Abstract present magnetic resonance imaging (MRI) findings of a case of testicular Introduction: Teratoma is one subtype of the germ cell tumor group that abscess that completely covered the right testicular tissue in a 53-year-old develops most commonly in ovaries or testicles.Teratoma of the liver is a male patient. rare neoplasm accounting for less than 1% of all teratomas. Less than 50 Materials and Methods: A 53-year-old male patient with a painful scro- cases of primary hepatic teratomas has been described in the literature. tal swelling was examined with 1.5 Tesla MRI scans (Magnetom Avanto, The aim of this case report is to discuss the imaging findings of teratoma Siemens Healthcare). of the liver in an infant. Results: In our case, scrotal Doppler ultrasound revealed a complicated Case Report: A 2 month old girl, whose neonatal ultrasound examination hypoechoic area without vascularization in the right testis, and MRI imag- revealed an incidental cystic liver lesion was further investigated with MRI. MRI demonstrated a cystic lesion with thin wall and a few septation which ing was performed. MRI examination showed testicular abscess in the was located in gallbladder site and extended to the liver parenchyma. Fat right hemiscrotum, that completely covered the right testicular tissue. or amorphous calcification signal was not seen in the lesion. In our case Abscess in size of approximately 6x5.5 cm, showed diffusion restric- operation was planned due to possible association of the cystic lesion tion on diffusion-weighted images and septal and peripheral contrast with the bile ducts. During the dissection, the cyst was perforated and enhancement after contrast injection. Orchiectomy was performed with the bile was seen as discharging from cyst lumen. Pathological examina- a diagnosis of abscess. tion revealed that the internal surface of the cyst lumen was lined by Conclusion: Intratesticular abscesses are usually E. coli lesions that can primarily biliary epithelium, occasionally lined with respiratory and gastric spread as hematogenous or urine reflux in association with advanced or epithelium. With all these findings, the final diagnosis was primary hepatic untreated epididymoorchitis. Testicular parenchyma spread may occur in cystic teratoma. 5.5% of untreated epididymo-orchitis. Immunosuppressed and diabetic Discussion: Teratomas are often incidentally detected and symptoms are patients are at risk. Diagnostic scrotal doppler ultrasonography and scrotal usually due to the mass effect on surrounding organs. Although it is typi- MRI can be used. More than 50% of cases result in orchiectomy. cal to see fat or calcification in the teratomas of the liver, it is described Keywords: Intratesticular abscess, magnetic resonance imaging in the literature that in some cases there may not be both, as in our case. In conclusion, although primary hepatic teratoma is a rare neoplasm, it should be remembered in the differential diagnosis of cystic liver lesions in the pediatric population. P - 012 Keywords: Teratoma, MRI, cystic mass, infant A RARE BENIGN SPLENIC LESION: SCLEROSING ANGIOMATOID NODULAR TRANSFORMATION (SANT) P - 014 OGUZ LAFCI, PINAR NERCIS KOSAR PRIMARY PELVIC MYXOID Ankara Training and Research Hospital, Ankara, Turkey LIPOSARCOMA MIMICKING AN Abstract OVARIAN MASS: MRI FINDINGS 1 1 1 Sclerosing angiomatoid nodular transformation (SANT) is a rare, HILAL SAHIN , YELIZ PEKCEVIK , ASLI IRMAK BIRANCI , 2 3 benign, proliferative vascular solid lesion of the spleen which was first MUSTAFA BAGCI , SAMIR ABDULLAZADE , 2 described by Martel et al. in 2004 and around a hundred cases have MUZAFFER SANCI been reported so far. Most benign splenic solid lesions are detected 1Department of Radiology, Tepecik Training and Research Hospital, İzmir, Turkey incidentally on cross-sectional imaging. Although it is difficult to make a 2Department of Gynecologic Oncology, Tepecik Training and Research proper diagnosis only by imaging, some certain characteristics of solid Hospital, İzmir, Turkey 3Department of Pathology, Tepecik Training and Research Hospital, İzmir, splenic lesions may help to differantiate between them. We present Turkey MRI findings of SANT which detected incidentally in a 50 year old male patient who had undergone contrast-enhanced thorax CT examination Abstract for his respiratory complaints. Introduction: Myxoid liposarcoma is a malignant neoplasia of fat tis- Keywords: SANT, MRI, spleen sue which is usually located at lower extremities, particularly thighs. Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S51

Liposarcomas involving the pelvis are uncommon and reported in few enhancing solid components. The patient underwent laparatomy and case reports in the literature. We present an unusual case of a myxoid histopathologically confirmed the diagnosis of clear cell carcinoma arising pelvic liposarcoma that presented as a mass near right ovary mimicking a from endometriosis. primary ovarian tumor. Keywords: Endometriosis, clear cell carcinoma, abdominal wall, mri Case Report: A 25 year-old woman presented with right flank pain. A urinary US revealed right hydronephrosis with right proximal ureter compressed with an adnexial mass. In pelvic MRI, T2-weighted imaging P - 016 demonstrated a 5 cm hyperintense mass near the right ovary. However, the mass was located outside of the ovary regarding extraovarian origin. In OVARIAN MATURE CYSTIC addition, abrupt interruption of right ureter with proximal dilatation was TERATOMA WITH MULTIPLE KERATIN a clue for retroperitoneal location. Fat signal was not demonstrated in the BALLS: THE IMPORTANCE OF lesion. In postkontrast imaging, intense contrast enhancement was seen in DIFFUSION WEIGHTED IMAGING IN the lesion. Tumor markers and laboratory findings were in normal limits. Operation was planned due to suspicion of malignancy. At laparotomy, a DIAGNOSIS mass was identified near the right external iliac vessels and apart from HILAL SAHIN1, YELIZ PEKCEVIK1, TUGCE HANCIOGLU1, the right ovary. The mass was separated from the ureter and removed. TUGBA KARADENIZ2, ORHAN TEMEL3, Histopathological analysis showed that the mass consisted of a myxoid MUZAFFER SANCI3 matrix as the predominant component with small amount of fat regarding 1Department of Radiology, Tepecik Training and Research Hospital, İzmir, the diagnosis of myxoid liposarcoma. Turkey 2 Conclusion: In young female population, myxoid liposarcomas may pres- Department of Pathology, Tepecik Training and Research Hospital, İzmir, Turkey ent as a pelvic mass mimicking an ovarian neoplasm. MRI findings are 3Department of Gynecologic Oncology, Tepecik Training and Research important to show the origin of those tumors, enable the proper diagno- Hospital, İzmir, Turkey sis and surgical planning. Abstract Keywords: Myxoid liposarcoma, pelvis, retroperitoneum, magnetic reso- Introduction: Floating keratin balls are uncommon features of ovarian nance imaging mature cystic teratomas (MCT) which are described in few case reports. Diffusion weighted imaging (DWI) is helpful in demonstrating the keratin content, especially when the teratoma does not contain major fat. We P - 015 present an unusual case of MCT with multiple floating keratin balls which COMPUTED TOMOGRAPHY AND were diagnosed with DWI. MAGNETIC RESONANCE IMAGING Case Report: A 57 year-old woman presented with a pelvic mass. A pelvic ultrasonography revealed a 12 cm cystic mass in the pelvis with multiple FINDINGS OF CLEAR CELL CARCINOMA floating echogenic spherules within it. Magnetic resonance imaging dem- ARISING FROM ENDOMETRIOSIS IN THE onstrated multiple floating balls with intermediate T2 signal intensity. ABDOMINAL WALL Major fat signal was not demonstrated in the cystic lesion, however minor fat was seen in the floating balls in T1 DIXON imaging. DWI showed evi- EMINE MERVE HOROZ, SEBNEM KARASU dent diffusion restriction in those balls regarding viscous keratin content. Department of Radiology, İzmir Katip Çelebi University School of Medicine, Tumor markers and laboratory findings were in normal limits. Operation İzmir, Turkey was planned with diagnosis of ovarian teratoma. At laparotomy, a cystic mass was identified originating from the right ovary. Smooth globules Abstract were felt manually inside the mass. The mass consisted of creamy yellow Endometriosis is defined as the presence of endometrial tissue outside liquid with compacted round shaped keratin material. Mature cystic tera- the uterine cavity. It is usually located in the ovaries and pelvic peritoneum toma was diagnosed after histological examination. but it can be found in the lung, bowel, ureter and abdominal wall. It affects Conclusion: Floating balls in mature cystic teratomas shows evident diffu- approximately 15-40% of women of reproductive age. Endometriosis- sion restriction due to viscous keratin material. DWI may help in diagnosis associated abdominal wall cancer (EAAWC) is a rare condition, with poor by detecting keratin content, particularly in teratomas without apparent prognosis. Few cases have been reported in the literature. Abdominal fat. wall is one of the most common locations of endometriosis outside the peritoneal region. In most of the cases a prior caesarean section or Keywords: Mature cystic teratoma, floating ball, keratin, diffusion weight- other gynaecological operations cause the seeding of endometrial tissue ed imaging implants in the abdominal wall. Here, we report a case of 43-years-old female with clear cell adenocarcinoma derived from pathologically confirmed endometriosis in the P - 017 abdominal wall. On computed tomography (CT) there was a well cir- IG G4- RELATED AUTOIMMUNE cumscribed, multiloculated, hypodense cystic large mass with solid parts in the left rectus muscle. On magnetic resonance imaging (MRI) the CHOLANGITIS: CT AND MRI mass had a malignant appearance which was predominantly cystic with FINDINGS S52 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

GURCAN ERBAY1, ELIF KARADELI1, BURCAK CAKIR PEKOZ2, diffusion restricted multifocal liver masses. Hepatic involvement caused KENAN CALISKAN1, FAZILET KAYASELCUK1 by granulomatous diseases can be particularly challenging to differentiate from lymphoma, since they can also result hepatic and lymp node involve- 1Başkent University Adana Hospital, Adana, Turkey 2Adana State Hospital, Adana, Turkey ment. Presence of necrotic rim-enhancing lymph nodes in tuberculosis and T2-hypointense nodules in sarcoidosis may help the differential diag- Abstract nosis. Regarding the involvement of multiple systems; liver, intestine, lymph Objective: Immunoglobulin G4-related disease is a new clinical entity that nodes and bone marrow, lymphoma will be esentially encountered in the has unique clinical, serological, radiological and pathological features with differential diagnosis. multiorgan involvement. Autoimmune cholangitis is a part of this clinical Keywords: Non Hodgkin lymphoma, liver, invagination picture. We aimed to present computed tomography (CT) and magnetic resonance imaging (MRI) findings of Ig G4-related autoimmune cholangitis (IgG4-RAC), which was diagnosed histopathologically. P - 019 Materials and Methods: A forty three year-old male patient was admitted to our hospital with complaints of abdominal pain and jaundice for A VASCULAR HERO: SUPERIOR 10 days. There was a history of cholecystectomy. CT and MRI were MESENTERIC ARTERY SUPPLYING performed. THE GASTROINTESTINAL SYSTEM, Results: CT showed a lesion with soft tissue density at extrahepatic bile HEPATOBILIARY SYSTEM AND THE ducts. MRI showed hypointense lesion at the junction of right and left SPLEEN ON ITS OWN intrahepatic bile ducts on T1 and T2 weighted images. There was mild enhancement on late phase. We observed slightly restricted diffusion SERDAR KARAKOSE, HASAN EMIN KAYA, on diffusion MRI. Serum Ig G4 level was increased. The patient under- CENGIZ KADIYORAN, ABDULLAH ENES ATAS, MELTEM ORUC went surgery because the findings didn’t exclude cholangiocarcinoma. Department of Radiology, Necmettin Erbakan University School of Medicine, Histopathologic evaluation showed IgG4-RAC, chronic inflammation and Konya, Turkey fibrosis. Abstract Conclusion: IgG4-RAC is an autoimmune disease usually involving bile ducts, and is associated with autoimmune pancreatitis by 90%. Diagnosis In patients with celiac axis stenosis the most common and important col- is very difficult if autoimmune pancreatitis is not accompanied, as our case. lateral vessels from the SMA are the pancreaticoduodenal arcades and the It may mimic many diseases such as primary sclerosing cholangitis, pseu- dorsal pancreatic artery. Severe stenosis of the celiac artery is commonly dotumoral lesions, and cholangiocarcinoma. Serum Ig G4 level elevation associated with enlargement of the arteries of the pancreaticoduodenal is an important finding but is not sufficient for diagnosis alone. IgG4-RAC arcade. Here we present a case with celiac axis and inferior mesenteric can be diagnosed by clinical, serological, radiological and histopathological artery occlusion which resulted in superior mesenteric artery supplying findings. Differential diagnosis is important to guide the treatment of the the whole gastrointestinal system, hepatobiliary system and the spleen disease. on its own. Keywords: Autoimmune cholangitis, Ig G4, MRI Keywords: MR angiography, celiac axis occlusion, superior mesenteric artery P - 018 P - 020 HEPATIC INVOLVEMENT OF NON HODGKIN LYMPHOMA IN A A BENIGN DIAGNOSIS MIMICKING PEDIATRIC PATIENT PERITONEAL CARCINOMATOSIS, MIRACE YASEMIN KARADENIZ BILGILI1, NESE ASAL1, CONFUSED WITH OVARIAN SELMIN PERIHAN KOMURCU ERKMEN1, CANCER IN IMAGING: MULTICYSTIC MERYEM ALBAYRAK2, MIKAIL INAL 1 PERITONEAL MESOTHELIOMA 1 Department of Radiology, Kırıkkale University School of Medicine, Kırıkkale, CEYLAN ALTINTAS, ELMIRE DERVISOGLU, Turkey 2Department of Pediatrics, Kırıkkale University School of Medicine, Kırıkkale, ALI KEMAL SIVRIOGLU, BURCU ALPARSLAN Turkey Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey Abstract Abstract Non-Hodgkin lymphomas are heterogeneous group B or T cell malignancies that usually originate from lymphocytes. We present an 8 year old Multicystic peritoneal mesothelioma (MPM) is a benign, rare disease child diagnosed to have invagination with ultrasound complaining abdomi- caused by mesothelial cells surrounding serous membranes. Pleural, nal pain. Abdominal CT demonstrated the invaginated segment in right pericardial, or peritoneal origin may occur and is frequently caused by lower quadrant as well as lymphadenopathy and multiple liver masses. the pelvic peritoneum. The incidence is 2/1,000,000 per year. According MRI, besides the invaginated segment and lymphadenopathies, dem- to our knowledge, up to 200 cases have been reported in English onstrated bone marrow infiltration as well as the T2 hyperintense and language papers. Preoperative diagnosis is difficult because of its rare Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S53 occurrence, imaging findings are not specific, and there are no obvious CEYLAN ALTINTAS, ELMIRE DERVISOGLU, diagnostic clinical manifestations. Patients usually have the preoperative ALI KEMAL SIVRIOGLU, BURCU ALPARSLAN diagnosis of peritonitis carcinomatosa, pseudomyxoma peritonei, appen- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, dicitis, or ovarian tumors. Ancestral diagnosis is made only by the patho- Turkey logical evaluation of surgical specimens. If female patients present with multicystic lesions in the pelvic region in the form of grape clusters, If the Abstract patients CEA and CA-125 values are close to normal or normal, and if Cavernous transformation of the portal vein occurs when the portal vein there is a clinical history of pelvic operation, MPM should be considered is thrombosed. Cavernous transformation results from recanalization of in the differential diagnosis. We hereby present the imaging findings of the portal venous thrombus as well as dilatation of paracholedochal veins a 45-year-old female patient diagnosed with postoperative multicystic in an effort to bypass the portal venous obstruction. Cavernous trans- peritoneal mesothelioma and aim to compare them to cases reported formation has been shown to form as early as 6 to 20 days after acute in literature. thrombosis of the portal vein. Cavernous transformation may cause wall Keywords: CT, MRI, multicystic peritoneal mesothelioma, peritoneal thickening in the biliary system, stenosis, dilatation in intra-extrahepatic carcinomatosis bile ducts, and pseudotumor appearance. Cavernous transformation may cause a mass appearance in the liver and secondary dilatation of the bile duct. For this reason, it is in the differential diagnosis of the masses in the P - 021 hilus of liver and it should also be made of the distinction of inflammatory pseudotumor. Diffusion imaging can be used at this distinction. Our ADRENIFORM SHAPE OF purpose in this presentation is to describe and evaluate MR findings of NON-ADENOMA ADRENAL LESION: tumorlike changes in three patients with cavernous transformation of the portal vein. LYMPHOMA Keywords: Cavernous transformation, MRI, pseudotumor FERHAT CUCE, KEMAL NIYAZI ARDA, UGUR BOZLAR Gülhane Training and Research Hospital, Ankara, Turkey Abstract P - 023 Introduction: Nod Hodgkin lymphoma (NHL) frequently involves adrenal A RARE ADRENAL TUMOR: gland and to be usually bilateral. The computed tomography (CT) and ONCOCYTIC ADRENOCORTICAL magnetic resonance imaging (MRI) is the most important radiological imaging modalities for differentiating other malignant lesions of adrenal CARCINOMA gland from lymphoma and prevent unnecessary surgical interventions to ELMIRE DERVISOGLU, CEYLAN ALTINTAS, adrenal lymphoma. ALI KEMAL SIVRIOGLU, BURCU ALPARSLAN Case Report: A 37-year-old male patient with a complaint of malaise Department of Radiology, Kocaeli University School of Medicine, Kocaeli, applied to the internal medicine in February 2017. No significant find- Turkey ings were found in the blood tests. As he described a blunt pain in the Abstract left upper quadrant on physical examination, abdominal ultrasonography (US) was performed. A hypoechoic lesion was detected adjacent to the Oncocytic tumors are mostly benign tumors that originates from upper pole of left kidney. The abdominal CT with intravenous contrast kidneys, thyroid, parathyroid, salivary and pituitary glands. Oncocytic material revealed a huge nonadenom adrenal mass lesion with 51x43x64 tumors of adrenal glands are so rare and generally nonfunctional benign mm size. The significant finding was an adreniform shape of the gland was tumors. According to Lin-Weiss-Bisceglia criteria, oncocytic neoplasms maintained in the lesion. The magnetic resonance imaging (MRI) was also divided into three groups histologically; benign oncocytoma, oncocytic scheduled. neoplasm with indeterminate malignant potential and oncocytic carcinoma. Up to now, 36 cases of oncocytic adrenocortical carsinoma have Discussion: Secondary involvement of the adrenal gland with NHL has been reported in the literature. Conventional adrenocortical carsino- been reported in as many as 25% of the patients. The adrenal lymphoma mas have biphasic age distribution (first and fifth decade) and female should be considered in patients with an adreniform shape of a non dominance but adrenocortical oncocytic carcinomas are only reported adenoma adrenal lesion on CT. The MRI enables differentiation of adrenal in adults and has no gender dominance. Conventional adrenocortical adenomas from other adrenal malignancies, but specific diagnosis might carsinomas are generally presented with findings caused by hormone not be achieved with this modality. In our previous radiological experience, we couldn’t see any nonadenom lesion of gland-like adreniform shape. hypersecretion but adrenocortical oncocytic carcinomas are generally presented with abdominal discomfort and back pain caused by mass Keywords: Lymphoma, adrenal, adreniform shape effect. There are many studies in the radiology literature about oncocytic neoplasms of kidney but studies on the imaging findings of adrenal oncocytic tumors are limited. In this case report, our aim is to present P - 022 magnetic resonance imaging (MRI) findings of oncocytic adrenocortical carcinoma in a 60 year old female patient and to compare with the find- CAVERNOUS TRANSFORMATION ings in the literature. OF THE PORTAL VEIN MIMICKING Keywords: Adrenal gland, magnetic resonance imaging, oncocytic carci- TUMOR: A PSEUDOTUMOR noma S54 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

P - 024 It is important to recognize this antiquity, as this appearance may mimic malignancy. We aimed to present the radiological findings compatible with A RARE CASE OF GRANULOMATOUS peliosis hepatis in a 71-year-old woman. PROSTATITIS AND PROSTATIC Keywords: Peliosis hepatis, hepatic sinusoid cystic dilatation ABSCESS: GRANULOMATOUS POLYANGIITIS P - 026 DUYGU IMRE, GULNAR AGHAYEVA, EMRE UNAL, MUSTAFA NASUH OZMEN BILATERAL GIANT MATURE CYSTIC Hacettepe University School of Medicine, Ankara, Turkey TERATOMA Abstract SINAN ULGEN, MEHTAP BARC ERGUN, AYSE EDA PARLAK, SAMET MUTLU, EMIN DURMUS Granulomatous polyangiitis is a rare necrotizing vasculitis which causes systemic involvement of paranasal sinus, lung, genitourinary tract etc. University of Health Sciences, Antalya Training and Research Hospital, Although it is rare, the lack of proper diagnosis and treatment may Antalya, Turkey increases the morbidity and mortality. Genitourinary system involvement Abstract is most commonly seen in the kidney, while the urethra, prostate, vagina, and testis are also can be involved. In our patient with Wegener granu- Dermoid cyst also known as mature cystic teratoma is a germ cell lomatosis, the involvement of the lung, paranasal sinus, ear and prostate tumour that is stemmed from all three germ layers. Tumor may contain gland are biopsy-proved. We discuss 32-year-old male patient refered components of different germ layers such as fat, tooth or hair. Although to our hospital with eksternal otitis symptoms, hearing loss in the right most cases are originated from gonads, it may be found in other locations ear, wound in nose and mouth, nose bleeding, hemoptysis and recurrent including anterior mediastinum, gastrointestinal tract, or retroperitoneal pneumonia. Then patient had developed diysuria, hematuria and fever space. Although it is a benign entity, it may reach to massive sizes and lead not responsive to antibiotics. The CT scan of the chest, showed multiple to further complications such as torsion or rupture. Thus, knowledge of cavitary and non cavitary nodules. Anti-c ANCA was positive and granu- imaging properties and accurate diagnosis of mature cystic teratoma is lomatous polyangiitis was diagnosed. Prostate MRI was performed on the important. US is preferred imaging modality and MRI is useful for difficult presence of heterogeneity in the prostate gland in abdomen CT.Prostate cases. We herein report imaging findings of a case with two giant dermoid MRI revealed a horseshoe-shaped abscess cavity in the internal gland of cysts in pelvic region. prostate. In biopsy materials obtained from the prostate gland, necrotizing Keywords: Dermoid cyst, mature cystic teratoma, germ cell tumor granulomatous inflammation and microabscess formation were detected (8). Prostate gland involvement is a rare finding of microscopic polyangiitis. The possibility of microscopic polyangiitis should be kept in mind, when P - 027 antibiotic resistant prostatitis occurs in younger patients, with no pre- disposing factor (suspicious sexual intercourse, etc.). If necessary, biopsy A RARE COMPLICATION FOLLOWING should be performed in such cases RADICAL PROSTATECTOMY: Keywords: Vasculitis, Wegener granulomatosis, prostatic abscess INABILITY TO WALK MEHMET SEYFI BURUK, LEYLA KARACA, ZEYNEP OZDEMIR, ISMAIL OKAN YILDIRIM, MEHMET GEZER P - 025 İnönü University School of Medicine, Malatya, Turkey MALIGNANT MIMIC: PELIOSIS Abstract HEPATIS Pubic complications after radical prostatectomy are rare. Osteonecrosis and ABDULLAH SUKUN, MEHTAP BARC ERGUN, inflammation of pubic rami present with severe pain during adduction and AYSE EDA PARLAK, SINAN ULGEN, EMIN DURMUS ambulation of the leg which causes diffuculty during walking. A 65-year-old male patient is scheduled for radical prostatectomy and radiotherapy with Department of Radiology, University of Health Sciences, Antalya Training diagnosis of prostatic adenocarcinoma. Incontinence and walking difficulty and Research Hospital, Antalya, Turkey occured during postoperative period. Abdominal and pelvic CT scans was Abstract negative for acute pathology. Contrast enhanced MRI of pelvis was performed. MRI demonstrated pubic osteonecrosis, inflamatory changes at Peliosis hepatis is a benign vascular disease cystic spaces ranging from 1 pubis, edematous signal changes in adductor muscles, collection in symphysis mm to several cm rarely seen in hepatic sinusoids.Pathogenesis is not fully pubis connected to prostatic urethra. Fluoroscopy guided percutaneous explained. The cases of 20-50% are idiopathic. Distortion of sinusoidal sampling from collection at symphysis pubis showed urine. Contrast mate- borders and dilatation of the vessel at the center of the hepatic lobule rial injected to joints pace reached to prostatic urethra and bladder. In this are suggested in the etiology. Patients are usually asymptomatic, but in case we showed inability to walk is related to urethral fistulation to symphy- some cases, bleeding may occur and lead to hepatomegaly and liver failure. sis pubis and secondary inflammatory changes. Additionly, etiology includes toxins, drugs, anabolic steroids, corticosteroids, immunoglobulin therapy and chronic diseases such as HCC, malig- Keywords: Radical prostatectomy, fistula to symphysis pubis, inability to nancy, tuberculosis. There may be spleen and bone marrow involvement. walk Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S55 P - 028 tumors. Adnexal torsion is an uncommon but significant cause of acute lower abdominal pain and morbidity. There are few reports of adnexal MAGNETIC RESONANCE FINDINGS torsion due to dysgerminoma in the literature. In this case report we OF DUODENAL DUPLICATION CYST: want to present radiological findings of ovarian dysgerminoma that cause adnexal torsion. CASE REPORT Case Report: A 30-year-old woman was admitted to the emergency ser- ENSAR TURK, SUAT INCE, CEMIL GOYA, vice with acute abdominal pain in the right iliac fossa. Except weak hCG ALPARSLAN YAVUZ positivity, her laboratory findings were unremarkable. Due to suspicions Van Yüzüncü Yıl University School of Medicine, Van, Turkey of early pregnancy, US and MRI were performed to identify the etiology. MRI revealed a large (10.5x9x5.5cm), twisted, heterogeneous and Abstract predominantly solid pelvic mass on the right adnexal side. Color Doppler Objective: We aimed to present magnetic resonance imaging (MRI) find- US demonstrated intratumoral flow signals. US showed the normal size ings of a case with duodenal duplication cyst which composes the 2-12% uterus and the left ovary. After surgery this tumor was diagnosed histo- of gastrointestinal system duplication cysts. pathologically as pure dysgerminoma of the right ovary. Materials and Methods: The initial B-mode US examination of a 8-year- Conclusion: Ovarian dysgerminoma may present as an acute abdomen old male with the complaints of abdominal pain, nausea and vomiting because of adnexal torsion and passive blood congestion. Ovarian dysger- revealed a cystic lesion adjacent to the head of pancreas. Contrast- minoma causing adnexal torsion should be considered in the differential enhanced abdominal computed tomography revealed a 4x3 cm thick- diagnosis in a young woman with acute abdomen. walled cystic lesion at the second part of duodenum. MRI and MRCP examinations were planned in order to correlate the cystic content of Keywords: Adnexal torsion, dysgerminoma, MRI the lesion that was described in the US and CT, and to evaluate the possible connection of the cystic lesion with pancreatic duct. In the abdomen MR and MRCP of the patient revealed a well-defined, homogeneous, P - 030 uniformly bounded T2-weighted hyperintense cystic lesion with distinct walls and suspicious connection by the doudenum lumen. The size of the A RARE CASE: PRIMARY MUCINOUS lesion was approximately 45x35 mm and it was located adjacent to the ADENOCARCINOMA OF VAGINA second part of duodenum and segment of the common bile duct by the head of pancreas. ELMIRE DERVISOGLU, CEYLAN ALTINTAS, ALI KEMAL SIVRIOGLU, BURCU ALPARSLAN Results: Due to the MRI findings of our patients indicating the diagnosis of duplication cyst, surgical resection of the cyst was decided. The histo- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, pathologic examination of the lesion was resulted as “duplication cyst”. Turkey Conclusion: Duplication cyst is a rare congenital condition that forms Abstract during the embryonic period of alimentary tract development. Cysts are mostly within 2 to 4 cm in size. They occur frequently in the distal ileum. Primary vaginal carcinoma is rare, accounting for only 1%-2% of gyneco- Conversely duodenal duplication cysts are very uncommon and represent logic malignancies. Of these, approximately 90% are squamous cell carci- only 2 to 12% of all digestive tract duplications. Imaging techniques initially nomas, with only 10% being adenocarcinoma.Squamous cell carcinoma is suggested for pre-diagnosis, however histopathologic analysis must be more commonly seen in postmenopausal women and tends to occur in performed for the confirmation. The criteria required for the definitive the proximal third of the vagina, in the posterior wall.Primary vaginal ade- diagnosis are the presence of alimentary mucosal lining, a smooth muscle nocarcinoma typically occur in younger women, mainly in the upper third coat, and an intimate attachment to the native gastrointestinal tract. and anterior wall of the vagina.Most vaginal adenocarcinomas are of clear Considering the present findings, duodenal duplication cyst should be cell histology. Mucinous adenocarcinomas of the vagina are rare and can considered in the differential diagnosis of cystic lesions that are adjacent to be further subtyped into endocervical and intestinal types.Intestinal type the pancreatic head section and second part of the duodenum. can not be distinguished pathologically from colorectal carcinoma metastasis, and a full clinicoradiologic workup of the patient is mandated prior Keywords: Duplication, cyst, duodenum to making this rare diagnosis.On MRI, a mucin-producing adenocarcinoma show higher signal components on T2-weighted images than other vaginal carsinomas.Mucinous adenocarcinoma of vaginashould be considered in P - 029 the differential diagnosis when high signal intensities similar to cyst are seenin a vaginal mass on T2-weighted images.In this case report, we aimed A RARE CAUSE OF ADNEXAL to present MRI findings of primary vaginal mucinous adenocarcinoma in a TORSION: OVARIAN DYSGERMINOMA 46 year old female patient. ILHAN HEKIMSOY, EZGI GULER, RAHMI AKYOL, Keywords: MRI, mucinous adenocarcinoma, vaginal mass MUSTAFA HARMAN, NEVRA ELMAS Department of Radiology, Ege University School of Medicine, İzmir, Turkey P - 031 Abstract Introduction: Dysgerminoma is a rare ovarian tumor, accounting for AN ATYPIC PROSTATE 3-5% of all ovarian malignancies and for 30-50% of all ovarian germ cell ADENOCARCINOMA METASTASIS S56 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

HASAN AYDIN1, KEMAL ARDA2, VOLKAN KIZILGOZ3, IBRAHIM ILIK, CEMIL GOYA, SUAT INCE, ENSAR TURK O., MEVLUDE ALTINTAS1, SUMEYYE KAYMAK1 ILYAS DUNDAR 1Department of Radiology, Ankara Oncology Training and Research Hospital, Department of Radiology, Van Yüzüncü Yıl University Dursun Odabaş Ankara, Turkey Medical Center, Van, Turkey 2Department of Radiology, Gülhane Training and Research Hospital, Ankara, Turkey Abstract 3 Department of Radiology, Kafkas University School of Medicine, Kars, Objective: We aimed to present the rare Herlyn-Werner-Wunderlich Turkey (HWW) syndrome with the context of MR and Ultrasonography (USG) Abstract findings. A 72 year old men with prostate cancer and radical prostatectomy, Materials and Methods: A 15-year-old female patient was admitted to was admitted to our MRI unit for Brain MRI to exclude any metastasis the clinic with complaints of pelvic pain. After the physical examination referred to this area.To our surprise, There were multipl heavily enhancing USG was taken to the patient. On the USG, a cystic lesion with a level of metastatic nodules and masses in the right petroz apex, in the Subcortical 5 cm was observed in the widest area extending from the left adnexial white matter of right temporal fossa, clivus in the midline, right parasellar area to the umbilicus level. And performed contrast enhanced pelvic MRI region. There were also multipl enhancing diffuse and/or nodular metas- to the patient. tasis in the dura of right temporo-parietooccipital region and right frontal Results: Images of the MRI shows the uterus didelfis appearance and its cortex at vertex. right segment is naturally seen. The segment on the left is dilated and Keywords: Prostate, adenoca, MRI-metastasis, clivus-dural hyperintense (hemorrhagic) fluid values are observed in T1-weighted series in the endometrium (hematometry). Dilated tortious tubular appearance is observed in the widest part extending to the lateral level of the superiorly umbilicus associated with the left segment, reaching a P - 032 diameter of approximately 5 cm. Hyperintense fluid values are monitored LEFT RENAL GIANT in luminal T1-weighted series (Hematosalpinx). The left kidney wasnt observed. Together with these findings, the case was interpreted as ANGIOMYOLIPOMA AND MULTIPL HWW syndrome. IATROGENIC COMPLICATIONS Conclusion: HWW syndrome is a rare mullerian duct anomaly char- DUE TO REPETITIVE BIOPSY acterized by obstructive hemivagina and ipsilateral renal agenesis with APPLICATIONS uterus didelfis. The actual incidence is unknown, but reported between 0.1% and 3.8%. CT and USG are the most common diagnostic methods HASAN AYDIN, ZEYNEL YOLOGLU, MUAZZEZ BENGI AKYOL, 4). However, MRI is thought to be more sensitive to imaging soft tissue SINEF HUVAJ AKSOY, OZKAN UNAL anatomy and identifying fine details of congenital anomalies. If treatment is Department of Radiology, Ankara Oncology Training and Research Hospital, delayed, complications such as endometriosis, infections and pelvic adhe- Ankara, Turkey sions may be develop. Abstract Keywords: Herlyn-Werner-Wunderlich Syndrome, Hematosalpinx, mul- A 57 years old men with huge renal mass was referred to our CT and MRI lerian duct anomaly units from Urology clinics, a giant left renal mass over 15 cm. diameter was observed, this mass contains minimal solid area but huge amount fatty component and also 1.5 cm stone was seen in the middle pole.Gerota P - 034 fascia was also obviously thickened mostly at the lower retroperitoneal area.We reported that left renal mass is most likely to be fat rich-Angio- IDENTICAL MASS WITH myolipoma and follow up of mass by CT and MRI was advised but unfor- UNEXPECTED PLACEMENT: tunately, urologists applied multipl true-cut and/or open surgical biopsies PRESACRAL & RETRORECTAL to this huge mass and lots of unwanted complications occured due to these interventions like left diaphragm perforation, multipl lacerations EPIDERMOID CYST of spleen,plevral and pericardial effusion,perforation of same jejenal seg- VELI SUHA OZTURK1, OZUM TUNCYUREK1, ments and etc.He had hospitalized for approximately 3 months and then YELDA DAYANIR1, PARS TUNCYUREK2 discharged with almost total cure, Histopathology only stated adipose and 1 fibrous tissue persistence at those unnecessary interventional procedures. Department of Radiology, Adnan Menderes University School of Medicine, Aydın, Turkey Keywords: Angiomyolipoma-renal-iatrogenic-biopsy-complications. 2Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey Abstract P - 033 Epidermal cysts are congenital lesions with ectoderm origin. Although A RARE CASE: CASE REPORT OF common in the brain, retrorectal & presacral region and they are quite rare. In this case report, we wanted to review the imaging findings of the HERLYN-WERNER-WUNDERLICH epidermoid cyst, which is one of the rare presacral cystic masses. 42-year- SYNDROME old male was found to have a cystic mass in the pelvic cavity in abdominal Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S57 ultrasonography performed at the public hospital due to pain on the Results: T4b mucinous adenocarcinoma originating from appendix vermi- lumbar and sacral vertebra, dysuria, constipation and tenesmus symptom. formis, appendix full-layer invasive and extending to bladder serosa was Patient with no additional findings in physical examination; after, multislice reported as a pathologic conclusion. computerized tomography (CT) with intravenous contrast administration Conclusion: Primary neoplasms of the appendix are very rare and less was performed. On the CT examination, a multiloculated cystic mass was than 2% of the appendectomy materials are detected. According to seen in the presacral space, located to the right of the midline, with high WHO 2010 classification, appendiceal mucinous neoplasms are defined density contents (mean 24 HU), and thin wall, minimal ring enhancement in 3 categories: mucinous adenomas, low grade mucinous neoplasms and and no internal septations. Subsequent Magnetic Resonance Imaging (MRI) showed high protein content with high T1W signal intensity and adenocarcinomas. Pseudomycosis peritonei may occur due to overgrowth also very high T2 signal intensity in the cystic component, whereas other of musculus mucosa or peritoneal dissemination of tumor resulting from areas showed mild hyperintensity on T2W slices in multiloculated cystic perforation. We aimed to present this case because of the absence of mass. There was no change in signal intensity on the T1W fat saturated pseudomyxoma peritoneum and the first case in the literature with blad- slices and no internal contrast enhancement except minimal ring enhance- der invasion. ment in dynamic postcontrast series. In the diffusion MR examination, Keywords: Appendix, bladder invasive, mucinous adenocarcinoma the most distinctive finding was that the mass showed significant diffusion restriction (ADC value: 0,79 ×10-³ mm²/sn). To our knowledge this finding is particularly important in the differential diagnosis of intracranial and intradural epidermoid cysts. In our case, surgery was performed and P - 036 histopathological analysis confirmed the diagnosis of epidermoid cyst with high protein content. Retrorectal developmental cysts (tailgut cyst, TORSION OF WANDERING SPLEEN, epidermoid cyst, dermoid cyst, teratoma, and duplication) are very rare PELVIC MASS MIMICS, A CASE OF diseases and the symptoms are not characteristic and sometimes difficult CHILD to make the differential diagnosis of these masses with imaging modalities. The differential diagnosis should definitely include anorectal abscesses, TULIN HAKAN DEMIRKAN, GULSAH BAYRAM complicated fistulas, and pylonidal disease. Significant heterogenecity in Dışkapı Pediatrics Hematology and Oncology Training and Research T1A and T2A sequences and significant diffuse restriction, which are Hospital, Ankara, Turkey two important imaging findings, are very helpful in distinguishing presacral epidermoid cysts from other lesions of this region. Abstract Keywords: Epidermoid, cyst, MRI, presacral, retrorectal Wandering spleen is a term used for hypermobile spleen following abnormal localization. The spleen loses fixation on the abdominal wall in its normal location and changes its position. It is one of the rare causes P - 035 of acute abdomen. It is usually asymptomatic but may be detected as a painless mass. However, rarely, tinnitus may result in splenic congestion, A RARE CASE: BLADDER INVASIVE infarction that may be accompanied by adjacent tissuesIn our case, a APPENDIX ORIGIN MUCINOUS 12-year-old girl was a case. Pelvic US; showed torsion of pelvic mass with pelvic pain. However, the ovaries were separately provided. In the MRI, ADENOCARCINOMA vascularization in the pelvic region was decreased and hypointense pelvic SUMEYRA DEMIRKOL ALAGOZ1, MESUT OZGOKCE1, mass was observed.Postoperative spontaneous torsion of the spleen was IBRAHIM AKBUDAK2, ADEM YOKUS3, HARUN ARSLAN1 found in the pelvic region. It was presented with the reason that it was a rare acute cause. 1Department of Radiology, Van Yüzüncü Yıl University School of Medicine, Van, Turkey Keywords: Wandering spleen, pelvic mass, torsion 2Batman State Hospital, Batman, Turkey 3Van Region Hospital, Van, Turkey Abstract P - 037 Objective: We aimed to present computed tomography (CT) and magnetic resonance imaging (MRI) findings of an appendix appendiceal A RARE, RADIOLOGICAL AND mucinous adenocarcinoma. CLINICAL DILEMMA: INGUINAL Materials and Methods: A 53-year-old male patient was admitted to HERNIA OR NUCK CANAL CYST? our hospital with complaints of abdominal pain, burning while urinating, 1 1 and intermittent yellowing particles of the urine. We performed patient- MEHMET KARAGULLE , SULEYMAN ONCU , 2 1 contrast computed tomography (CT), which detected a lesion in the FATMA ZEYNEP ARSLAN , MEHMET ONCU , 1 posterior wall of the bladder, and abdominal magnetic resonance (MRI) AHMET TAN CIMILLI imaging, for detailed examination. Approximately 5x4 cm sized dilate 1Bağcılar Training and Research Hospital, İstanbul, Turkey tubular structure extending from the caecum to the posterior wall of 2Konya Training and Research Hospital, Konya, Turkey the bladder and invading the mesentery was observed. There was no Abstract evidence of free fluid in the abdomen, inflammation in the perilesional mesentery, and pseudomycosis peritonei. Surgical right hemicolectomy Nuck canal cyst is a rarely seen pathological condition due to the pres- and partial cystectomy were performed for the mass. ence of patent processus vaginalis. Spermatic cord cysts that are detected S58 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 in males and nuck canal cysts are equivalent lesions. Typically irreduct- 1Department of Radiology, University of Health Sciences Konya Training and ible, painless cystic mass lesion located at the inguinolabial region is seen. Research Hospital, Konya, Turkey 2 Redness, increase in temperature and pain extending from inguinal region Department of Radiology, Bağcılar Training and Research Hospital, İstanbul, Turkey to labium majus can be seen when cystic mass infected. A 36-year-old female patient admited to outpatient policlinic due to painless swelling Abstract in the left inguinolabial region. Ultrasonography (USG) and Magnetic Presacral tailgut cysts, also known as retrorectal cystic hamartomas, are Resonance Imaging (MRI) performed with a provisional diagnosis of inguinal hernia. On USG; a cystic mass with intralesional thin septations in rare congenital lesions most often discovered incidentally in middle-aged the left inguinal canal was detected. There was no Doppler signal noted women and believed to arise from aberrant remnants of the postanal within lesion during sonograhic examination. In the left inguinofemoral gut when incomplete involution occurs during embryogenesis. Patients region, non-enhancing cystic mass lesion with a size of 28x14 mm, which usually asymptomatic, patients may develop symptoms resulting from is hypointense on T1-weighted series, hyperintense on T2-weighted series local mass effect. Patients may suffer from tenesmus, constipation, pain demonstrated. After lesion surgically removed, pathologically diagnosed rectal fullness and urinary rate changes. Initial presentation may also be as Nuck canal cyst. Differential diagnosis of Nuck canal cyst also includes delayed until complications occur, including infection The most important inguinal hernia, lymphadenopathy, neoplasia, bartolin cyst. In conclusion; complications of these cysts are infection with secondary fistulization Nuck canal cyst is rare but should be remember in female patients who and malignant degeneration. Cystic nature of the lesion can be demon- had a cystic lesion containing pure cystic or septa in the inguinal region. strated on sonographic examination. CT delineates a well- circumscribed Radiologists should be familiar with these rare lesions and these patients hypodense mass. On MRI; lobulated, multloculated cystic lesion can be are playing a key role in getting them to be diagnosed faster.Thus; the seen wich is hypointense on T1 and homogenously hyperintense on T2 number of unnecessary MRI examinations could be reduced and unnec- sequences. Herein, we reported MRI findings of a patient with Retrorectal essary surgeries may be prevent by diffrentiating Nuck canal cysts from Cystic Hamartoma. inguinal hernia accurately. Keywords: Retrorectal mass, retrorectal cystic hamartoma, tailgut cyst Keywords: Inguinal hernia, nuck canal cyst and nuck canal hydrocele

P - 040 P - 038 A RARE CAUSE OF SONOGRAPHIC RENAL AND URETERIC TUBERCULOSIS MURPHY SIGN: LOW GRADE RADIOLOGIC FINDINGS GALLBLADDER CANCER PRESENTING ELA KAPLAN, LEYLA KARACA AS A XANTHOGRANULOMATOUS İnönü University Turgut Ozal Medical Center, Malatya, Turkey CHOLECYSTITIS Abstract MEHMET KARAGULLE1, FATMA ZEYNEP ARSLAN2, 1 A 53 year old woman who has DM history presented urology poli- SULEYMAN ONCU clinic with painful urination. She had has this symptoms for five years. 1Department of Radiology, Bağcılar Training and Research Hospital, İstanbul, Her analysis result of urineare; leucocytes were three pozitive, glucose Turkey 2 was three pozitive, erythrocyte was one pozitive. Because of these result Department of Radiology, University of Health Sciences Konya Training and MRI Urography was wanted. In MRI Urography; it was calyceal dilatation Research Hospital, Konya, Turkey and peripheral wall thickining with contrast enhancement in left kidney Abstract superior zone. Left collecting system’s wall were thickining and irregular. Xanthogranulomatous cholecystitis (XGC) is a rare chronic inflam- Correspondingly; pelvicalcyceal system was expansion in inferior zone matory process characterized with multiple intramural nodules due and there was infindibular stenosis. Ureter tract was destroyed and from to progressive fibrosis of gallbladder wall. The reported frequency place to place narrowing and enlarged. Grade I-II hydronephrosis was left of XGC is ranged from 1.3% to 5.2%. It is usually seen in women pelvicalyceal system. These findings are special for tuberculosis a patient between 60 and 80 years of age. Approximately most of the patients has DM story who has these sypmtoms longstanding. In urine culture was has gallbladder calculus. In a small number of cases, cause of XGC proliferated TBC. and abdominal pain can be a gall bladder malignancy. Therefore; it is Keywords: Renal tuberculosis, MRI findings important to note that XGC and malignancy can be seen coexistently in a same gall bladder. Severe complications such as perforation, abse formation, adhesion to the intestinal wall and fistula may be seen. P - 039 Sonographically diffusely or focal wall thickening of the gallbladder, hypoechoic nodule formation in the gallbladder wall, adhesion to WHY SHOULD RADIOLOGISTS BE liver parenchyma and generally accompanying gallbladder stones FAMILIAR WITH RETRORECTAL can be seen. On computed tomography, heterogeneously enhancing CYSTIC HAMARTOMA? hypodense areas within the wall can be observed corresponding to sonographic appearance. Despite the fact that there is a limited litera- FATMA ZEYNEP ARSLAN1, SULEYMAN ONCU2, ture data about Magnetic Resonance Imaging findings of XGC; con- MEHMET KARAGULLE1, ISA DENIZ1 tinuous mucosal line, luminal surface enhancement, and gallbladder Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S59 stone highly suggest XGC. XGC may be misinterpereted as gall blad- P - 042 der malignancy due to increased wall thickness and focal adhesions or may be seen with gall bladder malignancy. In conclusion, although it METASTATIC POSTERIOR is not a malignant pathology because of the severe complications of MEDIASTINAL NEUROBLASTOMA MRI XGC and possible coexistence with malignancy, early diagnosis and appropriate surgical treatment are necessary. we presented a case FINDING in which sonographic Murphy sign was positive, sonographically wall SUAT INCE, ALPARSLAN YAVUZ, MESUT OZGOKCE irregularity observed and intramural collection and contrast enhance- Van Yüzüncü Yıl University School of Medicine, Van, Turkey ment seen on magnetic resonance imaging. Herein, we discussed MRI findings of a case pathologically confirmed as XGC and accompanying Abstract low grade gall bladder malignancy. Objective: In this case, we aimed to present a case of metastatic neuro- Keywords: Xanthogranulomatous cholecystitis, low grade gallbladder blastoma located in atypical localization in a 10 year old patient. cancer, murphys sign Materials and Methods: A 10-year-old girl, who was followed up for one week due to pneumonia at the external center, applied to the hospital for further examination.PA chest X-ray showed suspicious opacity in the P - 041 lower right zone.Pulmonary and upper abdominal MRI examinations were IMAGING FEATURES OF ATYPICAL performed for differential diagnoses. LOCALIZED LEIOMYOMA Results: In the MR examination, 78x74 mm mass consisting of heterogeneous contrasting and cystic degenerated areas was observed in the right ONUR BECERIK1, CANAN ALTAY1, TAYFUN BISGIN2, lower thoracic paravertebral region. The lesion could not be distinguished EMINE BURCIN TUNA3, SELMAN SOKMEN2, MUSTAFA SECIL1 from the right adrenal gland. The lesion extends through the foramen on 1Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, the medial side and narrows the right half of the spinal canal in a crescen- Turkey tic manner. In addition, the lesion was extended to the left paravertebral 2Department of General Surgery, Dokuz Eylül University School of Medicine, area and under the skin and signal changes compatible with invasion in İzmir, Turkey adjacent ribs were observed. In the anterior of right lobe of the liver, a 3Department of Pathology, Dokuz Eylül University School of Medicine, İzmir, solid mass measuring 11x10 mm in size compatible with metastasis was Turkey observed. The case was diagnosed as neuroblastoma result of histopatho- Abstract logic examination. Introduction: Leiomyomas are benign mesenchymal tumors that Conclusion: Neuroblastoma is the second most common tumor encoun- originates from smooth muscle. The most common area of occur- tered during childhood. Approximately 20% of all neuroblastomas rence in the body is the uterus. Rarely, they may develop at any sites originate posterior mediastinum. Neuroblastoma is seen as mixed intense where smooth muscle cells are found. Also malignant mesenchymal masses in MRI. Neuroblastoma shows different staining patterns with tumors such as leiomyosarcomas must be considered in the differ- intravenous contrast material. The staining can be diffuse homogeneous, ential diagnosis of soft tissue tumors. Here, we report the computed heterogeneous or circumferential thin. When the mass reaches large tomography (CT), and magnetic resonance imaging (MRI) findings of a dimensions, it can be observed that the ribs are displaced, thinned, and leiomyoma in the abdominal wall of the inguinal region. separated from each other. Case Report: A 67-year-old female was referred a history of palpat- Keywords: Neuroblastoma, posterior, mediastinal, metastatic ing mass in the right inguinal region. A physical examination showed a large and stiff mass at the anterior portion of right inguinal region. Consequently, CT, and MRI were performed. Contrast-enhanced-CT P - 043 of the abdomen revealed a heterogeneously hypodense, lobulated mass in the right inguinal region, anteriorly and superior to the muscle PANCREATIC ADENOCARCINOMA pectineus, medial to femoral artery and vein. The lesion extends into ORIGINATING FROM HETEROTOPIC the skin-subcutaneous fatty tissue and has irregular border with homo- PANCREATIC TISSUE OF THE geneous enhancement. MRI images reveal, hypointense and lobulated mass on T1-weighted images (WIs) and mildly heterogenous hypoin- JEJUNUM; MRI FINDINGS tense on T2WIs compare to muscle. Fat-suppressed T1-weighted AYSEGUL OZ1, BEDRIYE KOYUNCU SOKMEN1, images obtained after administration of a gadolinium-based contrast LEVENT ULUSOY1, SADIK SERVER1, SEZGI BARLAS1, material showed strong heterogeneous enhancement of the mass. The NAGIHAN INAN1, ESAT NAMAL2, YAMAN TOKAT3 pathology revealed a leiomyoma of the abdominal wall. 1Department of Radiology, İstanbul Bilim University Florence Nightingale Conclusion: MRI is the best radiologic imaging tools for the diagnosis Hospital, İstanbul, Turkey of the soft tissue tumors. A leiomyoma in the inguinal region present 2Department of Oncology, İstanbul Bilim University Florence Nightingale as a well-defined and homogeneous soft tissue lesion on the MRI. Hospital, İstanbul, Turkey 3Department of General Surgery, İstanbul Bilim University Florence Keywords: Leiomyoma, magnetic resonance imaging Nightingale Hospital, İstanbul, Turkey S60 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Abstract Case Report: A 48-year-old male presented with urinary symptoms, which were described as progressive urinary retention. The prostate-specific anti- Objective: MRI findings of pancreatic adenocarcinoma originating from gen (PSA) value was 2,55 ng/mL. MRI of the prostate was performed. MR heterotopic pancreatic tissue of the jejunum. Heterotopic pancreas images revealed a tumor extending from the base of prostate to the apex of (HP) can be located in anywhere in the gastrointestinal system from the prostate. The transitional zone of the prostate gland compromise of macrol- esophagus to the rectum. It has no vascular or anatomic contact with obulated heterogenous, hyper-intense mass with hipointense capsule on the the pancreas. Spleen, liver, Meckels diverticulum, gallbladder, bile duct, or T2-weighted images (WI). The prostatic mass has central hyperintense areas fallopian tube involvement is reported. It’s a very rare entity (0.6–5.6% within the mass on the T1WIs competible with mucin lakes. After contrast of autopsies) and usually incidentally detected. If symptomatic; epigastric administration, the lesion demonstrated strong heterogeneous enhance- pain, ileus, intussusception, bleeding, pancreatitis or very rarely carci- ment. Surgery was performed using a retropubic approach. Histopathological noma can occur. Fifty-one years old male patient consulted to emergency examination confirmed the presence of a prostatic adenocarcinoma with department with vomiting, intestinal obstruction symptoms. extraluminal mucinous pools involving >50% of the tumor volume. The final Results: On contrast enhanced MDCT an infiltrative mass with no con- Gleason score given was 4+4=8 and the stage pT4. nection to pancreas in the duodenojejunal junction extending to jejunum Discussion and Conclusion: Primary prostatic mucinous adenocarcinoma is was detected. On abdominal MRI, lesions enhancement and morpho- a rare and aggressive malignant tumor. The MRI features of mucinous adeno- logic pattern was identical with pancreatic adenocarcinomas, diffusion carcinoma is nonspecific, however, it can be seen hyperintense regions in the was restricted. After excision of the jejunal tumor by laparotomy, biopsy prostatic mass on on T1-WI and T2-WI due to presence of mucin pools. MRI revealed pancreatic adenocarcinoma in the jejunum. is also helpful for detecting the invasion of adjacent tissues and staging. Conclusion: Morphological and radiological findings of asymptomatic Keywords: Prostatic mucinous adenocarcinoma, magnetic resonance imaging HP of the gastrointestinal system are very similar to other submucosal gastrointestinal stromal tumors. HP can show homogenous or heterogeneous enhancement pattern depending on the predominant histologic composition (acini or cystic ducts) of the heterotopic tissue (Heinrich’s P - 045 classification). When symptomatic, MRI demonstrates signal characteristics that may vary according to the cellular component of the lesion. TYPE 2 LEFT RENAL VEIN VARIATION: Our case demonstrated similar signal, enhancement and morphologic MRI FINDINGS characteristics with pancreatic adenocarcinomas. HP should be kept in ALPER DILLI, IDIL GUNES TATAR mind, when a gastrointestinal pathology –a submucosal mass, an infiltrative tumor, inflammation or bleeding- reveals similar imaging patterns to Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey pancreatic tissue. Abstract Keywords: Heterotopic pancreas, MRI, pancreatic adenocarcinoma We aimed to present the MRI findings of Type 2 left renal vein variation. Lomber MRI examination of a 59-year-old male patient revealed the P - 044 incidental finding of Type 2 left renal vein variation where left renal vein had a retroaortic course joining inferior vena cava at the level of iliac vein MRI FEATURES OF PROSTATIC bifurcation at the level fourth lomber vertebra. It results from the oblitera- MUCINOUS ADENOCARCINOMA: tion of the ventral pre-aortic limb of the left renal vein and the remaining dorsal limb turns into a retroaortic left renal vein. Variations in the vascular A CASE REPORT anatomy should be reported when they are detected to aid the surgical CANAN ALTAY1, UYGAR MUTLU1, OZAN BOZKURT2, or interventional procedures which can potentially take place in the future. OMER DEMIR2, KUTSAL YORUKOGLU3, Keywords: Renal vein, retroaortic, variation, MRI ARAS EMRE CANDA4, MUSTAFA SECIL1 1Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey P - 046 2Department of Urology, Dokuz Eylül University School of Medicine, İzmir, Turkey 3Department of Pathology, Dokuz Eylül University School of Medicine, RARE PELVIC BASE HERNIA: İzmir, Turkey 4Department of General Surgery, Dokuz Eylül University School of SUPRAPRIFORM FORAMEN HERNIA Medicine, İzmir, Turkey HATICE GUL HATIPOGLU1, HAMZA OZER1, ALI DALGIC2, 1 Abstract SEMRA DURAN 1 Introduction: The mucinous subtype of prostate adenocarcinoma, also Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey referred to as colloid adenocarcinoma, is extremely rare as a primary 2Department of Neurosurgery, Ankara Numune Training and Research prostate lesion. The mucinous subtype of prostate adenocarcinoma has Hospital, Ankara, Turkey aggressive clinical behavior Surgical resection is the main therapeutic Abstract option. Herein, we describe the clinical and magnetic resonance imaging (MRI) features with histopathological correlation of a patient with pros- Perineal hernias are rare pelvic hernias, occurring through a defect tate mucinous adenocarcinoma. in the pelvic floor musculature. More common in females, with peak Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S61 age of presentation between 40 and 60 years. Perineal hernias are of soft-tissue neoplasms. However, the radiologic features of Ancient classified as anterior or posterior depending on their relationship with schwannoma occurred in the ischiorectal fossa have been rarely reported. the transverse perineal muscle. Anterior hernias are more common In this case, we describe the MRI findings in a case of a Ancient schwan- than posterior hernias, and occur almost exclusively in females.Large noma involving the ischiorectal fossa of a known primary breast cancer sciatic foramen-based hernias in the posterior group may cause symp- 67-year-old woman. toms such as sciatica, lumbago, and priformis syndrome. Clarification Keywords: Ancient schwannoma, ischiorectal fossa, MRI of etiology is very important for definite treatment and comfort of patient. We aimed to share the imaging findings of the patient who had followed as suprapriform syndrome for years and diagnosed as suprapriform herniation which was detected on perianal MRI examina- P - 049 tion in our clinic. ACCESSORY PANCREATIC LOBE: CASE Keywords: MRI, suprapriform hernia, perineal hernia REPORT AYSEGUL SAGIR KAHRAMAN1, BAYRAM KAHRAMAN3, P - 047 SEZAI YILMAZ2 1Department of Radiology, İnönü University School of Medicine, Malatya, GIANT CISTERNA CHYLI Turkey 2 DENIZ SOZMEN CILIZ, HAMZA OZER, Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey HATICE GUL HATIPOGLU, SEMRA DURAN, 3Department of Radiology, Malatya Park Hospital, Malatya, Turkey BULENT SAKMAN, MEHTAP CAVUSOGLU Abstract Ankara Numune Training and Research Hospital, Ankara, Turkey Accessory pancreatic lobe is a rare congenital duplication anomaly. Abstract Currently, Magnetic Resonance Imaging (MRI) and MR cholangiopan- Cisterna Chyli is a normal anatomic structure in the retrocrural area creatography (MRCP) is the first choice for investigating and diagnos- where lymphatic channels are formed as a saccular dilatation just to ing parenchymal and ductal pancreatic variations noninvasively. We the right of the abdominal aorta. Its main funciton is to transport aimed to report a case of a 68-year-old female patient diagnosed with digested fat. The size can be changed by contraction waves. It may also accessory pancreatic lobe who investigated for biliary stone disease. be confused with cystic lesions of the pancreas and retro-cranial lymph She presented with recurrent episodes of epigastric and right upper nodes due to its location. Differential diagnosis can be made with some quadrant pain since few months. MRI and MRCP investigated minimal criterias; such as, its characteristic location, structure, isointensity with biliary and gallbladder dilatation with cholelithiasis. Additionally, the CSF, and no significant change in the dimension within follow-ups. We duplicate pancreas detected incidentally that derived from the head of wanted to share the findings of ultrasonography, computed tomography the normal pancreas, looped back to the duedonum, course inferiorly and magnetic resonance imaging of this rare giant cisterna chyli case. adjacent to the second portion of duedonum and ended adjacent to Keywords: Cisterna chyli, MRI, cystic lesion the right pararenal space. The duct of duplicated pancreas drained into main pancreatic duct at the head of the pancreas. The main pancreatic duct drained into the duedonum separately from the choledoc. The P - 048 patient was explored for cholesistectomy and surgery confirmed MRI ANCIENT SCHWANNOMA OF THE findings. Although these cases usually remain asymptomatic; duplicated pancreas, if undetected, may be the cause of postoperative complica- ISCHIORECTAL FOSSA-A RARE CASE tions following pancreaticobiliary interventional procedures or surgery. WITH MRI FINDINGS Congenital anomalies of the pancreas cause variable morphological BEDRIYE KOYUNCU SOKMEN1, AYSEGUL OZ1, changes of the organ that can be evaluated by means of imaging SADIK SERVER1, SEZGI BURCIN BARLAS1, ESAT NAMAL2, modalities including MR and MRCP. 1 NAGIHAN INAN Keywords: Pancreas, MRI, MRCP, accessory pancreatic lobe 1Department of Radiology, İstanbul Bilim University Sişli Florence Nightingale Hospital, İstanbul, Turkey 2Department of Medical Oncology, İstanbul Bilim University Sişli Florence Nightingale Hospital, İstanbul, Turkey P - 050 Abstract TRIORCHIDISM (CASE REPORT) Ancient schwannomas are rare, encapsulated tumors of long duration SENAY BENGIN ERTEM1, GOKCEN YILDIZ2, and are benign in nature. Ancient schwannoma, a degenerative neuri- IBRAHIM KILCI3 lemmoma, is a schwannoma subtype characterized by degeneration and 1Department of Radiology, Çanakkale Onsekiz Mart University School of diffuse hypocellular areas. These changes are believed to occur because it Medicine, Çanakkale, Turkey takes a long time for schwannomas to develop. Schwannomas with these 2Department of Radiology, Private Cihan Hospital, Kocaeli, Turkey degenerative changes can be misdiagnosed as sarcomas or as other forms 3Department of Urology, Private Cihan Hospital, Kocaeli, Turkey S62 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Abstract P - 052 Introduction: Polyorchidism is a very rare anomaly, which is defined by the presence of more than two testicles. To date about 200 cases EXTRAGENITAL ENDOMETRIOSIS have been reported in literature. Triorchidism -three testicles- is MIMICKING CARCINOMA: A REPORT the most common form of polyorchidism. Extra testicles are usually OF TWO CASES found on the left scrotum. The etiology of polyorchidism is thought to be an embryological developmental abnormalty during the forma- BILGESU ARIKAN ERGUN, ANDELIB BABATURK, tion of testicles. Usually, patients present with an asymptomatic mass. DIGDEM KURU, G. AYSE ERDEN These extra testicles are at increased risk to develop malignancy Department of Radiology, Ankara University School of Medicine, Ankara, and torsion. Polyorchidism classified into four types. Polyorchidism Turkey is usually diagnosed on the basis of color Doppler US, further sup- Abstract ported by MRI. Introduction: Endometriosis is characterised by the presence of Case Report: 32 years old man suffering from right testicular pain applied functional endometrial glands outside the uterus. The most common to our hospital. On physical examination there is a painless mass in the left scrotum; than he referred to our department for testis US. extragenital location of the disease is gastrointestinal tract (GIT). Cases may be misdiagnosed as neoplastic diseases if this relatively rare entity Discussion: In testis US there were two testis in the left scrotum with is not evaluated their own epididymis. Than he was underwent to pelvic MRI. In pelvic MRI, there were two testis in the left scrotum. Both of them had their particularly. Here in this report of two cases, we aimed to present MR own epididymis and vas deferens (Type 4 polyorchidism). There were no imaging findings of rectal and small bowel endometriosis. sign of torsion or malignancy so patient was discharged by recommended Case 1: A 25-year-old woman had history of intermittant abdominal to US follow- up per year. pain and defecation difficulty. Abdominal computed-tomography (CT) Conclusion: Polyorchidism is a very rare anomaly. Doppler US is the revealed a mass lesion that extend along cul-de-sac, invade cervix and preferred method for diagnosis and follow-up. MRI may use in compli- posterior wall of uterine corpus. Pelvic magnetic resonance imaging (MRI) cated cases. Extra testicles are at increased risk to develop malignancy showed an and torsion. When such risk developed the extra testicle must be excised enhancing, diffusion-restricting lesion arising from posterior cervical wall, surgically. extending along cul-de-sac, invading rectum wall and radiating into sur- Keywords: Triochidism, color doppler US, MRI rounding tissue. Sagittal T2-weighted MR images showed “mushroom cap sign”, which is considered as a specific finding of solid invasive endometriosis. In the direction of these findings an endoscopic ultrasound-guided P - 051 biopsy was performed, the final pathologic results showed endometriosis with rectum involvement. MR UROGRAPHY: URETEROVAGINAL Case 2: A 44-year-old woman presented with chronic abdominal pain. FISTULA WITH DUPLICATED URETER Abdominal CT revealed segmental ileal bowel thickening and a soft tissue mass. MRI showed a diffusion restricting, progressive enhancing segmental SEHNAZ EVRIMLER1, EVRIM ERDEMOGLU2 intraluminal lesion which was thought to be a carcinoid tumor. 1Department of Radiology, Süleyman Demirel University School of Medicine, Isparta, Turkey Colonoscopy was not diagnostic. Surgery was performed; pathologic 2Department of Gynecologic Oncology, Süleyman Demirel University School results revealed multiple endometriotic lesions. of Medicine, Isparta, Turkey Conclusion: The most common extragenital location of endometriosis Abstract is GIT and it occurs in 3-37% of patients with endometriosis. Diagnosis Ureterovaginal, vesicovaginal fistulas can occur after pelvic operations of extragenital endometriosis can be difficult. Owing to the fact that dif- and the probability of them increases by the acompaniment of radioth- ferantial diagnosis consists mainly of neoplastic diseases which need radical eraphy. Other ethiologies are pelvic infectious and inflammatory diseases, surgical procedures, it is essential for radiologists to be aware of imaging traumas. Patients present with drainage of urine from vagina. Scopic findings of this entity. imaging techniques, computed tomography and magnetic resonance Keywords: Endometriosis, bowel involvement, magnetic resonance imag- (MR) imaging can be used for diagnosis. We aimed to demonstrate the ing probable fistula between urinery system and vagina with MR urography in our patient who complained of urine discharge into the vagina after hysterectomy operation. MR Urography images showed bilateral dublex collecting systems. On the left side both of the ureters fused proximally P - 053 to the ureterovesical junction level and fistulised to vagina. Findings were BLACK KIDNEYS: SIGN OF HEMOLYSIS compatible with ureterovaginal fistula. There was no vesicovaginal fistula detected. MR Urography findings were verified with cystoscopy and ure- ASSOCIATED WITH G6PDD terovaginal fistula was repaired with transabdominal approach successfully SEHNAZ EVRIMLER without complication. Department of Radiology, Süleyman Demirel University School of Medicine, Keywords: Fistula, magnetic resonance imaging, urography, ureter, vagina Isparta, Turkey Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S63

Abstract MERIC TUZUN, BAKI HEKIMOGLU Iron overload results in susceptibility effect especially on gradient-echo Department of Radiology, University of Health Sciences, Dışkapı Yıldırım sequences of magnetic resonance imaging (MRI). The major ethiologic Beyazıt Training and Research Hospital, Ankara, Turkey factor of renal hemosiderosis is intravascular hemolysis which can be Abstract caused by paroxysmal nocturnal hemoglobinuria, sickle cell disease, valvular heart disease. Renal cortex is totally involved and seen in hypointense Mucoepidermoid cancers of the head and neck are mostly seen in the signal on both T1- weighted and T2-weighted images. A 64 year-old major salivary glands or in the intraoral minor salivary glands. It is quite female patient who presented with epigastric pain, diarrhea and icteric rare to see in the neck lymph node without another known primary focus. sclera-skin. Allergy to fava bean and aspirin was detected in her medical In this case report, a 28 year old female patient with intranodal mucoepi- history. Anemia, hyperbilirubinemia, and Glucose-6-phosphate dehydro- dermoid cancer in the neck is presented with magnetic resonance imaging genase deficiency (G6PDD) was found in laboratory tests.There was no findings. sign for renal failure. Abdomen MRI showed bilateral entire renal cortex hypointensity on T1- weighted in-phase, isointense on T1- weighted out Keywords: Neck, mucoepidermoid cancer, lymph node, magnetic reso- of -phase, and hypointense on T2-weighted images, accompanied with nance imaging hepatosplenomegaly. Findings were compatible with renal hemosiderosis caused by hemolysis as a result of G6PDD.To the best of our knowledge, there has been no case report presenting renal iron overload MRI characteristics on MRI. Acute hemolytic episodes can cause renal injury in P - 056 G6PDD patients. MRI can be used for evaluating predisposition to renal SKIN METASTASIS OF injury in such patients, which needs to be investigated with further studies. LARYNGEAL SQUAMOUS CELL Keywords: Glucosephosphate dehydrogenase deficiency, hemosiderosis, kidney, magnetic resonance imaging CARCINOMA MERIC TUZUN, BAKI HEKIMOGLU Department of Radiology, University of Health Sciences, Dışkapı Yıldırım P - 054 Beyazıt Training and Research Hospital, Ankara, Turkey

A CASE OF CHOLESTEATOMA RARELY Abstract LOCATED IN THE MASTOID Skin metastasis is very rare in larynx cancer. It is often regarded as a sign NURSEN TOPRAK, MAHFUZ TURAN of poor prognosis. The incidence of skin metastasis in head and neck Van Yüzüncü Yıl University Dursun Odabaş Medical Center, Van, Turkey cancers is less than 1%. In this case report, a 62-year-old male patient with skin metastasis of laryngeal squamous cell carcinoma is presented with Abstract magnetic resonance imaging findings. Objective: We aimed to present a 33-year-old male with mastoid Keywords: Larynx, squamous cell carcinoma, neck, magnetic resonance congenital cholesteatoma cholesteatoma that manifested as left otor- imaging, skin rhea was presented in the presence of computed tomography (CT), magnetic resonance imaging (MRI) and diffusion-weighted image(DWI) Materials and Methods: CT, MRI and DWI was used for diagnosis P - 057 Results: CT scan revealed a 3.5x2 cm size destructive lesion at left – sided mastoid cellüler. MRI scans revealed a 3.5x2 cm size cholesteatoma SINONASAL MYXOFIBROSARCOMA: at left -sided with characteristic bright signal in T2 weighted imaging MAGNETIC RESONANCE IMAGING and restricted diffusion on DWI. Histopathologic studies revealed left mastoid cholesteatoma. FINDINGS Conclusion: Congenital cholesteatoma confined to the mastoid process MERIC TUZUN, BAKI HEKIMOGLU is a rare lesion. Symptoms are often lacking or nonspecific, and although Department of Radiology, University of Health Sciences, Dışkapı Yıldırım cases have a congenital origin, the diagnosis often is not made until Beyazıt Training and Research Hospital, Ankara, Turkey adulthood. CT, MRI and DWI are invaluable in the diagnosis of occult congenital cholesteatomas, especially those originating in the mastoid. Abstract Keywords: Congenital cholesteatoma, CT, MRI, DWI Myxofibrosarcoma is a malignant soft tissue tumor of fibroblast origin. It is more common in the trunk and extremities. It is rarely seen in the head and neck region. It is usually a slowly growing tumor with a high P - 055 recurrence rate and occasionally distant metastasis. In this case report, a 55-year-old male patient with sinonasal myxofibrosarcoma is presented A RARE LESION OF THE NECK: with magnetic resonance imaging findings. INTRANODAL MUCOEPIDERMOID Keywords: Myxofibrosarcoma, neck, magnetic resonance imaging, para- CANCER nasal sinus, neck S64 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

P - 058 Abstract SECONDARY MIDDLE TURBINATE Introduction: Graves’ disease is a common thyroid-related autoimmune disease. Graves’ ophthalmopathy is one of the complications of this EXTENDING INTO THE CONCHA disease and which is reduce the quality of patients life and makes visual BULLOSA disturbances. We presented MR images of a patient who had graves ophthalmopathy. MERIC TUZUN, BAKI HEKIMOGLU Case Report: 36-year-old female patient with diagnosis of Graves’ dis- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey ease was admitted to the hospital with the complaints that her eyes had protruded outward and restricted her eye movements. MR examina- Abstract tion revealed exophthalmos, hypertrophy in all extraocular muscles and Secondary middle turbinate is a rare osteomeatal variation. It is a bone T2 hyperintensities in these muscles which were thought to be due to structure extending from the lateral nasal wall to the middle meatus infiltration of fat tissue, retrocular fat tissue increase, lacrimal gland size and covered with soft tissue. The frequency of appearance varies increase, and maxillary sinus indentation of orbital floor. between 0.8% and 14.3% in different publications. It can be one-sided Discussion: Graves disease is a multisystem disease of unknown cause or two-sided. It can be accompanied with other osteomeatal variations. characterized by one or more of the three pathognomonic clinical Secondary middle turbinate extending into concha bullosa is very rare. entities: Hyperthyroidism, infiltrative ophthalmopathy and infiltra- In this case report, a unilateral secondary middle turbinate extending tive dermopathy. In the clinical features of thyroid orbitopathy are into the concha bullosa encountered incidentally on magnetic resonance exophthalmos, upper and lower eyelid retraction, limitation of eye imaging of the brain is presented. movements and eyelid edema. CT and MR imaging may show only Keywords: Secondary middle turbinate, concha bullosa, middle turbi- markedly swollen retrobulbar orbital contents causing bilateral pro- nate ptosis. Coronal images should be carefully assessed in evaluating the amount of orbital muscles hypertrophy and the optic nerve pressure. Other CT and MR imaging findings are increased orbital fat, edema P - 060 (fullness) of the eyelids, enlargement (engorgement) of the lacrimal glands, proptosis, anterior displacement of the orbital septum, and SINONASAL INVERTED PAPILLOMA stretching of the optic nerve. The increased orbital fatty tissue results in anterior displacement of the orbital septum and occasionally pro- WITH THE CHARACTERISTIC SIGN lapse of lacrimal glands. “CONVOLUTED CEREBRIFORM Keywords: Thyroid orbitopathy, graves disease, graves ophthalmopathy PATTERN”: A CASE REPORT DIBA SAYGILI, OZGE TANISMAN, ELIF AKTAS Ankara Oncology Training and Research Hospital, Ankara, Turkey P - 062 Abstract SKULL METASTASIS IN AN INFANT Sinonasal inverted papilloma (SIP) is a rare benign neoplasm of sino- WITH NEUROBLASTOMA nasal cavities. It is locally aggressive and has malignant transformation HASAN EMIN KAYA1, ALAATTIN NAYMAN2, potential; despite its benign histology. Thus making distinctive diagnosis 1 1 of SIP from other benign sinonasal cavity lesions and careful surveillance ULKU KERIMOGLU , SERDAR KARAKOSE for malignant transformations are essential. In this article, a 63-year-old 1Department of Radiology, Necmettin Erbakan University, Meram School man is reported who presented with nasal obstruction, headache and of Medicine, Konya, Turkey recurrent sinusitis. The patient was evaluated with CT and MRI. The 2Department of Radiology, Selçuk University School of Medicine, Konya, preliminary diagnosis of SIP was confirmed histopathologically. With this Turkey case report we aimed to draw attention to characteristic imaging find- Abstract ings and highlight the risk of malignant transformation of SIP. Metastatic involvement of the skull can be seen in up to 25% of patients Keywords: Sinonasal inverted papilloma, malignant transformation, con- with neuroblastoma. Typical appearances include bone thickening, “hair- voluted cerebriform pattern on-end” periosteal reaction, lytic defects, enhancing soft tissue masses, and separation of sutures. Here we present classic CT and MRI findings of skull metastasis of neuroblastoma in a six-month-old girl. P - 061 Keywords: Neuroblastoma, metastasis, bone, CT, MRI THYROID RELATED ORBITOPATHY CASE REPORT P - 063 IBRAHIM FEYYAZ NALDEMIR, ELIF NISA UNLU, OMER ONBAS TAKAYASU ARTERITIS: MR Düzce University School of Medicine, Düzce, Turkey ANGIOGRAPHY FINDINGS Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S65 UMMUGULSUM BAYRAKTUTAN, ALPER KIZILOGLU, P - 065 HAYRI OGUL, RECEP SADE, MECIT KANTARCI, AKIN LEVENT A RARE CASE OF PURPURA Department of Radiology, Atatürk University School of Medicine, Erzurum, FULMINANS WITH PRECENSE OF Turkey BRAIN INVOLVEMENT Abstract SAIM TURKOGLU, ABDUSSAMET BATUR

Objective: Takayasu arteritis is an inflammatory disease that involves the Department of Radiology, Van Yüzüncü Yıl Uinversity School of Medicine, Van, Turkey major branches of the aorta, the aorta, and the pulmonary arteries. It affects large vessels and causes damage to the vessel wall. We have tried Abstract to present magnetic resonance imaging angiography (MRA) findings in a Objective: Purpura fulminans (PF) is a rare syndrome with intravascular 30 year-old-female patient. coagulation and vascular collapse. Multiorgan can lead to insufficiency. MRI Materials and Methods: Neck MRA examination was performed in a holds an important place in the diagnosis. We aimed to use and present 30-year-old woman with complaints of dizziness, fatigue and weakness MRI patients with PF. with a 1.5 Tesla MR device (Magnetom Avanto, Siemens Healthcare). Materials and Methods: An 8-year-old male patient was followed up with Results: In our case, bilateral common carotid arteries, internal and ichthyosis, Central Hypothyroidism, Glaucoma and Protein C, S, AT-III, common skin rashes, coagulation parameters in laboratory tests and gen- external carotid arteries, vertebral artery, subclavian arteries and aorta eral condition further deteriorated. MR images showed T1 hyperintense to be more prominent on the right side showed luminal narrowing and diffusion restriction area accompanied by left parietotemporal bleeds. increased wall thickness. Erythrocyte sedimentation rate (ESR) and serum T2AG had edema and moderate hattan shift. C-reactive protein (CRP) levels, which are indicators of inflammation as laboratory findings, were also high. Takayasu arteritis was diagnosed due Results: MRI is considered as the ideal examination in showing PF brain to the present findings and differences in blood pressure values between involvement. Differential diagnosis should be made from the mass lesions arms. showing limited disease diffusion and the etiologies that may cause bleeding. Thus, the shape of the treatment can be given direction. Conclusion: Takayasu arteritis is characterized by prominent intimal proliferation in the arterial wall, granulomatous inflammation causing Conclusion: PF is acute onset and aggressive disease that is occured after fibrosis development in the media and adventitia. Stenosis, occlusion and infectious diseases and coagulation disorders; Intravascular hemorrhage, occasionally poststenotic dilatation and aneurysm may occur in the vas- thrombosis and infarcts result in multisystem involvement resulting in isch- culature. ESH, CRP elevation, blood pressure difference between both emia, necrosis, loss of integrity in the skin. It can rarely be seen with haem- arms can help to diagnose. Conventional angiography, CT angiography and orrhagic infarct in the brain as well as in our case. Brain involvement of MRA are used for diagnosis. CT angiography and MRA can clearly show the disease is non-specific and can interfere with many lesions. Although vessel wall changes that are difficult to detect in conventional angiography. physiopathology is not fully understood, it is thought to play a role in Corticosteroids are used in the treatment of the disease, but stenting multiple factor damage mechanisms. Extremity involvement is almost in partial or fully occluded vessels and surgical by-pass surgeries are also always a rule, but we can not reach clear literature information on brain involvement. Diagnosis is made in the clinic and laboratory but sometimes performed. biopsy is needed for diagnosis. In the present case we were diagnosed by Keywords: Takayasu arteritis, magnetic resonance imaging angiography clinical biocompatibility as well as biopsy from the skin. In accordance with histopathology, hemorrhagic infarct areas in the brain parenchyma of the patient were also thought to develop due to purpura fulminans. P - 064 Keywords: Purpura fulminans, magnetic resonance imaging, brain EXTENSIVE ABSCESS FORMATION DUE TO MANDIBULAR P - 066 OSTEOMYELITIS INVERTED PAPILLOMA OF THE OGUZ LAFCI, HASAN YIGIT, PINAR NERCIS KOSAR ANTERIOR CLINOID PROCESS Ankara Training and Research Hospital, Ankara, Turkey AYDAN ARSLAN1, MUSTAFA GUDUK2, ALP DINCER1, NECMETTIN PAMIR2 Abstract 1Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School Osteomyelitis is defined as an infection of medullary cavity which reaches of Medicine, İstanbul, Turkey to periosteum via Haversian canals. Although rare, mandibular ostemyeli- 2Department of Neurosurgery Acıbadem Mehmet Ali Aydınlar University tis is more frequent than maxillary osteomyelitis and is usually seen with School of Medicine, İstanbul, Turkey involvement of adjacent soft tissues. Here we present a case of a 33 year Abstract old man with extensive abscess formations involving masseter, pterygoid and temporal muscles secondary to mandibular osteomyelitis. Inverted papilloma (IP) is a benign tumor that usually occurs the nasal cavity and paranasal sinuses. The clinical presentation of IP is nasal obstruc- Keywords: Mandibula, osteomyelitis, MRI tion and headache as other nasal tumors. We aimed to discuss the MRI S66 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 features of a 48-year-old male patient who admitted to our clinic due to SUMEYRA DEMIRKOL ALAGOZ, IBRAHIM ILIK, headache. Magnetic resonance imaging (MRI) of the brain with contrast SUAT INCE, MESUT OZGOKCE, HARUN ARSLAN, showed mild expansile heterogeneous bone mass localized in the right ALPASLAN YAVUZ anterior clinoid, extending laterally to the sphenoid sinus. The lesion was Department of Radiology, Van Yüzüncü Yıl University, School of Medicine, reported as a possible inverted papilloma. Anterior clinoid IP is the first Van, Turkey case report in the English literature to our knowledge. Abstract Keywords: Inverted papilloma, anterior clinoid process, schneiderian papilloma, MRI, anterior clinoid inverted papilloma Objective: We aimed to present Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) findings of ectopic thymus tissue which is a rare cause of neck masses. The differential diagnosis of neck masses should be P - 067 considered especially in children. PAROTIS ADENOCARCINOMA AND ITS Materials and Methods: An 8-month-old male patient was admitted to METASTASIS, REPORT OF TWO CASES our hospital with complaints of swelling in the neck. In USG review; continuing bilaterally submandibular area to the inferior, hypoechoic accord- HASAN AYDIN, KEMAL ARDA, MUAZZEZ BENGI AKYOL, ing to thyroid parenchyma, with multiple echogenic linear seals, doppler MEVLUDE ALTINTAS examination with vascularity, lesions were observed that did not affect Department of Radiology, Oncology Research Hospital the surrounding tissues. Anterior mediastinal lesions were found to be echogenic and similar to thymus tissue. In MRI review the same intense Abstract lesions as the thymus tissue at the anterior mediastinum were detected at Two cases with parotis adenocarcinoma were presented here, both masess T1 and T2 weighted series. were located in the left parotid gland, one was in the superficial, the other was in the deep glandular localization. In both cases, lots of noduler pul- Results: Detected lesions were evaluated as bilateral ectopic thymus monary and plevral metastasis were shown in the lungs. In the superficially tissue with USG and MRI findings. Monitoring of the patient was recom- located parotid malignancy; multiple thoracic and mediastinal LAP, massive mended. pleural effusion and right pulmonary artery thrombus were present. Left Conclusion: Ectopic or aberrant thymus tissue can be seen anywhere iliac crest and right transverse process of L4 were also seen in this case. In from angulus mandibular to anterior mediastinum due to thymus descent the deep glandular one, Lots of Liver metastasis were shown. Both cases during embryological development or involution anomaly of the thy- were eveluated by Torax CT-Head and neck MRI-Abdominal MRI. mopharyngeal canal. It may show a solid or cystic character. Congenital Keywords: Parotis-Adeno-carcinoma-metastasis-MRI lesions, lymphadenopathies, benign and malignant tumors can often be confused with ectopic thymus. USG is considered as the first imaging method. Computed tomography (CT) is rarely used in infants and chil- P - 068 dren because of ionizing radiation. Magnetic resonance imaging (MRI) is considered to be the most reliable imaging modality for ectopic thymus. METASTATIC THYROID CARCINOMA, It is stated that in cases with characteristic features after being diagnosed REPORT OF THREE CASES with imaging methots, histopathological diagnosis is not necessary and follow-up is sufficient. KEMAL ARDA1, HASAN AYDIN2, VOLKAN KIZILGOZ1, SINEF HUVAJ AKSOY2, SUMEYYE KAYMAK2 Keywords: Cervical ectopic thymus, ultrasonography, magnetic resonance 1Department of Radiology, Gülhane Research Hospital, Ankara, Turkey 2Department of Radiology, Oncology Research Hospital P - 070 Abstract Three metastatic papillary thyroid carcinomas were presented here, All FETAL MAXILLOFACIAL TERATOMA three cases were evaluated by CT and MRI. In the first case, multiple MRI FINDINGS pulmonary metastatic nodules and multiple liver masses with iliac bone NUSRET SEHER, EMINE UYSAL, HAKAN CEBECI, invasion were shown. In the second case, multiple bone metastasis involv- MUSTAFA KOPLAY, YAHYA PAKSOY ing thoracolumbar vertebrae-both acetabulum-symphisis pubis-ischium- bilateral caput femoris etc. were seen. In the third case, multipl LAP in the Department of Radiology, Selçuk University School of Medicine, Konya, mediastinum, retroperitoneum, mesentery and anterior-posterior servical Turkey chains with occipital bone invasion were revealed Abstract Keywords: Thyroid-metastasis-carcinoma-MRI-CT Teratomas are germ celled tumors that may consist all of the three germ leaf. Fetal teratomas are very rare and they can be observed in 1/40.000 rate. Facial placed teratomas are very rare and they are approximately P - 069 in 1-2% rate. Fetal teratomas are generally not providing any findings so that they can be determined as incidental. In general they have solid and BILATERAL CERVICAL ECTOPIC cystic component and it must be kept in mind that they can be monitored THYMUS as contoured mass rarely. Facial teratomas are important due to air way Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S67 obstruction and pressure on other structures, high morbidity and mortal- DENIZ OZTURK KOCAKGOL1, DILARA ATASOY1, ity rates related with poly-hydra-amnios, hydrops fetalis, preterm birth MERVE ERKAN1, REZZAN SUMELI2, AYSEGUL CANSU1 and rupture. In this proceeding fetal maxillofacial teratomas and magnetic 1Department of Radiology, Karadeniz Technical University, School of resonance imaging (MRI) findings had been presented Medicine, Trabzon, Turkey 2 Keywords: Fetal MRI, maxillofacial teratoma Department of Pediatric Surgery, Karadeniz Technical University, School of Medicine, Trabzon, Turkey Abstract P - 071 Introduction: We aimed to present a case of congenital cervical teratoma with prenatal sonographic and postnatal neck MRI findings; that INSIDENTALLY FOUNDED was detected as a cervical mass during prenatal follow-up and had ASYMPTOMATIC UNILATERAL an operation at postnatal period. Congenital teratomas are generally benign malformations. They are extremely rare in head and neck region. SUBMANDIBULAR GLAND AGENESIS Despite the fact that the majority is benign, they require immediate (CASE REPORT) surgical intervention due to the high mortality rate because of com- pressing of the airway. Today, the widespread use of ultrasonography SENAY BENGIN ERTEM1, GOKCEN YILDIZ2 in prenatal follow-up allows early detection of cervical teratomas. Thus, 1Department of Radiology, Çanakkale Onsekiz Mart University School of necessary precautions are taken in the perinatal period and it is possible Medicine, Çanakkale, Turkey to intervene at birth in elective conditions and early surgical interven- 2 Department of Radiology, Private Cihan Hospital, Kocaeli, Turkey tion in postpartum period with multidisciplinary approach. In addition, Abstract preoperative planning for total surgical resection of teratomas is done by imaging methods (MRI-CT). Introduction: Congenital absence of major salivary glands is a rare condition of unclear etiology. The first case was presented in 1885 by Gruber Case: A 26-years-old first gravida female reported at 36th week with ante- was a bilateral submandibular gland aplasia. Since then approximitely 41 natal ultrasound of the fetus showing right sided fetal neck mass of size 78 x cases have been reported in medical literature. Congenital salivary gland 47 x 95 mm. The mass had predominantly solid character with cystic areas. Congenital cervical teratoma, neuroblastoma and sarcoma were considered agenesis is usually bilateral and sometimes assotiated with other devel- in differential diagnosis. After the fetus was born by caesarean section ın the opment anomalies of head and neck area. Clinical syndromes, such as MRI examination; a minimal heterogeneously enhancing mass was observed, lacrimo-auriculo-dento-digital syndrome and mandibulo-fascial-dyostosis of size 90x50x83 mm, which is predominantly solid character with cystic (Treacher-collins syndrome) may also be seen. Unilateral submandibular areas. The mass filled right parapharyngeal area and extended exophytic gland agenesis is often asymptomatic and discovered incidentally through to subcutaneous soft tissue. Oropharyngeal and laryngeal air column were imaging. In sypmtomatic cases dry mouth, dental problems or difficulty in slightly narrowed and vascular structures were deviated to posteromedial. chewing and swallowing are seen. The mass was excited in early neonatal period and teratoma was confirmed Case Report: 31 years old young woman suffering from chronic neck on histology. pain applied to our hospital. Her physical examination was normal and she Conclusion: The diagnosis of congenital cervical teratomas with pre- underwent to cervical MRI. natal US is important in terms of postnatal morbidity and mortality. Discussion: In cervical MRI it was discovered that her left submandibu- MRI examination should be performed to show the relationship of the cervical mass with other neck regions and airway for appropriate surgi- lary gland was absent. Than she was underwent to neck US. In US it was cal planning. observed that left submandibulary gland was absent and the other major salivary glands were normal both in size and echogenity. She had no spe- Keywords: Servical mass, teratom, prenatal us cific symptoms such as dry mouth, dysphagia, dental problems or difficulty in chewing and swallowing. Conclusion: Submandibular gland agenesis is a rare condition. Patient has P - 073 this condition either asymptomatic or suffered dental problems or dif- GIANT HEMANGIOMA ON THE ficulty in swallowing by dry mounth. Asypmtomatic patient may diagnosed incidentally through imaging. When such a case is encountered, symptoms, TONGUE AND LIP findings and other possible additional deformities should be reevaluated SUMEYRA DEMIRKOL ALAGOZ, FATMA DURMAZ, and concervative therapy should be given if necessary. HARUN ARSLAN, MESUT OZGOKCE, ABDUSSAMET BATUR Keywords: Submandibular Gland Agenesis Department of Radiology, Van Yüzüncü Yıl University School of Medicine, Van, Turkey P - 072 Abstract MRI FINDINGS OF CONGENITAL Objective: Hemangiomas are frequently seen in children with head and neck tumors. We aimed to present magnetic resonance imaging CERVICAL TERATOMA; A CASE (MRI) findings of giant-sized hemangiomas involving the lips and the REPORT tongue. S68 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Materials and Methods: A 9-year-old girl was admitted to our hospital P - 075 with the complaint of red-purple colored swelling of her tongue and lower-upper lips, which was born. Magnetic resonance imaging (MRI) was NASOLABIAL CYST: A CASE REPORT performed after clinical examination. In MRI examination; hypointense on WITH CT AND MRI FINDINGS T1-weighted images and hyperintense on T2-weighted images, a lobulated 1 2 contour mass lesion with millimetric signal fields was observed. It was seen SENAY BENGIN ERTEM , YUNUS KANTEKIN that the lesion reached the oropharynx and narrowed the air column. 1Department of Radiology, Çanakkale Onsekiz Mart University, School of Medicine, Çanakkale, Turkey Results: According to MRI findings, the patient was diagnosed with 2Department of Ear Nose Throat, Bozok University, School of Medicine, hemangioma. She received beta blocker therapy and a 1-year follow-up Yozgat, Turkey showed minimal reduction in lesion size. Abstract Conclusion: Hemangiomas are considered a benign proliferation of endo- Introduction: Nasolabial cyst also known as Klestadt’s cyst is relatively thelial cells. They are frequently found in childhood age groups of head rare soft tissue lesion of nasal alar region. It is a benign, slow-growing, and neck tumors. Hemangioomas are rarely seen in the mouth. We aim non-odontogenic, primarily unilateral (%90), extraosseous soft tis- to present it with MRI findings because of being a rare localization and sue lesion located in the nasal alar region below the nasolabial fold. being in large size. Common clinical features include slowly growing painless mass which Keywords: Giant hemangioma, tongue, lip results in obliteration of nasolabial sulcus, nasal vestibule and maxillary labial sulcus. Nasolabial cysts cannot be seen on conventional radiography if there are no associated bone changes. CT can show a well demar- P - 074 cated, rounded, homogeneous, low-density soft tissue lesion in the nasolabial region. MRI can show the characteristics of a liquid-containing A RARE CASE, POST-TRAUMATIC cyst, with hypointense on the T1-weighted images and hyperintense on ARTERIOVENOUS FISTULA OF THE the T2-weighted images. SCALP Case Report: 35 years old woman suffering from painless swelling on the right alar region and nasal obstruction applied to our haspital. On physical SUAT INCE, SUMEYRA DEMIRKOL ALAGOZ, examination there is painless, fluctuant, mass lesion at the right nasal alar HARUN ARSLAN region. Patient was underwent to paranasal sinus CT and maxillofacial Van Yüzüncü Yıl University, School of Medicine, Van, Turkey MRI. Abstract Discussion: In MRI well shaped, extraosseous located, T1 hypointense T2 hyperintense cystic mass lesion at the right alar region causing par- Objective: In this case, we aim to present a rare case of posttraumatic tially obliteration of nasal vestibule was reported as nazolabial cyst. In arteriovenous fistula of the scalp. paranasal CT there is no bony destruction. Than mass lesion was totally excised by operation. Lesion was reported as nasolabial cyst hystopatho- Materials and Methods: A 21-year-old male patient admitted to our logically. hospital due to noise on the left side of the head resulting from head trauma 3 months ago. When there was no pathology on the direct graphy, Conclusion: Nasolabial cyst should be considered in the differential MRI examination was performed on the patients in terms of differential diagnosis in patient who have a cystic mass in the nasal vestibuler area. Its diagnosis. clinical diagnosis is supported by its typical CT and MRI features. Results: MRI examination revealed enlargement of the subcutaneous Keywords: Nasolabial cyst veins and tortious appearance in the left temporo parieto frontal region. Doppler USG examination was performed because clinical and MRI findings suggested an arteriovenous fistula.In the Doppler USG examination, P - 076 fistula flow was observed in the tortuous vascular structures under the skin therefore an arteriovenous fistula was diagnosed. WYBURN-MASON SYNDROME: A Conclusion: An arteriovenous fistula (AVF) is an abnormal connection CASE REPORT between an adjacent artery and vein. AVF of the scalp is relatively rare VELI SUHA OZTURK, YUNUS EMRE ORUK, disease. The etiology of the AVF of the scalp is still controversial, how- CAN ZAFER KARAMAN ever, it may be either of congenital or traumatic origin. There are two Department of Radiology, Adnan Menderes University School of Medicine, theories about pathogenesis of the traumatic AVFs. One is a disruption Aydın, Turkey of the arterial wall and its vasa vasorum with endothelial proliferation to adjacent veins. The other is simultaneous lacerations of the artery and Abstract the accompanying vein result in a single fistula. An abnormal early signal Introduction: Wyburn-Mason syndrome (WMS) is an extremely rare enhancement in venous structures on MR angiography may help to find nonhereditary disorder and associated with multiple arteriovenous mal- the point of arteriovenous fistulae. Time-resolved imaging sequences in formations (AVMs) containing the orbit, brain and face. MRI (e.g. TRICKS or TWIST) may be helpful. Case Report: We present the radiological features of a 33-year-old- Keywords: Arteriovenous, fistula, traumatic, scalp woman with Wyburn-Mason syndrome, who suffered from decreased Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S69 visual acuity, headache and vomiting. In addition, she had a dark purple 2Department of Otorhinolaryngology, Ankara Numune Training and Research nodular mass located in medial canthus and upper eyelid. MRI examina- Hospital, Ankara, Turkey tion demonstrated an arteriovenous malformation from the orbit to the Abstract deep gray matter along the optic nerve on the left side. Cavernous sinus was also affected. Large arteriovenous malformations were detected in Myeloma is a neoplasm of plasma cells that causes painful, bone-destruc- the thalamus, basal ganglia and hypothalamus. Angiomas and enlarged ves- tive lesions. It may present as a solitary lesion (plasmacytoma), or involve sels were seen in the skin, especially in the orbital medial part. multiple sites (multiple myeloma). Extramedullary plasmocytoma is a relatively rare neoplasm. 90% of cases occur in the head and neck region. Discussion: The cause of Wyburn-Mason syndrome is unknown. AVMs Soft tissue plasmacytomas of the head and neck tend to involve the nasal may range from absence of the capillaries to the presence of large masses cavity or nasopharynx instead of oral cavity. Solitary plasmocytomas in the of widened and twisted blood vessels; mostly extend thru orbit into the parotid gland are rarely seen. We aimed to present the imaging findings midbrain. According to the sporadic brain AVMs, those are seen at a in this case. younger age. Orbit is the region that mostly affected. The complete form of WMS was defined as vascular malformations involving all 3 zones, while Keywords: Plasmacytoma, parotid, MRI the partial form of WMS was defined as vascular malformations involving 2 zones only. Decreased visual acuity, proptosis, blepharoptosis, dilated conjunctival vessels and nerve paralysis may occur in some individuals with P - 079 WMS and retinal racemose hemangioma can be seen with ophthalmic examination. Neurological symptoms associated with Wyburn-Mason ACCESSORY PAROTID GLAND syndrome include severe headaches, vomiting, seizures, paralysis of vari- ZEYNEP NILUFER TEKIN ous cranial nerves and neck stiffness also spontaneous hemorrhaging of these AVMs can lead to the sudden onset of symptoms. In rare cases, the Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey skin may be affected and angiomas may be seen. Abstract Conclusion: In conclusion, WMS is associated with a wide spectrum of multiple vascular malformations involving frequently unilateral orbits, brain 23-year-old female with a known disease of spondiloartropathy presented and/or face. This congenital malformation could be easily detected by MRI. to the romathology department of hospital with pain around her right ear radiating to her mandibula and neck. There was no other imaging find- Keywords: Arteriovenous malformation, Orbit, Brain, MRI ings to explain her pain. Neck magnetic resonance (MR) images showed accessory parotid gland presented on the lateral aspect of the masseter muscle, anterior and adjacent to the main parotid gland. Accessory parotid P - 077 glands have the same ultrasound echotexture, computed tomography density and MR imaging signal as the main parotid glands. These have a SINONASAL MUCOSAL MELANOMA typical appearence so that diferantiate from the other pathologies eas- HAMZA OZER, SEMRA DURAN, HATICE GUL HATIPOGLU, ily. Accessory parotid glands are a normal variant and represent ectopic DENIZ SOZMEN CILIZ, BULENT SAKMAN salivary tissue separate from, but usually in close proximity to, the main parotid glands. Occasionally the accessory tissue is contiguous with the Ankara Numune Training and Research Hospital, Ankara, Turkey main glands. Abstract Keywords: Accessory parotid gland, normal variant, magnetic resonance Malignant melanomas are rarely seen in the sinusoidal cavity; accounting imaging for %0.3 of all mucosal malignant melanomas and 4% of head and neck tumors. It is commonly seen in man and women whom in advanced years. CT/RT is performed after surgery. Prognosis is very poor. Prognosis is P - 081 determined by the size of the tumor, time of diagnosis and surgery. In our case, we presented a sinonasal malign melanoma case in a patient with SARCOIDOSIS PRESENTING AS unilateral nasal obstruction and edema. TRIGEMINAL NEVRALGIA: A CASE Keywords: Malign melanoma, sinonasal, MRI REPORT ELIF AYSE UCAR, MELTEM OZDEMIR, AYNUR TURAN, P - 078 BAKI HEKIMOGLU Health Science University Dışkapı Yıldırım Beyazıt Training and Research PLASMACYTOMA OF THE PAROTID Hospital, Ankara, Turkey GLAND Abstract 1 1 2 DENIZ SOZMEN CILIZ , HAMZA OZER , MUGE OZCAN , Introduction: Sarcoidosis most commonly presents as a systemic dis- 1 1 SEMRA DURAN , HATICE GUL HATIPOGLU , order. Infrequently, sarcoidosis can present as central nervous system 1 1 BULENT SAKMAN , MEHTAP CAVUSOGLU disorder, with granulomas involving the leptomeninges and presenting 1Department of Radiology, Ankara Numune Training and Research Hospital, with facial nerve weakness. Sarcoid of the trigeminal nerve is exceed- Ankara, Turkey ingly rare. S70 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Case Report: A 43-year-old woman presented with left-sided facial ment of the character with subretinal fluid accumulation without numbness and pain. Magnetic resonance imaging demonstrated thicken- traction or tear. The causes of retinal detachment include diabetic ing of left trigeminal nerve and upon contrast administration, enhance- retinopathy, trauma, high myopia, congenital cataract, surgery, congenital ment of all its course. There was also abnormal enhancement of the glaucoma, sickle cell disease, leukemia, systemic lupus erythematosus meninges along the Meckels caves. The right trigeminal nerve course and metastasis. Retinal detachment may result in complete loss of vision showed minimal signal change and mild enhancement. There was also in late diagnosis. MRI is a guiding for a diagnosis. mild enhancement of bilateral fascial nerves. We suspected of neuro- Keywords: Retinal detachment, MRI sarcoidosis with this MRI findings and asked the patient about other systemic symptoms. She declared that she has been in the follow up for pulmonary sarcoidosis in another hospital for 14 months. P - 083 Discussion: Imaging findings in neurosarcoid include dural thickening or mass, leptomeningeal involvement, enhancing and non-enhancing TWO CASES OF EPIGLOTTIC parenchymal lesions, cranial nerve involvement and spinal or nerve LARYNGEAL CYSTS WITH root enhancement. The most common cranial nerve deficit involves DIAGNOSTIC MR APPEARANCE the facial and optic nerves. Trigeminal nerve involvement, as in this case, is very rare with only few cases described in literature. Although rare, YESIM KARAGOZ, HANIFE GULDEN DUZKALIR, sarcoid infiltration of the Gasserian ganglion must be considered in the ZEHRA DONMEZ differential diagnosis of contrast-enhancing and T2 hypointense lesions İstanbul Training and Research Hospital, İstanbul, Turkey at Meckel’s cave. Abstract Conclusion: The diagnosis of neurosarcoidosis is always a challenge. For this reason definitive diagnosis requires the exclusion of other causes of Epiglottic cysts are rarest laryngeal cysts reported in english literature neuropathy. Recognizing and correctly diagnosing neurosarcoid leads to since 19th century as several case series or separate case reports. They proper treatment and decreased morbidity in patients. have different histogenetic origins diagnosed incidentally or causing diverse symptoms related to their location and size. Symptoms are Keywords: Sarcoidosis, cranial neuropathies, magnetic resonance imag- generally hoarseness and dysphagia. Adult patients are mostly around ing sixth decade, though many pediatric cases has been reported. Two middle-aged male patients both with difficulty in swallowing and hoarseness were referred to our radiology department at different times . P - 082 Before imaging , all patients were examined laryngoscopically. On oto- laryngologists note lesions were described as well defined swellings with MR FINDINGS OF RETINAL smooth mucosal surface bearing anterior vallecular wall and lingual face DETACHMENT of epiglottis. In all scan series, signal intensities were identical in both patients with slight different location along with sagittal plane (first case BAHAR YILMAZ CANKAYA, ADEM KARAMAN in the midline second one from right vallecula extending to midline). Department of Radiology, Atatürk University Health Research and Because of hypointensity on T2 weighted images lesions were almost Application Center, Erzurum, Turkey isointense to air column. They had no mural solid component and had Abstract homogeneous T1 hyperintensity. No enhancement was apparent after routine iv gadolinium injection. There are several classifications of these Objective: Retinal detachment occurs when the neurosensory retinal cysts representing a mixed group of benign laryngeal lesions that can layer and the retinal pigment epithelium are separated from each other. cause diagnostic and the rapeutic difficulties. Early diagnosis and surgical The liquid accumulates in the potential space created by separation. excision must be planned especially those with large dimensions. There Retinal detachment may result in decreased visual function or complete are some case reports of stridor and/or respiratory distress in neonates loss of vision. In this case, MR images of retinal detachment in a 75 year and young infants due to their small airway. old male patient were presented. Keywords: Laryngeal cyst, epiglottic cyst Materials and Methods: Brain imaging with a 1.5 T MRI device (Magnetom Avento, Siemens Healthcare) was performed to the patient who complained of headache and visual impairment. P - 084 Results: In brain MRI, in the right globe, in classical V-shaped T1 SE and T2 TSE-TRIM, where its apex in the optic nerve region, slightly hyperin- SINONASAL MENINGIOMA tense compared to vitreous fluid, and appearance compatible with retinal DENIZ SOZMEN CILIZ, HAMZA OZER, SEMRA DURAN, detachment was observed. HATICE GUL HATIPOGLU, BULENT SAKMAN, Conclusion: Retinal detachment occurs when the neurosensory retinal MEHTAP CAVUSOGLU layer and retinal pigment epithelium are separated from each other. Ankara Numune Training and Research Hospital, Ankara, Turkey There are four major types of retinal detachment, tractional retinal Abstract detachment, exudative retinal detachment and combined retinal decollement. Exudative retinal decollement is less common than regmatoin Meningioma consists of approximately 20% of all intracranial neoplasms retinal decollement and tractional retinal detachment, and is a detach- and are the second most common tumors of the central nervous system Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S71 following the gliomas. Meningiomas rarely (2% of all menengiomas) show Abstract extracranial localization, mostly in the head-neck, especially paranasal Objective: Fetal imaging is the most commonly used and first choice sinuses. Clinical and radiological features of these tumors are nonspecific method due to its low cost of ultrasonography (US). However in some and histopathological evaluations are required for diagnosis. We aimed to cases US is insufficient. Fetal Magnetic Resonance Imaging (MRI) is applied present the patient with sinonasal meningioma patient including his imag- in order to validate any abnormal condition we determined or we sus- ing and histopathology findings. pected and also execute distribution and anatomic relations of complex Keywords: Extracranial meningioma, MRI, sinonasal lesions and to determine additional abnormal conditions. Also in case of conditions like maternal obesity, oligo-anhydramnios or other inappropriate fetal positions that limits US causes MRI indication. In this proceeding P - 085 there had been fetal MRI examinations and monitored pathologies had been submitted. INCIDENTALLY DETERMINED Materials and Methods: Patients has been taken into this survey between PERIRENAL HEMANGIOMA IN ADULT November 2012-February 2018 in which are examined by 1.5 TESLA FEMALE PATIENT: CASE REPORT MR device. There has been coronal, axial and sagittal T2 HASTE, axial and coronal T1 weighted images and axial diffusion weighted images taken. HATICE KUBRA OZDEMIR, HASAN YIGIT, SONAY AYDIN, Results: 89 patients have been evaluated. There was twin pregnancy in ZEYNEP MUNTEHA AKBULUT, PINAR NERCIS KOSAR 2 patients. There has been intra-cranial examination conducted in 71 Ankara Training and Research Hospital, Ankara, Turkey patients, spinal examination has been conducted in 6 patients, thorax has been conducted in 3 patients, maxillo-facial examination conducted in Abstract 2 patients and abdominal pathologies has been examined in 3 patients. Hemangiomas are benign, vascular tumors and can be seen anywhere There has been no pathology found in 12 patients. For detected patholo- in the body. Renal hemangiomas are rare and most commonly localised gies ventriculomegaly (n=10), colpo-cephaly (n=16) had been monitored in the medulla and renal pelvis. Perirenal hemangiomas that will be and corpus callosum agenesis (n=10), corpus callosum disgenesis (n=3) mentioned on this poster are much more rare lesions. A 62-year-old had been accompanied with them. Isolated corpus callosum agenesis woman was examined with urinary ultrasonography due to a slight (n=1), isolated unilateral lateral ventricular dilatation (n=12), lissence- increase in creatinine values, and a solid lesion in the left kidney, which phalia (n=4), hydrocephalia (n=4) and secondary hydrocephalia has been may be consistent with angiomyolyoma was discovered. MRI confirmed monitored in 1 patient at MCA infarction. Dandy walker variance (n=5), the diagnosis of angiomyolipoma in the left kidney. We also diagnosed dandy walker malformation (n=2) has been monitored. Agria (gyrus a perirenal hemangioma at renal hilus, the size of 16x15 mm, observed deficiency) -pachygria (n=4), meningocele (n=3), encephalocoele (1) has been observed. In one each patient maxilo-facial teratoma, lymphangioma as hyperintense at T2WI and hypointense in T1WI. The lesion shows in oral cavity, omphalocele, renal agenesia, renal hypoplasia, bronchopul- peripheral-globular enhancement in arterial phase, and progressive monary sequestration, cystic adenoid malformation, diaphragmatic hernia, increase in contrast enhancement in the following phases. Perirenal sacral tail-gut cystic, alobar holoprosencephaly has been monitored. hemangiomas are rare, benign, mesenchymal vascular tumors. Small hemangiomas rarely have preoperative diagnosis because their findings Conclusion: MRI is more functional than US for distinguishing normal tis- are nonspecific. MR imaging shows homogeneous hypointense T1AG sue from pathological tissue and it has higher contrast resolution proper- signals and hyperintense T2AG signals. Signaling loss in the lesion is ties and due to these superior properties it is started to be used widely in primarily thought of as phlebolithia, and the existence of phlebolitia common and it must be used in case of requirement. makes it easier to diagnose with CT. Contrast-enhanced series show Keywords: Fetal MRI, ventriculomegaly, agenesis contrast enhancement in the arterial phase and progressive contrast enhancement in the ongoing phases. However, findings are nonspecific and may mimic hypervascular tumors, transitional cell carcinoma, P - 087 and renal cell carcinoma. The diagnosis of perirenal hemangiomas can be confirmed by histopathology or by long-term follow-up and MAGNETIC RESONANCE IMAGING IN characteristic imaging findings. In our patient, the defined lesion was SCROTAL DISORDERS diagnosed by the presence of classic imaging findings and stability in 6 FURKAN UFUK year follow-up. Department of Radiology, Pamukkale University, School of Medicine, Keywords: Hemangiomas, perirenal hemangiomas Denizli, Turkey Abstract P - 086 Scrotal pain may result from testicular or extra-testicular pathologies. Early diagnosis and treatment of acute scrotal pathologies is important FETAL MR IMAGING FINDINGS due to risk of infertility. Color Doppler ultrasound (CDU) is a recommended initial method to patients affected by scrotal pain. The depen- NUSRET SEHER, EMINE UYSAL, HAKAN CEBECI, dence of the observer’s experience and device quality has disadvantages MUSTAFA KOPLAY, YAHYA PAKSOY of CDU and in some cases CDUmay be insufficient for diagnosis. Recently, Department of Radiology, Selçuk University, School of Medicine, Konya, the use of magnetic resonance imaging (MRI) has been increasing in Turkey patients with scrotal pathologies, due to more detailed anatomical resolu- S72 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 tion. Radiologists should be familiar with MRI findings of common scrotal heterogenous signal in both T1 and T2 weighted images. The lesion and testicular disorders for accurate diagnosis. In this report, we aimed to revealed significant enhancement after intravenous contrast material present the MRI findings of patients with scrotal disorders. administration. The patient underwent thoracotomy and surgical excision was applied. Histology revealed a fibrous tumor with malignant features Keywords: Scrotal imaging, testicular tumors, testicular torsion, scrotal originating from the pleura. pseudotumors, trauma, magnetic resonance imaging Conclusion: SFTPs are commonly benign and rare neoplasms. There is a risk for recurrence and malignant transformation. Magnetic resonance P - 088 imaging reveals adjunctive details for tumor margins and invasion to adjacent organs. INFLAMMATORY MYOFIBROBLASTIC Keywords: MRI, pleura, tumor TUMOR OF LUNG: CT AND MRI FINDINGS ABDULLAH ENES ATAS1, NECDET POYRAZ1, ZEKI ILHAN1, SIDDIKA FINDIK2, TAMER ALTINOK3 P - 090 1Department of Radiology, Necmettin Erbakan University, Meram School MRI APPEARANCE OF TESTICULAR of Medicine, Konya, Turkey 2Department of Medical Pathology, Necmettin Erbakan University, Meram ADRENAL REST TUMOR School of Medicine, Konya, Turkey ABDULLAH ENES ATAS1, OMER FARUK YUCE1, 3Department of Thoracic Surgery, Necmettin Erbakan University, Meram 1 1 School of Medicine, Konya, Turkey OZGU ALCALI , SULEYMAN BAKDIK , YUNUS EMRE GOGER2, LEMA TAVLI3, ULKU KERIMOGLU1 Abstract 1Department of Radiology, Necmettin Erbakan University, Meram School of Inflammatory myofibroblastic tumor of the lung is a rare primary lung Medicine, Konya, Turkey tumor previously called as “inflammatory pseudotumor”. The tumor 2Department of Urology, Necmettin Erbakan University, Meram School of appears more common in young adult patients. Patients may be asymp- Medicine, Konya, Turkey tomatic, or present with nonspesific symptoms like cough, hemoptysis, 3Department of Pathology, Necmettin Erbakan University, Meram School of dyspnea or pleuritic pain. Because of atypical symptoms and signs, those Medicine, Konya, Turkey patients initially misdiagnosed as lung cancer and other pulmonary dis- Abstract eases. Here we present CT and MRI findings of 18-year-old male patient with pathologically proven inflammatory myofibroblastic tumor. Testicular adrenal rest tumor (TART) is a rare primary testicular tumor and described as an important complication of congenital adrenal hyper- Keywords: Inflammatory myofibroblastic tumor, inflammatory pseudotu- plasia (CAH). Patients who were diagnosed as CAH should be followed- mor, lung, computed tomography, magnetic resonance imaging up for testicular imaging because TART has risk of testicular damage and infertility. TART can mimic other primary testicular tumors like germ cell tumors. Here we present MRI appearance of 23-year-old male patient P - 089 with TART, formerly diagnosed as CAH. MALIGNANT SOLITARY FIBROUS Keywords: Testicular adrenal rest tumor, testicular, congenital adrenal hyperplasia, magnetic resonance. TUMOR OF THE PLEURA MUSTAFA YASIR OZLU, HAKAN CEBECI, EMINE UYSAL, MUSTAFA KOPLAY P - 091 Department of Radiology, Selçuk University, School of Medicine, Konya, PILOMATRIXOMA LOCATED ON Turkey UPPER EXTREMITY Abstract NESE ASAL, UMRAN CANKAYA, MEHMET HAMDI SAHAN Objective: Solitary fibrous tumor of the pleura (SFTP) is a very rare neoplasm arising from the submesothelial mesenchymal layer of the pleura. Kırıkkale University, School of Medicine, Kırıkkale, Turkey SFTPs are commonly benign lesions with potential malignant transforma- Abstract tion. Most of SFTPs are clinically asymptomatic and diagnosed incidentally in radiological imaging modalities. The clinical symptoms include cough, Pilomatrixoma is a rare, benign, limited, calcifying epithelial neoplasm that chest pain, dyspnea, finger clubbing and hypoglycemia. We aimed to pres- arises from the hair pluripotent precursor matrix cells. It is usually seen ent a case of a SFTP with malignant transformation. as an asymptomatic hard mass on the head and neck and on the upper extremity, skin or under the skin. Multiple occurrences often have family Materials and Methods: A 67-year-old male patient admitted to our clinic history, and are associated with some syndromes. The treatment is simple with complaints of cough and dyspnea. A round mass lesion with sharp excision. The definitive diagnosis is performed after histopathological margins was detected posterior to the hearth, in chest X-ray. Computed evaluation. In this case report, we aimed to increase the knowledge of the tomography showed a huge lesion with the size of 10x12x13 cm in pos- physicians about pilomatrixoma and to consider the differential diagnosis terior inferior mediastinum. Possible differential diagnoses were neuro- of pilomatrixoma among skin neoplasms. genic tumors, neoplasms originated from pleura and diaphragm. Magnetic resonance imaging revealed for detailed examination and showed a lesion Keywords: Pilomatrixoma, skin, tumor, cyst Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S73 P - 092 mechanism, that is always associated with insufficient blood formation. Among the various atypical presentations paraspinal involvement deserves A RARE CASE: CASTLEMAN special attention due to irreversible neurologic damage. Thalassaemia is a DISEASE PRESENTING IN THE LUNG hereditary haemolytic anaemia caused by deficiency of globulin chains. In this report, we present 34 year-old patient with Talasemia intermedia PARENCHYMA and typical MRI findings of paraspinal EH. Bilateral multipl large, lobulated FATMA DURMAZ1, MESUT OZGOKCE1, HARUN ARSLAN1, ,smooth-margined paraspinal masses along the thoracic vertebra were ADEM YOKUS2, IBRAHIM AKBUDAK3, ALI MAHIR GUNDUZ1 demonstrated in obtained MRI. Massescaused widening of the neural foramens and thickening of the adjacent posterior rib heads. There were 1Department of Radiology, Van Yüzüncü Yıl University, School of Medicine, Van, Turkey not any sign of neural compression nor any bone invasion. Lesions were 2TR Ministry of Health University, Van Training and Resarch Hospital, Van, composed of T1 and T2 hypointense homogenous enhanced solid com- Turkey ponents and cystic degeneration areas. Also, there were a decrease in the 3 Batman State Hospital, Batman, Turkey bone marrow intensity, a decrease in the T2 star value due to significant Abstract iron accumulation in liver and hepatosplenomegaly. MRI can clearly show anatomical details and extent of the masses within the spinal canal. In Objective: Castleman Disease (CD) is a rare lymphoproliferative disor- differential diagnosis NF1 and other neurologic tumors must be ques- der of unknown cause.Mediastinum is the most commonsite of localized tioned. During atypic soliter presentation biopsy can be done to conform CD.Extranodal involvement is rare. Here, we report the case of a patient diagnosis. In our case differential diagnosis was easy due to characteristic presenting with the hyalin vascular variant of the disease presenting as a topography ,history and past MRI series. solitary pulmonary mass, with CT and MR finding. Keywords: Extramedullary hematopoiesis, paraspinal mass, thalassaemia 20-year-old woman presented with nonspecifik Materials and Methods: intermedia caugh. CT revealed a solid hyperattenuating, well-circumscribed right lung lower lob. On MRI, the lung mass was homogeneously iso-hyperintense to muscle on T1-T2WI.Postcontrast imaging revealed avid enhancement of the lung mass. After performing open lung excisional biopsy, pathological P - 094 examination revealed hyalin-vascular type Castleman Disease. TUBOOVARIAN ABSCESS ARTER Discussion: CD is one of the more common causes of nonneoplastic DELIVERY: CASE REPORT lymphadenopathy.CD typically affects mediastinal lymph nodes, it can also affect intra-abdominal lymph nodes, as well as lymph nodes located in the LEYLA KARACA, FATIH ERBAY, GULEC DOGAN axillary, cervical, pelvis. Extranodal involvement may occur in lung, larynx, İnönü University, School of Medicine, Malatya, Turkey parotis, pancreas, meninx and muscles, in only 5% of cases.CD may be classified morphologically as localized and multicentric, histologically Hyalin Abstract Vascular-type, Plasma Cell-type and mixedtype. The most common type is A 32-years-old woman presented to the obstetrıc clinic with history of localized hyalin-vascular-type (%90). Majority of multicentric-CD is associ- low abdomen pain after just delivery. She had fever and unremarkable ated with an immunodeficiency state and patients also have an increased abdominal signs on physical examination. She had no complaint during risk for development of Kaposi sarcoma and lymphoma. Homogenous the pregnancy. Pelvic magnetic resonance imaging (MRI) revealed a cystic high enhancement is typically observed in Hyalin-Vascular-type CD due to lesion at the right adnexal region that was hypointense on T1 weighted the abundance of blood vessels. (T1W) images and hyperintense on T2 weighted (T2W) images. After Conclusion: Castleman disease can mimic many disease according to the gadolinium administration, there was peripheral enhancement of the cys- involved region. As in our case, if lung is involved, it can mimic adenocancer. tic lesion. Magnetic resonance imaging also showed multiple tubal ectasia CD should be kept in mind in differantial diagnosis of solitary lung masses, in Based on the above findings, the patient was diagnosed with tuboovarian the case of well circumscribed, especially avid enhaenced lesions. abscess. At the surgery its revealed tuboovarian abscess with massive purulent contamination of the abdominal cavity. Tuboovarian abscess can Keywords: Lung castleman disease, MRI occur at any during the any time periods. Tuboovarian abscess during pregnancy or immediately after birth are rare but it has been previously reported. According to an early literature, delayed diagnosis and inter- P - 093 vention may cause maternal death or fetal loss but in our case it’s not complaint during the pregnancy. We report the case of a patient with PARASPINAL CYSTIC DEGENERATING tuboovarian abscess after just delıvery. MASSES –ATYPICAL PRESENTATION Keywords: Tuboovarian abscess, delivery, pregnancy OF EXTRAMEDULLARY HEMATOPOIESIS GULNAR AGHAYEVA, DUYGU IMRE, TUNCAY HAZIROLAN P - 095 Hacettepe University, School of Medicine, Ankara, Turkey BRONCHIAL ATRESIA MIMICKING Abstract PULMONARY ARTERY ANEURYSM EH (Extramedullary hematopoiesis) is the proliferation of hematopoi- SERKAN GUNEYLI1, EMRAH CAGLAR1, etic precursor cells outside of bone marrow. In adults it is compensatory FATMA BUSRA CAYLAR1, MEHMET KORKMAZ2 S74 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

1Bülent Ecevit University, Zonguldak, Turkey P - 097 2Dumlupınar University, Kütahya, Turkey Abstract A RARE CASE OF THYMUS GLAND: TYMOLIPOMA Objective: Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus associated with OZLEM DEMIRCIOGLU, CANAN CIMSIT, hyperinflation of the distal lung. It is usually asymptomatic and may be NURI CAGATAY CIMSIT found incidentally. On imaging, it commonly presents as a proximal focal Marmara University Pendik Training and Research Hospital, İstanbul, Turkey tubular shaped opacity radiating from the hilum. In the differential diagnosis, pulmonary sequestration, bronchogenic cyst, endobronchial carcinoid Abstract tumor, pulmonary artery aneurysm, and allergic bronchopulmonary Thymolipomas are rare anterior mediastineal benign tumors that can aspergillosis should be considered. We aimed to evaluate the radiological occur at any age. Tumors are usually asymptomatic which grow slowly findings of a 56-year-old man with an opacity in the lung. causing mass effect to adjacent thoracic structures. These fat containing Materials and Methods: A 56-year-old man was admitted to our instu- slow- growing lesions usually give benign appearance which can enlarge in tion with weakness, weight loss, and back pain. Contrast-enhanced thorax years and present with cough, dyspnea, hemoptysis, chest pain, hoarse- computed tomography (CT), and magnetic resonance imaging (MRI) ness or paroxysmal atrial tachycardia. Thymomas can also arise from were performed. such lesions so close monitoring is necessary. Thymoma, thymic variation, hyperplasia of mediastinal fat, and neoplasms should be differentiated. Results: Our case has a history of hyperlipidemia, hypertension, diabetes Aplastic anemia, Graves, lymphoma and leukemia are described in asso- mellitus, and coronary artery disease. Twenty years ago, he had an acute ciation with thymolipoma. We present the case of 53 year-old man who ischemic stroke improved completely. Twenty-five years ago, he had a lung admitted to the Respiratory Disease Department with upper respiratory disease improved with treatment that was not clearly diagnosed. He has tract infection. Computed tomography demonstrated heterogeneous been complaining from weakness, weight loss, and back pain for 2 months. soft tissue mass with areas of extensive fat. Magnetic resonance imaging Chest X-ray revealed a tubular opacity in the left upper zone. Pulmonary demonstrated anterior mediastineal mass containing multiple areas of artery aneurysm, tumor, and bronchial atresia were considered as a pre- high signal in both T1 and T2 sequences with homogeneous enhance- liminary diagnosis. On contrast-enhanced CT, a lobulated lesion in the left ment. The patient was referred for surgical treatment and histopathology upper lobe without marked enhancement was demonstrated. MR image confirmed the diagnosis of thymolipoma. showed the non-enhancing tubular lesion with a finger-in-glove appearance. The diagnosis of a bronchial atresia was made. In the follow-up, Keywords: Tymolipoma, mediastinal mass, magnetic resonance control CT after 1 year revealed the lesion without any change. Keywords: Bronchial atresia, computed tomography, magnetic resonance P - 098 imaging, pulmonary artery aneurysm EXTRAMEDULLARY-INTRADURAL HEMANGIOMA P - 096 NIMET AKIN, BANU TOPCU CAKIR, AYHAN HIZ YIGIT, CONGENITAL MUSCULAR NURDAN CAY, AYSENUR OZCAN, KARABEKIR ERCAN DYSTROPHY FETAL MRI FINDINGS Ankara Atatürk Training and Research Hospital, Ankara, Turkey NUSRET SEHER, EMINE UYSAL, HAKAN CEBECI, Abstract MUSTAFA KOPLAY, YAHYA PAKSOY A 48-year-old male patient; contrast-enhanced thoracic MRI images Department of Radiology, Selçuk University, School of Medicine, Konya, were obtained upon mass lesion detection on the spinal cord in Turkey unenhanced thoracic MRI images taken for back pain. Made in review; Abstract Mass , which is extramedullary-intradural and 7x1 cm measured, was observed in the posterior of spinal cord.In addition,the lesion is Congenital muscular dystrophy (CMD), early onset hypotonia, weakness, hypointence in T1A images compared with spinal cord and hyper- myopathic findings and muscle in electromyography hereditary disease intence in T2A images compared with spinal cord. Spinal cord level with frequent dystrophic changes in biopsy muscle disease group. The is between T4-T7 spinal level.This mass is recognizable with diffuse incidence in the society is estimated to be about 1/100,000. Early diag- contrast material after contrast injection. The lesion was bilaterally nosis is very important for the management of the disease. Fetal MRI located at C5-C6 level and right neural foramene at C6-7 level. It was examination with pathologic changes in fetal intracranial structures should observed that it was anteriorly marked. In addition, linear enhance- be performed in US. Brain structures in fetal MRI are examined in more ment was observed, which is showed to be compatible with the detail, and MRI is superior to US in terms of maternal obesity, oligo-anhy- superior and inferior dural tail of the lesion. Meningioma was first dramnios, or inappropriate fetal positions, and US in distinguishing normal considered in the differential diagnosis of lesions with present findings. tissue from pathologic tissue, necessity due to its superior features such However, other intradural lesions (schwannomas, metastases ...) were as higher contrast resolution. In this proceeding there had been fetal MRI not ruled out. Histopathologic examination of the mass after surgery examinations and monitored pathologies had been submitted. showed that the lesion was compatible with hemangioma. Keywords: Fetal MRI, congenital muscular dystrophy Keywords: Intradural-extramedullary, hemangioma Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S75 P - 099 with the trichilemmal cyst in that center and operation decision has taken by clinicians. Clinical operation has been terminated due PRECOCCYGEAL EPIDERMOID CYST to intracranial extent of lesions in plastic surgery department. The PRESENTING AS TENESMUS patient was referred to our hospital. Craniography was performed on patient. The bone defect was presented at the vertex level in GOKHAN POLAT, HAYRI OGUL, RECEP SADE, graph. Cranial CT and MRI were performed on patient. A bone MECIT KANTARCI, SUAT EREN, AKIN LEVENT lesion was observed at vertex level with intracranial and extracranial Department of Radiology, Atatürk University, School of Medicine, Erzurum, extension. The lesion was well-circumscribed and destructed the Turkey bone. Patient was operated by neurosurgeon. HCC metastasis was diagnosed histopathologically after the operation. In addition, CT was Abstract performed on the patient. HCC carcinoma was observed in liver at A 23-year-old woman was admitted to our department with low back the CT. pain, tenesmus and functional constipation for a long time. MRI revealed Discussion: Common primary neoplasms of metastatic cranial a well-defined, unilocular, thin-walled cystic lesion in the retrorectal tumors are lung cancer, breast cancer, melanoma and colorectal precoccygeal space. The lesion had homogeneous hyperintense signal cancer. Calvarial metastasis is reported between 0.4% to 1.6% in characteristics on T2-weighted images . The cystic lesion also showed patients with HCC. HCCs calvarial metastasis has been described diffusion restriction with corresponding low intensity on apparent rarely in the literature. 3 type pattern of growth were observed in diffusion coefficient (ADC) map. Thus, the lesion was considered as involvement calvarial. The first is intracranial, second is extracranial epidermoid cyst accompanied by radiological features. The patient and the third is both intracranial and extracranial growth pattern. underwent surgical excision and the epidermoid cyst was corrected by The lesion presentation shows differences according to the growth histopathologically. pattern. It has been described in the literature, especially the Keywords: Precoccygeal epidermoid cyst, tenesmus, MRI masses which represent an intracranial growth pattern confused with hemorrhage. There is the both intracranial and extracranial growth pattern in our case. Extracranial growth pattern may con- P - 0100 fuse with frequently lesions of the scalp. Also, trichilemmal cysts are frequently observed in the scalp. This cyst may be calcification CALVARIAL MASS CONFUSED or remain in solitary structure. In this case, it may confuse with WITH TRICHILEMMAL CYST: HCC all solitary lesions of the head. The treatment of the trichilemmal cyst is surgical removal. Therefore, the imaging is important before METASTASIS interventional procedure in solitary lesions of the head. Imaging GOKHAN POLAT, RECEP SADE, HAYRI OGUL, detects the actual size and the extensions of the lesion. Also it MECIT KANTARCI, SUAT EREN, AKIN LEVENT shows that the lesions originated from skin or bone. Therefore, possible mistakes would be observing in diagnosis without utiliza- Department of Radiology, Atatürk University, School of Medicine, Erzurum, tion of the imaging methods. Consequently, the HCC, rare meta- Turkey static involvement of head, may be confused with other solitary Abstract lesions. Therefore, utilization of the imaging methods is important for accurate diagnosis and therapy. Introduction: The hepatocellular cancer (HCC) calvarial metastasis is a rare condition that commonly present cranial swelling. Therefore, Keywords: Calvarial mass, trichilemmal cyst, hcc metastasis calvarial swelling may confuse with frequently lesions of the scalp. Our patient was operated as trichilemmal cyst. But, intracranial extension was seen in operation. Calvarial metastasis of HCC was observed by P - 0101 examination of the patient. RARE AND SERIOUS COMPLICATIONS The hepatocellular cancer is the third most frequent tumor among cancer types. In addition, liver metastasis is the most frequent metas- OF SINUSITIS IN PEDIATRIC tasis of hepatocellular cancer. The most frequent metastasizes is PATIENTS: EPIDURAL ABCESS observed in the liver and lymph nodes among extrahepatic locations. GOKHAN POLAT, RECEP SADE, HAYRI OGUL, The skeletal system involvement of HCC is limited. The skull metas- BERHAN PIRIMOGLU, MECIT KANTARCI, SUAT EREN, tasis of hepatocellular cancer has been described rarely. Our case is AKIN LEVENT demonstrated the calvarial involvement which is rare involvement of HCC. The cranial lesion has been presented such as trichilemmal cyst Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey different from described cases in published data. There is no another case reported with first presentation form like ours and diagnosed Abstract with HCC in similar way to our case in published data. Introduction: Intracranial abscess has serious mortality. Therefore, early Case Report: 66-year-old male patient was admitted to neurosur- diagnosis and treatment is important. Intracranial abscess is rarely seen as gery clinic with complaint of cranial mass. The complaint of cranial a complication of sinusitis. Specially in children it has been reported rarely. swelling was noted in history of patient. Also patient was admitted to Fever and headache can indicate complications in children. Intracranial another hospital with these complaints. Thereafter, he was diagnosed abscesses are rarely reported in children and emerge due to bacterial S76 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 infections. Intracranial abscesses may observe as complication of sinus- Abstract itis. In addition, they were associated with high mortality and morbidity. Solitary plasmacytoma usually gives systemic findings. Particularly the Therefore, recognition of them is important. We have tried to show the involvement of the head without systemic symptoms is uncommon. If rare and serious complication of isolated sinusitis in patient with headache cranial involvement occurs, the patient usually comes with a complaint of and fever presented to the emergency department. calvarial swelling. Development of headache complaints in the patient may Case Report: 13-year-old male patient applied to the pediatric clinic indicate intracranial extension. with headache and fever. Patients had occasionally complained of headaches for a long time. Recently, the complaints such as fatigue and fever Keywords: Solitary plasmacytoma, intracranial extension, headache has emerged and headache became constant in patient. A significant pathology was not observed in patients physical examination. The slightly increased leukocytosis was reported in laboratory results. P - 0103 Patient was scanned cranial computerized tomography. The subdural fluid collection was observed at the right frontal level in cranial CT. A RARE COMPLICATION OF The cranial MRI was performed on the patient. There was collection CRANIOCERVICAL TRAUMA AND THE restricted diffusion at MRI in the right frontal. Appearance was evaluated as abscess. Moreover, there was sinusitis in the right maxillary IMPORTANCE OF THE MAGNETIC sinus and ethmoidal cells. Also the bone defect was not detected RESONANCE IMAGING at this level. The antibiotherapy was started on patient. The patient GOKHAN POLAT, HAYRI OGUL, MECIT KANTARCI, was operated for epidural abscess in neurosurgery service. Subdural RECEP SADE, SUAT EREN, AKIN LEVENT abscess was drained. The symptoms of the patient were decreased after the treatment. Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey Discussion: Epidural abscess is an important clinical entity. It may occur with hematogenous spread or direct contact. Direct contact is Abstract often observing as a complication of sinusitis. The intracranial transi- Craniocervical injury generally occurs secondary to trauma. Imaging tion has occurred with spread on lamina paprecea or direct contact findings are important for diagnosis. Because these patients may be with after posttraumatic fracture. The meningitis, cavernous sinus unconscious. Pseudomeningocele appearance is important for diagnosis. thrombosis, potts puffy tumor and intracranial abscesses are located Accompanying complications such as epidural hematoma can occur with between intracranial complications of sinusitis. Patients are generally craniocervical magnetic resonance imaging (MRI). MRI may be guided for presented to the clinic with triad of headache, fever and focal deficit guiding therapy and diagnosis. for epidural abscess. The fever and headache were observed but focal deficit was undeveloped in our case. Therefore, early diagnosis and Keywords: Craniocervical trauma, magnetic resonance imaging, pseudo- treatment are important to protect from focal deficits and complica- meningocele tions in these patients. The most frequently isolated pathogens are Streptococcus, Hemophilus influenza and Staphylococcus. Treatment of antibiotic and drainage may also be applied at epidural abscess. The P - 0104 treatment process is long and difficult. The high mortality and morbidity are observed in patients with untreated timely. Furthermore, the A RARE COMPLICATION treatment of sinusitis have an important role in the process. Especially, early diagnosis and treatment of sinusitis protect from complications AND PRESENTATION OF THE in patients with headaches. NEUROFIBROMATOSIS TYPE -1 Conclusion: Epidural abscess is uncommon but serious complication of GOKHAN POLAT, HAYRI OGUL, MECIT KANTARCI sinusitis. Therefore, the clinicians sufficiently should pay attention to the Department of Radiology, Atatürk University, School of Medicine, Erzurum, presence of complications as much as diagnosis and treatment of sinusitis Turkey in patients with headaches. Abstract Keywords: Sinusitis in pediatric patients, epidural abcess Neurofibromatosis is a genetic disease. Characteristic features of the neurofibromatosis include Lisch nodules, café au lait spots, and neurofi- P - 0102 bromas. It can also cause musculoskeletal abnormalities. Atlantoaxial dislocation associated with neuro fibromatosis is also very rare. Atlantoaxial SIGN OF INTRACRANIAL EXTENSION dislocation often leads to neurological symptoms. In our case, lesion IN SOLITARY PLASMACYTOMA observed at oropharyngeal area. We reported a unique case in which there was presence of dyspnea and progressive quadriparesis in the set- GOKHAN POLAT, RECEP SADE, HAYRI OGUL, ting of neurofibromatosis and atlantoaxial dislocation. MECIT KANTARCI, SUAT EREN, AKIN LEVENT Keywords: Neurofibromatosis Type -1, atlantoaxial dislocation, dys- Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey pnea Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S77 P - 0105 P - 0107 HYDATIDOSIS WITH MULTIPLE A RARE NONOBSTRUCTIVE MASS ORGAN INVOLVEMENT OF THE URETER: NON-HODGKIN’S LYMPHOMA GOKHAN POLAT, HAYRI OGUL, RECEP SADE, BERHAN PIRIMOGLU, MECIT KANTARCI, AKIN LEVENT, GOKHAN POLAT, UMMUGULSUM BAYRAKTUTAN, SUAT EREN MECIT KANTARCI, HAYRI OGUL, SUAT EREN, AKIN LEVENT Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey Abstract Abstract A 79 year-old woman was admitted to our department with intermittent non-specific pains. MRI revealed a well-defined, unilocular, thin-walled A 69-year-old man presented to hematology clinic complaining of fever and abdominal pain. Patient had non-Hodgkins lymphoma history. multiple cystic lesion in the spleen, liver and cardiac. The lesions had Abdominal computed tomography (CT) and Magnetic resonance imag- homogeneous hyperintense signal characteristics with the hypointense ing (MRI) were performed. MRI imagings revealed a massive increase rim on T2-weighted images. Some cystic lesions had germinative mem- in the ureteral wall thickness. On the diffusion-weighted imaging, the branes. Thus, the lesions were considered as hydatid cyst accompanied mass has relatively homogeneous increased signal intensity. The apparent by radiological features. Hydatid cyst was corrected by histopathologi- diffusion coefficient (ADC) map reveals decreased ADC. CT imagings cally and supported by enzyme-linked immunosorbent assay (ELISA) for showed that the ureter was completely involvement. Non-Hodgkin echinococcosis. The patient was treated with albendazole at a dose of 15 lymphoma arising primarily from the ureteral wall is exceedingly uncom- mg/kg/day. mon. Also, obstruction was not observed against the massive involvement. The absence of obstruction and restriction of diffusion is typical Keywords: Hydatidosis, ELISA, MRI for lymphoma. Keywords: Nonobstructive mass of the ureter, non-hodgkins lymphoma, P - 0106 magnetic resonance imaging GRANULOMATOUS INFECTION OF THE FACET JOINT P - 0109 GOKHAN POLAT, RECEP SADE, HAYRI OGUL, A RARE CAUSE OF EPISODIC BERHAN PIRIMOGLU, MECIT KANTARCI, SUAT EREN, PARESTHESIA: SPINAL CAVERNOMA AKIN LEVENT RECEP SADE, HAYRI OGUL, MECIT KANTARCI, Department of Radiology, Atatürk University, School of Medicine, Erzurum, BERHAN PIRIMOGLU, AKIN LEVENT Turkey Department of Radiology, Atatürk University, School of Medicine, Erzurum, Abstract Turkey A 17 year-old male presented to the pediatric clinic with complaints of Abstract lumbar pain and high fever. There was no history of trauma and surgery. A 57-year-old male patient was admitted to our neurosurgery depart- There was history of tuberculosis. The spinal magnetic resonance (MR) ment with episodic numbness in both lower extremities during the past imaging was performed. Magnetic resonance imaging (MRI) showed lum- 6 months. Neurological examination and cranial magnetic resonance bar 4/5 vertebrae facet joint heterogeneous hypointense on T1 weighted imaging were normal. Spinal magnetic resonance imaging was performed. (T1W), heterogeneous hyperintense T2-weighted (T2W) images and it Magnetic resonance images showed intramedullary cavernous angiomas was heterogeneously enhanced after contrast administration. Laboratory (CA) at cervical spinal cord. Cavernous angiomas are vascular malforma- findings showed increased inflammation markers. Lesion was identified as tions that occur throughout the central nervous system. Cavernous angio- a granulomatous inflammation via pathological examination. According to mas most commonly occur in the cerebral hemispheres, but spinal CA radiological and laboratory findings, the lesions were evaluated primarily are rare. Spinal CA can be intramedullary, intradural extramedullary, or tuberculosis involvement of the facet joint. Septic arthritis is most preva- extradural lesions. Intradural spinal CA are uncommon. Spinal CA occur lently secondary to a bacterial infection with less common, more slowly mostly in the thoracic spine. progressive infections resulting from fungal or mycobacterial causes. The common symptoms of spinal CA include paraesthesia, pain, and Septic arthritis is most prevalently seen in larger peripheral joints, how- weakness. The mechanism of episodic deterioration in these patients ever rarely reported in facet joints. is most likely episodic hemorrhage into the spinal cord parenchyma. A complete surgical resection is the goal of the treatment for spinal CA. Keywords: Granulomatous Infection, spinal magnetic resonance, facet joint Keywords: Episodic paresthesia, spinal cavernoma, MRI finding S78 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 P - 0110 P - 0112 A RARE LOCALIZATION: PRIMARY UTERINE ABSCESS AS A PLEOMORPHIC UNDIFFERENTIATED COMPLICATION OF ACUTE SARCOMA APPENDICITIS RECEP SADE1, LEYLA KARACA2, HAYRI OGUL1, OGUZ LAFCI, HASAN YIGIT, PINAR NERCIS KOSAR 1 1 UMMUGULSUM BARAKTUTAN , MECIT KANTARCI , Ankara Training and Research Hospital, Ankara, Turkey BERHAN PIRIMOGLU1, AKIN LEVENT1 Abstract 1Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey 2Department of Radiology, İnönü University, School of Medicine, Malatya, Turkey Acute appendicitis is a common cause of abdominal pain that requires Abstract surgical intervention. Main complications of acute appendicitis are perforation, abscess formation, peritonitis, bowel obstruction, septic seeding of A 51-year-old man with a 1 year history of back pain presented to our mesenteric vessels and gangrenous appendicitis, although in some rare neurosurgery clinic. Lumber magnetic resonance imaging (MRI) revealed occasions complications like appendico-vesical, appendico-cutaneous or a mass hypointense T1-weighted image and hyperintense T2-weighted appendico-uterine fistula formations may also occur. Here we present a image at the L1–T12 vertebrae and paravertebral tissue. The mass was case of a 83-year-old woman who was found to have uterine abscess due also spread into the retroperitoneal space. After injection of a contrast to acute appendicitis. agent, magnetic resonance imaging showed a heterogeneous enhancement in mass. The tumor was incompletely excised. It was diagnosed as Keywords: Acute appendicitis, uterus, appendicitis complications undifferentiated pleomorphic sarcoma. Undifferentiated pleomorphic sarcomas are very rare but have been reported in the literature. Keywords: Primary pleomorphic undifferentiated sarcoma, vertebrae, P - 0113 MRI findings AN ATYPIC MELANOMA METASTASIS KEMAL ARDA1, HASAN AYDIN2 P - 0111 1Department of Radiology, Gülhane Research Hospital, Ankara, Turkey 2 SEVERE TOXIC Department of Radiology, Oncology Research Hospital LEUKOENCEPHALOPATHY Abstract ASSOCIATED WITH TACROLIMUS A 64 year old men with previous diagnosis of malignant melanoma, was AFTER LIVING DONOR LIVER referred to CT and MRI unit for suspicion of metastasis, in the Torax CT metastatic pulmonary nodules were observed. In Abdominal CT and MRI, TRANSPLANTATION Metastatic masses were shown in liver and spleen; Bilobar multiple metas- HAYRI OGUL1, LEYLA KARACA2, BERHAN PIRIMOGLU1, tasis were visualized in liver, parencymal and subcapsular multiple spleen BULENT AYDINLI3, MECIT KANTARCI 1 metastasis were seen. In the Brain MRI, multipl cerebellar and cerebral metastasis were also observed mainly as Hyperintensities in T1W images. 1Department of Radiology, Atatürk University, School of Medicine, Erzurum, urkey 2Department of Radiology, İnönü University, School of Medicine, Malatya, Turkey Keywords: Melanoma-metastasis-MRI-ATYPIC 3 Department of General Surgery, Akdeniz University, School of Medicine, Antalya, Turkey Abstract P - 0114 A 32-year-old woman underwent living donor liver transplantation from ERDHEIM-CHESTER DISEASE (ECD); her mother in April 2013 and received tacrolimus therapy. About 8 weeks after starting immunosuppressive therapy, the patient presented PRESENTATION OF A CASE WITH to our emergency radiology department with acute onset of aphasia and MULTISYSTEMIC INVOLVEMENT headache. No other neurological deficits were noted. Magnetic resonance USING MULTIMODALITY IMAGING imaging (MRI) during the episode showed significant diffusion restriction, with reduced ADC values in the bilaterally frontal, parietal and occipital OSMAN CANCURI, SA TRAN, AJAY ARORA, white matter, internal capsule, middle cerebellar peduncle, corpus cal- SHWETA GUPTA losum. Tacrolimus blood level was within therapeutic range: 16.9 ng/mL Princess Royal University Hospital, England (normal values 5–20 ng/mL). The tacrolimus dosage was decreased and stopped; it was replaced by cyclosporine A. After a decrease in tacrolimus Abstract dosage, the lesions gradually disappeared. The radiologic findings of the ECD is a very rare multisystemic non-Langerhans-cell-histiocytosis. patient were consistent with the tacrolimus neurotoxicity. Clinical recov- The disease has a broad spectrum of organ manifestations. Bones are ery was complete within 3 months. the most common sites of involvement and scintigraphic appearance is Keywords: Tacrolimus, liver transplantation, acute toxic leukoencepha- pathognomonic. However nearly every organ may be involved. Cardiac lopathy disease commonly presents as right atrial pseudotumor. Retroperitoneal Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S79 disease involves the perirenal fat and kidneys. Herein, we present a case Abstract with bone, cardiovascular, retroperitoneal and renal involvement. An 81y Pulmonary sequestration, also called accessory lung, refers to the aber- old male patient was referred to radiology for Cardiac MRI for further rant formation of segmental lung tissue that has no connection with the investigation of a suspicious mass on echocardiography. MRI showed right bronchial tree or pulmonary arteries. The estimated incidence is 0,1%. atrial pseudomass with mediastinal/atrioventricular groove extension and There are two types:intralobar sequestration (ILS) and extralobar seques- superior vena cava (SVC) encasement. CT demonstrated additional distal tration (ELS). ELS more commonly presents in newborns as respiratory right coronary artery encasement and bilateral perirenal-renal infiltra- distress, cyanosis, or infection, whereas ILS presents in late childhood or tions. Skeletal survey revealed patchy sclerotic appendicular skeleton adolescence with recurrent pulmonary infections. Overall, sequestration lesions which showed high tracer uptake on bone scintgraphy. FDG PET/ preferentially affects the lower lobes. 60% of intralobar sequestrations CT revealed moderately increased metabolic activity of the right atrial/ affect the left lower lobe, and 40% the right lower lobe. Extralobar mediastinal lesion. Non-Langerhans-cell histiocytosis was diagnosed after sequestrations almost always affect the left lower lobe, however, ~10% CT-guided core biopsy of the retroperitoneal lesion. of extralobar sequestrations can be subdiaphragmatic. In this case report, Keywords: Erdheim-Chester disease (ECD), multimodality imaging, multi- ultrasonography and MRI findings of the pulmonary sequestration in the systemic involvement, Non-Langerhans-cell histiocytosis lower lobe of the left lung during 26 week intrauterine pregnancy examination was emphasized. Keywords: Pulmonary sequestration, fetal MRI, ultrasonography P - 0115 PIRIFORMIS SYNDROME MIMICKING P - 0117 LOMBER DISC HERNIA PARASITIC LEIOMYOMA IN THE LUNG FADIME GUVEN, HAYRI OGUL, MECIT KANTARCI ISMAIL YURTSEVER, RASUL SHARIFOV Atatürk University, School of Medicine, Erzurum, Turkey Department of Radiology, Bezmialem Vakıf University, School of Medicine, Abstract İstanbul, Turkey The piriformis muscle originates from the anterior of sacral 2 and 4 ver- Abstract tebrae and from the sacroiliac joint capsule. The PS is a rare entrapment Thoracic CT of 78-years-old female patient complaining of dyspnea and neuropathy in which the sciatic nerve is compromised by an abnormal weight loss revealed well defined multiple enhancing mass lesions together piriformis muscle. Several variations in the anatomical relationship of with infected bronchiectasis in the both lung parenchyma. For charac- the sciatic nerve and the piriformis muscle may be seen. Hypertrophy, terization of masses MRI was performed. Leiomyoma was diagnosed on inflammation, traumatic injury, anatomical variations of the piriformis biopsy. Myomectomy and coronary artery by-pass surgery were present muscle and/or the sciatic nerve, and myositis ossificans can cause PS. on history of the patient. Uterine leiomyomas are one of the most com- Approximately 6% of lower back pain and sciatica cases seen in a general mon tumors in women. Parasitic leiomyoma is an uncommon type of practice may be caused by PS. However, this ratio may be higher because uterine leiomyoma. It may present with a wide spectrum of symptoms. A it’s similarity with radicüler pain. The rarity, nonspecific clinical symptoms, parasitic leiomyoma that had blood supplies from the common iliac ves- and absence of definite diagnostic tests may cause the diagnosis of pirifor- sels was diagnosed during the operation. Total abdominal hysterectomy mis syndrome to be missed or delayed. MRI can be used to make a cor- and mass removal were performed without complication. Even though a rect diagnosis, to specify anatomic relationships for preoperative planning, parasitic leiomyoma is uncommon, it should be included in the differential diagnosis of pelvic and lung mass. and to differentiate piriformis syndrome from the more common causes of lower back pain and sciatic. In this case report, the patient presented Keywords: Parasitic leiomyoma, lung mass, hysterectomy to us as lumbar disc hernie who has with a complaint of pain spreading from hip to lower back and to left foot was evaluated by MRI. On MRI images it was seen that piriformis syndrome due to inflammation in the P - 0118 left piriformis muscle. A RARE LOCATION OF HYDATID CYST Keywords: Piriformis syndrome, sciatic nerve, magnetic resonance imaging FADIME GUVEN, RECEP SADE, MECIT KANTARCI Atatürk University, School of Medicine, Erzurum, Turkey P - 0116 Abstract Hydatid cyst is an endemic parasitic disease seen in people who are PULMONARY SEQUESTRATION: engaged in agriculture and animal husbandry. It is most commonly local- INTRAUTERIN ULTRASONOGRAPHY ized in the liver and lungs. In this case report, we aimed to identify MRI findings of a rare localization of cyst hydatid. A 25-year-old woman with AND MRI FINDINGS a complaint of swelling is seen in the left posterior cervical region with FADIME GUVEN, EMSAL PINAR TOPDAGI YILMAZ, a hydatid cyst located at C2-4 level in the side of the left arch of the MECIT KANTARCI vertebra. Atatürk University, School of Medicine, Erzurum, Turkey Keywords: Hydatid cyst, neck, magnetic resonance imaging S80 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

P - 0119 Abstract Introduction: Constrictive pericarditis; is a rare disease that develops due COR TRIATRIATUM SINISTER WITH to chronic inflammation of the pericardium and results in thickening of PRIMUM ATRIAL SEPTAL DEFECT the pericardium, adhesion between the pericardial leaves and occasionally

1 1 calcification. Diastolic filling of the heart is typically reduced, resulting in EMIN DEMIREL , CIGDEM OZER GOKASLAN , an increase in diastolic pressures. As a result, symptoms of systemic and 2 SERKAN GOKASLAN pulmonary venous congestion occur. A case of constrictive pericarditis is 1Department of Radiology, Afyon Kocatepe University, Afyonkarahisar, Turkey presented with imaging findings. 2Department of Cardiology, Afyon Kocatepe University, Afyonkarahisar, Case Report: A 62-year-old male patient with chronic liver failure was Turkey admitted to our hospital. Dynamic liver computed tomography (CT) Abstract examination revealed contour nodularity compatible with chronic liver disease in the liver and hypertrophy of the caudate lobe. Hepatic venules Cor triatriatum sinister is a comperatively rare congenital malforma- and inferior vena cava were significantly dilated. Pericardial thickening tion in which the left atrium is divided by a fibromuscular membrane and calcification was observed in the pericardium in the thorax sections into two seperated chambers. The embryologic origin of this congenital included in the study. Contrast-enhanced cardiac MR images, revealed defect is still debated. The presentation of patients can be during infancy, biatrial enlargement. The pericardium was thickened diffusely, especially childhood, or adulthood, and this is due largely to variation in both the in the vicinity of the right ventricle. The lateral wall of the right ventricle degree of obstruction to pulmonary venous return and the presence of was compressed. There was mild enhanecement in the pericardium. associated lesions. We describe the case of a patient presenting in early Paradoxical wall motion was observed in the interventricular septum. The adulthood with symptoms associated with cor triatriatum sinister and an findings were consistent with constrictive pericarditis. primum atrial septal defect. Conclusion: Constructive pericarditis is a rare but important disease that Keywords: Atrial septal defect, cardiac MRI, cor triatriatum sinistrum causes high morbidity and mortality. Diagnostic imaging methods can be used and MR imaging provides a significant advantage over other imaging P - 0120 modalities in terms of constrictive pericarditis in many ways. Keywords: Cardiac MRI, constrictive pericarditis, pericardial thickening PATTERNS OF MYOCARDIAL LATE ENHANCEMENT P - 0122 FURKAN BULUT, IBRAHIM HALIL OZYAVUZ, YUNUS EMRE AKPINAR, MENDUH DURSUN FOUR PATIENTS WITH CARDIAC Department of Radiology, İstanbul University School of Medicine, İstanbul, HYDATID CYST IN UNUSUAL LOCATIONS Turkey SAFIYE SANEM DERELI BULUT1, FUAT NURILI2, Abstract YASAR BUKTE1 1 Magnetic resonance imaging (MRI) was initially utilized to distinguish viable Department of Radiology, Health Sciences University Umraniye Research myocardium from scar tissue in the evaluation of cardiac pathologies. The and Training Hospital, İstanbul, Turkey 2Department of Radiology, Memorial Sloan-Kettering Cancer Center, New use of MRI for this purpose is important for evaluating different cardiac York, USA pathologies with a non-invasive examination method. Myocardial late contrast enhancement has an important role in cardiovascular magnetic Abstract resonance imaging. In this review, we aimed to describe late contrast Hydatid disease commonly involves liver but in rare cases, it can involve enhancement patterns on ischemic and non-ischemic cardiomyopathy cardiac structures. Cardiac involvement in hydatid disease is uncommon, cases such as myocarditis, sarcodiosis, amyloidosis, systemic sclerosis, constituting only 0.5–2% of all cases of hydatidosis. We report three Duchenne muscular distrophy, Becker muscular distrophy, systemic lupus cases of hydatid cyst in unusual locations of heart. All patients underwent erythematosus, hypertrophic cardiomyopathy, dilated cardiomyopathy, MR examination with a 1.5-T system (OPTIMA MR 450,GE) with ECG left ventricular non-compaction, arrhythmogenic right ventricular dyspla- triggering. Areas of cardiac involvement in hydatid disease usually include sia, pulmonary hypertension and infective endocarditis. the left ventricle (60% of cases), right ventricle (10%), pericardium (7%), Keywords: Cardiac imaging, ischemic cardiomyopathy, myocarditis, amy- pulmonary artery (6%), and left atrial appendage (6%); involvement of the loidosis interventricular septum is rare (4% of cases). One of our patients was 38 years old and the hydatid cyst was located in AV groove. In 13-year-old patient, hydatid cyst was located in the right ventricular free wall with P - 0121 pericardial massive effusion. the other patients cardiac mass was located in the lateral wall of the left ventricle. The diagnosis of hydatid cyst was CONSTRICTIVE PERICARDITIS MR confirmed by serological tests and operation. Early diagnosis and surgico- IMAGING FINDINGS medical treatment is the success key of treatment for cardiac hydatid disease. In endemic areas, hydatid cyst should be considered in differential EMEL YERLI, KEMAL BUGRA MEMIS, ELIF PEKER, diagnosis of heterogeneous echogenic lesions in ECHO on even if the BASAK GULPINAR, ANIL COLAKLAR, serologic tests are negative. Physician can use cardiac MRI to earn valuable MEMET ILHAN ERDEN information about the lesion and its relation to other structures. Ankara University School of Medicine, Ankara, Turkey Keywords: Hydatid cyst, cardiac MR, unusual involvement Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S81 P - 0123 tumor and they were usually used for conditions related with thrombi. To describe cardiac magnetic resonance imaging (CMR) and computed MASS-LIKE HYPERTROPHIC tomography angiography (CTA) features of a case with cardiac calcified CARDIOMYOPATHY: A DIFFICULT amorphous tumor. CASE TO DISTINGUISH FROM Materials and Methods: 62-year-old female patient with mass conform- CARDIAC MASSES ing findings near to mitral valve on echocardiography imaging, has been referred to our radiology department for further evaluation. CTA imaging MEHMET ERSEN, UGUR BOZLAR, SINAN AKAY, showed a calcified lesion near the posterior leaflet of mitral valve. After KEMAL NIYAZI ARDA, SALIH HAMCAN, that patient evaluated with CMR. CMR showed a mobil, hypointense HATICE TUBA SANAL, MUSTAFA TASAR lesion on T1 and T2-weighted images near the annulus on mitral valve posterior leaflets inferior surface. Late gadolinium enhancement on the Department of Radiology, Gülhane Gülhane Military Medicine Academy, Ankara Turkey around the lesion which associated with fibroinflammatory process was observed. Abstract Conclusion: Cardiac CAT is associated with nodular calcium deposits and Objective: Hypertrophic cardiomyopathy (HCM) is a cardiomyopathy with a background of fibrin and amorphous fibrillary material. Cardiac which continues with focal or diffuse ventricular wall thickening without CAT usually seen as calcified or partially calcified mass on CT images. They any other systemic or cardiological disease. HCM is the most-common usually visualized as hypointense lesions on T1 and T2 weighted images on primary cardiomyopathy and it has autosomal dominant genetic back- MRI images. They can be seen as mobile mass depending on the attach- ground. But some HCM types are difficult to diagnose like mass-like HCM. ment point. Cardiac CATs usually don’t show enhancement on early or To describe MRI features of a case with mass-like HCM. late gadolinium images. But our lesion showed peripheral enhancement related with fibroinflammatory reaction near lesion. Surgical excision in Materials and Methods: 49-year-old female patient with complaint of suitable patients can be curative. Valve repair may be necessary to prevent shortness of breath on exertion has been referred to our radiology valvular dysfunction. department for cardiac MRI imaging. Cardiac MRI showed T1 and T2 hypointense focal lesion in the basal-mid cardiac portion of the inter- Keywords: Calcified tumor, pseudotumor of heart, CMR, cardiac MRI ventricular septum. Lesion shows contractility on cine-steady state free precession (SSFP) and cine grid-tagged images. There were patch-like late gadolinium enhancement (LGE) areas in the lesion on phase sensitive P - 0125 inversion recovery (PSIR) images. Conclusion: Mass-like HCM’s are visualized as mass as similar intensity SACCULAR ANEURYSM IN GREAT with myocardium and causes lobulation in myocardium contours. These SAPHENOUS VEIN WHICH IMITATING findings lead to interpretation of this HCM subtype as a cardiac mass. HERNIA Cardiac MRI plays a critical role in distinguishing mass and mass-like HCM at this point. Diffuse or focal myocardial thickening and patch like late gad- BAHAR YILMAZ CANKAYA, HAYRI OGUL olinium enhancement on thickened part are the main diagnostic imaging Department of Radiology, Ataturk University Health Research and findings of HCM. But, these findings may not be enough to distinguish the Application Centeri Erzurum, Turkey focal/mass-like HCM from the cardiac masses. In such cases, demonstra- Abstract tion of myocardial contractility gains importance in differential diagnosis. Myocardial contractility can be assessed in cine-SSFP sequences or more Objective: Venous aneurysms are rare lesions and are important for the prominently in cine myocardial tagging images. risk of life-threatening pulmonary embolism. Differential diagnosis should be made with inguinal hernia, femoral hernia or lymphadenopathies with Keywords: Hypertrophic cardiomyopathy, tagging, mass-like HCM the location of the Great Safen venous aneurysm. In this case report, MRI findings of a 64 year old female patient with a large saccular aneurysm were included. P - 0124 Matherials and Methods: In the right femoral region, a thigh imaging CALCIFIED AMORPHOUS TUMOR OF with a 1.5 T MRI device (Magnetom Avento, Siemens Healthcare) was performed to the patient who complained of increasing swelling and pain HEART: A RARE CASE REPORT for 1 month. UGUR BOZLAR, MEHMET ERSEN, SALIH HAMCAN, Results: In the MRI taken for the right thigh region, signal changes were HATICE TUBA SANAL, KEMAL NIYAZI ARDA, observed proximal to the large saphenous vein, which corresponded to a SINAN AKAY, MUSTAFA TASAR 4.5 cm diameter, broad necked saccular aneurysm and a lumen thrombus. Department of Radiology, Gülhane Military Medicine Academy, Ankara, Conclusion: In primary venous aneurysms, jugular vein, anterior part of Turkey the arm, femoral vein and popliteal vein aneurysms are frequently seen, Abstract and rarely are large saphen vein aneurysms. Serious problems can be encountered if there is not enough evaluation before the operation or Objective: Calcified Amorphous Tumor (CAT) is a rare, non-neoplastic biopsy. mass which can mimic malign lesions of heart. It is first described in 1997. Before that time non-neoplastic masses of heart are known as pseudo- Keywords: Vein, aneurysm, MRI, hernia S82 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 P - 0126 P - 0128 SYNOVIAL HEMANGIOMA AND OSGOOD SCHLATTER DISEASE VARICOSE VEINS OF THE KNEE JOINT FOLLOWING SINDING-LARSEN- YASEMIN ALTINTAS JOHANSSON SYNDROME: MRI FINDINGS Private Adana Ortadoğu Hospital, Adana, Turkey OF TWO OSTEOCHONDROSIS OF KNEE Abstract IN SAME PATIENT 2 1 Introduction: Synovial hemangiomas are rare benign tumors of the knee BUKET YAGCI , ICLAL ERDEM TOSLAK , 1 joint. In childhood and early adulthood, there is confusion with knee pain BERNA AK YILDIZ and non traumatic hemarthrosis. They are often diagnosed late. Magnetic 1 Antalya Training and Research Hospital, Antalya, Turkey resonance imaging is the best diagnostic method and the best radiological 2 Kastamonu State Hospital, Kastamonu, Turkey examination in the differential diagnosis of other lesions of the knee joint. Abstract Case Report: A 40-year-old male patient presented to our clinic with Introduction: Sinding-Larsen-Johansson (SLJ) syndrome is an osteochon- complaints of swelling and limitation of movement in the left knee. MRI drosis of the inferior pole of the patella. SLJ affects the proximal end of showed suprapatellar, infrapatellar lobuleted mass containing fibrous septa the patellar tendon as it inserts into the inferior pole of the patella. The and common varicose vein around the knee joint. SLJ syndrome is caused by increased tension and pressure due to repeti- Conclusions: Synovial hemangiomas should be considered in patients tive traction by the patellar tendon on the lower pole of the patella. SLJ with recurrent pain and swelling of the knee joint. Patients with late diag- disease is seen in active adolescents, typically between 10-14 years of age nosis develop osteoarthritis at an early age. For this reason, typical MR . SLJ syndrome has a pathogenesis similar to that of the Osgood-Schlatter disease and two disorders sometimes occur simultaneously. In this case findings should be evaluated correctly. report, we aimed to present MRI findings in an 11-year-old-boy with a Keywords: Synovial hemangioma, knee joint, MRI, varicose veins prior diagnosis of SLJ in whom Osgood Schlatter Disease and Clergyman knee developed in a year after SLJ diagnosis. Case Report: A 11-year-old boy presented to a pediatric outpatient P - 0127 clinic with a 2-month history of knee pain. The pain was exaggerated especially after climbing stairs or walking for long distances. Standard FREIBERG DISEASE IMAGING X Rays on AP and lateral projections and right/left knee MRI were FINDINGS: A COMMON CAUSE OF performed. A bony fragment at inferior pole of patella was seen on METATARSALGIA REVISITED plain radiograph. There was also associated thickening of proximal patellar tendon. On MRI, the inferior pole of the patella, proximal and ABDULLAH SUKUN, BERNA AK YILDIZ, SINAN ULGEN, posterior part of the patellar ligament and surrounding soft tissues were BULENT CEKIC, ICLAL ERDEM TOSLAK hypointense on T1-weighted MRI sequences and hyperintense on fluid sensitive T2-weighted MRI sequences. A diagnosis of Sinding-Larsen- Department of Radiology, Health Sciences University Antalya Training and Research Hospital Antalya, Turkey Johansson syndrome (osteochondrosis of the inferior pole of the patella) was made and patient was treated conservatively. At 1-year follow-up Abstract examination another series of X ray and knee MRI was performed for the same knee as the patient’s symptoms hadn’t resolved. On X ray, Freiberg disease, osteochondrosis of metatarsal heads, is a common cause fragmented apophysis at tibial tuberosity and obscuring of infrapatellar of metatarsilgea. It is the only osteochondrosis seen more frequently in fat planes were seen suggesting edema/effusion in this region. On MRI women than in men. When first identified, it was so called aseptic or avas- there were soft-tissue swelling anterior to the tibial tuberosity, loss of cular necrosis of the metatarsal head, and defined as the inco mpleteness the sharp inferior angle of the Hoffa’s fat pad, thickening and edema of of the metatarsal head. Normally, the current load is distributed to each the inferior patellar tendon and infrapatellar bursitis. Patient was diag- metatarsal bones. Overloading of one of the metatarsal head in Freibergs nosed as Osgood Schlatter disease and Clergyman’s knee. disease causes micro fractures in the cortical changes of the long but less mobile metatarsal head. Recurrent microtrauma results in impaired sub- Conclusion: Osteochondrosis of the tibial tuberosity (Osgood Schlatter chondral flow, resulting in chondral collapse and necrosis. Wearing high- disease) and osteochondrosis of the inferior patella (SLJ syndrome) occur heel shoes may be a reason especially in adolescents and young women, at tendinous insertions of the patella at the distal and proximal levels, in which one foot and one metatarsal is usually involved. One in ten of the respectively. Infrapatellar bursitis (clergyman knee) occurs with inflam- patients may have both feet involvement. Accompanying reactive synovitis mation of bursae around the insertion of the distal patellar tendon. may cause swelling and limitation of motion in the joint. Pain is more Infrapatellar bursitis may be a component of Osgood-Schlatter disease. pronounced in weight bearing and lean feet walking. MRI is important in Keywords: Sinding-Larsen-Johansson syndrome, Osgood-Schlatter, MRI the diagnosis at early stage. Surgical rescue osteotomy is performed in the early period of recovery and plays an important role management of the diseases. We aimed to present the radiological features of Freiberg disease P - 0129 including radiographic, CT, and MRI findings. Keywords: Freiberg disease, metatarsalgy, avascular necrosis of metatarsal GIANT SOLITARY SYNOVIAL head OSTEOCHONDROMA OF THE HIP Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S83

RAFAIL JOMARDOV, IPEK TAMSEL, MEHMET ARGIN pulley. Pulleys are 2 types including anulus and krusiform. While the annular scales are thicker and stronger than the crusiform scales are thinner and the Department of Radiology, Ege University School of Medicine, İzmir, Turkey annular scales prevent tendon dislocation, they also allow optimal joint motion. Abstract Krusiform pulley facilitates the movement and contributes to flexibility. Scales sticking to the periosteum and volar plate of phalanges slide along the fibrous Giant or solitary osteochondroma is part of a rare disorder known as syno- canal. Except for the thumb, there are a total of 8 pulleys, 5 of which are ann- vial osteochondromatosis. Usually arising from the juxta-articular soft tissues lar and 3 of which are crusiform. The pulleys supporting the synovial sheath without attaching to the bone, these lesions can be large and show clinical are separated according to joint levels. There is A1 at the level of the MKP and radiological features of a malignant process. It usually present in adult joint, A3 at the PIF joint level, and A5 Pulleyi at the DIF joint level. A2pulley population and is rare in children. The main symptoms are pain, swelling and is from the MP joint to the begining of proximal phalanx. A4 pulley is proxi- limitation of movements in the affected joint. This report is about 22 old male mal to middle phalanx. In the absence of A2 and A4 pulleys, finger flap loss patient present with pain and limited range of motion at hip and right leg increases. Thus it must be repaired absolutely. Generally pulley rupture include caused by giant solitary synovial osteochondroma of the hip. In this rare case long fingers. Pulley injuries usually start at A2 and these injuries are called we demonstrate the X-ray and MRI findings of the giant osteochondroma. climber’s finger. Isolated A1 pulley injury is rare. We aimed to present A1 rup- Keywords: Solitary osteochondroma, pain, hip ture findings in a 34-year-old man who presented with hand pain complaints. Keywords: Pulley rupture, A1 pulley injury, climbers finger P - 0130 HUMERAL CHONDRAL DEFECT AND P - 0132 LABRAL TEAR ASSOCIATED WITH MALIGN PERIPHERAL NERVE SHEATH PARAGLENOID LABRAL CYST: A CASE TUMOR: A CASE REPORT REPORT ABDULLAH SUKUN, SAMET MUTLU, EMIN DURMUS, BERHAN PIRIMOGLU, HAYRI OGUL, MECIT KANTARCI BERNA AK YILDIZ, ICLAL ERDEM TOSLAK Department of Radiology, Atatürk University School of Medicine, Erzurum, Department of Radiology, Health Sciences University Antalya Training and Turkey Research Hospital, Antalya, Turkey Abstract Abstract Objective: To report an unusual combination of paraglenoid labral cyst By definition, malignant soft tissue tumors arising from nerve tissue, including and labral tear with chondral defect of the humeral head. neurofibrosarcoma, neurosarcoma and malignant schwannoma, are included. The origin may be the schwann cell as well as the fibroblast and the perineural Clinical Presentation: A 34-year-old man presented with right shoul- cell. These are called malignant peripheral nerve sheath tumors (MPSCT) der pain. Conventional MR imaging showed paraglenoid labral cyst. MR because of the difficulty in distinguishing them. The great nerve involvement in arthrography revealed a humeral chondral defect and labral tear associ- the extremity and body is frequent. It is seen in 2-5% of patients with neurofi- ated with paraglenoid labral cyst, and a defect of the posterior inferior bromatosis. However, half of the patients with MPSCT are NF-1. Involvement labrum extending to the superior labrum and humeral chondral defect. in children is rare. The mass does not show any sign until it reaches a certain The patient underwent arthroscopic surgery. size, so the mixture comes out as massive masses. Symptoms such as pain, Conclusion: This case showed the importance of MR arthrography in a weakness and numbness occurs late. 1/5 of the tumors come to the upper case that involved an unusual combination of paraglenoid labral cyst and extremity. This constitutes approximately 3% of all malignant tumors of the labral tear with chondral defect. hand. We aimed to present the radiological features of malignant peripheral nerve sheath tumors in a 79-year-old woman with wrist pain. Keywords: Paraglenoid labral cyst, 3D VIBE MR arthrography sequence, labral tear, chondral defect Keywords: MPSCT, NF-1, Nerve sheath tumor

P - 0131 P – 0133 RIGHT HAND 2ND FINGER A1 PULLEY CHARCOT SHOULDER: A RUPTURE DIFFERENTIAL DIAGNOSIS TO BE ABDULLAH SUKUN, BERNA AK YILDIZ, EMIN DURMUS, KEPT IN MIND SINAN ULGEN, ICLAL ERDEM TOSLAK MURAT UCAR, BERRAK BARUTCU, UMUT ASFUROGLU, Department of Radiology, Health Sciences University Antalya Training and NIL TOKGOZ Research Hospital, Antalya, Turkey Gazi University School of Medicine, Ankara, Turkey Abstract Abstract Flanks movements are provided by deep and superficial flexor tendons. The Neuropathic arthropathy, also known as Charcot joint, is a progressive and fibrous construct that provides stabilization of the flexor tendons is called chronic degenerative disease which causes loss or reduction of sensation S84 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 and pain or destruction of the affected joint. One of the most common P - 0136 causes is syringomyelia. Patients with syringomyelia frequently suffer from shoulder involvement. Neuropathic arthropathy may develop early or late A RARE ENTITY; OSTEOID OSTEOMA in the course of syringomyelia and occurs 25% all cases of syringomyelia. OF TALUS MRI is the most useful imaging modality to diagnose syringomyelia and neuroarthropathy. In the early stage of the disease, joints can be warm and CIGDEM OZER GOKASLAN, CANAN INCEOGLU erythematous and it can be difficult to differentiate from septic arthritis. In addition to this, joint effusion, soft-tissue swelling, joint space narrowing, sub- Department of Radiology, Afyon Kocatepe University School of Medicine, chondral sclerosis and osteophytes are early radiologic findings in common Afyonkarahisar, Turkey with primary osteoarthrosis in the early stages. It is important to think about Abstract differential diagnosis due to varied treatment plans. Herein, we present MRI findings of a patient with neuropathic arthropathy of the shoulder second- Osteoid osteoma is a benign, osteoblastic well circumscribed tumor of ary to Chiari type I malformation associated with syringomyelia. spongy bone. Osteoid osteoma can be localized in all bones. It is more common in the lower extremities. It is most common in femur and sec- Keywords: Charcot joint, syringomyelia, neuropathic artropathy ondly in tibia. Osteoid osteoma is localized approximately % 60 in femur and tibia. In %20 of the cases, it locates in hand and foot bones. It is seen most in proximal phalanx, metacarpal bones and scaphoid. It is seen % 4-5 P - 0134 in talus, %2-3 in calcaneus. Approximately %10 of cases is localized vertebrae. High degree of suspicion is needed for early diagnosis and delay INTRAMUSCULAR EXTRAOSSEOUS in diagnosis can cause significant disability because of osteoid osteoma is PLASMACYTOMA: A CASE REPORT a rare entity in the tarsal bones. If the diagnosis is made early, it can be treated without complication. Radiofrequency ablation is safe, minimally IPEK TAMSEL, MEHMET ARGIN invasive method especially to treat juxta-articular and inaccessible lesions. Department of Radiology, Ege University School of Medicine, İzmir, Turkey We present radiological findings of a osteoid osteoma of the talus which Abstract was not been suspected over a long time because of its rare location. In multiple myeloma, secondary infiltration of muscle structures adjacent Keywords: Osteoid osteom, talus, CT, MRI to bone lesions is frequently seen. Nevertheless, plasmacytoma, which occurs directly in muscle tissue without bone lesions, is rarely reported. P - 0137 Typically seen in the head and neck. It accounts approximately 3% of all plasma cell neoplasms. MRI examination of a 78-year-old male patient KNEE SYNOVYAL SARCOMA: MRI who presented with swelling and pain on the way to our institution FINDINGS revealed a solid mass lesion within the triceps muscle. The result of the biopsy was an extraosseous plasmacytoma. In this case report, we present UMMUGULSUM BAYRAKTUTAN, HAYRI OGUL, RECEP radiological imaging findings of isolated extraosseous plasmacytoma in the SADE, MECIT KANTARCI, AKIN LEVENT triceps muscle without bone lesion. Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey Keywords: Multiple myeloma, muscles, neoplasms, plasmacytoma, plasma cell Abstract Objective: Synovial sarcoma is a malignant soft tissue tumor. It is seen P - 0135 around joints in the young adults. The most common sight after the knee is the foot. We present a magnetic resonance imaging (MRI) scan of a SYNOVIAL CHONDROMATOSIS 55-year-old female patient with synovial sarcoma of the left knee. MIMICKING SOFT TISSUE Materials and Methods: A 55-year-old female patient who presented CHONDROSARCOMA with swelling and pain in the left knee and had no trauma history was IPEK TAMSEL, MEHMET ARGIN examined by magnetic resonance imaging with a 1.5 Tesla MRI device (Magnetom Avanto, Siemens Healthcare) for knee imaging. Department of Radiology, Ege University School of Medicine, İzmir, Turkey Results: In our case, there was a lobulated, enhancing mass which is seen Abstract as heterogeneous hypointense on T1-weighted images, heterogeneous Synovial chondromatosis, joint, tendon sheath or synovial membrane of the hypo-hyperintense on T2-weighted images in periarticular soft-tissue on bursa metaplasia is characterized by the formation of multiple chondral or the lateral side of the left knee joint. The case was diagnosed as synovial osteochondral nodules within the resultant synovium. It is benign and usually sarcoma histopathologically after surgical resection. monoarticular. It is most often seen in large joints such as the knees, hips, Conclusion: Synovial sarcoma accounts for 5-10% of all soft tissue shoulders and elbows, less frequently in the joints of the foot and ankle. In sarcomas. It is seen often between 3 and 5. decades. 65% of the cases this case report, we present MRI findings of a 39-year-old female patient have lower extremity location around the knee is the most common with synovial chondromatosis diagnosed as aggressive behavior that mimics location. The most common finding is a mass with pain and sensitivity. soft tissue chondrosarcoma causing erosion in adjacent bone structures in Biphasic type, monophasic fibrous type and poor differentiated type infiltrative form at the level of intertarsal and tarsometatarsal joints. are the histopathological types. The prognosis is poor. Synovial sarcoma Keywords: Synovial chondromatosis, joint, soft tissue chondrosarcoma often grows slowly. The organ in which soft tissue sarcomas metastasize Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S85 in the first place is the lung. For this reason, computerized tomography Abstract of thorax and whole body bone scintigraphy should be requested. The Accessory ossicles are secondary ossification centres these are dis- tumor site can be best demonstrated by MRI. Standard treatment is crete from the attached bones. Sesamoids and accessory ossicles are surgery and lesion show sensitivity to chemotherapy. In the postopera- often found on the feet, knees and hands. They are often congenital, tive period, recurrence or pulmonary metastasis should be controlled at intervals. although they appear as a result of trauma or local degenerative diseases. The incidence of symptomatic accessory bones is relatively Keywords: Synovial sarcoma, MRI small. Accessory ossicles may be associated with painful syndromes, as well as trauma, infection, inflammation, degenerations.it can be very difficult to differentiate between incidental variants and what is really P - 0138 symptomatic. However, the main clinical importance of accessory bones is their ability to mimic avulsion fractures and lead to compression A CASE REPORT - MULTIPLE syndromes. Accessories muscles are anatomical variants characterised ENCHONDROMATOSIS (OLLIER by an additional distinct muscle encountered along a normal muscle. DISEASE) Although they are generally asymptomatic, and randomly encountered. Sometimes, these may be symptomatic. Such symptom often mass SUMEYYA DURAN KAYMAK, ZEYNEL YOLOGLU, effect of the supernumerary muscle. The other presenting with either OZKAN UNAL a palpable swelling or secondary compression of near structures such Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research as nerves, vessels, or tendons. Our purpose in this report is to present Hospital, Ankara, Turkey the radiological features of accessory muscles and bones that causing Abstract various clinical symptoms. Olliers disease (OD) is one of the rare disorders which is characterised Keywords: Accessory bone, accessory muscle, compression syndrome by non-hereditary multiple enchondromatosis with at least 3 enchon- dromas seen in the metaphyseal regions of appendicular skeleton. The prevalence of the disease is 1 / 100.00.The phalanges and metacarpals P - 0140 are the most commonly effected sites by the disease. It is often manifested in first decade of life. A 12-year-old female who was complaining CARDIAC METASTATIC TUMOURS pain on her left hand for 3 months after trauma had gone to X-ray YUNUS EMRE AKPINAR, FURKAN BULUT, study. An osteolytic lesion was seen on the 3rd phalanx. Hence she was IBRAHIM HALIL OZYAVUZ, MEMDUH DURSUN refered to MRI. The findings were regarded as a multiple enchondromatosis. OD was first described by Ollier in 1899.Spranger classification İstanbul University İstanbul School of Medicine, İstanbul, Turkey which is comprehensive for multiple enchondromatosis is used for the Abstract definition of the disease. OD is Spranger type 1.The pathogenesis of enchondromatosis is not clearly understood. Recently, some authors Metastatic cardiac tumors are seen about 30 times more common believe that the heterozygous mutations of PTHR1, IDH1(most com- than primary cardiac masses in adult population. Many patients with mon) and IDH2 genes play some role in pathogenesis of the disease. cardiac metastatic disease usually have no significant symptoms Approximately 30% of cases with multiple enchondromatosis may therefore their diagnosis is usually discovered postmortem. Cardiac transform into chondrosarcomas similar to other echondromas.In addi- metastatic tumours can spread to heart through four alternative tion they are at risk of developing glioma, pancreas tumors and ovarian pathways:by direct invasion from peripheral adjacent tissues (lung, juvenile granulosa cell tumors. Even if OD is a rare disorder, proper breast, esophagus), lymphatic extension, hematogenous spread by diagnosis and follow-ups are crucial because of the risk of malignant blood vessels (melanoma, lymphoma, leukemia) or transvenous exten- transformation. Our aim present a case repor with Ollier Disease and sion to both atriums (renal cell carcinoma, hepatocellular carcinoma). talk about the epidemiology, diagnosis and radiological findings of ollier The most common tumors that metastasize to the heart are lung disease. and breast carcinomas, lymphoma, malignant melanoma. Cardiac Keywords: Multiple enkondrom, syndrom, malignity magnetic resonance imaging is very sensetive and specific to detect cardiac massses but there is no specific signal characterization of cardiac metastases on magnetic resonance imaging. These masses are P - 0139 usually seen hypointense on T1 weighted series and hyperintense on T2 weighted series except malignant melanoma metastases. Almost ACCESSORIES MUSCLES all malignant lesions will show detectable signal enhancement on AND OSSICLES IN THE contrast-based sequences. In this report, cardiac metastases from different origins that spread to heart through different pathways, such as MUSCULOSKELETAL SYSTEM invasive thymoma, anaplastic thyroid cancer, hepatoselluler carcinoma, IBRAHIM HALIL OZYAVUZ, YUNUS EMRE AKPINAR, leukemia, lymphoma nasopharynx carcinoma, renal cell carsinoma and FURKAN BULUT, MENDUH DURSUN lung carcinoma were emphasized. Department of Radiology, İstanbul University İstanbul School of Medicine, Keywords: Cardiac magnetic resonance, metastatic cardiac masses, İstanbul, Turkey spread of metastasis to heart S86 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

P - 0141 Case Report: A magnetic resonance imaging (MRI) was obtained from a 15-year-old male who presented to the orthopedic outpatient clinic with A RARE CAUSE OF MEDIAN NERVE a complaint of low back pain and hip pain on the left side for six months. ENTRAPMENT NEUROPATHY: On pelvic MRI, an millimetric interruption was observed on the subchondral bone and the cartilage of the left acetabulum. A defect was detected CARPAL LIPOMA on the left pars interarticularis of the L5 vertebra on lumbar MRI and the NILUFER AYLANC, BURAK KAYMAZ, MUSTAFA RESORLU, patient’s complaint was attributed to this lesion. CANAN AKGUN TOPRAK Conclusion: The radiological interruption of the medial portion of the Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey acetabular roof which is commonly seen in normal subjects is an anatomical notch in the apex of the acetabulum. This has no known function and Abstract represents an anatomic variant. Superior acetabular notchs are commonly Introduction: Lipomas are common benign soft tissue tumors and may seen on MR and MR-arthrograms. That a superior acetabular notch is appear in different anatomical regions of the body, are rarely seen in the symmetric, that it has well defined borders and an absence of pathologic hand. These lesions, in varying sizes, can cause some complications and signal change of the medulla, is important to distinguish a superior acetab- clinical symptoms depending on the mass effect on the anatomic region. ular notch from an osteochondral defect. The remarkable aspect of our Especially lesions in the hand, can cause carpal tunnel syndrome (CTS), case was that the lesion was unilateral, because this unilaterality might lead due to the proximity to the median nerve or to compression effect. to a wrong diagnosis as an osteochondral lesion. Besides this, the typical In this article, the lipoma causing median nerve entrapment will be localization, morphology and absence of pahologic signal changes in the discussed, although it is not located just in the carpal tunnel but distally. periphery all support the presence of normal variation. Case Report: A 75-year-old female patient presented to the orthopedic Keywords: MR, normal variant, superior acetabular notch clinic with a right hand palmar mass and median nerve entrapment clinical symptoms. EMG examination, than radiologic imaging was performed considering CTS as a preliminary diagnosis. EMG results supported CTS. P - 0143 On MRI, in the 3-4. metatarsal levels, a lipomatous mass was found in the dimensions of about 3x3x4 cm, displacing the tendons of the flexor SPINAL DYSRAPHYSM SPECTRUM group on the palmar side of the hand. The histopathologic evaluation REMEMBER WITH CASES obtained after surgical intervention was compatible with lipoma. MUSTAFA TASAR, SEREF BARBAROS ARIK, Conclusion: Lipomas causing carpal tunnel syndrome are very rare SALIH HAMCAN, SINAN AKAY, UGUR BOZLAR, lesions and can lead to symptoms of entrapment neuropathy, particu- KEMAL NIYAZI ARDA, HATICE TUBA SANAL larly in the carpal tunnel or near it, by compression of median nerve. Department of Radiology, Gülhane Research and Training Hospital, Ankara, CTS is the most common entrapment neuropathy of the upper extrem- Turkey ity, often seen between the ages of 36-60 years and mostly in female. EMG is quite useful in diagnosis. However, MRI plays a very important Abstract role in the differential diagnosis of mass lesions that may cause CTS, and Introduction: The spine and spinal cord are a complex anatomic struc- also demonstrate lesion characteristics and the relationship between the ture. That’s why their congenital anomalies tend to be complex and mass and the adjacent anatomic structures detailly, thus contributing to confusing. This complexity make the neuroradiologic diagnosis challenging. the highlightening the symptomatology as well as to the management of Because magnetic resonance imaging plays a crucial role in both diagnosis the treatment. and postoperative evaluation, we aim to remember useful Tortori-Donati and Rossi classification with understandable short notes and to provide an Keywords: Carpal tunnel syndrome, lipoma, MRI algorithm for an organized approach. CASE 1: Syringohydromyelia + cervical diastematomyelia P - 0142 CASE 2: Closed dysraphism with no mass + complex form (diastemato- AN ANATOMICAL VARIANT myelia + causdal agenesia) + cervical ectasia + dermal sinus OF ACETABULUM: ‘SUPERIOR CASE 3: Closed dysraphism with no mass + simple form (tight filum ACETABULAR NOTCH’ terminale) + filar cyst + ventriculomegaly CASE 4: Closed dysraphism with no mass + simple form (dermal sinus + DERYA GUCLU, ELIF NISA UNLU tight filum terminale + diastematomyelia + persisten terminal ventricle) Department of Radiology, Düzce University School of Medicine, Düzce, Turkey CASE 5: Spinal dysraphism mimicker postoperative changes Abstract CASE 6: Postoperative lumbar dural tear and subcutaneous CSF leak Introduction: A superior acetabular notch has been described as an Conclusion: Congenital malformations of the spine and spinal cord can be anatomic variant where there is a focal defect within the subchondral complex and confusing. An organized approach to imaging findings allows bone of the acetabular roof. The purpose of this case is to describe this greater ease in diagnosis. anatomic variant of acetabulum to distinguish it from pathologic osteochondral lesions. Keywords: Spinal dysraphysm, algorithm, classification Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S87

P - 0144 Materials and Methods: 35 years old women who is complaining about chronic pain on the anterior part of her knee is consulted to our radiol- THE RARE CAUSES OF THE KNEE ogy department. On rontgenogram, CT and MR images findings are PAIN AND CHRONIC EFFUSION: consistent with edema, inflammation and ossifying mass lesion with in her LIPOMA ARBORESCENS infrapatellar fat with no bone destruction. Results and Conclusion: Hoffa’s pad tumors are an uncommon and SUMEYRA DEMIRKOL ALAGOZ, SAIM TURKOGLU, rarely diagnosed lesions that can be misinterpreted as any knee pathol- HARUN ARSLAN, MESUT OZGOKCE, ABDUSSAMET BATUR ogy. It’s important to diagnose this clinical condition early and to start the Department of Radiology, Yüzüncu Yıl University, Van, Turkey appropriate treatment in order to avoid morbidity. Although the majority of tumours are benign, malignant tumours should be considered especially Abstract in the paediatric population. Objective: We aimed to present magnetic resonance imaging (MRI) find- Keywords: Hoffas pad, extraskeletal chondroma, chronic pain ings of lipoma arborescens, a rare cause of long-lasting pain and recurrent effusion attacks in the knee joint. Materials and Methods: A 53-year-old male patient was received to our P - 0146 hospital with the complaint of a knee pain which continued for a long time and increased with movement. No increase in temperature was observed PATELLAR TENDON GANGLION IN on physical examination. Patients with no significant laboratory findings PATELLAR TENDON-LATERAL FEMORAL knee MR imaging was performed in the radiology clinic. Effusion in suprapatellar bursa and multiple nodular lesions with hyperintensities on T1 CONDYLE FRICTION SYNDROME and proton density-weighted images in the synovium was detected. The BURCU SAHIN, ELIF AKTAS, NAZAN CILEDAG, signal intensity of the lesions was coexistent with subcutaneous adipose HIDIR KAYGUSUZ, OZKAN UNAL tissue. Suppression was detected in oil-imprinted sequences. The signal Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research intensity of the lesions was coexistent with subcutaneous adipose tissue. Hospital, Ankara, Turkey Suppression was detected in oil-imprinted sequences Abstract Results: According to the findings of knee MRI, the patient was diagnosed with lipoma arborescens (LA). Intratendinous ganglia are rare. We report the case of a 55 year old woman with chronic anterolateral pain of the knee and a ganglion of the patellar Conclusion: Lipoma arborescens (LA) is a rare intraarticular lesion tendon as indicated on magnetic resonance (MR) examination. There was formed by lipomatous proliferation of synovium. There are slowly evidence of patellar tendon-lateral femoral condyle friction syndrome with increasing, painless swelling in the knee joints of patients for many years significantly close contact between the patellar tendon and the lateral facet and recurrent effusion attacks. Diagnostic magnetic resonance imaging of the femoral trochlea. To our knowledge, we report the second case of a (MRI) is the gold standard. Pathologically, villous proliferation of synovial ganglion of the patellar tendon subsequent to patellar tendon-lateral femoral membrane and hyperplasia of mature fat tissue in subsynovial tissue are condyle friction syndrome. We believe that this case is illustrative of mucoid present. LA is usually seen in middle-aged men. LA is a disease that should degeneration in connective tissue due to chronic repetitive microtraumas. be remembered in patients with long-standing swelling in the knee joint. Keywords: Patellar tendon, ganglion, friction syndrome Keywords: Lipoma arborescens, magnetic resonance, knee pain

P - 0147 P - 0145 A RARE CASE, PRIMARY PATELLAR A RARE MASS LESION IN HOFFA: ANEURYSMAL BONE CYST MRI EXTRASKELETAL CHONDROMA FINDINGS HATICE TUBA SANAL, SEREF BARBAROS ARIK, SUAT INCE, ENSAR TURK O., HARUN ARSLAN MUSTAFA TASAR, KEMAL NIYAZI ARDA, SALIH HAMCAN, SINAN AKAY, UGUR BOZLAR Yüzüncü Yıl University, Van, Turkey Department of Radiology, Gülhane Research and Training Hospital, Ankara, Abstract Turkey Objective: Aneurysmal bone cyst (ABC), which is seen in 1% of primary Abstract bone tumors, is a rare bone lesion and patellar location is very rare. In this case, we aimed to present primary patellar aneurysmal bone cyst. Objective: Hoffa’s pad is an intracapsular extrasynovial wedge shape adipose tissue that is localized anterior of the knee. Abnormalities related Materials and Methods: A 15-year-old male patient was admitted to our with Hoffa commonly are the consequences of trauma and degeneration, hospital because of left-sided knee pain which continued for one year, but inflammatory and neoplastic diseases can arise in the fat pad. The increased activity and decreased at rest. The last 15 days have developed purpose of this paper is to describe a rare mass lesion with in Hoffa’s pad swelling in the area of pain. A direct radiograph was requested from the and to increase awareness about Hoffa’s pad tumors. patient in terms of differential diagnosis. S88 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Results: On a direct X-ray examination, a multiloculated lytic lesion ABDULLAH SUKUN, EMIN DURMUS, BERNA AK YILDIZ, causing enlargement of the patella was detected. In terms of differen- BULENT CEKIC, ICLAL ERDEM TOSLAK tial diagnoses, MRI examination was requested. On T1-weighted and Department of Radiology, Health Sciences University Antalya Training And T2-weighted MR images, a multiloculated cystic lesion filled with the entire Research Hospital, Antalya, Turkey patellar lumen with fluid-fluid levels was observed (and 3). Post contrast images showed septal contrast nhancement. The patient was evaluated as Abstract primary ABC with radiological and histopathological findings. The process of ossification of long bones during skeletal maturation Conclusion: ABC is a tumor-like, benign, enlarging bone lesion that occurs is a complex and dynamic process. The ossification centers within the in 1% of primary bone tumors. ABC can develop in normal bone, and it can cartilage-containing epiphysis centers undergo endochondral ossification. develop in a pre-existing lesion base such as giant cell tumor, chondroblas- During this process, a nodular and fragmented appearance may occur toma, chondromyxoid fibroma, osteosarcoma, fibrous dysplasia, eosinophilic at the edges during ossification. Irregular ossification centers are com- granuloma, trauma, and it is called as secondary ABC. Typical radiographic monly seen at the distal femoral condyle epiphysis, humeral trochlea, and appearance of ABC is eccentrically located, expansile, occasionally osteolytic navicular bone. Females are more frequently affected during rapid growth bone lesion.In computed tomography and magnetic resonance imaging, the periods. The medial compartment is affected more frequently than the lesion resembles honeycomb with internal septa and fluid-fluid levels. lateral compartment, however irregular ossification areas may be bilateral. This normal variations in developmental period may be confused with Keywords: Aneurysmal, cyst, patellar, primary osteochondral defects and OCD. The absence of bone marrow edema helps to diagnosis. Both has a similar appearance on plain radiographs. Irregular cortical borders on the radiographs may also mimic fracture P - 0148 lines. Irregular ossification centers are frequently located in the posterior inferior portion of lateral femoral condyle. The cartilage must be intact HEREDITARY MULTIPLE in irregular ossification. MRI is helpful in differential diagnosis. We aimed EXOSTOSES WITH GIANT PELVIC to present the radiological findings of irregular ossification at knee joint in CHONDROSARCOMA: MR IMAGING a 7 year-old-male. FINDINGS Keywords: Irregular ossification, lateral femoral condyle HALIL CAYLAK, VILIAM GASANOVI, BULENT YILDIZ, MEHMET H. ATALAR P - 0150 Department of Radiology, Cumhuriyet University Hospital, Sivas, Turkey ANEURYSMAL BONE CYSTS CAUSED Abstract TO FORAMINAL OBLITERATION AND Hereditary multiple exostoses (HME), also known as diaphyseal aclasis, MONOPARESIA is an rare disease with autosomal dominant condition, characterised by the development of multiple osteochondromas. Ostochondomas are HARUN ARSLAN1, IBRAHIM ILIK1, cartilage-covered bone tumors that arise from metaphyses of long bones ABDURRAHMAN AYCAN2, SUMEYRA DEMIRKOL ALAGOZ1, and grow outwards. The diagnosis can be made with radiological and / or SUAT INCE1 clinical findings. Many complications of HME have been described., but the 1Department of Radiology, Van Yuzuncu Yıl University Dursun Odabas most feared is malignant transformation. The prevalence of chondrosar- Medical Center, Van, Turkey coma in the general population is 1 in 250,000-100,000. In patients with 2Department of Neurosurgery, Van Yuzuncu Yıl University Dursun Odabas HME, the risk is 5%. Axial skeletal elements (pelvis, scapula, rib, vertebrae) Medical Center, Van, Turkey are the most common sites of sarcomatous degeneration in osteochondromas. We will present MRI findings of a 38-year-old male patient Abstract referred to our hospital with a complaint of giant palpable mass in his pel- Objectives: Aneurysmal bone cysts (ABCs) are rare entities that vis. Pelvic localization of the lesion caused to marked increase in lesion size causes expansile and destruction of bone tissue lesions characterized without any symptoms. Histopathologic examination of the giant pelvic by response to reactive proliferation of connective tissue.. We aimed to mass was found to be compatible with chondrosarcoma. On the skeletal present MR findings of ABC that caused significant foraminal compression survey; Madelung deformity and a large number of osteochondromes in and monoparesia in this case. the upper and lower extremities and in the ribs were observed. Materials and Methods: A 16-year-old female patient admitted to clinic Keywords: Hereditary multiple exostoses, osteochondroma, chondro- with lomber pain, swelling and suffering of being unable to walk which sarcoma started 3-4 months ago. After the examination, lomber MR planned to the patient in our department. Results: On the contrast-enhanced spinal MR, showed that neural fora- P - 0149 men obliteration with in the right half of the L1 vertebra approximately 63x46 mm dimension, lytic and expansive, hypointense with septations NORMAL DEVELOPMENTAL on T1-weighted images, heterogeneous hyperintense showing fluid-fluid IRREGULAR OSSIFICATION OF THE levels in T2-weighted images, peripheric and septal contrast enhancement lesions were observed after intravenous contrast material injection. The LATERAL FEMORAL CONDYLE: lesion, which was interpreted as an ABC, was reported as ABC with IMAGING FINDINGS postoperative pathologic result. Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S89

Conclusion: ABC is a benign, tumor-like, high vascular quality, local Abstract aggressive and relatively rare osteolytic lesion. Lesions occur primary in Ischiofemoral impingement (IFI) is a recently identified clinical condition the first two decades of life, with relatively female dominance. The third most common benign bone tumor is aneurysmal bone cyst after osteoid characterized by the decreased space between the lesser trochanter and osteoma and osteoblastoma. Primary aneurysmal bone cysts constitute ischial tuberosity leading to compression of quadratus femoris muscle in 1.4% of primary bone tumors. They holds vertebral column especially the between (1). IFI usually occurs in middle-aged to elderly women, with a lumbar-posterior bone elements and forms 3-30% of cases. Differential presenting symptom of hip pain. However, it may affect both genders at diagnosis of the ABC are other benign-malignant tumors with fluid-fluid all ages, ranging from 11 to 77 years. Bilateral hip involvement has been levels (giant cell tumor, chondroblastoma, and telangiectatic osteosar- observed in 25-40 % of patients (2). MRI findings include abnormalities coma). quadratus femoris muscle (muscle edema, partial tear, and atrophy). Up to 50 % of patients have also associated hamstring tendon edema and 25% Keywords: Aneurysmal bone cysts, MR findings, bone tumours partial tear. We here in aimed to describe MRI findings of IFI syndrome in a 55 year-old-woman with low back pain. P - 0151 Keywords: Ischiofemoral impingement syndrome, MRI A RARE CAUSE OF HEEL PAIN: BAXTER NEUROPATHY P - 0153 ANDELIB BABATURK, BILGESU ARIKAN ERGUN, WRISBERG VARIANT, A RARE ORHAN AVCI, ZEHRA AKKAYA, GULDEN SAHIN SUBTYPE OF DISCOID MENISCUS Department of Radiology, Atatürk University Achool of Medicine, Erzurum, Turkey NESRIN ERDOGAN, MURAT UCAR, NIL TOKGOZ Abstract Department of Radiology, Gazi University School of Medicine, Ankara, Turkey Objective: Entrapment of the primary branch of lateral plantar nerve Abstract (Baxter nerve entrapment) is one of the rare causes of heel pain. Clinically it is difficult to diagnose but there are clues for a radiologist who knows Wrisberg variant is less common form of discoid meniscus that means what to look for. In this presentation, magnetic resonance imaging (MRI) lack of posterior meniscocapsular attachment to joint capsula and tibia findings of a case with Baxters neuropathy (BN) are summarized. of lateral meniscus and can leads to anteriorly flipped posterior horn of meniscus. Here, we aimed to present 18 years old female patient who Materials and Methods: Forty-one year old female patient with chronic have bilateral wrisberg variant discoid meniscus with anterior subluxation. heel pain for 1.5 years, unresponsive to conservative treatments, was referred to our clinic for further investigation. Frontal and lateral view Keywords: Wrisberg variant, discoid, meniscopathy radiographs of the ankle and 3.0 T MRI were performed, which revealed a calcaneal spur and severe, isolated fatty atrophy in the adductor digiti minimi muscle. P - 0154 Conclusion: Differantial diagnosis of heel pain includes various entities such as plantar fasciitis, fat pad atrophy, calcaneal stress fracture, neoplasia, DIAGNOSIS OF RARE SKELETAL infections. BN is a rare cause for which treatment of choice is decompres- MUSCLE INVOLVEMENT IN A sion surgery. It presents with medial sided heel pain similar to plantar MALT LYMPHOMA CASE USING fasciitis, which itself may be a cause of nerve entrapment. Characteristic MRI findings are atrophic changes in adductor digiti minimi muscle due to DISTINCTIVE IMAGING FINDINGS denervation, which are best appreciated on T1- weighted images without OSMAN CANCURI, AJAY ARORA, SA TRAN, fat suppression at late stages as in our case. MRI plays a key role both in SHWETA GUPTA revealing the undelying pathology as well as ruling out other possible dif- Princess Royal University Hospital, Orpington, UK ferential diagnoses such as stress fractures, masses, plantar fasciitis, tendon pathologies. Abstract Keywords: Baxter neuropathy; inferior calcaneal nerve entrapment; lat- Involvement of skeletal muscles either primary or secondary is an eral plantar nerve; magnetic resonance imaging extremely rare feature of all type of lymphomas. Extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) of skeletal muscles are even more rare. Nevertheless, the P - 0152 imaging findings are distinctive. Regardless of the imaging modality, long segmental and multicompartmantal involvement, intralesional vessels, ISCHIOFEMORAL IMPINGEMENT: HIP infiltrative appearance, adjacent subcutaneous stranding and skin thicken- PAIN OF INFREQUENT CAUSE ing are the main features of skeletal muscle lymphomas. They are highly vascular and cellular tumours. Herein, we present a MALT lymphoma 1 2 ICLAL ERDEM TOSLAK , BUKET YAGCI case with involvement of skeletal muscles in order to highlight the imag- 1 Antalya Training and Research Hospital, Antalya, Turkey ing features. An 80y old female patient presented to opthalmology clinic 2 Kastamonu State Hospital, Kastamonu, Turkey with a lump on her left eyelid and right forearm. After excision of eyelid S90 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 lesion she was referred for radiological evaluation of her forearm lump. P – 0157 US revealed a hypervascular mass within the flexor muscle group which had echotexture similar to normal musculature. MRI demonstrated a EXTRAPLEURAL SOLITARY FIBROUS homogeneous infiltrative lesion showing restricted diffusion. The muscles TUMOR OF THE INGUINAL AREA: were enlarged with preserved architecture. Encasement of the neuro- vascular bundle and nodular subcutaneous extension were also noted. CASE REPORT MALT lymphoma was diagnosed after US-guided core biopsy. The eyelid NURDAN CAY1, BANU CAKIR1, KARABEKIR ERCAN1, lesion demonstrated same histopathology. CT revealed further chest and YETKIN AGACKIRAN2 abdominal wall masses. 1Department of Radiology, Ankara Yıldırım Beyazıt University School of Keywords: Extranodal marginal zone lymphoma (EMZL), mucosa associ- Medicine, Atatürk Training and Research Hospital, Ankara, Turkey 2 ated lymphoid tissue (MALT), skeletal muscle lymphoma, diffusion weight- Department of Medical Pathology, Health Sciences University School of ed imaging (DWI), magnetic resonance imaging (MRI), ultrasound (US) Medicine, Ankara Atatürk Pulmonary Diseases and Chest Surgery Health Implementation and Research Center, Ankara, Turkey Abstract P - 0155 Solitary fibrous tumors (SFT) are rare tumors of mesenchymal origin. MRI FINDINGS OF MYONECROSIS They form less than 2% of soft tissue tumors. They mostly show intrathoracic placement although their wide anatomical distributions. One third of WHICH OCCURS AFTER HIGH them show extrathoracic location and may originate from any soft tissue VOLTAGE ELECTRICITY BURN or visceral localization. The differential diagnosis includes benign nerve tumors, smooth muscle tumors and monophasic synovial sarcoma. In this SEMRA DURAN, HAMZA OZER, DENIZ SOZMEN CILIZ, case report, a 43-year-old female patient was presented with magnetic HATICE GUL HATIPOGLU, BULENT SAKMAN resonance imaging findings of extrapleural SFT in the right inguinal region. Ankara Numune Training and Research Hospital, Ankara, Turkey Keywords: Extrapleural, soft tissue tumor, solitary fibrous tumor Abstract Myonecrosis is a myopathy which involves the infarction of the skeletal muscle. Although secondary to clostridial infections is the main cause; P - 0158 trauma can be reason for myonecrosis. Differantiating from the intraabdominal abscess is important to determine the appropriate treatment TWO CASES OF UNDIFFERENTIATED regime. In this case, we both aimed to present the MRI findings of left arm PLEOMORPHIC SARCOMA OF myonecrosis due to high-voltage. SHOULDER AND THIGH AS A Keywords: MRI, electrocution, myonecrosis PAINLESS LARGE MASS NURDAN CAY, SERHAN EREN, GOKHAN YUCE, KARABEKIR ERCAN, MAHMUT NEDIM AYTEKIN P - 0156 Clinic of Radiology, Ankara Atatürk Training and Research Hospital, Ankara, ANGIOIMMUNOBLASTIC T-CELL Turkey LYMPHOMA MIMICKING ABSCESS: Abstract CASE REPORT Soft tissue sarcomas arises from transformed cells of mesenchymal origin. Soft tissue sarcomas are not common tumors but unfortunately NURDAN CAY1, KARABEKIR ERCAN1, BANU CAKIR1, in adults soft tissue malignancies are one of the most common can- MAHMUT NEDIM AYTEKIN2 cers. The most common types of soft tissue sarcomas are liposarcoma, 1Department of Radiology, Ankara Yıldırım Beyazıt University School of fibrosarcoma, dermatofibrosarcoma protuberans and malignant fibrous Medicine, Atatürk Training and Research Hospital, Ankara, Turkey histiocytoma. Sarcoma is classified for their differentiation pattern as low 2 Department of Orthopedics, Ankara Yıldırım Beyazıt University School of grade, intermediate grade, high grade and undifferentiated respectively. Medicine, Atatürk Training and Research Hospital, Ankara, Turkey Undifferentiated pleomorphic sarcoma, or named as malignant fibrous Abstract histiocytoma previously, is a type of soft tissue cancer which usually originated from arms, legs, and less often in abdominal cavity and retroperito- Angioimmunoblastic T-cell lymphoma (AITL) is a rare subset of peripheral neum. Undifferentiated pleomorphic sarcoma are rare tumor, accounting T-cell lymphoma, which accounts for 1-2% of non-Hodgkins lymphomas. for 4th most common soft tissue sarcoma and incidence has been evalu- They frequently appear in the 7th decade and present with generalized ated to 1-9 per 100000 per year. Clinically, undifferentiated pleomorphic lymphadenopathy and hepatosplenomegaly. Extranodal involvement such sarcoma has no specific signs and presents with painless large mass, as lung, skin and bone marrow may also be present. In this case report, pathological fractures and rapidly growing mass. We present two cases of a 38-year-old male patient with a diagnosis of AITL mimicking abscess in undifferentiated pleomorphic sarcoma thigh and shoulder. A 39-year-old biceps brachii muscle was presented with magnetic resonance imaging man presented with a 25 cm diameter rapidly growing painless mass in findings. the left shoulder for one month and a 71- year- old man presented with Keywords: Abscess, angioimmunoblastic T-cell lymphoma, extranodal a 18 cm diameter rapidly growing mass in the right thigh. In MRI examina- Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S91 tion, poorly demarcated solid masses with cystic component were seen. extremity CT angiography examination and compatible with hypotenar In T1 sequence, both masses have heterogeneity iso-high signal intensity hammer syndrome. with prominent enhancement of solid components and In T2 sequence, Discussion: Ulnar artery provides blood flow to most of the fingers. The intermediate to high signal intensity were seen. superficial palmar arch of the hand is generally formed by the ulnar artery Keywords: Undifferentiated pleomorphic sarcoma, MRI, shoulder, thigh and superficial palmar branch of the radial artery. The arc is superficial and easily damaged. Also there are too many variations on this connection. Because of these variations, the clinical findings of hypotenar hammer P - 0159 syndrome are very different. On pysical examination the Allen test can provide important clues. Radiography and doppler US may be helpful for PARADOXIC HYPERTROPHY OF the diagnose. MRI and MR angiography provides a detailed examination THE SCIATIC NERVE AFTER LIMB of this region. AMPUTATION Keywords: Hypotenar hammer syndome, hand pain, MRI NURDAN CAY, KARABEKIR ERCAN, SERHAN EREN, BANU CAKIR P - 0161 Clinic of Radiology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey A HUGE CUTANEOUS Abstract DERMATOFIBROMA: MRI FINDINGS Paradoxic sciatic nerve hypertrophy can occur in following lower limb 1 1 2 amputation for malignant and nonmalignant conditions. Sciatic nerve DERYA GUCLU , NISA UNLU , EMIN OZLU , 3 hypertrophy is greatest in transection site and gradually decrease proxi- MEHMET GAMSIZKAN mally. It is called paradoxic because of nerve atrophy usually occured 1Department of Radiology, Düzce University School of Medicine, Düzce, after limb amputation. The etiology is unclear and dysregulated axonal Turkey 2 transport may cause of paradoxical hypertrophy. It cause unnecessary Department of Dermatology, Düzce University School of Medicine, Düzce, Turkey biopsy whether a residual or locally recurrent tumor can occur. In this 3Department of Pathology, Düzce University School of Medicine, Düzce, case we present of paradoxic sciatic nerve hypertrophy after left lower Turkey limb amputation. A 34 year-old man bove-knee amputation underwent a surveillance MRI of the lower extremities. It revealed an tubular structure Abstract of high signal intensity compared to muscle on coronal STIR, axial fat-sat- Introduction: Subcutaneous dermatofibroma is a benign tumor usually urated T1-W and T2-W images along the medial left thigh, representing seen on proximal extremities. It was aimed to present MRI findings of a a hypertrophied sciatic nerve. histologically confirmed dermatofibroma case and emphasize its distinc- Keywords: Paradoxic sciatic nerve hypertrophy, limb amputation tive features. Case Report: A 30-year-old woman applied to the dermatology outpatient clinic with a swelling on the superolateral aspect of her thigh that P - 0160 had become more prominent in recent years. Ultrasonography and magnetic resonance imaging (MRI) was planned for the lesion that appeared HYPOTENAR HAMMER SYNDROME on physical examination as a firm, solitary tumoral mass, with a regular surface. Ultrasonography revealed a hypoechoic, lobulated solid lesion ONUR KARACIF, AYNUR TURAN showing increased vascularization. On MRI, the lesion appeared as a soft Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research tissue mass located in the skin and subcutaneous tissue with a dimension Hospital, Ankara, Turkey of 5,5x5x3 cm. It was isointense compared to muscles on T1-weighted Abstract sequence, slightly hyperintense compared to muscles, but hypointense compared to fat, with a hypointense rim on T2-weighted sequence. After Introduction: Hypotenar hammer syndrome is seen in some occupational IV contrast infusion it showed an intense heterogenous contrast enhance- groups or some athletes who use objects that can cause trauma to the ment with fine aberrant, tortuous vascular structures in the periphery. superficial palmar region of the ulnar artery. After technological develo- The lesion was lobulated and well demarcated without any muscle and ments MRI is very important to evaluate of wrist pathology as well as fascial involvement. Also because the lesion persisted for a long time, the angiography. By this case we aim to discuss the imaging findings of hypo- soft tissue mass was considered benign. Punch biopsy was evaluated as a tenar hammer syndrome. cellular dermatofibroma and excision was suggested.

Case Report: 39 years male cobbler with left wrist swelling, pain and 4-5. Conclusion: Dermatofibromas may be mistaken for several benign and th distal finger joint pain. Also he hasn’t any chronic disease. Contrast- malignant masses like especially dermatofibrosarcoma protuberans and enhanced MRI was to be compatible that wrist level aneurysmatic dilata- also other lesions like malignant fibrous histiocytoma, giant cell tumor, tion of ulnar artery and superficial palmar segments and on these arteries rhabdomyosarcoma and desmoid tumors. Accurate differential diagnosis is made by a immunohistochemical examination while MRI is quite useful diffuse wall thickening(reaching 4 mm) and contrast enhancement also in determining the localization and extension to surrounding structures loss of signal void due to slow flow or thrombosis of the artery lumen. and in discriminating atypical cases. The findings were thought to be compatible with vasculitis and hypotenar hammer syndrome. The MRI findings were confirmed by left upper Keywords: Cutaneous, dermatofibroma, MRI S92 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

P - 0162 boss. Therefore, MRI may be of additional diagnostic value in patients with persistent pain and preoperatively. FIBROLIPOMATOUS HAMARTOMA OF Keywords: Carpal boss, MRI, dorsal hand pain THE MEDIAN NERVE MEHMET GEZER1, ZEYNEP MARAS OZDEMIR1, MEHMET SEYFI BURUK1, MEHMET SAH SAKCI2, KADIR ERTEM2 P - 0164 1Department of Radiology, İnönü University School of Medicine, Malatya, Turkey MEDULLARY LIKE INVASIVE DUCTAL 2 Department of Orthopedics, İnönü University School of Medicine, Malatya, Turkey CARCINOMA MIMICKING PHYLLODES Abstract TUMOR 1 1 Fibrolipomatous hamartoma (FLH) of the nerve or neural fibrolipoma is ISIL BASARA AKIN , KEMAL CAGLAR TUNA , 2 3 a rare benign fibrofatty tumor of nerves first described in 1953. Median MERIH GURAY DURAK , SULEYMAN OZKAN AKSOY , 1 nerve is most commonly affected nerve and usually affected at the wrist PINAR BALCI level. Affected nerve is enlarged due to fibrous and fatty infiltration 1Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey around nerve fascicles into epineurium and perineurium. We report a 2Department of Pathology, Dokuz Eylül University School of Medicine, İzmir, Turkey 3 28 years old male patient diagnosed with fibrolipomatous hamartoma of Department of General Surgery, Dokuz Eylül University School of Medicine, median nerve presented with carpal tunnel syndrome findings. İzmir, Turkey Keywords: Fibrolipomatous hamartoma, median nerve, carpal tunnel Abstract syndrome Medullary carcinoma of breast arises from supporting stromal cells of the breast. Invasive ductal carcinomas with some, but not all, the histologic features of medullary carcinomas are defined as medullary like invasive P - 0163 carcinomas (MLIDC). MLIDCs have similar radiologic features with phyllodes tumor (PT) and may be misdiagnosed. Herein we present a patient CARPAL BOSS CASE REPORT with MLIDC misdiagnosed as PT. A 32-year-old female patient with palpable right breast lesions was evaluated. Ultrasonography, mammography ONUR KARACIF, AYNUR TURAN, BAKI HEKIMOGLU and magnetic resonance imaging (MRI) were applied. MRI revealed that Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research the lesions were hypointense with internal septa in T1 and T2 weighted Hospital, Ankara, Turkey images. There were intense peripheral and heterogeneous central Abstract enhancements with restricted diffusion. Type 3 pharmacokinetic curves were provided. The preliminary diagnosis was PT and she was redirected Introduction: Carpal boss is a bone prominence at the dorsal aspect of to surgery. Histopathology was medullary like invasive ductal carcinoma. nd rd the 2 or 3 carpometacarpal joint, whose incidence is underestimated, Histologic appearance of medullary carcinoma can mimic that of poorly which has been linked to various etiologies, including trauma, os styloi- differentiated intraductal carcinoma. MLIDC has similar radiologic findings deum, osteophyte formation, and partial osseous coalition. From the clini- with medullary carcinoma and PT. PTs may have a typical morphology cal point of view, the main obstacle to its recognition is the nonspecificity with smooth margins, internal cysts, and septa at MRI. PT shows hetero- of symptoms, frequently attributed to dorsal ganglion cysts, since both geneous enhancement due to solid components. Dynamic enhancement conditions share a similar location on the dorsum of the wrist. On this patterns can be changed as the tumor has malignant components. In case we purpose highlight the MRI findings of carpal boss impingement MRI, MLIDCs are mostly oval or lobular shaped with smooth margin. and secondary osteoarthritis. Additionally, peripheral enhancement is detected. In the present case, MRI Case Report: 15 years female with pain and swelling on the dorsal aspect examination was not useful in lesion discrimination. MLIDCs are rare and of the right wrist for a few months, without a history of trauma. This have similar imaging findings with PT. However, it is important to aware of pain has been recurrent for a few years and exacerbated by activities that the malignant lesions like medullary breast carcinomas and MLIBC. require wrist movements. After routin radiographics, MRI was performed Keywords: Magnetic resonance imaging, medullary like invasive carcino- for further assessment, which revealed a dorsal bone process at the mas, phyllodes tumor quadrangular joint representing fused to the base of the 3rd metacarpal. Minimal bone marrow edema was observed at this abnormal joint level. No ganglion cyst, a common finding in dorsal wrist pain and swelling, was P - 0165 evident. The fused osseous synchondrosis with the adjacent trapezoid bone at its dorsal aspect. Degenerative osteophytic spurs developing at METASTASIS OF OVARIAN PAPILLARY the dorsal aspect of the base of the 3 rd metacarpal were observed and, in SEROUS CARCINOMA TO THE conjunction with the os trapezoid at the dorsal aspect of the quadrangular joint, constituted the “carpal boss”. BREAST 1 1 2 Discussion: Clinical examination and plain radiography will usually reveal AYDAN ARSLAN , CAN ATALAY , EYLEM AKAR OZKAN , 1 the diagnosis. US and CT also may be helpful. MRI may illustrate a vari- ERKIN ARIBAL able bone morphology and additional bone and soft tissue pathologies. 1Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul Turkey Bone marrow edema shows a significant correlation with a painful carpal 2Acıbadem Altunizade Hospital, İstanbul, Turkey Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S93

Abstract UMIT AKSOY OZCAN, SILA ULUS, DENIZ MUTLU Breast metastasis from primary ovarian papillary serous carcinoma is unusual. Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul Clinical history and imaging morphology can help for metastasis vs primary Turkey tumor differentiation. Additionally Pax8, is a transcription factor, has high sen- Abstract sitivity in distinguishing metastasis from primary. A 47- year- old female with no familial or personal cancer history was admitted to the general surgery Introduction: Breast augmentation with various injectable materials department due to the abdominal pain and breast lump. Dynamic contrast- has been performed for decades. Aquafilling was developed in 2005 enhanced breast MRI (DCE-MRI) revealed a complex cystic mass which was as soft tissue filler for facial contouring and recently its use for breast located at 7:00 oclock in left breast. The lesion had a large cystic component augmentation has started in several countries. Although not approved with a mural nodule of 5 mm in size. Contrast enhancement of the solid by FDA the procedure is increasingly applied in Turkey. Thus, familiar- component (mural nodule) showed persistent contrast enhancement (type ity with the specific imaging findings and complications of this entity 1). Clinical history and immunohistochemical examinations of the lesion were is important. Hereby we present two cases with a history of breast typical over-induced serous papillary adenocarcinoma metastasis. augmentation with aquafilling.

Keywords: Dynamic contrast-enhanced breast MRI, breast metastasis, Case 1: The patient presented to the plastic surgery department of our serous papillary adenocarcinoma metastasis, PAX8, ovarian metastasis hospital due to progressive swelling of the right breast. The patient has a history of augmentation mammoplasty with Aquafilling (declared composition: % 98 water, % 2 copoliamid) four years ago. The right breast was P - 0166 twice the size of the left breast in the physical examination. The patient was referred to our radiology department for breast sonography (US). MRI FINDINGS OF A PATIENT WITH An ill-defined complex cystic structure 11x2 cm in size with multiple and AUTOLOGUS FAT GRAFTING TO THE mobile hypoechoic inner foci in the retroglandular area of the right breast BREAST was noted. In addition, a similar yet smaller complex cystic structure was noted at the retroglandular location of the left breast. Then, the patient ISIL BASARA AKIN, PINAR BALCI was referred for breast magnetic resonance imaging (MRI) for further Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey investigation. Axial T2-weighted (T2-W) turbo spin echo (TSE), 2 dimensional (2D) fat saturated (fat sat) time of repetition-independent multislice Abstract (TRIM), 3D Flash T1-W, and 2D WS-FS short tau inversion recovery Autologous fat grafting is a technique that involves using the patient’s (STIR) sequences were obtained with 1.5T MR (Siemens Espree; Siemens own adipose tissue to be applied on a subcutaneous area of the body to Medical Solutions, Erlangen, Germany). No contrast medium was used. increase total fat volume. Autologous fat is a soft-tissue filler that is easy to Breast MRI revealed hyperintense and heterogenous loculated areas in harvest and does not cause hypersensitivity or foreign-body reactions on the T2-W sequences. The region of injection appeared more spheric implantation. The postoperative complications of autologous fat grafting in the right breast compared to the left breast. Hyperintense injection are similar to other breast augmentation techniques and include fat necro- material was noted among pectoral muscle fibers in the superior parts of sis, sclerosis, and calcification and breast disfigurement. These patients, both breasts. In addition, Aquafilling material was seen between the left should be considered by breast magnetic resonance imaging (MRI) a first pectoralis major and minor muscles. Migration of the Aquafilling material line screening tool or at least used when clinical suspicion or radiographic into the subcutaneous fat tissue in the bilateral middle-inner quadrants abnormality is indeterminate. Herein we present breast MRI findings of was noted. The patient was referred to her clinician for the excision of a patient with autologous fat grafting. A 35-year-old female patient with the material. palpable right breast lesions and pain was evaluated. MRI was applied. Case 2: A 32-year-old female was referred to our radiology depart- MRI revealed that there was a global edema, ill defined, heterogeneous ment for routine breast US. She had no complaints. The patient had enhancing lesions and granulomas. Right breast findings were similar but a history of breast augmentation with Aquafilling one year ago. An ill- less prominent. The findings were diagnosed as fat necrosis due to autolo- defined and complex cystic structure approximately 3x1.5 cm in size gous fat grafting; in second look ultrasonography the diagnosis was veri- with multiple mobile hypoechoic foci in the retroglandular area of the fied. Autologous fat grafting in the breast is not a simple procedure and right breast was noted. Breast MRI was performed for further evalua- should be performed by highly trained and skilled surgeons. The recipient of autologous fat grafting is at risk of calcification, multiple cyst formation, tion and it revealed hyperintense and heterogenous loculated areas in focal breast indurations, pain, infection, and abscesses, abnormal breast the T2-W sequences. Also, migration of the Aquafilling material into discharge, and reactive lymphadenopathy. MRI has been reported to be the subcutaneous fat tissue in the bilateral middle-inner quadrants was more capable than mammography of early detection of fat necrosis and noted. The patient was also referred to her clinician for the excision clinically non-detectable masses, nodules and other complications. of the material. Keywords: Autologus fat grafting, breast, magnetic resonance imaging Conclusion: In conclusion, there can be severe complications of bilateral breast augmentation with Aquafilling injection. Knowledge of the radiologic characteristics of Aquafilling injected breasts as well as of related P - 0167 complications is very useful to make an accurate diagnosis and suggest proper management.

BREAST IMAGING AFTER Keywords: Breast augmentation, aquafilling, sonography, magnetic reso- AUGMENTATION WITH AQUAFILLING nance imaging S94 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

P - 0168 did not show any pathological finding. Lumbar puncture was performed, CSF had inflammatory features (pleocytosis withwith lymphocyte pre- EXTRACAPSULAR INVASION OF dominance). On MRI there are nonspecific white matter lesions located LYMPH NODE METASTASIS FROM at brainstem, at midline and on the left. The lesions do not enhance. One day later from the MRI scan, in blood culture, ampicillin-resistant Listeria BREAST CARCINOMA: CAN WE FIND monocytogenes was identified. Listerial rhombencephalitis accounts of CLUES FROM MRI? approximately 9% of CNS listeriosis cases. Immunocompetent patients LEMAN GUNBEY KARABEKMEZ consist of 42–92% of examined patients with listerial rhombencephalitis. Blood cultures are positive in 61% of cases. MRI is capable of detecting Department of Radiology, Yıldırım Beyazıt University School of Medicine, parenchymal lesions and usefull in early diagnosis. Patchy signal hyperin- Ankara, Turkey tensity throughout the medulla and cerebellar peduncles on T2 weighted Abstract images, in association with a hypointense dot, and multiple gadolinium- enhanced microabscesses in the rhombencephalon are some imaging Objective: The aim of the study is to find radiological signs for extracapsu- characteristics. Listeriosis is a rare cause for rhombencephalitis, and must lar invasion in metastatic axillary lymph nodes in breast carcinoma. be kept in mind in the presence of a cerebellar or medullary lesions on Materials and Methods: Patients with breast magnetic resonance imag- MRI. ing (MRI) and consequently radical mastectomy and axillary lymph node Keywords: Listeria, rhombencephalitis, MRI dissection were searched. Among the 51 patients 5 had extracapsular invasion of metastatic lymph node. Non-fat saturated T1, fat saturated T2 and dynamic images were reviewed. P - 0170 Results: It is found that the heterogeneous fat tissue around involved lymph nodes, ondulated border and striated fat tissue on non-fat satu- CYSTIC DILATATION OF rated T1 images and enhancement of perilymphatic adipose tissue were VENTRICULUS TERMINALIS: CASE seen on MRI. REPORT Conclusion: Extra capsular invasion has been blamed for local and distant recurrences in breast carcinoma. Evaluations of lymph nodes are limited ADEM YOKUS on breast MRI. Heterogeneous fat tissue around involved lymph nodes, Van Training and Research Hospital, Van, Turkey ondulated border and striated fat tissue on non-fat saturated T1 images and enhancement of perilymphatic adipose tissue are found on patients Abstract with extracapsular invasion of metastatic lymph nodes. These findings Objective: Ventriculus terminalis (VT) is a space filled with CSF which require further studies on breast MRI in order to have information on is coated by ependymal cells in conus medullaris of medulla spinalis. It extracapsular invasion of metastatic lymph nodes of breast carcinoma. is also known as the ependymal cyst or the 5th ventricle. It has been Keywords: Breast cancer, magnetic resonance imaging, axillary lymph reported in the literature that the dilated VT is seen in 2.6% of pediatric nodes, extracapsular invasion patients under five age, but observed rarely in adults. In this presentation, we aimed to present Magnetic Resonance Imaging (MRI) findings of cystic dilatation of VT in a middle-aged female patient with low back pain complaint. P - 0169 Materials and Methods: MRI was performed in a 33-year-old female LISTERIA RHOMBENCEPHALITIS: MRI patient with a low back pain complaint. FINDINGS Results: Thoracolumbar region images were obtained by using routine SONAY AYDIN, ERDEM FATIHOGLU, HASAN YIGIT, MRI sequences. On sagittal and axial T2-weighted images, a cystic dilata- PINAR KOSAR tion with dimensions of 11x8mm which is isointense with CSF in all MRI sequences was detected in the centre of medulla spinalis at conus medul- Ankara Training and Research Hospital, Ankara, Turkey laris (T12-L1) level. Pre-contrast and post-contrast T1-weighted images Abstract showed no contrast enhancement in the lesion. The signal intensity of medulla spinalis was observed to be normal, perilesional cord edema was Listeria monocytogenes, the main cause of human listeriosis, is a gram- not detected. There was no septation within the detected lesion. There positive facultatively intracellular bacterium. The main way for infecting were no additional spinal anomalies such as hydromyelia cavity and verte- people is ingestion of contaminated food. Listeriosis usually affects immu- bral deformities that could accompany the lesion. nocompromised patients, the elderly, and pregnant women. The infection of healthy individuals is rare. Two forms of the disease are defined: nonin- Conclusion: Ventriculus terminalis is a cavity covered with ependymal cells vasive gastrointestinal listeriosis (immunocompetent people) and invasive in conus medullaris. The VT was described as a normal developmental listeriosis (immunocompromised adults). A 40-year-old female, with a phenomenon in newborns and pediatric cases; but it is a rare pathology 2-week history of headache, vertigo,and nausea, was referred to radiology in adults and few cases have been reported in the literature. Coleman et for MRI scan. On admission to hospital, she was conscious (12 points in al. (2) reported that there is no pathology associated with VT and they GCS). Fever is 39°C. Neck stiffness were stated. Brain CT examination reported also VT has no pathological prognosis in their study on 418 chil- Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S95 drens MR images. In the same study, the incidence of childhood VT was Department of Radiology, Atatürk University School of Medicine, Erzurum, found to be 2.6% in children under the age of five. Suh et al. reported Turkey that septation, perilesional cord edema, kyphosis and arteriovenous mal- Abstract formation were associated with ventriculus terminalis in a study of 10 adult patients with VT. A 3-year-old girl presented with acute signs of hepatic encephalopathy including abdominal pain, nausea, vomiting and impairment of conscious- In adults, VT is rarely encountered in thoracolomber MR images. Cystic ness. Physical examination revealed mild confusion and minimal changes neoplasms located at the same level take place in the differential diagnosis, in memory, concentration, and coordination. The laboratory findings therefore the image feature and intensity of the lesion must be known. indicated elevated alanine aminotransferase (ALT), aspartate amino- VT cases are usually asymptomatic and the treatment is based on clinical transferase (AST), total bilirubin levels (AST: 103 IU/L, reference levels: findings. Patients with nonspecific symptoms are followed up by conserva- 6–40 IU/L; ALT: 93 IU/L, reference levels: 7–56 IU/L and total bilirubin: tive treatment; however, surgical treatment may be required in cases with 3 mg/dL, reference levels: 0.1–1 mg/dL). After 12 h of acetaminophen focal neurological deficits. The cystic dilatation of the VT is seen as an overdoses, magnetic resonance imaging (MRI) showed the widespread ovoid-shaped, regular wall structure in MR images, with no septation and edema and minimal diffusion restricted to cortical gray matter of both continuing with canalis centralis. The intensity of fluid within the lesion is brain hemispheres. MRI obtained two weeks after treatment demon- hypointense on T1-weighted images, hyperintense on T2-weighted imag- strated periventricular hyper-intensities, cortical laminar necrosis and es, and isointense with CSF in all MRI sequences. No contrast enhance- markedly diffusion restrictions. Follow-up MRI with gadolinium also ment is found within the cyst, on the wall or in the surrounding tissues. As showed the contrast-enhanced areas at the bilateral leptomeningeal a conclusion, MR imaging is very important in the diagnosis and follow-up regions. of ventriculus terminalis. Keywords: Acute hepatic encephalopathy, MRI, Leptomeningeal enhance- Keywords: Ventriculus terminalis, cystic dilatation, conus medullaris, mag- ment, Cortical laminar necrosis netic resonance imaging

P - 0173 P - 0171 GUILLAIN BARRE SYNDROME AND BILATERAL FRONTAL MRI FINDINGS: CASE REPORT POLYMICROGYRIA AND ECTOPIA ADEM YOKUS LENTIS Van Training and Research Hospital, Van, Turkey YASEMIN KUCUKCILOGLU, MURAT KOCAOGLU, Abstract BURCIN SANLIDAG Introduction: Guillain-Barre Syndrome (GBS), is an acute and inflamma- Near East University, Nicosia, Cyprus tory polyneuropathy, that is usually progressive and ascendant and char- Abstract acterized by symmetrical weakness and areflexia. It emerges usually 2-3 weeks after a non-specific infection such as respiratory tract infection or Polymicrogyria is a form of cortical displasia in which normal gyral pat- gastroenteritis and is characterized by ascendant progressive weakness tern is replaced by multiple small gyri, separated by shallow sulci. Focal, and areflexia. Regarding the laboratory findings, an increase of protein diffuse, bilateral and unilateral involvement has been described. Studies level without an increase of the cell count in the cerebrospinal fluid to delinate the genetic basis of the finding have become frequent for indicates GBS. GBS is most common between the ages of 4 and 9 years the past years. Ectopia lentis is defined as displacement or malposition in the pediatric population. In this report, our objective was to present of the lens of the eye. It has been described in genetic syndromes like a case with Guillain-Barre Syndrome and its imaging findings. Marfan or Weill-Marchesani, also isolated forms have been reported. In this report we present a pediatric patient with bilateral frontal polymi- Case Report: An eight-year-old female patient, who had gastroen- crogyria and unilateral ectopia lentis. teritis approximately for 2 weeks, had pain in legs and could not walk in the last three days, applied to the pediatric outpatient department Keywords: Polymicrogyria, bilateral frontal polymicrogyria, ectopia lentis of our hospital. During the physical examination, bilateral muscle strength was measured as 2-3/5 in the lower extremities and 4/5 in the upper extremities. Deep tendon reflexes were impaired in the upper P - 0172 extremities and could not be examined in the lower extremities. The examination of the cerebrospinal fluid showed an albuminocytologic UNUSUAL MRI FINDINGS dissociation. Electromyography showed axonal involvement and acute motor-sensorial polyneuropathy. Clinically GBS was considered and a IN A GIRL WITH ACUTE spinal Magnetic Resonance Imaging (MRI) examination was requested. HEPATIC ENCEPHALOPATHY: Spinal MRI revealed thickening in the cauda equina fibers at the level of LEPTOMENINGEAL ENHANCEMENT conus medullaris. Following the administration of the contrast agent, AND CORTICAL LAMINAR NECROSIS prominent contrast agent uptake was observed in the nerve roots (1a, b, 2a, b). As the findings were consistent with GBS and the patient was HAYRI OGUL, BERHAN PIRIMOGLU, MECIT KANTARCI hospitalized for follow-up and treatment. S96 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Supplementary treatment was administered for the relief of the symp- present a left-sided petrous apex cephocele with an empty sella asso- toms and intravenous immunoglobulin treatment (400 mg/kg/day) was ciatiob in a 68-year-old female patient with cerebral MRI, complaining administered for 5 days. On the 5th day of the treatment, the muscle of dizziness. strength became 3-4/5 in the lower and 4-5/5 in the upper extremities and the patient was able to walk. As the general status of the patient Keywords: Petrous apex, cephalocele, empty sella gradually improved and the muscle strength became normal, the patient was discharged on the 16th day of the hospitalization. The patient was referred to the physical therapy and rehabilitation program and included P - 0175 in the outpatient follow-up plan for controls. We observed that the symptoms resolved completely at the end of 2.5 months and the patient FETAL ATYPICAL TERATOID was able to walk without aid. RHABDOID TUMOUR: A RARE AND Discussion: GBS is an acute, inflammatory and demyelinating disease FATAL CASE of the peripheral nerves and nerve roots. GBS was considered as an autoimmune disease, which is characterized by the production of the IBRAHIM SULKU, EMIN DEMIREL, antibodies against antigenic proteins of the peripheral nerves follow- CIGDEM OZER GOKASLAN ing the T-cell activation (1). GBS is usually diagnosed during the clinical Department of Radiology, Afyon Kocatepe University School of Medicine, examination. Spinal MR imaging is useful in the diagnosis of the disease Afyonkarahisar, Turkey and the exclusion of the additional pathological conditions. In patients Abstract with severe back pain, sensory deficit at a certain level or sphincter dysfunction, spinal MRI examination should be urgently performed in order Congenital intracranial tumors are rare and usually fatal. The incidence to exclude the compression of the spinal cord. Intracranial complica- of congenital brain tumors has been estimated at 0.5–1.9% of all tions such as hydrocephaly, pseudotumor cerebri and papilledema may pediatric tumors. Primary central nervous system atypical rhabdoid/ emerge in very rare cases. Computerized Cranial Tomography, Cranial teratoid tumour (ATRT) is a rare and highly malignant tumour that MRI and Orbital MRI may make important contributions to the diagnosis tends to occur in infancy and early childhood. The majority of tumours and follow-up of these complications. (approximately two-third) arise in the posterior fossa. The optimal Conclusion: Guillain-Barre Syndrome is principally diagnosed with the treatment for ATRT remains unclear. Fetal ATRT is quite rare and clinical and laboratory findings. The imaging methods are mostly used nearly always fatal. for the exclusion of other conditions such as spinal cord compression Keywords: Atypical teratoid/rhabdoid tumour, fetal MRI, fetal brain and transverse myelitis. tumours Keywords: Guillain-Barre Syndrome, magnetic resonance imaging, peripheral neuropathy P - 0176 P - 0174 IMAGING FINDINGS IN PARTIAL FACIAL DUPLICATION (A RARE PETROUS APEX CEPHALOCELE AND DIPROSOPUS): A CASE REPORT AND EMPTY SELLA COMBINATION: MRI LITERATURE REVIEW FINDINGS IKRAM EDA DUMAN, GAZANFER EKINCI ABDULLAH SUKUN, BERNA AK YILDIZ, SAMET MUTLU, Marmara University School of Medicine, İstanbul, Turkey BULENT CEKIC, ICLAL ERDEM TOSLAK Department of Radiology, Health Sciences University School of Medicine, Abstract Antalya Training and Research Hospital, Antalya, Turkey The craniofacial duplication or diprosopus (Greek; di-, “two” + prosopon, Abstract “face”), which is one of the conjoined twinning types defining the duplication of all the facial structures, is a rarely seen malformation. Partial facial Petrous apex cephalocele is an asymptomatic rare form of cephalocele duplication defines the spectrum of congenital anomalies that can be eccentrically located on the posterolateral side of the Meckel cave. symmetrical or asymmetrical and include nose, maxilla, mandible, palate, It is usually seen bilaterally and detected incidentally. There is a slight and tongue. In the present case, as well as nose, also the cerebral frontal female predilection. Pathogenesis is not fully understood. Congenital lobes and superior sagittal sinus rostral segment were determined to or acquired CSF pulsations may lead to dehiscence in patients with be duplicated. Three anterior cerebral arteries were observed. Corpus pneumatized petrous apex. Histology may contain all or only one of the callosum agenesis was detected. Computed tomography (CT), magnetic meninges layers. Imaging plays an important role in the diagnosis as well resonance imaging (MRI), MR angiography-venography, and MR tractog- as differentiation of other common non-neoplastic cystic lesions of the raphy were utilized for determining the level of cranial duplications and petrous apex including cholesterol granuloma, mucocele and congenital the accompanying cranial malformations. In the present case report, we cholestatoma., and less commonly from petrous apicitis and Meckels aimed to present the partial facial duplication case, which is a rare variant Cave schwannoma. Petrous apex cephalocele may be associated with of diprosopus, and to review the literature. empty sella and Ushers syndrome. Patients may present with headache, dizziness, sensorineural hearing loss, and trigeminal neuralgia. We herein Keywords: Diprosopus, partial facial duplication Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S97

P - 0177 Abstract MULTIPLE SYSTEM ATROPHY: Rhombencephalosynapsis (RES) is a rare cerebellar malformation of unknown etiology characterized by vermal agenesis or hypogenesis, fusion CLINICAL AND MRI FINDINGS of hemispheres and the dentate nuclei. Clinical presentation and progno- ERANIL ASLAN, EMIN DEMIREL sis are extremely variable and generally depends one the associated supratentorial anomalies. We report RES diagnosed by magnetic resonance Department of Radiology, Afyon Kocatepe University School of Medicine, imaging (MRI) in a 1year-old girlborn to consanguineous parents. The child Afyonkarahisar, Turkey had neuromotor development delay. Abstract Keywords: Rhombencephalosynapsis, brain, MRI Multiple system atrophy (MSA) is a sporadic, progressive neurodegenerative disorder of unknown etiology, characterized by various combinations of autonomic, cerebellar, pyramidal and extra pyramidal signs. The annual P - 0180 incidence of MSA is 0.6/ 1,00,000. MSA is a distinct clinic-pathologic entity previously known as olivopontocerebellar atrophy, striatonigral degenera- MRI FINDINGS OF POSTERIOR SPINAL tion and Shy-Dragger syndrome are now all named as MSA.Based on the NERVE ROOT SHEATH CYSTS AT ALL consensus criteria, patients with MSA are classified as MSA-C and MSA-P. MRI plays critical role in early diagnosis. Characteristic findings are hot LEVELS: CASE REPORT crossed bun sign, brain stem and cerebellar atrophy, symmetric cerebral SAMET MUTLU, AYSE EDA PARLAK, atrophy. In our report we present 62-yo male patient with parkinsonian MEHTAP BARC ERGUN, iCLAL ERDEM TOSLAK, features predominate (MSA-P). EMiN DURMUS Keywords: Multiple system atrophy, neuroradiology, MRI, parkinson, hot Department of Radiology, Health Sciences University Antalya Training and crossed bun Research Hospital, Antalya, Turkey

Abstract

P - 0178 In 1938, Tarlov was first described perineural cysts in sacral spines as an incidental finding at autopsy. Perineural cysts are CSF filled dilatations of MILLER DIEKER SYNDROME: A RARE the nerve root sheath at the dorsal root ganglion. They can be asymptom- NEURODEVELOPMENTAL DISEASE atic or cause progressive neurological symptoms including pain, paraes- ERANIL ASLAN, EMIN DEMIREL thesia and weakness according to the localization. Generally it is incidental findings observed on MRIs or CT scans. We report MRI findings in a case Department of Radiology, Afyon Kocatepe University School of Medicine, of a 53-year-old female with tarlov cysts at all spinal levels presented with Afyonkarahisar, Turkey cervical spine and bilateral upper limb pain. Abstract Keywords: Tarlov cyst, spine, perineural cyst Miller-Dieker syndrome (MDS) is a rare, devastat-ing neurodevelopmental disease of childhood.This gene micro-deletion syndrome results from a mutation on chromosome 17p 13.3 and is char-acterized by craniofacial abnormalities and with clas-sical lissencephaly (lissencephaly type 1). We P - 0181 report a MDS associated with chorea,consegecious paretns, psychomotor EXTREME WIDENING retardation in a 6 years old girl. eneralized agyria, a figure-eight appearance of the brain, a wide and shallow Sylvianfissure, enlarged subarachnoid VIRCHOW-ROBIN SPACE: space, and ventriculomegaly are the main MRI findings in MDS The poste- ASYMPTOMATIC PATIENT rior fossa structures usually look normal. EMIN DEMIREL, IBRAHIM SULKU Keywords: Miller-Dieker syndrome, MRI, brain, lissencephaly type 1 Department of Radiology, Afyon Kocatepe University School of Medicine, Afyon, Turkey

P - 0179 Abstract ISOLATED Virchow-Robin spaces are very well-known radiological entities. They are RHOMBENCEPHALOSYNAPSIS WITH normally surround the perforating arteries that enter the brain. But, the giant cystic widening of Virchow-Robin spaces is quite rare in asymptom- MRI AND CLINICAL FINDINGS atic patients. We report a patient presenting with giant cystic widening ERANIL ASLAN, EMIN DEMIREL of Virchow-Robin spaces located in both cerebral hemispheres with mild cerebral atrophy. Department of Radiology, Afyon Kocatepe School of Medicine, Afyonkarahisar, Turkey Keywords: Perivascular space, virchow-robin space, brain MRI S98 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

P - 0182 IBRAHIM FEYYAZ NALDEMIR, ELIF NISA UNLU, OMER ONBAS MRI FINDINGS OF MULTIPLE ANOMALIES Düzce University School of Medicine, Düzce, Turkey OF LUMBAL SPINE: CASE REPORT Abstract Introduction: Bilateral thalamic infarction is a rare condition. One of the SAMET MUTLU, AYSE EDA PARLAK, MEHTAP BARC ERGUN, reasons this situation is the occlusion of Artery of Percheron (AOP), ICLAL ERDEM TOSLAK, ABDULLAH SUKUN which is variational structure that suppiles bilateral paramedian thalami Department of Radiology, Health Sciences University Antalya Training and and rostral midbrain. We presented a bilateral thalamic infarction accom- Research Hospital, Antalya, Turkey panying the infarction of the posterior cerebral artery supply area. Abstract Case Report: A 49-year-old male patient was brought to the hospital because of seizures. According to the information received from the Diastematomyelia (split cord malformation) is a rare form of spinal dysra- patients’ relatives, his seizures continued for about 45 minutes. In brain phism characterized by a sagittal cleft that splitting the spinal cord, conus CT, hypodense areas were observed on bilateral thalamus. After, in the medullaris, or filum terminale. There may be other associated abnormali- diffuse MR examination the signal changes were observed in the bilateral ties including tethered cord, which is an abnormal attachment of the spinal thalami and left posterior cerebral artery (PCA) supply area, consistent cord to the end lower in the lumbar or sacral spinal canal, lipomyelocele with acute diffusion restriction. The patient was diagnosed with left PCA and syringomyelia. Lipomyelocele is also one of the most common type and AOP territory infarction. Because the patient was not suitable, angio- of occult spina bifida generally occurs in the lowermost part of the spine graphic imaging could not performed. A month later control MRI showed and extends to subcutaneous soft tissues posteriorly through a spina bifida chronic stage ischemic changes on this areas. defect from spinal cord. Syringomyelia is a fluid-filled cystic cavity inside the spinal cord. In this case, we report MRI findings of a 42-year-old female with Conclusion: Bilateral thalamic infarctions are rare condition. The AOP infarc- diastematomyelia, tethered cord, lipomyelocele and syrinx cavity. tion accompanied by the PCA infarct is much less common. AOP occlusion should be considered especially in ischemia where paramedian regions are Keywords: Lipomyelocele, diastematomyelia, tethered cord syndrome, present. Brain CT, diffusion MRI and if possible angiographic imaging studies spinal dysraphism, syringomyelia, split cord malformation should be performed in patients with impaired consciousness. The patients’ story, symptoms, and evaluation of imaging findings facilitate diagnosis. P – 0183 Keywords: Artery of percheron, bilateral thalamic infarct, paramedian thalami, PCA infarct REVERSE TIGROID PATTERN DUE TO DIFFUSE ENLARGED VIRCHOW - ROBIN SPACES P - 0185 MERIC TUZUN, BAKI HEKIMOGLU MRI FINDINGS OF HEMORRAGHIC Department of Radiology, Health Sciences University, Dışkapı Yıldırım BRAINSTEM GLIOMA: CASE REPORT Beyazıt Training And Research Hospital, Ankara, Turkey SAMET MUTLU, AYSE EDA PARLAK, MEHTAP BARC ERGUN, Abstract ICLAL ERDEM TOSLAK, BERNA AK YILDIZ Tigroid pattern is characterized by the radiating linear hypointensities Department of Radiology, Health Sciences University Antalya Training and (spared perivascular white matter) within hyperintense demyelinating Research Hospital, Antalya, Turkey periventricular white matter areas on T2-weighted images. It is a classical Abstract magnetic resonance imaging finding described in diseases such as meta- chromatic leukodystrophy, Pelizaeus-Merzbacher disease. Widespread Brain tumors are second most common childhood tumors after leuke- enlarged Virchow - Robin spaces are seen very rarely. In this report, a case mia and brainstem gliomas constitues 10 - 20 % of all childhood brain with radiating linear hyperintensities due to diffuse enlarged Virchow- tumors. The incidence in pediatrics is higher than in adults. The most common localization of these tumors is between the aqueduct of Sylvius Robin spaces within periventricular white matter on T2-weighted images and the fourth ventricle. Prognosis is usually poor thus accurate diagnosis that we defined as reverse tigroid pattern is presented. is important. Brain stem gliomas are classified into four different types: Keywords: Tigroid pattern, reverse tigroid pattern, Virchow - Robin diffuse, focal brainstem glioma, (dorsally) exophytic and cervicomedullary. spaces, magnetic resonance imaging We here in report MRI findings in a 6-year-old with hemorraghic diffuse brainstem glioma presented with loss of consciousness. Keywords: Brainstem, glioma, brain tumors, childhood P - 0184 BILATERAL THALAMIC INFARCTION P - 0186 DUE TO OCCLUSION OF ARTERY A CAUSE FOR GRE T2* HYPOINTENSE OF PERCHERON ACCOMPANIED FOCI ON BRAIN MRI IN CHILDREN: BY POSTERIOR CEREBRAL ARTERY EXTRACORPOREAL MEMBRANE OCCLUSION OXYGENATION Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S99 OGUZ LAFCI, HASAN YIGIT, PINAR NERCIS KOSAR P - 0188 Ankara Training and Research Hospital, Ankara, Turkey CONGENITAL DERMAL SINUS TRACT: Abstract A RARE ENTITY Gradient echo (GRE)-T2* hypointense foci on brain MRI are expected MUZEYYEN KALKAN, GAMZE TURK, GULTEKIN SERT to be seen in adults with underlying amyloid angiopathy or hyperten- Clinic of Radiology, Health Sciences University Kayseri Training and Research sion and represent microhaemorrhage. In children, same finding may Hospital, Kayseri, Turkey also occur among recievers of extracorporeal membrane oxygenation Abstract (ECMO) treatment. ECMO is a life support technique which is also indicated in cardiac failure following repair of congenital heart defects. Here Congenital dermal sinus (CDS) is an epithelium-lined tract extending we present a case of a 5 year old child with tetralogy of Fallot (TOF) from the skin to the deep tissues that results from the incomplete sepa- who had undergone cardiac repair surgery and afterwards recieved ration of cutaneous and neural ectoderms. The tract may end within the skin layers or adjacent to the neural structures. CDS is most commonly ECMO treatment. diagnosed during childhood, though adulthood cases have also been Keywords: GRE, ECMO, MRI, brain reported. A number of pathologies such as tethered cord, bifid lamina, split cord malformation, epidermoid and dermoid cysts, tethered filum terminale, meningomyelocele may accompany CDS. Cervical CDS is the least common type and consist 1% of all dorsal CDS cases. Herein we P - 0187 present MRI findings of an adult CDS patient that presented with dermal DIFFUSION WEIGHTED MAGNETIC ostium at the neck and had incidental stress-induced tremor. RESONANCE IMAGING IN CEREBRAL Keywords: Congenital dermal sinus, cervical, magnetic resonance imaging FAT EMBOLISM SYNDROME BULENT YILDIZ1, ERTAN UNVER1, KAYHAN KARAKUS1, P - 0189 MEHMET HAYDAR ATALAR1, OZLEM KAYIM YILDIZ2 TRANSIENT SPLENIAL 1Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey LESION PRESENTING WITH 2Department of Neurology, Cumhuriyet University School of Medicine, Sivas, HYPERVENTILATION Turkey NILUFER AYLANC, FATIH BATTAL, OZAN KARATAG, Abstract MUSTAFA RESORLU, NEBIL EKER, Fat embolism syndrome (FES) is a serious and life-threatening clini- CANAN AKGUN TOPRAK cal picture in which respiratory, hematological, neurological, and skin Çanakkale University School of Medicine, Çanakkale, Turkey manifestations of fat particles into to the circulatory system for any reason. It is estimated that after long bone fractures, the incidence of Abstract FES development is less than 1% and mortality is about 10-20%. The Introduction: Transient splenal lesions of the corpus callosum are revers- criteria developed by Gurd-Wilson are widely used in FES. According ible isolated lesions which may also be associated with mild encephalitis/ to these criteria, major findings are triad respiratory failure, neurological encephalopathy and are frequently detected during MR imaging (MRI) symptoms and petechiae. As minor findings including tachycardia, fever, and may arise due to various etiologies. In this case, a transient splenic jaundice, oliguria-anuria, retinal changes, anemia-thrombocytopenia, lesion arising in association with respiratory alkalosis due to hyperventila- elevated sedimentation rate, fat macroglobulinemia. At least two major tion and this case is presented because of rhinovirus-related MERS case. or at least one major and four minor criteria are required for diagno- Case Report: 4-year-old female patient presented to pediatric emergency sis. Neurological findings are nonspecific. It extends into a coma from clinic with vomiting, fever,dizziness and respiratory distress symptoms (tachy- temporary memory loss. Magnetic resonance imaging (MRI) is the most pnea, abdominal respiration). Other systemic examination findings were sensitive imaging method for cerebral embolism in cases with FES. In normal. The patients routine blood count and biochemical tests were normal, present case, we are presented diffusion weighted imaging (DWI) MRI blood gas pH: 7.60, pCO2:11.2, HCO3:18.3, mmol/L BE:-10.5 mmol/L and findings of a patient with fat embolism syndrome after traumatic femur compatible with respiratuar alkalosis. Blood serological studies were normal fracture. Previously healthy, 68-year-old male admitted to emergency and no pathology was detected in EEG. CSF studies were normal and CSF services after a trauma. The patient underwent operation after the PCR results were negative. In the nasopharyngeal swab, multiplex PCR intertrochanteric fracture was detected in the right femur as a result revealed rhinovirus was detected positive. On cranial MRI, a focal restricting of the examinations. On the third postoperative day following surgery, area on DAG sequence, was detected in the splenium of the corpus callosum. MRI examination was performed because of no respond to verbal stim- The patient was thought to be compatible with viral encephalitis and acyclo- uli and developing tachycardia, tachypnea confusion. DWI was showed vir and single dose IVIG treatment were given. On the 7th day of follow-up multiple hyperintense lesions in sentrum semiovale, and periventricular tachipne was regressed and, also regression of the lesion was seen on the white matter. The lesions were seen hypointense in ADC map. MRI find- cranial MRI taken on the 10th day of the follow-up. ings were favored by cerebral fat embolism. Conclusion: Transient splenic lesions are not associated with hemispheric Keywords: Fat embolism syndrome, trauma, MRI disconnection, unlike other splenic lesions of the corpus callosum, and there S100 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 are many factors in the etiology including epilepsy and antiepileptic drug Because of the lesion patterns and locations, tuberculous meningitis and lep- interruption, electrolyte imbalance, demyelination, ADEM, PRES, diffuse tomeningeal carcinomatosis should be considered in differential diagnosis and axonal injury, hypoglycemia and infections. MRI plays an important role in absence of any abnormality except high protein levels in CSF analysis is helpful the diagnosis of splenic lesion and in the etiologic diagnosis stage. Prognosis to discriminate. Specific immunohistochemical methods must be performed is generally favorable if the lesion is due to epileptic or antiepileptic drug on the pathologic specimen for the diagnosis of DLGNT. Ventriculoperitoneal withdrawal, but generally varies depending on the underlying condition. shunt placement, surgery, chemotherapy and radiotherapy are helpful in treatment. Here, we aimed to present MRI findings and clinical course of a Keywords: Transient splenial lesion, MRI, encephalitis 35-year-old male patient who was diagnosed with DLGNT. Keywords: Glioneuronal tumor, leptomeninges, hydrocephalus P - 0190 TECTAL PLATE CYST MRI FINDINGS P - 0192 M. YASEMIN KARADENIZ BILGILI, UMRAN CANKAYA EXPANSILE AND DESTRUCTIVE SKULL LESION AND SUNBURST SIGN: Kırıkkale University School of Medicine Hospital, Kırıkkale, Turkey PRIMARY OSTEOSARCOMA Abstract FERHAT CUCE, HATICE TUBA SANAL Tectal plate cysts are very rare benign, tumor-like lesions. Asymptomatic Gülhane Training and Research Hospital, Ankara, Turkey patients can be diagnosed incidentally. Increased size may cause obstructive hydrocephalus and associated symptoms. Patients may present with Abstract symptoms such as headache, vomiting, diplopia, cognitive impairment, Introduction: The primary osteosarcoma of the skull is an extremely rare ataxia and urinary incontinence. It can be confused with pineal region tumor and the incidence is 1-2% among all skull tumors. The benign and tumors. As the resolution of magnetic resonance imaging (MR) devices malignant lesions such as eosinophilic granuloma, hemangiopericytoma, increases, it is possible to distinguish between tumors. In this case we metastasis, and other sarcomas should be considered with the primary presented a tectal plate cyst in the adult patient who presented with osteosarcoma in the differential diagnosis of an expansile, destructive headache and did not cause hydrocephalus. skull lesion in a young patient. The sunburst sign as a CT finding may be Keywords: Tectal plate, pineal region, cyst, hydrocephalus an important clue to suggest osteosarcoma. Case Report: A 23-year-old male patient was presented with a rubbery hard swelling of a left temporoparietal region which he first noticed 18 P - 0191 months ago but it has grown rapidly in the last five months. A painless mass fixed to bone approximately 7x5 cm was observed on physical A RARE CENTRAL NERVOUS examination. The CT imaging was scheduled for the patient with the SYSTEM NEOPLASIA: DIFFUSE normal neurological examination as well routine blood tests. LEPTOMENINGEAL GLIONEURONAL Discussion: The differential diagnosis of a skull lesion should primarily be TUMOR made according to the age of the patient. The osteoma is the most common (26%) skull lesion, but eosinophilic granuloma should be considered ATILLA HIKMET CILENGIR1, MUSTAFA FAZIL GELAL1, firstly for an expansile lesion in young patients. In our case, the CT showed TURKAN ATASEVER REZANKO2, CIHAT UZUNKOPRU3, numerous, thin, linear calcifications within the skull lesion so-called sun- HASAN KAMIL SUCU4 burst sign which is typical for skull hemangioma and osteosarcoma have mostly seen in the long bone metaphysis. 1Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey Keywords: Calcarium, osteosarcoma, sunburst sign 2Department of Pathology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey 3Department of Neurology İzmir Katip Çelebi University Atatürk Training and P - 0193 Research Hospital, İzmir, Turkey 4Department of Neurosurgery, İzmir Katip Çelebi University Atatürk Training ACUTE HYPERAMMONEMIC and Research Hospital, İzmir, Turkey ENCEPHALOPATHY Abstract SONAY AYDIN, KUBRA OZDEMIR, HASAN YIGIT, Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare central ner- PINAR KOSAR vous system neoplasia. It occurs predominantly in childhood and young-adult ages. Presenting symptoms such as headaches and seizures are related with Ankara Training and Research Hospital, Ankara, Turkey hydrocephalus due to obstruction of cerebrospinal fluid (CSF) flow. Irregular Abstract leptomeningeal thickening and enhancement, small cysts over the parenchyma surface around basal cisterns and subarachnoid spaces without intraparency- Acute hyperammonemic encephalopathy, generally presents with altered mal mass are the characteristic magnetic resonance imaging (MRI) findings. mentality, and can even progress to coma state. The most common involving Irregular and enhancing mass can also be seen in the subarachnoid spaces. sites are insula, diffuse cerebral cortex, cingulate cortices, and bilateral thalami. Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S101

MRI has an important role in diagnosis. A 17-year-old female patient present- Conclusion: Moyamoya disease is an idiopathic progressive cerebrovascu- ed nausea, vomiting and lethargy. She had the diagnosis of arginase deficiency. lar disease characterized by narrowing of the distal (supraclinoid) internal Ammonia level is 302 ug/dL. On MRI, edema is present on cerebral and cer- carotid artery. DSA, CTA, and MRA show predominantly marked stenosis ebellar hemispheres. On DWI, diffusion restriction is present at both caudate of both supraclinoid ICAs (“bottle neck” sign). Prominent deep-seated and lentiform nucleus. On T1WI, lineer hyperintensities belonging to laminer lenticulostriate and thalamoperforator collaterals are present, forming cortical necrosis are detected at cortical surfaces in bilateral frontotemporo- the “puff of smoke” appearance characteristic of moyamoya. And also an parietal lobes. She was diagnosed as acute hyperammonemic encephalopathy “ivy” sign with sulcal hyperintensity from slow flow in leptomeningeal col- by laboratory and imaging findings. Sudden onset drowsiness and seizures laterals is sometimes seen on FLAIR and contrast enhaced T1 scans often show leptomeningeal enhacement. These are the characteristic imaging are some common signs of the disease. Lated diagnosis and treatment can findings of Moyamoya disease. cause permanent brain injury. Bilateral involvement of the insular cortex and cingulate gyrus was a strikingly common feature, restricted diffusion is seen in Keywords: Moyamoya disease, ivy sign, puff of smoke insula, cingulate cortex and diffuse cerebral cortex. Cortical laminal necrosis is commonly seen. Thalamic involvement (dorsomedial thalami) is told to be more common than cortical involvement. Plasma ammonia levels and MRI P - 0195 findings are correlated. Ammonia levels are told to correlate with clinical outcome, too. MRI features have only moderate correlation with outcome. Acute COMMON BENIGN CHOROID PLEXUS hyperammonemic encephalopathy is reversible with prompt and proper TUMORS diagnosis and treatment. Seeing that, knowing the typical MRI findings and SEREF BARBAROS ARIK, HATICE TUBA SANAL, correlating them with laboratory findings is crucial for the patient. KEMAL NIYAZI ARDA, SINAN AKAY, SALIH HAMCAN, Keywords: Hyperammonemic encephalopathy, MRI, DWI UGUR BOZLAR, MUSTAFA TASAR Department of Radiology, Gülhane Training and Research Hospital, Ankara, Turkey P - 0194 Abstract THE LEPTOMENINGEAL “IVY SIGN” Introduction:Choroid plexus tumors are rare. Choroid plexus papillomas ON FLAIR MR IMAGING IN A CASE are far more common than carcinomas (ratio of 5:1). In some cases WITH MOYAMOYA DISEASE distinction between choroid plexus papillomas and choroid plexus carcinomas may only be made by histologically. Choroid plexus carcinoma is a DILARA ATASOY, ILKER EYUBOGLU, AHMET SARI, highly aggressive malignant tumor (WHO grade-III) that usually presents DENIZ OZTURK KOCAKGOL, CEMAL AYDOGAN, with CSF obstruction. The differential diagnosis includes choroid plexus MERVE ERKAN papilloma (WHO grade-I), meningioma and metastatic papillary neo- Karadeniz Technical University School of Medicine, Trabzon, Turkey plasms. In this paper, we describe two cases of choroid plexus tumors to discuss and remember the radiological characteristics. Abstract Case Report: Introduction: We aimed to present the imaging findings of the Moyamoya disease on the basis of a case got the diagnose with ivy sign on the FLAIR 1st Case: Choroid Plexus Papilloma image. Moyamoya disease (MMD) is an idiopathic progressive arteriopathy 2nd Case: Intraventricular Menengioma (we assumed it was plexus car- characterized by stenosis of the terminal segment of (supraclinoid) internal carotid arteries (ICAs) and formation of an abnormal vascular network called cinoma and frozen examination was malign but final pathology report is ‘Moyamoya vessels’ at the base of the brain. These Moyamoya vessels are mul- atypical menengioma) tiple enlarged telangiectatic lenticulostriate, thalamo-perforating, leptomenin- Conclusion: Choroid plexus tumors arise from the choroid plexus epi- geal, dural, and pial arteries develop as compensatory circulation. Moyamoya thelium in ventricles especially derive from lateral ventricles in children and disease’s etiology is unknown some of is seen with some genetic, acquired and fourth ventricle in adults. Approximately 80% of choroid plexus carcinomas environmental factors. When MMD presents in childhood, the initial symp- arise in children. In adults choroid plexus carcinomas are rare. There is toms are usually ischemic. However in adults intracranial hemorrhage from currently no accepted treatment protocol for choroid plexus carcinoma. rupture of the fragile collateral vessels is more common. With high diagnostic The main treatment option is complete resection of the tumor; however, accuracy, magnetic resonance (MR) imaging and MR angiography (MRA) are a gross total resection sometimes may not be possible. Chemotherapy and very useful in assessing moyamoya disease. postsurgical radiotherapy may be considered if the patient is an adult. Case Repor: An 8-year-old boy was referred to our department after Keywords: Choroid plexus, carcinoma, menengioma, papilloma choreiform movement intervals. Magnetic resonance imaging of brain revealed hyperintense cerebral sulcus on FLAIR images and then we decided to examine the case with contrast enhanced T1A and MRA images. Leptomeningeal enhancements were seen on contrast-enhanced P - 0196 T1A images. Moyamoya disease was diagnosed with the MRA examina- A CASE OF GASTRIC CANCER tion that revealed markedly narrowed bilateral supraclinoid ICAs and widespread lenticolostriate-thalamoperforated collaterals (Moyamoya MANIFESTING AS A SOLITARY vessels) on the base of brain. CEREBELLAR METASTASIS S102 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

SUMEYYA DURAN KAYMAK, BURCU SAVRAN SAHIN, ELIF a 5x5 mm sized cystic lesion compatible with the optic nerve coloboma. AKTAS, NAZAN CILEDAG, OZKAN UNAL In both frontal lobes, heterotopes were observed in periventricular and subcortical areas. The case was diagnosed as Aicardi syndrome with clini- Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey cal and radiological findings.

Abstract Conclusion: Three cardinal findings of the disease; corpus callosum agenesis, infantile spasms, chorioretinal lacunations. In addition, major findings Introduction: Gastric cancer is fourth most common cancer in world- include cortical malformations, periventricular and subcortical heteroto- wide. Therewithal gastric cancer is third leading cause of cancer-related pia, choroid plexus papillomas, third ventricle or intracranial cysts, optic mortality. Stomach cancer metastasize most commonly to peritoneum, nerve coloboma. Microphtalmia and other ocular anomalies, vertebral lymph nodes, liver, lungs and bones. Brain metastasis of gastric cancer or extremity anomalies, cerebral hemispheric asymmetry, hipsaritmia or is extremely rare with less than 1% frequency. Our aim is to present a burst-suppression in EEG are the supporting findings of the disease. The rare case of stomach cancer with cerebellum metastasis. diagnosis is made by three cardinal findings or two cardinal findings + Case Report: A 37-year-old female patient was diagnosed with two major findings or two cardinal findings±major findings+supportive stomach cancer in 2014 and had an operation. On the follow-up, the findings. patient underwent brain CT due to headache complaint. The brain Keywords: Aicardi sydrome, MRI, chorioretinal lacunae MR is being taken after the headache of the ongoing patient. CT revealed a decrease in the depth of the cerebellar sulci, an isodense mass lesion in the right cerebellum which is 39x37 mm in length with a peripheral hypodense ring. Then the patient was examined with P - 0198 MRI. MRI showed a mass lesion in right cerebellum which is approximately 38x36 mm in length, heterogenously hyperintense (thought to WERNICKE ENCEPHALOPATHY contain blood-degrading products) in T1-weighted sequences, hetero- AFTER SLEEVE GASTRECTOMY: MR geneously hyperintense appearance in T2-weighted sequences, het- IMAGING FINDINGS erogeneously enhancing after contrast medium injection. The lesion caused no diffusion restriction. PINAR DIYDEM YILMAZ1, CENGIZ KADIYORAN2, SULEYMAN KARGIN1, SEHER KAYALI3 Discussion: Brain metastasis from gastric cancer is rare. Also solitary brain metastases are even rarer compared to multiple metastasis. The 1Medicana Konya Hospital, Konya, Turkey differential diagnosis of intracranial solitary hemorrhagic lesion must 2Department of Radiology, Necmettin Erbakan University Meram School of include metastases if the patient has a primary tumor history; even if Medicine, Konya, Turkey 3 Konya Medova Hospital, Konya, Turkey the histologic type of the tumor has low incidence of brain metastases. Abstract Keywords: Gastric cancer, brain metastasis, solitary Introduction: The number of surgical treatment for obesity has risen in recent years. Bariatric surgeries suh as sleeve gastrectomy and gas- P - 0197 tric banding are effective for controlling the body weight but they can A RARE CASE; MRI FINDINGS OF cause surgical and metabolic complications. Wernicke encephalopathy can occur due to thiamine defficiency after obesity surgery. This AICARDI SYNDROME metabolic complication presents with confusion, ophtalmoplegia, nys- SUAT INCE, IBRAHIM ILIK, HARUN ARSLAN tagmus and ataxia. MR imaging is useful in early diagnosis of Wernicke encephalopathy. In this case we present MR imaging of Wernicke Yüzüncü Yıl University, Van, Turkey encephalopathy, occurs after sleeve gastrectomy and recovery after Abstract administration of thiamine.

Objective: In this case, we aimed to present the MRI findings of aicardi Case: 19 years old woman who had undergone laparoscopic sleeve syndrome. gastrectomy surgery 2 months prior to our examination. She was referred for MR imaging because of neurologic symptoms. She had Materials and Methods: Infantile spasm type seizure was detected in ataxia, disartry, vision problems, difficulty in walking and alter in mental the EEG examination performed in our 10-month-old girl. Chorioretinal state. On MR imaging symmetrical alterations and diffusion restriction lacunae were observed in the optic disc. Brain MRI examination was perin the basal ganglia are seen. After administration of thiamine her formed for the diagnosis. symptoms were disappeared. 2 weeks later MR imaging confirmed Results: n MRI examination, no corpus callosum was observed, lateral again and no definite structural abnormalities or signal changes seen. ventricles were wide, contours were curved, and occipitotemporal horns Conclusion: Depending on the increase in surgical treatment for obe- were parallel to each other. The right cerebellar hemispherical anterior sity, metabolic complications such as Wernicke encephalopaty need to was 21x14 mm in size and the left occipital lobe parafalin was 23x17 mm be known and early diagnosed. MR imaging is useful in early diagnosis in size, with extraaxial placement and arachnoid cyst compatible lesions. of acute Wernicke encephalopathy. Cystic lesions of 6x5 mm in the right lateral ventricle and 7x5 mm in the fourth ventricle were observed. The retrobulbar area in the right eye had Keywords: Wernicke, obesity, sleeve gastrectomy Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S103

P - 0199 Materials and Methods: A sixteen year-old girl presented with headache and seizure for 3 months. Neurological examination was normal. A RARE CASE: SUBAKUT SKELEROUS Electroencephalography recorded epileptiform discharge in left temporal PANENSEFALITE (SSPE) lobe. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed. The diagnosis confirmed by operative and patho- SUMEYRA DEMIRKOL ALAGOZ, FATMA DURMAZ, HARUN logical findings. ARSLAN, MESUT OZGOKCE, ABDUSSAMET BATUR Results: CT showed cortical calcification and hypodensity of the subcorti- Department of Radiology, Yüzüncü Yıl University School of Medicine, Van, cal white matter around the silvian fissure in the left temporal lobe. At the Turkey same localization, MRI showed gyriform enhancement with subcortical edema. There was no mass effect. Restricted diffusion was not observed Abstract on diffusion MRI as increased perfusion was not detected on perfusion Objective: Subacute sclerosing panencephalitis (SSPE) is a rare neurode- MR. MR spectroscopy showed no choline peak. The patient underwent generative disease caused by measles virus. We aimed to present cranial left temporal craniotomy and the lesion was resected. Histopathology magnetic resonance (MRI) findings due to its rare nature. confirmed the diagnosis of meningioangiomatosis.

Materials and Methods: A 16-year-old girl was admitted to our hospital Conclusion: Meningioangiomatosis is a rare benign tumor that has with complaints of spasm two years ago. In contrast cranial MRI, several not malignant potential. These lesions usually cause refracter epilepsy. hyperintense foci were detected in T2-weighted and FLAIR-weighted Resection is the only curative treatment in 85% of meningioangiomatosis images in bilateral frontal, parietal, and temporal lobe anterior white cases. The differential diagnosis includes oligodendroglioma, granuloma- matter. Contrast and diffusion restriction were not detected. No specific tous meningitis, meningioma, parasitic disease, and calcified vascular mal- diagnosis could be made for the patient according to MRG findings. A cra- formation. The radiographic findings of meningioangiomatosis may show a nial MRI examination was performed 6 months after the onset of akinetic variety of features and recognition of meningioangiomatosis is important for correct treatment. mutism. More pronounced in the frontal lobe bilateral frontal, parietal and temporal lobe common white matter, hyperintense on T2 and FLAIR Keywords: Meningioangiomatosis, MRI, seizure, sporadic weighted images, hypointense lesions on T1-weighted images and newly developing atrophy in the brain were detected.

Results: Patient who had positive measles antibody in CSF examination P - 0201 and who supported by MRI findings was diagnosed as SSPE. The patient BRAIN MR FINDINGS IN ADULT who started myoclonus and drop attacks and whose clinic became worse was unfortunately died 7 months later. PATIENT WITH UREMIC ENCEPHALOPATHY: CASE REPORT Conclusion: SSPE is a rare late complication of measles infection. It is most commonly seen between 5 and 15 years. Cranial magnetic reso- HATICE KUBRA OZDEMIR, HASAN YIGIT, SONAY AYDIN, nance (MR) and CT may be normal or have non-specific findings in the BUNYAMIN ECE, PINAR NERCIS KOSAR early stages of the disease. However, progressive cortical atrophy, gray Ankara Training and Research Hospital, Ankara, Turkey matter changes with inflammation in the early stages, hyperintense lesions usually occur in the subcortical white matter. Over time, symmetric peri- Abstract ventricular white matter changes become more pronounced Uremic encephalopathy (UE) is a toxic metabolic encephalopathy that Keywords: Subacute sclerosing panencephalitis (SSPE), magnetic reso- develops secondary to uremia. Radiological findings of a uremic encepha- nance lopathy case will be presented. A 68-year-old male with chronic renal insufficiency was admitted to emergency department with deficit in consciousness. Brain CT was performed, P - 0200 and no pathological finding was present. In DWI restricted diffusion was present in bilateral basal ganglia. In addition there is hyperintensity in inter- SPORADIC MENINGIOANGIOMATOSIS: nal and external capsules, bilateral basal ganglia, excluding the thalamus, CT AND MRI FINDINGS and caudate nuclei (lentiform fork sign) on T2WI. Mild contrast enhancement is present on T1WI in defined areas. BURCAK CAKIR PEKOZ1, OZLEM ALKAN2, EMRE DURDAG2 UE is a severe toxic metabolic encephalitis that develops secondarily to 1Adana State Hospital, Adana, Turkey uremia. MRI is more sensitive in diagnosis, but usually no pathological 2Başkent University Adana Hospital, Adana, Turkey findings are detected. Abnormal findings are usually bilateral, symmetrical, and they tend to regress after dialysis. Laboratory and clinical correlation Abstract is important for diagnosis, along with imaging.

Objectives: Meningioangiomatosis is a rare benign hamartomatous lesion CT typically shows hypodensity in bilateral basal ganglia, and thalamus, involving the leptomeninges and the cerebral cortex. Meningioangiomatosis secondary to cytotoxic edema; MRI shows hyperintensities in basal ganglia, may occur sporadically, or in association with neurofibromatosis type II in thalamus, and mesial temporal lobes in the T2WI/FLAIR sequences, sec- up to 50% of patients. We aimed to present a case of sporadic menin- ondary to edema. Diffusion restriction is not typical for UE. Hyperintesity gioangiomatosis. seen in the white matter surrounding the basal ganglia, internal, and S104 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 external capsules, and medullary laminae (lentiform fork sign) is a typical Materials and Methods: A 31-year-old HIV-positive patient presented to finding for UE, as in our case. hospital with forgetfulness, disorganized behavior and complaints of not walking. On neurological examination, the patient was distracted and the Keywords: Uremic encephalopathy, lentiform fork sign patient was partially co-operative. MRI examination was performed to the patient in terms of differential diagnosis. P - 0202 Results: MRI examination revealed symmetrical widespread signal increases in white matter in both cerebral hemispheres. In both cerebral hemi- A RARE CASE, HALLERVORDEN-SPATZ spheres, atrophy-related enlargement was present in the sulcus. The SYNDROME patient was diagnosed AIDS related dementia with clinical and radiological findings. SUAT INCE, ILYAS DUNDAR, HARUN ARSLAN Conclusion: AIDS associated dementia complex, is a progressive sub- Yüzüncü Yıl University School of Medicine, Van, Turkey cortical dementia, attributed to direct infection of the CNS with HIV. Abstract According to histopathologic analysis, patients either have HIV encephalitis, HIV leukoencephalopathy, or both; some authors consider these Objective: Hallervorden-Spatz syndrome is a collection of symptoms that conditions to be the extremes of a spectrum of HIV-induced disease. inherit autosomal recessive pathogenesis, also known as pantothenate On magnetic resonance (MR) images, a diffuse cerebral atrophy with kinase-dependent neurodegeneration, with globus pallidus, substantia symmetric, patchy or confluent areas of T1 and T2 prolongation are nigra and nucleus ruberin pigmentary degeneration. In this case, we seen within the periventricular and deep white matter. Proton (1H) MR presented magnetic resonance imaging (MRI) findings of a patient with spectroscopy reveals decreased N-acetylaspartate (NAA) and elevated Hallervorden-Spatz syndrome. peaks of in choline and myoinositol. HIV encephalopathy does not result in Materials and Methods: We performed a brain MRI examination of a mass effect or enhancement. If either of these findings is present, another 25-year-old male patient to explain neurological findings such as dystonia, diagnosis must be considered. Parkinsonism and tremors in the hands. Keywords: AIDS, dementia, HIV, encephalopathy Results: MRI showed hypointensity due to iron deposition in the bilateral globus pallidus, hyperintensity due to central gliosis in T2, T2-FLAIR and SWI sequences. Our patient was classified as classical Hallervorden-Spatz syndrome on the basis of the age of onset, clinical evaluation, and the P - 0204 specific pattern demonstrated on MRI. HORIZONTAL GAZE PALSY WITH Conclusion: Pantothenate kinase-2 associated neurodegeneration (PKAN) or Hallervorden-Spatz syndrome (HSS) is a rare autosomal recessive PROGRESSIVE SCOLIOSIS (HGPPS): A degenerative disorder. In HSS, neurons of the globus pallidus and substantia CASE REPORT nigra are affected due to excessive iron deposition. The characteristic MRI findings of bilateral symmetrical hyperintense signals surrounded by hypoin- HALIL CAYLAK, VILIAM GASANOVI, BULENT YILDIZ, tensity on T2W images lead to the “eye-of-the-tiger” sign. The surrounding MEHMET H. ATALAR hypointensity is caused by signal loss (susceptibility) from the iron deposi- Department of Radiology, Cumhuriyet University School of Medicine, Sivas, tion, while the central hyperintensity is due to axonal swelling, formation of Turkey spheroids, gliosis, and neuronal loss and degeneration. MRI is the preferred Abstract radiological imaging method in patients with Hallervorden-Spatz syndrome and the imaging findings are very typical for this disease. HGPPS is a rare autosomal recessive congenital anomaly caused by mutation of ROBO3 gene on chromosome 11 and chacterized with abnormal Keywords: Hallervorden-Spatz, syndrome, MRI, iron horizontal gaze while normal vertical gaze and kyphoscoliosis. Horizontal gaze requires the action of ipsilateral abducent nerve and contralateral P - 0203 oculomotor nerve and mediated by the abducens nucleus. In this condition, there is congenital absence of the abducens nucleus results in abnor- AIDS ASSOCIATED DEMENTIA: A mal horizontal gaze. The ROBO3 protein plays a critical role in ensuring CASE REPORT that motor and sensory nerve pathways cross over in the brainstem. The cause of progressive scoliosis in HGPPS is unclear. We report a case of a SUAT INCE, IBRAHIM ILIK, HARUN ARSLAN 6-year-old girl who presented with complaints of defective vision in both Yüzüncü Yıl University School of Medicine, Van, Turkey eyes. On examination, she had restricted abduction in both eyes and lack of conjugate eye movement. Magnetic resonance imaging of the brain and Abstract orbit showed deep midline pontin cleft (split pons sign), and a butterfly confugiration of the medulla oblongata which are the MRI findings seen in Objectives: HIV affects the nervous system producing different clini- this disorder. Her axial postura was normal on physical examination but cal manifestations,for which neuropsychological disorders are the most there was mild scoliosis in thoracalomber vertebra on antero-posterior common. We aimed to present the MRI findings of a patient diagnosed radiography. with AIDS related dementia with clinical and radiological findings in our 31-year-old HIV-positive patient. Keywords: Horizontal gaze palsy, progressive scoliosis, ROBO3 Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S105 P - 0205 unnecessary surgery. Hemispherectomy is recommended early in patients with severe epilepsy. In this case report, we aimed to discuss the radio- ABNORMAL DILATATION OF logical findings of hemimegalcephaly in 3-year-old girl with epilepsy clinic. PERIVASCULER SPACES: A CASE Keywords: Hemimegaencephaly, childhood epilepsy REPORT ABDULLAH SUKUN, MEHTAP BARC ERGUN, EMIN DURMUS, MURUVET AKIN, AYSE EDA PARLAK P - 0207 Department of Radiology, Health Sciences University Antalya Training and POST-SHUNTING CALLOSAL CYSTIC Research Hospital, Antalya, Turkey DEGENERATION: A CASE REPORT Abstract BUSRA HAS, OMER ONBAS, ELIF NISA UNLU Perivascular spaces are pia-plied and surround the small perforating artery, Düzce University School of Medicine Hospital, Düzce, Turkey small arteries and arterioles that penetrate the brain surface. These spaces are not directly related to the subarachnoid space. These areas, which Abstract are normally microscopic, were first described by the German pathologist Introduction: Demonstration of cystic degenerations that may occur in Rudolf Virchow (1821-1902) and the French anatomist Charles Philippe ventriculoperitoneal (V/P) shunt after long-term lateral ventricular dilata- Robin (1821-1885). T2A axial image are seen as smoothly confined tion and decompression induced corpus callosum. fluid-filled hyperintense cysts less than five mm. It is usually asymptomatic and rarely causes obstructive hydrocephalus due to mass effect. When Case Report: A 40-year-old male patient underwent V/P shunt due to these spaces reach very large sizes called tumefactive perivascular spaces. hydrocephalus 5 years ago was admitted to the neurosurgery polyclinic Perivascular spaces are located in the lower half of the basal ganglia and with headache complaint. Cranial magnetic resonance (MR) imaging of around the anterior commissur but cortical areas are generally protected. the patient revealed hypointense on T1-weighted image (T1WI), hyper- Three types are defined according to their location. The level of basal gan- intense on T2-weighted image (T2WI), and cystic formations with no glia supplied by from the lenticulostriate arteries is called type 1, the gray contrast enhancement on post-contrast sections in corpus callosum body matter level supplied by the perforated medullary arteries is called type section. There were simultaneous intracranial hypotension findings after 2, and the found in the middle brain is type 3. Perivascular spaces may be shunt. associated with traumatic brain injury, mucopolysaccharidoses and mus- Discussion: Prolonged lateral ventriculomegaly causes stretching and cular dystrophies. If there is no vascular risk factor in the young patient, it impingement of the corpus callosum against the rigid falx cerebri, resulting should be considered first. Perivascular spaces may be confused with small in chronic ischemia. Rapid decompression of this long-standing hydro- vascular disease, demyelinating disease, and postcontrast changes. In this cephalus results in transcallosal demyelination. MR changes of corpus study, we aimed to present the radiological findings of abnormal perivas- callosum degeneration after shunting are clinically alleviated although they cular spaces in a 23-year-old asymptomatic female patient. are striking. The asymptomatic nature of these changes is assumed to be Keywords: Perivascular spaces, Virchow-Robin cysts due to the relative sparing of the splenium. Recognizing these imaging findings is important to avoid unnecessary interventions to the patient. P - 0206 Keywords: Corpus callosum, post-shunting degeneration, cranial magnetic resonance HEMIMEGALENCEPHALY: A CASE REPORT P - 0208 ABDULLAH SUKUN, MEHTAP BARC ERGUN, SAMET MUTLU, EMIN DURMUS, MURUVET AKIN COMBINATION OF MILD Department of Radiology, Health Sciences University Antalya Training and ENCEPHALOPATHY WITH A Research Hospital, Antalya, Turkey REVERSIBLE SPLENIAL LESION Abstract (MERS) AND ENSEPHALITIS AFTER Hemimegaencephaly is a rare hamartomatous malformation that devel- INFLUENZA-INFECTION - A CASE ops during neuronal migration and cellular organization, leading to excessive asymmetry of a cerebral hemisphere. The cause of 0.2% of REPORT childhood epilepsy is hemimegaencephaly. Most patients present with NEVIN SAHIN1, ILHAN HEKIMSOY1, CENK ERASLAN1, focal or generalized infantile spasms. Hemimagalencephaly can lead to MEHMET ARDA KIVANC2, SERKAN GUNEYLI3, developmental retardation and hemiparesis. Ventriculomegaly, abnormal OMER KITIS1, MEHMET CEM CALLI1 gyrus formation, and colposcopy occur on the affected side. There are 1Department of Radiology, Ege University School of Medicine Hospital, three forms: isolated, syndromic or total hemimegalencephaly. Posterior İzmir, Turkey falx midline contralateral displacement, increased signal intensity of white 2Department of Child Health and Diseases, Ege University School of matter, white matter calcifications are additional findings. Early diagnosis is Medicine Hospital, İzmir, Turkey very important, although there is a lot of imaging and pathologic evidence. 3Department of Radiology, Bülent Ecevit University Hospital, Zonguldak, Misdiagnosis of obstructive hydrocephalus and cerebral neoplasia lead to Turkey S106 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Abstract EKIM GUMELER, SAFAK PARLAK, KADER KARLI OGUZ Influenza is a common disease induced by a viral pathogen of the upper Hacettepe University School of Medicine, Ankara, Turkey respiratory tract. Influenza infaction can result central nervous system Abstract (CNS) dysfunction and it has been reported worldwide. In patients with decreased consciousness after influenza infection, we should consider Auditory brainstem implantation (ABI) is a treatment method used espe- various diagnoses, including viral encephalitis, medicationrelated encepha- cially in children with cochlear nerve anomalies. In this case report, we lopathy, and MERS. We herein report a case of influenza-associated MERS present a complication of auditory brainstem implantation which has not and encephalitis in a child. An 8-year-old girl was admitted to outer medical been defined in the literature previously. A 2.5-year-old female patient with bilateral incomplete partition type 1 anomaly, bilateral cochlear center due to a high-grade fever. Antibiotic treatment was started. Three hypoplasia-aplasia had ABI. CT images acquired at 1 month after the days after the treatment, the patient presented with vomiting, sterotypic procedure showed that the electrode was terminated in the 4th ventricle. movements in the hands, jaw shift, leftward slipping in the eyes and bruising. The patient developed triventricular hydrocephalus after 5 months and A No specific findings were found in CSF examination and laboratory results, VP shunt catheter was inserted. The patient had follow-up with CT scans but positive for Influenza A in serology. Brain MRI on admission showed intermittently during 8 months. Proggressive edema starting from the high intensity in the center of the splenium of corpus callosum (SCC) on periventricular area of the fourth ventricle, extending to the brainstem diffusion imaging. Hypointense lesions were noted on T1WI, hyperinten- and cerebellar hemispheres and a cystic lesion in the right cerebellopon- sity on T2W/FLAIR imaging. No contrast enhancement was observed in tine angle was detected. On the MRI examination with necessary precau- post-contrast images. Follow-up MRI, there was high signal intensty on tions, T2A and FLAIR images showed significant edema around the fourth bilateral hippocampus and medial parts of temporal lobes (limbic system ventricle extending to both cerebellar hemispheres and brainstem, and on involement). The findings were evaluated in favor of influenza-associated post-contrast (gadoterate meglumine, 10 mL) axial T1W images contrast encephalitis. The lesion of SCC was disappeared on follow-up imaging. enhancement around the fourth ventricle, surrounding the electrode was Keywords: Influenza, MERS, encephalitis, MRI. revealed. This appearance suggested a reactive inflammation of the ventricle due to migrated electrode, as the patient did not have fever or there is no sign of infection in the patients repeat CSF cultures. In the follow-up P - 0209 CT images of the patient who was under dexamethasone treatment, the edema of the brain stem and cerebellum resolved significantly. CENTRAL NERVOUS SYSTEM Keywords: Auditory brainstem impantation, MRI LYMPHOMA ABDULLAH SUKUN, MEHTAP BARC ERGUN, SINAN ULGEN, AYSE EDA PARLAK, SAMET MUTLU P - 0211 Department of Radiology, Health Sciences University Antalya Training and BILATERAL PEDICLE STRESS Research Hospital, Antalya, Turkey FRACTURE IN THE LUMBAR SPINE Abstract MERVE ERKAN, ILKER EYUPOGLU, DILARA GUNGOR, Primary central nervous system lymphoma is a relatively rare tumor, DENIZ OZTURK KOCAKGOL, AHMET SARI which covers 2. 5% of all brain tumors and 1% of NHL lymphomas. Department of Radiology, Karadeniz Technical University School of The incidence is increased immunocompromised patients. Most of them Medicine, Trabzon, Turkey are diffuse large B-cell lymphomas. Terminology is divided into three sub-groups as immunological failure, intravascular lymphoma and dura Abstract malt-lymphoma. In epidemiology, it is more frequent at 50 years old and Introduction: We aimed to present bilateral pedicle stres fracture imag- twice as common in men. Masses of different sizes have different clinical ing findings of the L5 vertebra with chronic backpain without trauma or presentation. Intracranial pressure increase, focal neurological deficits surgical history. Stress fractures occur in normal or abnormal bone when and seizures may occur. In view, characteristically, T1 is hypointense, T2 prolonged and repetitive mechanical load exceeds the biological capac- iso-hypointense. If there is necrosis, T2A is seen as lesions that cause ity of the bone. Because the pars interarticularis is the weakest part of hyperintense, diffusion restriction in the sequences. Lesions tend to be the neural arch, the stress fractures of the vertebral neural arch usually solitary, and supratentorial white matter, periventricular areas, and corpus involve the pars interarticularis. The pedicle is the second weakest part of callosum involvement are frequent. Vasogenic edema is usually seen. It is the vertebrae after the pars interarticularis. However, stres fractures of important to note that in immunocompromised individuals the appearances tend to be more heterogeneous. We aimed to discuss the radio- the pedicle are much less common. These fractures may occur bilateral logical features of the central nervous system lymphoma in a 36-year-old or unilateral. Bilateral pedicle stress fracture is a rare entity. Few cases male patient. have been reported in the literature. Most pedicle stress fractures have been reported in association with previous spine surgery,trauma or stress- Keywords: Primer central nervous system lymphoma related activities such as in athletes. Case Report: Lumbar spine magnetic resonance imaging (MRI) examina- P - 0210 tion performed to 53-year-old female patient with chronic low back pain. AN UNUSUAL COMPLICATION MRI of lumbar spine revealed edema in both pedicles of L5 vertebrae that was seen hypointense on T1W images and hyperintense on STIR OF AUDITORY BRAINSTEM sequence. In addition, a hypointense linear line was observed on T1W IMPLANTATION and STIR images in both pedicles. With suspicion of fracture, lumbar Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S107 spine computed tomography (CT) examination was performed. CT is two times higher than females. Maternal alcohol use during pregnancy examination demonstrated fracture line on both pedicle and the patient is an important risk factor. In cases with corpus callosum agenesis, many was diagnosed as bilateral L5 pedicle stress fracture. Because there are no central nervous system anomalies are accompanied. Some of these are complications such as spinal stenosis and spondylolisthesis, conservative hydrocephalus, colpocephaly, holoprosencephaly, polymicrogyri, inter- treatment planned. hemispheric cyst, intracranial lipoma, Chiari and Dandy-Walker malformations. it causes hippocampus hypoplasis in the limbic system. We aimed Conclusion: The STIR sequence is an important sequence in the lomber to present the radiological findings of interhemispheric cyst, gray matter vertebra MRI. In the presence of hyperintensity in the pedicle on the STIR heterotropy, polymicrogyri associated with corpus callosum agenesis in 38 sequence stress fracture and accompanying edema should be kept in mind. years-old-male. Similarly, hyperintensity in the pedicle on STIR sequence may be associated Keywords: Polymicrogri, interhemispheric cyst, intracranial lipoma, corpus with infection, hemangioma, osteoid osteoma, or other bone neoplasms. callosum agenesis Untreated stress fractures can lead to nonunion, spondylolisthesis, and spinal stenosis. Early detection and treatment are therefore important. P - 0214 Keywords: Bilateral, pedicle, stress fracture, lomber spine CEREBRAL ASPERGILLOSIS: NEUROIMAGING FEATURES OF THE P - 0212 DEVELOPMENTAL STAGES DENIZ SOZMEN CILIZ, DINARA MAMEDOVA, EWING SARCOMA PLACED ON AYSEL KOCAGUL CELIKBAS, SIMTEN DAGDASH, CEREBELLAR TENTORIUM DENIZHAN DIVANLIOGLU, BULENT SAKMAN, GULSUM OZET NUSRET SEHER, EMINE UYSAL, HAKAN CEBECI, Ankara Numune Training And Research Hospital, Ankara, Turkey MUSTAFA KOPLAY, YAHYA PAKSOY Abstract Department of Radiology, Selçuk University School of Medicine, Konya, Introduction: Cerebral Aspergillosis is a rare infection observed mainly Turkey among immunosuppressed patients. It is associated with poor prognosis Abstract and high mortality (88-99%). The spread of Aspergillus species in the central nervous system occurs via hematogenous spread from the lungs Ewing sarcoma is a small circular cell tumor that creates 6-8% of the or direct invasion via the paranasal sinuses. Most common presentation of primer malign bone tumor appeared mainly on bone and soft tissues and cerebral aspergillosis is brain abscess but various presentations have been it is mainly observed between 5-25 ages. It can rarely show extra-skeletal reported. Blood and tissue cultures have low sensitivity for identifying placement. Tentorial placement is very rare and it is seen approximately in infection, with as many as 90% of cases not confirmed until postmortem 0.5%. Extra-skeletal ewing sarcoma is rarely seen and it can be also named examination. We present neuroimaging features of the developmental as peripheral primitive neuro-acto-dermal tumor (pPNET). Generally it stages of cerebral aspergillosis. can be placed on posterior fossa as extra-axially and it can elongate to Case Report: 37-year-old female patient admitted to hospital due to a head- spinal canal. In this proceeding findings of magnetic resonance imaging ache for 2 weeks with nausea, vomit. Soon she developed neutropenic fever (MRI) of ewing sarcoma placed on tentorial had been shown. and eventually was consulted to hematology department. Blood marrow Keywords: Tentorial ewing sarcoma, MRI, pnet analyses revealed Acute lymphoblastic leukemia. Serial MR examinations of the brain were made because of confusion and deterioration of symptoms. Detailed MRI findings explained in figures. Findings pointed to Aspergillus abscess. The number of lesions progressed after the following examination. P - 0213 The patient underwent surgery. A well-encapsulated pus pocket was found, and histopathology resulted in the diagnosis of aspergillosis. Despite appropri- CORPUS CALLOZUM AGENESIS ate anti-fungal treatment, the patient eventually died from cardiac arrest. AND CENTRAL NERVOUS SYSTEM Conclusion: This case highlights the importance of the high level of vigi- ANOMALIES: HETEROTROPHY, lance in detecting the early imaging findings of cerebral aspergillosis, which POLYMICROGRY can be difficult to diagnose clinically. Neuroimaging features with careful observation and detailed history-taking can help to make a final diagnosis. ABDULLAH SUKUN, MEHTAP BARC ERGUN, Keywords: Aspergillosis, cerebral, MRI SINAN ULGEN, SAMET MUTLU, AYSE EDA PARLAK Department of Radiology, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey P - 0215 Abstract METRONIDAZOLE INDUCED Corpus callosum is the widest commissure that joins the cerebral hemispheres. The development of the corpus callosum is anterior to posterior, ENCEPHALOPATHY but myelination starts from the splenium part and proceeds anteriorly. SULEYMAN ONCU1, ISMAIL SERIFOGLU1, They are classified as agenesis, partial agenesis and hypogenesis according 1 2 to the defects during development. The incidence of corpus callosum MEHMET KARAGULLE , FATMA ZEYNEP ARSLAN agenesis has not been clearly determined since most cases are asymptom- 1Bağcılar Training and Research Hospital, İstanbul, Turkey atic. The incidence is approximately 1 in 20,000 patients. In males, the rate 2Konya Training and Research Hospital, Konya, Turkey S108 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Abstract cerebellopontine angle. Diffusion restriction of the cystic component of the lesion was noted in diffusion-weighted studies. The lesion was apply- Metronidazole-induced encephalopathy (MIE) is a rare condition and ing pressure to fourth ventricle, mesencephalon and pons. The lesion associated with long-term use of high-dose metronidazole. Clinically, was then surgically removed and pathologically identified as epidermoid it manifests as convulsive seizures, ataxia, dysarthria and confusion. carcinoma. Radiologically, T2A and FLAIR hyperintense signal changes can be seen symmetrically in bilateral dentate nuclei, brain stem, and corpus cal- Conclusion: Epidermoid carcinoma is a rare tumor that should be kept losum. in mind in intracranial-extraaxial lesions, especially in the pontocerebellar angle; because the treatment is surgical, radiological diagnosis is of In our case, 38 years old female diagnosed with type 1 DM had suffered great importance. from foot trauma 2 months ago and started her treatment due to osteomyelitis developing in calcaneus. Brain MRI was performed on the devel- Keywords: Cerebellopontine angle, epidermoid carcinoma, epidermoid opment of dysarthria and confusion during treatment. Brain MRI revealed cyst that bilateral dentate nucleus hyperintensities on T2W-FLAIR images. When the treatment was questioned, it was learned that a total of 75 gr IV metronidazole was used over a period of 45 days. MIE was considered P - 0217 and metronidazole therapy was terminated. 3 weeks after termination, patients’ symptoms were regressed. BALO’S CONCENTRIC SCLEROSIS: A Metronidazole is commonly used in the treatment of anaerobic bacteria CASE REPORT and protozoan-related infections. Most common side effect on nervous EMIN DURMUS, MEHTAP BARC ERGUN, AYSE EDA PARLAK, system is peripheral neuropathy, rarely convulsive seizures, ataxia, dysar- BERNA AK YILDIZ, ABDULLAH SUKUN thria, confusion, and encephalopathy can be seen. Previous cases shown Health Sciences University Antalya Training and Research Hospital, Antalya, that side effects are related to long-term, high-dose metronidazole usage. Turkey The most common finding on brain MRI is high signal intensity in symmetrical bilateral dentate nucleus on T2W/FLAIR images.. Its mechanism Abstract and frequency aren’t fully known. Canavan disease, MSUD and type 1 Objective: Balo’s concentric sclerosis is a demyelinating disease similar glutaric aciduria can cause dentate nucleus hyperintensities but MIE should to Multiple Sclerosis (MS). Typically demyelinating areas are seen as be regarded in the long-term metronidazole usage. concentric lesions (circular) on imaging. This is a rare variant of MS and Keywords: Metronidazole, dentate nucleus, dysarthria is often as monophasic type in young people. Material and Methods: A 24-year-old female patient with acute neurologic findings in our hospital emergency department had a suspicious P - 0216 hypodense lesion in the left periventricular area in the first brain CT scan. Due to suspicion of CVD, firstly diffusion brain MRI was perfomed. CEREBELLOPONTINE ANGLE After diffusion brain MRI didn’t show any diffusion restriction. A con- EPIDERMOID CARCINOMA: A RARE trast enhanced brain MRI was planned. CASE Results: A lesion of approximately 3 cm in diameter, which appeared as a rounded lesion with alternating layers in the white matter adjacent to EMIN DURMUS, AYSE EDA PARLAK, MEHTAP BARC ERGUN, body of left lateral ventricle was observed on FLAIR-weighted imaging. SINAN ULGEN, SAMET MUTLU In addition, hyperintense signal changes were observed at temporal lobe Health Sciences University Antalya Training and Research Hospital, Antalya, periventricular white matter and hippocampus in T2-FLAIR sequences. Turkey Peripheral rim enhancement was observed at left periventricular area Abstract following intravenous contrast matter administration. There was no significant edema in the periphery of the lesion. Balo’s concentric scle- Objective: Intracranial epidermoid cysts are congenital lesions and con- rosis was considered due to age, characteristic periventricular lesions sist 1% of brain tumors. These lesions grow very slowly. It’s mostly seen observed and accompanying white matter lesions. between ages is 20 and 40. They are located in cerebellopontine angle 40-50% of cases and typical imaging features are high signaling in diffusion Conclusion: Typical MRI findings of Balo’s Concentric Sclerosis are weighted sequences. These lesions may rarely show epidermoid carci- lesions with concentric rings on T2-weighted images and on contrast noma degeneration. enhanced T1-weighted images as target nodules. In some studies these layered-concentric areas are said to represent demyelinating and Materials and Methods: A 59-year-old female patient with long-standing remyelinating regions. Despite the presence of a single hemispheric headache was referred to our clinic for first imaging CT scan. The suspi- lesion, lesions were reported in cerebellum, brain stem, spinal cord, and cious lesion was diagnosed with advanced contrast-enhanced brain MRI optic chiasm were reported and clinical findings of these lesions were and brain diffusion MR imaging. described. In our case, age, characteristic localization of the lesions observed and accompanying white matter lesions pointed out Balo’s Results: Brain MRI revealed a 63×30×40 mm lesion appearing hyper- concentric sclerosis and it is shown that disease can diagnosed with intense in T2A, mildly suppressed in FLAIR sequences, showing a radiologic imaging. heterogenous peripheral rim contrast enhancement after intravenous contrast medium administration. This lesion was also including a 23x12 Keywords: Balo’s concentric sclerosis, demyelinating disease, multiple mm solid nodule with a diffuse homogeneous enhancement at left sclerosis Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S109 P - 0218 coabdominal CT were performed to identify the etiology. Centrilobular nodules and numerous bilateral upper-lobe predominant cysts of varying CRANIAL MAGNETIC RESONANCE sizes were detected on chest CT. The costophrenic angles were spared. AND MAGNETIC RESONANCE Hyperintense lesions were depicted in pons, middle cerebellar peduncles and cerebellar white matter on T2W images. Diagnosis of LCH with CNS ANGIOGRAPHY IN MOYAMOYA involvement was made according to imaging findings. Pathological confir- MERAL KAPLAN, OMER ONBAS, ELIF NISA UNLU mation of the diagnosis was also made by wedge resection of the lung and immunohistochemical examination was performed. Department of Radiology, Düzce University School of Medicine, Düzce, Turkey Conclusion: Radiology plays a large role in the diagnosis of patients with LCH. Familiarity with the rare imaging appearances of LCH is crucial for Abstract appropriate patient management. Objective: To demonstrate cranial magnetic resonance (MR) and MR Keywords: Cerebellar syndrome, langerhans cell histiocytosis, MRI angiographic findings of collateral vascular structures observed in moyamoya disease. Materials and Methods: Cranial MR and MR angiography of an 8-year- P - 0220 old girl who was followed up due to resistant epilepsy revealed marked thinning of the cerebral arteries in the supraclinoid segments in the Wills DYKE DAVIDOFF MASSON SYNDROME polygon, fine-tortuous vascular collaterals in the perivascular neighbor- IN ADULT PATIENT hoods and bilateral basal ganglia. SINAN ULGEN, AYSE EDA PARLAK, MEHTAP BARC ERGUN, Conclusion: Moyamoya disease is an arteriopathy that usually results ABDULLAH SUKUN, BERNA AK YILDIZ from bilateral, idiopathic and progressive narrowness or occlusion of the branches of distal supraclinoid internal carotid arteries and the main Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey branches of the Wills polygon. Colleteral vascular structures are usually observed in this disease due to its occlusive nature in main supplier arter. Abstract Moyamoya is a Japanese word that refers the collateral vascular structers Dyke davidoff masson syndrome is rare condition. Clinical findings of resembling cigarette smoke. Two thirds of cases are seen in children and the syndrome are facial asymmetry, hemiplegia or hemiparesis, mental most of these individuals are younger than 10 years. Moyamoya disease retardation, sensorineural hearing loss, psychiatric disorders, epilepsy. is progressive and long-term results are usually poor. In children, the clinic Radiological findings are cerebral hemiatrophy, unilateral thickening of the usually shows signs of ischemia. skull, extensive widening of paranasal sinuses and increase in air levels. Here we report a case of a 39 years old female patient who has depres- Keywords: Magnetic resonance angiography, magnetic resonance imaging, sion and anxiety disorder. Cranial MRI scan shows modarate frontal lobe moyamoya disease atrophy in left hemisphere, thickening of the nearby skull and widening of left side of the frontal sinus. All clinical and imaging findings are suggestive for Dyke Davidoff Masson Syndrome. P - 0219 Keywords: Dyke-Davidoff-Masson sydrome, Neuroradiology, Cerebral A RARE CAUSE OF CEREBELLAR hemiatrophy SYNDROME: LANGERHANS CELL HISTIOCYTOSIS P - 0221 ILHAN HEKIMSOY, NEVIN SAHIN, CENK ERASLAN, OMER KITIS, SELEN BAYRAKTAROGLU SYMPTOMATIC HYPERTROPHIC Department of Radiology, Ege University School of Medicine, İzmir, Turkey OLIVARY DEGENERATION SECONDARY TO PONTINE CAVERNOMA Abstract SEBAHAT NACAR DOGAN, ISMAIL SINAN DUMAN, Objective: Langerhans cell histiocytosis (LCH) is a rare multisystemic AYLIN HASANEFENDIOGLU BAYRAKGOZ, disease which is characterized by proliferation of myeloid progenitors SELEN BEYZA KAVUNCU with altered differentiation program and similar phenotypic features to epidermal dendritic cells termed Langerhans cell. Neurological involve- Department of Radiology, Gaziosmanpaşa Taksim Training and Research ment is observed in 5 to 10% of cases. In this case report we want to Hospital, İstanbul, Turkey present radiological findings of neuro-LCH which is a rare cause of cer- Abstract ebellar syndrome. We report a case of unilateral hypertrophic olivary degeneration second- Materials and Methods: A 50-year-old man was admitted to the neurol- ary to pontine cavernoma. The patient was 63-year-old man who had ogy service with a history of gait disturbance, imbalance and dysphagia for hemorrhage of a cavernous malformation in the pons 17 month ago. He 1.5 years. On examination, dysarthria with nasal sound were also noted. complained rest, postural and kinetic tremor of his left upper extremity. All his tests were negative including tumor markers and autoantibodies. On magnetic resonance imaging (MRI), a cavernous malformation was It was determined as a cerebellar syndrome. Cranial MRI and thora- detected on the right side of pons. The ipsilateral olivary nucleus was S110 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 markedly enlarged and T2 weighted axial MRI sequence demonstrated be kept in mind that, contrary to what is known, methylmalonic acidemia increased signal intensity of the right inferior olivary nucleus. may not cause globus pallidus involvement. Hypertrophic olivary degeneration (HOD) is a rare condition, a sec- Keywords: Methymalonic asidemia, MRI, inborn ondary trans-synaptic degeneration of the inferior olivary nucleus. Disruption of triangle of Guillain-Mollaret (dentato-rubro-olivary tract) by hemorrhage, either due to hypertension, trauma, and surgery or, as P - 0223 in our patient, a vascular malformation, ischemia and demyelination can cause HOD. The dentato-rubro-olivary fibers connect the ipsilateral red PHACE SYNDROME: A CASE REPORT nucleus and inferior olive with the contralateral dentate nucleus. HOD is EGEMEN OZTURK, CELAL CINAR, CENK ERASLAN, matchless because the degenerating olive initially becomes hypertrophic ISMAIL ORAN due to cytoplasmic vacuolation of neurons rather than atrophic. HOD may appear in three patterns depending on the involvement of dentato- Department of Radiology, Ege University School of Medicine, İzmir, Turkey rubro-olivary tract: ipsilateral olivary hypertrophy, contralateral olivary Abstract hypertrophy and bilateral olivary hypertrophy. The palatal myoclonus is classical symptom but as in our case, dentate-rubral tremor is also seen. PHACE syndrome is an uncommon disorder of unknown etiology characterized by large segmental hemangiomas of the face and various develop- We aim to remember the imaging findings of HOD to prevent inaccurate mental defects. PHACE is an acronym that refers to a group of abnormal diagnosis of other pathology. medical findings. People with PHACE syndrome may have Posterior fossa Keywords: Hypertrophic olivary degeneration, cavernoma, pons brain malformations, Hemangioma, Arterial lesions (blood vessel anomalies in the head or neck), Cardiac anomalies, and Eye anomalies. Its exact incidence and prevalence are unknown. There are over 300 individual case reports and case series published in the literature. In an analysis of P - 0222 150 PHACE patients from the PHACE Syndrome International Clinical MAGNETIC RESONANS IMAGING Registry, the female to male ratio was 4. 2:1. the diagnosis can be made based upon the presence of a facial hemangioma greater than 5 cm in AND CT FINDING IN A CASE OF diameter plus one major or two minor criteria. Here we aimed to pres- METHYLMALONIC ACIDEMIA ent a 3 months old female patient with a diagnosis of PHACE syndrome with a facial hemangioma, Dandy-Walker complex and intracranial arterial FATMA DURMAZ1, ABDUSAMET BATUR2, dolichoectasia. MESUT OZGOKCE1, SUMEYRA DEMIRKOL ALAGOZ1, ILYAS DUNDAR1 Keywords: PHACE syndrome, hemangioma, Dandy-Walker complex 1Department of Radiology, Yüzüncü Yıl University School of Medicine, Van, Turkey 2Department of Radiology, Selçuk University School of Medicine, Konya, P - 0224 Turkey CENTRAL NERVOUS SYSTEM Abstract TUBERCULOSIS: PARENCHYMAL Objectives: Methylmalonic acidemia (MMA) is an inborn disorder of TUBERCULOSIS amino acid metabolism that commonly presents with neurologic deficits. CT and MR imaging of the brain typically reveal atrophy, delay in myelina- ERTAN ZENGIN tion, and abnormalities in the basal ganglia, predominantly in the globi Department of Radiology, Recep Tayyip Erdoğan University Training and pallidi. Here, we aimed to present CT-MRI finding of a 3 year-old patient Research Hospital, Rize, Turkey with a diagnosis of MMA, with diffuse parenchymal atrophy, ventricular Abstract dilatation, and prominent subdural effusion without involvement of globi pallidi or basal ganglia. Tuberculosis is a disease caused by Mycobacterium tuberculosis and is thought to cause around 8 million deaths worldwide annually. Central Materials and Methods: The conversion of methylmalonyl acid to suc- nervous system (CNS) involvement of the tuberculosis is an important cinic acid requires an apoenzyme (methylmalonil-CoA mutase) with and serious extrapulmonary spread. Approximately 10% of all patients coenzyme (adenosylcobalamine). Deficiency of these enzymes results with tuberculosis have CNS involvement in immunocompromised in accumulation of methylmalonic acid in patients with MMA. The patients, this rate increases by up to 15%. CNS involvement is a serious pathophysiology of brain injury is attributed to competitive inhibition life-threatening condition and may mimic many infectious and nonin- of succinate dehydrogenase (an enzyme essential for mitochondrial fectious involvements For this reason, familiarity with imaging findings aerobic glucose oxidation) by methylmalonic acid accumulation. The is important for radiologists and infectious disease specialists. Prompt basal ganglia, predominantly globi pallidi, are particularly susceptible and accurate diagnosis contributes to reducing morbidity and mortality to mitochondrial dysfunction and are thus the main target for brain in affected patients. Granulomatous inflammatory reaction can affect damage. Contrary to what is believed, in our case there wasn’t meninges, brain parenchyma, cranial nerves, spinal cord, bone struc- involvemenet of globi pallidi. tures surrounding brain and spinal cord. Meningitis is the most common Conclusion: In MMA symmetrical involvement in the brain and progres- manifestation of CNS tuberculosis. Enhancing exudates in basal cisterns sive white matter loss can be detected early on CT and MR imaging. are the most common imaging findings and are very specific manifesta- Imaging plays an important role in early diagnosis and follow-up. It should tion of leptomeningeal tuberculosis. The most common lesion in the Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S111 parenchymal involvement is tuberculoma and may be solitary, multiple P - 0226 or miliary. Tuberculomas are most commonly seen in the parietal and frontal lobes. Imaging findings depend on whether the tuberculoma is A RARE CASE REPORT OF caseating, and if so, whether the center is liquid or solid. We aimed to LISSENCEPHALY TYPE II present the imaging findings of central nervous system involvement of tuberculosis in a patient with myasthenia gravis history and immunosup- FATMA ZEYNEP ARSLAN, SEDA SOGUKPINAR KARAAGAC, pressive drug therapy. SERDAR ARSLAN, MERAL BUYUKTERZI, HASAN ERDOGAN, VEFA ONER Keywords: Tuberculosis, central nervous system, Mycobacterium Tuberculosis Department of Radiology, Health Sciences University Konya Training and Research Hospital, Konya, Turkey Abstract P - 0225 Lissencephaly defines approximately complete absence of normal gyra- tion and sulcation of the cerebral cortex, and is frequently accompanying DRUG ABUSE ASSOCIATED by microcephaly. Patients may suffer from developmental delay, intellec- TRANSIENT SPLENIAL LESION tual disability, and medically intractable epilepsy. There is two subgroup OF CORPUS CALLOSUM: of Lissencephaly spectrum. The classical form, named as lissencephaly type I, is a primitive neuronal undermigration, apart from the type II. CONVENTIONAL AND DIFFUSION- Lissencephaly type II occurs secondary to overmigration resulting in WEIGHTED MAGNETIC RESONANCE abnormal settlement of the cortical plate. Thus; an extracortical neuroglial IMAGING FINDINGS WITH A CASE layer leads to agyria with or without irregular, “cobblestone”, surface of the brain and ventriculomegaly. The lissencephaly-pachygyria spectrum EDA BEYKOZ CETIN, MAKSUDE ESRA KADIOGLU, ERTAN may be associated with varying disease such as Walker-Warburg syn- ZENGIN, TUGBA ELDES drome, muscle-eye-brain Disease and Fukuyama muscular and cerebral Department of Radiology, Recep Tayyip Erdoğan University Training and dystrophy. Research Hospital, Rize, Turkey An 8-year-old female patient’s complainning from intractable seizures Abstract admitted to our hospital. On MRI; a few poorly formed gyri and a smooth outer surface of frontoparietal cortex observed. Introduction: Transient lesions of splenium of the corpus callosum are associated with various entities such as drug use, malignancy, infection, Morphological changes can be evaluated using antenatal USG, computed metabolic disorders, and other many entities. It is generally agreed that tomography or MRI. However; most superior modality is MRI examina- these callosal lesions with reduced diffusion (low apparent diffusion tion. On MRI; few shallow sulci and shallow Sylvian fissures, an hour glass coefficient [ADC] value) are caused by cytotoxic edema. Therefore, the appearance may be seen on axial images. Subcortical band heterotopia other name of these lesions is Cytotoxic Lesions of the Corpus Callosum and markedly thickened cortex is generally noted. The lissencephaly- (CLOCCs). Diagnosis would be confusing if there is not enough history pachygyria spectrum is usually diffusely and symmetricly affect cortex but from such patients. We would like to discuss Magnetic Resonance Imaging only anterior-posterior involvement is can be seen depending the under- (MRI) findings of cytotoxic lesion of the corpus callosum with a drug lying mutations. Enlarged ventricles, hypoplastic anterior corpus callosum and cavum septum pellucidum et vergae are additional features of the abuse case. lissencephaly-pachygyria spectrum. Case: A 21-year-old woman who had history of drug abuse applied to In conclusion; lissencephaly is a rarely seen abnormaly and may be accom- our hospital and her main complaints were dysarthria and confusion. No pany with syndromic disorders. abnormal laboratory findings were detected to explain any metabolic diseases. Magnetic resonance imaging was performed to confirm the diag- Keywords: Lissencephaly, epilepsy nosis. On the MRI; there was an abnormal signal area at the splenium of the corpus callosum and this lesion had no mass effect. On the diffusion weighted images there was restricted diffusion at the lesion with low P - 0227 ADC values. On follow-up MRI; the splenium was totally resolved and no abnormalities were detected at diffusion weighted images. We aimed PETROUS APEX CEPHALOCELE to demonstrate the changes at the lesion of the corpus callosum with REPRESENTED WITH RHINORRHEA: follow-up MRI. REPORT OF TWO CASES Conclusion: Transient focal lesions of splenium of the corpus callosum SEBAHAT NACAR DOGAN, MERVE SAM OZDEMIR, is a rare condition that may occur in patients with many reasons. In our AYLIN HASANEFENDIOGLU BAYRAKGOZ case the restricted diffusion (low ADC values) representing cytotoxic edema was demonstrated at splenium of the patient’s corpus callosum. Department of Radiology, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey Radiologist should be familiar to these lesions to prevent unnecessary invasive treatment protocols. Abstract Keywords: Drug abuse, transient splenial lesions, CLOCCs, magnetic Petrous apex cephalocele is herniation of the posterolateral Meckel’s resonance imaging (MRI) cave margin and contents into the petrous apex. Petrous apex cephalo- S112 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 cele (PAC) is a rare condition that exact etiology is not known. It is either Abstract a congenital or acquired. The theory is that chronically increased intracra- Objective: Fetal MRI is the main supplementary imaging modality of pre- nial pressure that is transmitted into the Meckel cave could cause PAC. natal ultrasound in diagnosis of central nervous system (CNS) anomalies. PACs are usually bilateral, and occur more often in women than in men. With modern fast sequences, motion artefacts are minimized and high They are usually incidental but could be rarely symptomatic. Complaints resolution of regions like the brain made possible. A combination of pre- of patients could be headache and rhinorrhea. Magnetic resonance imag- natal ultrasound and MRI can be used to detect and characterize many ing (MRI) depicts a cystic-appearing petrous apex lesion with CSF signal primary and secondary CNS abnormalities in the developing fetus. Our intensity in all MRI sequence and continuous with Meckel’s cave. According aim is to report the fetal MRI findings of CNS anomalies with the current to bone remodeling or erosion on computed tomography (CT), PACs are literature knowledge. characterized into aggressive or non-aggressive. Materials and Methods: We retrospectively reviewed fetal MRI We report two unusual cases of PAC that were 31 year old and 42 year findings from October 2016 to November 2017. Six fetuses of six old female who had intermittent rhinorrhea and headache. Both of them pregnant women (4 singleton, 2 twin pregnancies) were included in had no operation, trauma or infection. Their neurologic examination had this study on the basis of their fetal MRI findings which depicted CNS no abnormality. On MRI, bilateral herniation of Meckel cave into petrous lesion or abnormality. Hydrocephalus was identified in 2 fetuses, one apex was depicted. On CT, bony defect in petrous apex was detected in fetus had evidence of corpus callosum agenesis, one had intracranial both of case. hemorrhage, one had Chiari type II malformation and one had Dandy Walker malformation. Familiarity to imaging features of PAC, especially aggressive ones, could be very important in symptomatic patients in whom surgical intervention Conclusion: Fetal MRI plays an increasingly important role in the prenatal could be necessary. diagnosis of CNS anomalies. For proper interpretation and diagnosis of fetal CNS anomalies, radiologist should be familiar with the normal devel- Keywords: Petrous apex cephalocele, rhinorrhea, magnetic resonance oping fetal anatomy and limitations of fetal MRI. imaging Keywords: Anomalies, congenital, MRI

P - 0228 P - 0230 HEMORRHAGIC COLLOID CYST A RARE CASE REPORT: CANSU OZTURK, OZLEM GUNGOR, OMER FARUK GULER, RHOMBENCEPHALOSYNAPSIS SELMA UYSAL RAMADAN FATMA ZEYNEP ARSLAN, HASAN ERDOGAN, Keçiören Training and Research Hospital, Ankara, Turkey SERDAR ARSLAN, SEDA SOGUKPINAR KARAAGAC, Abstract MEHMET SEDAT, VEFA ONER Colloid cysts are benign cystic lesions with thin walls. These lesions are Department of Radiology, Health Sciences University Konya Training and located in the anterior part of the third ventricle and located near the Research Hospital, Konya, Turkey foramen Monroe. They constitute about 0.5% to 1% of all intracranial Abstract tumors. They usually asymptomatic but sometimes grow rapidly, and may be symptomatic such as headache, diplopia, and sixth cranial nerve palsy. Rhombencephalosynapsis is a cerebellar anomaly characterized by hypo- Acute hemorrhage in colloid cyst is extremely rare and may present with genesis of cerebellar vermis and fusion of the cerebellar hemispheres, acute symptoms and even sudden death. Although hemorrhagic changes the middle cerebellar peduncles, and the dentate nuclei. The vermian of colloid cysts can give rise to an acute increase of cyst dimension result- maldevelopment which is generally sporadic can be seen as an absence of ing in an acute and complete obstruction of CSF circulation, the cause of the anterior vermis or a deficiency of the posterior vermis. hemorrhage is not known. We report a rare case of a hemorrhagic colloid Overall life expantancy could short compared to unaffected people since cyst in a thirty years old male patient with sudden onset headache. Rhombencephalosynapsis patients tend to die in childhood or early adult Keywords: Colloid cyst, third ventricule, hemorrhagie life. Diagnosed Rhombencephalosynapsis in an adult patients is unusual.

A 48-year-old male patient complaining of headache admitted to our outpatient polyclinic. There was no history of known disease. Hypoplasia P - 0229 in the cerebellar tonsils were noted and cerebellar hemispheres were FETAL MRI IN PRENATAL DIAGNOSIS posteroinferiorly fusioned. OF CENTRAL NERVOUS SYSTEM Rhombencephalosynapsis has also can see with Gomez-Lopez-Hernandez syndrome and VACTERAL syndrome or with varying abnormalities such ANOMALIES as absent olfactory bulbs, dysgenesis of the corpus callosum, absent sep- ILHAN HEKIMSOY, CENK ERASLAN, OMER KITIS, tum pellucidum and atypical forms of holoprosencephaly. CEM CALLI Severity of rhombencephalosynapsis classified as mild form which is Department of Radiology, Ege University School of Medicine, İzmir, Turkey characterized with the partial absence of nodulus, anterior, and pos- Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S113 terior vermis; moderate form described as the absence of posterior radiological findings that may contribute diagnosis should be evalu- vermis with some anterior vermis and nodulus present; severe form ated carefully. MR imaging may help detection of the etiology, early in which posterior and anterior vermis is absent with some nodulus diagnosis and treatment planning of vascular and idiopathic intracranial present. hypertension.

Affected patients may have severe congenital hydrocephalus, cerebral Keywords: Intracranial hypertension, optic nerve, headache palsy and mental retardation or may be asymptomatic.

Rhombencephalosynapsis has a typical Magnetic Resonance Imaging appearance (MRI). P – 0232 Fusion of the cerebellar hemispheres leads to continuous cerebellar folia, VERTEBRAL ARTERY LOOP flat-based cerebellum without cerebellar vallecula and diamond-shaped FORMATION CAUSING fourth ventricle is observed on MRI. RADICULOPATHY In conclusion; rhombencephalosynapsis may be associated with intellectual 1 1 deficits thus and ait is important to be familiar with thise rare appearences. FATMA ZEYNEP ARSLAN , OZGUR ONER , MEHMET KARAGULLE2, SULEYMAN ONCU2 Keywords: Rhombencephalosynapsis, magnetic resonance imaging, brain 1Department of Radiology, Health Sciences University Konya Training and Research Hospital, Konya, Turkey 2Department of Radiology, Bağcılar Training and Research Hospital, P - 0231 İstanbul, Turkey

VASCULAR INTRACRANIAL Abstract

HYPERTENSION WITH Cervical radiculopathy is an important health issue characterized with a CHARACTERISTICS MR RESULTS dysfunction of a nerve root of the cervical spine among population. Most HANIFE GULDEN DUZKALIR1, YESIM KARAGOZ1, commonly, the cause of cervical radiculopathy is cervical disk herniations ABDULLAH SOYDAN MAHMUTOGLU1, and/or osteophyte formationCR secondary to compression from anoma- SERAY KURT GUNEY1, ALI HALUK DUZKALIR2 lous VAs is a rarely seen entity with an incidence of approximately 2. 7% in cadaveric specimens (1). An ectatic VA loop can directly compress the 1İstanbul Training and Research Hospital, İstanbul, Turkey exiting nerve root. 2Kartal Dr Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey A 45-year-old woman presented with stabbing pain in her neck and upper Abstract back above her left shoulder, radiating into both arms. Examination results Objective: Intracranial hypertension is characterized by increased were normal. Somatosensory evoked potentials showed significantly cerebrospinal fluid (CSF) pressure, severe headache, reduction/loss prolonged latency of the left C4 nerve root. Cervical spine MRI demon- of vision, nausea and vomiting, and many factors play role in etiology. strated tortuous vertebral arteries looping into the C3-C4 neural foram- It is divided into two types as vascular and idiopathic. Venous stasis is ina impinging the left C4 nerve roots. one of the etiologic factors. Magnetic resonance imaging (MRI) may A 35-years-old male admited to our outpatient clinic with cervical pain. help identifying the etiology and protecting vision by contributing to Examination results were normal. On MRI; cervical radiculopathy second- early diagnosis. ary to direct neural compression from an aberrant loop of the VA at the Materials and Methods: We aimed to present typical findings of vascular level of C5-6 is observed. intracranial hypertension using brain MRI, CSF flow MRI and brain MRI Symptomatic patients usually present with radicular pain and palsy in the venography in a 37-year-old woman presenting with paroxysmal head- C3 to C6 range. ache. Vertebral artery loop formation may lead to bony erosions or vertebro- RESULTS: Here we report typical MRI findings of intracranial hypertension characterized by an enlarged subarachnoidal space around the optic basillar insufficiency. A good initial prognostic sign on MRI is an enlarged nerve, optic nerve tortuosity, posterior scleral flattening and papilledema neural foramina containing a vascular structure. with protrusion of the optic nerve head, enlarged arachnoid cavities In conclusion; this is a very important cause of radiculopathy because of (suprasellar cisterna, Meckel cave enlargement), enlargement of CSF possible negative sequelae if missed on imaging i. e. cervical spine CT. space around cavernous sinus lateral wall and oculomotor nerve, thinned Neurosurgical attempt of discectomy is likely to cause vertebral artery venous sinuses, slit ventricles, caudal extension of cerebellar tonsils, injury. increased skin fat thickness in the head and neck. Due to progression of the symptoms of the patient receiving medical treatment for the history Keywords: Cervical radiculopathy, vertebral artery, hernia of dural sinus thrombosis and intracranial hypertension, lumboperitoneal shunt was performed for detection of 48 cm H2O CSF pressure in lum- P - 0233 bar puncture.

Conclusion: It should be kept in mind that intracranial hypertension A RARE CAUSE OF EARLY-ONSET may present only with paroxysmal headache as in our case. Secondary ATAXIA: MRI FINDINGS OF “ARSACS” S114 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

BILGESU ARIKAN ERGUN, HAKAN BAS, ELIF PEKER, the diagnostic. A 16-year-old male patient, who was followed-up at the M. ILHAN ERDEN external center with the diagnosis of Neurocysticercosis since 10 years, was referred to our clinic for brain MR imaging because of the newly Department of Radiology, Ankara University School of Medicine, Ankara, Turkey developed obsessive-compulsive disorder. In this case report, we aimed to present findings of Disseminated oligodendroglial-like leptomeningeal Abstract tumor MR imaging.

Introduction: Inherited ataxias include a heterogenous group of neuro- Keywords: Tumor, leptomeninges, MRI, pediatrics degenerative disorders. Autosomal recessive spastic ataxia of Charlevoix Seguenay (ARSACS) is a complex disorder characterized by spasticity, ataxia, polyneuropathy and amyotrophy of distal muscles. Magnetic resonance imaging (MRI) has a vital role in differential diagnosis. We aimed to P - 0235 emphasize that ARSACS is one of the causes that leads childhood ataxia ACUTE METHANOL INTOXICATION and tigroid pattern at pontine level is specific. PRESENTED WITH ATYPICAL MRI Case Report: 17 year-old female applied to our hospital with complaints FINDINGS of imbalance and walking difficulty. In the physical examination, spastic paraparesis, bilateral Achilles clonus, patellar clonus and bilateral Babinski HANIFE GULDEN DUZKALIR, reflex positivity were observed. Her medical history revealed a tendency ABDULLAH SOYDAN MAHMUTOGLU, YESIM KARAGOZ, to fall. The patient had consanguineous parents. MRI showed atrophic SERAY KURT GUNEY superior vermis, deepened cerebellar folia and bilateral-symmetrical İstanbul Training and Research Hospital, İstanbul, Turkey transvers linear hypointensity on T2- and T2-FLAIR weighted images in the pons. EMG showed signs of polineuropathy. ARSACS was suspected; Abstract and the genetic testing is still running. Objective: Acute methanol intoxication may cause serious neurological Conclusion: ARSACS have been identified as a rare cause of early-onset sequelae. Severe metabolic acidosis can cause permanent neurological ataxia. Most patients show a typical triad of early-onset cerebellar ataxia, sequelae such as blindness, or even death. Computed tomography (CT) limb spasticity and polineuropathy. A specific pontine tigroid pattern has and magnetic resonance imaging (MRI) may show toxic effects in the been described in ARSACS. Other common but less specific findings brain of the methanol. The most important finding is bilateral putaminal include cerebellar hemisphere atrophy, inferior vermis and superior spinal necrosis. Other findings such as subcortical and deep white matter lesions, cord atrophy, thalamic T2 hyperintensities and corpus callosum thinning. cerebral and cerebellar cortical lesions, midbrain lesions, cerebral and These changes could help diagnose ARSACS earlier in young children, in intraventricular haemorrhage may also be observed. whom the disease is often mistaken for cerebral palsy. Inherited ataxias Materials and Methods: We report brain CT and MRI findings in a include a heterogenous group of neurodegenerative disorders and MRI 33-year-old male who presented with a sudden loss of vision after drink- has a vital role in differential diagnosis. ing methanol in our emergency department.

Keywords: ARSACS, childhood ataxia, magnetic resonance imaging, Results: There was no pathological finding on CT imaging at the time of the tigroid pattern admission. Diffusion MR imaging of the patient with severe metabolic acidosis and progressive Glasgow Coma Scale (GCS) regression revealed bilateral putaminal FLAIR signal enhancements with diffuse restriction of subcortical P - 0234 and deep white matter. Symmetrical diffusion restriction was also observed in retrobulbar segments of both optic nerves. The patient was admitted to DISSEMINATED intensive care unit due to respiratory arrest during follow-up. OLIGODENDROGLIAL-LIKE Conclusion: In cases of severe methanol intoxication, besides bilateral LEPTOMENINGEAL TUMOR: A RARE basal ganglia lesions, diffuse subcortical and deep white matter lesions can also be observed in brain MRI. The amount of metabolic acidosis, CHILDHOOD TUMOR cumulated formic acid and prognosis depends on the amount of metha- KURSAT ERMAN, A. UTKU SENOL nol taken by the patient. Early diagnosis is important for the prognosis. Detection of optic nerve involvement using brain diffusion MRI in cases Akdeniz University School of Medicine, Antalya, Turkey presenting with sudden visual impairment may provide early diagnosis and Abstract treatment.

Disseminated oligodendroglial-like leptomeningeal tumor is a recently Keywords: Methanol intoxication, optic nerve, basal ganglia known entity whose radiological characteristics have rarely been discussed before. It should be differentiated clinically and radiographically from granulomatous or infectious conditions such as tuberculous menin- P - 0236 gitis. The key to the diagnosis, even at an early stage, might be the presence of tiny T2 hyperintense lesions on the surface of the brain or spine. CHOROID PLEXUS PAPILLOMA When suspected, a meningeal biopsy should be performed to confirm PRESENT WITH HIGH PERFUSION Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S115

RAFAIL JOMARDOV, CENK ERASLAN, OMER KITIS, the best of our knowledge, there is no literature data about CTTH in GOKCEN COBAN, CEM CALLI, TANER AKALIN adults. In this report, we aimed to summarize the clinical data of a twenty- year-old woman with a diagnosis of systemic lupus erythematosus with Department of Radiology, Ege University School of Medicine, İzmir, Turkey symmetrical CTTH on magnetic resonance imaging. Abstract Keywords: Central segmental hyperintensity, Systemic lupus erythema- Choroid plexus papillomas benign (WHO grade 1) neuroepithelial intraven- tosus tricular tumour which can occur in both the paediatric and adult population. The frequent locations are the lateral ventricle in infants and children and the fourth ventricle in adults. Choroid plexus papillomas are isointense on T1-waighted images and iso-hyperintense on T2-waighted images to the P - 0239 cortex and enhanced strongly after contrast administration. Advanced MR imaging techniques such as perfusion-weighted imaging could provide addi- RADIOLOGICAL SPECTRUM OF tional information on tumor vascularization that may help in the differential IDIOPATHIC INTRACRANIAL diagnosis. Perfusion maps showed hypoperfusion low values of rCBV generally. Studies reported high perfusion values for choroid plexus carcinoma and HYPERTENSION: A CASE SERIES low perfusion values for choroid plexus papilloma perspectively. In this rare ALI MURAT KOC1, OZGUR ESEN1, case we demonstrate choroid plexus papilloma with high perfusion values. GULSEN YUCEL OGUZDOGAN1, NESLIHAN ESKUT2, 1 Keywords: Choroid plexus papillomas, choroid plexus carcinoma, rCBV, ZEHRA HILAL ADIBELLI high perfusion 1Clinic of Radiology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey 2Clinic of Neurology, University of Health Sciences, İzmir Bozyaka Training P - 0237 and Research Hospital, İzmir, Turkey Abstract TENTORIUM CEREBELLI HYPOPLASIA WITH CEREBRAL HERNIATION Seven patients with suspected intracranial hypertension were evaluated with cranial MRI. All patients were referred for cranial MRI scan with symp- MERIC TUZUN, BAKI HEKIMOGLU tom of headache. One of the patients found to had a history of venous Department of Radiology, Health Sciences University, Dışkapı Yıldırım sinüs thrombosis. Four patients had papilledema, two with blurry vision. Beyazıt Training and Research Hospital, Ankara, Turkey One of the patients had runny nose and suspected for rhinorrhea. Beta-2 transferrin test was positive, hence diagnosed as CSF leak. All of the patients Abstract had elevated CSF opening pressures, which were evaluated after MRI scan. Tentorium cerebelli hypoplasia is an uncommon condition and generally Most common findings were enlarged subarachnoid spaces around optic is seen with other central nervous system malformations. The cause of nerves and partial empty sella, seen in 6 of 7 patients. Other common this anomaly is unknown. It may be due to perinatal injury or impaired findings were flattening of posterior sclera and arachnoid pits, seen in 4 embryological development. In this report, a case with tentorial hypopla- patients. Slit-like ventricles, enlarged meckel caves were seen in 3; menin- sia and cerebral herniation without coexisting anomaly is presented with gocele and optic nerve tortuosity seen in 2; tonsillar ectopy and venous magnetic resonance imaging findings. sinüs thrombosis were seen only in one patient. Intracranial hypertension is a clinical syndrome with specific radiological findings. Detection of venous Keywords: Tentorium cerebelli, hypoplasia, herniation, magnetic reso- sinüs thrombosis and meningocele with possible CSF leakage are crucial at nance imaging the time of diagnosis. Radiological signs of intracranial hypertension should be kept in mind in patients with headache. P - 0238 Keywords: Intracranial hypertension, HRI, headache SYMMETRICAL T2 HYPERINTENSE SIGNAL OF THE CENTRAL TEGMENTAL P - 0240 TRACT IN AN ADULT PATIENT PRIMARY CYSTIC CENTRAL NERVOUS NUR HURSOY1, ELIF PEKER1, SINAN GENC2, ILHAN ERDEN1 SYSTEM LYMPHOMA MIMICKING 1Ankara University School of Medicine, Ankara, Turkey FUNGAL ABSCESS 2Dr Behçet Uz Child Diseases Training and Research Hospital, İzmir, Turkey ALi MURAT KOC1, OZGUR ESEN1, BETUL BELKIS TOKLU1, Abstract AYSE YAGCI3, ISMAIL AKKOL2, ZEHRA HILAL ADIBELLI1 The symmetrical T2 hyperintense signal of the central tegmental tract 1Department of Radiology, University of Health Sciences, İzmir Bozyaka (CTTH) is a rare finding in the pediatric population. In children, this imag- Training and Research Hospital, İzmir, Turkey ing finding can be associated with brain tumors, epilepsy, developmental 2Department of Neurosurgery, University of Health Sciences, İzmir Bozyaka delay, metabolic disorders and genetic syndromes, hypoxic-ischemic Training and Research Hospital, İzmir, Turkey encephalopathy, and epilepsy. Because of this different clinical conditions, 3Department of Pathology, University of Health Sciences, İzmir Bozyaka some authors also suggest that CTTH might be a physiologic process. To Training and Research Hospital, İzmir, Turkey S116 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Abstract P - 0242 Central nervous system lymphomas are relatively uncommon pri- IMAGING FINDINGS OF WALLENBERG mary brain tumors. Due to their hypercellular nature, they are usually solid, enhancing tumors. CT examinations show hyperdense tumors, SYNDROME whereas MRI demonstrates T2-hypointense tumors with little per- EMEL YERLI, KEMAL BUGRA MEMIS, ELIF PEKER, ilesional edema. Diffusion imaging is helpful in differential diagnosis MEMET ILHAN ERDEN where lower ADC values are in favor of lymphoma diagnosis. Here we present a 70-year-old lady admitted to hospital with weakness of Ankara University School of Medicine, Ankara, Turkey left leg started one week ago. MRI examination demonstrated a cystic Abstract 2 cm mass in right precentral gyrus with solid T2-hypointense wall Wallenberg syndrome is one of the cerebrospinal syndromes that occur and prominent perilesional vasogenic edema. Lesion was peripherally due to the infarction of the lateral medulla and cause neurological symp- enhancing and diffusion imaging showed low ADC values in thick wall toms. In this case series Magnetic resonance (MR) imaging findings of of the cystic lesion. MR spectroscopy showed lactate peak with little three patients with Wallenberg syndrome are presented. elevation in Choline. Radiological differential diagnosis was in favor of fungal abscess or a necrotic metastasis. Intraoperative ultrasonography Diffusion wieghted MR imaging of three patients with Wallenberg syn- demonstrated precise location of the right frontal mass with semi- drome revealed acute ischemia on the right posterolateral of the bulbus, solid sonographic echogenicity. Pathological diagnosis of the mass was diffusion restriction at the right cerebellar hemisphere and right postero- surprisingly a central nervous system lymphoma. Although primary lateral portion of the bulbus and diffusion restriction at the right half of CNS lymphomas resembles many other pathologies including tumors the bulbus compatible with acute ischemia. and abscesses; it’s even more rare when they appear as cystic lesions. Wallenberg syndrome is one of the brain stem syndromes that occur with Keywords: Lymphoma, CNS, cystic the infarction of the lateral medullary. Keywords: Wallenberg syndrome, bulbus, acute ischaemia, diffusion restriction P - 0241 WALLERIAN DEGENERATION OF P - 0243 MIDDLE CEREBELLAR PEDINCULE A RARE CAUSE OF CAVERNOUS EMEL YERLI, KEMAL BUGRA MEMIS, ELIF PEKER, MEMET ILHAN ERDEN SINUS AND SUPERIOR OPHTALMIC VEIN THROMBOPHLEBITIS: FUNGUS Ankara University School of Medicine, Ankara, Turkey BALL IN SPHENOID SINUS Abstract ALI MURAT KOC1, ABDULHALIM AYSEL2, FATIH YILMAZ2, Introduction: Wallerian degeneration is defined as distal axonal injury UGURTAN ERGUN2, DENIZ TUNA EDIZER2, AYSE YAGCI3, and antegrade destruction of the myelin sheath secondary to the injury GULSEN YUCEL OGUZDOGAN1 of proximal axon or cell body. High signal abnormalities in white matter 1 and atrophy may be seen at MRI. The most common cause of wallerian Clinic of Radiology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey degeneration is infarct, but it can be due to many factors such as hemor- 2Clinic of Otorhinolaryngology, University of Health Sciences, İzmir Bozyaka rhage, trauma and neoplasia. We report a case of Wallerian degeneration Training and Research Hospital, İzmir, Turkey in the corticospinal tract and both middle cerebellar peduncles due to 3Clinic of Pathology, University of Health Sciences, İzmir Bozyaka Training pons infarction. and Research Hospital, İzmir, Turkey Case Report: A 45-year-old male patient was admitted to our hospital Abstract with complaints of hypertension and headache who has Buergers dis- Cavernous sinüs thrombophelibitis (CST) is a rare disease but it has high ease in the history. On nonenhanced magnetic resonance (MR) imag- potential of morbidity and mortality. Most common cause of CST is para- ing, encephalomalacia was observed at the pons. Hyperintense signal nasal sinusitis, followed by odontogenic and/or otogenic infections. Patients which crossed the descending pyramidal tract in the inferior bulbus and with CST commonly have multiple cranial nerve palsies, headache, fever, extended to the lateral corticospinal tract, was observed. In both middle periorbital edema, chemosis, proptosis and vision loss. Herewe present a cerebellar peduncles, hyperintense signal in T2 AG and FLAIR sequences 67 year old lady admitted to hospital with headache, redness in right eye, were observed. double vision for the last 10 days. Neurological examination showed right Conclusion: Wallerian degeneration is most commonly seen on the orbital proptosis, chemosis, restricted ocular movements in right, supe- corticospinal tract. In cerebellar peduncles, wallerian degeneration is rior and inferior directions. Cranial MRI examination showed asymmetic enlargement and enhancement of right cavernous sinus. There was also relatively rare, but the most common part is middle cerebellar peduncles dural enhacement through the right temporal lobe. Right superior oph- because they are larger than others and are the main component of the talmic vein was thickened, tortuose with peripheral edema; post-contrast pontocerebellar tract. images showed enhancement through walls of the vein and also filling Keywords: Wallerian degeneration, cerebellum, middle cerebellar pedin- defect favoring thrombosis. MRI together with CT images showed soft cule tissue obliteration of right side of sphenoid sinus which is hypointense on Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S117

T2 images and showed calcified spots inside in CT images. CT also showed University of Health Sciences, İzmir Bozyaka Training and Research sclerosis of sphenoid sinus walls. Imaging findinds were consistent of right Hospital, İzmir, Turkey cavernous sinus and superior ophtalmic vein thrombosis with a possible Abstract etiology of chronic fungal infection in sphenoid sinus. Patient was treated with steroids and operated afterwards. With endoscopic sphenoidotomy Focal cortical dysplasias (FCDs) are the most common cause of epilepsy of the spheniod sinus at the affected side, fungal ball was diagnosed and in children. There are typical findings in MRI dedicated to FCD: cortical infectious material was cleared from the sinus. Follow-up examinations thickening, blurring, cortical signal changes, subcortical signal changes, and showed complete resolution of findings together with full recovery of “transmantle” sign. The transmantle sign is often presented as a focal clinical symptoms. finding, typically limited to one or several gyri with well-defined epileptic tissue. MRI shows signal abnormality extending from the cortex to the Keywords: Cavenous sinus thrombosis, superior ophtalmic vein, mri, superolateral wall of the lateral ventricle. Histological findings are cortical fungus ball disorganization, neuronal cytomegaly, balloon cells, indistinct cortical gray matter-white matter junctions, and variable accompanying astrogliosis. MRI is critical to determine the morphological alterations in cortical dysplasia P - 0244 - the placement and full content of the lesion and the correlation of the lesion to the eloquent areas of the brain. Here we present MRI findings of SPONTANEOUS VENTRICULOSTOMY FCD II by reporting 3 patients who shows symptoms of epilepsy or fixed DUE TO A THIRD VENTRICULAR neurologic deficits. One patient has (right parietooccipital), two patients ARACHNOID CYST: A CASE REPORT have (left frontal) lobe FCD with gray/white matter blurring on T2 images. Cortical thicknening is well demonstrated with T1-IR images through its YUSUF KENAN CETINOGLU, ATILLA HIKMET CILENGIR, high contrast ratio between gray and white matter. Transmantle sign is OZGUR TOSUN, MUSTAFA FAZIL GELAL nicely presented on T2 and T1-IR images.There was no contrast enhance- Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and ment in the lesions but one of them was observed with DNET. Its crucial Research Hospital, İzmir, Turkey to define the exact location of FCD because in many patients, surgical resection of the epileptogenic focus can control the seizures when the Abstract location of the lesion is precisely evaluated preoperatively. Arachnoid cysts (AC) are benign, extra-axial space-occupying developmental Keywords: Focal cortical dysplasias, MRI, Transmantle sign lesions that filled with cerebrospinal fluid (CSF). Almost 50% of ACs are located in the middle cranial fossa. Rarely, they can occur within the intraventricular system. Although intraventricular ACs are usually asymptomatic and discovered incidentally, sometimes patients may present with a non-specific P - 0246 headache, seizures and obstructive hydrocephalus symptoms. Surgical inter- CEREBELLAR CLEFT vention is usually needed if hydrocephalus is present. On the other hand, in few cases of chronic obstructive hydrocephalus, spontaneous ventriculostomy OZLEM GUNGOR, ALPER BATAK, CANSU OZTURK, may occur. Spontaneous ventriculostomy is a very rare condition that results SELMA UYSAL RAMADAN from spontaneous rupture of ventricular wall connecting the ventricular Keçiören Training and Research Hospital, Ankara, Turkey system to the subarachnoid space mostly seen on the floor of the third ventricle. Herein, we report a case of 49-year-old women who presented Abstract with a non-specific headache. Obstructive hydrocephalus which is secondary Cerebellar cleft (CC), one of the cerebellar disruptions, had have little pay to third ventricular AC above the superior portion of cerebral aqueduct attention in the literature. There are not consensus of causes and clinical and also giant multilobulated Virchow-Robin (VR) space causing aqueductal consequences of CC in the literature. Some exogenous (i.e. infections) narrowing in the pontomesencephalic region was seen on her MRI. On CSF or intrinsic (i.e. coagulopathies) causes or a complication of extreme pre- flow study, there was no aqueductal flow but a CSF flow between the third maturity accused on the pathogenesis of cerebellar disruptions. Although ventricle and the prepontine cistern was seen. Since she had no history of the pathogenesis of CC is not clear, some malorientation of cerebellar surgical intervention, it was thought to be a spontaneous ventriculostomy. As foliation and irregular gray/white matter junction can be seen on CC and far as we know, this is the first reported case of obstructive hydrocephalus cerebellar hemispheres are asymmetric volumes due to the fact that the due to third ventricular AC and an overlapped midbrain giant VR space which affected hemisphere is smaller than contralateral side. Clinical symptoms resulting in spontaneous third ventriculostomy. are highly variable such as truncal ataxia, dysarthria, ocular motor apraxia, Keywords: Arachnoid cyst, obstructive hydrocephalus, spontaneous ven- intellectual disability, speech impairment, and behavioral changes. CC is triculostomy, CSF flow study, Virchow Robin space diagnosed usually during childhood ages in the literature. In this present study, we presented a 32-year-old man with speech impairment since his childhood. His right cerebellar hemisphere was smaller than P - 0245 contralateral side and it had linear defect filling with CSF extending from the surface of cerebellar hemisphere to fourth ventricle on MRI. There TRANSMANTLE SIGN: A SPECIFIC was not additional supratentorial and contralateral cerebellar hemisphere FINDING OF FCD TYPE II abnormality. According to this MRI findings CC was diagnosed in this patient. ALI MURAT KOC, GULSEN YUCEL OGUZDOGAN, The cases of CC were generally diagnosed during childhood ages in the BETUL BELKIS TOKLU, ZEHRA HILAL ADIBELLI, OZGUR ESEN literature. However, we presented a case with CC who was diagnosed on S118 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 adult age. This shows that CC can be under-recognized until adult age. GULSEN YUCEL OGUZDOGAN, ALI MURAT KOC, Because of that, a special care must be given during evaluation of cerebel- BETUL BELKIS TOKLU, OZGUR ESEN, ZEHRA HILAL ADIBELLI lum on cranial MRI. University of Health Sciences, İzmir Bozyaka Training and Research Keywords: Cerebellar cleft, adult age,cerebellar disruptions Hospital, İzmir, Turkey Abstract Primitive trigeminal artery (PTA) is the most common anomaly of P - 0247 primitive carotid-basilar anastomosis with an incidence between 0.1% and 0.3% and is related with cerebrovascular anomalies, such as aneurysm. CEREBRAL AND CEREBELLAR Approximately 14% of patients with a persistent trigeminal artery also METASTASES OF SMALL-CELL LUNG have an intracranial aneurysm. In 1950, Sutton was the first to show PTA angiographically. CANCER MIMICKING MULTIPLE Giant or large cavernous aneurysms associated with PTA are rare, and ISCHAEMIC LESIONS treatment strategies differ when compared to large or giant aneurysms SUAT INCE, IBRAHIM ILIK, FATMA DURMAZ, without PTA. Therefore; determining the PTA is important. HARUN ARSLAN There are 2 different types (Saltzman type I, Saltzman type II) of PTA. Van Yüzüncü Yıl University School of Medicine, Van, Turkey In first type, distal vertebro-basilary arteries are supplied by PTA. The PCOM is absent and the caudal BA is absent or hypoplastic with hypo- Abstract plastic distal vertebral arteries. In the second type, PTA provides superior cerebellar arteries with the PCAs supplied by the PCOM. Objective: Restricted diffusion that is found on typically indicates acute ischaemic stroke. However, restricted diffusion can also occur in other Here we present a 61-year-old woman who has been suffering from thun- diseases, like metastatic brain tumours, which we describe in this case derclap headache recently. Magnetic resonance imaging (MRI) revealed a report. tubular signal void lesion near the left cavernous segment of ICA. MR angiography demonstrated a vascular structure extending from the cav- Materials and Methods: 55-year-old patient who was followed up for ernous segment of the left internal carotid artery to basillary artery, which small-cell lung cancer was referred to the emergency department due is consistent with persistent trigeminal artery. Furthermore, a tortuosity to severe headache and dizziness. Non-contrast brain CT and magnetic and dilatation were noted, indicating an aneurysmal filling in PTA. Hence resonance diffusion-weighted imaging (DWI) were performed on the the PCOM was also absent, the findings were compatible with Saltzman patients in terms of differential diagnosis. type 1. Results: Non-contrast brain CT revealed multiple hyperdense lesions The presence of PTA should be suspected in cases where Neptune’s tri- in both basal ganglion and cerebral-cerebellar hemispheres. Lesions dis- dent sign or Tau sign is observed in sagittal angiographic images. played restricted diffusion on DWI and mimic acute ischemia. Clinical- Keywords: Persistent trigeminal artery, aneurysm, MRI radiological findings and following the patient, the described lesions were evaluated as hypercellular metastatic focus due to small-cell lung cancer. P - 0249 Conclusion: Restricted diffusion on DWI is observed primarily in acute or hyperacute ischaemic infarcts, abscesses, and in certain hypercellular CEREBRAL CORTICAL VENOUS brain tumours. Restriction of diffusion that is observed in cerebral THROMBOSIS metastases could result from a high nuclear-cytoplasmic ratio with relative hypercellularity of cancer cells, liquefactive necrosis, and haemor- ALI MURAT KOC, GULSEN YUCEL OGUZDOGAN, rhage. A potential relationship between primary tumour cell type and BETUL BELKIS TOKLU, TURKER ACAR, ZEHRA HILAL ADIBELLI presence of cerebral metastases that are characterised by restricted University of Health Sciences, İzmir Bozyaka Training and Research diffusion has been studied by some authors. Those authors noted that Hospital, İzmir, Turkey cerebral metastases with restricted diffusion were observed primarily Abstract in patients with lung cancer (small-cell and non-small-cell carcinoma) or breast cancer. Moreover, 15 patients with colon cancer and prostate Cerebral venous thrombosis (CVT) is a rare thrombotic disorder involv- cancer also presented with cerebral metastases that displayed restricted ing the cerebral veins and dural sinuses. CVT mainly affects adults younger diffusion. than 50 years and children. People older than 65 years represents only %10 of the patients. %75 of the cases are seen in women. Although Keywords: Metastases, restricted diffusion, cancer, ischaemic presenting symptoms are variable, headache is usually the first symptom, often in combination with focal neurologic deficits and epileptic seizures. Mortal rate in the acute phase is %5 up to 10, mostly caused by trans- P - 0248 tentorial herniation due to large parenchymal lesions or by generalized cerebral edema. Patients who survive the acute phase, %70 to 80 recover PERSISTENT TRIGEMINAL ARTERY without functional disability, but chronic symptoms such as headache and WITH ANEURYSM fatigue can be seen often. Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S119 2 patients who have CVT are presented: P - 0251 First patient is 40 years old man with MS disease. Intracranial hypotension PARTIAL SPINAL CORD AGENESIS MR and headache developed after lumbar puncture. Following this, MRI and MR venography examination demonstrated thrombosis in the Superior IMAGING FINDINGS Sagital Sinus and cortical veins. SAIM TURKOGLU, ABDUSSAMET BATUR, Second patient is 25 years old woman. She admitted with a seizure story SUMEYRA DEMIRKOL ALAGOZ, FATMA DURMAZ starting from the right upper extremity continue as generalized seizure. Departman of Radiology, Van Yüzüncü Yıl Universty School of Medicine, MR-MR venography was performed upon the suspicious hyperdense Van, Turkey appearance revealed at left frontal lobe in CT imaging. At the vertex level, Abstract no flow signal was detected in a cortical vein draining in to the superior sagittal sinus (Trollard vein) and thrombus-mediated hypointense signal Objective: Caudal regression syndrome is a rare neural tube defect that changes were noted. Edema-related signal increase and microhemorrhage involves spinal and visceral abnormalities ranging from coccygeal agenesis was also noted in the same gyrus in the left frontal region. to thoracic vertebral levels. Caudal agenesis is divided into two types. In type 1, the medullar is in a high position and ends suddenly. Although type Keywords: Trolard vein, lumbar punction, cortical vein trombosis 2 conus medullaris are observed in a low position. We aimed to present the MRI findings of the spinal cord partial agenesis with caudal regression syndrome. P - 0250 Materials and Methods: 2.5 year old female patient was suspected of der- MULTISYSTEM ATROPHY WITH MSA-P mal sinus tract and suspected of possible neural tube defects. Spinal cord fibers were not detected from the upper thoracal cavity within the spinal AND MSA-C SUBTYPES: MRI FINDINGS canal at the ultrasound. Spinal cord was observed up to T2-3 vertebra OF TWO CASES level and no significant spinal cord structure was observed from the distal end of this level. Irregular heterogeneous signal changes in the spinal canal AYTEKIN TAMER1, YUSUF KENAN CETINOGLU1, leading to expansions and cystic areas of 8mm in diameter sprouting in the FATMA UNCU CETIN2, YESIM SECIL2, MUSTAFA FAZIL GELAL1 spinal canal were observed at the lumbar region. Results were consistent 1Deparment of Radiology, İzmir Katip Çelebi University, Atatürk Training and with Type 1 partial agenesis of spinal cord variant. Research Hospital, İzmir, Turkey Discussion: Caudal regression syndrome is rare. Radiological findings 2 Deparment of Neurology, İzmir Katip Çelebi University, Atatürk Training include a sharp ending spinal cord, sacral hypoplasia or aplasia, lumbosacral and Research Hospital, İzmir, Turkey vertebral dysgenesis or hypogenesis. Often accompanied by spinal anoma- Abstract lies such as vertebral anomalies, congenital cardiovascular anomalies, pulmonary hypoplasia can be accompanied by cases. In our case, there was Multisystem Atrophy (MSA) is a relatively rare, sporadic, an adult-onset isolated partial spinal cord agenesis without any of them. progressive neurodegenerative disease characterized by parkinsonism, cerebellar ataxia, and autonomic dysfunction clinically. The disease is in Conclusion: MRI is the gold standard for imaging and surgical planning of the spectrum of synucleinopathies among with Parkinson disease and spinal cord abnormalities. Lewy body disease. On the basis of symptoms at onset, MSA has been Keywords: Spinal cord, spinal cord agenesis, mri divided into two subtypes: MSA-C (olivopontocerebellar atrophy) with predominance of cerebellar symptoms, MSA-P (striatonigral degenera- P - 0252 tion) with predominance of Parkinsonism. In both subtypes, autonomic symptoms can be seen. Because of a lack of reliable diagnostic biomark- HYDATID CYSTS OF THE HEART AND ers, MRI should be performed in patients with suspected MSA. Here, we BRAIN: A CASE REPORT WITH A aimed to present two rare cases of MSA. Our first patient, a 66-year-old woman, presented with imbalance, falling episodes for 5 years progressed COMPLICATION within the last 2 years. Additionally, she had amnesia and hypotension for GOKAY KARACA, ATILLA HIKMET CILENGIR, 4 months. MRI showed excessive parenchymal, middle cerebellar pedun- SEDAT ALTAY, EMINE MERVE HOROZ, OZGUR TOSUN, cular, brainstem, and olivary nucleus atrophy. On T2-weighted images, MUSTAFA FAZIL GELAL “hot cross bun sign” defined as cross-like T2 hyperintensity in pons was seen. Clinically, this patient was diagnosed with MSA-C and radiologic find- Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey ings were supportive. Our second patient was an 82-year-old man who was diagnosed with Parkinson disease two years ago in an outer clinic. Abstract He presented with bradykinesia, dysarthria, flexion rigidity, urgency, and Hydatid cyst is a parasitic disease which is endemic in many parts of the incontinence. MRI showed putaminal volume loss, decreased T2 signal world. It can develop in many organs of the human body and liver is the within the putamen relative to the globus pallidus. Abnormal bilateral primary affected organ. Other most common locations are lung, spleen, T2 linear rim surrounding the putamen called “putaminal rim sign” was kidney, bones, brain and heart. After opening of the eggs in the gastro- also noted. Clinical and radiological findings of this patient supported the intestinal tract, the larvae migrate to the liver, then they spread to other diagnosis of MSA-P. organs with systemic circulation. Although cardiac involvement is not a Keywords: Multisystem atrophy, olivopontocerebellar atrophy, striatoni- very common clinical condition, it may cause life threatening complica- gral degeneration, synucleinopathies, MRI tions such as rupture, tamponade, embolism, anaphylactic shock, infec- S120 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 tion, rhythm disorders, acute coronary syndrome and valve dysfunction. Keywords: DVA, developmental venous anomaly, AVM, cavernoma, capil- The most common locations in the heart are the left ventricular wall, lary telangiectasias, MRI right ventricular wall and interventricular septum, in decreasing order of frequency. In the brain, which is another rarely effected organ, cycts are located in the vascular territory of the middle cerebral artery. Isolated P - 0254 cerebral hydatid cyst is quite rare, it generally coexists with other visceral involvement. Cystic lesions are usually single, round and unilocular. When PEDIATRIC ACUTE it reaches large dimensions neurological symptoms due to increased intra- ENCEPHALOMYELITIS cranial pressure can be seen. ZEYNEP NILUFER TEKIN1, ATILLA DAMLACIK2, We present a 26-year-old male patient who had cerebral and cardiac OZLEM SAYGILI3 hydatic cyst. Since he did not have neurological symptoms, first cardiac surgery was performed. After cardiac surgery the patient presented with 1Medeniyet University, Göztepe Training and Research Hospital, İstanbul, seizure and numbness in the left arm. CT scan showed that hydatid cyst Turkey 2Acıbadem Kadıköy Hospital, İstanbul, Turkey in the right frontal lobe had ruptured. The patient was taken to surgery 3Acıbadem University, İstanbul, Turkey immediately. Herein we aimed to present a rare case with simultaneous cerebral and cardiac involvement, complicated with cerebral cyst rupture Abstract after cardiac surgery. A 4-year-old female child patient who had a history of a recent acute Keywords: Hydatid cyst, cardiac, interventricular septum, brain, rupture otitis media treatment presented with high fever, weakness, quadriparesis and rapidly progressive gait disturbance. Ataxic gait and drop, neck stiffness and drowsiness were observed on her physical examination. P - 0253 Contrast-enhanced cranial and whole spinal magnetic resonance imaging (MRI) were performed to demonstrate the pathology. Cranial MRI A RARE DEVELOPMENTAL showed bilateral otomastoiditis and increased signal intensity in basal VENOUS ANOMALY WITH THREE ganglia, pons and right thalamus without any pathological contrast enhancement. Whole spinal MRI demonstrated partly well-defined, LARGE COLLECTOR VEINS: CASE multifocal, integrative, minimally expansile plaque-like lesions within all PRESENTATION, BRAIN MRI, segments of spinal cord. The lesions showed no contrast enhancement. SWI, MRA, DSA FINDINGS WITH When all these imaging findings and clinical conditions were taken into consideration; the definitive diagnosis was made as acute encepha- DIFFERENTIAL DIAGNOSIS lomyelitis developed after bilateral severe viral acute otomastoiditis. RAHIME SEZER, MUHTESEM AGILDERE The patient was admitted to intensive care unit in order to be given antivirals, intravenosus immunoglobulin (IVIG), steroids as an efficient Başkent University School of Medicine, Ankara, Turkey and wide-spectrum treatment. The patient’s symptoms were resolved Abstract progressively during a period of twenty days. The lesions in the spinal cord showed nearly total regression in all segments on her control MRI. By definition developmental venous anomalies have one main collector This case emphasizes that clinicians must be aware of the possibility of vein but in presented case there are three large collector veins draining acute encephalomyelitis associated with viral infections, because early into straight sinus, hypoplastic left transverse sinus and vein of Galen, and aggressive treatment (antivirals, IVIG, steroids, plasmapheresis) interestingly with a large mass effect. In this presentation by the findings of improve the overall clinical outcome in these cases. this rare case of DVA with three collector veins, other vascular anomalies including pial arteriovenous malformation (AVM), dural AVM, cavernoma Keywords: Acute encephalomyelitis, pediatric, magnetic resonance imag- and capillary telengiectasia will be discussed as differential diagnosis on the ing basis of crucial imaging findings. A 19 years old man with a history of blind head trauma will be discussed with his brain CT, MRI, MR Venography (MRV) and Digital Substruction P - 0255 Angiography (DSA) imaging findings. A USEFUL SIGN IN DIAGNOSTIC The lesion had 3 large collector veins which drains into the straight NEURORADIOLOGY: ‘HOT CROSS sinus through the ambient cistern, vein of Galen through the left lateral BUN SIGN’ IN A PATIENT WITH ventricle and left hypoplastic transvers sinus with a transcortical course. On susceptibility Weighted Images (SWI) medullary veins of the DVA CEREBELLAR TYPE OF MULTIPLE had high signal areas and collector veins had low signal areas due to dif- SYSTEM ATROPHY (MSA-C) ference of the blood flow. In phase and out of phase images showed no haemorrhage. SHWETA GUPTA, JOERG EDERLE, OSMAN CANCURI Princess Royal University Hospital, Locksbottom, England The number and size of collector veins may vary due to size of the lesion. Abstract Surgical treatment or other interventions should be avoided. The association of cavernoma with DVA is not rare and if its symptomatic look for Multiple system atrophy (MSA) is a sporadic, progressive neurode- a cavernoma and if ıts needed the treatment should be for cavernoma. generative disorder characterized clinically by autonomic dysfunction, Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S121

Parkinsonism (MSA-P), and cerebellar ataxia (MSA-C) in any combina- ing MRA examination was within normal limits. The imaging findings were tion. The Hot Cross Bun sign (HCB) describes cruciform hyperintensity evaluated in terms of autoimmune paraneoplastic extralimbic encephalitis, of the pons on the transverse T2 weighted MR images. The HCB sign as the findings of the patient were atypical and incompatible with other has mostly been described in patients with multiple system atrophy of encephalitis findings. After this treatment regression was observed in the the cerebellar type (MSA-C). Although this sign is not pathognomonic findings of the patient. It was presented for the rare occurence. for MSA-C, it has high diagnostic value. Herein, we present a case of Keywords: Paraneoplastic ensefalitis, autouimmune encephalitis, limbic MSA-C to emphasize the value of the HCB sign. A 53y female patient ensephalitis presented to neurology clinic with long standing complaints of walking difficulty, slurring, speech and handwriting problems, mild urinary symptoms. On physical examination she had mild limb and gait ataxia. MRI revealed HCB sign associated with pontine atrophy, bilateral symmetrical P - 0257 T2 hyperintensity and atrophy of the middle cerebellar peduncles. CSF study was unremarkable. The genetic testing for ataxia syndromes was MAGNETIC RESONANCE FINDINGS negative. MSA-C was finally diagnosed based on appropriate neuroimag- OF ZELLWEGER SYNDROME ing and clinical findings. ERGIN SAGTAS1, HAKAN ABDULLAH OZGUL2 Keywords: Multiple System Atrophy (MSA), the Hot-Cross-Bun (HCB) 1Department of Radiology, Pamukkale University School of Medicine, sign, Neurodegenerative Disease Denizli, Turkey 2Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey P - 0256 Abstract A CASE OF CHILD WITH REVERSIBL Zellweger syndrome (ZS) as also known cerebrohepatorenal syndrome EXTRALIMBIC PARANEOPLASTIC is the most severe peroxisomal metabolic disease, inherited autosomally recessive. In the case of Zellweger syndrome, especially the central ner- ENCEPHALOPATIES vous system, the liver and kidneys, and the musculoskeletal systems are TULIN HAKAN DEMIRKAN1, GULSAH BAYRAM1, affected. In this syndrome, which is very rare, patients are usually diagnosed OZLEM BALIK2, HAVVA AKMAZ UNLU1, MESUT SIVRI1, in the prenatal period and they generally die within the first year of life. MEHMET TIFTIK1 Radiological imaging methods have an important role in the clinical diagnosis of ZS but the most valuable imaging method in diagnosis is Magnetic 1 Dışkapı Children Health and Diseases, Hematology Oncology Training and Resonance Imaging (MRI). Herein we present MRI findings of ZS. Research Hospital, Ankara, Turkey 2Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey A 35-week-old fetus applied to our hospital because of hydrocephalus detected during ultrasonography in the prenatal period. Patient with Abstract APGAR score 3 at birth, admitted to a neonatal intensive care unit. Autoimmune encephalitis has begun to be defined in the medical litera- Brain MRI was applied due to hydrocephalus. Brain MRI revealed lateral ture with an entity to characterize with a change in the initial onset of ventricular diameter of 12 mm and third ventricular diameter of 6 mm. mental status. Although increasingly defined, it is often diagnosed in large Patient with cavum septum pellucidum et vergae variation, MRI showed tertiary centers. Autoimmune encephalitis is a group of closely related diffuse intensity increase in white matter in T2W. In addition pachygyria disease processes that overlap with each other and share neuroimaging and polymicrogyria patterns was detected. Patient had other components findings. However, different underlying SSS constructs differ from the of ZS such as hepatomegaly, hyperechoic kidneys, and the presence of specific antibody types that vary according to the underlying system. a typical facial appearance. With these findings samples were sent for Antibody attack made by neuronal construction causes localized inflam- genetic studies. Radiologic examinations, especially MRI in the diagnosis matory changes. Clinical and imaging findings are specific to the variability of ZS have a high importance. ZS should be considered in the differential of the underlying immune response in the nervous system. Autoimmune diagnosis of hydrocephalus. encephalitis is the most frequent involvement of the limbic system, Key Words: Zellweger syndrome, magnetic resonance imaging, hyrdro- depending on the profile of the original antibody, the degree of involve- cephalus ment may vary from neocortex, striatum, posterior fossa, medulla spinalis and peripheral nerves. Paraneoplastic disorders may present with limbic encephalitis, cerebellar P - 0258 degeneration, and brain stem encephalitis. While most of the cases show classic presentation, in some cases, paraneoplastic neurological findings A RARE CASE: BRAIN INVOLVEMENT may involve focal or multifocal cerebral or cerebellar hemispheres other OF LIPOID PROTEINOSIS, MRI than the limbic system. FINDINGS Our case was a 2 year old girl who was being treated with the cause of embryonal rhabdomyosarcoma. On the other hand, in the MR examination SINAN AKAY, ALAKBAR IMANLI, UGUR BOZLAR, performed changes, unilateral spreading on the right cortical side and diffu- MUSTAFA TASAR, KEMAL NIYAZI ARDA, SALIH HAMCAN, sion restriction on the basal ganglions were observed while cortical diffusion HATICE TUBA SANAL restrictions were observed in the left cortical pattern while regression was Department of Radiology, Gülhane Training and Research Hospital, İstanbul, observed in the follow-up control examinations. At this time, the withdraw- Turkey S122 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Abstract DINARA MAMEDOVA, DENIZ SOZMEN CILIZ, Introduction: Lipoid proteinosis (Urbach-Wiethe disease), is a rare, MEHTAP CAVUSOGLU, HATICE GUL HATIPOGLU CETIN, autosomal-recessive, genetic disorder characterized by intracellular depo- BULENT SAKMAN sition of amorphous hyaline material and multisystem involvement. Skin, Ankara Numune Training and Research Hospital, Ankara, Turkey mucosa, and central nervous system are commonly affected. In this Abstract report, we aimed to present cranial MRI findings of characteristic brain involvement in lipoid proteinosis. Introduction: Intracranial chondrosarcomas are very rare (0.15%) tumors mostly occurring in the skull base. Primary location supratentorialy has Case report: 25-year-old female patient previously diagnosed with lipoid a very low occurrence rate. In our case report, we present Intracranial proteinosis was admitted to our hospital due to new lesions on her Supratentorial Chondrosarcoma mimicking calcified brain tumor. face. On physical examination, besides hoarseness, she had small papules and atrophic plaques on her face region, elbows and fingers. Contrast Case Report: A 48-year-old man presented to the emergency depart- enhanced Brain MRI was obtained for possible brain involvement. MRI ment (ED) after a fall and a head trauma. The patient was suffering revealed that, bilateral symmetric markedly T2 hypointense lesions in from a severe headache. Initial Computed tomography (CT) of the head amigdala. There wasn’t any diffusion restriction or contrast enhancement. showed 8x4.5x6 cm well-defined lobulated, calcified tumor located in a With these findings lesion sustained as calcification. left frontoparietal region with no extension to the calvarium. The tumor had ring and arc calcifications. The scan also revealed intra end extra axial Conclusion: Lipoid proteininosis is a multisystemic disease due to ECM1 hemorrhages due to trauma (not shown). Also left to right shift. MRI gene mutation. Central nervous system involvement is seen in 50-75% examination of the patient was performed. The tumor had no diffusion of cases. The hallmark findings are calcifications, mostly occurring in the restriction and had peritumoral edema. The patient underwent surgery, amygdala, hippocampus, parahippocampal gyrus, or even the striatum. histopathology result showed grade 1 Chondrosarcoma. The patient Keywords: Lipoid proteinosis, MRI, amigdala, calcification underwent follow-up, MRI spectroscopy, which revealed residual tumor. The patient received adjuvant radiotherapy and the tumor disappeared. Conclusion: Intracranial chondrosarcomas are rare but should be consid- P - 0259 ered as a differential diagnosis of intracranial tumors. MRI FINDINGS IN Keywords: Intracranial, supratentorial, Chondrosarcoma RHOMBENCEPHALOSYNAPSIS, REPORT OF THREE CASES P - 0261 NUR HURSOY, ELIF PEKER, ILHAN ERDEN TUBER CINEREUM HAMARTOMA: MRI Ankara University School of Medicine, Ankara, Turkey FINDINGS Abstract ALPER DILLI1, IDIL GUNES TATAR1, SELDA TEZEL1, We presented the imaging findings of three adult cases (a 48-year-old female, NURSU ERDOGAN2 25-year-old, and 39-year-old male patients) and two of them have partial 1Department of Radiology, University of Health Sciences, Ankara Dışkapı rhombencephalosynapsis. Rhombencephalosynapsis is a rare posterior fossa Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey anomaly which characterized by fusion of the cerebellar hemispheres and 2Department of Neurology, University of Health Sciences, Ankara Dışkapı the vermian agenesis/hypogenesis. There could be associated supratentorial Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey anomalies. Obersteiner first described the post-mortem findings at 1914 and at 1991, MR imaging findings of three cases have been published. The main Abstract pathology is the fusion of cerebellar hemispheres (single-lobed cerebellum) The aim of this case was to demonstrate the MRI findings of tuber with no cyst or cleft between them. In magnetic resonance imaging, the find- cinereum hamartomas which are benign non-neoplastic gray matter het- ings include a narrow fourth ventricle and transversely oriented cerebellar erotopias. A ten-year-old boy with gelastic seizures was referred to the folia. The clinical presentation depends on vermian agenesis/hypogenesis and radiology department for MRI. His cranial MRI examination revealed a the degree of cerebellar dysfunction. Since the imaging findings are unique solid parasellar lesion of 31x20x20 mm located between the optic chiasm and pathognomonic, the radiologist should be aware of this clinical entity thus and mammillary bodies. The lesion was diagnosed as tuber cinereum may guide clinicians to the appropriate diagnosis. hamartoma since it was isointense to the gray matter and did not show Keywords: Complete rhombencephalosynapsis, partial rhombencepha- contrast enhancement. losynapsis Tuber cinereum hamartomas are benign non-neoplastic gray matter heterotopias which originate between optic chiasm and mammillary bodies. Radiologically they can be sessile or pedinculated. When increased in size P - 0260 they can exert pressure to the third ventricule or optic chiasm. Since they are gray matter heterotopias they are isointense to gray matter on MRI INTRACRANIAL SUPRATENTORIAL sequences. However they can show high T2 signal due to the increase of CHONDROSARCOMA MIMICKING the glial cell content. Clinically central puberty precox, gelastic seizures CALCIFIED BRAIN TUMOR: A RARE and visual field problems can occur. CASE REPORT Keywords: Tuber cinereum, hamartoma, MRI Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S123 P - 0262 Syndrome which is an autosomal recessively inherited degeneration with iron deposition in the brain. The eye of the tiger sign demonstrates the A CHILD CASE WITH HEMAFAGOCYTIC central T2 hyperintense spot within the hypointense globi pallidi due to LYMPHOHISTYOSIS CNS INVOLVMENT vacualisation and gliosis. Clinically it is presented with spasticity, rigidity, tremors, progressive dementia and cognitive impairment. TULIN HAKAN DEMIRKAN1, GULSAH BAYRAM1, AYSEGUL ALIMLI1, OZLEM OZGOKHAN BALIK2, Keywords: Pantothenate kinase-associated,neurodegeneration, eye of the tiger, MRI HAVVA AKMAZ UNLU1, MESUT SIVRI1, MEHMET TIFTIK1 1Dışkapı Children Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey 2Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey P - 0264 Abstract MOYAMOYA DISEASE: MRI FINDINGS Hemophagocytic lymphohistiocytosis (HLH) is a multisystemic disease OF A RARE DISORDER characterized by diffuse infiltration of multiple organs by histiocytes. IDIL GUNES TATAR, ALPER DILLI These include FAQs. It can be seen in adults as well as being more frequently identified in children. Department of Radiology, University of Health Sciences, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey It is a life-threatening condition that occurs as a result of uncontrolled development of hemophagocytic lymphohistiocytosis patients. It is a life Abstract threatening condition resulting from response to clinical, histopathological A 29-year-old male patient was referred to the radiology department with and laboratory studies. Lung fever, hepatosplenomegaly, hematopoiocyto- follow up of previous watershed infarcts. MRI and MRA revealed multi- sis in various organs (blood cells are swallowed by active macrophages), segmental luminal narrowings in both internal carotid artery and middle cytopenia, hypofibrinogen, ferritin, soluble in triglycerides CD25 sCD25, cerebral artery with collateral vessels suggestive of Moyamoya disease. sIL2RA) and an increase in liver enzymes. Moyamoya disease is a rare idiopathic progressive cerebrovascular disease HLH can be divided into primer and secondary. due to occlusion of the arteries involving the circle of Willis, most commonly the supraclinoid internal carotid arteries. The disease was initially In pediatric HLH patients, the cranial findings may vary widely. described in Japanese patients as the name refers to ‘’puff of smoke’’ Lymphocytosis is seen in the CSF lining as a result of extensive lepto- appearance on angiography. meningeal involvement of lymphocytes and histiocytes in extensive cNS involvement. If parenchymal involvement occurs, perivascular infiltration Keywords: Vasoocclusive disease, Moyamoya, MRA is observed. In many cases demyelination and tissue necrosis, especially in white matter, can be observed. We present a 2-year-old male patient with bilateral involvement of white P - 0265 matter, especially temporal lobes, as a result of CNS involvement. In addition, an acute focal parenchymal infarct area was observed in the left SPONTANEOUS LUMBAR EPIDURAL upper lateral ventricle. HEMORRHAGE MIMICKING It was presented for the rare occurence. EPIDERMOID CYST: CT AND MRI Keywords: Hemophagocytic lymphohistiocytosis (HLH), HLH CNS FINDINGS involvement SALIH HAMCAN, UGURCAN BALYEMEZ, MUSTAFA TASAR, UGUR BOZLAR, HATICE TUBA SANAL, SINAN AKAY, KEMAL NIYAZI ARDA P - 0263 Department of Radiology, University of Health Sciences, Gülhane Institute PANTOTHENATE of Health Sciences, Ankara, Turkey KINASE-ASSOCIATED Abstract NEURODEGENERATION: Objective: Spontaneous spinal epidural hematomas (SSEH) have very MRI FINDINGS rare occurrence. They have an estimated incidence of 0.1 in 100,000 per year. Without any trauma or iatrogenic history the diagnosis can be IDIL GUNES TATAR, ALPER DILLI challenging and called as spontaneous spinal epidural hematoma (SSEH). Department of Radiology, University of Health Sciences, Ankara Dışkapı We aimed to present CT and MRI findings of a lumbar SSEH case, which Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey mimics lumbar epidermoid cyst. Abstract Materials and Methods: 63-year-old female patient admitted to emergency department with new onset lower extremity weakness. Neurological A 19-year-old boy was referred to MRI with mental retardation and examination confirmed the weakness and patient evaluated with CT and sensorial type polyneuropathy. MRI revealed the deposition of iron in red MRI scans. nuclei, substantia nigra and globi pallidi as hypointense signal changes in T2 weighted images. The findings were interpreted as pantothenate kinase- Result: CT scan revealed that there is mildly hyperdense space occupy- associated neurodegeneration, previously named as Hallervorden-Spatz ing lesion in spinal canal between twelfth thoracal and second lumbar S124 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 vertebral level. The density of the lesion was not pathognomonic for P - 0267 hematoma and MRI scan was applied. On MRI, there was a T1 hypo-, T2 hyperintense, non enhancing, diffusion restricting space occupying PRIMARY UVEAL MALIGNANT lesion. The diffusion restriction was confounding finding and there wasn’t MELANOM METASTASIS MRI any hemosiderin referring T2 signal void area. The diagnosis discussed between epidural hematoma and epidermoid cyst. After surgery, patho- FINDINGS logical diagnosis confirmed the epidural hematoma. MELTEM YILDIRIM EROL, BANU TOPCU CAKIR, Conclusion: Spontaneous spinal epidural hematomas are challenging lesions AYHAN HIZ YIGIT, NURDAN CAY, AYSENUR OZCAN, of spinal imaging especially in acute periods. In our patient surgical prepara- KARABEKIR ERCAN tion tests shows an important finding, which the INR value of the patient, Yıldırım Beyazıt University School of Medicine, Atatürk Training and was 4.3. In patients with new onset spinal cord or spinal nerve compression Research Hospital, Ankara, Turkey symptoms, and oral anticoagulant usage history, spontaneous spinal epidural Abstract hematoma diagnosis should be considered in differential diagnosis. Uveal malignant melanoma is the most common primary intraocular malig- Keywords: Lumbar epidural hematoma, spine, MRI nancy. Tumor incidence increases with age. Less than 1% of patients develop metastatic at the onset but most of the time. Bone metastasis is very rare and is usually seen in advanced disease. Typically, it is lytic metastasis. We P - 0266 aimed to present spinal metastasis findings of rare ocular melanoma in this case. An 86-year-old male patient underwent MRI examination of the A RARE CASE REPORT: PEDIATRIC cervical vertebrae when he presented with neck pain. In this examina- MULTIFOCAL CEREBRAL tion, a mass lesion with destructive, T1A hyperintense, T2A hypointense, GLIOBLASTOMA WITH SPINAL CORD heterogeneous contrast material enhancement located on the C1 and C2 vertebra corpus anterior were detected. It was thought that the lesion was METASTASIS compatible with malignant melanoma metastasis because of the hyperin- UGURCAN BALYEMEZ, MEHMET SERINDERE, tense lesion of T1A and the patient was diagnosed with eye evisceration 6 KEMAL NIYAZI ARDA, HATICE TUBA SANAL, SINAN AKAY, years ago and was diagnosed with malignant melanoma. SALIH HAMCAN, UGUR BOZLAR, MUSTAFA TASAR Keywords: Malignant melanoma, metastasis, MRI Department of Radiology, University of Health Sciences, Gülhane Institute of Health Sciences, Ankara, Turkey Abstract P - 0268 Objective: Glioblastoma is a World Health Organisition’s (WHO) Grade CONGENITAL BILATERAL IV tumor which is most common adult primary intracranial neoplasm. PERISYLVIAN SYNDROME WITH The incidence of glioblastoma in pediatric age group is very rare and its considered together with the other paediatric high-grade gliomas in the CHILD CASES literature due to this lower incidence. We aimed to present a pediatric TULIN HAKAN DEMIRKAN1, GULSAH BAYRAM1, case with multifocal cerebral glioblastomas, spinal cord and leptomenin- MESUT SIVRI1, HAVVA AKMAZ UNLU1, geal involvement. OZLEM OZGOKHAN BALIK2, MEHMET TIFTIK1, 1 Materials and Methods: 10 years-old male child presented with headache, AYSEGUL ALIMLI paraperasis and weakness on his right arm for two weeks. CT and MRI 1Dışkapı Children Health and Diseases, Hematology Oncology Training and scan revealed heterogen and moderate enhancing mass lesion which Research Hospital, Ankara, Turkey infiltrate left talamus, lentiform nucleus and posterior aspect of insular 2Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey cortex. After surgery, lesion was defined as glioblastoma. On follow up Abstract cranial and spinal MRI scans, cerebral and spinal multifocal new lesions and leptomeningeal involvement were detected. Congenital perisylvian syndrome is a rare anomaly that can be diagnosed at birth, during infancy or during late childhood. It is characterized by paralysis Result: Multifocal glioblastoma can occur with three ways including cere- (diplegia), tongue, tooth and throat (pseudobulbar paralysis), difficulty brospinal fluid dissemination, spread through the white matter tracks or speaking, dentition, dysphagia, epilepsy in bilateral muscles of the face. local metastasis. Multifocal glioblastoma has been shown to have a poorer prognosis than solitary tumors. Multifocal glioblastoma in pediatric age Polymicrogia is the most common anomaly of cortical development. Small group is rarely reported and management or outcome of these tumors cortical folyls are observed, often accompanied by deterioration in corti- has not studied yet. cal lamination as well as joints. Polymicrogia is most frequently observed in perisilvian areas, although it is present in many localizations. Conclusion: Pediatric glioblastoma is very rare primary cranial pediatric We present a 16 - year - old male patient who underwent bilateral poly- tumor. These tumors can be presented with multifocality or spinal metas- microgia on MR examination with epilepsy. Congenital muscular dystro- tasis. Full neuroaxis MRI is helpful for detecting the spinal cord involve- phy of the patient was noted but no other CNS findings were observed. ment and shoud be performed suspected patients which neurological symptoms can not explained by the primary lesion. It was presented for the rare occasion. Keywords: Multifocal GBM, spine, MRI Keywords: Congenital polymicrogyria, perısylvıan syndrome, bilateral Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S125 P - 0269 can cause hearing loss, ear tinnitus, vertigo, facial nerve dysfunction. The extremely rare endolymphatic sac tumors were associated with von COGNARD TYPE 4 DURAL AVF: Hippel Lindau syndrome at the end of 1990s. Here, we present endolym- A CASE REPORT WITH CROSS phatic sac tumor MR imaging findings in which endolymphatic sac tumor and cerebellar hemangioblastoma were detected in the MR imaging and SECTIONAL IMAGING FINDINGS AND later renal cell carcinoma was detected and von Hippel Lindau syndrome DSA CORRELATION was diagnosed. ALI MURAT KOC, OZGUR ESEN, BETUL BELKIS TOKLU Keywords: Endolymphatic sac, cerebellar hemangioblastomas, Von hippel Lindau disase Clinic of Radiology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey Abstract P - 0271 Dural arteriovenous fistulas (dAVF) is an arteriovenous shunts between arterial branches of internal, external carotis or vertebral arteries and NEUROMYELITIS OPTICA: TWO CASE dural vessels. They are mostly acquired and most commonly seen in trans- REPORT verse, sigmoid sinuses followed by cavernous sinüs, superior sagittal sinüs, HATICE GUL HATIPOGLU, HAMZA OZER, SEMRA DURAN, straight sinüs etc. They can present with tinnitus, cranial neuropathies and hemorrhage. Gold standart diagnostic method is Digital Substraction DENIZ SOZMEN CILIZ, BULENT SAKMAN Angiography (DSA). Diagnosis with cross sectional methods is challenging Ankara Numune Training and Research Hospital, Ankara, Turkey in cases without any sign of hemorrhage. Abstract Here we present a case of 57 year old man admitting to ED with con- Neuromyelitis optica (NMO) is a rare and serious primary demyelinating ciousness. Neurological examination showed left sided weakness. CT disease. It is presented with the demyelination of both optic nerves and showed right temporo-parietal 6 cm hematoma with surrounding edema. spinal cord in acute or recurrent fashion. Distinguishing patients with NMO MRI also showed hematoma with a 6 mm vascular dilatation in contiunity from neoplasia and other central infectious pathologies is very important with dilated cortical veins draning into superior sagittal sinüs on T2 and in terms of management and early immunosuppressive treatment plan of SWI images. CT-angiography also confirmed the dilated cortical drainage that disease. Because of the immunosuppressive treatment initiated by early veins with ectasy at the periphery of hematoma. Neither nidus nor fed- diagnosis, the progressive progression of NMO may stop. Unlike ADEM; ing arteries could have been defined on CT and MR angiography images. demyelinating changes do not return and persist as sequelae in patients with Patient was referred to DSA with initial diagnosis of Dural AVF with NMO. For this reason, early diagnosis of NMO is very important for the venous ectasia. DSA demostrated dAVF suppllied with branches of right management of the disease. The role of radiological evaluation in diagnose ICA with venous ectasia and cortical venous drainage hence the diagnosis of early stage is high. We also aimed to present both clinical and imaging was a Cognard Type IV dAVF. findings of two patients diagnosed with NMO in our clinic. Cross sectional imaging is essential in patients presenting with acute Keywords: Neuromyelitis optica, MRI, demyelinating disease hematoma. Venous ectasia, nidus, dilated feeder and drainage vessels are important in diagnosis of possible AVF or AVM in patients with intracranial hematoma in locations unusual for hypertensive etiologies. P - 0272 Keywords: Dural arteriovenous fistula, cognard, MRI, CT angiography TUMEFACTIVE PERIVASCULAR SPACE OZLEM GUNGOR, CANSU OZTURK, ALPER BATAK, P - 0270 SELMA UYSAL RAMADAN VON HIPPEL-LINDAU DISEASE WITH Keçiören Training and Research Hospital, Ankara, Turkey ENDOLYHPMHATIC SAC TUMOR AND Abstract CEREBELLAR HEMANGIOBLASTOMA Perivascular spaces are small cystic structures in the brain. They are about 1-2 mm in size. When enlarged termed as giant tumefactive perivascular HUSEYIN COSKUN, AYNUR TURAN, ONUR KARACIF, space (GTPVS), which can cause mass effect upon the surrounding struc- ELIF AYSE UCAR, AZAD HEKIMOGLU tures. Depend on location they can cause specific clinical manifestations. University of Health Sciences, Ankara Dışkapı Yıldırım Beyazıt Training and The most common symptom is headache, and other symptoms include Research Hospital, Ankara, Turkey dizziness, dementia, visual changes, syncope, seizure, stroke, poor balance, memory problems, and poor concentration. Abstract They can be mistaken such as cystic neoplasms, nonneoplastic neuroepi- Von Hippel Lindau is an autosomal dominant syndrome with a prevalence thelial cysts, ventricular diverticula, cystic infarction parasitic infections, or of 1/39000 which includes renal cysts and renal cell carcinoma, pheochro- mucopolysaccharidosis. mocytoma, pancreatic cysts, neuroendocrine tumors, cystadenomas of genital and adnexal organs, retinal angiomas and cerebellar hemangioblas- We report a woman, 46 years old; which were initialy mistaken for cystic tomas. Endolymphatic sac tumors are local invasive epithelial neoplasms neoplasm. Brain MRI showed clustered cystic areas in right mesencepha- arising from the endolymphatic sac located in the temporal bone and lothalamic region that doesn’t cause hydrocephalus. S126 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

GTPVS can be misinterpreted as other pathologic processes, most often The differential diagnosis of MVNT are dysembryonic neuroepithe- a cystic neoplasm. GTPVS must be considered when a lesion is round lial tumor, focal cortical dysplasia (type II), Virchow-Robin perivascular or oval, single or multilocular lesions that are isointense relative to CSF spaces. regardless of imaging sequences and do not enhance. In this case report, we aimed to present MRI findings of MVNT. Keywords: Giant tumefactive perivascular space, cystic neoplasm Keywords: MVNT, DNET, temporal lobe lesions, epilepsy

P - 0273 P - 0275 CONGENITAL MUSCULAR ATRETIC CEPHALOCELE: MRI DYSTROPHY FINDINGS OF TWO CASES HAVVA AKMAZ UNLU, MEHMET TIFTIK, MESUT SIVRI, EMEL EMIR YETIM, KAMIL KARAALI TULIN HAKAN DEMIRKAN, NAZLI GULSUM AKYEL Akdeniz University School of Medicine, Antalya, Turkey Ankara Children Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey Abstract Abstract Atretic cephaloceles are congenital, benign malformative lesions which are skin-covered midline subscalp lesions at parietal region. They consist Congenital muscular dystrophies (CMD) are heterogenous group of autoso- meningeal structures or neuronal and glial remnants. mal recessive myopathies presenting at birth with hypotonia, delayed motor development and early onset of progressive muscle weakness, confirmed with Atretic cephalocele is considered as benign and curable neural tube clo- a dystrophic pattern on muscle biopsy. Best diagnostic clue is Cobblestone sure defect and is important because of accompanying central nervous brain and Z shaped brainstem in hypotonic infant. Myelination defects, hypo- system (CNS) anomalies. plastic vermis, ventriculomegaly and dysgenesis of the corpus callosum may be The prognosis is determined by the accompanying CNS anomalies such as seen. We aimed to demonstrate kranial MRI findings in our patient. cortical developmental anomalies, cortical heterotopy, holoprosencephaly, Keywords: Congenital muscular dystrophy, myelination defects, hypotonic infant Dandy-Walker malformation, corpus callosum hypogenesis, ventriculomegaly. If one of these anomalies are present, prognosis is much worse. Although radiographs, CT and US imaging can be used for the diagnosis, P - 0274 MRI is the best imaging method because it reveals key findings, helps to MULTINODULAR VACUOLATING exclude differential diagnoses, and doesnt contain ionizing radiation. NEURONAL TUMOR (MVNT): A CASE Findings evaluated in MRI are; a subgaleal cystic mass with herniation of intracranial structures from a sharp limited calvarial defect, a vertically REPORT oriented primitive falciparum vein terminating in the cystic mass and the EMEL EMIR YETIM, KAMIL KARAALI accompanying linear CSF tract,, cephalocele associated fibrous stalk, superior displacement of the posterior tentorium and tentorial insisor, Akdeniz University School of Medicine, Antalya, Turkey superficial sagittal sinus fenestration at the level of atretic cephalocele Abstract and prominence of the superior cerebellar cistern and suprapineal recess. Multinodular vacuolating neuronal tumor (MVNT) was first described in 2013 Differential diagnoses primarily include sinus pericrania and dermoid / as a seizure-related benign lesion with characteristic histopathological features. epidermoid cysts. Also encephalocele,hematoma, vascular lesions such as hemangioma, tumors such as langerhans cell histiocytosis, rhabdomyosar- Until the revision of WHOs most recent revision in central nervous system coma and bone marrow or soft tissue infections should be kept in mind. tumors (2016), it remains unclear whether a true neoplastic process or malformative lesion or dysplastic hamartomatous lesion. MVNT was defined In this presentation, we aimed to present MRI findings of two patients as a specific cytologic pattern of gangliocytoma in the revision classification. with atretic cephalocele. As well, relevant literature is reviewed along with the findings. The epidemiology of this newly identified tumor group is unclear. Many of them are asymptomatic and are seen incidentally. For these reasons, this Keywords: Atretic cephalocele, cystic scalp lesion tumor is usually underdiagnosed. In the reported cases, the lesions are mostly located in the temporal lobe, which are usually present in young- middle aged patients with epilepsy. P - 0276 MRI findings are lesions which are clusters of well circumscribed high T2 signal bubbles located predominantly in the subcortical white matter. RADIOLOGIC STAGING IN They are hyperintense on T2 and T2-FLAIR images and lesions contrast NEUROBLASTOMA: CT OR MRI? enhancement or mass effect are almost never present. FATMA CEREN SARIOGLU1, MUHAMMET SALMAN1, MVNT is considered a “leave me alone” lesion; it must be managed YASIN ERTUG CEKDEMIR1, HATICE NUR OLGUN2, properly in order to avoid unnecessary biopsy or surgery, taking into DILEK INCE2, EMRE CECEN2, DENIZ KIZMAZOGLU2, consideration the stability of the case especially if it is found incidentally. MELEK OZDENER2, HANDAN GULERYUZ1 Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S127

1Department of Radiology, Dokuz Eyül University School of Medicine, İzmir, 2Department of Children Health and Diseases, Harran University School of Turkey Medicine, Şanlıurfa, Turkey 2Department of Pediatric Oncology Dokuz Eylül University School of Medicine, İzmir, Turkey Abstract Abstract Objective: Hypoxic ischemic encephalopathy is the most important cause of neurological morbidity and mortality in preterm and term newborns. Objective: Neuroblastomas are the most common extracranial solid 15-20% of cases with HIE die during neonatal period and 30% of sur- tumors in pediatric age group. “International Neuroblastoma Staging vivors have neurodevelopmental disorders such as cerebral palsy and System (INSS)” which is described based on the postoperative findings mental retardation. In our study, the efficacy of DAG in determining the is used for staging of neuroblastoma. The “International Neuroblastoma diagnosis and prognosis of the HIE of the newborn was investigated. Risk Group Staging System (INRGSS)” is designed for pre-treatment tumor staging. According to the INSS; neuroblastomas are categorized Materials and Methods: We evaluated the images of eleven patients and as localized-resectable (Stage 1-2), unresectable (Stage 3), and meta- six control cases who were diagnosed with HIE in the last 6 months in static (Stage 4-4S). According to the INRGSS; they are classified as local- our hospitals newborn unit. Diffuse MRI images were evaluated in frontal ized (L1-2) and metastatic (M, MS) disease. The aim of this study is to and parietal white matter, basal ganglia, thalamus, splenium and cerbellar compare the effectiveness of computed tomography (CT) and magnetic white matter. ADC values of patient and control group were compared resonance imaging (MRI) in the staging of neuroblastomas according to with student T test. the INRGSS. Results: There were 5 female 6 male patients in the patient group and 1 Materials and Methods: We evaluated 20 patients with neuroblastoma, female 5 male in the control group. Significant differences were detected who had both CT scan and MRI, and were staged based on the INSS between the findings of the corpus callosum splenium component in between 2005 and 2018. The INRGSS stages corresponding to the correlation with the ADC values obtained from ROIs placed in different INSS stages of the tumors were determined. The image-defined risk regions in the patient and control group, Student T test (p<0.05). There factors of tumors (vascular encasement, intraspinal extension, airway was no significant difference in measurements made from other regions compression, visceral organ infiltration, and involvement of multiple (p>0.05). There was no significant relationship between gender in the body compartments) were evaluated by CT scan and MRI. Then, stages patient and control group (p>0.05). of tumors were described according to the INRGSS for CT and MRI, Conclusion: Early detection of neurological damage in HIE babies is the separately. Kappa test was used to evaluate the compatibility between most important step in determining appropriate preventive treatment expected tumors’ stages and tumors’ stages which were considered by approaches. The radiological method that shows the ischemic changes of using CT scan and MRI. the brain at the earliest is DAG. In our study, the efficacy of determin- Results: The mean age of 20 patients was 22.9±28months. The distri- ing the prognosis and the diagnosis of HIE of newborn of newborn was bution of tumors’ stages according to the INSS was stage 1 2/20; stage investigated. 2 2/20; stage 3 6/20; stage 4 7/20; stage 4S 3/20. The distribution of Keywords: HIE, newborn, DWI expected tumors’ stages was L1 2/20; L2 8/20; M 7/20, MS 3/20. The level of agreement between expected tumors’ stages and tumors’ stages which were considered by using CT was found as good (k=0.77), by using MRI was excellent (k=0.86). MRI was also superior to CT for P - 0278 determination of metastatic disease and bone marrow infiltration. CT was more useful to consider the relationship between tumors and vas- A BOY WITH SEVERE EPIGASTRIC cular structures. PAIN: ACUTE NECROTIZING Conclusion: MRI and CT have high diagnostic accuracy rates in the stag- PANCREATITIS ing of pre-treatment neuroblastomas. MRI is important in pre-treatment BERHAN PIRIMOGLU, RECEP SADE, GOKHAN POLAT, evaluation of neuroblastomas because of the higher detection of metas- MECIT KANTARCI, AKIN LEVENT tases as well as the lack of ionizing radiation. Department of Radiology, Atatürk University School of Medicine, Erzurum, Keywords: Neuroblastoma, MRI, CT, staging Turkey

Abstract P - 0277 A 9-year-old male child was admitted with severe vomiting and epigastric abdominal pain for one week. There was no known medical history of THE EFFICACY OF DIFFUSION- our patient. The plain X-Ray of the abdomen was unremarkable. The WEIGHTED IMAGING IN HYPOXIC axial transvers abdominal ultrasonography revealed the cystic hypoechoic (white asterisk), necrotic and inflammatory (black asterisk) hyperechoic ISCHEMIC ENCEPHALOPATHIES OF changes at the level of the pancreatic corpus and tail. T2-weighted axial NEWBORNS magnetic resonance image showed the signal characteristics referring the cystic-necrotizing pancreatitis at the level of the pancreatic corpus and tail. 1 1 2 ADEM AGYAR , MESUT CETIN , HUSEYIN GUMUS , The serum amylase level was 288 U per L; normal range: zero to 88 U 1 2 1 OSMAN DERE , HALIL ASLAN , ABDURRAHIM DUSAK per L. Acute necrotizing pancreatitis was diagnosed by imaging and labora- 1Department of Radiology, Harran University School of Medicine, Şanlıurfa, tory findings. Thus, our patient underwent therapy including intravenous Turkey hydration, pain control and bowel rest. S128 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Acute necrotizing pancreatitis is a serious condition associated BERHAN PIRIMOGLU1, HAYRI OGUL1, with high morbidity and mortality. Necrotizing pancreatitis is well DUYGU OZKORUCU YILDIRGAN2, RECEP SADE1, described in adults; but the pediatric literature is very limited. The MECIT KANTARCI1 imaging features of acute pancreatitis in pediatric patients are similar 1Department of Radiology, Atatürk University School of Medicine, Erzurum, to those seen in adults include pancreatic collection, edema, hemor- Turkey rhage or necrosis of the pancreatic parenchyma, peripancreatic fat. 2Clinic of Hematology and Oncology, Erzurum State Training and Research Acute pancreatic pseudocysts smaller than 5 cm in diameter are Hospital, Erzurum, Turkey managed with observation for 4-6 weeks. Pancreatic pseudocysts larger than 5 cm in diameter may require surgical intervention. Abstract

Keywords: Epigastric pain, pediatric, MRI, pancreatitis We present an unusual case of hypophyseal involvement in a girl with T-cell lymphoblastic lymphoma via magnetic resonance (MR) imaging findings. In our case, the T-cell lymphoblastic lymphoma of the pitu- P - 0279 itary gland was accurately distinguished from a pituitary adenoma by contrast-enhanced dynamic hypophysis MR imaging studies.

AN UNUSUAL CAUSE OF A 14-year-old boy was referred to our radiology department to HYDRONEPHROSIS IN A 9-YEAR-OLD perform the contrast-enhanced brain magnetic resonance (MR) imag- CHILD: RENAL HYDATID CYST ing. There was known history of T-cell lymphoblastic lymphoma and course of chemotherapy for three years in his medical background. BERHAN PIRIMOGLU, GOKHAN POLAT, RECEP SADE, During follow-up in remission, the patient had visual disturbance MECIT KANTARCI in bilateral eyes and severe headache for one week. We detected Department of Radiology, Atatürk University School of Medicine, Erzurum, a large, homogeneously enhancing intrasellar/suprasellar lesion on Turkey post-contrast fat suppressed T1-weighted brain MR images. We did not decide whether it was hypophyseal involvement of T-cell lym- Abstract phoblastic lymphoma or pituitary adenoma. To make a differential A 9-year-old girl presented with right flank pain for three months. diagnosis, contrast-enhanced dynamic hypophysis MR imaging pro- Physical examination revealed right costovertebral angle tender- cedure was performed to the patient. This lesion displaced the optic ness. The laboratory findings, including renal function tests revealed chiasm and extending into the hypophyseal stalk. It had homogeneous elevated creatinine levels (3.1 milligrams per deciliter; normal levels: hyperintense contrast enhancement pattern on dynamic post-contrast 0.84-1.21 milligrams per deciliter) and urine tests were within normal fat suppressed T1-weighted hypophysis MR images. Since pituitary limits. Ultrasonography (US) imaging of abdomen presented mild adenoma has usually hypointense signal characteristics on dynamic hydronephrosis and a well-defined, hypoechoic, thin walled cystic post-contrast fat suppressed T1-weighted hypophysis MR images; lesion in the lower pole of the right kidney. The US imaging study radiologically, these findings were thought to represent a hypophyseal also showed a well-defined, hypoechoic, thin walled cystic lesion in involvement of T-cell lymphoblastic lymphoma in our patient. Thus, the left lobe of the liver. Then, abdominal MR imaging studies were the patient underwent chemotherapy and hypophyseal hormone performed. It revealed a well-defined, 65x55 mm cystic lesion in the lower pole of the right kidney. This cystic lesion was hypointense replacement treatments. After three months of follow-up, control on T1-weighted and hyperintense on T2-weighted MR images. The dynamic post-contrast fat suppressed T1-weighted hypophysis MR cyst wall was hypointense on T2-weighted MR images, isointense on images showed apparent regression of hypophyseal involvement. The T1-weighted images. It had not any solid component and septa. There T-cell lymphoblastic lymphoma of the pituitary gland was accurately were no contrast enhancement patterns in this cystic lesion on the distinguished from a pituitary adenoma by contrast-enhanced dynamic contrast enhanced T1-weighted images. The MR images also showed hypophysis MR imaging technique in our patient. grade II pelvicalyceal dilatation of the right kidney secondary compres- Keywords: Hypophysis, lymphoma, MRI sion of the ureter. In addition, it revealed a well-defined, 35x41 mm cystic lesion in the left lobe of the liver. MR signal characteristics of this cystic lesion were similar to the cystic lesion in kidney. Immunological findings also revealed elevated Echinococcosis antibody titers (IgG P - 0281 levels:2.95; positive values >1.1). Abdominal surgical exploration showed the renal and hepatic hydatid cyst and open cystectomy was A RARE LOCATION: ISOLATED performed for both cysts. MULTIPLE PSAMMOMATOUS Keywords: Renal, hydatid cyst, hydronephrosis, MRI MENINGIOMAS RECEP SADE1, LEYLA KARACA2, HAYRI OGUL1, UMMUGULSUM BAYRAKTUTAN1, MECIT KANTARCI1, P - 0280 AKIN LEVENT1 HYPOPHYSEAL INVOLVEMENT OF 1Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey T-CELL LYMPHOBLASTIC LYMPHOMA 2Department of Radiology, İnönü University School of Medicine, Malatya, MIMICKING PITUITARY ADENOMA Turkey Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S129

Abstract of cerebellum, corticospinal and corticobulbar tracts of brainstem.These MRI findings were consistent with hypoglycemic hypoketotic encepha- A 13-year-old girl presented to the neurosurgery clinic with progres- lopathy secondary to primary carnitine deficiency. MRI is helpful in the sive motor weakness and sensation disturbance. Magnetic resonance diagnosis, therapy planning, and follow-up of encephalopathic cases with imaging revealed multiple intradural extramedullary mass at the cervi- carnitine deficiency. cothoracal region causing cord compression. The lesions were hyperintense on T2-weighted (T2W) and hypointense on T1-weighted Keywords: MRI, primary carnitine deficiency, encephalopathy (T1W) images. After injection of contrast agent, magnetic resonance imaging showed a homogenous enhancement in masses. Pathologic specimens obtained at surgery showed psammomatous meningiomas. P - 0284 Isolated multiple spinal meningiomas are very rare but have been reported. PATHOLOGICAL CONDITIONS Keywords: Isolated multiple psammomatous meningiomas, spine, MRI CAUSING ABNORMAL SHAPE AND findings DEFORMATION OF THE FOURTH VENTRICLE: MRI FINDINGS P - 0282 MEHMET H. ATALAR, BULENT YILDIZ, KAYHAN KARAKUS A DIAGNOSTIC CHALLENGE: FOCAL Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey FATTY LIVER OR METASTASIS? Abstract BERHAN PIRIMOGLU, RECEP SADE, MECIT KANTARCI The fourth ventricle is at the center of the posterior fossa. It is sur- Department of Radiology, Atatürk University School of Medicine, Erzurum, rounded by critical nuclear structures and important foraminal structures. Turkey A wide array of pathological conditions may affect the fourth ventricle, Abstract ranging from congenital anomalies to mass lesions. A thorough understanding of the anatomic relationships in the posterior fossa and the effect A 12-year-old girl was referred to our radiology department to of various pathological conditions on the ventricle’s shape play a key role perform imaging of the contrast-enhanced thorax and abdomen via computed tomography. There was history of T-cell lymphoma man- in the assessment of imaging findings and making differential diagnosis. aged with chemotherapy for 3 years. We detected a hypodense well- Some pathologies involving the fourth ventricle may cause alterations of circumscribed lesion located at the perivascular region adjacent to the its shape, creating some characteristic shapes such as “tent”, “bat wing”, right portal vein. This hypodense lesion was not seen on the previous “key holes”, and “butterflies”. Some of these deformities helps make a abdominal computed tomography examination. To differentiate the “aunt ayşe” diagnosis known to a radiologist in daily practice. In many lesion, a magnetic resonance (MR) imaging procedure was performed. cases, an asymmetric appearance or shift in the shape, volume, and local- This lesion had hyperintense signal characteristic on in-phase MR ization of the fourth ventricle may be the only sign of a pathological lesion. images but was hypointense on out-of-phase MR images. There was Thus, a more comprehensive scan is needed in radiological evaluation. no contrast enhancement pattern on postcontrast T1-weighted MR In this report, various pathological conditions causing dysmorphism and images. The focal fatty liver was accurately distinguished from a meta- deformation of the fourth ventricle were reported with a large number static liver lesion by inand out-of-phase sequences of abdomen MR of cases and MRI findings. imaging procedure. Keywords: Anomalies, fourth ventricle, magnetic resonance imaging, Keywords: Fatty liver, metastasis, MRI, pediatric posterior fossa

P - 0283 P - 0285 BRAIN MRI FINDINGS IN PRIMARY BONE MARROW TRANSPLANTATION CARNITINE DEFICIENCY: A CASE COMPLICATION: “PRES”S THE MIND REPORT KEMAL NIYAZI ARDA, SEREF BARBAROS ARIK, MUSTAFA YILDIRIM, AHMET KURSAD POYRAZ HATICE TUBA SANAL, MUSTAFA TASAR, SINAN AKAY, SALIH HAMCAN, UGUR BOZLAR Fırat University School of Medicine, Elazığ, Turkey Department of Radiology, Gülhane Training and Research Hospital, Ankara, Abstract Turkey We presented MRI and DWI findings of a 16-year-old boy manifested Abstract with hypoglycemic hypoketotic encephalopathy. Objective; Posterior reversible encephalopathy syndrome (PRES) is a In our case, T2 hyperintensity and diffusion restriction were noted bilater- complex but well understood radiological entity. However the patho- ally in the centrum semiovale, cerebral white matter, deep white matter genesis is not completely understood. It is believed that damaged auto S130 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 regulation and endothelial dysfunction is responsible from vasogenic sub P - 0287 cortical edema without infarction. Patients who undergo bone marrow transplantation are at risk for devel- ATROPHY OF THE LEFT FACE oping graft versus host disease (GVHD). Calcineurin inhibitors, such as AND SHORTNESS OF THE tacrolimus or cyclosporine, are agents commonly used to prevent the LEFT EXTREMITIES: MIDBRAIN development of GVHD. One rare but significant side effect of these drugs CAVERNOMA IN A PEDIATRIC is PRES. The incidence of PRES secondary to tacrolimus is not well known. PATIENT In this poster we aim to remember radiologic features of PRES by giving an 1 2 example of magnetic resonance images (MRI) of a pediatric hematology patient. AYSE GUL ALIMLI , MESUT SIVRI , NAZLI GULSUM AKYEL 2, HAVVA AKMAZ UNLU 2 Materials and Methods: 10 years old boy who has a seizure after bone mar- 1 row transplantation is consulted to our radiology department to perform Department of Pediatric Radiology, Health Sciences University, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, MRI scan. Seizure was explained with no other reasons. On his MR images Ankara, Turkey frontoparietal patchy hyperintensities without diffusion restriction are seen. 2Department of Radiology, Health Sciences University, Ankara Child Health Conclusion: The seizures are frequent manifestations of neurological and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey complications after pediatric hematopoietic stem cell transplantation. In most cases seizures are the first manifestation of effected brain. Also they Abstract were often repeated and/or long lasting requiring treatment. Cavernous hemangiomas (cavernoma) are 9% of cerebral vascular malfor- In pediatric patient in some cases neuroimaging is essential to diagnose mations.Cerebral cavernomas tend to be cerebral hemispheres. Thalamic and treat correctly. Because in these cases it is required to be ensured and midbrain cavernomas are relatively rare. These lesions frequently acute antiepileptic treatment, but a long lasting prophylactic therapy with symptomatic because of their significant location. We aimed to present 10 benzodiazepines and/or phenytoin is not usually necessary. That’s why years old female patient who admitted to hospital complaint of atrophy PRES has to be kept in mind in differential diagnosis. of the left face and shortness of the left extremities with hemiparesis. Keywords: PRES, pediatric petient, bone marrow transplantation Magnetic resonance imaging, susceptibility weighted imaging and diffusion weighted imaging findings are discussed. Keywords: Midbrain cavernoma, face atrophy, magnetic resonance imag- P - 0286 ing, susceptibility weighted imaging PRENATAL DIAGNOSIS OF RHOMBENCEPHALOSYNAPSIS P - 0288 ESRA OZKAVUKCU, EMEL YERLI, NURAY HALILOGLU SYDENHAM CHOREA: THREE Department of Radiology, Ankara University School of Medicine, Ankara, Turkey PEDIATRIC PATIENTS Abstract NAZLI GULSUM AKYEL, HAVVA AKMAZ UNLU, Rhombencephalosynapsis (RC) is a rare cerebellar malformation with MESUT SIVRI, AYSE GUL ALIMLI unknown etiology. It is usually sporadic, and clinical presentation can be Department of Radiology, Health Sciences University, Ankara Child Health variable. RC refers to the absence of cerebellar vermis, cerebellar fusion and Diseases, Hematology Oncology Training and Research Hospital, and apposition or fusion of the dentate nuclei. RC is frequently associ- Ankara, Turkey ated with other cerebral and extracerebral malformations. RC is known to co-exist with congenital ventriculomegaly in 45-65% of the cases. Abstract Ventriculomegaly can be a result of aqueductal stenosis, or abnormal Sydenhams chorea is a late manifestation of acute rheumatic fever and orientation of the 4th ventricle. thought to be an autoimmune disorder. The neuroimaging findings of this entity rarely reported. In this report we aimed to present Magnetic Herein, we present the fetal US and MRI findings of a rare case of RC Resonance Imaging (MRI) findings of three patients with Sydenhams at 20 weeks of gestation. Second trimester fetal US revealed dichorionic chorea. diamniotic twin pregnancy. Twin A appeared normal on US. Twin B had hypoplastic and fused cerebellar hemispheres, as well as agenetic cerebel- Keywords: Sydenhams chorea, chorea, Magnetic Resonance Imaging lar vermis. In addition to these findings, twin B also showed triventricular hydrocephaly (atrial width: 21 mm), with the 4th ventricle being normal. No additional fetal anomalies were detected on US. Fetal MRI confirmed P - 0289 the US findings, with better delineation of the cranial anatomy. Final diagnosis was RC with aqueductal stenosis. TAYLOR DYSPLASIA (TYPE II FOCAL In conclusion, RC is a rare abnormality that can be identified in the prena- CORTICAL DYSPLASIA) IN CHILDREN: tal period by US and fetal MRI. CASE SERIES Keywords: Rhombencephalosynapsis, fetal MRI, fetal ultrasound, prenatal NAZLI GULSUM AKYEL, MESUT SIVRI, AYSE GUL ALIMLI, diagnosis HAVVA AKMAZ UNLU Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S131

Department of Radiology, University of Health Sciences, Ankara Child DERYA BAKO KESKIN, SUAT FITOZ Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey Department of Pediatric Radiology, Ankara University School of Medicine, Ankara, Turkey Abstract Abstract Type II focal cortical dysplasia (FCD) is most common cause of drug resistant epilepsy in pediatric population and curable by surgery. It is highly epileptogen- Objective: Our main purposes were to compare agreement between ic lesion that missed by magnetic resonance imaging (MRI) in about one third M Mode echocardiography and MRI for left ventricular ejection fraction of cases. The most common findings on MRI include focal cortical thickening (LVEF) measurements; to evaluate biventricular volumes and pulmonary or thining, increased signal on T2 weighted and FLAIR sequences in the gray valve dynamics in patients with repaired Tetralogy of Fallot (TOF) and to and subcortical white matter, blurring of the gray-white matter junction. We compare agreement of tomographic and VEC-PC methods for pulmo- present radiological findings of Taylor dysplasia in seven children with epilepsy. nary regurgitation quantification. Keywords: Focal cortical dysplasia, taylor dysplasia, magnetic resonance Materials and Methods: 25 patients were studied. Left ventricle volumes imaging, epilepsy of all patients were measured from short axis images. Intraclass correlation coefficient (ICC) was used to compare MRI and echocardiography P - 0290 measurements for LVEF. Biventricular volumes and functions were evaluated and compared to control group in repaired TOF patients. Also pul- CHILD WITH HERLYN-WERNER- monary valve flow was assessed by VEC-PC and tomographic methods WUNDERLICH (HWW) SYNDROME and agreement evaluated. TULIN HAKAN DEMIRKAN1, GULSAH BAYRAM1, Results: Measurements of left ventricle EF correlated mildly between NAZLI GULSUM AKYEL1, OZLEM OZGOKHAN BALIK2, MRI and echocardiography (ICC 0.54). MRI comparison of biventricular MEHMET TIFTIK1, MESUT SIVRI1 metrics of patients with repaired TOF with normal controls confirmed an 1Dışkapı Children Health and Diseases, Hematology Oncology Training and increase in RVEDVI, RVESVI, RVSVI and LVEF (p<0.05). LVSVI was higher Research Hospital, Ankara, Turkey in control group (p<0.05). High agreement (r=0.81, p 0.026) between 2Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey VEC-PC and tomographic methods for pulmonary regurgitant flow mea- Abstract surement was noted. Herlyn-Werner-Wunderlich (HWW) syndrome is a rare anomaly of the Conclusion: Cardiac MRI has many advantages over echocardiography mullerian duct. The uterus is involved with the didelphys, the hemivagina in diagnosis, follow up and evaluation of postoperative complications is obstructed, and the unilateral is renal agenesis. and valvular pathologies of patients with congenital heart disease. Echocardiography cannot be used as an alternative of MRI in quantifica- The most common finding is hematocolposa secondary to abdominal and tion of left ventricular EF, because of the very wide variances and mild pelvic pain, dysmenorrhea. correlation between two techniques. Biventricular evaluation is essential This syndrome was first described in 1922 with regular menstruation, in patients with repaired TOF for detection of left ventricular dysfunction. with increasing pelvic pain and a pelvic mass beginning with menarche. Increase in LVEF might be the first finding of early dysfunction. Our case was a 15-year-old girl with agenesis in the left kidney, a corpus Keywords: Cardiac, pediatric, TOF in the left uterus with uterus didelphys, which was normal, and heterogeneous in the cervix filling hemorrhage. Once the cervix was emptied, the lesion recurred. For the second time, P - 0292 the cervix was drained. It was presented for the rare occurence. ECTOPIC PARTIAL INTRAHEPATIC Keywords: Herlyn-Werner-Wunderlich (HWW) syndrome, uterus didel- GALLBLADDER: RADIOLOGICAL phis, mullerian duct anomaly, hematocolpos FINDINGS OF AN UNUSUAL ANATOMICAL VARIANT

1 2 P - 0291 OZKAN OZEN , MANI HABIBI 1Department of Radiology, Alanya Alaaddin Keykubat University School of PEDIATRIC CARDIAC MAGNETIC Medicine, Antalya, Turkey RESONANCE IMAGING: COMPARISION 2Department of General Surgery, Alanya Alaaddin Keykubat University, Alanya Training and Research Hospital, Antalya, Turkey OF MRI MEASUREMENT OF LEFT VENTRICULAR EJECTION FRACTION Abstract TO ECHOCARDIOGRAPHY, Objective: Ectopic gallbladder is very rare and can be found in intra- EVALUATION OF BIVENTRICULAR hepatic, suprahepatic, retrohepatic, retroperitoneal, falciform ligament, abdominal wall, left quadrant of abdomen and intrathoracic localizations. VOLUMES AND FLOW DYNAMICS In this study we aimed to present an ectopic partial intrahepatic gallblad- IN PATIENTS WITH REPAIRED der anomaly by radiological methods, which was only able to be revealed TETRALOGY OF FALLOT in surgery and cadaver studies so far. S132 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

Materials and Methods: Ultrasonography of a 43-year-old male patient patients hemorrhage was an associated feature. In one patient exhibited with right upper quadrant pain in the abdomen revealed a lobulated cystic intense enhancement after intravenous contrast injection. lesion associated with gallbaldder in the liver. In CT, a lobulated, non- Conclusion: Atypical MRI findings of PRES are seen quite often in pedi- contrasting cystic structure associated with gall bladder at segment 8 of atric patients; especially involvement of the cerebellum, frontal lobe and the liver observed. The patients laboratory values were normal. temporal lobe. In addition diffusion restriction, contrast enhancement and Magnetic Resonance Cholangiopancreatography (MRCP), dynamic mag- hemorrhage can also be seen. netic resonance (MR) after IV Gadoxetate disodium (commercial names Keywords: Atypical findings, MRI, cerebellum, PRES Primovist and Eovist) injections and MRCP at the 30th and 60th minutes after and drug injection was performed for the diagnosis. Unenhanced MRCP was also found that gallbladder associated with the P - 0294 lesion. MR showed that the cystic structure was connected to the gallbladder and based on MRCP findings at 60th minutes after the contrast injec- THE BENEFIT OF ENDORECTAL tion; it revealed that the lesion was homogeneously filled with the contrast COIL USAGE IN DIAGNOSING Conclusion: It is important to recognize ectopic intrahepatic gallbladder BIOCHEMICAL RECURRENCE: CASE before surgery. Cholecystectomy in intrahepatic gallbaldder variations is REPORT more difficult and dangerous. If these cases are accompanied by cholecystitis, it is even more difficult to recognize it radiologically. For this reason, it MEHMET COSKUN, MERVE HOROZ, KAMIL YUCEL, is important to diagnose this anomaly with preoperative imaging methods. MUHSIN ENGIN ULUC Contrast-enhanced MRCP may contribute to diagnosis. Department of Radiology, İzmir Katip Çelebi University Atatürk Training And Keywords: Gallbladder, magnetic resonance cholangiography, varvation Research Hospital, İzmir, Turkey Abstract Introduction: After radical prostatectomy(RP),a significant drop expect- P - 0293 ed in prostate specific antigen (PSA) level to 0.01ng/mL. Post-RP level of PSA above 0.2ng/mL is defined as biochemical recurrence( BCR). It is dif- POSTERIOR REVERSIBLE ficult to detect BCR with MRI after RP when PSA is below 1ng/ml. In this ENCEPHALOPATHY SYNDROME IN case report, early diagnosis of BCR and incidental small polipoid bladder PEDIATRIC PATIENTS: FALL IN LOVE carcinoma was demonstrated with use of endorectal coil(ERC). WITH CEREBELLUM, FRONTAL LOBE Case Report: Twelve-quadrant systemic tru-cut biopsy were performed AND TEMPORAL LOBE? to the 78 years old patient with PSA=8.24ng/mL and diagnosed Gleason 3+3 at 5 cores with maximum 80% involvement. Thoracoabdominal AYSE GUL ALIMLI1, HAVVA AKMAZ UNLU2, computerized tomography, whole body scintigraphy were negative for NAZLI GULSUM AKYEL2, MESUT SIVRI2 metastasis. Gleason 3+4 tumour with 5% involvement determined by RP specimen(upgrade after RP) and the surgical margin was tumor posi- 1 Department of Pediatric Radiology, Health Sciences University, Ankara Child tive on the right. Multiparametric prostate MRI (mpMRI) was performed Health and Diseases, Hematology Oncology Training and Research Hospital, with 1.5 Tesla (T) (Avanto, Siemens, Germany) due to high post-op PSA Ankara, Turkey 2Department of Radiology, Health Sciences University, Ankara Child Health (0.59ng/mL). ERC was used to increase diagnostic accuracy. In this MRI, a and Diseases, Hematology Oncology Training and Research Hospital, 2.4mm nodular lesion was detected on right side of bladder neck anas- Ankara, Turkey tomosis. This lesion had low signal on T2W, slightly restricted diffusion, nodular enhancement and was reported as residue which was supported Abstract with laboratory findings and proven pathologically. 4.5mm bladder tumor Objective: Posterior reversible encephalopathy syndrome (PRES) is was coincidentally noticed and confirmed by cystoscopy. a clinico-radiological disease with characteristic magnetic resonance Conclusion: The standard use of ERC is controversial, but it is recom- imaging (MRI) findings. MRI shows subcortical/cortical hyperintensity in mended for 1.5T devices in prostate imaging reporting and data system T2-weighted sequences, typically in posterior circulation distribution. version 2 (PIRADSv2). ERC can increase signal-to-noise ratio by 4-9 folds. Although parieto-occipital regions involvement is most common; atypi- Sensitivity of mpMRI without ERC is relatively low in treated cases. The cally, involvement of the cerebellum, frontal lobe and temporal lobe in usage of ERC seems to be beneficial in treated patients with prostate pediatric patients are often detected. We aimed to present clinical and carcinoma. radiologic findings of PRES with atypical MRI findings in pediatric patients. Keywords: Prostate carcinoma, biochemical recurrence, endorectal coil, Materials and Methods: We retrospectively evaluated the MRI findings of MRI, PIRADSv2 9 cases of pediatric PRES. Results: Three of the patients were girls, six were boys. The patients’ age ranged from 5 to 16 years (mean age, 9.4 years). All lesions had P - 0295 subcortical/cortical hyperintensity in T2-weighted sequences. All patients FRONTOORBITAL ANEURYSMAL had parieto-occipital regions involvement, eight patients had frontal lobe, seven patients had cerebellar and temporal lobe and one patient had BONE CYST: A RARE CASE REPORT splenic involvement. In two patients cortical diffusion restriction, in two WITH LITERATURE REVIEW Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S133

MESUT SIVRI NAMIK KEMAL ALTINBAS Department of Radiology, University of Health Sciences, Ankara Child Ankara University School of Medicine, Ankara, Turkey Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey Abstract Abstract Olfactory neuroblastomas (esthesioneuroblastoma) are neuroectodermal tumors arising from nasal cavity olfactory recess. In this case report, a Aneurysmal bone cysts are uncommon, benign, vascular, multicystic nineteen year-old male patient with nasal stuffiness was presented via lesions destructing the cortical bone by the expansion of the vascular computed tomography (CT) and magnetic resonance imaging (MRI) channel in the diploic space. That occur most frequently in long bones, findings. CT findings were useful for the detection of bony destruction. vertebrae, and the pelvis. It has been reported incidence with 0.14 cases CT images were revealed that right medial wall of the orbit and maxil- for every 1,000,000 people. Fronto orbital involvement is very rare and lary sinus resorbing with soft tissue extension. The lesion demonstrated less than 100 patients has been reported in the literature to our knowl- intermediate signal intensity on T1 and T2 weighted images. Also, contrast edge. We present X-ray, CT and MR imaging findings and literature review enhancement was marked in MRI study. This patient with extension to the of an aneurysmal bone cyst of the fronto orbital region with intracranial orbit staged as group C. extension in a 4-year-old female confirmed histopathologically. Keywords: Esthesioneuroblastoma, olfactory, CT, MRI Keywords: Aneurysmal bone cyst, CT, frontal, MRI, orbita,

P - 0298 P - 0296 TWO RARE CASES OF BILATERAL IDIOPATHIC ORBITAL INFLAMMATORY SYNDROME OPTIC NERVE SHEATH MENINGIOMA SIBEL CAGLAR ATACAN1, AJDA AGIRBAS1, NACIYE AKAN2 BERNA AK YILDIZ, ABDULLAH SUKUN, ICLAL ERDEM TOSLAK, SINAN ULGEN, BULENT CEKIC 1Department of Radiology, Forensic Medicine Institute, İstanbul, Turkey 2Forensic Medicine Institute, İstanbul, Turkey Antalya Training and Research Hospital, Antalya, Turkey Abstract Abstract We describe two cases of bilateral optic nerve sheath meningioma in Idiopathic orbital inflammatory syndrome, also known as orbital pseudo- which the diagnosis was missed for more than 3 years after the onset of tumor, is a nonspecific, non-neoplastic inflammatory process of the orbit, symptoms. Clinical features led to a misdiagnosis of optic neuritis in all and 3rd most common ophthalmologic disease of the orbit, following cases. Radiologically, these tumors can easily be overlooked on routine Graves disease and lymphoproliferative disorders. Pathologically, orbital imaging protocols. Radiologists must be aware for the early diagnosis of pseudotumors show a nonspecific infiltration of inflammatory cells com- optic nerve sheath meningioma in patients with progressive visual loss. posed of lymphocytes, plasma cells, neutrophils, and macrophages. It may Keywords: Optic nerve sheath meningioma, MRI, radiologic malpractice involve any part of the orbit including muscles, tendons, fat, optic nerve, nerve sheet, lacrimal gland. The symptoms of idiopathic pseudotumors reflect the degree of the inflammatory response (acute, subacute, or chronic) and location of the inflammatory tissue. The radiological findings P - 0299 of pseudotumor are characterized by inflammatory changes and in the various intraorbital structures. MRI is gold standard particularly useful in FOLLOW-UP IMAGING OF A NON- assessing muscular involvement, extraorbital extent, such as cavernous FAMILIAL CHERUBISM CASE WITH sinus and to determine the tendinous involvement in addition to extra- MAXILLARY AND MANDIBULAR ocular muscles which suggests pseduotumor orbita and is a key finding INVOLVEMENT in distinguishing pseudotumor orbita from thyroid eye disease. MRI findings include T2-weighted hypointensity (possibly reflecting the fibrotic SEHNAZ EVRIMLER, DUYGU KOC KELES, HUSEYIN AYDIN changes), rarely hipo-izointensity and marked gadolinium enhancement. Department of Radiology, Süleyman Demirel University School of Medicine, The disease respondes well to steroid therapy. We herein present the Isparta, Turkey MRI findings of a case with idiopathic orbital inflammatory syndrome that was treated with medical therapy and both symptoms and follow-up MRI Abstract scans were improved dramatically. Introduction: The aim of this case report is to inform clinicians and Keywords: Idiopathic orbital inflammatory syndrome, orbital pseudotu- radiologists about Cherubism, a rare pediatric maxillofacial disease which mor spontaneously resolves after puberty and doesn’t require any operation or medication unless a complication or severe symptom occurs. Case Report: We present a case with seven years follow-up, who has late P - 0297 onset of the Cherubism disease. Firstly, our seven-years old, male patient presented with swelling of bilateral jaws in 2010. Maxillofacial Computed A CASE OF OLFACTORY Tomography (CT) showed multiple, hypodense, multilocular cystic lesions NEUROBLASTOMA in bilateral maxilla and mandible. Histopathological findings of the lesions S134 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 were osteoclast type multinucleated giant cells. According to clinical, Abstract radiological and histopathological findings, the patient with no disease or family history was diagnosed with Cherubism. He did not have any severe Objective: In this study, it is aimed to discuss the patient presented to symptoms or complication during his clinical follow up within routine peri- emergency services due to sudden chest pain, dyspnea, and weakness in the lower extremities with suspected of having aortic dissection and in ods. Seven years after the first diagnosis, bilateral exophtalmus occured in whom cerebral and spinal cord ischemia developed during the follow-up his adolescence. Orbital Magnetic Resonance Imaging (MRI), Maxillofacial along with literature. CT were performed in order to evaluate for orbital wall infiltration which showed resolvement of the cystic lesions. Mandibular condyle involve- Material and Methods: 76 years male patient consulted to emergency ment, a rare presentation of Cherubism disease and proptosis in despite service due to the sudden chest pain, dyspnea and weakness in lower of the regression of the lesions was observed. extremities. According to these findings thorax CT, cranial diffusion magnetic resonance imaging (MRI) and thoracolumbar MRI imaging was Conclusion: Clinicians and radiologists should keep in mind Cherubism, performed. which spontaneously resolves after puberty, for differential diagnosis of children with jaw swelling and tooth maloclusion in order to avoid unnec- Results: In cranial diffusion MRI there were acute ischemia areas in left essary interventions. occipital and right parahippocampal gyrus. According to the thoracolumbar MRI, hypointense signal changes in T1W series and hyperintense signal Keywords: Cherubism, mandible, maxilla, computed tomography, mag- changes in T2W series causing expansion were detected in the spinal cord. netic resonance imaging It was diagnosed as spinal cord ischemia In thorax CT dissection of descending aorta in 2 cm segment at distal thoracal level was confirmed. Pleural fluid reaching 10 cm of thickness was seen at left hemithorax. Laboratory P - 0300 examination result of the fluid was consistent with hemothorax Conclusion: The patient was diagnosed with only 2 cm segment aortic COSTAL CHONDROBLASTOMA dissection and rupture based on the Thorax CT findings. The patient was MIMICKING BREAST CANCER IN AN diagnosed with spinal cord and cerebral ischemia due to malperfusion. ELDERLY MALE: A CASE REPORT Sudden chest pain is generally the first symptom of aortic dissection, but aortic dissection patients can also consult with atypical symptoms like TURKAN IKIZCELI paraplegia and syncope without pain. Health Sciences University Haseki Training and Research Hospital, İstanbul, Keywords: Aortic dissection, ischemia, MRI, thorax CT Turkey Abstract P - 0302 Although chondrosarcoma is common among the bone tumors, costal chondrosarcoma is a very rare malignant tumor of the bone. They are MRI FINDINGS OF SUBACUTE most commonly found in elderly patients within the long bones especially SCLEROSING PANENCEPHALITIS: A upper and lower extremities. In rare instances, the chest wall can be involved, with chondrosarcomas occurring in the ribs, sternum, anterior CASE REPORT WITH REVIEW OF THE and posterior costosternal junction. Some types of chondrosarcomas LITERATURE grow slowly and, provided they are removed completely, have a low risk MEHMET FATIH ERBAY, LEYLA KARACA of spreading to other organs. Others grow rapidly and have a high risk of metastasis. Most patients present with an enlarging painful anterior chest Department of Radiology, İnönü University Turgut Özal Medical Center, wall tumor. Primary chondrosarcoma of the breast is extremely rare in Malatya, Turkey the literature. Abstract Here, a case of costal chondrosarcoma mimicking breast cancer in Subacute sclerosing panencephalitis (SSPE) is a rare, chronic, demyelinating 76-years old male with a tumor size of 14×10 cm on the right breast and progressive encephalitis of central nerve system (CNS) affecting primar- involving the chest wall and 8th rib was presented with Magnetic ily children and young adults that is caused by persistent infection of measles Resonance Imaging (MRI) findings. virus. The disease typically involves periventricular and subcortical white matter but grey matter may also be affected. Corpus callosum, basal ganglia Keywords: Chondrosarcoma, costa, male breast cancer and brainstem are rarely involved structures. In this case report, findings of conventional mri and proton mr spectroscopy of a 20 years old male who was diagnosed with SSPE are presented with the review of the literature. P - 0301 Keywords: SSPE, conventional mri, proton mr spectroscopy CEREBRAL AND SPINAL CORD ISCHEMIA DEVELOPING SECONDARY TO P - 0303 SHORT SEGMENT AORTIC DISSECTION FATMA AKTAS A RARE CAUSE OF TEMPORAL Department of Radiology, Gaziosmanpaşa University School of Medicine, LOBE EPILEPSY: INCOMPLETE Tokat, Turkey HIPPOCAMPAL INVERSION Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S135

BERNA AK YILDIZ, MEHTAP BARC ERGUN, stem and cerebellum. Incidence varies between 1/80.0000 -1/100.000. AYSE EDA PARLAK, SAMET MUTLU, EMIN DURMUS We aimed to present CT and MRI findings of this rare syndrome in a 2-month-old girl. Antalya Training and Research Hospital, Antalya, Turkey Case Report: A 2-month-old girl was referred to pediatric neurology clin- Abstract ic with complaint of developmental retardation and seizure. Noncontrast Hippocampal development is completed between 8-21 gestational weeks. brain CT and MRI for seizure etiology revealed vermian hypoplasia and During this period, folding of dentate gyrus and cornu ammonis around dilate bat wing-like 4. ventricle. It was observed that thickening, elongation the hippocampal sulcus, so called hippocampal inversion, takes place. If of the superior cerebellar peduncle and not connected peduncles of mid- this process is not completed, incomplete hippocampal inversion (IHI) line. In MRI, splenium of corpus callosum was not observed in compatible occurs. IHI is a rare cause of in temporal lobe epilepsies. The hippocampus with corpus callosum dysgenesis, lateral ventricles were large and parallel becomes more rounded, and positioned more vertically and medially than to each other. Findings were interpreted radiologically with Joubert syn- it should be. Hippocampal signal intensity and size is usually normal, while drome. Ultrasonography of the abdomen showed no organ anomalies. internal structure may be blurred. We herein present the MRI findings of incomplete hippocampal inversion as epileptogenic foci in two cases Discussion: Joubert syndrome is a rare autosomal recessive disorder; it is with epilepsy. characterized by congenital ataxia, hypotonia, neonatal respiratory disturbances, developmental retardation, abnormal eye movements. The delay Keywords: Incomplete hippocampal inversion, temporal lobe epilepsy in diagnosing this disease is usually due to the different and nonspecific presentation of the disease. Multidisciplinary approach is needed for management of the disease. The prognosis depends on the prevalence of the P - 0304 disease, the severity of the respiratory problems and systemic anomalies. Awareness of the characteristic clinical and radiological findings of this FAT DROPLETS IN SUBARACHNOID disease will help early diagnosis and provide appropriate rehabilitation. SPACE DUE TO RUPTURED DERMOID Keywords: Joubert, molar tooth, respiratory disregulation CYST: A RARE ENTITY ILKER OZGUR KOSKA P - 0306 Ege University School of Medicine, İzmir, Turkey Abstract PSEUDOMENINGOSEL AFTER TYPE 1 Intracranial dermoid cysts are extremely rare, slow-growing, congenital CHIARIAN DECOMPRESSION inclusion cysts, originating from an ectodermal inclusion during develop- VEYSEL ATILLA AYYILDIZ, AYSE SAY, ABDULKERIM SALKACI ment of the neural tube.So, they preferentially occur in the posterior skull Department of Radiology, Süleyman Demirel University School of Medicine, base and the supra- and parasellar region. The secretion and accumulation Isparta, Turkey of epithelium, or fat lead to slow growth of the cyst. Symptomatic complications usually occur in the 2nd to 3rd decade of life, due to space-occu- Abstract pying effect, or rupture. Headache, nause, vomitting, epilepsy or chemical Introduction: Type I Chiari malformation is inferior cerebellar tonsiller menigitis may be the presenting symptoms. We presented 26 years old herniation from foramen magnum. Cervical syringomyelia is frequently male admitted to hospital because of severe headache. MRI examination accompanied. Posterior fossa decompression is applied in the treatment. It revealed 4x2.5 cm T1 and T2 hyperintense fat containing extraaxial mass has been reported that the frequency of pseudomeningocele, which is the adjacent to sphenoidal bone and fat droplets in subarachnoid space patho- most common postoperative complication in literature, varies between gnomic for ruptured dermoid cyst. 3% and 40%. In this case, we aimed to reveal the magnetic resonance Keywords: Ruptured dermoid cyst, fat droplets imaging (MRI) findings of a patient who was operated due to type 1 Chiari malformation. Case Report: A 31-year-old female was admitted for 1 year back pain and P - 0305 numbness on both arms. On cervical MRI cerebellar tonsils were about 7 mm inferior from foramen magnum. At C7-Th1 level were observed RADIOLOGICAL IMAGING FINDINGS OF syrinx cavity. Posterior fossa decompression was performed. Six days after JOUBERT SYNDROME WHICH IS RARE the operation, patient applied with swelling and discharge in operation. VEYSEL ATILLA AYYILDIZ, AYSE SAY, ABDULKERIM SALKACI area to emergency department. Patient was admitted to the neurosurgical service with pre-diagnosis of CSF flow. On cervical MR examination, the Department of Radiology, Süleyman Demirel University School of Medicine, collecting area which does not contrast, same density with the CSF and Isparta, Turkey dura defect at this level was noticed. Radiological findings were evaluated Abstract in favor of postoperative pseudomeningocele. Introduction: Joubert syndrome is a rare autosomal recessive disease Conclusion: Surgical management of Type 1 Chiari malformation allows characterized by neonatal respiratory disregulation, developmental retar- the patient to improve relieve pain, disability of mobility and quality of life dation, hypotonia, ataxia, nystagmus and facial dysmorphism. It is charac- in a prominent and sustainable way. Large-size C1 laminectomy without terized by varying degrees of vermian hypoplasia and horizontal course of duraplasty facilitates the formation of pseudomeningocele and eventually the superior cerebellar peduncle as a result of thickening between brain cord herniation into this cavity. Pseudomeningocele development should S136 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137 be considered in patients who have undergone posterior fossa surgery 1Department of Radiology, Gaziosmanpaşa University School of Medicine, and who present with complaints of swelling and discharge. Tokat, Turkey 2Department of Radiology, Tokat State Hospital, Tokat, Turkey Keywords: Chiari malformation, posterior fossa, pseudomeningosel Abstract Complex type 1 respiratory chain deficiency is one of the most common observed defect in childhood-onset mitochondrial diseases. Defects in P - 0307 complex I are genetically heterogeneous and clinically associated with a wide range of presentations, including marked and often fatal lactic aci- REVERSIBLE CRANIAL MRI dosis with cardiomyopathy, Leigh syndrome, myopathy, hepatopathy, renal FINDINGS IN AN ANTI-RI POSITIVE tubular dysfunction, stroke-like episodes (MELAS), and leukodystrophy. PARANEOPLASTIC SYNDROME CASE The majority of affected individuals present during the first year of life and have a rapidly progressive leukoencephalopathy and fatal course. Here, SABRIYE SENNUR BILGIN 1, NESRIN HELVACI YILMAZ 2 we aimed to present the findings of necrotic leukoencephalopathy due to complex type 1 respiratory chain deficiency in a 5-year-old male patient 1Department of Radiology, Medipol University School of Medicine, İstanbul, Turkey who underwent contrast-enhanced magnetik resonance imaging (MRI), 2Department of Neurology, Medipol University School of Medicine, İstanbul, diffusion MRI and MR spectroscopy. Turkey Keywords: Complex type 1 respiratory chain deficiency, leukoencepha- Abstract lopathy, magnetic resonance imaging, magnetic resonance spectroscopy Case Report: 46-year old female came in our neurology clinic with complaints of diplopia one year ago. Neurologic examination revealed bilateral horizontal and vertical sight impairment, prominent truncal ataxia and P - 0309 trismus. The patient exhibited a 4th cranial nerve paralysis. On examination the patient also had difficulty swallowing, hoarseness and imbalance. T2 TRANSECTION OF THE weighted cranial magnetic resonance imaging (MRI) scan showed sym- INFUNDIBULAR STALK AFTER THE metric hyperintensities on the parapontine reticular formation and medial BOMBING IN A SYRIAN REFUGEE longitudinal fasciculus. Having paraneoplastic syndrome in mind, lung x-ray, CAUSING CENTRAL DIABETES breast ultrasound and mammography was performed. Breast ultrasound revealed a solid lesion; and mammography clustered microcalcifications INSIPIDUS on the right breast. FDG-PET-CT scan demonstrated hypermetabolic MESUT SIVRI, NAZLI GULSUM AKYEL, AYSE GUL ALIMLI right breast tail and axillary lymph node (SUV-max 6.4) Breast biopsy was interpreted as invasive ductal carcinoma. Cerebrospinal fluid showed a Department of Radiology, Health Sciences University Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, glucose level of 50mg/dL, protein level of 42mg/dL, cell count of 30 with Turkey monocyte cell dominance and no atypical cells. On the paraneoplastic cell panel anti-Ri antibodies were tested positive. After mastectomy che- Abstract motherapy was started with the diagnosis of invasive ductal carcinoma. Diabetes insipidus (DI) is a clinical syndrome characterized by excessive Also, methylprednisolon and intravenous immunoglobulin (IVIG) therapy urination, excessive thirst and excessive drinking of water. It is defined as was added to the treatment. 4 months later control MRI scan revealed the passage of large volumes (>3 L/24 hr) of dilute urine (<300 mOsm/ prominent regression of prior intensity changes of the pons, 9 months kg). There are two major forms of DI; central (neurogenic, pituitary, or later MRI findings disappeared. neurohypophyseal) and nephrogenic. In the central form, secretion of Discussion: Anti-Ri antibody positivity is a rare form of paraneoplastic antidiuretic hormone decreases secondary to neoplastic and infectious or syndrome. Often it has been linked to ovarian, breast and small cell lung inflammatory causes. It may rarely be secondary to trauma, in particular cancer. Here, primary objective is the diagnosis of underlying tumor and by motor vehicle accidents. We present MR imaging findings of transec- its treatment and occult malignancy screening should be performed for tion of the infundibular stalk causing central DI in a 13-year-old male at least 5 years. Next to tumor resection and chemotherapy, there are Syrian refugee after the bombing. also immunosuppressive and immunomodulatory treatment protocols. Keywords: Bomb, diabetes insipidus, infundibular stalk, transection In our patient, with prednisolone and IVIG treatment clinical symptoms decreased and MRI findings disappeared. Keywords: Anti-Ri positive, paraneoplastic sydrome, MRI P - 0310 MESIAL TEMPORAL SCLEROSIS IN P - 0308 PEDIATRIC AGES NECROTIC LEUKOENCEPHALOPATHY NAMIK KEMAL ALTINBAS DUE TO COMPLEX TYPE 1 Ankara University School of Medicine, Ankara, Turkey RESPIRATORY CHAIN DEFICIENCY Abstract ERKAN GOKCE1, MURAT BEYHAN2 Mesial temporal sclerosis (hippocampal sclerosis) is relatively less com- Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S137 mon in children than adults and associated with refractory temporal Abstract lobe epilepsy. In this case report, two pediatric patients were presented. Introduction: Posterior reversible encephalopathy syndrome (PRES) A male case sample with left mesial temporal sclerosis was 16 years old is a clinico-radiological disease with characteristic magnetic resonance and suffering from intractable focal epilepsy. There was reduced volume imaging (MRI) findings. MRI shows subcortical/cortical hyperintensity in and increased T2 signal of left hippocampus compared to the right on T2-weighted sequences, typically in posterior circulation distribution . magnetic resonance (MR) images. A female patient with left hippocampal Although parieto-occipital regions involvement is most common; atypi- sclerosis was 14 years old and suffering from intractable complex partial cally , involvement of the cerebellum, frontal lobe and temporal lobe in temporal lobe epilepsy. There were similar changes on MR images. pediatric patients are often detected. We aimed to present clinical and radiologic findings of PRES with atypical MRI findings in pediatric patients. Materials and Methods: We retrospectively evaluated the MRI findings of P - 0311 9 cases of pediatric PRES. POSTERIOR REVERSIBLE Results: Three of the patients were girls, six were boys. The patients’ ENCEPHALOPATHY SYNDROME IN age ranged from 5 to 16 years (mean age, 9,4 years). All lesions had subcortical/cortical hyperintensity in T2-weighted sequences. All patients PEDIATRIC PATIENTS: FALL IN LOVE hadparieto-occipital regions involvement, eight patients had frontal lobe, WITH CEREBELLUM, FRONTAL LOBE seven patients had cerebellar and temporal lobe and one patient had AND TEMPORAL LOBE? splenic involvement. In two patients cortical diffusion restriction, in two patients hemorrhage was an associated feature.In one patient exhibited AYSE GUL ALIMLI1, HAVVA AKMAZ UNLU2, intense enhancement after intravenous contrast injection. NAZLI GULSUM AKYEL2, MESUT SIVRI2 Conclusion: Atypical MRI findings of PRES are seen quite often in pedi- 1Department of Pediatric Radiology, University of Health Sciences, Ankara atric patients; especially involvement of the cerebellum, frontal lobe and Child Health and Diseases Hematology Oncology Training and Research temporal lobe. In addition diffusion restriction, contrast enhancement and Hospital, Ankara, Turkey hemorrhage can also be seen. 2Department of Radiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Keywords: Atypical findings, MRI, cerebellum, PRESXeremperiam ra non- Ankara, Turkey senis quide endae simaxim as dunt. TÜRK MANYETİK REZONANS DERNEĞİ ULUSLARARASI KATILIMLI

23. YILLIK BİLİMSEL TOPLANTISI

10-12 MAYIS 2018, ANKARA SHERATON OTEL

KONGRE ÖZET KİTAPÇIĞI Sözlü Bildiriler S2 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı S - 01 TRANSFÜZYON BAĞIMLI BETA TALASEMİ MAJOR HASTALARINDA SPLENİK DEMİR BİRİKİMİNİN SHEAR WAVE ELASTOGRAFİ VE MANYETİK REZONANS T2* GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ MEHMET FATİH ÖZKILIÇ, BÜLENT ÇEKİÇ, ERDAL KURTOĞLU Sağlık Bilimleri Üniversitesi Antalya Eğitim ve Araştırma Hastanesi, Antalya, Türkiye Özet Amaç: Bu çalışmada, uzun dönem transfüzyon tedavisi gören Beta Talasemi Major hastalarında splenik demir birikiminin GRE T2* (star) görüntüleme ve shear wave elastografi ile değerlendirilmesi ve normal populasyon ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: 21-45 yaş arası 30 sağlıklı gönüllü ve uzun dönem transfüzyon tedavisi almakta olan 15-40 yaş arası 30 Beta Talasemi Major hasta- sında dalağa yönelik MRG (multi TE GRE sekansı) ve shear wave elastografi incelemeleri yapıldı.Hasta grubunda serum ferritin değerleri kaydedildi. Her olguda MRG ile karaciğer ve dalak T2* (star) değeri ölçüldü. Shear wave elastografi ile dalak shear wave stiffness ve hız değerleri saptandı. Bulgular: Talasemi grubunda dalak T2* değerleri kontrol grubuna oranla anlamlı düşük saptandı (p<0,05). Talasemi grubunda dalak shear wave stiffness ve hız değerleri kontrol grubuna oranla anlamlı yüksek saptandı (p<0,05).Dalak T2* değerleri ile serum ferritin değerleri arasında anlamlı negatif korelasyon saptandı (p<0,05). Shear wave elastografi parametreleri ile dalak T2* veya serum ferritin değerleri arasında anlamlı korelasyon saptanmadı (p>0,05). Sonuç: Talasemi Major hasta grubunda dalak T2* değerleri demir birikimine bağlı olarak azalma göstermektedir. Splenik biyopsinin dahil edileceği çalış- malarla demir yükü tayininde dalak için eşik T2* değerleri belirlenebilir. Shear wave elastografi parametreleri dalak T2* ve serum ferritin değerleri ile korelasyon göstermediğinden dalak demir yükü saptanmasında kullanımı pratik değildir.

S - 02 GASTROİNTESTİNAL SİSTEM MALİGNİTESİ BULUNAN HASTALARIN KARACİĞER METASTAZLARININ MRG İLE GÖRÜNTÜLENMESİNDE GADOKSETİK ASİT VE GADOPENTATE DİMEGLUMİNİN ETKİNLİĞİNİN KARŞILAŞTIRILARAK DEĞERLENDİRİLMESİ CENGİZ KADIYORAN Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet Amaç: Bu çalışmanın amacı gastrointestinal sistem malignitesi bulunan hastaların karaciğer metastazlarının MRG ile görüntülenmesinde gadoksetik asit ve gadopentate dimegluminin etkinliğinin karşılaştırılarak değerlendirilmesidir. Gereç ve Yöntemler: Histopatolojik olarak gastrointestinal sistem malignite tanısı kesinleşmiş hastaların daha önceden çekilmiş olan BT ve MRG tetkikleri retrospektif olarak değerlendirilmiştir. Bu hasta grubunda karaciğer metastazı bulunan 50 hasta seçilerek çalışmaya dahil edil- miştir. Çalışmaya dahil edilen hastalar yapılacak işlem konusunda bilgilendirilmiş ve yazılı onayları alınmıştır. Her iki kontrast madde grubu ile prekontrast standart serileri takiben arteryel, portal ve 5. dakikada geç faz seriler elde olunmuştur. Gadoksetik asite özel 20. dakikada seriler elde edilmiştir. Her iki kontrast madde grubunda da arteryel, portal ve geç fazda da karaciğer parankiminden komşuluğunda vasküler yapı ve metastatik lezyonun izlenmediği parankim alanından intensite ölçümü yapılmıştır. Ayrıca her üç fazda da nekrotik alan içermeyen bir metastatik lezyondan intensite ölçümü yapılarak elde edilen değerler kaydedilmiştir. Gadoksetik asit verilen hasta grubunda alınan 20. dakika serilerde de benzer şekilde ROI yardımı ile karaciğer parankim ve metastatik lezyon intensite ölçümü yapılarak değerler kaydedilmiştir. Hem gadoksetik asit hem de gadopentate dimeglumine uygulanan hastalarda arteryel, portal ve geç faz elde edilen karaciğer parankim intensite ve metastatik lezyon intensite değerleri karşılaştırılmıştır. Gadoksetik asit uygulaması sonrasında 20. dakikadaki seriler ile gadopentate dimeglumine uygulanan hastalardaki geç fazda elde edilen seriler karaciğer parankim ve metastatik lezyon intensiteleri açısından karşılaştırılmıştır. Daha sonra gadoksetik asit grubunda hem karaciğer parankiminin hem de metastatik lezyonun sekanslar ilerledikçe gösterdiği intensite değişikliğini değerlendirmek amacı ile arteryel, portal, geç faz ve 20. dakikadaki serilerde daha önceden ölçmüş olduğumuz intensite değerleri karşılaştırılmıştır. Elde edilen intesite değerleri tabloda özetlenmiştir. Gadoksetik asit ile edilen serilerde 20.dakika serilerin yeni metastaz tespitine olan katkısını değerlendirebilmek amacı ile portal fazda izlenen metastatik lezyonlar, 20. dakikadaki serilerde ki metastatik lezyonlar ile karşılaştırılmış, yeni tespit edilen lezyon varsa not edilmiştir. Bulgular: Gadoksetik asit ile elde edilen 20. dakikadaki serilerin gadopentate dimeglumine ile elde edilen 5. dakikadaki seriler ile karaciğer parankimi ve metastatik lezyon intensiteleri açısından karşılaştırılmasında gadoksetik asit lehine istatistiksel anlamlı fark bulunmuştur. Arteryel, portal ve geç fazda her 2 kontrast madde arasında intensite değerleri açısından anlamlı fark saptanmamıştır. Gadoksetik asit uygulmasını takiben arteryel fazda artmaya başlayan karaciğer intensitesi, portal ve geç faz karşılaştırıldığında anlamlı artış göstermemektedir. Ancak 20. dakika elde olunan serilerde karaciğer parankim intensitesi portal faza göre anlamlı artış göstermiştir. Bu sırada matastatik lezyon intensitesi fazlar arası anlamlı farklılık göstermemiştir. Gadoksetik asit Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S3 uygulanan hastalarda portal faz ve 20. dakikada elde edilen serilerde tüm hastalardaki metastazlar sayılarak karşılaştırıldığında metastatik lezyon sayısında bu iki faz arasında anlamlı farklılık izlenmemiştir. Sonuç: Gadoksetik asit hepatoselüler bir kontrast madde olup gastrointestinal sistem maligniteli hastaların karaciğer metastazlarının manyetik rezonans ile değerlendirilmesinde 20. dakikada elde edilen serilerde önemli tanısal katkılar sağlar. Karaciğer kontrastı artarken metastatik lezyonlardaki kontrastlan- manın artmıyor olması karaciğerdeki metastatik lezyon ve normal karaciğer parankimi arasında belirgin kontrast farkına yol açmaktadır. Böylece zamanla gittikçe artan karaciğer kontrastlanmasını takiben fazlar süresince anlamlı artış göstermeyen metastatik lezyon intensitene de bağlı olarak lezyonların tespiti kolaylaşmaktadır.

S - 03 KLİNİK OLARAK VAS DEFERENS AGENEZİ TANISI OLAN HASTALARDA VAS DEFERENS VE SEMİNAL VEZİKÜLÜN MAGNETİK REZONANS GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ HAKAN İMAMOĞLU Erciyes Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Kayseri, Türkiye Özet Amaç: Erkek infertilitesinde kesin tanı ve uygun tedavi için Magnetik Rezonans (MR) görüntüleme kullanılabilir. MR görüntüleme, vas deferensin intraabdominal parçasını da gösterebildiğinden vas deferensi değerlendirmede ultrasonografiye kıyasla üstünlük gösterir. Bu çalışmanın amacı klinik olarak vazal agenezi (VA) tanısı olan hastalarda vas deferens ve seminal vezikülün MR görüntüleme ile değerlendirilmesidir. Gereç ve Yöntemler: Klinik olarak unilateral veya bilateral VA olan 17 hastanın MR görüntüleri aksial, koronal ve sagittal düzlemlerde 1.5 Tesla cihaz ile endorektal koil kullanılmadan elde olundu. Görüntülerde unilateral veya bilateral VA; seminal vezikül (SV) defekti (hipoplazi veya atrofi); SV agenezisi, SV kisti ve vas deferensin ampulla dışındaki pelvik (intraabdominal) parçası araştırıldı. Unilateral ve bilateral VA olan hastaların MR görüntüleme bulguları arasındaki fark ki-kare testi ile değerlendirildi. Bulgular: Klinik olarak 9 hastada bilateral, sekiz hastada ise unilateral VA vardı. Vas deferensin intraabdominal parçası bilateral VA’si olan hastaların dördünde, unilateral VA’si olan hastaların ise birinde mevcuttu. Bilateral VA’si olan hastalarda intraabdominal parça saptanma oranı unilateral VA’si olan hastalardan yüksek olsada her iki grup arasındaki fark istatistiksel olarak anlamlı değildi (p>0,05). Ek olarak, unilateral ve/veya bilateral VA’si olan hastaların %94’ünde eşlik eden SV defekti ve/veya agenezisi saptandı. Sonuç: Klinik olarak unilateral veya bilateral VA tanısı alan hastalarda vas deferensin intraabdominal parçasının MR görüntüleme ile araştırılması önerilir. Bu yaklaşım VA’nin etiyolojisini aydınlatmaya katkıda bulunabilir.

S - 04 PERİTONEAL İMPLANTLARDA ADC VE ULTRASON ELASTOGRAFİNİN TANIDAKİ YERİ MESUT ÇETİN 1, ADEM AĞYAR 1, OSMAN DERE 1, ABDURRAHİM DUSAK 1, HAKAN BÜYÜKHATİPOĞLU 2 1Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye 2Harran Üniversitesi Tıp Fakültesi, Tibbi Onkoloji Bilim Dalı, Şanlıurfa, Türkiye Özet Amaç: Ovaryan ve GİS malignitesi olan hastalarda periteonal implantların share –wave elastografi hız değerleri ile difüzyon MR da ADC değerleri ara- sında ilişkinin araştırılması. Gereç ve Yöntemler: Ekim 2017 ve mart 2018 tarihleri arasında Kadın hastalıkları ve onkoloji kliniklerinden bilinen over malignitesi olan veya şüphesi bulunan hastaların 3 Tesla Mr da çekilen abdomen Mr ları aynı gün değerlendirildi. Peritonal implantı olan hastalar eş zamanlı Shear-wave elastografi tek- niğiyle hız ölçümleri yapıldı. Overyan ve GİS malignitesi olan 28 hastanın abdomen mr incelemesinde 9 hastada peritonal implant saptandı. Bu hastalarda implantı olan hastalarda boyutu en büyük olan ve cilde yakın olan seçildi. ADC haritalamada 3 adet 4 mm² ROİ değerleri alındı. Shear-wave elastografide ADC değeri alınan implanttan 3 adet 1,5 mm² ROİ kullanılarak hız değerleri ölçüldü. Elde edilen ortalama değerler Spearman’s korelasyon testi kullanıldı. P≤0,05 değeri istastiksel olarak anlamlı kabul edildi. Bulgular: Hasta sayımız 9 olup ortalama yaş 52,5 olarak saptandı. Ortalama ADC değeri 1,02 (min:0,87, max:1,8) bulundu. Share-wave hız değeri ortalama 2,1 m/ sec (min:1,8, max:2,8) olarak hesaplandı. Peritonal implantlardan elde edilen ADC değeri ve ortalama hız değerleri arasında ters orantı saptandı. Sonuç: Bu çalışmamızdaki veriler ile shear -wave elastografinin peritonal implantların saptanmasında Difüzyon mr kadar değerli olduğunu düşünmekteyiz. S4 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı S - 05 PERİANAL FİSTÜL GÖRÜNTÜLEMESİNDE VÜCUT KOİLİ İLE YÜZEYEL FLEX KOİLİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI NAZLI GÜLSÜM AKYEL 1, KAYIHAN AKIN 2, DİLEK KÖSEHAN 3, ASLI KÖKTENER 2 1Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Ankara, Türkiye 2Ankara Umut Hastanesi, Ankara, Türkiye 3Memorial Ankara Hastanesi, Ankara, Türkiye Özet Amaç: Manyetik rezonans görüntüleme (MRG) ile anal fistül değerlendirilmesinde vücut koili ile yüzeyel Flex-M koilin tanıya yararının karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Anal fistül klinik tanısı ile MRG yapılan 19u erkek, 10u kadın 29 hasta çalışmaya dahil edildi. Toplam 31 fistül değerlendirildi. İncelemeler 1.5 Tesla MR cihazında (Achieva; Philips Medical Systems; Best, Netherlands) 8 kanallı faz dizilimli body koil kullanılarak gerçekleştirildi. Rutin protokole ek olarak Flex-M koil ile aksiyel planda yağ baskılı T2 ağırlıklı sekans tekrarlandı. İki uzman radyolog birbirinden bağımsız olarak ve ayrı zamanlarda body koil ve Flex koil ile alınan görüntüleri inceledi. İç ağız, dış ağız, abse ve sekonder trakt görüntülenebilirliği değerlendirildi. Olgular Parks ve St. James Üniversitesi Sınıflamalarına göre sınıflandırıldı. Bulgular: Birinci radyolog; dış ağızların body koil ile 27, Flex koil ile 29unu, iç ağızların body koil ile 19, Flex koil ile 30unu, sekonder traktların body koil ile 6, Flex koil ile 8ini görebildi. İkinci radyolog; dış ağızların body koil ile 25, Flex koil ile 27sini, iç ağızların body koil ile 18, Flex koil ile 28ini, sekonder traktların body koil ile 6, Flex koil ile 8ini görebildi. Hastalardaki 6 absenin tamamını iki radyolog da her iki koille görebildi. İki hastada ikişer fistül vardı ve radyologların ikisi de ikinci fistülü body koil ile göremedi. Flex koil ile birinci radyolog fistüllerin her ikisini de, ikinci radyolog birini görebildi. Gözlemciler arası değişkenlik istatistiksel olarak anlamlı değildi ve kappa değerleri uyumluydu. Sonuç: Bu çalışmada yüzeyel koil ile çözünürlüğün daha iyi olduğunu ve özellikle iç ağız görüntülemesi olmak üzere tanıya katkı sağladığını ortaya koyduk.

S - 06 KARACİĞER PARANKİMİNDE FARKLI KONTRAST MADDELERİN KONTRASTLANMA PATERNLERİNİN KARŞILAŞTIRILMASI MEHMET MERT GERES, UMUT ERDEM, BADE KELEŞ, ŞÜKRÜ MEHMET ERTÜRK Sağlık Bilimleri Üniversitesi Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye Özet Amaç: Gadoterate meglumine, gadoversetamide, gadobutrol, gadodiamide ve gadoxetate sodyum adlı gadolinyum içeren manyetik rezonans (MR) kontrast ajanlarının intravenöz enjeksiyonu sonrasında gerçekleştirilen dinamik batın MR incelemelerinde, arteryel fazda aorta ve karaciğer parankiminin, portal venöz ve denge fazlarda karaciğer parankiminin sinyal intensitelerinin karşılaştırılması. Gereç ve Yöntemler: Retrospektif çalışmaya gadoxetate sodyum için 0,05 mmol/kg, diğer her bir kontrast madde için 0,1 mmol/kg intravenöz yolla gadolinyum enjekte edilmiş, 25’er adet dinamik kontrastlı abdominal MR çalışması dahil edildi. Arteryel fazda, aortadan ve karaciğer parenkiminden, portal venöz ve denge fazlarında ise yalnızca karaciğer parankiminden sinyal intensite ölçümleri yapıldı. Hepatosit spesifik fazda elde edilen görüntüler gadoxetate sodyum’a özgü oduklarından farklı kontrast madde kullanılmış gruplar arasında sinyal intensite farkları ANOVA testi kullanılarak araştırıldı. ANOVA testi ile istatistiki anlamlı fark ortaya çıkan durumlarda gruplar arası karşılaştırmalar ad hoc Tukey testi kullanılarak gerçekleştirildi. Bulgular: Arteryel faz esnasında aortadan yapılan ölçümler arasında anlamlı fark yoktu. Arteryel fazda karaciğer parankiminden yapılan ölçümler göz önüne alındı- ğında gadoxetate sodyum grubunda sinyal intensitesi (555,1±122,3) gadobutrol grubunun sinyal intensitesinden (474,1±170,8) anlamlı derece yüksekti (p<0,05). Portal venöz fazda karaciğer parankiminden yapılan ölçümlerde, gadoxetate sodyum grubunda sinyal intensitesi (339,0±71,1) gadoversetamide (255,4±86,9) ve gadobutrol (255,5±83,6) grubundan anlamlı derece yüksekti (p<0.05). Denge fazında karaciğer parankiminden yapılan ölçümlerde gadoxetate sodyum grubunda sinyal intensitesi (368,6±74,2) gadoversetamide (280,0±96,7) ve gadobutrol (279,0±93,4) grubundan anlamlı derece yüksekti. Sonuç: Gadoxetate sodyum, daha az gadolinyum içermesine rağmen, arteryel, portal venöz ve denge fazlarında karaciğerde diğer gadolinyum içeren kontrast maddelere göre aynı miktarda ya da daha fazla sinyal artışı sağlamaktadır. Gadoxetate sodyuma özgü hepatosit spesifik faz, diğer ajanlar ile bu fazda görüntü elde edilmesi mümkün olmadığından çalışma kapsamına alınmamıştır.

S - 07 SAFRA KESESİ VE SAFRA YOLLARI TAŞ OLUŞUMUNDA MRKP İLE BELİRLENEN MORFOLOJİK PARAMETRELERİN DEĞERİ ÖZGÜR KARABIYIK, ALİ KOÇ, TURGUT TURSEM TOKMAK, GAMZE TÜRK, MUSTAFA BİLGİLİ Sağlık Bilimleri Üniversitesi Kayseri Eğitim ve Araştırma Hastanesi, Kayseri, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S5

Özet Amaç: Safra kesesi, intra ve ekstrahepatik taş oluşumunda birçok etyolojik faktör bulunmaktadır. Ancak ekstra ve intrahepatik safra yollarının morfolojik özellikleri ve taş oluşumu ile ilgili günümüze kadar yapılan yeterli çalışma yoktur. Bu çalışmadaki amacımız safra yolları ve safra kesesi taşlarında sağ ve sol intrahepatik safra kanalı arasındaki açı (SSHKA), sistik kanal-ana hepatik kanal birleşim açısı (SHA), hepatikokoledokal açı (HKA) ilişkisini saptamak ve ayrıca sistik kanal uzunluğu ve çapının taş oluşumuna katkısı olup olmadığını literatürle karşılaştırmaktır. Gereç ve Yöntemler: 63 olguya ait MRKP (manyetik rezonans pankreatikokolanjiyografi) tetkikleri retrospektif olarak incelendi. Olguların safra kesesi açısı (SKA), SHA, sistik kanal uzunluğu (SKU), sistik kanal çapı (SKÇ), SSHKA, HKA, intra-ekstrahepatik kanallarda taş olup olmaması, sistik kanal tipi not edildi. Görüntülerin incelenmesinde PACS ortamında MIP ve diğer kesitsel imajlar birlikte kullanıldı. SPSS programı ile İstatistiki olarak olgulara ait tanımlayıcı analiz ve korelasyon testleri uygulandı. Bulgular: Olguların %46’sı erkek, %56’sı bayan idi. Olguların yaş ortalaması 59 idi. Olguların 46 sında (%73) safra kesesinde taş vardı. Olguların 27 sinde (%43) koledokta, 5 tanesinde (%8) ana hepatik kanalda, 4 tanesinde (%6) intrahepatik safra yollarında taş tespit edildi. SKA, ortalama 62 derece; SHA, 24 derece, SKU, ortalama 43 mm; SKÇ, ortalama 5,4 mm; SSHKA, ortalama 63 derece; HKA, ortalama 132 derece ölçüldü. Yaş arttıkça SHA,SSHKA ve HKA açıları azalıyordu. Ancak istatistiksel olarak anlamlı değildi (p>0,05). Bayanlarda SHA ve HKA açısı erkeklere göre artarken, SSHKA açısı azalıyordu (p>0,05). Safra kesesinde taş olanlarda SHA ve SSHKA açıları azalırken (p>0,05), HKA artıyordu (p=0,05). Koledokta taşı olanlarda SHA, SSHKA ve HKA açılarının hepsinde artış vardı (p>0,05). Ana hepatik kanalda taşı olanlarda SHA ve HKA azalırken, SSHKA açısı artıyordu (p>0,05). Sonuç: Safra kesesi ve yollarının morfolojik yapısı da taş oluşumu etyoljisi açısından dikkatlice değerlendirilmelidir.

S - 08 BÖLGEMİZDE KARACİĞER TRANSPLANTASYON ÖNCESİ DONÖRLERDE SAFRA YOLLARI VARYASYONLARININ İNSİDANSININ MRCP İLE ARAŞTIRILMASI MUSTAFA KOÇ Fırat Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Elazığ, Türkiye Özet Amaç: Bu çalışmanın amacı; bölgemizde, karaciğer donörlerinde safra yolları varyasyonlarının manyetik rezonans kolanjiyopankreatografi (MRKP) yön- temi ile insidansını değerlendirmektir. Gereç ve Yöntemler: Ocak 2016-Şubat 2018 tarihleri arasında, kliniğimizde 1.5 T MRG ile MRKP uygulanan karaciğer donörü hasta dosyalarına ait kayıtlar, retrospektif olarak incelendi. Çalışmaya 32 olgu dâhil edildi. Olguların 19 u erkek (%59), 13 ü kadın (%41) idi. Yaşları 22 ile 65 arasında değiş- mekte olup, ortalama yaş 47±10.3 bulundu. Safra yollarının anatomisi incelendi. Safra yolları varyasyonları Huang sınıflamasına (Tip A1-A5) göre yapıldı. Varyasyonların varlığı ve tipi kaydedildi. Bulgular: 21 olgunun (%66) safra yolları normal anatomik görünümde olup varyasyon tespit edilmedi (Tip A1). Kalan 11 olguda (%34) çeşitli varyasyonlar mevcuttu. 6 olguda (%19) Tip A2, 3 olguda (%9) Tip A3, 1 olguda Tip A4 (%3) ve 1 olguda (%3) Tip A5 varyasyonu mevcuttu. Tip A1 ve Tip A2 olguları (%85) safra yolları açısından transplantasyon için uygun değerlendirilmiş, Tip A3-A4 ve A5 varyasyonlu olgular (%15) ise transplantasyona uygun bulunmamıştı. Sonuç: Karaciğer transplantasyonu işleminde, preoperatif görüntülemede, hepatik arteriyel ve venöz yapıların, safra yollarının normal anatomisinin ve varyasyonlarının değerlendirilmesi, operasyon esnasında veya postoperatif takiplerde oluşacak komplikasyonlar açısından büyük önem taşımaktadır. Biliyer varyasyonlar sık gözükmekte olup, morbiditenin büyük kısmı biliyer anastomozlarla ilgili komplikasyonlara bağlıdır. Komplikasyonların önüne geç- mek için, preoperatif verici adaylarının biliyer sistemlerinin, noninvazif radyolojik yöntemler kullanılarak, dikkatlice değerlendirilmesi gerekmektedir. Biliyer anatominin ve varyasyonların değerlendirilmesinde MRKP ilk tercih edilecek non invazif radyolojik modalitedir.

S - 010 BENİGN VE MALİGN TİROİD NODÜLLERİNİ AYIRMADA DİNAMİK KONTRASTLI PERFÜZYON MANYETİK REZONANS GÖRÜNTÜLEMENİN KULLANIMI MURAT BEYHAN 1, RECEP SADE 2 1Devlet Hastanesi, Radyoloji Kliniği, Tokat, Türkiye 2Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Amaç: Tiroid nodülleri sıklıkla görülür ve genel popülasyonun%60ında gözlenir. Ancak bu nodüllerin sadece %3-7si maligndir. Malign tiroid nodüllerini benign nodüllerden ayırma tiroid lezyonlarında gereksiz cerrahinin ve zaman kaybının önlenmesi açısından oldukça önemlidir. Çalışmamızda amaç tiroid nodüllerinde benign-malign ayrımında perfüzyon manyetik rezonans görüntülemenin (MRG) etkinliğini araştırmaktır. Gereç ve Yöntemler: Aralık 2016-Aralık 2017 arasında tiroid bezinde kitlesi olan 18 yaş ve üzeri 24 hastanın görüntüleri 3-T MRde dinamik kontrastlı MRG kullanılarak elde edildi. Bu görüntüler software üzerinde seçilmiş regions of interest (ROI) ile post-processing işleminden geçirilerek ROI içindeki S6 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

trans 2 her voksel için kantitatif veriler elde edildi. K , Ve, Kep, iAUC ve chi otomatik olarak hesaplandı. Daha sonra benign ve malign lezyonların dinamik kontrastlı MRG değerleri karşılaştırıldı. Bulgular: Hastaların 15’i kadın 9’u erkekti. Yaş ortalaması 36,2 idi. Hastaların 14’ünde benign lezyon 10unda malign tümör mevcuttu. Malign lezyonlarda trans 2 ortalama K , Kep, Ve, iAUC ve chi değerleri sırasıyla 0.265, 1.046, 0.419, 20.579 ve 0.442; benign lezyonlarda 0,531, 1.498, 0.438, 29.64 ve 0.434; normal parankimde ise 0.859, 1.63, 0.461, 35.85 ve 0.39 idi. Malign lezyonlardaki ortalama Ktrans ve iAUC değerleri benign lezyonlardan anlamlı olarak trans daha düşüktü (0.028 ve 0.049). Malign lezyonlarda K , Kep ve iAUC değerleri normal parankim değerlerinden istatistiksel olarak anlamlı derecede düşüktü (sırasıyla p 0.001, 0.002 ve 0.001). Sonuç: Diğer dokuların aksine, tiroid kitlelerinde perfüzyon MRG değerleri maligniteye doğru gidildikçe Ktrans ve iAUC değerlerinde bir azalma sergiler. Perfüzyon MRG’nin kullanımı benign ve malign tiroid nodüllerini ayırmada daha büyük çalışmaların sonucu olarak bir cut-off değeri oluşturulduktan sonra yararlı olabilir.

S - 013 ULTRASON REHBERLİĞİNDE MR ARTROGRAFİK İNTRAARTİKÜLER ENJEKSİYON TEKNİKLERİ GÖKHAN POLAT, SERHAT KAYA, HAYRİ OĞUL, BERHAN PİRİMOĞLU, MECİT KANTARCI, AKIN LEVENT Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Amaç: Biz çalışmamızda tanı ve tedavi açısından önemli olan intraartiküler enjeksiyon yöntemlerinin ultrason kılavuzluğunda uygulanış yöntemlerini tanıtmayı amaçladık. Gereç ve Yöntemler: 100 cc serum fizyolojik, MR kontrast madde,BT kontrast madde,İnsülin enjektörü,20cc enjektör, Gazlı bez /batikon, Steril eldiven,Steril prob kılıfı, Damar yolu Kontrast maddenin hazırlanması; 1) MR artrografi için; • 100cc serum fizyolojik içerisine 0,5 cc MR kontrast madde verilir. • 20cc steril enjektör içerisine hazırladığımız karışım alınır. 2) MR artrografi+CT artrografi için; • 100 cc serum fizyolojik içerisine 0,75cc MR kontrast madde verilir. • 20 cc enjektör içerisine 5 cc CT kontrast maddeden 15 cc dilüe ettiğimiz MR kontrast maddeden alınır. İşlem Öncesi Hazırlık; • Enjeksiyon yapılacak eklem antiseptik solüsyon ile steril edilir. • Lineer transducere steril ultrason prob kılıfı geçirilir. • Girişimsel işlemi yapacak doktorumuz steril giyinmesi gerekiyor. • Ultrasonda lineer prob (5-12 MHz) ve MSK modu seçilir. Bulgular: Posterior Yaklaşımda Omuz eklemi İçin; • Hasta dik oturur pozisyonda yerleştirilir. • Linear prob infraspinatus kasına paralel yerleştirilir. • Humerus başı ve glenoid kemik arasında eklem boşluğu görülür. • İğnemiz probumuzun yaklaşık 1cm uzağından, yaklaşık 45 derecelik açı ile ve probun uzun aksına paralel olacak şekilde ilerletilir. • Posterior yaklaşımda hedef iğnemizin humerus başı ile glenoid kemik arasına yerleştirilmesidir. • Yaklaşık 10-15 cc (12 cc) arasında hazırladığımız dilüe kontrast madde enjekte edilir. 2) Tibiotalar Eklem İçin; • Hasta sedye uzerinde oturur pozisyonda durur ve işlem yapılacak ayak için ayak tabanı sedyeye paralel yerleştirilir. • Lineer prob tibia diafizine paralel olacak şekilde eklem üzerine yerleştirilir. • Tibia epifizi ve talus domu arasından eklem boşluğu görülür. • İğnemiz probumuzun yaklaşık 1cm uzağından,yaklaşık 45 derecelik açı ile ve probun uzun aksına paralel olacak şekilde ilerletilir. • Hedef iğnemizin tabiotalar eklem boşluğuna yerleştirilmesidir. • Yaklaşık 3-5 cc (4 cc) arasında hazırladığımız dilüe kontrast madde enjekte edilir. 3) Lateral Yaklaşımda Radiohumeral Eklem İçin; • Hasta sedye yanında sedyeye vücudunun yan tarafı gelecek şekilde oturtulur. • Humerus sedye üzerine paralel şekilde yerleştirilir. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S7

• Ön kol 90 derece fleksiyonda ve baş parmak yukarıda olacak şekilde yerleştirilir. • Lineer prob radius diafizine paralel olacak şekilde radius başında eklem üzerine yerleştirilir. • Radius başı ile kapitellum arasından eklem boşluğu görülür. • İğnemiz probumuzun yaklaşık 0,5 cm uzağından,yaklaşık 45 derecelik açı ile ve probun uzun aksına paralel olacak şekilde ilerletilir. • Lateral Yaklaşımda hedef radiokapitellar eklem boşluğunda iğnemizin radius başına uzanmasıdır. • Yaklaşık 3-5cc (4 cc) arasında hazırladığımız dilüe kontrast madde enjekte edilir. 4) El Bileği İçin; • Hasta sedye yanında yüzü sedyeye dönük yerleştirilir. • El bileği altına mümkünse bileğin hafif fleksiyonda durmasına yardımcı olacak aparat yerleştirilir. • El bileği hafif ulnar deviasyona getirilir. • Lineer prob radius diafizine paralel olacak şekilde distal radius epifizi üzerine yerleştirilir. • Radiokarpal eklem mesafesi görülür. • İğnemiz probumuzun yaklaşık 0,5 cm uzağından,yaklaşık 45 derecelik açı ile ve probun uzun aksına paralel olacak şekilde ilerletilir. • Hedef iğnemizin radiokarpal eklem boşluğunda radius distal epifizine ulaşmasıdır. • Yaklaşık 2-4cc (3 cc) arasında hazırladığımız dilüe kontrast madde enjekte edilir. Sonuç: Ultrason gerçek zamanlı bir tetkik olduğu için işlem sırasında iğne trasesi daha iyi değerlendirilebilir. Özellikle pediatrik hasta grubunda radyas- yondan korunmak ve daha efektif bir enjeksiyon için tercih edilir.

S - 014 DİNAMİK KONTRASTLI MRG DE WASH-IN, WASH-OUT VE MAKSİMUM KONTRASTLANMA SKORU: PROSTAT KANSERİ SAPTAMA VE LOKALİZE ETMEDEKİ YERİ FEYZA YILMAZ Gaziantep Üniversitesi Tıp Fakültesi, Gaziantep, Türkiye Özet Amaç: Çalışmamızda dinamik Magnetik Rezonans (MR) görüntüleme ile normal ve anormal prostatik dokuların karakteristik kontrastlanma özelliklerini saptayarak; histolojik derece (Gleason skoru) ve tümör belirteçleri ile ilişkilerini değerlendirdik. Gereç ve Yöntemler: Prostat kanseri olan 27 hastada gadopentetat dimegluminin bolus enjeksiyonunu takiben dinamik MR görüntüleri elde edildi. Aynı anatomik pozisyonda T2 ağırlıklı ve diffüzyon görüntülerinde yeri belirlenen 27 tümör dokusu, 21 normal periferal zon, 13 normal santral zondan ve 8 benign prostat hiperplaziden zaman-sinyal yoğunluğu parametreleri olan; kontrastlanma başlangıç zamanı, maksimum kontrastlanma zamanı, kontrastlanma bitiş zamanı, başlangıç sinyal değeri, maksimum kontrastlanma sinyal değeri, bitiş kontrastlanma sinyal değeri kullanılarak wash-in, wash-out ve maksimum kontrastlanma skoru elde edilerek; normal doku ve benign patolojilerle, kanser dokusu karşılaştırıldı. Ayrıca tümörün histolojik derece (Gleason skoru) ve serum prostatik spesifik antijen (PSA) seviyeleri ile korele edildi. Bulgular: Periferik zon ve tümör arasında başlama zamanı hariç sinyal yoğunluğu parametreleri ile anlamlı fark bulundu. Santral gland ve tümör kontrastlanma parametreleri değerleri arasında maksimum kontrastlanma zamanı ve wash in skoru hariç fark izlenmedi. BPH ve tümör kontrastlanma parametreleri değerleri arasında maksimum kontrastlanma zamanı hariç fark izlenmedi. Bununla birlikte, Gleason skoru veya PSA seviyeleri ile önemli bir korelasyon görülmedi. Sonuç: MR kontrastlanma özelliklerinin değerlendirilmesi özellikle periferal zonda normal doku- tümör ayrımı yapılmasına olanak tanıdığı bilinmekle birlikte maksimum kontrastlanma zamanı BPH ve tümör ayrımında faydalı olabilir.

S - 016 PERİFERAL ZON YERLEŞİMLİ PROSTAT ADENOKARSİNOM VAKALARINDA DİFÜZYON AĞIRLIKLI GÖRÜNTÜLERİN OBJEKTİF VE SUBJEKTİF DEĞERLENDİRİLMESİ GÖKHAN TONKAZ, GÖKHAN POLAT, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Amaç: Multiparametrik prostat MR (mpMRG) çekilen ve sonrasında yapılan biyopsi sonucu prostatik adenokersinom gelen hastalarda lezyonlarının subjektif ve objektif difüzyon karakterlerinin incelenmesi. S8 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Gereç ve Yöntemler: Ocak 2016 – Ocak 2018 tarihleri arasında bölümümüzde mpMRG çekilen ve sonrasında biyopsi yapılan hastalar retrospektif olarak değerlendirildi. Biyopsi sonucu prostatik adenokersinom gelen 26 tane hasta tespit edildi. Mevcut 26 hastadaki lezyonların tamamına ait difüzyon ağırlıklı görünütüler 5 yıllık tecrübeye sahip abdominal radyolog ve 2 yıllık tecrübeye sahip radyoloji uzmanlık öğrencisi tarafından incelendi. Lezyonların b50, b1000, b1500 deki sinyal intensiteleri subjektif olarak (4 puanlık skala) ile belirgin sinyal artışı göstermeyen (0 puan), hafif derecede (1 puan), orta derecede (2 puan) ve ileri derecede hiperintens diye sınıflandırıldı. Lezyonların difüzyon karakterleri objektif olarak ADC değerleri ölçüldü. b50, b1000, b1500 deki sinyal intensitelerinin subjectif değerlendirilmesi ve ADC haritasındaki veriler iki radyolog arasındaki interobserver agreement (kappa) değerleri ile incelendi. Bulgular: Mevcut 26 hastadaki 26 adet periferik zon yerleşimli prostatik adenokanser lezyonun ortalama ADC değeri 626.3±70.2 mm2/s olarak gözlendi. İki radyolog arasında ADC ölçümleri için kappa değeri 0,88 ile yüksek uyumluluk göstermektedir. İki radyolog arasında b50’deki sinyal intensiteleri ara- sındaki subjectif uyum için elde olunan kappa değeri 0.51 (zayıf), b1000’deki sinyal intensiteleri arasındaki subjectif uyum için elde olunan kappa değeri 0.63 (orta) ve b1500’deki sinyal intensiteleri arasındaki subjectif uyum için elde olunan kappa değeri ise 0.65 (orta) olarak gözlendi. Lezyonların büyük çoğunluğunun b1500 ve b1000 görüntülerde yüksek sinyal intensitesine sahip olduğu gözlendi. Sonuç: Çalışmamızda gözlendiği gibi farklı b değerleri arasında interobserver agreement değerleri düşük olduğu için ADCnin sayısal olarak ölçülmesi, radyologların objektif verilerinin rapora yansıtılmasını sağlayarak, MR sonuçlarını iyileştirilmesini ve prostat kanserinin daha iyi tespit edilmesine olanak tanır. Daha düşük ADC değerleri ile difüzyon kısıtlaması, biyopsi öncesinde multiparametrik MRGda kanseri öngörmek için iyi bir parametredir.

S - 017 OSTEOİD OSTEOMA TANISINDA YÜKSEK REZOLÜSYONLU MR GÖRÜNTÜLEMENİN ÖNEMİ GÖKHAN POLAT 1, AYSEL ÖNEM AYDIN 1, HAYRİ OĞUL 1, SERHAT KAYA 1, MECİT KANTARCI 1, KUTSİ TUNCER 2 1Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye 2Atatürk Üniversitesi Araştırma Hastanesi Ortopedi ve Travmatoloji Anabilim Dalı, Erzurum, Türkiye Özet Amaç: Çalışmamızda MRG de ince kesit 3D volumetric interpolated breathhold examination (VIBE) sekansının osteoid osteomayı değerlendirmede ince kesit BT’ye göre etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Kas iskelet sistemi ile ilgili raporlama deneyimi olan 3 radyologun rutin muayenesinde 25 hasta kör olarak değerlendirildi. Değerlendirme için BT, kontrastsız VIBE ve kontrastlı VIBEden sadece biri radyologa randomize teslim edildi. Daha sonra radyologların radyolojik tanısı değerlendirildi. Daha sonra radyologlardan VIBE, kontrastlı VIBE ve BT görüntüleri ile birlikte osteoid osteomalı hastaları değerlendirmeleri istendi. Bu ikinci görüşte OO bileşenlerinin değerlendirilmesi talep edildi. Görüntülerde sklerotik marjın varlığı, nidus ve nidus kalsifikasyonun değerlendirilmesi istendi. Resimlerde görülen her özellik için 0 ile 2 arasında bir skala yapıldı (0=izlenmedi, 1=kısmen izlendi, 2=mükemmel izlendi). Bulgular: BT, VIBE ve kontrastlı VIBE tanıları patolojik tanı ile karşılaştırıldığında anlamlı fark saptanmadı (p = 1). Nidus ve nidus kalsifikasyonun değer- lendirilmesinde görüntüleme yöntemleri arasında anlamlı bir fark yoktu (sırasıyla p = 0.385, p = 1). Sklerotik marjinin değerlendirilmesinde BT, VIBE ve kontrastlı VIBE arasında BT anlamlı derecede daha etkin bulundu (sırasıyla p = 0,0002, p = 0,0031). Sonuç: Çalışmamız VIBE ve kontrastlı VIBE sekanslarının osteoid osteoma tanısında altın standart olarak kabul edilen ince kesit BT kadar etkin bir yöntem olduğunu göstermiştir. Böylece osteoid osteoma tanısında hastaların maruz kaldığı radyasyon miktarı azaltılabilir.

S - 018 İNTRAKRANİAL ANEVRİZMALARIN DSC PA-MRG İLE DEĞERLENDİRİLMESİ GÖKHAN POLAT, EMİNE İZGİ, SUAT EREN, AKIN LEVENT, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Amaç: Çalışmamız, anevrizma tedavisinin beyin perfüzyonunu nasıl etkilediğini belirlemeyi amaçlamaktadır. Gereç ve Yöntemler: Endovasküler anevrizma tedavisi olmuş 42 hasta incelendi. Sekiz hasta dahil edilme kriterlerini karşılamadığı için çalışmaya alınmadı. Çalışmada 34 hasta ile ilgili veriler değerlendirildi. Beyin perfüzyon parametreleri, işlem öncesi, işlemden 3 gün sonra ve işlemden 1 ay sonra ölçülmüş- tür. Ayrıca, rCBV, rCBF, MTT ve TTP parametreleri posterior dolaşım ile karşılaştırıldı ve perfüzyon parametrelerindeki değişiklikler istatistiksel olarak değerlendirildi. Bulgular: Anevrizmaların boyutu hastalarımızda ≤10 mm olarak ölçüldü. Böylece bu hastalar küçük anevrizma sınıfında değerlendirildi. Perfüzyon parametreleri karşılaştırıldığında, rCBV, rCBF ve MTT açısından preoperatif ve postoperatif değerler arasında anlamlı fark yoktu. Elde edilen p değerleri: rCBV için p=0.652; rCBF için p=0.563; ve MTT için; p=0.865. TTP haritasından elde edilen değerler arasında ise anlamlı fark vardı (p=0.025). TTP değerlerinde operasyondan önce alınan ölçümlere göre, operasyondan sonraki üçüncü günde uzama gözlendi ve işlem sonrası birinci ayda azalma oldu. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S9

Sonuç: Beyin perfüzyonu sırasında küçük çaplı anevrizmalar (<10 mm) rCBV ve rCBFyi etkilemediğinden, anevrizmaların tedavisi sırasında görülebilen perfüzyonla ilgili komplikasyonlar (hiperperfüzyon sendromu) beklenmemektedir. TTP’nin üçüncü gününde uzaması ve ilk ayında kısalması, prosedür sırasında veya sonrasında gelişebilecek beyin ödemi ve vasospazm gibi komplikasyonların göstergesi olabilir.

S - 019 SEZARYEN SKAR GEBELİĞİNDE MANYETİK REZONANS GÖRÜNTÜLEME: OLGULARLA DEĞERLENDİRME ÖMER ERKAN YAPÇA, EMSAL PINAR TOPDAĞI YILMAZ, GÖKHAN POLAT Atatürk Üniversitesi Araştırma Hastanesi, Erzurum, Türkiye Özet Amaç: Sezaryen skar gebeliği, her ne kadar en nadir ektopik gebelik formlarından birisi olsa da insidansı, hızla artmakta olan sezaryen doğum oranları nedeniyle yükselmektedir. Nadir görülüyor olmasına karşın obstetrik kliniğinin yaşamı en tehdit edici acillerindendir. Acil servislerde akut batın ve vajinal kanama durumlarında b-HCG değerinin yüksek olmasına sekonder abdominal ultrasonografi sonrası olası başka patolojilerin ekartasyonu için pelvik MRG çekimleri yapılabilmektedir. Bu akut durumlar içerisinde nadiren insizyonel gebelikler görülebilmekte ve bunlar yaşamı tehdit edici sonuçlarından dolayı erken tanınması gerekmektedir. Gereç ve Yöntemler: Hastanemize 2012-2018 tarihleri arasında akut batın ve vajinal kanama şikayeti ile başvuran ve gebelik şüphesi nedeniyle manyetik rezonans görüntüleme yapılan 40 hasta incelendi. Bu hastalardan 4 tanesinde insizyonel gebelik,12 tanesinde akut appendisit, 5 tanesinde uterus dışı ektopik gebelik, 3 tanesinde over torsiyonu, 6 tanesinde over kist rüptürü, 10 tanesinde ürolojik sebepler bulundu. İnsizyonel gebelik nihai tanısı alan 4 hastanın manyetik rezonans görüntüleri değerlendirildi ve görüntüleme bulguları çalışmamızda değerlendirildi. Vaka 1: 40 yaşında hasta acile karın ağrısı ve vajinal kanama şikayeti ile başvurdu. Hastanın gravida 3, parite 2 gebelik öyküsü mevcut. B-Hcg değeri 132000 ölçülmüş olup 8 hafta gebelik öyküsü mevcuttu (FKA -). Gebeliğin insizyon skar düzeyine yerleştiği görüldü. Hastaya ardısık mtx verildi ve hastaya full küretaj yapıldı. Vaka 2: 36 yaşında hasta acile karın ağrısı ve vajinal kanama şikayeti ile başvurdu. Hastanın gravida 3, parite 2 gebelik öyküsü mevcut. B-Hcg değeri 47 ölçülmüş olup gebeliğin insizyon skar düzeyine yerleştiği görüldü (FKA +). Hastaya ardısık mtx verildi ve hastaya full küretaj yapıldı. Vaka 3: 38 yaşında hasta acile vajinal kanama şikayeti ile başvurdu. Hastanın gravida 2, parite 1 gebelik öyküsü mevcut. B-Hcg değeri 156 ölçülmüş olup gebeliğin insizyon skar düzeyine yerleştiği görüldü. Hastaya bilateral hipogastrik arterlere balon anjiyoplasti sonrası full küretaj yapıldı (FKA +). Vaka 4: 32 yaşında hasta acile vajinal kanama şikayeti ile başvurdu. Hastanın gravida 2, parite 1 gebelik öyküsü mevcut. B-Hcg değeri 156000 ölçülmüş olup gebeliğin insizyon skar düzeyine yerleştiği görüldü (FKA -). Hastaya ardısık mtx verildi ve hastaya full küretaj yapıldı. Sonuç: Sezaryen skar gebeliğinin tanısının konmasında gecikme olması yaşamı tehdit edici sonuçlara neden olabileceği gibi yanlış tanı konması halinde ise gereksiz ve komplikasyonlara neden olabilecek tıbbi girişimler ile sonuçlanabilir. Acil servise akut batın ve vajinal kanama ile başvuran hastalarda insizyonel gebelik tanısı akılda tutulmalıdır. Manyetik rezonans görüntüleri gebelik haftası ve FKA (+)’liğine göre farklılıklar gösterebilmektedir. Erken haftalarda basit bir kist görünümündeyken ileri haftalarda ve FKA negatifliğine göre heterojen-komplike kistik görünümlerede neden olabilmektedir. Bu nedenle hastanın öyküsü ve klinik verileri iyi analiz edilmeli ve insizyonel gebelik şüphesi akılda tutulmalıdır.

S - 023 MEDİAL MENİSKÜS PROTRÜZYONU MEDİAL STABİLİZATÖRLERİN HASARINI GÖSTEREBİLİR Mİ? HASAN ALİ EKŞİLİ 2, UĞUR TOPRAK 1 1Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Eskişehir, Türkiye 2Süleyman Demirel Üniversitesi Tıp Fakültesi, Isparta, Türkiye Özet Amaç: Medial menisküs protrüzyonu ile meniskokollateral ligament ve diğer posteromedial köşe stabilizatörlerinin hasarı ve osteoartrit arasındaki ilişkinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Retrospektif olarak medial menisküste protrüzyonu olan 214 diz MR olgusu ile çalışıldı. Anterior ve medial protrüzyon miktarları ölçüldü. Meniskotibial (MTL) ve meniskofemoral (MFL) bağlar, gastroknemius ve semimembranozus tendonlarının varsa hasar tipleri kaydedildi. Medial menisküs ve çapraz bağların anormallikleri, eklem effüzyonu, kemik ve kıkırdak yapıların hasar durumu değerlendirildi. Bulgular: Medial menisküste 172 olguda (%80) anteriora, 209 olguda (%97) mediale protrüzyon mevcuttur. Hem MTF ve MFL bağ hasarında medial protrüzyon daha fazladır (p<0.001). MTL bağ hasarı olan hastalarda MFL bağ hasarı daha fazla bulunmuştur (p<0.001). Anterior protrüzyon, MTL veya MFL bağ hasarı olanlarda farklı değildir (p>0.05). Menisküsü normal olanlarda her iki bağda da hasar görülme yüzdesi hem meniskal dejenerasyon hem S10 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı de yırtık olanlara oranla anlamlı düzeyde düşük bulunmuştur (sırasıyla p<0.001, p<0.01). Menisküs dejenerasyonu olanların medial protrüzyon değerleri, hem meniskal yırtık hastalarindan (p=0.01) hem de menisküsü normal (p<0.001) olan gruptan fazladır. Meniskal hasarı olan hastalarda semimembranozus tendonunda yaralanma anlamlı oranda yüksek bulunmuştur (p=0.009). Tibial kondromalazide her iki bağ hasarı ve menisküsün anteriora ve mediale protrüzyonu daha yüksektir (p<0.05). Femural kondromalazide meniskotibial bağ hasarı daha sık saptandı (p=0.021). Eklem içi effüzyonu olan hastalarda menisküsün protrüzyonu daha sık görülmüştür (p<0.01). Yaş ile meniskal hasar (p=0.002), bağ hasarları (p<0.01) artmaktadır. Medial protrüzyon yaş (p<0.001) ve vücut ağırlığı (p = 0.027) ile artmaktadır. Sonuç: Medial menisküsün özellikle mediale protrüzyonu diz posteromedial köşe yapılarının hasarı ile yakından ilişkilidir. Protrüzyonun meniskokollateral ligamanların hasarını da işaret ettiği bilinmeli ve bu yapılar dikkatlice gözden geçirilmelidir.

S - 024 TİBİAL TÜBERKÜL-TROKLEAR OLUK MESAFESİNİN NORMAL POPULASYONDA MANYETİK REZONANS GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ HATİCE KAPLANOĞLU Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Türkiye Özet Amaç: Patellar instabilite, yüksek nüks oranı olan, multifaktöryel yaygın bir diz patolojisi olup, semptomlar devam eder ve hastayı kondromalaziye ve osteoartrite yatkın hale getirir. Patellofemoral eklem instabilitesinin değerlendirilmesinde tibial tüberosit-troklear oluk mesafesi (TT-TO) çok önemlidir. Bu çalışmanın amacı, farklı yaş gruplarında erkeklerde ve kadınlarda TT-TO mesafesi’nin normal değerini bildirmek ve TT-TO mesafesi ölçümünde manyetik resonans görüntülemenin (MRG) güvenilirliğini değerlendirmektir. Gereç ve Yöntemler: Bu çalışma Ocak 2017-Aralık 2017 tarihleri arasında, 18 yaşın üzerinde, diz ağrısı olan ancak diz muayenesi, diz MRG’si normal olan 99 hasta üzerinde yapılmıştır. Diz MRG’ sinde veya diz muayenesinde anormal bulgusu olan hastalar çalışmadan dışlandı. MR görüntüleri, 1.5 Tesla MR tarayıcısında TR 2560, TE 30, and 4 mm kesit kalınlığı kullanılarak elde edildi. Görüntüler, diz full ekstansiyon ve quadriseps gevşemiş şekildeyken elde edildi. Bulgular: Araştırma kapsamında toplam 99 hasta incelendi. İncelenen hastaların yaş ortalaması 41.1±11.0 yıl, ortancası 40 (18-68) yıldır. Hastaların %54.5’i (n=54) kadın, %45.5’i (n=45) erkekti. Toplam populasyonda ortalama TT-TO mesafesi 9.3±3.3 mm dir. Ortalama TT-TO mesafesi erkeklerde 9.9±3.6 mm; kadınlarda 8.8±3.0 mm; ≤30 yaş altında 10.2±3.9mm; 31-50 yaş arasında 9.2±3.2 mm; ≥51 yaş üzerinde 8.9±3.1 ölçülmüştür. Hastaların yaş grupları ve cinsiyetleri arasında TT-TO mesaafesi açısından fark saptanmadı (sırasıyla; p=0.618; p=0.131). TT-TO mesafesi ölçümünde erkek ve kadın hastalar ile; ayrı ayrı yaş grupları arasında fark saptanmadı (sırasıyla; p=0.646; p=0.570). Sonuç: Bu çalışmanın sonucunda, TT-TO mesafesi ölçümünde, farklı yaş gruplarında erkeklerde ve kadınlar arasında anlamlı bir farklılık saptanmadı. TT-TO mesafesinin normal değerini 9.3±3.3 mm olarak tespit etti. Bu çalışma MRG’nin TT-TO mesafesinin değerlendirilmesinde güvenilir bir yöntem olduğunu göstermiştir.

S - 025 PATELLAR VOLÜM VE KARTİLAJ KALINLIĞI İLE KONDROMALAZİ ARASINDAKİ İLİŞKİNİN DEĞERLENDİRİLMESİ MEHMET ŞİRİK Adıyaman Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Adıyaman, Türkiye Özet Amaç: Bu çalışmada patella volümü ve patellar kartilaj kalınlığı ile kondromalazi gelişimi arasındaki ilişkiyi değerlendirdik. Gereç ve Yöntemler: Çalışmaya 01.01.2017 ile 31.05.2017 tarihleri arasında kliniğimizde diz ağrısı nedeniyle diz manyetik rezonans (MR) çekimi yapılan ve inceleme sonucu kondromalazi saptanan 111 olgu ile diz MR incelemesi normal olan 51 olgu dahil edildi. Tüm olguların patella volümleri iş istasyo- nunda yarı otomatik yazılım kullanarak analiz edildi. Kondromalazi saptanan olgularda evreleme Outerbridge kalsifikasyonuna göre evre 1-4 arasında gruplandırıldı. Patella volümü ile kondromalazi varlığı ve derecesi, kartilaj kalınlığı, yaş ve cinsiyet arasındaki ilişki istatistiksel olarak analiz edildi. Bulgular: Çalışmaya dahil 162 olgunun 67’si (%41,4) erkek, 95’i (%58,6) kadındı. Patellar kondromalazi saptanan olguların 23’ünde (%20,7) grade I, 52’sinde (%46,8) grade II, 32’sinde (%28,8) grade III, 4’ünde (%3,6) ise grade 4 kondromalazi mevcuttu. Çalışmaya dahil edilen olguların ortanca yaşı 44’tü. Patella volümü minimum 12,24, maksimum 39,44, ortanca patella volümü ise 21,4 cm3’tü. Patellar kondromalazi bulunan olgularda yaş bulunmayan olgulara göre daha yüksek bulunmuş olup sonuç istatistiksel olarak anlamlıydı (p=<0,0001). Patellar kondromalazi bulunan olgularda patella volümü daha yüksekti (p=0,026). Ayrıca patellar kondromalazi bulunan olgularda medial fasetteki kıkırdak kalınlığı istatistiksel olarak daha düşüktü. Patellar kondromalazi bulunan olgularda kondromalazi evresi ile patella volümü arasında istatistiksel olarak anlamlı, zayıf, pozitif korelasyon mevcuttu (p=0,446; r=-0,073 ve p=0,444; r=-0,073). Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S11

Sonuç: Çalışmamızda kronik ön taraf diz ağrısının önemli nedenleri arasında yer alan patellar kondromalazi ile patella volümü arasındaki anlamlı ilişki ve patella medial yüz kartilaj kalınlığının kondromalazili olgularda lateral yüze göre daha ince olduğu gösterilmiştir. Kondromalazi gelişimi yaş ile pozitif korelasyon göstermekle beraber kadın ve erkek arasında anlamlı bir fark gözlenmemiştir.

S - 026 OS AKROMİYALE OLGULARINDA; ROTATOR MANŞET YIRTIK TİPLERİNİN, BİSEPS TENDONU, BURSA VE GLENOİD LABRUM ANORMALLİKLERİNİN MRG İLE DEĞERLENDİRİLMESİ ALİ KOÇ, TURGUT TURSEM TOKMAK, ÖZGÜR KARABIYIK Kayseri Eğitim ve Araştırma Hastanesi, Kayseri, Türkiye Özet Amaç: Literatürde, os akromiyale ile rotator manşet patolojisi arasındaki ilişki; yayınlanmış birçok çalışmadaki yetersiz metodlara bağlı henüz tanımlan- mamıştır. Bu çalışmanın amacı; MR inceleme ile os kromiyale olgularında, rotator manşet, biseps tendonu, bursalar ve glenoid labrum ile ilgili patolojileri değerlendirmektir. Gereç ve Yöntemler: PACS’ta kayıtlı, omuz ağrısı şikayeti ile başvuran ve omuz MR incelemesi yapılan 1642 hastadan os akromiyalesi olan, yaşı 24 ve üzerinde toplam 43 olgu çalışmaya dahil edildi. MR incelemeleri; rotator manşet tendon yırtık tipleri, biseps tendonu, bursalar ve glenoid labrum patolojileri yönünden değerlendirildi. Bulgular: Os akromiyale sıklığı %2.6 bulundu. Olguların %81.4’ünü bayanlar oluşturdu. Rotator manşet yırtığı 38 (%88.3) hastada tanımlandı. Supraspinatus tendonunun parsiyel kat yırtığı 31 (%72) hastada mevcuttu. Parsiyel kat yırtıklar, 22 (%70) hastada rim-rent şeklinde idi. Supraspinatus tendonunun tam kat yırtığı sadece yedi (%16) hastada mevcuttu. Subakromiyal ve subkorakoid bursit, sırasıyla 31 (%72) ve 14 (%32) hastada tanımlandı. Biseps tendon patolojisi üç (%7) hastada, labral patoloji ise sadece bir (%2) hastada izlendi. Sonuç: Os akromiyale olgularında, rotator manşet yırtıklarının görülme oranı artmıştır. Çoğu rotator manşet yırtığı supraspinatus tendonu ile ilişkili bulunmuştur ve en sık yırtık tipi parsiyel kat şeklindedir. Biseps tendonu ve glenoid labrum ile ilişkili patolojilerin görülme oranında artış saptanmamıştır.

S - 027 ANKİLOZAN SPONDİLİTLİ HASTALARDA AŞİL TENDONUNUN KANTİTATİF T2* (T2 STAR) İLE DEĞERLENDİRİLMESİ; ÖN ÇALIŞMA SONUÇLARI MEHMET BEYAZAL1, MÜNEVVER SERDAROĞLU BEYAZAL2 1Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Rize, Türkiye 2Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Fiziksel Tip Ve Rehabilitasyon Anabilim Dalı, Rize, Türkiye Özet Amaç: Bu çalışmanın amacı ankilozan spondilitte (AS) aşil tendonunun kantitatif T2* (T2 star) bulgularını değerlendirmek ve bu bulguların hastalıkla ilgili parametrelerle ilişkisini incelemektir. Gereç ve Yöntemler: Çalışmaya AS tanılı 30 hasta (19 erkek, 11 kadın; ortalama yaş, 42,3 yıl; aralık 23-60 yıl), yaş ve cinsiyeti eşleştirilmiş 15 sağlıklı kontrol alındı. Hastalık aktivitesi, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) kullanılarak değerlendirilirken, fonksiyonel durum, Bath Ankylosing Spondylitis Functional Index (BASFI) kullanılarak değerlendirildi. Eritrosit sedimentasyon hızı ve C-reaktif protein (CRP) kaydedildi. Bulgular: Ankilozan spondilitli hastalarda kontrol grubuna göre sağ ve sol aşil T2* değerlerinde belirgin azalma saptandı (140,2±13.9 vs 151.9±9.4, p=0.005; 137.8±14.1 vs 149.8±10.9, p=0.006, respectively). Sol aşil T2* değeri hastalık aktivitesi ve fonksiyonel durum arasında anlamlı bir korelasyon göstermedi. Sağ aşil T2* değeri CRP ile anlamlı negatif korelasyon göstermesine rağmen (p=0,019, r=-0,427) diğer hastalıkla ilişkili parametreler ile arasında anlamlı bir ilişki bulunmadı. Sonuç: T2* değeri ASli hastalarda aşil entezitinin değerlendirilmesinde yardımcı olabilir.

S - 028 SIKIŞMA SENDROMUNUN NADİR BİR NEDENİ: OS AKROMİALE AYŞEGÜL ALTUNKAŞ Gaziosmanpaşa Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, İstanbul, Türkiye S12 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Amaç: Os akromiale akromial apofizin 4 osifikasyon merkezinden herhangi birinde olan birleşme kusuru nedeniyle ortaya çıkan kemikçiktir. Bu anatomik oluşum birkaç çalışmada omuz impingement sendromu ile ilişkilendirilmiştir. Biz bu çalışmamızda toplumumuzda os akromiale sıklığı ile birlikte os akromiale bulunan semptomatik hastaların radyolojik bulgularını literatür bilgileri eşliğinde sunmayı amaçladık. Gereç ve Yöntemler: Çalışmaya 2014 Ocak-2018 Ocak tarihleri arasında çekilen omuz MR tetkikleri dahil edildi. Toplamda 864 omuz MR tetkiki değerlendirildi. Os akromiale tespit edilen hastaların fibröz-sinkondroz eklem ilişkileri, dejeneratif değişiklikleri ve aynı zamanda supraspinatus tendon bütünlüğü ve sinyal intensitesi değerlendirildi. Bulgular: 58 hastada (%6,7) os akromiale tespit edildi. 39 hastada os akromiale sinkondrozis ekleminde hipertrofik, dejeneratif değişiklikler ve komşu subakromial bursada fokal efüzyon mevcuttu. Bu hastalarda aynı zamanda akromiohumeral mesafeye uzanan osteofit dikkati çekti. 36 hastada supraspinatus tendonunda yırtık mevcuttu 6 hastada ise tendinozis saptandı. Sonuç: Os akromiale genellikle radyolojik incelemelerde raslantısal olarak saptanır. Semptomatik olguların sıklığı ise bilinmemektedir. Literatürde os akromialenin değişik yolarla omuz impingement sendromuna neden olabileceği ileri sürülmüştür. Özellikle MR tetkikinde eklemde oluşan dejeneratif değişiklikler kolaylıkla değerlendirilebilmektedir. İmpingement ön tanısı ile çekilen MR tetkikinde izlenen os akromiale izlenen hastada başka radyolojik bulunmasa bile os akromiale etyolojide akılda tutulmalıdır.

S - 029 SAKROİLİAK EKLEMLERİN MR GÖRÜNTÜLEMESİNDE KONTRAST MADDE KULLANIMI GEREKLİ Mİ? KONTRASTLI ÇEKİMLERİN SAKROİLEİT TANISINDA ANLAMLI KATKISI VAR MI? MEHMET SEDAT DURMAZ1, HAKAN CEBECİ2, MEHMET ÖZTÜRK2 1Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Birimi, Konya, Türkiye 2Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet Amaç: Sakroileit ön tanısı ile MRG çekilenlerde kontrast madde kullanımının gerekliliğinin tartışılması amaçlanmıştır. Gereç ve Yöntemler: Ocak 2017-Ocak 2018 arasında, Konya ilinde iki üniversite hastanesi radyoloji bölümünde sakroileit ön tanısı ile çekilen toplam 1144 sakroiliak MRG tetkiki içerisinden seçkisiz (sistematik) örnekleme yöntemiyle seçilen 106 hastanın sakroiliak eklem MR görüntüleri retrospektif olarak değerlendirildi. Tüm MRG çekimleri 1,5 Tesla MR ünitesinde gerçekleştirilmişti. Sakroiliak eklem MRG sekanslarından STIR ve kontrastlı görüntüler kemik iliği ödemi-osteitis açısından 5 ve 8 yıllık deneyimli 2 ayrı radyolog tarafından, bağımsız olarak ve sonrasında birlikte değerlendirildi. 106 hastada toplamda 212 sakroiliak eklem değerlendirildi. Sağ ve sol sakroiliak eklemlerde sakroiliet ile uyumlu bulgular 0-4 puanlı skala üzerinden skorlandı. Sekanslar arasındaki uyum ve gözlemciler arası değişkenlik değerlendirildi. Sakroileit tanısında kontrastlı yağ baskılı incelemenin STIR sekansına ek katkısı olup olmadığı araştırıldı. Bulgular: İki radyolog arasında STIR sekansında sakroiliak eklem bulguları açısından gözlemciler arasındaki uyum sağ sakroiliak eklemde %93 (K=0,519, p<0,001), sol sakroiliak eklemde %93,9 (K=0,511, p<0,001) olarak saptandı. Ortak konsensus ile sakroileit bulguları STIR sekansında 16 sağ, 15 sol sakroiliak eklemde, kontrastlı incelemede ise sakroileiti destekleyen bulgular 17 sağ, 17 sol sakroiliak eklemde izlendi. Değerlendirilen 212 sakroiliak eklemin 34 ünde (%16,03) sakroileit ile uyumlu bulgular mevcuttu. Sakroileit tanısında kontrast madde sonrası ek olarak sadece 3 sakroiliak eklemde sakroileit tanısı kondu. Sonuç: Kontrastlı görüntüler sakroileit tanısında ek bilgiler verebilir ancak sakroileit tanısında STIR sekansına anlamlı üstünlüğü yoktur. Özellikle kontrast maddelerin yan etkileri, maliyet, tetkik süresi gözönüne alındığında sakroileit ön tanısı ile MRG çekilen hastalarda kontrast madde kullanımına gerek yoktur, sınırlı sayıda hasta grubunda, gerekli görüldüğünde ek çekim olarak kontrastlı inceleme yapılabilir.

S - 030 ÖN ÇAPRAZ BAĞ YARALANMALARINDA POSTERİOR TİBİAL EĞİM AÇISININ MANYETİK REZONANS GÖRÜNTÜLEME İLE BİRLİKTE DEĞERLENDİRİLMESİ EMRAH SAYIT1, ASLI TANRIVERMİŞ SAYIT2 1Samsun Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Samsun, Türkiye 2Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Radyoloji Ana Bilim Dalı, Samsun, Türkiye Özet Amaç: Bu çalışmanın amacı posterior tibial eğim (PTE) açısının komplet ön çapraz bağ (ÖÇB) rüptürü ile arasındaki ilişkiyi manyetik rezonans görüntüleri (MRG) ile birlikte araştırmaktır. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S13

Gereç ve Yöntemler: ÖÇBde yırtık bulunan 60 hasta ile yaşı ve cinsiyeti uyumlu 60 sağlıklı bireyin diz MRG’si geriye dönük olarak değerlendirildi. Travma öyküsü, parsiyel ÖÇB yırtığı, implant, geçirilmiş diz cerrahisi öyküsü ve kemik tümörü olan hastalar çalışmaya alınmadı. Her iki grup için PTE açısı sagittal T1 ağırlıklı imajlardan ölçüldü. Tibianın uzun aksına dik çizilen hatla medial tibia platosuna parelel çizilen hat arasında kalan açı medial PTE açısı, lateral tibia platosuna paralel çizilen hat ile arasında kalan açı ise lateral PTE açısı olup ÖÇB’de yırtık olan hastalar ve kontrol grubunda ayrı ayrı ölçüldü. Medial ve lateral PTE açılarının medyan değerleri hesaplandı ve her iki grup arasında istatistiksel olarak anlamlı farklılık olup olmadığı araştırıldı. Bulgular: Komplet ÖÇB yırtığı olan 60 hastanın 25’i kadın, 35’i erkek olup median yaşı 39’dur. Kontrol grubunun 27’si kadın, 33’ü erkek olup median yaşı 37’dir. Medial PTE açısı, komplet ÖÇB yırtığı olan hastalarda 3.2°, kontrol grubunda 3.1° ölçülmüş olup istatistiksel olarak aralarında anlamlı farklılık saptanmadı (p=0,4). Lateral PTE açısı, komplet ÖÇB yırtığı olan hastalarda 4,5°, kontrol grubunda 3.8° olup anlamlı olarak daha geniş saptandı (p<0,01). Sonuç: Çalışmamızda lateral PTE açısında, komplet ÖÇB yırtığı olan grup ile kontrol grubu arasında anlamlı farklılık saptandı. Lateral PTE açısındaki (≥4,5°) artışın ÖÇB yırtığı için anatomik bir risk faktörü olabileceği düşünüldü

S - 031 MEME LEZYONLARINDA SHEAR WAVE VE ADC DEĞERLERİNİN KARŞILAŞTIRILMASI TEVFİK GÜZELBEY1, NAİL UZUNLULU2, EZGİ KARTAL2, ARDA KAYHAN2 1İstanbul Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye 2İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye Özet Amaç: Bu çalışmada meme lezyonlarında shear wave elastografi (SWE) değerleri ile manyetik rezonans görüntüleme ADC değerlerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Ele gelen meme lezyonu olan 22 kadın hastada (ortalama yaş 48,69±12,49) 24 lezyon SWE ve MRG ile değerlendirildi. SWE ve ultrason eşliğinde biyopsi aynı seansta gerçekleştirildi. SWE lezyonun en sert yerinden ölçüldü. ADC ölçümleri lezyonun tümünden ve ADC haritasında en koyu alandan yapıldı. Bulgular: Biyopsi sonuçlarına göre 9 fibroadenom, 9 invaziv duktal karsinom, 2 intraduktal papillom, birer tane invaziv lobular karsinom, atipik duktal hiperplazi, sklerozan adenozis ve duktal karsinoma in situ saptandı. SWE ile lezyonun tümünden ölçülen ADC değerleri (p=0,009, korelasyon katsayısı -0,520) ve en koyu yerden ölçülen ADC değerleri (p=0,002, korelasyon katsayısı -0,620) arasında orta derecede negatif korelasyon saptandı. Sonuç: Çalışmamızda meme lezyonlarında dokunun sertliğini ölçen SWE değerleri ile suyun hareketini ölçen ADC değerleri arasında anlamlı korelasyon saptanmıştır.

S - 032 MEME ARKA PLAN KONTRASTLANMASININ MEMENİN MORFOFİZYOLOJİK PARAMETRELERİ VE MEME LEZYONLARI İLE KORELASYONU LEYLA İSAYEVA1, ZEHRA HİLAL ADIBELLİ2, ALİ MURAT KOÇ2 1Medilife Beylikdüzü Hastanesi, İstanbul, Türkiye 2İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İzmir, Türkiye Özet Amaç: Dinamik kontrastlı manyetik rezonans inceleme hormona duyarlı glandüler doku ile fibröz bağ dokuları arasındaki farkı gösterir. Arka plan kontrastlanması fibroglanduler dokunun kontrast enjeksiyonu sonrası normal boyanmasıdır. Normal arka plan kontrastlanması minimal (tip1; glanduler doku kontrastlanması %25’in altı), ılımlı (tip 2; glanduler doku kontrastlanması %25- %50 arası), belirgin (tip 3; glanduler doku kontrastlanması %50-%75 arası) ve şiddetli (tip 4; glanduler doku kontrastlanması %75’in üstü) olarak sınıflandırılmıştır. Bizim bu çalışmadaki amacımız; meme APK nı tiplendirerek, meme yoğunluğu ile karşılaştırmak, benign lezyonlarla, malign lezyonların subtipleri ile, hasta yaşı ve meme hacmi ile ilişkisinin olup olmadığını göstermekti Gereç ve Yöntemler: Bu çalışma İzmir Bozyaka Eğitim ve Araştırma Hastanesi Radyoloji bölümünde Mayıs 2015 ile Şubat 2016 tarihleri arasında meme MR tetkiki yapılmış hastalarda etik kurul onayı alınarak gerçekleştirildi. Çalışmamızda 1210 hasta dinamik meme MRG ile değerlendirildi. Hastanemizde premenapozal dönemdeki olgularda menstrüel siklusun APK üzerinde olumsuz etkilerinden kaçınmak amacı ile meme MRG tetkiki siklusun 7-14. günleri arasında uygulanmaktadır. APK şiddetinin düzgün değerlendirilmesi için neoadjuvan kemoterapi, hormon terapi, mastektomili hastalar ve erkek hastalar çalışma dışı bırakıldı. Ayrıca meme MR bulgularına göre BIRADS 1 olarak raporlanan hastalar arasında diğer meme görüntülemelerinde her hangi lezyon tespit edilen hastalar da çalışma dışı bırakıldı.Bu kriterlere uyan toplam 899 hasta çalışmaya dahil edildi. Çalışmaya dahil edilen hastalara ait görüntüler iki radyolog tarafından, birbirlerinden ayrı ve bağımsız olarak değerlendirildi, farklı sonuç olduğunda konsensus ile tek bir sonuç belirlendi. S14 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Bulgular: Çalışmamıza dahil edilen 899 kadın hastada ortalama yaş 47,10±11,90 olarak hesaplandı. 246 (%27,4) hastada tip 1,286 (%31,8) hastada tip 2, 237 (%26,4) hastada tip 3, 130 (%14,5) hastada tip 4 arka plan kontrastlanması izlendi. 110 hasta BIRADS 1, 175 hasta BIRADS 2, 380 hasta BIRADS 3, 126 hasta BIRADS 4, 108 hasta BIRADS 5 kategoride değerlendirildi. Toplam 246 hastanın patolojik sonucu olup bu hastaların 140’ı malign,116’ı benign grupta değerlendirildi. Toplam hastalarda, premenapozal, perimenapozal ve postmenapozal dönemdeki hastalarda yağlı memede arka plan kontrastlanması dens memelere göre anlamlı düşüktür (sırasıyla p;<0,001; 0,013;<0,001; 0,001). BIRADS 1, benign ve malign lezyon görülen hastalarda menopoz durumları açısından gruplar arasında istatistiki açıdan anlamlı fark saptandı (p<0,001). Tüm lezyonların en sık perimenapozal dönemde görüldüğü belirlendi. Toplam hastalarda, BIRADS 1, benign ve malign hastalarda yağlı memede arka plan kontrastlanması dens memelere göre anlamlı düşük bulundu. Sonuç: Sonuç olarak yaptığımız analizler meme APK sının aslında meme parankim yoğunluğuyla ilişkisi olduğunu göstermiş olup, özellikle malign lezyonlarla ve moleküler subtipleri ile ilişkili olmadığını göstermiştir. Çalışmamızda benign hastalarda meme parankim yoğunluğu ve dolayısıyla APK yüksektir, ancak benign subgruplar arasında ilişki gösterilememiştir. Aynı şekilde meme parankim yoğunluğu ve APK’sı malign hastalarda düşüktür. Çalışmamıza göre yüksek APK, dens meme parankim yoğunluğu meme malignitesi gelişimi için bir risk faktörü değildir.

S - 033 MEME KANSERLİ HASTALARDA, TÜMÖRÜN MOLEKÜLER ALT TİPLERİNE GÖRE MR BULGULARI BİRNUR YILMAZ Okan Üniversitesi Tıp Fakültesi Hastanesi, İstanbul, Türkiye Özet Amaç: Son 11 yılda, meme karsinomunun moleküler subtipleri karakterize edilmiştir. Bilgilerin büyük kısmı, son yıllarda öğrenilmiş olup, moleküler tak- sonomi hala gelişmekte ve önümüzdeki yıllarda daha da gelişecek gibi görünmektedir. Bu çalışmada; meme kanserli hastalarda MR bulguları ile tümörün moleküler alt tiplerinin ilişkisinin olup, olmadığı değerlendirildi. Gereç ve Yöntemler: Ekim 2016- Şubat 2018 arasında hastanemizde, meme kanseri tanısı almış ve pre-operatif meme MRI çekilmiş hastaların MR bulguları, retrospektif olarak değerlendirildi ve kaydedildi. Bulgular BI-RADS MR sınıflamasına uygun olarak sınıflandırıldı. Kitlesel olmayan ve boyanma gösteren meme lezyonları çalışma dışında tutuldu. Patoloji sonuçlarına göre tümörün moleküler alt tipleri belirlendi ve kaydedildi. Tümörün alt tipleri ile MR bulgularının ilişkisinin olup olmadığı, istatiksel olarak değerlendirildi. Bulgular: Toplam 98 tru-cut biyopsi yapılan ve meme kanseri tanısı almış olgularda patolojik tanı; 34’ü Luminal A, 32’si Luminal B, 18’i HER2 pozitif ve 14’ü triple negatif tümör olarak geldi. Kitle lezyonlarında düzgün ve lobüle kenar, halkasal boyanma ve tümör nekroz varlığı ile, üçlü negatif tümör alt tipi arasında anlamlı ilişki bulundu. Tümörün moleküler alt tiplerine göre kitle lezyonlarında; MR bulgularının dağılımı Tablo 1’de gösterildi. Sonuç: Meme kanserinde tedaviyi ve prognozu belirleyen, en önemli faktörlerden biri tümörün patolojik moleküler alt tipidir. Meme kanserinin pre-operatif evreleme ve izleminde MR, görüntülemeye önemli katkı sağlayan bir yöntemdir. Meme MR ile saptanan düzgün ve lobüle kenar özellikleri, halkasal kitle boyanması ve tümör nekrozu, üçlü negatif tümörlerde de sık görülen bulgulardır. Meme MR’ında; benign lezyonlarda da görülebilen bu bulguların, tümörlerde de görülebileceğinin bilinmesi önemlidir. Biyopsi kararı verilirken, bu olasılığında olduğu akılda bulun- durulmalıdır.

S - 034 MEME KANSERİNDE DİNAMİK EĞRİ TİPLERİ İLE PROGNOSTİK FAKTÖRLER ARASINDAKİ İLİŞKİNİN ARAŞTIRILMASI IŞIL ESEN BOSTANCI, HALE AYDIN, BAHAR GÜNER Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye Özet Amaç: Meme kanserinde kinetik MRG bulguları ve patolojik prognostik faktörler ile dinamik eğri tipleri arasındaki ilişkiyi saptamak amaçlanmıştır. Gereç ve Yöntemler: Ocak 2016-Aralık 2016 tarihleri arasında bölümümüzde çekilen meme MRG tetkikinde BI-RADS4 ve BI-RADS5 olarak rapor edilen ve patolojisi İnvaziv duktal karsinom olarak gelen 98 olgu değerlendirildi. Bunlardan 4 olgu prognostik faktörlerin değerlendirimi için yetersiz doku örneği olması,3 olgu patoji sonucunun duktal karsinoma in-situ gelmesi,10 olgu da benign patolojik sonuç gelmesi nedeni ile çalışmadan çıkarıldı. Meme MRG’de dinamik eğri tipleri incelenerek patolojik prognostik faktör sonuçları ile karşılaştırıldı. Bulgular: Çalışmaya 81 hasta dahil edildi. Ortalama yaş 47,27+12,13 idi. 63 (%77,8) olgu invaziv duktal karsinom iken 9 (%11,1) olgu invaziv lobüler karsinom tanısı almıştı. Tümör derecelendirmesinde 11 (%14,9) olgu grade 1, 29 (%29,2) olgu grade 2 ve 34 (%45,9) olgu grade 3 idi. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S15

7 olgunun derecendirmesi yapılmamıştı. 45 (%55,6) olgunun duktal karsinoma in-situ komponenti, 10 (12,3) olgunun lobuler karsinoma in-situ komponenti vardı. Ki 67 oranı grade 3 tümörlerde belirgin derecede yüksekti (p<0,001). C-erb B2 pozitif olan 15 (%73,3) olgunun 11’ide grade 3 idi (p=0,011).Olgular başlangıç kontrastlanmalarına göre üç gruba ayrıldı. Prognostik faktörlerle anlamlı ilşki saptanmadı. Olgular dinamik eğrilere göre ikiye ayrıldı; tip 3 eğrili ve tip 1-2 eğrili. Prognostik faktörler ile dinamik eğriler arasında ilişki değerlendirildi. Sonuç: Meme kanserinde dinamik MRG eğri tipleri ile patolojik prognostik faktörler arasında anlamlı ilişki saptanmamıştır.

S - 035 MEME LEZYONLARININ DEĞERLENDİRİLMESİNDE MRG İLE SHEAR WAVE ELASTOGRAFİ KARŞILAŞTIRMASI NURŞEN TOPRAK, ALİ MAHİR GÜNDÜZ Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Van, Türkiye Özet Amaç: Bu çalışmanın amacı, ultrasonografide meme lezyonlarının sertlik düzeyini akustik radyasyon kuvvet impulse elastografi (ARFI UE) ile değerlendi- rerek benign ve malign ayrımını yapmada manyetik rezonans görüntüleme (MRG) ile karşılaştırmaktır. Gereç ve Yöntemler: Bu çalışma Van YYÜ Tıp Fakültesi Radyodiagnostik AD.de meme ünitesine başvuran memesinde Birads 3-5 kitlesi olan 16 hasta üzerinde yapıldı. Tüm hastalar ARFI UE ve MRG ile değerlendirildi. Tüm hastalardan trucut biyopsi ile histopatolojik veriler elde edildi Bulgular: ARFI UE ortalama kayma dalgası hızı (SWV) malign lezyonlarda 8,38±1,74 m/sn, bening lezyonlarda 4,30±1,94 m/sn idi. Malign lezyonların SWV değerleri literatür ile uyumlu iken bening lezyonların SWV değerleri literatür verilerinin üzerinde idi. MRG de kontrast zaman eğrisi oranları 8 (%50) hastada tip 1, 5 (%31,2) hastada tip 2, 3 (%18,8) hastada tip 3 idi. Histopatoloji 5 (%31,2) İDC, 3 (18,8) skar dokusu, 5 (%31,2) fibroadenom 2 (%12,5) mastit, 1 (%6,2) yağ nekrozu idi. 5 (%31,2) hasta malign, 11 (%68,8) hasta bening idi. ARFI UE ile SWV 3m/sn üzerinde elastisite gösteren skar dokusu, yağ nekrozu ve mastit olguları MRG’de tip 1 kontrast zaman eğrisi göstermiştir. Sonuç: ARFI UE malign meme lezyonlarını artmış SWV ye dayanarak mükemmel bir şekilde karakterize eder, ancak bizim çalışmamızda olduğu gibi doku sertliği gösteren yağ nekrozu mastit ve skar dokusu gibi lezyonlarda yalancı pozitiflik gösterip gereksiz biyopsiye neden olabilir. MRG ve UE beraber kullanımı biyopsi kararı vermede daha etkilidir. Bizim çalışmamız sınırlı hasta grubunda yapılmış olup bu bulguları doğrulamak için daha ileri çalışmalara ihtiyaç vardır.

S - 036 3 TESLA MR’DA MALİGN MEME LEZYONLARININ T1 HARİTALAMA İLE GÖRÜNTÜLENMESİ VE B1 DÜZELTMENİN KANTİTATİF DİNAMİK KONTRASTLI MR GÖRÜNTÜLEMESİ ÜZERİNE ETKİSİNİN DEĞERLENDİRİLMESİ ÖZLEM ÜNAL Yıldırım Beyazıt Üniversitesi Ankara Atatürk Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Ankara, Türkiye Özet Amaç: 3 T manyetik rezonans (MR) görüntülemede B1+ düzeltmesinin, kontrast madde enjeksiyon öncesi ve sonrasında, meme dokusu ve malign lezyonlardaki T1 haritalama üzerine etkisini ölçmek ve değerlendirmek. Gereç ve Yöntemler: Şubat 2017-Şubat 2018 tarihleri arasında 25 invaziv duktal karsinomu olan kadın (ortalama 52 yaşında; 66-44 yaş ara- lığında) hasta değerlendirilerek ameliyat öncesi 3T MR ile dinamik kontrastlı manyetik rezonans görüntülemeleri elde edildi. Her iki memede fibroglandüler doku ve malign lezyonlarda, T1 haritalama (mapping) üzerindeki etkisini değerlendirmek için enjeksiyon öncesi ve sonrası B1+ düzeltmesi (correction) yapıldı. Düzeltme yapıldıktan sonra 7 yıllık deneyimli radyolog tarafından ölçüm yapılarak parametreler hesaplandı. Sonuçlar histolojik derece ile korele edildi. Bulgular: Ölçümlerde malign lezyonlar ile fibroglandüler doku arasında ve malign lezyonlarda ilaç öncesi-sonrası ölçümleri arasında anlamlı bir farklılığın bulunduğu, ilaç sonrası ölçüm değerlerinin ilaç öncesi ölçüm değerlerine göre azaldığı görülmüştür. Sonuç: Bu çalışmada, 3T MR görüntülemede B1+ düzeltmesinin kontrast madde enjeksiyonu öncesi ve sonrası alınan T1 haritalama üzerinde, malign lezyonları ayırt etmede dinamik serilere anlamlı katkısı olduğu sonucuna ulaşılmıştır. S16 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı S - 037 MEME DIŞI KANSERLERİN MEMEYE METASTAZLARININ DEĞERLENDİRİLMESİNDE MR İNCELEME VE MULTİMODALİTER YAKLAŞIM MEHMET ALİ NAZLI, İLHAN NAHİT MUTLU, AYTÜL HANDE YARDIMCI, FADİME DİDEM CAN TRABULUS, ŞEFİKA AKSOY, ESRA CANAN KELTEN Sağlık Bilimleri Üniversitesi İstanbul Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye Özet Amaç: Meme dışı alanlardan memeye metastaz literatürde oldukça ender görülmekte olup görülse de memede saptanan malign özellikli kitlelerin ayırıcı tanısında metastaz olabileceği dikkate alınmalıdır, çünkü bu hastaların tedavi ve prognozu belirgin farklılıklar göstermektedir. Bu nedenle hastaların tedavi ve yönetiminde primer hastalıktan ayırımı çok önemlidir. Biz bu çalışmada kliniğimizde memede metastaz şeklinde bulgu veren olgularımızın radyolojik ve özellikle MR inceleme bulgularını sunmayı, histopatolojik ve immunohistokimyasal moleküler tanı kriterlerini gözden geçirmeyi amaçladık. Gereç ve Yöntemler: (SBU IEAH) Radyoloji kliniğimizde 2013-2018 yılları arasında meme kanseri nedeni ile incelenen olgulardan memeye metastaz tanısı almış 18-77 yaş aralığında (ort=49,4) 13 olgunun radyolojik tüm inceleme bulguları, MR inceleme özellikleri retrospektif olarak yeniden gözden geçirildi. Histopatolojik ve immunohistokimyasal olarak metastaz kaynağını gösterebilecek moleküler parameterler incelendi, tanı koyma kritlerleri irdelendi. Bulgular: Radyoloji kliniğimiz meme görüntüleme biriminde biopsileri yapılan ve histopatolojik tanısı bulunan 1350 meme kanser hastasından 13 (%0.96) tanesinde, toplamda 15 memede meme dışı diğer organ ve sistemlerinden metastaz tespit edildi (n=15). Bunlar sırasıyla 4 olgu akciğer kanseri (%30), iki olgu lenfoma (%15) ve diğer olgular lösemik infiltrasyon, kolon, böbrek, over, mesane, multiple myeloma, bir olguda ise Ewing sarkomu göğüs ön duvardan memeye direk lokal invazyonu şeklinde idi. Mesane tümörü ve Multiple myelomada her iki memeye metastaz vardı (%15). Memede tespit edilen tümör morfolojisi büyük çoğunlukta (%80) iyi sınırlı, oval veya sferik formlu idi. Parankimal distorsiyon, kalsifikasyon veya DCIS komponenti yoktu. Lösemik infiltrasyon, lenfoma tutulumu ve mesane tutulumu gösteren bir memede yaygın infiltran tutulum görüldü, özellikle lenfomada lokal cilt eksülserasyon ve memede yaygın deformasyon vardı. Sonuç: Meme dışı organlardan kaynaklı memeye metastazlar genellikle memenin primer kanserlerine göre benign morfolojide ve iyi sınırlı kitleler şeklinde radyolojik görüntü vermekte, ayrıca in-situ komponent ve mikrokalsifikasyonlar gibi ek bulgular genellikle eşlik etmemektedir. Ayrıca bizim iki olgumuzda olduğu gibi ebklenmedik şekilde yaygın infiltran tutulum görülebilmektedir. Memenin metastatik tutulumu çok nadiren de olsa görülebilmek- te, tedavi yaklaşımları birincil meme kanserinden farklı olup teşhis edilmesi önem arzetmektedir.

S - 040 SOLİTER BEYİN METASTAZI VE GLİOBLASTOMA AYIRICI TANISINDA PERİTÜMÖRAL ADC DEĞERLERİNİN YERİ MURAT TEPE1, SUZAN SAYLISOY2, UĞUR TOPRAK2, İBRAHİM İNAN3, ZÜHTÜ ÖZBEK4, EMRE ÖZKARA4, ALİ ARSLANTAŞ4 1Midyat Devlet Hastanesi, Radyoloji Bölümü, Mardin, Türkiye 2Eskisehir Osmangazi Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Eskişehir, Türkiye 3Adıyaman Üniversitesi Eğitim Araştırma Hastanesi, Radyoloji Bölümü, Adıyaman, Türkiye 4Eskisehir Osmangazi Üniversitesi Tıp Fakültesi, Beyin Cerrahisi Anabilim Dalı, Eskişehir, Türkiye Özet Amaç: Glioblastom (GBM) ve soliter metastazı birbirinden ayırmak konvansiyonel manyetik rezonans görüntüleme (MRG) yöntemleri ile her zaman mümkün değildir. Bu çalışmada peritümöral alandan ölçülen ADC oranlarının, ADC gradientlerinin ve minimum ADC değerlerinin bu iki lezyonu ayır- mada yararlı olup olmadığı araştırılmıştır. Gereç ve Yöntemler: Bu retrospektif araştırma üniversite etik kurul onayı alındıktan sonra gerçekleştirilmiş olup hastalardan onam formu alınması çalışmanın retrospektif doğası gereği etik kurul tarafından gerekli görülmemiştir. Medikal ve cerrahi tedavi öncesinde 43 hastanın (12 GBM ve 31 soliter metastaz tanılı) konvansiyonel Beyin ve Difüzyon MRG (b=0, b=1000) görüntüleri elde olundu. Peritümöral ödem dokusu içinden tümöre en yakin, orta uzaklıkta ve en uzak kesimden kantitatif ADC ölçümleri yapılıp sırasıyla ADC1, ADC2, ADC3 olarak kodlandı. Bu üç değer birbirine oranlanarak peritümöral ADC oranları, birbirinden çıkartılarak peritümöral ADC gradientleri hesaplandı. Bunların dışında tümöral ve peritümöral dokudan minimum ADC değerleri, ipsilateral normal görünümlü beyaz cevherden ve kontralateral normal beyaz cevherden ADC değerleri ölçülerek sırasıyla ADCTMIN, ADCPMIN, ADCI, ADCC olarak kodlandı.

Bulgular: GBM ve soliter metastaz ayrımında ADC3/ADC1 değeri en güçlü parametre olarak bulunmuş olup kestirim değeri 1.105 olarak alındığında duyarlılık %91,7, özgüllük %87,1 olarak hesaplandı (p<0,001). ADC3/ADC2 parametresi için kestirim değeri 1.025 olarak alındığında duyarlılık %91,7 ve

özgüllük %74,2 olarak hesaplandı (p<0,001). ADC2/ADC1 için ise kestirim değeri 1.055 olduğunda duyarlılık %83,3, özgüllük %67,7 olarak hesaplandı

(p=0,002). ADC3–ADC1 için kestirim değeri 150 olarak alındığında duyarlılık %91,7, özgüllük %83,9 olarak hesaplandı (p<0,001). ADC3–ADC2 parametresi için kestirim değeri 55 olarak alındığında duyarlılık %91,7, özgüllük %77,4 olarak hesaplandı (p=0,001). ADC2–ADC1 için kestirim değeri 75 olarak alındığında duyarlılık %91,7, özgüllük %61,3 olarak hesaplandı (p=0,003). Sonuç: Difüzyon MRG tekniği, MR Spektroskopi, MR Perfüzyon, Difüzyon Tensör Görüntüleme gibi ileri MRG tekniklerinden biri olup konvansiyonel MRG ile birlikte değerlendirildiğinde peritümoral ADC oran ve gradient ölçümleri GBM ve soliter metastaz ayrımı konusunda önemli katkılar sağlayabilir. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S17 S - 041 STROK GEÇİRMİŞ HASTALARDA KRANİAL MRG’DE OLFAKTOR BULBUS VOLÜMÜ VE OLFAKTOR SULKUS DERİNLİĞİNİN DEGERLENDİRİLMESİ ADİL DOĞAN1, VEYSEL BURULDAY2, MURAT ALPUA3 1Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi, Radyoloji Bölümü, Kahramanmaraş, Türkiye 2Kırıkkale Üniversitesi Tıp Fakültesi, Radyoloji Bölümü, Kırıkkale, Türkiye 3Kırıkkale Üniversitesi Tıp Fakültesi, Nöroloji Bölümü, Kırıkkale, Türkiye Özet Amaç: Strok geçirmiş hastalar ile sağlıklı kontrol grubunun kranial MRG’de olfaktor bulbus volümü ve olfaktor sulkus derinliğinin karşılaştırılması. Gereç ve Yöntemler: Hasta grubunu strok geçirmiş nörodejeneratif hastalığı olmayan hastalar oluşturdu.Sağlıklı bireylerden uygun yaş ve cinsiyete göre kontrol grubu oluşturuldu.Olfaktör bulbus volümü ve olfaktör sulkus derinliğinin ölçümü 1.5 Tesla MRI cihazında coronal T2 agırlıklı görüntülerden elde edildi.Görüntüler iki radyolog tarafından değerlendirildi. Bulgular: Hasta grubunu 45 strok geçirmiş (21 erkek-24 kadın) yaş ortalaması 47,7±10,7 ve kontrol grubunu 45 sağlıklı (19 erkek-26 kadın) oluşturmakta olup yaş ortalaması 44,5±8,7 (p>0,05).Hasta grubunun sağ-sol olfaktör bulbus volümleri kontrol grubu ile karşılaştırıldığında hasta grubunun olfaktör bulbus volümlerinin azaldığı tespit edildi (p<0,001). Hasta grubunun sağ-sol olfaktör sulkus derinliği kontrol grubu ile karşılaştırıldığında anlamlı fark saptanmadı (p>0,05). Sonuç: Strok geçirmiş hastalarda olfaktör bulbus hacminde azalma olduğu tespit edildi.Olfaktör bulbus hacim azalmasına bağlı geliştiği düşünülen koku disfonksiyonu hastaların yaşam kalitesini, yiyecek seçimlerini ve duman, doğal gaz veya diğer toksinleri çevre içinde bulgulama kabiliyetini etkileyebilir.

S - 042 GAMMA KNİFE İLE TEDAVİ GÖREN KAVERNÖZ MENENJİOMALI HASTALARDA GÖRME YOLAKLARININ DTG ÖZELLİKLERİNİN DEĞERLENDİRİLMESİ HAFİZE OTCU TEMUR1, MUSTAFA AZİZ HATİBOĞLU2, ALPAY ALKAN1, İSMAİL YURTSEVER1, KERİME AKDUR2, MEHMET HAKAN SEYİTHANOĞLU2 1Bezmialem Vakıf Üniversitesi Tıp Fakültesi Hastanesi, Radyoloji Kliniği, İstanbul, Türkiye 2Bezmialem Vakıf Üniversitesi Tıp Fakültesi Hastanesi, Beyin ve Sinir Cerrahisi Kliniği, İstanbul, Türkiye Amaç: Gamma Knife Radyocerrahisi (GKR) kavernöz sinus menenjiomalı hastaların tedavisinde etkin bir yöntemdir. Bununla birlikte optik sinir radyasyon toksitesi riski altındadır. Çalışmamızda GKR tedavisi sonrasında görme yolaklarındaki (Difüzyon Tensör Görüntüleme) DTG değişikliklerini ve DTG değişiklikleri ile radyocerrahi tedavi değişkenleri arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çalışmamız 13 kavernöz sinus menenjiomalı hasta ve 15 sağlıklı kontrol içermektedir. DTG ile görme yolaklarından apparent diffusion coefficient (ADC), fractional anisotropy (FA), mean diffusivity (MD) ve radial diffusivity (RD) değerleri ölçülmüştür. Kontrol grubu ile hasta grubunda GKR öncesi ve sonrasında görme yolaklarından elde edilen DTG değerleri karşılaştırılmıştır. Ayrıca DTG değerleri ile radyocerrahi tedavi değişkenleri arasındaki ilişki araştırılmıştır. DTG, GKR tedavisinden önce ve 12 ay sonra yapılmıştır. Bulgular: Sağlıklı kontrol grubu ile hasta grubundan GKR öncesinde ve sonrasında görme yolaklarından elde edilen ADC, FA, MD ve RD değerleri arasın- da istatistiksel olarak anlamlı farklılık izlenmemiştir. Optik kiazmadan elde edilen FA ile prekiazmatik optik sinirin aldığı maksimum ve ortalama radyasyon dozu arasında negatif korelasyon mevcuttur. Oksipital lobdan elde edilen FA ile optik aparatusun aldığı maksimum ve ortalama radyasyon dozu arasında negatif korelasyon mevcuttur. Optik kiazmadan elde edilen RD ile optik aparatusa verilen maksimum radyasyon dozu arasında pozitif korelasyon mevcuttur. Oksipital lobdan elde edilen ADC, MD, RD değerleri ile optik aparatusa verilen ortalama radyasyon dozu arasında pozitif korelasyon mevcuttur. Sonuç: GKR tedavisi sonrasında görme yolaklarında oluşan radyasyon ile ilişkili mikroyapısal değişikliklerin saptanması, uygun ve güvenilir bir tedavi yaklaşı- mının belirlenmesi açısından yararlı bilgiler sağlayabilir. DTI kavernöz sinus menenjiomalı hastalarda GKR tedavisi ile görme yolaklarında oluşan radyasyona bağlı değişiklikleri karakterize etmede faydalı bilgiler sağlayabilir.

S - 043 DİSK HERNİLİ HASTALARDA LOMBER AÇININ DEĞERLENDİRMESİNDE DİREK GRAFİNİN MRG’YE ÜSTÜNLÜĞÜ EMİNE DAĞISTAN Abant İzzet Baysal Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Bolu, Türkiye Özet Amaç: Bel ağrısı nüfüsün yaklaşık %80’inde yaşamının herhangi bir döneminde görülen yaygın bir problemdir. Dejeneratif disk hastalığı önemli bir aktivite S18 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı ve iş kaybı sebebi olan bel ağrısının en sık nedenidir. Lomber lordozda azalma disk hastalığının önemli bulgularından biri olup dejeneratif sürecin sonucu olarak ortaya çıkmaktadır. Bu retrospektif çalışmada, disk hernisi olan hastalarda Manyetik Rezonans Görüntüleme (MRG) ve direk grafilerle lordoz açılarının ölçülmesi ve normal popülasyonla karşılaştırılması amaçlandı. Gereç ve Yöntemler: 2014 ve 2017 yılları arasında bel ağrısı ve siyatalji şikayeti olan ve hastanemiz polikliniğimize başvuran hastalar çalışmaya dahil edildi. Hastalar üç gruba ayrıldı: Grup 1 (kontrol) herhangi bir yapısal bozukluğu olmayan ancak bel ağrısı olan hastalar; Grup 2; L4-5 düzeyinde disk hernisi olan hastalar; Grup 3; L5-S1 düzeyinde disk hernisi olan hastalar. Tüm olguların hem MRG hem lomber direk grafi incelemeleri mevcuttu. Lomber lordoz açısı MRG ve direk grafilerde ölçüldü. Bulgular: L5-S1 disk hernisi olan 27 olgu, L4-5 disk hernisi olan 56 olgu ve kontrol grubunda 27 olmak üzere toplam 110 olgu değerlendirildi. Çalışma popülasyonunda 63 erkek ve 46 kadın vardı. Cobb açısı ile ilgili erkek ve kadınlar arasında anlamlı fark yoktu. MRG de yapılan ölçümlerde gruplar arasında anlamlı farklılık yoktu (p=0,12). Düz grafide yapılan ölçümlerde ise gruplar arasında anlamlı farklılık görüldü (p<0,001) Direk grafi ve MRG görüntülerinin karşılaştırılması. 62 yaşındaki bayan hastanın aynı gün çekilen lateral lumbosakral direk radyogram (1a) ve MRG (1b) görüntüsü. Lomber lordoz açısının MRG de azaldığı görülmektedir). Sonuç: Lordoz açısının değerlendirmesinde MRG ile Direk grafi ölçümlerinin karşılaştırlması literatürde bizim bilgimize göre ilktir. Bu çalışmanın çarpıcı sonucu, disk herniasyonlu hastalarda düz radyografi ile belirlenen lomber lordoz açılarının sağlıklı kontrollere göre anlamlı olarak azaldığı ve MRG ölçüm- leri ile karşılaştırıldığında direk grafi ile ölçümün daha anlamlı olduğu görülmektedir.

S - 044 KAROTİS İNTİMA MEDİA KALINLIĞI İLE MRG’DE İSKEMİK / GLİOTİK ODAK YAYGINLIĞI ARASINDAKİ İLİŞKİSİNİN ARAŞTIRILMASI ÖMER KAYA Ceyhan Devlet Hastanesi, Radyoloji Bölümü, Adana, Türkiye Özet Amaç: Çalışmamızda arteryel sistemdeki erken dönem aterosklerotik değişikliklerin önemli göstergesi olan karotis intima media kalınlığı artışı ve ileri yaşta çoğunlukla küçük damar hastalığının sonucu olabilen MRGde iskemik/gliotik beyaz cevher hiperintensiteleri arasındaki ilişki araştırıldı. Gereç ve Yöntemler: 50 yaş üzeri 138 hastanın serebral MR görüntülemesi yapılmış ve beyaz cevher hiperintensiteleri Fazekas skorlamasına göre değerlendirilmiştir. Hastalara eksternal karotid sisteme yönelik Doppler Ultrasonografi ile internal karotid arter proksimalinden intima media kalınlıkları ölçülmüştür. Aralarındaki korelasyon değerlendirilmesi istatistiksel olarak yapılmıştır. Değerlendirmede 0,05’ten küçük değerler anlamlı kabul edilmiştir. İntima media kalınlığı için sınır değer 0,9 mm kabul edilmiştir. Bulgular: Değerlendirilen 138 hastada Fazekas skorlamasına göre beyaz cevher T2A hiperintensitelerinde evre arttıkça intima media kalınlıklarında istatistiksel olarak anlamlı artış saptanmıştır. Sonuç: Sonuç olarak serebral beyaz cevherde iskemik/gliotik değişiklikleri temsil eden T2A hiperintensitelerinin olası varlığı ve MR görüntüleme gerekliliği için internal karotid arter intima media kalınlığının ölçümü anlamlı ve pratik bir öngörüsel yöntem olarak düşünülmektedir.

S - 045 KARACİĞER VEYA BÖBREK NAKLİ UYGULANMIŞ PEDİATRİK HASTALARIN BEYİN MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI MERT BAYRAMOĞLU, FERİDE KURAL RAHATLI, FULDEM YILDIRIM DÖNMEZ, TÜLİN YILDIRIM, AHMET MUHTEŞEM AĞILDERE Başkent Üniversitesi Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye Amaç: Karaciğer veya böbrek nakli uygulanmış pediatrik hastaların beyin manyetik rezonans görüntüleme (MRG) bulgularını retrospektif olarak analiz etmektir. Gereç ve Yöntemler: 2004-2018 yılları arasında Başkent Üniversitesi Tıp Fakültesi Hastanesinde 235 karaciğer, 155 böbrek nakli uygulanmış toplam 390 pediatrik hastanın 64 tanesine (39 karaciğer nakli, 25 böbrek nakli) değişik sebeplerle yapılan beyin MRG tetkikleri retrospektif olarak değerlendirilmiştir. Bulgular 3 grupta sınıflanmıştır. Grup 1’de nakil ile ilişkili bulgular, grup 2 de kronik hastalık ile ilişkili bulgular, grup 3 de ise nakil yada kronik hastalık ile ilişkili olmayan bulgular kaydedilmiştir. Bulgular: En sık transplantasyon nedeni karaciğer hastaları için fulminan hepatit iken (%12,8) iken, böbrek hastaları için glomerülonefritlerdir (%24). Nöbet öyküsü hem karaciğer (%46), hem de böbrek (%40) hastaları için en sık görüntüleme istem nedenidir. Karaciğer nakli uygulanmış 13 (%20,3), böbrek nakli uygulanmış 14 (%21,8) hastanın görüntülemesinde herhangi bir patolojiye rastlanmamıştır. Geri kalan 37 (%57,8) hastadan bazılarının birden fazla bulgusu bulunduğundan istatistik hesaplanırken toplam sayı yerine grup içerisindeki sayı Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S19 göz önüne alınmıştır. Karaciğer hastalarında grup 1 de 14, grup 2 de 14 kişi, böbrek hastalarında grup 1 de 6,grup 2 de 3 kişi bulunmaktadır. Grup 3 de toplam 14 kişi bulunmaktadır. Hem karaciğer (%64,2), hem böbrek (%50) hastalarında grup 1 de en sık bulgu posterior reversibl ensefalopati sendromu olmuştur. Hem karaciğer (%50), hem böbrek (%100) hastalarında grup 2 de en sık bulgu serebral atrofi olmuştur. Grup 3 de en sık bulgu konjenital anomalilerdir (%50). Sonuç: Karaciğer ve böbrek nakli öncesinde ve sonrasında nörolojik komplikasyonlar görülebilir. Komplikasyonların acil tanısında ve takibinde beyin MRG çok önemlidir.

S - 048 NADİR GÖRÜLEN NÖROMETABOLİK HASTALIKLARDA BEYİN MRG VE SPEKTROSKOPİ BULGULARI MEHMET SEDAT DURMAZ1, FAYSAL EKİCİ2, SERDAR ARSLAN1 1Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Birimi, Konya, Türkiye 2Dicle Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Diyarbakır, Türkiye Özet Amaç: Çocukluk çağı nörometabolik hastalıkları biyokimyasal maddelerin sentezlenememesi, anormal birikimi sonucu beyin dokusunun hasar görmesi ile karakterizedir. Klinik belirtilerin başlama yaşı, ortaya çıkış şekli ve seyri, görüntüleme bulguları tanı konulmasında önemlidir. Bu sunumda nadir görülen 9 metabolik hastalığın tanısal beyin MRG ve MR spekstroskopi bulguları ve ayırıcı tanılarının, ayırıcı tanıya yönelik ipuçlarının mevcut literatür bilgileri eşliğinde tartışılması amaçlanmıştır. Gereç ve Yöntemler: 2014-2018 yılları arasında nörometaolik hastalık ön tanısıyla çekilen beyin MR görüntüleri retrospektif olarak tarandı. Tanı alan nadir görülen nörometabolik hastalıkların tanısal beyin MRG bulguları ve MR spekstroskopi bulguları, labaratuar bulguları değer- lendirildi. Bulgular: Kardeş iki olguda ardıç ağacı kokulu idrar hastalığı, bir olguda kreatinin eksikliği, bir olguda molibden kofaktör eksikliği, iki olguda Kanavan hasta- lığı, iki olguda vander nap hastalığı, bir olguda Leigh hastalığı (subakut nekrotizan ensefalopati), bir olguda L2 hidroksi glutarik asidüri, bir olguda glutarik asidüri tip 1, bir olguda Dars 2 gen mutasyonuna sekonder gelişen beyin sapı ve spinal kord tutulumunun eşlik ettiği lökoensefalopati ile uyumlu beyin MRG ve-veya MR spektroskopi bulguları izlenen olan toplam 12 hasta mevcuttu. Sonuç: Çocukluk çağı nörometabolik hastalıklarında tanı, spesifik MRG veya MR spektroskopi bulgularının varlığıyla konulabilir.

S - 049 PEDİATRİK DİRENÇLİ EPİLEPSİ OLGULARINDA 3T MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIMIZ BERHAN PİRİMOĞLU Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Pediatrik Radyoloji Bilim Dalı, Erzurum, Türkiye Özet Amaç: Çalışmamızda pediatrik radyoloji bölümümüze medikal tedaviye dirençli epilepsi ön tanısı ile beyin manyetik rezonans görüntüleme (MRG) için başvuran pediatrik yaş grubu hastalarda tespit ettiğimiz dirençli epilepsi nedenlerini ve 3T beyin MRG bulgularını sunmayı amaçladık. Gereç ve Yöntemler: Çalışmamıza Ocak 2015 – Ocak 2018 tarihleri arasında bölümümüze başvuran medikal tedaviye dirençli epilepsi tanılı 52 hasta dahil edildi. 52 hastada dirençli epilepsi nedeni olan organik beyin lezyonları 3T MRG bulguları 3 yıllık tecrübeye sahip pediatrik radyolog ve 1 yıllık tecrübeye sahip pediatrik radyoloji yandal uzmanlık öğrencisi tarafından ortak konsensus ile değerlendirildi. Lezyonların natür, lokalizasyon ve 3T MRG sinyal özellikleri kaydedildi. Tanımlayıcı istatistiksel analiz yapıldı. Bulgular: Hasta yaş aralığı 6 ay-17 yaş (ortalama 9,1±2,3 yaş) olarak gözlendi. Mevcut 52 hastadan 21`sinde (%38,1) sulkasyon-migrasyon anomalileri (heterotopi (n=11 hasta), şizensefali (n=3 hasta), lizensefali (n=3 hasta), hemimegalensefali (n=2 hasta), polimikrogri ve agiri-pakigri (n=2 hasta)), 8ìnde (%14,5) nörokutanöz sendrom (tuberozskleroz (n=6 hasta), sturge-weber sendromu (n=2 hasta)), 7`sinde (%12,8) fokal kortikal displazi, 6`sında (%10,9) tümöral lezyonlar (DNET (n=3 hasta), astrositom (n=2 hasta), PNET (n=1 hasta)), 5ìnde sekel değişiklikler (%9,1) (travma (n=3 hasta), iskemi (n=1 hasta) ve hipoksiye (n=1 hasta) sekonder), 2`sinde (%3,6) kavernöz malformasyon (kavernom), 1ìnde (%1,86) Rasmussen ensefaliti, 1ìnde (%1,86) Van der Knaap hastalığı, 1ìnde ise (%1,86) mezial temporal skleroz gözlendi. 3 hastada (%5,42) belirgin intrakranial patoloji izlenemedi. Sonuç: Medikal tedaviye dirençli epilepsiler özellikle pediatrik yaş grubunda çok önemli bir problem olup, 3T MRG çalışmalar oldukça tanısal özellikler göstermekle birlikte iyonizan radyasyon içermemesiyle pediatrik çağda önemli avantaj sağlamaktadır. S20 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı S - 050 SUSEPTİBİLİTE AĞIRLIKLI GÖRÜNTÜLEMENİN, ÇOCUK BEYİN MR İNCELEMELERİNDE, KONVANSİYONEL SEKANSLARA EKLENMESİNİN HEMORAJİ, KALSİFİKASYON VE VASKÜLER ANOMALİLERİ TANIMLAMADA ETKİNLİĞİNİN ARAŞTIRILMASI KEMAL ÇAĞLAR TUNA, FATMA CEREN SARIOĞLU, MUHAMMET SALMAN, YASİN ERTUĞ ÇEKDEMİR, HANDAN GÜLERYÜZ Dokuz Eylül Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, İzmir, Türkiye Özet Amaç: Çalışmamızda pediatrik beyin görüntülemede SAG sekansının konvansiyonel sekanslara eklenmesinin kalsifikasyon, kanama ürünleri içeren odak ve anormal venöz yapıların gösterilmesindeki etkinliğini, SAG’ın çocuk hastalarda kullanım alanlarını, SAG’deki sinyallerin özelliklerini, sekansa özgü arte- faktları ve yanılgıları araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmada farklı ön tanılarla MR incelemeleri olan ve SAG sekansında patolojik sinyal odakları saptanan, çocuk hastaların görün- tüleri retrospektif olarak incelenmiştir. Odaklar homojen paramanyetik, primer paramanyetik, homojen diyamanyetik ve primer diyamanyetik olarak sınıflandırılmıştır. Lezyonların kalsifikasyon veya kanama olarak sınıflandırılması ise BT ve konvansiyonel MR görüntüleri, tıbbi geçmişi ve laboratuvar, patoloji sonuçlarını içeren klinik bilgiler dâhilinde yapılmıştır. Bu odakların konvansiyonel sekanslarda karşılıkları araştırılmıştır. Kalsifik odakların gold stan- dartı olarak BT’de 100 HU’dan yüksek dansite ölçüt olarak kabul edilmiştir. Verilerin sınıflandırılmasında deskriptif istatistiksel yöntemleri kullanılmıştır. Konvansiyonel sekans ve SAG’nin uyumu yönünden ki-kare ve BT’de izlenen kalsifik odakların konvansiyonel sekanslar ve SAG ile karşılaştırılması için ki-kare testi kulanılmıştır. Bulgular: SAG imajlarda 287 hipointens odak saptanmıştır. Bu odakların 135’i diyamanyetik yani kalsifikasyon, 149’u paramanyetik yani hemorajik odak, 13’ü ise vasküler anomali olarak sınıflandırılmıştır. Konvansiyonel sekanslarda kalsifik odakların karşılığında T1 AG’de 6, T2’de AG’de 11 ve FLAIR’de sekan- sında ise 7 kalsifikasyonu destekler sinyal değişiklikleri vardır. Toplamda 135 diyamenyetik odaktan 13 tanesi (yaklaşık %9,6) konvansiyonel sekanslarda seçilebilmiştir. Hemorajik odakların karşılığında T1 AG’de 19, T2 AG’de 20 ve FLAIR’de sekansında ise 15 kanama ürünlerinin varlığını destekler bulgu vardır. Toplamda 149 odaktan 25 tanesi (yaklaşık %16,7) konvansiyonel sekanslarda seçilebilmiştir. On üç hastada izlenen vasküler anomalilerden sadece bir tanesi konvansiyonel sekanslarda seçilebilmektedir. BT görüntülerinde 143 kalsifikasyon odağı mevcuttur. SAG’de bu sayı 135’tir. Sekiz kalsifik odak SAG’de ayırt edilememiştir. SAG eklenmiş konvansiyonel sekansların kalsifikasyon saptamadaki etkinliği ile sadece konvansiyonel sekansların kalsifikasyon saptamadaki etkinliğinin karşılaştırılması için Ki-kare testi kullanılmış ve p değeri 0,001 olarak bulunmuştur. Hemorojik odaların artan çapla orantılı faz imajlarda heterojen sinyalde olma ihtimali artmaktadır. Sonuç: SAG sekansı ile kalsifik ve kanama ürünleri içeren odakların odakların anlamlı oranda saptanılabilirliği, kanama odaklarının doğası gereği heterojen olabileceği ve bazı artektlar içerebeleceği saptanmış bunların odak boyutu ile ilişkisi gösterilmiş ve aynı zamanda venöz anomalilerin teşhisinde sekansın önemli bir tanı aracı olabileceği gösterilmiştir.

S - 051 OBSTETRİK BRAKİAL PLEKSUS PARALİZİLİ ÇOCUKLARDA OMUZ ULTRASONOGRAFİSİNİN KLİNİK VE MRG BULGULARI İLE KORELASYONU ALTAN GÜNEŞ1, ADALET ELÇİN YILDIZ1, AKIN ÜZÜMCÜGİL2 1Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Ankara, Türkiye 2Hacettepe Üniversitesi Tıp Fakültesi, Ortopedi Ve Travmatoloji Anabilim Dalı, Ankara, Türkiye Özet Amaç: Obstetrik brakial pleksus paralizili (OBPP) çocuklarda, glenohumeral displazi ve omuz dislokasyonu,klinik olarak hareket kısıtlılığına neden olmadan da gelişebilen, OBPP’nin komplikasyonlarındandır.Çalışmadaki amacımız, OBPP ile takip edilen hastalarda, omuz ultrasonografisi ile MRG ve klinik bulgular arasındaki korelasyonu değerlendirmektir. Gereç ve Yöntemler: Çalışmamız, ebeveynlerin ve etik kurul onayı alınarak prospektif yapıldı (onay no:16969557–627). Mayıs 2014 ile Mart 2018 tarihleri arasında, Ortopedi ve Travmatoloji Anabilim dalında, klinik olarak Modifiye Mallet sistemiyle, aynı ortopedist tarafından 1-3 aylık süreler ile takip edilen OBPP’li 72 hastaya (32 erkek, 40 kız, sağ [59], sol [13]), aynı pediatrik radyolog tarafından, ön hazırlık yapılmadan, seri omuz ultrasonu yapıldı. Bulgular: Ortalama yaşı (3,2±2,1 ay) 72 hastaya toplamda 168 ultrason incelemesi yapıldı. Hastaların 19’unda (yaşları 3,5-8 ay), klinik olarak da doğru- lanan dislokasyon saptandı. Ultrason ile MRG arasında Sonuç: OBPP’li çocukların, klinik ve MRG ile de uyumlu bulunan omuz ultrasonografisi ile takip edilmeleri, klinik olarak saptanmadan önce de dislokasyon tanısının konularak erken tedavi başlanmasına olanak sağlar. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S21 S - 052 PEDİATRİK TORAKS PATOLOJİLERİNDE DİFÜZYON MANYETİK REZONANS GÖRÜNTÜLEMENİN ÖNEMİ: OLGULARLA DEĞERLENDİRME GÖKHAN POLAT Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Difüzyon ağırlıklı manyetik rezonans görüntüleme (MRG)`nin pediatrik yaş grubu hastalarda toraks patolojilerinde önemi olgular ile sunulmuştur. Olgu 1: 15 yaşında bir erkek olguda toraks BT incelemede anterior mediasten bölgesinde tespit edilen yumuşak doku dansitesinde lezyon için yapılan MRG incelemede T2 ağırlıklı serilerde ara intensitede difüzyon ağırlıklı serilerde hafif derecede difüzyon kısıtlayan kitle lezyon imajı izlenmektedir. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 1,42±0,23x10-3 mm2/sn olarak izlendi. Olgu 2: 6 yaşında bir kız olguda anterior mediasten yerleşimli T2 ağırlıklı serilerde belirgin hiperintens, difüzyon ağırlıklı serilerde anlamlı difüzyon kısıtlılığı göstermeyen kitle lezyon imajı izlenmektedir. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 2,89±0,38x10-3 mm2/sn olarak izlendi. Olgu 3: 4 yaşında bir kız olguda posterior mediasten-paravertebral mesafe düzeyinde lokalize olan difüzyon ağırlıklı serilerde anlamlı difüzyon kısıtlayan ve T2 ağırlıklı serilerde belirgin hiperintens kitle lezyon imajı izlenmektedir. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 0,71±0,23x10-3 mm2/sn olarak izlendi. Olgu 4: 10 aylık bir kız olguda anterior mediasteni tama yakın dolduran difüzyon ağırlıklı serilerde sağ lateral kesiminde hafif derecede difüzyon kısıtlayan, T2 ağırlıklı serilerde ara intensitede kitle lezyon imajı izlenmektedir. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 0,58±0,11x10-3 mm2/sn olarak izlendi. Olgu 5: 17 yaşında bir kız olguda akciğer alt lob düzeyinde difüzyon kısıtlılığı göstermeyen T2 ağırlıklı görüntülerde germinatif memban içeren heterojen hipointens lezyon izlendi. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 1,80±0,86 53x10-3 mm2/sn olarak izlendi. Tartışma: Birinci olguda histopatolojik olarak karsinoid tümör tanısı konuldu. İkinci olguda ise yapılan yüzeyel ultrasonografi, MRG ve histopatolojik veriler ile kavernöz hemanjiom tanısı konuldu Üçüncü olguda ise belirgin difüzyon kısıtlaması var olup, histopatolojik olarak nöroblastom metastazı tanısı konuldu. Dördüncü olguda ise tru-cut biyopsi ile timoma tanısı konuldu. Beşinci olguda germinatif membranlar izlenmiş olup laboratuar verileride hidatik kist tanısını doğrulamıştır. Malign lezyonlarda ADC değeri, benign ve kistik natürdeki lezyonlara göre belirgin olarak daha düşük olmaktadır. Diğer konvansiyonel MRG bulguları ile birlikte değerlendirildiğinde difüzyon görüntüleme toraks lezyonlarında ayırıcı tanıya katkı sağlamaktadır. ROI ölçümüne imkan tanıyıp aynı zamanda kantitatif değerlendir- meye olanak sağlamakta olup benign-malign lezyon ayrımında katkı sağlamaktadır. Hem 1,5 hem 3 Tesla cihazlarda pediatrik vakalarda difüzyon ağırlıklı görüntüleme toraks MRG incelemelerine kolaylıkla eklenebilmektedir. Sonuç: Difüzyon MRG kısa sürede elde edilebilen bir tetkik olup, pediatrik toraks patolojilerinde rutin görüntülemeye mutlaka eklenmesi gereken bir inceleme yöntemidir.

S - 053 GLUTARİK ASİDÜRİ TİP 1 HASTALARİN TANISINDA KRANİAL MRG MESUT ÇETİN1, ADEM AĞYAR1, OSMAN ÖZDERE1, SİBEL KARAYOL1, MERYEM KARACA2 1Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye 2Harran Üniversitesi Tıp Fakültesi, Çocuk Metabolizma Anabilim Dalı, Şanlıurfa, Türkiye Özet Giriş: Glutarik asit tip 1 (GA tip 1) glutaril-CoA dehidrogenaz enziminin eksikliği sonucu gelişen, otozomal resesif geçişli nadir bir metabolik hastalıktır. Lizin, hidroksilizin, triptofan amino asitlerin bir metaboliti olan glutarik asitin dekarboksilasyonu ve dehidrojenasyonunda glutaril-CoA görev alır. Hastalık makrosefali, diskinezi, nöbet, ensefalopati, nöromotor gelişimde gerilik olarak kendini gösterir. Erken safhada klinikten çok kranial MRG bulguları erken tanıda yardımcı olur. Erken tanı ve tedavinin nörolojik sekellerin önlenmesinde başarılı olduğu gösterilmiştir. Çocuk metabolizma polikliğine başvurmuş veya takibinde GA tip 1 li 10 vakanın kranial MRG bulgularını sunmayı amaçladık. Olgu: Son bir yıl içerisinde çocuk metabolizma ve radyoloji departmanları tarafından tanı ve takibinde yer alınan 10 GA tip 1 hastasının beyin MRG leri ele alındı. Hastaların 7’i erkek 3 si kızdı. Hastaların tanı alma yaşı ortalama 9-10 ay olup yaş ortalamaları 30 ay olarak hesaplandı. Kranial MRG bulguları genişlemiş silvian fissür (n=10), frontotemporal atrofi (n=10),), bazal ganglion tutulumu (n=7,özellikle globus pallidus), beyaz cevher tutulumu (n=9), genişlemiş mezensefalik sistern (n=6), makrosefali (n=8) medial leminiskus (n=6) ve dentate nukleus tutulumu (n=4), difüzyon kısıtlılığı (n=4), subdural koleksiyon (n=2) olarak bulundu. Sonuç: GA tip 1 kranial MRG bulguları çeşitlilik göstermektedir. Çoğu vakada makrosefali, frontotemporal atrofi, silvian fissür genişlemesi en sık bulgular olarak karşımıza çıkmaktadır. Bazal ganglion tutulumu ve beyaz cevher tutulumunun eşlik etmesi GA tip 1 tanısını güçlendirir. Hastalığın hayatın ilk yıllarında bulgu vermemesi ve serebral palsi ile karıştırılması nedeniyle klinik olarak şüpheli vakalarda beyin MRG bulguları tanıya yardımcı olmaktadır. Poster Bildiriler Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S23 P - 01 KÖTÜ KONTROLLÜ TİP1 DİABETES MELLİTUSTA GLİKOJENİK HEPATOPATİNİN RADYOLOJİK TANISI HÜSEYİN AYDIN1, MÜGE ATAR2 1Süleyman Demirel Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı, Isparta, Türkiye 2Süleyman Demirel Üniversitesi Tıp Fakültesi Pediatri Anabilim Dalı, Isparta, Türkiye Özet Jinekolojik hepatopati kontrol edilmemiş diyabetin bir sonucu olarak görülen nadir bir durumdur. Hiperglisemi ve hiperinsülinemi hepatositlerde glukoz birikimine ve hepatomegaliye neden olur. 17 yaşında kadın hasta diyabetik ketoasidoz tanısı ile birçok kere hastanede yatarak tedavi edilmiştir. Laboratuvar ve görüntüleme bulguları ile birlikte glikojenik hepatopi tanısı konmuştur. Hepatomegalisi ve karaciğer enzimlerindeki artış sıkı bir kan şekeri kontrolü ile düzelmiştir. Diyabeti kontrol altında olmayan hepatomegali ve karaciğer enzimlerinde artış tespit edilen hastalarda glikojenik hepatopi tanısı akılda tutulmalıdır. Tanı için biyopsiden önce radyolojik görüntüleme yapılmalıdır.

P - 02 AKUT PANKREATİTİN NADİR BİR KOMPLİKASYONU: MEDİASTİNAL PSÖDOKİST ERTAN HAZAR, EZGİ GÜLER

Ege Üniversitesi Radyoloji Anabilim Dalı, İzmir, Türkiye Özet Giriş: Akut pankreatit pankreasın steril inflamasyonudur. Çoklu organ yetmezliğine ve ölüme neden olabilir. Atlanta klasifikasyonuna göre major olarak iki tipe ayrılır; İnterstisyel ödematöz pankreatit ve nekrotizan pankreatit. Etiyolojide safra taşları, alkol, otoimmün, metabolik, herediter, iyatrojenik nedenler yer alır. Olgu Sunumu: 46 yaş erkek olgu. Akut pankreatit nedeni ile takipte olan hasta, karın ağrısı, dispne ve yutma güçlüğü nedeni ile tetkik ediliyor. BT de pankreas gövde ve kuyruk komşuluğunda izlenen psodokistin yanı sıra, pankreas baş kesiminden posterior mediastende hiatusa doğru uzanan multiloküle psödokist izlendi. Ayrıca peritonit bulguları ve asit sıvısı mevcuttu. MRGde BT ile benzer şekilde posterior mediastene uza- nım gösteren T1A hipointens, T2A hiperintens, postkontrast imajlarda periferal kontrastlanma gösteren hafif kalın duvarlara sahip multiloküle psödokist izlendi. Pankreas parankiminde nekroz bulgusu saptanmadı. Tartışma: Atlanta kriterlerine göre nekroz varlığı veya yokluğuna göre ve 4 haftalık zaman intervali dikkate alınarak peripankreatik sıvıya bazı tanımalamar getirilmiştir. Nekrotizan pankreatit diyebilmek için akut pankreatit atağı üzerinden 72 saat geçmesi gerekmektedir. Nekroz var ise <%30, %30-50, >%50 şeklinde yüzde belirtmek gerekir. Pankreatik nekroz en sağlıklı geç arteryel (yaklaşık 35-40. sn) fazda ayırt edilir. Komplikasyon olarak; nekroz, enfeksiyon, apse, psödokist, hemorajik veya amfizematöz pankreatit, vaskuler yapılarda tromboz veya psödoanev- rizma gelişebilir. Ayırıcı tanıda pankreatik lenfoma, peptik ülser, maligniteler düşünülebilir. Mediastinal psödokist: Akut pankreatit sonrasında olu- şan pankreatik psödokistin diyafragmatik hiatus aracılığı ile posterior mediastene uzanımı ile oluşur. Nadir bir komplikasyondur. Psödokistlerin yaklaşık %20 si ekstrapankreatik görülmektedir. Bası bulgusu nedeniyle dispne, disfaji gelişebilir. Psödokist enfekte olabilir, hemoraji ile komplike olabilir. BT, MRG de kistik, duvarda kontrastlanma gösteren yapılar şeklinde izlenir. MRCP ile safra ve pankreatik kanal ilişkileri daha net ortaya konabilir. Serolojik olarak amilaz yüksekliği kuşku uyandırmalıdır. Tedavide medikal ve cerrahi seçenekler mevcuttur. Sonuç: Akut pankreatit fatal olabilen bir hastalıktır. Akut pankreatite eşlik eden dispne veya yutma güçlüğü akla mediastinal psödokisti getirmelidir. Pankreatite eşlik eden komplikasyon varlığı mutlaka raporda belirtilmelidir. Olgumuzda da izlendiği gibi psödokistlerin uzandığı kompart- manlar net olarak belirtilmelidir. Enfeksiyon süreçlerinin tabloya eklenebileceği unutulmamalıdır.

P - 03 CAROLİ HASTALIĞI ZEMİNİNDE GELİŞEN KOLANJİYOSELLÜLER KANSER OLGUSU ERTAN HAZAR, EZGİ GÜLER

Ege Üniversitesi Radyoloji Anabilim Dalı, İzmir, Türkiye S24 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Giriş: Caroli hastalığı intrahepatik safra yollarının sakküler kistik dilatasyonu ile ilişkili konjenital bir hastalıktır. Hastalık otozomal resesif geçiş göstermektedir. Genellikle çocuk ve genç erişkin dönemde bulgu verir. Todani sınıflamasında Tıp 5 koledok kisti kategorisine girmektedir. Kolanjiyosellüler kanser riskini ciddi oranda artırmaktadır. Olgu Sunumu: 50 yaşında kadın olgu. Caroli hastalığı nedeniyle uzun süredir takipte olan hasta10 yıl önce kolanjiyosellüler kanser nedeni ile opere olmuş. Sırta vuran sağ üst kadran ağrısı nedeniyle kliniğe başvurmuş. BTde intrahepatik safra yollarında yaygın sakküler genişlemeler, dilate safra yolları içerisinde taş ve çamura ait dansiteler, segment 8 düzeyinde infiltran karakterde çevre parankimde çekinti yapmış malign morfolojide kitle izlendi. Koledok çapı yaklaşık 8 mm idi. Portal hilusta ve peripankreatik metastatik lenf bezleri mevcuttu. MRG de T2A görüntülerde yaygın intrahepatik kistik safra yolları içerisinde çok sayıda taşa ait sinyalsiz oluşum izlendi. MRCP de sakküler genişlemelerin safra ağacı ile ilişkisi ortaya konuldu. Portal hilus düzeyinde metastatik lenf bezlerinde ve kitlede kısıtlanmış difüzyon bulguları gözlenmiştir. PET BT de karaciğerde infiltran karakterde kolanjiyoselüler kanserde artmış FDG tutulumu mevcuttu. Ayrıca portal ven çapı intrahepatik konfluens düzeyinde eksternal bası nedeni ile preokluziv darlık derecesinde azalmıştı. Tartışma: Caroli hastalığı sarılık, sağ üst kadran ağrısı, kolanjit, portal hipertansiyon, özefagus varisleri, kolanjiyosellüler kanser gibi bulgularla ortaya çıkabilir. Genetik temelde Caroli hastalığı PKHD1 geni aracılığı ile polikistik böbrek hastalığı veya medüller sünger böbrek hastalığı ile ilişkili olabilir. Karaciğer tutulumu segmental, lober veya diffüz olabilir. Basit tip ve periportal tip şeklinde iki alt gruba ayrılır. Basit tip geniş santral safra yollarından, periportal tip ise geniş ve periferal küçük safra yollarından kaynaklanmaktadır. Sonuç: Dilate safra kanalı içinde portal veni temsil eden santral nokta işareti tipiktir. MRCP de kistik genişlemelerin safra ağacı ile ilişkisi gös- terilmelidir. Hastalığın ayırıcı tanısında polikistik karaciğer hastalığı, biliyer hamartom (Von Meyenburg kompleksi), primer sklerozan kolanjit, piyojenik apseler yer alır. Tedavide segmental veya lober tutulumda cerrahi seçeneği var iken diffüz tutulumda karaciğer nakli veya konservatif tedavi uygulanmaktadır.

P - 04 SKROTAL KİTLE AYIRICI TANISINDA ÜRETRAL DİVERTİKÜL KALKÜLÜ FATMA UYSAL, MUSTAFA REŞORLU Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi, Çanakkale, Türkiye Özet Giriş: Üretranın konjenital divertikülü nadir görülen bir anomalidir. Üretra ile divertikülün bağlantılı kısmın genişliğine bağlı olarak akut enfektif epizotlar meydana gelir veya üretraya drenaj yeterli ise zamanla içerisinde kalkül gelişebilir. Bu olgu sunumunda skrotal kitle nedeniyle başvuran penil üretral divertikül içerisinde yerleşen kakül saptanan olguya ait ultrasonografi (US) ve manyetik rezonans görüntüleme(MRG) bulgularını sunduk. Skrotumu da içeren alt batın MRG ve yüzeyel US tetkiki değerlendirilmiştir. Olgu Sunumu: Skrotumda ele gelen kitle ve idrar yaparken zorlanma şikayeti ile başvuran 63 yaşındaki erkek hastanın skrotumu içeren alt batın MR tetkikinde skrotum sol paramedian alanda ekstratestiküler yerleşimli 28x38 mm boyutta, T1 aksiyal- T2 aksiyal-sagittal ağırlıklı serilerde homojen hipointens iç yapıda, postkontrast serilerde kontrast tutulumu göstermeyen düzgün, keskin konturlu kitlesel lezyon izlendi. T1 ve T2 ağrlıklı serilerde hipointens olması nedeniyle pür kalsifik kitle, paratestiküler fibröz psödotümör, egzofirik divertikül içerisinde kalkül düşünül- dü. MR tetkiki sınırlarında lezyonun üretra ile bağlantısı görülmemekteydi. Yapılan US incelemede posteriorundaki belirgin akustik gölgelenme nedeniyle içeriği değerlendirilemeyen kitlesel lezyon saptandı. Operasyonda penil kök düzeyinde üretral divertikül içerisinde yer alan kalkül görülerek eksize edildi. Tartışma: Üretral divertikül konjenital, periüretral abse, travma ya da striktüre sekonder edinsel olabilir. Üretral divertikül daha çok stres inkontinası olan kadınlarda görülür. Görülme sıklığı yaklaşık %1-6 dır. Genelde 3-5. dekatlar arasında bulgu verir. Enfekte boş divertikülün tanısı üretrogram ile konur. Eğer kalkül mevcutsa palpe edilebilir ve radyolojik tanı üretroskopi ile doğrulanabilir. Tedavisi divertikül ve kal- külün eksizyonudur. Disüri, dispareunia, tekrarlayan üriner enfeksiyon, hematüri, stres inkontinansı gibi semptomlara neden olabilir. Üretral divertikül olgularının %10 unda kalkül gelişebilir. Tekrarlayan enfeksiyon, ve irritasyon üroepiteliumda malign transformasyon açısından predispozandır. Sonuç: Skrotal kitle ile başvuran olguda ayırıcı tanıda nadir de görülse üretral düvertikül ve içerisinde yerleşen kalkül akılda bulundurulmalıdır.

P - 05 İNSİDENTAL OLARAK TANI ALAN ZİNNER SENDROMU OLGUSU ADEM AĞYAR, MESUT ÇETİN, OSMAN DERE, ATAKAN KIRTEKE, ABDURRAHİM DUSAK Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S25

Özet Giriş: Konjenital seminal vezikül kistleri (SVK) nadir ve çoğunlukla aynı taraftaki böbrek yokluğu ile birliktelik gösterir. Eğer beraberinde eja- külatör kanal obstrüksiyonu varsa “Zinner Sendromu” olarak bilinir. SVK çoğunlukla semptom vermez veya nonspesifik semptom verdiğinden dolayı tanı gecikebilir. Görüntüleme yöntemlerinin sık kullanıldığı günümüzde başka nedenlerle yapılan tetkikler sonucu rastlantısal olarak tanı konulmaktadır. Bu çalışmamızda skrotal kitle nedeniyle görüntüleme yapılan 34 yaşındaki olguyu sunuyoruz. Olgu Sunumu: 34 yaşında erkek hasta, 3 çocuk sahibi, sağ skrotumda şişlik şikayeti ile başvuran hastanın fizik muayenesinde sağ hemiskrotum proksimal kesimde ele gelen kitlesi var. Karın ultrasonografisinde (USG) mesane posteriorunda solda 30x20 mm boyutunda kalın duvarlı iç yapısında yoğun sıvı olduğu düşünülen görünüm ve sol böbrek yokluğu tesbit edildi. Manyetik rezonans görüntülme(MRG)de sol böbrek izlen- memiştir. Sol vezikula seminalis ile ilişkili olması muhtemel T2AG hiperintens T1AG iso-hiperintens, iyi sınırlı lobule konturlu kistik lezyon sap- tandı. Seminal vezikül kisti olarak değerlendirilen olguda ipsilateral böbrek yokluğu ve ejakulatör kanal obstrüksiyonu olması nedeniyle Zinner Sendromu tanısı konuldu. Hastada ek olarak sağ hemiskrotumda 62x37 mm boyutlarında ölçülen teratom saptandı. Sonuç: Konjenital seminal vezikül kistleri mezonefrik kanaldan kaynaklanmaları nedeniyle çoğunlukla ipsilateral üriner anomaliler ile ilişkilidir. Çoğu olgu asemptomatik olup infertilite nedeniyle incelenirken tanı alır. Olgularda dizüri, ağrılı ejakulasyon, pelvik ağrı gibi yakınmalar olabilir. Zinner Sendromu kadınlarda görülen Mayer-Rokitansky-Kustner-Hauser sendromunun erkek versiyonu olup renal agenezi, ipsilateral seminal vezikül kisti ve ejakulator duktus tıkanıklığı triadından oluşan nadir görülen bir infertilite nedenidir. Ayırıcı tanıda prostat kistleri, ejakulator duktus kistleri, mesane divertikülü, üreterosel gibi diğer pelvik kistler düşünülmelidir. Tanıda İVP, ultrason ve kesitsel görüntüleme yöntemleri rol alır.

P - 06 ÖZEFAGUS LEİOMYOMU: MRG BULGULARI HASAN ERDOĞAN, FATMA ZEYNEP ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, GÜL ESER Sağlik Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Özefagus leiomyomu, özefagusun muskularis propria tabakasından köken alan, düz kas hücrelerinin benign tümörüdür. Genellikle tek, düzgün sınırlı submukozal kitle şeklinde ortaya çıkar. Bütün gastrointestinal leiomyomların %10’u özefagusta görülür. Leiomyomlar genellikle özefagusun orta ve alt 1/3’lük kısmında yerleşirler. Disfaji, nonspesifik retrosternal ağrı, kilo kaybı gibi septomlara yol açabilirler. Bu sunumda özefagusta leiomyom histopatolojik tanısı olan 59 yaşındaki erkek olgunun manyetik rezonans görüntüleme bulguları sunulmuştur.

P - 07 PANKREASIN SERÖZ KİSTADENOKARSİNOMUNU TAKLİT EDEN JUKSTAPAPİLLER DUODENUM DİVERTİKÜLÜ SEMİH ASOĞLU, MUSTAFA ALPER BOZKURT, EMİNE UYSAL, MUSTAFA KOPLAY Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet Giriş: Divertikül hastalığının kolondan sonra ikinci en sık yerleşim yeri duodenumdur. Dudenum divertikülünün insidansı %2-5 olup, en sık duoedenum ikinci veya üçüncü kıtada yerleşirler. Duodenum divertikülü genellikle asemptomatik olup semptomatik hastalarda perforasyon, ağrı, kanama, divertikülit, kolanjit ve pankratit bulguları izlenebilir. Duodenal divertiküller içlerinin tamamen hava ile dolmasıyla veya sıvı-gaz kombinasyonlarıyla bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) ile tanınabilirler. Divertikülün içi tamamen sıvı ile doluysa pankrasın kistik tümörlerini taklit edebilir. Olgu Sunumu: 61 yaşındaki kadın hastanın karın ağrısı sebebiyle yapılan ultrasonografi incelemesinde karaciğerde lobüle konturlu, içerisinde septasyonların bulunduğu kistik lezyon görüldü. Hastaya daha sonra yapılan MRG incelemesinde pankreas başı düzeyinde 20x12 mm ebatlı, ince septasyon içeren, kistik lezyon görüldü. Ayırıcı tanılar arasında pankreas seröz kistadenomu ve duodenum divertikülü düşünüldü. Hastanın takiplerinde şiddetli karın ağrısı olması sebebiyle çekilen IV-oral kontrastlı abdomen BT’sinde duodenum 2. segmentten periampüller alana doğru uzanım gösteren yaklaşık 3 cm uzunluğunda 1 cm çapında, içerisinde hava dansiteleri ve kontrast içeren lezyon alanının duodenum divertikülü olduğu anlaşıldı. Sonuç: Duodonal divertiküller primer veya sekonder olabilir. Primer divertiküller gerçek divertiküller olup bağırsağın tüm katmanlarını içerir. Sekonder divertiküller ise kronik duodenal ülserin bir sonucu olarak ortaya çıkabilir. Duoedenum divertikülleri sıklıkla periampuller bölgede lokalizedir. Duodenum divertiküllerinin görülme sıklığı yaşla artar ve en sık 50-60 yaş aralığında görülür. Duodenal divertiküllerin pankreas başına olan komşulukları, görüntüleme yöntemlerinde pankreasın kistik neoplazmları ile karışmalarına neden olmaktadır. Görüntüleme yön- temlerinde pankreas başı kistik neoplazmları düşünülen hastalarda duodenal divertiküller ayırıcı tanıda akla gelmeli ve hastalar bu yönden ek inceleme ile tetkik edilmelidir. S26 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı P - 08 BÖBREK LENFOMA TUTULUMU MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI SEMİH ASOĞLU, MUSTAFA KOPLAY, MUSTAFA ALPER BOZKURT, YAHYA PAKSOY Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet Giriş: Böbrek lenfoması genellikle multisistemik lenfoma spektrumunun bir parçası olarak görülür. Böbrekler lenfomanın en yaygın ekstranodal bölgeleridir. Böbrek lenfoması yaygın olarak non-Hodgkin lenfoma ile ortaya çıkmakla birlikte çoğunluğu B hücreli lenfoma alt tipidir. Biz bu sunumda her iki böbreği tutan B hücreli lenfomanın manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık. Olgu Sunumu: 73 yaşında KOAH tanılı hasta karın ağrısı ve nefes darlığı şikayetiyle acile başvurdu. Pulmoner bilgisayarlı tomografi (BT) anjiografisinde emboli izlenmedi ancak paratrakeal alanda ve anterior mediastende en büyüğü 2 cm çapa ulaşan multipl sayıda lenfadenopatiler izlendi. Kesit alanına giren üst abdomen bölgesinde diyafragma komşuluğunda, parakardiyak yağ yastıkçığı içerisinde lenf nodları izlendi. Ayrıca batın içerisinde ve böbrek superiorunda multipl sayıda lenf nodları ve omental kirlenmeler mevcuttu. MRG incelemede paraaortik, parakaval alanlarda büyüğü sol paraaortik alanda 5x3. 5 cm ebatlı olmak üzere paraaortik, parakaval yerleşimli konglomerasyon oluşturan multiple lenfadenopatiler izlendi. Gerota fasiyasında ve pararenal yağlı dokuda belirgin kalınlaşma yanısıra retroperitonael yerleşimli lenfadenopatilerin belirgin invazyonu mevcuttu. Her iki pararenal alanda ve böbrek parankiminde diffüzyon kısıtlanmaları da izlendi. Bulgular sekonder böbrek lenfoması olarak değerlendirildi. Sonuç: Renal lenfomalar unilateral veya bilateral olarak izlenebilir. Bazen de karşımıza fokal kitleler (tekli veya çoklu) veya fokal kitle olmadan diffüz böbrek tutulumu yaparak böbreklerde büyümeye sebep olabilir. Yapılan çalışmalar renal ve perirenal lenfoma tutulumunu göstermede MRG’ ‘nin de kontrastlı BT kadar doğru sonuç verdiğini göstermiştir. Lenfomalar genel olarak böbrekte büyüme, kontrastlanmayan alanlar, parankimal nodüler lezyonlar şeklinde izlenmekle birlikte daha nadir görülen pararenal tutulum, kortikal invazyon şeklinde tutulumda izlenebilir.

P - 09 OVER HİPERSTİMÜLASYON SENDROMU OLAN BİR OLGUDA OVER TORSİYONU: KONVANSİYONEL VE DİFÜZYON MRG BULGULARI AHMET BAYTOK, EMİNE UYSAL, SEMİH ASOĞLU, MUSTAFA KOPLAY Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet Giriş: Over hiperstimülasyon sendromu (OHSS), invitro fertilizasyon (İVF) uygulanan kadınlarda karşılaşılan en önemli komplikasyondur. Ovulasyon indüksiyonu ile büyüyen overler belirgin torsiyon riski taşır. Tanıda renkli doppler ultrasonografi (RDUS) ilk sırada kullanılmakla birlikte manyetik rezonans görüntüleme (MRG) ileri incelemede önemli bir yere sahiptir. Burada IVF tedavisi sonrası OHSS ve over torsiyonu tanısı alan bir olguda konvansiyonel ve özellikle difüzyon MRG bulgularını sunmayı amaçladık. Olgu Sunumu: 23 yaşında kadın hasta ani başlayan sağ adneksiyel ağrıyla başvurdu. Bir hafta önce İVF hikayesi olan hastaya yapılan RDUS incelemede her iki overde multiple kistler ve pelviste serbest sıvı izlendi. RDUS incelemede sağ overde belirgin kanlanma saptanmadı. Yapılan MRG incelemede her iki over boyutlarında artış, homojen yapıda büyüğü 4,5 cm çaplı basit kistler ve bir adet hemorajik kist izlendi. Ayrıca stromal ödeme bağlı intensite artımı ve difüzyon MRG de sağ over periferinde daha belirgin olan anlamlı difüzyon kısıtlanması izlendi ve görünüm OHSS’ye sekonder over torsiyonu açısından anlamlı bulundu. Sonuç: Over torsiyonu; overyan vasküler pedikülün kısmi veya tam rotasyonu olup arteriyel ve/veya venöz dolaşımın durması sebebiyle OHSS’nin jinekolojik acil oluşturan komplikasyonlarındandır. Tanıda primer görüntüleme yöntemi RDUS olup over kanlanmasının net değerlen- dirilemediği durumlarda MRG önemli ipuçları vermektedir. Torsiyone overdeki asimetrik büyüme, periferik foliküller, stromal ödem, hemoraji, over pedikülündeki dönme (girdap işareti), ipsilateral fallop tüpünde duvar kalınlaşması, pelvik serbest sıvı ve uterusta torsiyon tarafına devias- yon izlenebilir. DAG’lerde düşük apparent diffusion coefficient (ADC) değerleri hemorajik enfarkt açısından yüksek sensitiviteye sahiptir. Sonuç olarak, difüzyon MRG torsiyonu ve buna bağlı gelişen enfarktı tespit edip ayırıcı tanıda önemli role sahiptir.

P - 010 OKSİPİTAL MENİNGOSEL: FETAL MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI AHMET BAYTOK, MUSTAFA KOPLAY, EMİNE UYSAL, YAHYA PAKSOY Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S27

Özet Giriş: Meningosel; embriyolojik yaşamın erken dönemlerinde ektodermal yaprağın nöroektoderme dönüşememesine bağlı kemik yapıda defekt oluşması ve bu defektten meninkslerin fıtıklaşması olarak tanımlanmaktadır. Sıklıkla torakolomber bölgede görülmekle birlikte oksipital yerle- şim nadirdir (%1-8). Bu olguda nadir görülen oksipital meningosel olgusunun fetal manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık. Olgu Sunumu: 33 yaşında kadın hastanın 27 gebelik haftasında yapılan ultrasonografide oksipital defekt görülmesi üzerine fetal MRG yapıldı. MRG’de her iki lateral ventrikül posterior hornlarında kolposefalik genişleme ve orta hatta oksipital kemikteki küçük bir defektten posteriora uzanım gösteren 15 mm çaplı kese izlendi. Kese içerinde nöral parankime ait görünüm saptanmadı ve oksipital meningosel tanısı konuldu. Sonuç: Spinal kord gelişiminde sırasıyla gastrulasyon, nörülasyon ve differensiasyon aşamaları olurken erken embriyonik dönemdeki defektler spinal disrafizmlere neden olmaktadır. Spinal disrafizmler açık ve kapalı olmak üzere klinik olarak iki alt gruba ayrılırken meningosel kapalı disrafizm grubunda yer almaktadır. Meningoselde herniye kese içerinde meninksler ve beyin omurilik sıvısı bulurken nöral parankim izlenmez. Oksipital yerleşim meningosel için nadir olmakla birlikte ayırıcı tanıda kistik higroma da düşünülmelidir. Fetal MRG primer görüntüleme yöntemi olmayıp USG’yi tamamlayıcı görüntüleme yöntemi olarak kullanılmaktadır. MRG; özellikle meningoselin içeriğinin saptanması, medulla spinalis ile olan ilişkilerin ortaya konması ve eşlik eden lezyonların detaylandırılmasında önemli yere sahip olup olası cerrahi planlanmasına da klavuzluk etmektedir.

P - 011 FETAL BRONKOPULMONER SEKESTRASYON: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI MUSTAFA ALPER BOZKURT, SEMİH ASOĞLU, YAHYA PAKSOY, MUSTAFA KOPLAY Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet Giriş: Pulmoner sekestrasyon, trakeobronşiyal ağaca bağlanmayan ve sistemik bir arter tarafından dolaşımı sağlanan anormal bir akciğer dokusu içeren konjenital anomalidir. Antenatal izlemde ultrasonografinin (USG) rutin hale gelmesi ile birlikte akciğer ve toraksa ait birçok konjenital anomalinin prenatal erken tanısı konulabilmektedir. Ancak ayırıcı tanıya gidilemediği veya anatomideki değişikliklerin detaylı olarak anlaşılamadığı durumlarda manyetik rezonans görüntüleme (MRG) kullanılabilir. Bu sunumda pulmoner sekestrasyonda MRG bulguları sunulmuştur. Olgu Sunumu: 23 yaşında, primigravid, G1P0, 23. gebelik haftasında olan hasta, rutin izlemler sırasında toraksta kitle ön tanısı ile merkezimize refere edildi. Hastanın tıbbi özgeçmişinde özelliği yoktu. Yapılan USG de sol akciğerde ekojen bir odak izlendi. Ancak vasküler yapısı net olarak değerlendirilemedi. Hastaya ayırıcı tanı amacıyla yapılan Fetal MRG de, sol akciğer inferiorunda ekstralober yerleşimli yaklaşık 2. 5x1. 5 cm ebatlı, triangüler şekilli intensite artışları dikkati çekmekte olup, aortadan bu intensite artışı gösteren alana doğru hipointens lineer uzanım gösteren vasküler yapı izlendi. Bu bulgular bronkopulmoner sekestrasyon ile uyumlu bulundu ve postnatal dönemde doğrulandı. Sonuç: Antenatal izlemde USG nin daha sistematik ve etkin kullanılması toraksta yer işgal eden lezyonların daha erken tanı almasına olanak sağla- mıştır. Ancak bazı bronkopulmoner sekestrasyon olgularında USG ile vasküler yapı gösterilememektedir. Bu gibi durumlarda kistik adenomatoid malformasyondan ayrımı, ek patolojilerin varlığı, akciğer hacminin ölçülebilmesi avantajlarını sağladığı için MRG kullanılabilir.

P - 012 SİSTİK KANAL YARALANMASINDA GADOKSETAT DİSODYUM İLE MANYETİK REZONANS KOLANJİYOPANKREATOGRAFİ BULGULARI MUSTAFA ALPER BOZKURT, SEMİH ASOĞLU, ABDÜSSAMET BATUR, MUSTAFA KOPLAY Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet: Giriş: Safra kaçağı travmatik veya iatrojenik safra yolları yaralanması sonucu gelişebilir. Laparoskopik kolesistektomide safra yolu yaralanma- ları açık kolesistektomiye oranla daha sık görülmektedir. Postoperatif dönemde komplikasyon şüphesinde ultrasonografi (US) ve bilgisayarlı tomografi (BT) sık kullanılan görüntüleme yöntemleridir. Ancak bu yöntemlerde safra ile diğer postoperatif sıvı koleksiyonları güvenilir şekilde ayırt edilemeyebilir. Manyetik rezonans görüntüleme (MRG) ve hepatosit spesifik kontrast madde kullanılarak yapılan manyetik rezonans kolanjiyopankreatografi (MRKP) tetkiklerinde anatomik ve fonksiyonel bilgi daha net ayırt edilir ve tanıya daha kısa sürede ulaşılabilir. Bu sunumda kolesistektomi sonrası safra kaçağı gelişen olguda gadoksetat disodyum ile çekilen MRKP bulguları sunulmuştur. Olgu Sunumu: 56 yaşında erkek hasta laparoskopik kolesistektomi sonrası gelişen karın ağrısı ve bulantı - kusma şikayetleriye tetkik ediliyor. US ve kontrastlı BT incelemesinde karaciğerde apse ile uyumlu sıvı lokülasyonu izlendi. Safra yolları ile ilişkili olabileceği şüphesi üzerine hastaya gadoksetat S28 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı disodyum içeren kontrast madde kullanılarak uygulanan üst abdomen MRG ve MRKP tetkikinde perihepatik alanda apse ile uyumlu görünüm izlendi. 30. ve 60. dakikalarda alınan görüntülerde apse içerisinde kontrast madde izlenmiş olup safra kaçağı ve sistik kanal seviyesinden rüptür olduğu görüldü. Sonuç: Hepatobiliyer ameliyatların artması beraberinde safra kaçağı gibi komplikasyonların da artmasına neden olmuştur. Komplikasyonların değerlendirilmesinde görüntüleme yöntemleri büyük önem arz etmektedir. Safra kaçağı gibi durumları göstermede US ve BT yetersiz kalabilir. Hepatosit spesifik kontrast madde kullanılarak uygulanan MRG ve MRKP tetkiki safra kaçağını saptayabilen ve diğer postoperatif komplikasyonlardan ayıran faydalı bir görüntüleme yöntemidir. Non-invaziv bir yaklaşım olduğu için endoskopik retrograd kolanjiyopankreatografi ve perkütan transhepatik kolanjiyografi yerine tanıda ön planda düşünülmelidir.

P - 013 NADİR BİR OLGU SUNUMU: RADYOTERAPİYE BAĞLI GELİŞEN PERİANAL FİBROSİS VE KOLON OBSTRÜKSİYONU MERAL BÜYÜKTERZİ, ÖZGÜR ÖNER, MEHMET SEDAT DURMAZ, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, İSMET TOLU Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Giriş: Radyoterapiye bağlı gelişen komplikasyonlar tipik olmayan semptomları nedeni ile tanı konulması zor patolojilerdir. Pelvik bölgeye uygulanan radyoterapi barsak segmentlerinde, genitoüriner sistemde, kemiklerde veya deride çeşitli hastalıklara yol açabilir. Bu olgu sunumunda prostat karsinomu nedeni ile radyoterapi tedavisi almış bir hastanın radyoterapiye bağlı gelişen perianal fibrozis bulgularının manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık. Olgu Sunumu: 68 yaşında erkek hasta hastanemizin acil servis bölümüne gaz-gayta çıkaramama ve yaygın karın ağrısı şikayetleri nedeni ile baş- vurdu. Hastanın prostat karsinomu nedeni ile bir yıl önce opere olduğu ve radyoterapi ve kemoterapi tedavisi aldığı öğrenildi. Hastaya uygulanan ayakta direkt batın grafisinde barsak anslarında yaygın dilatasyon ve hava sıvı seviyelenmeleri saptandı. Bilgisayarlı tomografi tetkikinde kolon segmentlerinde belirgin dilatasyon ve hava-sıvı seviyelenmeleri saptandı. Ayrıca rektum distal kesiminde anal girim düzeyinde diffüz duvar kalın- laşması izlendi. Hastaya uygulanan MRG tetkikinde ise rektum distal kesiminde rektum mukozasında diffüz kalınlaşma izlendi. Bu düzeyde sınır veren kitle lezyonu saptanmadı. Opere edilen hastanın patolojik tanısı fibrozis ile uyumlu olarak sonuçlandı. Sonuç: Pelvik radyoterapi tedavisi uygulanan hastalarda anal ülserasyon, kanama, şişkinlik ve kabızlık, hemoroid, uykusuzluk, mukozal akıntı gibi çok çeşitli semptomlar ortaya çıkabilir. Bu semptomlardan bazıları radyoterapi dozuna bağlı olduğu gibi bir kısmı dozdan bağımsızdır. Barsak obstrüksiyonları, fistül ve sekonder karsinomlar radyoterapiye bağlı daha geç dönemde ortaya çıkabilen gastrointestinal semptomlardır.

P - 014 NADİR BİR OLGU: KAUDAL DUPLİKASYON SENDROMU ERTAN HAZAR, EZGİ GÜLER, MUSTAFA HARMAN, NEVRA ELMAS Ege Üniversitesi Radyoloji Anabilim Dalı, İzmir, Türkiye Özet Giriş: Kaudal duplikasyon sendromu insidansı 1/100000’den az olan nadir bir hastalıktır. Hastalık kloaka ve nöral tüpten gelişen distal gastrointestinal, genitoüriner sistemde parsiyel veya komplet organ duplikasyonu ve nöral tüp defektlerine neden olmaktadır. Etiyoloji net olmamakla birlikte bazı teoriler ortaya atılmıştır. Bu teorilerden en kabul göreni monozigot ikizlerin inkomplet ayrışmasıdır. Asemptomatik olabileceği gibi inferitilite, anorektal ve genitoüriner şikayetlere neden olabilir. Kızlarda 2 kat fazla görülmektedir. Olgu Sunumu: 27 yaşında kadın olgu. İnfertilite nedeni ile araştırılmakta olan hastaya yapılan pelvik mrg de ortadan fibröz bir septumla tamamen ayrılmış iki mesane, uterus didelfis anomalisi, rektum, sigmoid kolon ve inen kolonda duplikasyon izlendi. İki ayrı serviks uteri kavitesi tek vajen aracılığı ile perineye açılmaktaydı. Gastrointestinal olarak tek bir anal kanal ve anal açıklık mevcuttu. Apendiks tek olarak lojunda yer almaktaydı. Üretra ve eksternal genitalyada duplikasyon gözlenmedi. Her iki over normal lorunda yer almakta olup bilateral fizyolojik boyutlarda folikül kistleri barındırmaktaydı. Ayrıca T11 vertebrada kelebek vertebra anomalisi ve lumbosakral düzeyde skolyoz dikkat çekmiştir. Eşlik edebilecek toplayıcı sistem değerlendirmesi için yapılan BT ürografide her iki böbrek normal lojunda yer almaktydı. Üreter duplikasyonu veya ek üreter malformasyonu izlenmedi. Her üreter kendi tarafındaki mesaneye drene olmaktaydı. Fistüloz bir ilişki seçilmedi. Tartışma: Kaudal duplikasyon sendromu embriyolojik olrak kloaka ve nöral tüpten gelişen yapıların parsiyel veya komplet duplikasyonu olarak değerlendirilir. Genitoüriner sistemde ektopik böbrek, üreter, üretra, eksternal genitalya, mesane duplikasyonu veya üreteral ektopi görülebilir. Gastrointestinal sistemde bağırsak anslarında ve apendikste duplikasyon, anorektal malformasyonlar, batın ön duvarı defektleri, intestinal mal- rotasyon, duodenal agenez, vertebrada kelebek vertebra, hemivertebra, diyastometamiyeli, spina bifida, sakral agenez, myelomeningosel gibi anomaliler eşlik edebilir. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S29

Sonuç: Hastalığın prognozu tutulan organ ve sistemlere göre farklılık göstermektedir. Bizim olgumuzda bulgular infertilite etiyolojisi araştırması sırasında insidental olarak izlenmiştir. Tedavide duplikasyon gösteren organ sisteminde cerrahi onarım yer almaktadır. Özellikle üretra ve eksternal genitalya duplikasyonunda cerrahi sonrası başarılı kozmetik sonuçlar elde edilmektedir.

P - 015 NADİR BİR OLGU: XP11 TRANSLOKASYON HÜCRELİ KARSİNOMUN MR BULGULARI ÖNER ÖZBEY, EZGİ GÜLER, MUSTAFA HARMAN, NEVRA ZEHRA ELMAS Ege Üniversitesi Radyoloji Anabilim Dalı, İzmir, Türkiye Özet Xp11 translokasyon hücreli karsinomu genç yaşta ve kadınlarda daha sık görülen; kistik değişiklikler, lenf nodu metastazı ve uzak metastaz eğiliminin diğer subtiplere göre daha yüksek olduğu, genetik olarak tamamında Xp11. 2 kesiminin tutulduğu nadir bir renal hüreli tümör sub- tipidir. Biz bu posterde karın ağrısı nedeniyle yapılan USGde renal kitle saptanması üzerine MRG ile T2A görüntülerde düşük sinyalli, belirgin kontrastlanma etkileşimi göstermeyen, paraaortik metastatik lenfadenopatilerin eşlik ettiği gözlenen; histopatolojik olarak translokasyon hücreli karsinom tanısı alan ve post-op 2. yıl kontrolünde akciğer metastazı gelişen 21 yaşında kadın olgunun görüntüleme bulgularını sunmayı amaçladık.

P - 016 NADİR BİR OLGU: SÜPERİOR MEZENTERİK ARTER ORJİNLİ ANA HEPATİK ARTERİN VARYASYONU SEDA SOĞUKPINAR KARAAĞAÇ, HASAN ERDOĞAN, ZEYNEP ARSLAN, MEHMET SEDAT DURMAZ, SERDAR ARSLAN Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Mezenterik arteriyel varyasyonlar toplumda oldukça sıktır. Bu varyasyonlar, giderek artan girişimsel radyolojik işlemler, transplantasyon ve vas- küler cerrahi işlemler nedeniyle daha fazla önem kazanmaktadır. Hepatik arter varyasyonları bunlar içinde %40 gibi bir oranla en sık görülen mezenterik arter varyasyonlarıdır. Normalde çölyak trunkusun üç dalından biri olan ana hepatik arter, duedonum’un birinci kısmının üst yüzün- de arteria hepatica propria ve arteria gastroduedonalis dallarını verir. Biz de % 2 oranında görülen ana hepatik arterin süperior mezenterik arterden orjin alan varyantının MRG görüntülerini sunmayı amaçladık. 44 yaşında buerger tanısıyla takipli erkek hastanın çekilen abdominal MRG anjiografisinde ana hepatik arterin süperior mezenterik arterden orjin aldığı izlenmiştir. Vasküler görüntülemede altın standart olarak kabul edilen konvansiyonel kateter anjiyografinin invaziv doğasından dolayı, kesitsel tanı yöntemleri önem taşımaktadır. Bu nedenlerle, hem tanısal hem de girişimsel radyologların, başta çölyak arter ve hepatik arter olmak üzere mezenterik arteriyel varyasyonların kesitsel ve üç boyutlu anatomisine hakim olması, cerrahların da olası vasküler varyasyonların varlığı konusunda bilgili olması gerekmektedir.

P - 017 ATİPİK MAYER-ROKİTANSKY-KÜSTER-HAUSER SENDROMU: OLGU SUNUMU FATMA ZEYNEP ARSLAN 1, VEFA ÖNER 1, MEHMET KARAGÜLLE 2, SÜLEYMAN ÖNCÜ 2, İSA DENİZ 1 1Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye 2Bağcılar Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İstanbul, Türkiye Özet Mayer-Rokitansky-Kuster-Hauser (MRKH) sendromu, uterus aplazisi ve vajen hipoplazisi ile seyreden nadir olarak görülen konjenital bir has- talıktır. 5000 canlı doğumda bir görülür ve hastalarda normal karyotip izlenir. Tipik formlu MRKH’de; uterus ve vajen üst 2/3 ü izlenmez iken overler normaldır. Atipik formunda ise ovarian, tubal ve genitüriner sistem anomalileri de izlenir. 18 yaşındaki kadın hasta primer amenore yakınması ile hastanemize başvurmuştur. Labaratuar tahlilleri ve fizik muayenenormal olarak izlenmiştir. Çekilen pelvik ultrasonografide; uterus ve vajen net olarak izlenemedi ve sağ böbreğin pelvik yerleşimli olduğu görüldü. Çekilen pelvik MRG tetkikinde; uterus ve vajen kafı süperior kesimi rüdimente görünümde idi. Vajen kafı düzeyinden sol inguinal kanala doğru uzanan 12 mm kalınlıkta yaklaşık 45 mm uzunlukta Müllerien kanal displazisi ile uyumlu tübüler yumuşak doku intensitesi izlenmekteydi. Ayrıca pelvik yerleşimli sol böbrek izlendi. Hastalarda en önemli klinik semptom primer amoneredir. Tanıda pelvik MRG en önemli radyolojik tetkiktir. MRG’de; uterus ve vajen üst 2/3 ü hipoplaziktir. Ayrıca bu hastalarda vertebral anomaliler, eşlik eden başka ürogenital anomaliler sıklıkla izlenmektedir. Sonuç olarak; MRKH nadir bir hastalıktır ve radyologların bu nadir görünümlere aşina olup eşlik eden olası ek anomalilere karşı dikkatli olmaları önemlidir. S30 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı P - 018 TAİLGUT KİSTİ: MRG BULGULARI MERAL ÇETİNKAYA, MEHMET ŞEKER, AFAK DURUR KARAKAYA Medipol Üniversitesi Radyoloji Bölümü, İstanbul, Türkiye Özet Amaç: Tailgut hintgutun kaudal parçası olup embriyonik hayatın 8. haftasında involüsyona uğrar. Tailgut kisti involüsyona uğramayan kalıntılardan köken alır. Nadir karşılaşılan tailgut kisti orta yaş grup kadınlarda daha sık izlenen benign gelişimsel lezyonlardır. Konstipasyon ve kronik pelvik ağrı gibi şikayetlere yol açabileceği gibi insidental olarak da bulunabilir. Burada tailgut kistinin MR bulgularını sunmayı amaçladık. Gereç ve Yöntemler: Konstipasyon ve kronik pelvik ağrı şikayeti ile gelen 27 yaşındaki bayan hastada kontrastlı alt batın MR görüntüleri elde edilmiştir. Bulgular: Alt batın MR’ de, retrorektal yerleşimli, T1A kesitlerde hipointens, T2A kesitlerde hiperintens, internal septumlarda içeren, posteriorda müsinöz içerik, yüksek protein ya da hemoraji içerik ile uyumlu milimetrik boyutlarda T1A kesitlerde hiperintens, T2A kesitlerde hipointens komponenti de bulunan kontrast madde tutulumu izlenmeyen iyi sınırlı, multiloküle, rektumu anteriora deplase eden kistik kitle izlendi. Sonuç: Tailgut kistleri, MR görüntülemede tipik olarak retrorektal yerleşimli, genellikle multiloküle, daha ender uniloküle T1A imajlarda hipointens, T2A imajlarda hiperinten izlenir. T2A imajlarda internal septa varlığı özgün bir bulgudur. Presakral kistik kitleler arasında epidermoid kist, dermoid kist, rektal duplikasyon kistleri ve anterior meningosel genellikle unilokuler, tailgut kistleri ve kistik lenfanjiomlar genellikle multikistik- lerdir. Fokal irregüler duvar kalınlaşması, polipoid kitle varlığında malign transformasyondan şüphelenilmelidir. Adenokarsinom, nöroendokrin karsinom ve sarkom gelişebilmesi riski nedeniyle, preoperatif rektum ve kemik yapılar ile ilişkisinin ortaya konmasında, yumuşak doku rezolüs- yonun iyi olması ve cerrahiye yardımcı olacak multiplanar görüntüleme kapasitesi nedeniyle tailgut kistlerinde seçilecek en uygun görüntüleme yöntemi MR olmuştur.

P - 019 FARKLI KLİNİK TABLOLAR OLUŞTURAN İNTRAPERİTONEAL KİST HİDATİK OLGUSU ÇİLEM KOLCA, MEHMET KARAGÜLLE, ESRA BİLGİ, CANDAN VARLIK, TUĞBA POLAT ADMIŞ Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye Özet Hidatik kist, ekinokokkus granülosusun yaptığı paraziter bir hastalık olup bir çok organ tutulumu bulunmaktadır. Ülkemizde endemik olarak görülen bir halk sağlığı sorunudur. Tutulan organlara göre farklı klinik tablolar oluşturmaktadır. Bizim olgumuzda 32 yaşında erkek hasta uzun zamandır karında şişkinlik, dispeptik şikayetler, sık idrara çıkma, sol yan ağrısı ve tenezm hissi gibi nonspesifik semptomlarla genel cerrahi polik- liniğine başvurdu. Fizik muayenesinde sağ üst kadran, epigastrik bölge ve batın alt kadranda ele gelen kitle ve hassasiyet tespit edildi. Bunun üzerine çekilen batın USG de ve sonrasında yapılan MR incelemede karaciğerde, subhepatik alanda, lesser sacta WHO evre 1 hidatik kistler ile karaciğer ve majör pelviste WHO evre 2a hidatik kistler izlendi. Majör pelviste yerleşen hidatik kistin mesane, sol üreter ve rektuma basısı görülmektedir. Kist hidatik en sık karaciğer ve akciğer olmak üzere tüm dokularda görülebilir. MRda genellikle evresine göre değişmekle beraber T1A hipointens T2A hiperintens kalın cidarlı periferik kontastlanan basit veya kompleks kistik lezyonlar şeklinde görülmektedir. Karaciğerde yer- leşenlerin ayırıcı tanısında basit karaciğer kisti ve kistik neoplaziler bulunmaktadır. İntraabdominal yerleşimli olanların ayırıcı tanısında pankreas psödokisti, pankreasın kistik neoplazileri, konjenital mezenterik kistler ve retroperitoneal mezenkimal tümörler düşünülmelidir. İntraabdominal büyük boyutlu kistik lezyonların ayırıcı tanısında kist hidatik hastalığı akılda tutulmalıdır.

P - 020 UTERİN MİYOM EMBOLİZASYONU UYGULANMIŞ OLGUDA TEDAVİ ETKİNLİĞİNİN MR VERİLERİ İLE DEĞERLENDİRİLMESİ MEHMET FATİH İNECİKLİ, MEHMET BEYAZAL, ARZU TURAN, MAKSUDE ESRA KADIOĞLU, FATMA BEYAZAL ÇELİKER Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, Türkiye Özet Amaç: Miyomlar, kadınlarda en sık izlenen benign tümörlerdir. Menoraji, pelvik ağrı, dismenore, fertilitede azalma, spontan abotrusta artış, üriner retansiyon ve konstipasyona neden olabilirler. Uterin arter embolizasyonu (UAE), miyom tedavisinde endovasküler olarak uygulanan bir Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S31 yöntemdir. UAE’da amaç, her iki uterin arterin selektif embolizasyonu ile hipervasküler miyom beslenmesini bozarak miyomda enfarkt oluş- turmak, endometrial ve myometrial kanlanmanın devamını sağlamaktır. Embolize olan miyomlar, zamanla küçülmekte ve semptomları büyük oranda kaybolmaktadır. Bu bildiriyi sunmamızdaki amaç, endovasküler miyom embolizasyonu uygulanmış olguda tedavi etkinliğini, işlem öncesi ve sonrası MR verileri ile ortaya koymaktır. Gereç ve Yöntemler: 42 yaşında bayan hasta. Dismenore, menometroraji ve pelvik ağrı şikayetleri ile başvurdu. Ultrasonografide uterus myo- metriumu içinde multiple myom saptandı. Yapılan pelvik MR tetkikinde 8 adet intrauterin miyom saptandı. Olguya Girişimsel Radyolojide miyom embolizasyonu uygulanmasına karar verildi. Sağ common femoral arter yoluyla her iki uterin artere mikrokateter ile ulaşıldı. 500-700 mikron şekilli PVA partikülleri ile embolizasyon uygulandı. 6 ay sonraki pelvik MR tetkikinde miyom sayı ve boyutlarında regresyon sağlandı. Miyomların vaskülarizasyonunda tama yakın azalma saptandı. Sonuç: UAE, miyoma uteri tedavisinde etkin bir yöntemdir. Jinekolojik problemlerin ve pelvik ağrının azalmasını sağlar. Tedavi etkinliği kontrastlı Pelvik MR tetkiki ile kolaylıkla değerlendirilir. UAE sonrası, özellikle T1A kontrastlı imajlarda miyom vaskülaritesini azalması, miyomlardaki yüksek T2A sinyal intensitesinin, UAE sonrası, işlem öncesine göre belirgin derecede azalması önemli bir bulgulardır. P - 021 ABONDAN VAJİNAL KANAMALARDA AKILDA TUTULMASI GEREKEN BİR PATOLOJİ: UTERİN AVM ÇİLEM KOLCA, MEHMET KARAGÜLLE, ESRA BİLGİ, AHMET TAN CİMİLLİ Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye Özet Uterin AVM nadir görülen sıklıkla 18-64 yaş grubunu etkileyen konjenital veya akkiz olabilen ve hayatı tehdit edebilen bir lezyondur. Akkiz uterin AVM sebeplerinden en sık görüleni geçirilmiş uterin cerrahidir. En yaygın semptom, aralıklarla olan menoraji veya menometroraji olup olgularn %30’unda kan transfüzyonu gerekmektedir. Adet düzensizliğİ nedeniyle hastanemize başvuran 49 yaşındaki iki sezaryen doğum öyküsü olan kadın hastada USGde uterus korpusunda insizyon hattı altında tortüyöz vasküler görünümde kitle lezyon izlendi. Tümör markerları negatif saptanan hastanın sonografide kitle lezyon olarak tariflenen alanın MRGde keskin sınırlı T2 heterojen hiperintens, T1 hipointens, periferinde hemorajik odakların izlendiği, kontrastlı hetreojen tutulumunun izlendiği ve diffüzyon kısıtlamayan lezyon olduğu görüldü. Solda parauterin vasküler yapılarda belirginleşmiştir ve sol ovarian ven dilatedir. Komşu yapılardaki dilatasyon ve yerleşim yerinin insizyon hattında olması Uterin AVM tanısını koydurmuştur. Tedaviye yanıtsız anormal uterin kanaması olan ve özgeçmişte cerrahi işlem varsa uterin arteriovenöz malformasyonlar akılda tutulmalıdır. Ultrasonografide anekoik, tortuöz görünümlü alan AVM’nin damar paketini temsil etmektedir. USG ile tanı konulamayan veya şüphede kalınan durumlarda noninvaziv ve radyasyon içermeyen bir tetkik MRI tanıda iyi bir yol göstericidir.

P - 022 MEME KANSERİ OLGUSUNDA HEPATOPORTAL SKLEROZ: MRG BULGULAR ELİF KARADELİ 1, GÜRCAN ERBAY 1, BURÇAK ÇAKIR PEKÖZ 2, FAZİLET KAYASELÇUK 1 1Başkent Üniversitesi Adana Hastanesi, Adana, Türkiye 2Adana Şehir Hastanesi, Adana, Türkiye Özet Amaç: Hepatoportal skleroz nadir bir hastalık olup nonsirotik portal hipertansiyonun nedeni olarak bilinmektedir. Etyolojisi henüz anlaşılama- makla birlikte, altta yatan protrombotik durumlar, antiviral tedaviler ve HIV suçlanmaktadır. Tanı karaciğer biyopsisi ile konur. Histopatolojik incelemede fibrozisin sadece portal traktlar çevresinde olması sirozdan ayrımını sağlar. Bu sunumda portal hipertansiyon bulgularının eşlik etmediği ve tanısı histopatolojik olarak desteklenmiş olan hepatoportal skleroz olgusunun MRG bulgularını sunmayı amaçladık. Gereç ve Yöntemler: Kırk yaşında kadın hasta meme kanseri nedeni ile üç yıldır hastanemizde takip edilmekte idi. Kontrol abdomen ultrasonografi incelemesinde karaciğerde fokal lezyon saptanmdı. Metastazı ekarte etmek amacıyla MRG ile tetkik edildi. Sağ lobda T2 ağırlıklı serilerde hiperintens, T1 ağırlıklı seride hipointens, intravenöz kontrast madde verilmesini takiben homojen kontrastlanma gösteren lezyon izlendi. Difüzyon MRG’de hafif derecede difüzyon kısıtlaması eşlik etmekteydi. Primer meme kanseri nedeni ile metastaz ekarte edilemedi ve lezyondan biyopsi alındı. Histopatolojisi hepatoportal skleroz ile uyumlu bulundu. Sonuç: Hepatoportal skleroz etiyolojisi bilinmeyen nadir bir hastalık olup nonsirotik portal hipertansiyonun nedeni olarak bilinmektedir. Literatürdeki hepatoportal skleroz olgularının çoğunda kaudat lob hipertrofisi, sağ hepatik lob atrofisi ve splenomegali izlenmiş olup genellikle karaciğer konturlarında nodülarite eşlik etmemektedir. Bu olguların çok azında karaciğerde T2 hiperintens ve kontrastlı serilerde homojen kontrastlanma gösteren fokal lezyonlar bildirilmiştir. Primer meme kanseri nedeni ile tedavi edilen olgumuzda karaciğerde izlenen fokal lezyonun özellikleri literatürde belirtilene uymaktaydı. Olgumuzda portal hipertansiyon bulguları eşlik etmemekteydi. Doxorubicin, endoxan, tamoxifen kullanım öyküsü olan olguda bu ilaçların özellikle de doxorubicinin karaciğerde hasar, skleroz yapabildiği bilinmektedir. Olgumuzdaki bulgunun da öncelikle kemoterapi ilaçlarının yan etkisi olduğunu düşündük. S32 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı P - 023 BAŞ BOYUN BÖLGESİ LENFOMALARINDA DİFÜZYON AĞIRLIKLI MR SEKANSLARININ TANIYA KATKISI MEHMET FATİH İNECİKLİ1, FATMA BEYAZAL ÇELİKER1, METİN ÇELİKER1, SİBEL GÖK İNECİKLİ2, ARZU TURAN1 1Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, Türkiye 2Rize İl Sağlık Müdürlüğü, Rize, Türkiye Özet Amaç: Baş-boyun kitlelerinde, özellikle erişkinlerde, neoplazik hastalıklar ön plandadır. Baş-boyun kitlelerinde malign-benign ayrımının yapıl- masında görüntüleme yöntemlerinin katkısı yüksektir. Çeşitli Manyetik Rezonans (MR) sekansları ile benign kitleler malign kitlelerden ayırt edilebilmektedir. MR görüntüleme yöntemlerinden biri olan difüzyon ağırlıklı görüntüleme (DAG), su moleküllerinin dokulardaki rastgele hare- ketlerini, mikroskopik difüzyonunu inceleyen fonksiyonel bir yöntemdir. İnsan vücudunda moleküllerin iletilen difüzyonunun ölçülen büyüklüğü ADC (Apparent Diffusion Coefficient – Görünüşteki Difüzyon Katsayısı) olarak bilinir. ADC değeri difüzyonel hareketin hızını ifade eder ve bir dizi difüzyon ağırlıklı MRG görüntüsünde sinyal intensitesi ölçülerek ve hesaplanarak elde edilir. ADC değerinin lezyonun sellüler yoğunluğuna, dokuların mikroyapılarına ve patofizyolojik durumlarına göre değişmesi beklenir. Malign lezyonlar düşük ADC değerleri gösterirken, benign lezyonlarda yüksek ADC değerleri izlenmektedir. Bildiriyi sunmamızdaki amaç, baş boyun bölgelerindeki kitlelerin benign malign ayrımında DAG ve ADC değerlerinin tanıya yaptığı katkıyı ortaya koymaktır. Gereç ve Yöntemler: Boyunda şişlik nedeni ile başvuran 21 yaşında bayan hasta. Boyun sağ level 2de 3x3 cm boyutunda sert fikse kitlesel lezyon mevcut. Boyun ultrasonografisinde korteksi kalınlaşmış, yağlı hilusu silinmiş lenf nodu olarak tarif edilmiş. Dış merkezde 2 kez ince iğne aspirasyon biyopsisi yapılmış ve süpüratif lenfadenit teşhisi konulmuş. Antibiyotik kullanmasına rağmen şişliği artan hastaya kontrastlı boyun MR tetkiki yapılmış. Sağ servikal zincirde seviye 2de 32x23 mm boyutunda periferal kontrastlanma ve difüzyon kısıtlanması gösteren lenfadenopati izlendi (süpüratif lap?) olarak raporlanmış. Tekrar yapılan ince iğne aspirasyon biyopsisinde Reaktif lenfoid hiperplazi olarak patoloji tarafından rapor edilmiş. Hastaya merkezimizde kontrastlı boyun MR ve difüzyon MR tetkiki yapıldı. DAG’lerde b: 0sn/mm2, b: 1000sn/mm2, b: 2000 sn/mm2 ve b: 3000 sn/mm2değerleri kullanıldı. Sağ zon 2A’da lobule konturlu, T1A’da hipointens, T2A’da hiperintens, intravenöz kontrast kullanımı sonrası periferal kontrastlanma gösteren, DAG’lerde b: 1000sn/mm2 imajlarda hiperintens izlenen lezyon, b: 2000 sn/mm2 ve b: 3000 sn/mm2 değerlerinde de hiperintens izlenmekteydi. ADC değerleri 0,433 x10-3 mm2/sn gibi çok düşük ölçüldü. Difüzyon kısıtlanması çok belirgindi. İlgili klinisyene, MR verilerine göre kitlenin yüksek olasılıkla lenfoma gibi malign neoplastik bir lezyon olduğu, multiple odak kesici iğne biyopsi ya da eksizyonel biyopsi yapılması gerektiği ifade edildi. Kitle total eksize edildi. Tanı “Yüksek dereceli atipik lenfoid proliferasyon, Burkitt Lenfoma” olarak geldi. Hastaya uygun tedavi yapıldı. Sonuç: Tümör dokusu gibi yüksek hücre yoğunluğuna sahip dokularda su moleküllerinin hareketi daha çok kısıtlanmıştır. Genellikle büyük nük- leuslu ve hipersellüler malign tümörlerde su moleküllerinin difüzyonu zorlaşır ve bu lezyonlar daha düşük ADC değerleri gösterir. Baş-boyun bölgesindeki malign lenfomaların ortalama ADC değerlerinin karsinomlara göre belirgin düşüktür. Boyun kitlelerinde ADC değerleri tanıda yardımcı olabilir. Baş-boyun lezyonlarının görüntülemesinde rutin protokollere difüzyon görüntülemenin eklenmesi, lezyonların değerlendiril- mesinde ve ayırıcı tanısında katkı sağlar.

P - 024 YÜZDE AV-MALFORMASYON HÜSEYİN ALPER KIZILOĞLU, HASAN OGÜN ÖZDEMİR, HAYRİ OĞUL Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Vasküler anomaliler konusunda günümüze kadar değişik açılardan sınıflamalar yapılmıştır. Bunlar arasında anatomopatolojik veya embir- yolojik sınıflamalar yapılmış. Anomalilerin mikroskop altında kanal yapıları incelenerek anatomopatolojik sınıflama yapılmıştır. Eskiden bütün vas- küler anomaliler hemanjiom olarak değerlendirip sınıflandırılırdı. Günümüzde; hemanjiom ve valküler malformasyon olarak genel sınıflandırma yapılmaktadır. Radyolojik olarak farkları hemanjiom lobüle yapıdadır genelde, vasküler malformasyonlar çeşitli anjiografik bulgular sergilemek- tedir. Vasküler malformasyonlar, embiryonik devrenin 4-10. haftalarında oluşan morfojenik proçesler sırasındaki hatalar sonucu oluşan yapısal anormalliklerdir. Bu anormallikler, nadir olup, genellikle nonfamilyaldir. Çoğunluğu doğum sırasında belirgin olmayıp, yıllar sonra ortaya çıkar. Arteriovenöz malformasyonlar yüksek akımlı vasküler malformasyonlar başlığı altında incelenir ve en sık bizim olgumuzda olduğu gibi baş-boyun bölgesinde izlendir. Biz de olgumuzda baş-boyun bölgesine yerleşimli demonstratif MRA görüntüsünü sunmayı amaçladık. Olgu Sunumu: 20 yaşında bayan hasta yüzde şişlik ön tanısıyla sonografik muayene sonrası vasküler malformasyon ön tanısıyla karotis-vertebral arter MRA çalışması yapılıyor. USG de tübüler anekoik yapılar ve renkli doppler incelemede yapıların vasküler komponente ait olduğu; ancak vasküler yapıların orjinleri saptanamıyor. Şekilde izlenen bukkal bölge üzerinde kontrastlanan vasküler yapılar sol a. carotis internadan perfüze olduğu ve drenajının v. jugularis eksternaya ait olduğu izleniyor. Sağ tarafta eksternal juguler vende kontrast izlenmezken solda erken venöz drenajı yansıtır kontrastlanma izlenmektedir. Tariflenen MRA bulguları yüzde AVM için yüksek spesifitededir. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S33

Sonuç: En sık görülen vasküler lezyonlar hemanjiomlardır. Tüm olgular göz önüne alındığında vakaların %32’si yüzeyel hemanjiom, %14’ü derin hemanjiom, %14’ü mikst hemanjiom idi. Hemanjiomlarda Kadın/Erkek oranı 2,33 iken, vasküler malformasyonlarda 1,22 idi. Vasküler anomali terimi, normal kutanöz vaskülarizasyonun dışında kalan anormal vasküler yapılanmalar için kullanılmaktadır. Bunlar konjenital yada akkiz olabilir. Geçmişte hemanjiom terimi tüm konjenital yada edinsel vasküler lezyonların tanımlanmasında kullanılmış, ancak bu yanlış alışkanlık tedavide de yanlışlıklara neden olmuştur. Vasküler malformasyonlar, vasküler morfogenezdeki hatalar sonucu oluşur. Hücresel hiperplazi yoktur. Damarlarda progresif ektazi gö rülür. Hemanjiom - vasküler malformasyon ve vasküler malformasyonları subtiplerine ayırmada radyoloji önemli yer tutmak- tadır, Preauriküler alan veya servikal bölge gibi yerlerde derin hemanjiomla lenfatik veya venöz malformasyonun ayrılması zor olabilir. Kontrastlı bilgisayarlı tomografi ile proliferatif fazdaki hemanjiom iyi sınırlı homojen dansiteler şeklinde görülürken involüsyon fazında yoğun dansite ve lobüler yapıda görülür. Venöz anomalilerde genellikle kalsifikasyonlar bulunur. Pür lenfatik anomaliler septalarla bölünmüş multiloküler kistler şeklinde görülür. İskelet deformiteleri hemanjiomlarda nadiren görülür. Kemik hipertrofisi ve distorsiyonlar lenfatik ve venöz malformasyonlar için daha tipiktir.

P - 025 BAŞ BOYUN DERİSİNDEKİ SKUAMÖZ HÜCRELİ KANSERİN PAROTİS BEZİNE DİREK İNVAZYONU MERİÇ TÜZÜN, BAKİ HEKİMOĞLU Sağlık Bilimleri Üniversitesi Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Türkiye Özet Baş boyun deri skuamöz hücreli kanserlerinin parotis bezine metastazı genellikle lenf nodları şeklinde olur. Parotis bezine direkt invazyonu ise çok nadir görülür. Bu olgu sunumunda, 64 yaşındaki bir erkek hastada, cilt ve cilt altı dokuyu tutan, komşuluğundaki parotis bezine infiltrasyon gösteren bir skuamöz hücreli kanser olgusu manyetik rezonans görüntüleme bulguları ile sunulmaktadır. Anahtar kelimeler: Skuamöz hücreli kanser, parotis bezi, deri, manyetik rezonans görüntüleme

P - 026 GLOMUS KAROTİKUM MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI: NADİR SPORADİK BİLATERAL GLOMUS KAROTİKUM OLGUSU MÜCAHİT DOĞRU, GİZEM ABACI, TUĞBA İLKEM KURTOĞLU ÖZÇAĞLAYAN, ÖMER ÖZÇAĞLAYAN Namık Kemal Üniversitesi, Tekirdağ, Türkiye Özet Giriş: Glomus karotikum karotid bifurkasyonunda yerleşim gösteren nöroektodermal hücrelerden kaynaklanan nadir bir baş boyun tümörüdür. Sporadik formda glomus karotikum tümörlerinde bilateral izlenme oranı düşüktür. Radyolojik tanısı sıklıkla ultrasonografi, kontrastlı boyun bilgisayarlı tomografi (BT) ve manyetik rezonans (MR) görüntüleme ile konulmaktadır. Olgu Sunumu: Olgumuzda 72 yaşında kadın hasta, üç senedir süren tek taraflı boyunda şişlik şikayeti ile tarafımıza sonografi tetkiki için başvur- du. Hastanın yapılan ultrasonografisinde her iki karotid bifurkasyonunda internal ve eksternal karotis arterlerinde ayrışmaya neden olan kitle lezyon görünümleri izlendi. Hastanın kontrastlı boyun MR incelemesinde karotid bifurkasyon düzeyinde sağda 35x25 mm ve solda 10x8 mmlik yoğun kontrastlanma gösteren radyolojik olarak glomus karotikum ile uyumlu kitle lezyon görünümleri izlendi. Hasta kulak burun boğaz kliniği tarafından opere edildi ve patolojik tanısı paraganglioma ile uyumlu olarak raporlandı. Sonuç: Sporadik formdaki glomus karotikum vakalarının %5’inden azında bilateral tümör izlenirken, ailesel formda bilateral tümör oranı yaklaşık %35 oranındadır. Sonuç olarak sporadik vakalarda nadir de olsa bilateral olabileceği akılda bulundurulmalıdır. Ayrıca literatürde bilateral vakalarda sonografi ve kontrastlı BT görüntüleri sık olmasına rağmen MR görüntüleme bulgularına daha az sıklıkta rastlanmaktadır. Bizim vakamızda literatür eşliğinde MR görüntüleme bulguları üzerinde durulmuştur.

P - 027 NADİR BİR OLGU: EKSTERNAL JUGULAR VEN İLE İLİŞKİLİ VENÖZ MALFORMASYON AYSUN ÇAKIR, YELİZ PEKÇEVİK, HİLAL ŞAHİN, ASLI IRMAK BİRANCI, TUĞÇE HANCIOĞLU Sağlık Bilimleri Üniversitesi, İzmir Tepecik Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İzmir Türkiye S34 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Amaç: Vasküler malformasyonlar yavaş akımlı ve hızlı akımlı malformasyonlar olarak 2 grupta toplanır. Yavaş akımlı vasküler malformasyonlar; kapiller, venöz, lenfatik, mikst tip iken hızlı akımlı malformasyonlar; arteriyovenöz fistül, arteriyovenöz malformasyondur. Venöz malformasyonlar en sık görülen vasküler malformasyonlardır ve %40 baş-boyun bölgesinde, %40 ekstremitelerde görülür. Bu lezyonlar genelde asemptomatik- ken, ağrı, şişlik, kozmetik problemlere sebep olabilir. Eksternal juguler ven (EJV) kaynaklı venöz malformasyon oldukça nadirdir. Bu bildiride EJV kaynaklı venöz malformasyon tanısı alan olgunun görüntüleme özellikleri tartışılmıştır. Bulgular: Boyun sağ yarısında lokalize şişlik sebebiyle başvuran 21 yaşındaki kadın hastaya yapılan doppler ultrasonografik incelemede boyun sağ seviye 5Bde cilt altında EJVe yakın komşuluk gösteren içinde vasküler akımın izlendiği komprese olabilen 16x10x18 mm boyutlarında kitlesel oluşum izlenmiştir. Yapılan kontrastlı boyun MRG tetkikinde aynı lokalizasyonda T2Ada belirgin hiperintens, postkontrastlı T1A görüntülerde belirgin kontrastlanan venöz malformasyonla uyumlu lezyon izlenmiştir. Lezyon EJVe bitişik olup EJV ile ilişkili venöz malformasyon lehine değer- lendirilmiştir. Sonuç: EJV ile ilişkili venöz malformasyonlar çok nadir olmakla birlikte EJVe bitişik komprese olabilen vasküler lezyon varlığında ayırıcı tanıda düşünülmelidir. P - 028 NADİR BİR OLGU SUNUMU: DERİN VEN OKLÜZYONUNA BAĞLI GELİŞEN TALAMİK ENFARKT MERAL BÜYÜKTERZİ, VEFA ÖNER, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, SERDAR ARSLAN Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Giriş: Serebral venöz tromboz daha sıklıkla transvers sinüs, sigmoid sinüs ve süperior sagittal sinüslerde görülmektedir. Derin venöz sistem trombozları çok daha nadir olarak saptanmakta ve prognozu daha kötü seyretmektedir. Bu nedenle derin venöz trombozunun erken tanısı ve tedavisi çok önemlidir. Bu olgu sunumunda derin venöz tromboz nedeni ile takip edilen bir hastanın manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık. Olgu: 15 yaşında erkek hasta akut gastroenterit ve buna bağlı gelişen dehidratasyon nedeni ile hastanemizin pediatri bölümüne başvurdu. Pediatri servisinde takip edilen hastada ani gelişen baş ağrısı nedeni ile hastaya beyin MRG ve MR venografi tetkikleri uygulandı. MR venografi tetkikinde inferior sagittal sinüs, gelen veni, straight sinüs, sol transvers ve sol sigmoid sinüste akut tromboz ile uyumlu sinyal kaybı izlendi. Difüzyon ağırlıklı MRG tetkinde sağ talamusta ve beyaz cevher içerisinde milimetrik çaplı akut enfarkt ile uyumlu diffüzyon kısıtlaması gösteren alanlar saptandı. Tartışma: Derin venöz trombozun etyolojisinde hiperkoagülasyon bozuklukları, oral kontraseptif kullanımı, gebelik, malignensi, dehidratasyon ve enfeksiyon gibi birçok faktör rol oynamaktadır. Derin venöz venler derin beyaz cevher, talamus ve bazal ganglionların drenajında rol oyna- maktadır. Bu nedenle derin venöz tromboz gelişen hastalarda bu alanlarda venöz enfarkt bulguları daha çok ortaya çıkar. MRG ve MR venografi bu hastaların erken tanısında en önemli görüntüleme yöntemleridir.

P - 029 NADİR BİR OLGU SUNUMU: HİPOTALAMİK HAMARTOM MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI SERDAR ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, MERAL BÜYÜKTERZİ, HASAN ERDOĞAN, MEHMET SEDAT DURMAZ, İSMET TOLU Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Giriş: Hipotalamik hamartomlar veya diğer adıyla tuber sinerum hamartomları ventral hipotalamusun nadir görülen konjenital malformas- yonlarıdır. Radyolojik olarak sesil veya pedinküllü olarak iki şekilde görülebilmektedir. Sesil olan tipleri mamiller bölge ile ilişkilidir ve forniks anterolaterale yer değiştirebilir. Pedinküllü olan tip ise tuber sinerum ile ilişkilidir ve suprasellar sisterne uzanım gösterir. Bu olgu sunumunda hipotalamik hamartom nedeni ile takip edilen bir hastanın manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık. Olgu: 10 yaşında kadın hasta hastanemizin pediatri bölümüne erken telarş ve pubik ve aksiller tüylenme şikayetleri ile başvurdu. Puberte prekoks ön tanısı ile hastaya uygulanan beyin ve hipofiz MRG tetkiklerinde infindubulum proksimalinde, sol lateral yerleşimli T1 ve T2 ağırlıklı serilerde serebral korteks ile izointens, düzgün konturlu, kontrast madde tutulumu göstermeyen hipotalamik hamartom ile uyumlu lezyon saptandı. Tartışma: Hipotalamik hamartomlar epilepsi, görme problemleri, puberte prekoks ve davranış bozuklukları gibi klinik problemlere yol açabi- lirler. Bu hastalarda puberte prekoks çok sıklıkla görülmekte olup Gonadotropin-releasing hormone (GnRH) hormonun aşırı salınımına bağlı Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S35 oluşur. Hipotalamik hamartomlar diğer hipotalamo-hipofizer bölge tümörleri ile karışabilmektedir. Radyolojik olarak T1 ve T2 ağırlıklı serilerde serebral korteks ile izonintens olması ve kontrast madde tutulumu göstermemesi diğer lezyonlardan ayırımında önemlidir. MR spektroskopide NAA/Cr oranında azalma ve mI pikinde artış saptanabilir.

P - 030 GLOMUS KAROTİKUM: MRG BULGULARI HASAN ERDOĞAN, FATMA ZEYNEP ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, SERDAR ARSLAN, İSMET TOLU Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Paraganglioma olarak da bilinen glomus tümörleri, nöral krest kaynaklı yavaş büyüyen, oldukça vasküler, nadir görülen tümörlerdir. Baş-boyun tümörlerinin %0,6sını oluşturan bu tümörlerden en sık görüleni glomus karotikumdur. Glomus karotikum, karotid bifurkasyoda yerleşim göste- rir. Bu tümörleri göstermede kontrastlı manyetik rezonans görüntüleme (MRG)nin duyarlılık ve özgüllüğü oldukça yüksektir. Bu sunumda glomus karotikum tümörü olan 81 yaşındaki kadın olgunun MRG bulguları sunulmuştur.

P - 031 SUPRASTERNAL YERLEŞİMLİ NADİR BİR KUTANÖZ BRONKOJENİK KİST OLGUSU SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, HASAN ERDOĞAN, ZEYNEP ARSLAN, MERAL BÜYÜKTERZİ Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Bronkojenik kistler embriyonik dönemde trakea divertikülünün anormal tomurcuklanmasıyla oluşan trakeobronşiyal sistemin gelişimsel bir malformasyonudur. Sıklıkla akciğer parankimi veya mediastende yerleşirler. Kütanöz veya subkütanöz bronkojenik kistler daha çok çocukluk döneminde görülen nadir bronkojenik kist tipidir. Kutanöz bronkojenik kistler için en sık yerleşim yerleri olarak suprasternal ve presternal bölgeler bilinmektedir. Genellikle asemptomatik eleve papüller şeklindedir. Biz de sol suprasternal yerleşimli nadir kutanöz bronkojenik kist vakasını sunmayı amaçladık. 8 yaşında boyun sol yarısında ağrısız şişlik ile gelen hastaya yapılan US incelemede tiroid bezi sol lob anteriorunda yerleşimli, retrosternal uzanımı bulunan, superiorda SCM kası ile yakın komşuluğu bulunan 2,5 cm çapında lobüle konturlu yoğun içerikli kistik lezyon izlendi. Çekilen boyun MRG incelemde sol sternoklavikular eklem superiorunda, tiroid sol lobu anteroinferior kesimi lateralinde, sup- raklavikular alana uzanımı izlenen juguler ven hemen anteriorunda, komşu kas yapıları posteriora yaylandıran, cilt altında yerleşimli kontrastlanma ve difüzyon kısıtlaması göstermeyen, 2x2,5 cm boyutunda kistik lezyon saptandı. Hastanın yaşı ve kistik lezyonun yerleşimi göz önünde bulundurulduğunda ayırıcı tanıda öncelikle 3 veya 4. brankial kist düşünüldü, ancak görüntüleme yöntemleri ile fistül traktı saptanamadı. Hastaya tanı ve tedavi amaçlı cerrahi işlem uygulandı. Kisint total eksizyonu sonrası hasta şifa ile taburcu edildi. Patolojik incelemesi bronkojenik kist ile uyumlu geldi. Hastaya ek bir tedavi önerilmedi. Bronkojenik kistler çoğunlukla mediastinal ve akciğer parankiminde yerleşim göstermekte olup kutanöz ve boyun bölgesinde nadir de olsa saptanabilmektedir. Yaş grubu ile birlikte değerlendirildiğinde boyun bölgesinde konjenital lezyonlar açısından başta brankial yarık kisti, timik kist, tiroid kisti, tiroglossal kanal kisti, epidermal inklüzyon kisti ve kistik higroma gibi diğer lezyonlar ayırıcı tanıda düşünülmelidir.

P - 032 DİSFAJİNİN NADİR BİR SEBEBİ OLARAK DİFFUSE IDİOPATHİC SKELETAL HYPEROSTEOSİS; OLGU SUNUMU MEHMET SEDAT DURMAZ, SEDA SOĞUKPINAR KARAAĞAÇ, ZEYNEP ARSLAN, HASAN ERDOĞAN, SERDAR ARSLAN, İSMET TOLU Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Birimi, Konya, Türkiye

Özet Diffüz idiopatik iskelet hiperostozu (DISH) ligamanlar ve entezis gibi yumuşak dokuların kalsifikasyonu ve ossifikasyonu ile karakterize bir hastalıktır. 50 yaş üstü ve erkeklerde daha sık görülen, etyolojisi bilinmeyen, özellikle torakal vertebralarda intervertebral disk yüksekliğinin S36 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı korunarak vertebraların anterior ve sağ lateral kesimlerindeki kaba ve ardışık tarzdaki ossifikasyonları ile karakterize bir hastalıktır. DISH’te en sık karşılaşılan semptomlar omurgada ağrı ve sertlik, hareket kısıtlılığı ve nadiren özofagus kompresyonuna bağlı yutma zorluğudur. Bu sunumda yutma zorluğuna neden olan DISH’in servikal MRG bulgularını sunmayı amaçladık. Boyun ağrısı ve yutma zorluğu semptomları gelen 61 yaşındaki erkek hastaya direkt iki yönlü servikal grafi ve servikal MRG çekildi. Hastanın bilinen romatolojik hastalığı ve travma öyküsü yoktu. Boyun hareketlerinde kısıtlılık mevcuttu. Çekilen iki yönlü servikal direkt grafide servikal eklem aralıklarında daralma, eklem yüzlerinde subkondral skleroz anteriorda daha belirgin olmak üzere eklem köşelerinde dejeneratif osteofitik sivrileşmeler mevcuttu. MRG incelemede servikal vertebraların korpus anterior köşelerinde izlenen osteofitlerde köprüleşme, ardışık ligamen- töz kalsifikasyonlar mevcut olup özefagusa belirgin bası izlendi. Sonuç olarak, DISH’te alt torasik vertebra tutulumu tipiktir ancak servikal tutulum da olabilir. Tutukluk, hareket kısıtlılığı, ağrısı, gibi semptomların yanı sıra servikal tutulum olan olgular yutma güçlüğü şikayeti ile de başvurabilir. Yutma zorluğu ile gelen olgularda ayırıcı tanılar arasında düşünülmelidir. Tanıda iki yönlü vertebra grafisi genellikle yeterlidir ancak MRG ile vertebra anterior komşuluklukları- na uzanım, bası daha net bir şekilde değerlendirilebilir. Bu hastalarda direkt graﬁ sonrasında ilk tercih edilmesi gereken görüntüleme yöntemi MRG olmalıdır.

P - 033 BİLATERAL, DERİN VE YÜZEYEL SERVİKAL BÖLGE YERLEŞİMLİ MULTİPLE HEMANJİOMLAR OKAN DİLEK, SEVGİ MUTLU, KERİM ÇALAR Sağlık Bilimleri Üniversitesi, Gaziantep Dr. Ersin Aslan Eğitim ve Araştirma Hastanesi, Gaziantep, Türkiye

Özet Yumuşak doku hemanjiyomları benign histolojik kökenli yaygın neoplazmlardır. Anjiyomatöz lezyonların en sık görülenleridir ve genel popülas- yondaki tüm yumuşak yumuşak doku tümörlerinin% 7sine kadarını temsil ederler. Kadınlar erkeklerden daha sık etkilenir. Yerleşim yerlerine göre yüzde 50-60 ı baş boyun, yüzde 25’ i gövde ve yüzde 15 i ekstremite yerleşimlidir.Bizim olgumuzda 29 yaşında kadın hastada yüzeyel ve derin servikal yerleşimli, bilateral, multiple hemanjiomlar izlendi. Nadir görülen bu vaka literatür bilgiler eşliğinde tartışılacaktır.

P - 034 SİNONASAL NÖROENDOKRİN KARSİNOM OLGUSUNDA MRG, DİFÜZYON MRG VE BT BULGULARI MERT BAYRAMOĞLU1, TÜLİN YILDIRIM1, FULDEM YILDIRIM DÖNMEZ1, FERİDE KURAL1, IŞILAY ÖZ2, SELİM SERMED ERBEK2 1Başkent Üniversitesi Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye 2Başkent Üniversitesi Hastanesi, Kulak Burun Boğaz Anabilim Dalı, Ankara, Türkiye Özet Sinonazal trakt kaynaklı nöroendokrin tümörler nadir görülen tümörlerdir. Tüm sinonazal malign tümörlerin %5’ini oluştururlar. Lokal agresif ve rekürren seyir gösterirler. Kötü prognozlu bu tümörlerin tedavisinde cerrahi tedavi sonrası kemoterapi ve radyoterapi uygulanır. Bu sunumda etmoid sinüsden kaynaklanan; paranazal sinüslere, orbitaya ve anterior kranial fossaya uzanım gösteren sinonazal nöroendokrin tümörün MRG, difüzyon MRG ve BT bulguları tartışılmıştır.

P - 036 NADİR BİR OLGU, AKCİĞER PARANKİMAL CASTLEMAN HASTALIĞI FATMA DURMAZ 1, MESUT ÖZGÖKÇE 1, HARUN ARSLAN 1, ADEM YOKUŞ 2, İBRAHİM AKBUDAK 3, ALİ MAHİR GÜNDÜZ 1 1Van Yüzüncüyıl Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Van, Türkiye 2Sağlık Bakanlığı Üniversitesi,Van Eğitim ve Araştırma Hastanesi, Van, Türkiye 3Batman Bölge Devlet Hastanesi, Batman, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S37

Özet Amaç: Castleman hastalığı (CH), anjiyofolliküler lenf nodu hiperplazisi ya da dev lenf nodu hiperplazisi olarak da bilinen nadir görülen etiyolojisi bilinmeyen bir lenf nodu hastalığıdır. Hastalığın hiyalin vasküler, plazma hücreli ve mikst olmak üzere üç histolojik tipi vardır.En sık mediastende yerleşir.Ekstranodal tutulum nadirdir. Bu çalışmamızda nadir yerleşim yeri olarak akciğeri tutan Castleman Hastalığı olan bir olgunun BT ve MRG bulgularını sunmayı amaçladık. Gereç ve Yöntemler: 20 yaşında bayan hasta, öksürük şikayeti nedeniyle çekilen PA akciğer grafisinde sağ parahiler opasite saptandı. Kliniğimizde yapılan kontrastlı Torax BT ve MR incelemesinde sağ akciğer alt lob anteriorda parahiler alanda düzgün sınırlı, MR’da T1 ve T2’de kasa göre izo-hiperintens, IVKM sonrası yoğun homojen kontrastlanan kitle lezyon izlendi. Mediastinal LAP yada ek bulgu saptanmadı.Eksizyonel biyopsi sonucu hyalin-vasküler tip CH olarak raporlandı. Tartışma: CH nadir görülen etyolojojisi bilinmeyen lenfoproliferatif bir hastalıktır.Non-neoplastik lenfadenopatinin sık nedenlerinden biridir. Çoğunlukla insidental olarak saptanır.Tipik olarak mediastinal lenf nodlarını etkilemekle beraber intraabdominal,pelvik,aksiller, boyun lenf nodları da tutulabilir.Ekstranodal olarak akciğer,larinks,parotis,pankreas,meninksler ve kaslarda görülebilir ve olguların sadece %5’ini oluşturur. Morfolojik olarak lokalize ve multisentrik, histolojik olarak hyalin-vasküler, plazma hücreli ve miks tip olarak sınıflandırılır.En sık görülen (%90) lokalize hyalin vasküler tiptir.Multisentrik olguların çoğu HIV ve HHV-8 ilişkili olup kaposi sarkomu ve lenfoma gelişimi açısından yüksek risk taşırlar. Görüntülemede kontrast sonrası hyalin vasküler tipte vasküler yapı yoğunluğu nedeniyle yoğun kontrastlanma izlenir. Sonuç: Castleman hastalığı tuttuğu bölgeye göre birçok hastalığı taklit edebilir.Bizim olgumuzda olduğu gibi akciğeri tutmuşsa adenokanser ile karışabilir.Akciğerde solid lezyonların ayırıcı tanısında düzgün sınırlı, özellikle de belirgin kontrast tutan kitlelerde castleman hastalığı akılda tutulmalıdır.

P - 037 İNTRAAKSİYEL VEYA EKSTRAAKSİYEL LEZYONLARIN ORJİNİNİN BELİRLENMESİNDE MR TRAKTOGRAFİ GÖKHAN POLAT, HAYRİ OĞUL, RECEP SADE, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Amaç: Biz çalışmamızda intrakranial kitlelerin intraaksiyel veya ekstraaksiyel yerleşiminin belirlenmesinde MR traktografi etkinliğini değerlen- dirmeyi amaçladık. Gereç ve Yöntemler: Hastanemizde haziran 2014- mart 2015 tarihleri arasında intrakranial kitle tanısıyla opere edilecek hastalar seçilmiştir. Hastaların lezyonlarının intraaksiyel veya ekstraaksiyel orjin açısından şüpheli bulunan ve konvansiyonel MR yöntemleri ile net ayrımı yapılamayan hastalar çalışmaya dahil edilmiştir. Hastalara operasyon öncesi 3 Tesla MR (Siemens Magnetom Skyra Erlangen/Germany) cihazı ile MR traktografi çekimi yapılmıştır. MR traktografi tetkikleri 2 radyolog tarafından değerlendirilmiştir. Bulgular: MR Traktografi beyin parankiminde seyir gösteren yolakların gösterilmesinde kullanılan bir yöntemdir.Çalışmamızda intraaksiyel yerle- şimli lezyonların içine doğru bu yolakların devam ettiği görülürken ekstraaksiyel yerleşimli lezyonların bu yolakları ittiği izlenmiştir. Sonuç: İntraaksiyel ve ekstraaksiyel lezyonların yerleşim yerinin belirlenmesinde MR Traktografi özellikle şüpheli lezyonlarda operasyon öncesi faydalıdır. Kitle ayırıcı tanıları ve operasyon planlaması için oldukça faydalıdır.

P - 038 PRİMER SANTRAL SİNİR SİSTEMİ LENFOMASI GÖKHAN POLAT, HAYRİ OĞUL, RECEP SADE Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Primer santral sinir sistemi lenfoması ekstrakraniyal bir hastalık olmaksızın nöral parankimde lenfoma gelişmesi demektir ve tanı konması daha zordur. Primer SSS lenfomaları daha çok immün sistemin bozuk olduğu durumlarda gelişirken sporadik olarak da görülebilir. Primer SSS lenfoması nonglial primer beyin tümörleri içinde ‘’hemopoietik’’ tümörler grubunda yer alan nadir bir tümördür. Tüm SSS tümörlerinin yaklaşık %1’ini oluşturur .Bu tümörler B lenfosit kökenli Non-Hodgkin lenfoma grubunda yer alır. Olgu: 67 yaşında erkek hastanın departmanımızda yapılan beyin MRG ve BT tetkikinde her iki hemisfere uzanan yer kaplayıcı kitle lezyon izlenmektedir.Hastaya çekilen PET CT de primer SSS lenfoma tanısının doğrulanması için başka odak izlenmediği görüldü. Tartışma: Primer SSS lenfoması nadir görülen beyin tümörleridir. Hastaların yarısında fokal nörolojik defisitler ortaya çıkmaktadır. Primer SSS lenfomasında beyin en çok tutulan yerdir.Bazende göz, meninksler ve omurilik tutulabilir. Beyinde multipl tutulum sıktır fakat immün sistemin durumuna göre tek lezyonda izlenebilir. Primer SSS lenfomasında kontrastlı kraniyal MR inceleme tanıda en önemli tetkiktir.Beyinde en çok S38 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı bazal ganglionlar, periventriküler bölge ve korpus kallozum tutulması tipiktir.MRS kolin/kreatinin ve kolin/NAA oranında belirgin artış izlenir. Kranial BT de de hiperdens kitlenin görülmesi tanıyı destekler. MRG ve BT bulguları ile nadirde olsa primer SSS lenfoması beyin kitlelerinde ayırıcı tanıda düşünülmelidir.

P - 039 SİSTEMİK LUPUS ERİTAMATOZUS ABDOMİNAL DUVAR TUTULUMU FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Sistemik lupus eritomatozis etiyolojisi bilinmeyen multipl organ ve sistem tutulumu yapabilen kronik otoimmün bir hastalıktır. Kadınlarda erkeklere oranla 8-10 kat daha sık görülmektedir. Malar raş, diskoid döküntü, fotosensitivite, alopesi, polartrit, sitopeni, proteinüri gibi bulgular hastalığın klasik bulguları arasındadır. Olgu: 21 yaşında kadın hasta karın ağrısı şikayeti ile romatoloji kliniğine başvurdu. Sistemiklupuseritamatozus tanısı ile takipli olan hastanın MR incelemesinde abdominal duvarda ödematoz sinyal değişiklikleri izlendi. Tartışma: SLE intestinal, üriner, kardiyovasküler, respiratuar, hematolojik sistem gibi farklı sistemleri tutabilir. Trombositopeni, anemi, artrit gibi bulguların yanında peritonit gibi serözit tablosu ile kendini gösterebilir. MR inceleme de özellikle T2 gibi sıvı duyarlı sekanslarda sinyal artışları serözit gibi inflamatuar hadiseleri saptamada duyarlıdır. Bizim vakamızda da daha az sıklıkla görülen abdominal ön duvar tutulumu MR incelemede izlenmektedir.

P - 040 MULTİPL ORGAN TUTULUMU GÖSTEREN OD POLİKİSTİK BÖBREK HASTALIĞI FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Polikistik böbrek hastalığı son evre böbrek yetmezliğine ilerleyen sık görülen herediter bir hastalıktır.Hastalık sadece böbrekleri etkileme- mekte ve bir çok organda veya vücudun herhangi yerinde multipl kistlere neden olabilmektedir. Polikistik böbrek hastalığı otozomal dominant veya resesif polikistik böbrek hastalığı, multikistik displastik böbrek ya da sistemik bir hastalığın parçası olarak farklı tablolar ile ilişkili olabilmektedir. Polikistik böbrek hastalığı yüksek kan basıncı, sırt ağrısı, hematüri gibi klinik tablolarla sıklıkla ilişkili olabileceği gibi uzun süre boyunca asemptomatik de seyredebilir. Olgu: 68 yaşında bilinen kronik böbrek hastalığı nedeni takip edilen hasta karın ağrısı yüksek ateş gibi şikayetlerle hastanemize başvuruyor. Hastanın elde olunan MR incelemelerinde batında yaygın kistlerin olduğu izlenmektedir. Tartışma: Polikistik böbrek hastalığı kadın ve erkekte eşit sıklıkta görülen ve milyonlarca kişiyi etkileyen bir hastalıktır. Hastalar ortalama 55 yaşında son dönem böbrek hastalığına ilerlemektedir. Erken yaşta ortaya çıkan hipertansiyon, hematüri veya proteinüri gelişimi, böbreklerde genişleme ve erkek cinsiyet gibi etkenler hastalığın son dönem böbrek hastalığına ilerlemesi açısından predispozan nedenlerdir. Vakamızda elde olunan MR görüntülerinde batın içinde yaygın farklı sayı ve ebatlarda kistler oldukça demonstratif şekilde izlenmektedir.

P - 041 OLDUKÇA NADİR BİR VAKA: İNVERTED İNTERKOSTAL HERNİ FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Giriş: İnterkostal herniler oldukça nadir görülen hernilerdir. Etiyolojisinde büyük oranda travma ve geçirilmiş torakal cerrahiler bulunmaktadır. İnverted interkostal herni genellikle dispne, göğüs ağrısı gibi nonspesifik bulgulara neden olmakla birlikte asemptomatik de seyredebilir. Olgu: 81 yaşında erkek hasta nefes darlığı ve şuur bozukluğu şikayeti ile başvuruyor. Kliniğimizde çekilen toraks BT incelemelerinde toraks sağ lateral duvardan cilt altı dokuların intratorasik alana herniasyonu izlendi. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S39

Tartışma: İnterkostal herniler konjenital veya edinsel (postoperatif-travmatik) gelişebilir. Genellikle postoperatif dönemde torakal duvarın tam kapanmaması sonucu gelişir.Büyük oranda akciğerin interkostal aralıktan toraks dışına herniasyonu görülmektedir. Yumuşak dokuların interkostal aralıktan intratortasik alana herniasyonu ise oldukça nadir görülmektedir. Radyolojik olarak BT ve MR da yumuşak dokuların interkostal aralıktan herniasyonu izlenmektedir.

P - 042 KC TRANSPLANTASYONU SONRASI BİLİER STRİKTÜR VE SAFRA KAÇAĞI MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, GÖKHAN POLAT, ALPER KIZILOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi, Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: KC nakli sonrası bilier komplikasyonlar %6-38 sıklığında bildirilmektedir.Bu olgularda en sık bilier stenoz veya kaçaklar gelişmekte olup bu durum canlıdan yapılan nakil olgularında daha sıktır. Biliyer anastomozlar iskemik hasara çok duyarlıdır. Major safra kanallarına kan desteği hepatik arterin dalları ile sağlandığından hepatik arter trombozu olan bir çok hastada biliyer anastomozun açılması veya iskemik darlıklar nedeniyle biliyer kaçak gelişmektedir. Striktürlerin %20 den fazlasında darlığın hepatik arter trombozu ile ilişkili olduğu, hepatik arter trombozu olan hastaların darlıklar ve retransplantasyon için yüksek risk grubunda olduğu bildirilmiştir. Çoğu biliyer komplikasyonlar; ateş, kolanjit, karın ağrısı gibi enfeksiyöz semptomlarla klinik verirler ve çoğu durumlarda problemi tanımlamak açısından abdominal USG ve diğer noninvaziv görüntü- leme yöntemleri gereklidir. Olgu: 47 yaşında KC transplantlı erkek hasta ateş ve sağ üst kadran ağrısı ile acil servise başvurdu. Hastaya departmanımızda MRCP planlandı MRCP de anastomoz hattında obstrüksiyon görüldü. Obstruksiyona rağmen intrahepatik safra yollarının belirgin dilate olmaması safra kaçağı şüphesini akıllara getirdi Geç faz abdominal MR görüntülemede hepatosit spesifik kontrast ajan ile safra kaçağı gösterildi. Tartışma: Noninvaziv görüntüleme yöntemleri (USG, BT, MR ve MRCP) safra yollarında dilatasyon ve intraabdominal mayi koleksiyonu hakkın- da bilgi verir. İntraabominal gaz varlığında veya abdominal ağrı nedeniyle USG’nin sınırlandığı hastalarda abdominal CT veya MR biliyer sistem problemleri hakkında daha fazla bilgi sağlayacaktır. Posttransplant biliyer anatominin MR kolanjiografi ve perkütan transhepatik kolanjiografi ile değerlendirilmesi uygundur. Nakil sonrası geç fazda viral enfeksiyon veya akut selüler rejeksiyonla açıklanamayan biyokimyasal anomalisi olan asemptomatik hastalarda; MRCP nakil sonrası geç biliyer komplikasyonları safra yollarını mükemmel şekilde değerlendirmek suretiyle meydana çıkarır. Noninvaziv yaklaşım bu hastalarda kanama, akut pankreatit ve asendan kolanjit riskini azaltır.

P - 043 KC TRANSPLANTASYONLU HASTADA ALVEOLAR EKİNOKOKUN SEREBRAL METASTAZININ İLERİ NÖROGÖRÜNTÜLEMESİ MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Echinococcus multilocularis tenyanın larva aşamasından kaynaklanır. Echinococcus multilocularis ve E. granulosus, Türkiyede endemiktir. İnsanlar, ara konakçı olarak hizmet ederler. Yetişkin tenya normalde tilki, çakal ve köpeklerde bulunur Hastalık parazit yumurtalarının ağız yoluyla alınmasıyla elde edilir. Karaciğer hastalığın birincil odak noktasıdır ve serebral lokalizasyon nadirdir (yaklaşık %1) ve genelde ölümcül seyreder. Ekinokokkoz tanısı, görüntüleme teknikleriyle belirlenen lezyon morfolojisine, immünodiagnostik ve diğer laboratuvar testleri ile klinik bulgulara dayanmaktadır. Serebral parazitozlar radyolojik olarak spesifik lezyonlar olarak görülüyor. Olgu: 1 yıl önce alveolar KC kisti nedeniyle transplant olan 30 yaşında erkek hasta baş ağrısı, ateş ve halsizlik şikayeti ile hastanemize tekrar başvuruyor. Departmanımızda hastaya yapılan ileri nörogörüntüleme yöntemleri sonucunda alveolar kist metastazıyla uyumlu görünümler saptanmıştır. Tartışma: Serebral lezyonlar soliter ve multifokal olabilir. Genel olarak supratentorial ve orta serebral arter sulama sahasına dağılır. Kranial BT ve MR da solid, semisolid ve multilokuler kist şeklinde görülebilirler. Kalsifikasyon ve perifokal ödem yaygındır. Lezyonların ring-like, heterojen, nodüler ve karnıbahar benzeri kontrastlanma paternleri bildirilmiştir. Kontrastlanma paterni alveolar ekinokoku serebral malignitelerden ve tüberküloz, bakteriyel apseler, mantar enfeksiyonu, toksoplazmoz, sistiserkoz ve kistik ekinokokkoz gibi diğer enfektif serebral hastalıklardan ayırt etmek açısından önemlidir. S40 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı P - 044 TORSİYONE MYOMA UTERİ EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Myomlar, düz kastan köken alan kadın genital sistemin en sık rastlanan tümörleridir. Nadiren pedinküllü myomlarda görülen önemli komplikasyonlardan biri torsiyon gelişimidir. Biz 46 yaşında bayan hastada nadir görülen bir torsiyone myom vakasını prezente etmeyi amaçladık Olgu: 46 yaşında bayan hasta acil servise ani başlayan şiddetli karın ağrısı ile başvurdu. Hastanın BT görüntülerinde pelvik bölgede multiple hipoekoik myoma uturi ve uterus korpusundan bir sap ile ayrılan umblikus superioruna kadar uzanan heterojen hipodens kitle lezyon izlendi. Kitle çevresinde ve pelvik bölgede kirlenme ve mayi mevcuttu. Hastanın eski MR ve BT görüntüleri ile komfirme edildiğinde uterus korpus anteriorundan kaynaklanan MR görüntülerinde T2 AG heterojen, myometriuma yakın intensitede, BT görüntülerinde heterojen hipodens myom ile uyumlu olabilecek lezyonun güncel incelemede boyut artışı gösterip umblikus superioruna yer değiştirdiği tespit edildi. Görünüm torsiyone myom olarak değerlendirildi. Ameliyata alınan hastanın histopatolojisi lezyonu myom olarak doğruladı. Tartışma: Uterin leiomyomlar, düz kastan köken alan kadın genital sistemin en sık rastlanan tümörleridir. Sıklığı reproduktif dönemde artar, menapozdan sonra ise azalır. Lokalizasyonlarına göre submukozal, intramural ve subseröz olarak sınflandırılırlar. Myomlarda, kan akımındaki değişiklikler, hızlı büyüme, mekanik olaylar ve postmenopozal atrofi sonucu çeşitli dejeneratif değişiklikler ortaya çıkabilir. Çoğunlukla asempto- matiktirler. En sık görülen semptom anormal uterin kanamadır. Kronik pelvik ağrı, dismenore ve disparoni gibi semptomlara sebep olabilecekleri gibi mesane, rektum ve üreter basısına bağlı olarak pollaküri, konstipasyon, tenesmus, hidroüreter ve hidronefroz gelişebilir. Bazen abdominal kaviteyi tamamen doldurarak dev boyutlara ulaşabilirler. Özellikle pedinküllü myomlarda oldukça nadir görülen önemli komplikasyonlardan biri de torsiyon gelişimidir. Ayırıcı tanıda adenomyozis, hematometra, uterin sarkomlar ve overyan kitleler düşünülmelidir.

P - 045 HEPATOSPLENİK CANDİDİAZİS EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Hepatosplenik Candidiazis oldukça nadir karşılaşılan özellikle immunsuprese hastalarda görülen kandida etkeninin dissemine tutulumudur. Bu olgu sunumu ile amacımız, nadir görülen bu vakayı MR görüntüleriyle tanıtmaktır. Olgu: KT almakta olan B cell ALL tanılı 24 yaşında erkek hasta bir haftadır devam eden bulantı kusma, subfebril ateş şikayetleriyle dahiliye klini- ğine başvurdu.Labaratuvarında nötropeni ve sedim, CRP yüksekliği mevcuttu. Hastanın USG ve kontrastsız alınan BT görüntülerinde anlamlı bir bulgu saptanmadı. Hastanın ileri inceleme amaçlı alınan MR görüntülerinde karaciğer ve dalakta T2 AGlerde demir birikimine sekonder diffüz intensite azalması ve milimetrik ebatlı multiple sayıda T2 AG serilerde hafif hiperintens, diffüzyon kısıtlılığı gösteren anlamlı kontrast tutmayan nodüler lezyon alanları izlendi. Görünümler Hepatosplenik Candidiazis olarak düşünülmüştür. Tartışma: İmmunsuprese hastalarda fungal infeksiyonların en sık patojeni Candidadır. Candida’nın hematojen yayılımı sırasında en sık etkilenen organlar, böbrekler, beyin, kalp, akciğerler, karaciğer, dalak, deri, gözler, kaslar, kemik ve eklemlerdir. Etkilenen organda multipl küçük mikro veya makro apseler gelişir. Bununla birlikte bu apseler ölmeden önce nadiren ultrasonografi ile belirlenebilecek büyüklüğe ulaşırlar; ancak karaciğer, dalak ve böbreklerde abdominal kontrastlı BT yada MRG ile belirlenebilir. Sağ üst kadranda ağrı, duyarlılık, transaminazlarda hafif, alkalen fosfa- tazda daha belirgin yükselme eşlik edebilen diğer bulgulardır. CRP belirgin yüksektir.

P - 046 WARTHİN TÜMÖRÜ EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Warthin tümörü en sık parotiste görülen benign tükürük bezi tümörlerindendir. Tüm tükürük bezi tümörlerinin yaklaşık % 6- 10’unu oluşturur. Biz 58 yaşında erkek hastada nadir görülen bu lezyonu prezente etmeyi amaçladık. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S41

Olgu: 58 yaşında erkek hasta Kulak Burun Boğaz kliniğine sağ parotis lojunda şişlikle başvurdu. Hastanın US görüntülerinde sağ parotis bezinde yaklaşık olarak 28x34 mm ebatlı içerisinde kistik komponenti izlenen RDUS de internal renk kodlanması alınan heterojen hipoekoik lezyon izlendi. Hastanın MR’ında ise sağ parotis bezi içerisinde yaklaşık 45x37 mm ebatlarında,T1 AG lerde heterojen hipo-hiperintens,T2 AG lerde heterojen intensitede izlenen, difüzyon kısıtlılığı oluşturan, postkontrast kesitlerde kontrast tutulumu gösteren, ortasında nekrotik-hemorajik komponenti olan lezyon alanı izlendi. Görünüm tarafımızca Warthin tümörü olarak düşünüldü ve opere edilen hastanın histopatolojisi de bu yönde geldi. Tartışma: Warthin tümörü tükürük bezlerinde pleomorfik adenomdan sonra ikinci en sık karşılaşılan neoplazidir. Tüm tükürük bezi tümörlerinin yaklaşık % 6- 10’unu oluşturur. Daha çok parotis bezinden kaynaklanan bu benign tümör, genellikle parotis kuyruğunda yerleşir, kistik ve solid komponentler içeren, düzgün sınırlı kapsülle çevrili bir lezyon olarak karşımıza çıkar. Hastaların %12-20’sinde çok odaklı ve %5-14’ünde bilateral görülebilir. Sıklıkla 4.dekattan sonra karşılaşılır ve daha çok erkeklerde (10/1) görülür. Parotis bezi dışında görülme olasılığı çok düşüktür; nadiren submandibüler bezde, servikal lenf nodlarında ya da minör tükürük bezlerinde rastlanabilir.

P - 047 PARAVERTEBRAL GANGLİONÖROMA EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Ganglionöroma nadir görülen, benign nöronal bir tümördür. Çoğunlukla asemptomatiktir ve insidental olarak tanı konur. Feokromasitoma, nöroblastoma, lenfadenopati gibi benign yada malign durumlarla karışabilir. Biz 55 yaşında bayan hastada nadir görülen bu lezyonu prezente etmeyi amaçladık. Olgu: 55 yaşında bayan hasta karın ağrısı ile genel cerrahi polikliniğine başvurmuştur. Hastadan USG istenmiştir ve USG de paravertebral alanda konglomere yumuşak doku ekojeniteleri lenfadenopati olarak yorumlanmıştır. İleri inceleme amaçlı hastadan BT ve kontraslı MR istenmiştir. BT sinde paravertebral alanlarda solda daha belirgin multiple sayıda konglomere yumuşak doku dansitesinde lezyonlar mevcuttur. MR görüntüle- rinde ise paravertebral alanlarda büyüğü yaklaşık 49x27 mm ebatlı, birkaç adet, yer yer konglomere özellik gösteren, difüzyon ağırlıklı görüntü- lerde difüzyon artışı gösteren,T2 AG lerde heterojen hiperintens,T1 AG lerde heterojen hipointens, poskontrast kesitlerde minimal heterojen kontrast tutulumu izlenen lezyon alanları mevcuttur. Kesitsel incelemelerin ardından söz konusu lezyonlar için ganglionöroma ayırıcı tanıda ise lenfadenopati düşünülmüştür.Hastanın histopatolojisi ganglionöroma olarak gelmiştir. Tartışma: Ganglionöroma nadir görülen, nöroblastomun matürasyonu şeklinde veya “de novo” gelişebilen benign nöronal bir tümördür. Mediasten ve retroperiton en sık yerleşim yeri olup, sıklıkla 3-20 yaş aralığında görülür. Bu kitleler sıklıkla asemptomatik ve hormonal olarak sesiz seyreden kitlelerdir. Nadiren salgıladığı vazoaktif polipeptide bağlı olarak diyare, hipotansiyon, hipokalemi veya maskulinizasyon görülebilir. Sıklıkla asemptomatik kitleler olduğundan büyük boyutlara ulaşmadan nadiren tespit edilirler. Günümüz tanı yöntemleriyle, histopatlojik inceleme olmadan feokromasitoma ve nöroblastoma gibi malign nöroendokrin kitlelerden ayırt etmek mümkün değildir. Çoğunlukla ilişkili olmayan bir sebeple yapılan taramalar esnasında insidental olarak rastlanır.

P - 048 AKUT ALT EKSTREMİTE DERİN VEN TROMBOZUNDA DİFÜZYON -AĞIRLIKLI MANYETİK REZONANS GÖRÜNTÜLEME ZEYNEP NİLÜFER TEKİN 1, ALİ TÜRK 2, ÖZLEM SAYGILI 3 1Medeniyet Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye 2Acıbadem Bakırköy Hastanesi, İstanbul, Türkiye 3Acıbadem Üniversitesi, İstanbul, Türkiye Amaç: Bu çalışmanın amacı difüzyon-ağırlıklı görüntüleme (DAG) ve apparent diffusion coefficient (ADC) değerinin akut derin ven trombozu (DVT) tanısına katkısını incelemektir. Gereç ve Yöntemler: Bu çalışmaya iki yıl zaman aralığında, tipik klinik bulgular ile akut başlangıçlı DVT tanısı olan 34 hasta dahil edildi. Hastalar, tecrübeli bir radyolog tarafından Doppler Ultrason ile değerlendirildi. Hastalara aynı gün, aksiyel T1, T2 ağırlıklı, gradient eko, difüzyon ve ADC sekanslarından oluşan protokol ile manyetik rezonans görüntüleme (MRG) gerçekleştirildi. ADC değeri iki radyolog tarafından bağımsız şekilde, diğer sekanslar ise ortak olarak fikir birliği ile değerlendirildi. Bulgular: Doppler bulguları; 15 (44.1%) hastada pozitif, 18 (52.9%) hastada negatif, 1 (2.9%) hastada şüpheli bulundu. Ortalama ADC değeri trombüslü hastalarda 1.1x10-3mm2/s bulunurken, akut trombüsü olmayan hastalarda 2.7x10-3mm2/s olarak hesaplandı. S42 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Sonuç: Çalışmamızda DAG’nin ADC haritalama ile birlikte akut DVT’yi saptayabildiği gözlenmiştir. Alt ekstremite difüzyon MRG inceleme, derin venöz sistemin sonografik olarak optimal değerlendirilemediği ekstremiteleri kalın ve ödemli hastalarda DVT tanısına katkıda bulunabilir.

P - 049 İNEN AORTADA YÜZEN TROMBÜS OLGUSU CENK HOŞGEÇİN, HAKAN İMAMOĞLU Erciyes Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Kayseri, Türkiye Özet Amaç: Aortada yüzen trombüs büyük oranda emboliye neden olabilen ve nadir görülen serbest trombüs örneğidir. Bu olgumuzda inen aortada yüzen trombüsün Bilgisayarlı Tomografi (BT) ve Magnetik Rezonans Görüntüleme (MRG) bulgularını sunmaya amaçladık. Gereç ve Yöntemler: Göğüs ağrısı nedeniyle hastanemize başvuran 76 yaşındaki kadın hastada ekokardiyografide asendan aortada geniş- leme saptanması nedeniyle BT Anjiografi ve olası tümöral oluşumun dışlanması için kontrastlı MRG Anjiografi tetkikleri yapıldı. Bulgular BT Anjiyografide; inen aorta lümeninde, pedinküle görünümde, 6,5 cm uzunluğunda ve 1,5x1 cm boyutunda hipodens lezyon izlendi. Lezyon akım yönüne doğru seyir göstermekteydi ve lezyonun serbest ucu çölyak trunkus orijininde sonlanmaktaydı. Ayrıca dalakta kapsüler tabanlı, kamasal hipodens alanlar izlendi. Sonrasında istenen kontrastlı MRG görüntülerde lezyonda kontrastlanma saptanmadı. Tartışma: Yüzen trombüs serbest trombüs örneğidir. Trombüsün bir ucu damar duvarına tutunurken, diğer ucu damar lümeninde akım yönüne doğru serbestçe yüzmektedir. Arteriyel serbest trombüsün beraberinde getirdiği %73 oranındaki embolik olay insidansı klinik açıdan önemlidir. Bu olguda inen aorta kaynaklı yüzen trombüsün serbest ucu çölyak trunkus orijinine doğru uzanmaktaydı ve dalakta akut enfarktı düşündüren kamasal hipodens alanlar izlenmekteydi. Trombüsün medikal tedavisi süresince embolik risklerin artarak devam etmesi nedeniyle cerrahi olarak çıkarılmasını öneren çalışmalar da bulunmaktadır. Yüzen trombüsler venöz damarlarda nispeten sık izlenirken, arteriyel damarlarda nadir olarak karşımıza gelir. Bu sebeple, pedinküle şeklide izlenebilecek olan arteriyel tümörlerden ayırıcı tanısının yapılması gerekir. Bu olguda olduğu gibi, çekilen kontrastlı MRG incelemesinde kontrastlanmanın olmaması trombüs tanısını destekler. Sonuç: Aortada pedinküle lezyon ile karşılaşıldığında; akım yönüne doğru seyri, beraberinde embolik olayların görülmesi ve kontrastlı MRG incelemesinde kontrastlanmanın bulunmayışı nadir olarak görülen yüzen trombüs tanısını koydurur.

P - 050 ATRİYAL KİTLE İLE KARIŞAN BELİRGİN KRİSTA TERMİNALİS OLGUSU HAKAN İMAMOĞLU, CENK HOŞGEÇİN, SERAP DOĞAN, GÜVEN KAHRİMAN Erciyes Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Kayseri, Türkiye Özet Amaç: Krista terminalis sinus venosus ve primitif sağ atriyum bileşkesinde uzanan, iyi sınırlı fibromusküler katlantıdır. Sağ atriyum posterolateral duvarı boyunca uzanmaktadır. Bu anatomik yapı bazen belirgin olarak izlenmekte ve sağ atriyum kitlesi ile karıştırılmaktadır. Bu olgumuzda atriyal kitle ile karışan belirgin krista terminalisin Magnetik Rezonans Görüntüleme (MRG) bulgularını sunmaya amaçladık. Gereç ve Yöntemler: Kırk dokuz yaşındaki bayan hastada sistemik sklerozun kardiyak tutulumu şüphesiyle yapılan transözofageal ekokardiyografide (TÖE) sağ atriyum duvarında, lümene doğru protrüde, iyi sınırlı kitle görünümü izlenmesi üzerine hastaya kontrastlı kardiyak (MRG) incelemesi yapıldı. Bulgular Kardiyak MRG’ de sağ atriyum posterolateral duvarı boyunca kraniyokaudal seyir gösteren, iyi sınırlı, 6 mm kalınlı- ğında lezyon izlendi. Lezyon tüm sekanslarda atriyal kas tabakasıyla benzer sinyal özellikleri taşımakta olup, patolojik kontrastlanma göstermedi. Bu özellikleri nedeniyle belirgin krista terminalis lehine tanı aldı. Tartışma: Krista terminalis kalınlığı erişkin dönemde 3-6 mm arasında değişmektedir. Belirgin krista terminalisin tanı kriteri veya prevalansı ile ilgili yeterli veri bulunmamaktadır. Atriyal aritmilere neden olabileceğini belirten çalışmalar bulunmaktadır. Sağ atriyumun posterolateral duvarı boyunca, inferior vena kava ve süperior vena kava komşuluğuna doğru olan uzanımını göstermek tanıda yönlendiricidir. TÖE’de bikaval planda bu uzanım bir hat şeklinde gösterilebilir. Sıklıkla süperior vena kavaya yakın kesimler görüntülenememektedir. Bu sebeple trombüs, tümör ya da vejatasyon gibi atriyal kitleler ile karıştırılmaktadır. Kardiyak MRG’de lokalizasyon daha kolay ortaya koyulmakta ve ek sekanslar, kontrastlı görüntüler ile tanı desteklenir. Sonuç: Belirgin krista terminalis kalbin sağ atriyal kitleleri ile karışabilir. Anatomik yerleşimi ve kitlesel morfolojinin bulunmayışı radyolojik olarak doğru tanıya yönlendirir. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S43 P - 051 YETİŞKİN DÖNEMDE KARDİYAK TEK VENTRİKÜL TANISI ALAN 2 OLGU HAKAN İMAMOĞLU, CENK HOŞGEÇİN, SERAP DOĞAN, GÜVEN KAHRİMAN Erciyes Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Kayseri, Türkiye Özet Amaç: Tek ventrikül olguları sıklıkla yenidoğan döneminde tanı almaktadır ve çoğu süt çocukluğu döneminde kaybedilmektedir. Erişkin dönemde nadiren görülür. Bu 2 olguda yetişkin dönemde tanı alan tek ventrikülün Magnetik Rezonans Görüntüleme (MRG) bulgularını sunmaya amaçladık. Yöntem: Nonspesifik kardiyopulmoner şikayetler ile başvuran, 32 ve 40 yaşlarındaki iki erkek hastada ekokardiyografide tek ventrikül görülmesi üzerine kardiyak MRG incelemesi yapıldı. Bulgular: Olguların ikisinde de sağ ventriküler morfolojinin izlendiği ve büyük arterlerin transpozisyonun (L-form) eşlik ettiği fonksiyonel tek ventrikül saptandı. Sol ventrikül rudimenter olarak izlendi. İki olguda da çift atriyoventriküler (AV) kapak mevcuttu. Her iki olguda da kalp normalden genişti. Tartışma Tek ventrikül, her iki atriyumun tek ventriküle açıldığı, 6500 canlı doğumdan birinde görülen, nadir konjenital kalp hastalığıdır. Tek ventrikül ile doğan hastalara ait ölümlerin %74’ü ilk 6 ay içinde olmaktadır. Olgularda sıklıkla iki ventriküler odacık da bulunmakta olup, biri (sıklıkla sağ ventrikül) rudimenter olarak izlenir ve diğer ventrikül fonksiyonel olarak iş görür. AV bağlantı ise mitral ve triküspit kapak halinde iki kapakçık veya ortak kapak şeklinde görülebilir. Bazen AV kapaklardan biri atreziktir. Büyük arterlerin transpozisyonu (genellikle L-form) anomaliye sıklıkla eşlik etmektedir. Uzun dönem prognozunun çift AV kapak, tek veya sol ventriküler morfoloji, L-transpozisyon, sistemik çıkış darlığı bulunmaması, ılımlı pulmoner çıkış darlığı bulunması durumlarında daha iyi olduğu düşünülmektedir. Sonuç: Tek ventrikül gibi konjenital kalp hastalıkları erişkin dönemde de tanı alabilmektedir. Tek ventrikül anomalisinin komponentleri, eşlik eden diğer kardiyak anomalilerin ve kapak hastalıklarının varlığı prognozu ve operasyon kararını etkileyeceğinden kardiyak MRG ile aydınlatılması gereklidir.

P - 052 NADİR BİR TORASİK LEZYON: PLEVRANIN SOLİTER FİBRÖZ TÜMÖRÜ MUSTAFA KOÇ Fırat Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Elazığ, Türkiye Özet Amaç: Plevranın soliter fibröz tümörü nadir görülen, submezotelyal bağ doku orjinli bir benign tümördür. Görülme sıklığı 2.8/100.000 olarak bildirilmektedir. Literatürde, lokalize fibröz mezotelyoma, benign mezotelyoma, plevral fibroma, submezotelyal fibroma veya subserosal fibroma olarak ta isimlendirilmektedir. Bu çalışmada sağ akciğerde soliter fibröz tümör tanısı konulan olgu sunuldu. Gereç ve Yöntemler: 4-5 aydır geçmeyen öksürük ve balgam şikayeti ile polikliniğe başvuran, 43 yaşındaki erkek hastaya, radyolojik olarak PA akciğer grafisi ve kontrastlı toraks bilgisayarlı tomografi (BT) incelemesi yapıldı. Bulgular: Olgunun PA akciğer grafisinde, sağ akciğerde, alt zonda, parakardiyak alanda, büyük boyutlu, düzgün konturlu, nodüler radyopasite izlendi. Yapılan İ.V. kontrastlı toraks BT incelemede, sağ akciğer alt lob süperiorda, paravertebral alan komşuluğunda, plevral tabanlı, yaklaşık 13x10 cm boyutta, hipodens, düşük atenuasyon değerleri veren, belirgin kontrastlanmayan, düzgün konturlu kitlesel lezyon görüldü. Olgu cerrahi olarak tedavi edildi. Tanımlanan lezyonun histopatolojik tanısı, plevranın soliter fibröz tümörü olarak rapor edildi. Sonuç: Plevranın soliter fibröz tümörü, tüm yaş gruplarında görülmekle birlikte, altıncı ve yedinci dekatta pik yapar. Nadir olarak akciğer parankiminde, perikartta, mediastende, üst hava yolunda, peritonda, böbreklerde, memede ve karaciğerde görülebilir. Hastalar asemptomatik olabi- leceği gibi, kitlenin boyutuna ve lokalizasyonuna bağlı olarak öksürük, nefes darlığı, göğüs ağrısı gibi semptomlarla da başvurabilirler. Radyolojik olarak; soliter, sınırları belirgin, yumuşak doku yoğunluğunda, plevral tabanlı, göğüs duvarı invazyonu göstermeyen kitle varlığında, ayırıcı tanıda soliter fibröz tümör de düşünülmelidir.

P - 053 MR GÖRÜNÜMÜ İLE SOLİTER KEMİK KİSTİNE BENZEYEN KLAVİKULA YERLEŞİMLİ ANEVRİZMAL KEMİK KİSTİ ORHAN OYAR 1, ALİ MURAT DÜLGEROĞLU 2, EMİNE MERVE HOROZ 1, TÜRKAN ATASEVER REZANKO 3, ÖZGÜR TOSUN 1, ENGİN ULUÇ 1 1 İzmir Katip Çelebi Üniversitesi Tıp Fakültesi, Atatürk Eğitim ve Araştirma Hastanesi Radyoloji Anabilim Dalı, İzmir, Türkiye 2 İzmir Katip Çelebi Üniversitesi Tıp Fakültesi, Atatürk Eğitim ve Araştirma Hastanesi Ortopedi Anabilim Dalı, İzmir, Türkiye 3 İzmir Katip Çelebi Üniversitesi Tıp Fakültesi, Atatürk Eğitim ve Araştirma Hastanesi Patoloji Kliniği, İzmir, Türkiye S44 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Giriş: Anevrizmal kemik kisti (AKK) ilk olarak 1942’de adlandırılmış, intramedüller alana yerleşen, ekspansil-litik özellikte, benign natürde bir kemik tümörüdür. Tüm kemik tümörlerinin %1’ni oluşturur. En sık çocuk ve genç erişkinlerde görülür. Hemen hemen tüm kemikler tutulabilirse de uzun kemik metafizleri ve vertebralar en sık tutulum yerleridir. Tüm yassı kemikler içinde klavikula tümör veya tümör benzeri lezyonların nadir görüldüğü yerlerden biri olup AKK açısındanda da çok nadir yerleşim yerlerinden biridir. Bu çalışmada, nadir yerleşimi yanında MR görün- tüsü ile soliter kemik kisti iç yapı özelliklerini düşündüren sağ klavikula yerleşimli AKK saptanmış ve cerrahi olarak tedavi edilmiş 8 yaşında bir olgu sunulmaktadır. Olgu Sunumu: Sağ klavikulası üzerinde ağrısız şişliği olan 8 yaşındaki kız çocuğunun fizik muayenesinde sağ klavikula dış kesimine doğru lokalize, 2 x 2 cm’lik ağrısız, fikse, ciltte bozukluk ve renk değişikliği oluşturmamış şişlik sa ptanmıştır. Olgunun biyokimyasal incelemeleri, PTCsinde ve eritrosit sayısında hafif artış, MHCsinde ise hafif azalım dışında normal sınırlardaydı. Klavikulaya yönelik röntgende ekzantrik yerleşimli, septasyonlu, ekspansil radyolüsent lezyon izlenmiştir. BT incelemede; sağ klavikulada 40 x 20 mm boyutlarda ekspansil, heterojen dansitede, korteksi yer yer inceltmiş kemik lezyonu saptanmıştır. Olgunun MR incelemesinde ise sağ klavikulada yaklaşık 40 x 20 mm boyutlarda, T2 ağırlıklı görüntülerde homojen iç yapıda, santralinde ince bir septasyonla ayrılmış bilobule yüksek sinyalli kitlesel lezyon izlenmştir. Kontrastlı incelemede lezyonun periferik tarzda kontrastlanma gösterdiği ancak belirgin bir sıvı-sıvı seviyelenmesi içermediği tespit edilmiştir. BT ve MR’da lezyon iç yapısının oldukça homojen oluşu ve sıvı-sıvı seviyelenmeleri göstermemesi soliter kemik kisti açısından kuşku çekmiş, lezyon içersinde fokal, biraz da kontrastlanan sahalar görülmesi telenjiektatik osteosarkom ayırıcı tanısını da düşündürmüştür. Sağ klavikuladaki şişlikten yapılan biyopsiden alınan materyalin çok küçük bir alanında anevrizmal kemik kistine uyabilecek bulgulara rastlanmıştır. Enfeksiyon izlenmemiştir. Olgu daha opere edilmiş, sağ klavikuladan frozen çalışması ile alınan küretaj materyalinden yapılmış seri kesitlerde tanı anevrizmal kemik kisti olarak gelmiştir. Materyalde malignite ve atipi bulunmamıştır. Ameliyatla lezyon kürete edilmiş, klavikuladaki boşluk kemik greft ile doldurulmuştur. Olgu takip edilmek üzere yönlendirilmiştir. Tartışma: Klavikula, kemik tümörleinin nadir yerleşim yerlerinden biridir. Bu kemiğin primer benign lezyonları malign lezyonlardan daha nadirdir. AKK her ne kadar benign karakterli düşünülse de solid tipi özellikle radyolojik olarak tanısal güçlüklere neden olabilir ve yüksek mitotik ve hücresel aktivitesi nedeniyle telanjektatik osteosarkomla karışabilir. Bu nedenle radyolojik olarak benign özellik taşıyan lezyonlarının bile malign histopatolojik natürde olabileceği unutulmamalıdır. Bu lokalizasyonda ayırıcı tanıda kondroblastom, kondromiksoid tümör, fibröz displazi, nonos- sifiye fibrom gibi fibröz lezyonlar ile dev hücreli tümör, hemanjioperisitoma, tümör metastazları, osteosarkomlar düşünülmelidir. AKK, radyolografik olarak kortekste incelmeye neden olan ekspansil, osteolitik lezyon şeklinde görülür. Olgularda korteks bütünlüğü korunur, normal kemik-lezyon arasında geçiş zonu dardır ve yumuşak doku komponenti izlenmez. Ancak kortikal kemik kenarlarında düzensizlik ile birlikte geniş geçiş zonu şeklinde de izlenebildiği gibi, tamamen destrüktif, osteolitik görünen ve yumuşak doku komponenti içeren, agresif malign bir lezyonu düşündüren görünüm de sergileyebilir. Nadiren incelmiş korteksle birlikte lezyon içerisinde sabun köpüğü görünümü saptanır. Lezyon kenarlarında izlenen periosteal yeni kemik oluşumu kelebek görünümüne neden olur ve bu özellik soliter kemik kistinden ayırımını kolaylaştır- maktadır. BTde yer yer seviyelenme veren sıvı dansitesinde alanlar bulunur. MRG incelemede T1A görüntülerde düşük sinyalli görünüm, kist içi akut kanama var ise seviyelenme gösteren veya göstermeyen yüksek sinyalli alanlar izlenir. T2 ağırlıklı kesitlerde düşük veya orta derecede sinyal özelliği, kist içeriğine bağlı olarak heterojen yüksek sinyalli alanlar izlenebilir. İnternal septasyonlarla birlikte düşük sinyalli bir rim multiloküle kistik görünümü oluşturur. Sonuç: Bu olgu sunumunda röntgen incelemesi ile AKK ön planda düşünülen ancak BT ve MR görünümleri ile daha ziyade solid, ince septalı, sıvı-sıvı seviyelenmesi göstermemesi, kontrastlanma özellikleri ile daha çok soliter kemik kisti veya telenjiektatik osteosarkoma benzeyen sağ klavikuler AKK olgusu sunulmuş, ayırıcı tanı kriterleri gözden geçirilmiştir. Klavikulada ekspansil lezyon saptandığında ayırıcı tanıda AKK akla gelmelidir. AKK çoğunlukla primer görülmesine karşın sekonder de görülebileceği hatırlanmalı ve AKK olarak saptanan olgularda ikincil lezyon veya ikincil tümör olasılığı araştırılmalıdır.

P – 054 NADİR YERLEŞİMLİ ASETABULER ANEVRİZMAL KEMİK KİSTİ OLGUSU VE MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI MÜCAHİT DOĞRU 1, GİZEM ABACI 1, TUĞBA İLKEM KURTOĞLU ÖZÇAĞLAYAN 1, RÜMEYSA DOĞRU 2, ÖMER ÖZÇAĞLAYAN 1 1 Namik Kemal Üniversitesi Tp Fakültesi, Tekirdağ, Türkiye 2 Malkara Devlet Hastanesi, Tekirdağ, Türkiye Özet Giriş: Anevrizmal kemik kisti ağrı, şişlikle karakterize ve kemikte ekspansiyona neden olan benign natürde kemik psödotümörüdür. Etyolojisi aydınlatılamamış olup büyük oranda hemorajik ve hiperplastik natürdedir. Daha çok kadın hastalarda ve 10-20 yaş aralığında görülür. En sık üst- alt ekstremite uzun kemiklerinde ve vertebral kolonda izlenmekle birlikte vücudun tüm kemiklerinde bu lezyona rastlanabilir. Primer olabileceği gibi başka bir kemik lezyonunun hemorajik transformasyonuna sekonder de gelişebilmektedir. Tedavisinde cerrahi, radyoterapi ve kanamalı olgularda selektif arteryel embolizasyon gibi girişimsel radyolojik prosedürler tercih edilebilir. Olgu Sunumu: 12 yaşında kız hasta son altı aydır sol kalçada yaygın ağrı ve yürümede güçlük şikayeti ile hastanemiz ortopedi kliniğine başvurdu. Plan radyografi tetkiki için Radyoloji kliniğimize refere edilen hastanın grafisinde sol asetabulumda hipodens litik karakterde ekspansil kitle lezyon Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S45 görünümü dikkati çekti. Bunun üzerine yapılan ileri manyetik rezonans (MR) görüntülemesinde sol pubik ramus proksimalinden başlayarak sol asetabulumu dolduran ve iliak kanat proksimaline uzanım gösteren yaklaşık 77x58x75 mm boyutlarında internal kanamaya sekonder sıvı-sıvı seviyelenmeleri bulunan T1A sekansta hipointens, T2A sekansta büyük oranda hiperintens karakterde anevrizmal kemik kisti ile uyumlu yer kaplayıcı lezyon izlendi. Tartışma: Anevrizmal kemik kisti sıklıkla üst yada alt ekstremite uzun kemiklerinin metafizinde ve vertebra korpuslarında yerleşim göstermekte olup pelvik yerleşimli olanlar tüm vakaların yaklaşık %8-12 si civarındadır. Asetabuler yerleşim ise oldukça nadirdir. Vakamızda nadir bir lokalizasyon olan asetabuler yerleşimli anevrizmal kemik kistinin radyografi ve MR görüntüleme bulgularından literatür eşiliğinde bahsettik.

P - 055 DERİN YERLEŞİMLİ DERMATOFİBROM MEHTAP BALABAN, BURAK YAĞDIRAN, MESUT AY, ALİ İPEK, FURKAN NALBANT Ankara Atatürk Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Türkiye Özet Amaç: İnterskapular yerleşimli ağrısız sert kitlenin sonografik görüntüleme bulguları eşliğinde tanımlanması ve histopatolojik korelasyonu. Gereç ve Yöntemler: Sırt bölgesinde ele gelen şişlik şikayeti olan 32 yaşındaki bayan hasta ortopedi poliklinik muayenesi sonrasında kitle karakterizasyonu için bölümümüz ultrasonografi (US) departmanına yönlendirildi. Bulgular: İnterskapular lokalizasyonda şişlik tariflenen alana 14 Mhz’lik lineer prob ile yapılan yüzeyel US incelemede cilt-cilt altı yağ doku içeri- sinde 31X8 MM boyutlarda anteriorda cilt ile ara planları kısmen net seçilemeyen, bu lokalizasyonda ciltte belirgin incelmeye neden olan, renkli Doppler US (RDUS)’de belirgin vaskülarizasyonu izlenen heterojen hipo-zayıf hiperekoik solid lezyon dikkati çekti. Lezyona yönelik yapılan eş zamanlı kompresyon sonoelastografi (SEL) incelemede lezyonun renk skalasına göre mavi ağırlıklı sert kodlandığı izlendi. Sonografik bulgular eşliğinde dermatofibrosarkomprotuberans (DFSP) radyolojik ön tanısıyla histopatolojik korelasyon önerildi. Tanı ve tedavi amaçlı total eksizyon yapılan lezyon dermatofibrom olarak rapor edildi. Sonuç: Dermatofibrom fibroblastik ve histiyositik hücrelerden kaynaklanan ve sık görülen benign tümörlerdir. Sıklıkla dermis yerleşimli olup subkutan doku yerleşimli olgular nadir görülür. Terminolojide benign fibröz histiyositom olarak da isimlendirilir. Etyolojide travma önemli rol oynar. Subkutan doku ve kas doku yerleşimli olgular derin yerleşimli penetre dermatofibrom olarak anılmakta olup tüm dermatofibrom olguları- nın %1-2’sinden azıdır. 25 yaş üstü ve erkeklerde insidansı fazladır. Ekstremitelerin proksimal kısımları ve baş-boyun bölgesinde görülen lezyonlar olup benign ve malign subkutan tümörlerle ayırıcı tanısı önemlidir. En önemli ayırıcı tanı DFSP ile yapılmalıdır. DFSP subkutan bölgede daha sık yerleşmekte olup konturları daha infiltratiftir. Sonografik ve SEL bulguları benzer olup kesin ayırıcı tanı immünohistokimyasal olarak yapılır. Yeterli cerrahi sınır gözetilerek yapılan total eksizyon küratif ve tanısaldır.

P - 056 İKİ OLGU: TENDON KILIFININ DEV HÜCRELİ TÜMÖRÜ; US, RDUS,SEL VE HİSTOPATOLOJİ MEHTAP BALABAN, MESUT AY, BURAK YAĞDIRAN, ALİ İPEK Ankara Atatürk Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Türkiye Özet Amaç: İki ayrı olguda el yerleşimli tendon kılıfının dev hücreli tümör kitlelerinin sonografik, sonoelastografik (SEL) bulgularının tanımlanması ve eksizyonel biyopsi ile histopatolojik verifikasyonu. Gereç ve Yöntemler: 41 yaşında erkek olgu sağ el 2. parmak orta falanks ve 42 yaşında kadın olgu sağ el 4. parmak metakarpofalangial (MKF) eklem komşuluğunda tarifledikleri hafif ağrılı şişlikler için departmanımız ultrasonografi(US) ünitesine yönlendirildi. Bulgular: Her iki olguda elde tanımlanan kitlelere yönelik yüzeyel ultrasonografi (US), renkli Doppler US(RDUS), SEL inceleme yapıldı. Erkek olguda sağ el 2. parmak orta falanks süperficialdijitaltendon anterioru yakın komşuluğunda 18,5x12,5 mm boyutlarda düzgün konturlu, RDUS’de belirgin vaskülarizasyonu izlenmeyen heterojen hipoekoik solid lezyon rapor edildi. Kadın olguda sağ el palmar bölge 4. parmak MKF eklem komşuluğundaki fleksördijitaltendonu kompresyon etkisi izlenmeden çevreleyen 11,3x8,9 mm boyutlarda lobüle düzgün konturlu, RDUS’de vaskülarizasyonu izlenen heterojen hipoekoik solid lezyon rapor edildi. Tanımlanan lezyonlara yönelik eş zamanlı yapılan kompresyon SEL incelemede her iki lezyonun da renk skalasına göre mavi renkte sert kodlandığı dikkati çekti. Sonografik bulgularla öncelikle her iki olguda tendon kılıfının dev hücreli tümörü (TKDHT) düşünülen kitlelerin eksizyonel biyopsi sonucu TKDHT olarak rapor edildi. Sonuç: Tendon kılıfından köken alan dev hücreli tümör etyolojisi net bilinmeyen benign yumuşak doku tümörüdür. Rekürren yumuşak doku travmalarına sekonder gelişen inflamatuar yanıt sonucu meydana gelebileceği iddia edilmektedir.En sık el bölgesinde yerleşim göstermekte olup el ve el bileğinin en sık görülen ikinci benign tümörüdür. Yavaş büyüyen, sert, ağrısız, immobil, soliter kitle lezyonlarıdır. Kadınlarda ve sıklıkla S46 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

30-40 yaş aralığında görülmektedirler. Ayırıcı tanıda gangliyon kistleri, lipom, hemanjiom, yabancı cisim ve sinoviyal karsinom düşünülmelidir. Tedavi ve tanı amaçlı total ekzisyon önerilmekle birlikte cerrahi sonrası ilk iki yıl içindeki lokal nüks oranı yaklaşık % 27 olarak rapor edilmiştir. Nadiren de olsa lezyonların malign transformasyon riski göz önünde bulundurulmalıdır. Ve bu durum özellikle nüks görülen vakalarda akılda tutulmalıdır. TKDHT’leri nadir görülen kitleler olsalar da lezyonların sonografik ve SEL bulgularının bilinmesi ayırıcı tanıda yardımcı olacaktır.

P - 057 SFENOİD KEMİKTE TELEANJİEKTATİK OSTEOSARKOM RADYOLOJİK AYIRICI TANI ÖZELLİKLERİ LEYLA İSAYEVA 1, ÖZGÜR ASLAN 1, ALİ MURAT KOÇ 2 1 İstanbul Medilife Beylikdüzü Hastanesi, İstanbul, Türkiye 2 İzmir Bozyaka Eğitim ve Araştırma Hastanesi, İzmir, Türkiye Özet Amaç: Telenjiektatik osteosarkom, bütün osteosarkomların %5-lik kısmını oluşturur. Görüntüleme bulguları klasik osteosarkomdan farklıdır. Dekstrüktif, kötü sınırlı, geniş osteolitik lezyon ve küçük bir alanda osteoid matriks ile daha çok AKK’ne benzer bulgular içermektedir. Lezyona agresif periost reaksiyonu, yumuşak doku kitlesi ve patolojik kırık eşlik eder. MRG’de AKK-de olduğu gibi kan ile dolu kistik kavitelerle sıvı- sıvı seviyeleri ve arada solid nodüler komponentler mevcuttur. Kontrast madde sonrası kalın septal ve nodüler parlaklaşmalar AKK’den ayırıcı tanıda önemlidir. Ayrıca yumuşak doku kitlesinin genişliği, kortikaldestruksiyon ve BT’ de matriks mineralizasyonu AKK’den ayırımda önemlidir. Amacımız özellikle kalvaryal kemikte oldukça nadir gözlenen bu tümörün görüntüleme bulgularını, ayırıcı tanı özelliklerini sunmak ve literatür eşliğinde tartışmaktır. Gereç ve Yöntemler: Hastanemiz nöroloji kliniğine 1 haftadır sol gözde bulanık görme ve başağrısı şikayetiyle başvuran 38 yaşlı bayan hastaya etiyoloji araştırılması için kraniyal manyetik rezonans görüntüleme (MRG) ve bilgisayarlı tomografi (BT) tetkikleri yapılmıştır. Kraniyal mrg tetkiki 1.5 tesla Siemens symphony, BT tetkiki 64 kesitli Toshiba cihazlarıyla gerçekleştirilmiştir. Bulgular: Yapılan tetkiklerde sol temporal fossada sfenoid kemik büyük kanadını destrukte eden içerisinde kan ve sıvı seviyelerinin izlendiği kontrastlı serilerde yoğun noduler septal kontrastlanmasının izlendiği diffüzyon serilerde kısıtlanmış diffüzyon alanları da içeren litik lezyon sap- tandı.ek olarak elde edilen BT görüntülerde lezyonun destruktif uzanımı daha ayrıntılı değerlendirildi.Hastanın 9 ay önce yapılan kontrastsız mrg tetkiki tamamen normaldi.Lezyonun agressiv davranışı,yeni oluşması,kemik destruksiyonun olması ve içerisinde kan sıvı seviyelerinin izlenmesi nedeniyle teleanjiektatic osteosarkom ön planda düşünüldü.Ayırıcı tanıda yer alan anevrizmal kemik kisti ve venolenfatik malformasyon eski tetkikte olmaması nedeniyle ekarte edildi. Sonuç: Baş boyun yerleşimli osteosarkomlar çok nadir ve oldukça aggresivdirler.Osteosarkomalar bütün baş boyun malignitelerinin %1-ni oluş- turur.baş boyun bölgesi osteosarkomları genellikle III ve IV dekadlarda ekstremite osteosarkomları ise daha genç yaşlarda ve çocuklarda görülür. Teleanjiektatik osteosarkomlar anevrizmal kemik kisti ile oldukça yakın radyolojik ve histopatolojik özellikler içermektedir. Kalvaryal kemik yerleşimli teleanjiektatik osteosarkom oldukça nadirdir.Anevrizmal kemik kisti ile histopatolojik olarak bile oldukça benzer olması nedeniyle radyolojik tanı çok değerlidir. Erken tanı ve erken agressiv cerrahi prognozu etkilemektedir.

P - 058 DİSTAL BİSİPİTAL TENDİNİT MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI SERDAR ARSLAN, FATMA ZEYNEP ARSLAN, MERAL BÜYÜKTERZİ, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, İSMET TOLU Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Giriş: Distal bisipital tendinopati, dominant kolda biseps travmalarının %3-10 ’unu oluşturmaktadır. Özellikle ağır antreman yapan atletlerde bu oran daha da artış göstermektedir. Manyetik rezonans görüntüleme (MRG) bu hastalarda distal biseps tendonunda rüptür veya diğer ten- dinopatilerin değerlendirilmesinde önemli bir görüntüleme yöntemidir. Bu olgu sunumunda distal bisipital tendinit tanısı alan bir hastanın MRG bulgularını sunmayı amaçladık. Olgu Sunumu: 35 yaşında erkek hasta dominant kolunda ağır yük kaldırarak zorlama nedeni ile 1 haftadır geçmeyen sağ ön kol ağrısı nedeni ile hastanemize başvurdu. Hastaya uygulanan MRG tetkikinde distal biseps tendonu radial tuberositas yapışma yeri düzeyinde yağ baskılı T2 ağır- lıklı sekanslarda intensitesinde ve tendon kalınlığında artış saptandı. Radial tuberositas düzeyinde yaygın kemik iliği ödem alanları izlendi. Ayrıca tendon etrafında artmış effüzyona ait görünüm izlendi. Rüptür veya retraksiyona ait olabilecek MRG bulgusu saptanmadı. Bu bulgular üzerine hastaya distal bisipital tendinit tanısı konuldu. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S47

Tartışma: Distal bisipital tendinit aşırı ezersiz yapanlarda veya ani kontraksiyonlar sonucu meydana gelmektedir. Distal biseps tendonu genellikle iki ana tendon lifinden oluşur. MRG ile tendinozis, parsiyel veya komplet rüptür gibi tendinopatiler bu liflerden ayrı ayrı veya komplet olup olmadığını ayırmada önemli bir görüntüleme yöntemdir. Tendinozisde artmış sinyal intensitesi, kalınlaşma ve tendon etrafında sıvı saptanabilir. Bununla birlikte parsiyel ve komplet rüptür gelişen hastalarda distal bisipital tendon yapışma yeri düzeyinde tendon bütünlüğünde bozulma, ayrılma ve retraksiyon saptanabilir. Ayrıca bu düzeyde tendon etrafında sıvı, tendonda intensite artışları izlenebilmektedir.

P - 059 NADİR BİR OLGU: DİZ EKLEMİNDE PRİMER SİNOVİAL KONDROMATOZİS MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI SERDAR ARSLAN, FATMA ZEYNEP ARSLAN, HASAN ERDOĞAN, MERAL BÜYÜKTERZİ, SEDA SOĞUKPINAR KARAAĞAÇ, İSMET TOLU Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Giriş: Primer sinovial kondromatozis diğer adıyla Reihel sendromu, etyolojisi bilinmeyen sinovial metaplazi ve proliferasyon sonucu multipl intraartiküler osteokondral lezyonlarla karakterize bir eklem hastalığıdır. En sık diz eklem mesafesinde görülmekle birlikte daha az sıklıkla kalça, dirsek ve omuz ekleminde de görülebilmektedir. Bu olgu sunumunda dizde primer sinovial kondromatozis gelişen bir hastanın manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık. Olgu Sunumu: 23 yaşında erkek hasta hastanemizin ortopedi bölümüne sağ dizde ağrı ve şişlik şikayetleri ile başvurdu. Hastaya uygulanan MRG tetkikinde sağ diz eklem mesafesinde ve suprapatellar bursada artmış effüzyon izlendi. Ayrıca sinoviumda yer yer hipertrofik görünümler ve T2 ağırlıklı serilerde santrali hiperintens periferi hipointens, T1 ağırlıklı serilerde hipointens multiple serbest osteokondral cisimler izlendi. Tartışma: Primer sinovial kondromatozis kendini sınırlayan benign neoplastik bir süreçtir. Sinoviumda proliferatif kondroid nodüller ile karakterizedir. Radyografik incelemelerde kondroid nodüllerin ossifkasyon derecesine bağlı olarak görünür hale gelebilir. %25-30 hastada radyografik incelemeler normal olabilir. MRG ile kondroid lezyonların sinyal intensitesi ossifikasyon derecesine göre farklılık göstermekte olup duyarlılığı radyografik incelemelerden daha yüksektir. Bu lezyonların ayrıcı tanısında pigmente villonodüler sinovit, lipoma arboresans, sinovial kondrosarkom akılda tutulmalıdır.

P - 060 CAMPTOCORMİA SENDROMU MEHMET KARAGÜLLE 2, FATMA ZEYNEP ARSLAN 1, MERAL BÜYÜKTERZİ 1 1 Konya Eğitim Araştırma Hastanesi, Konya, Türkiye 2 Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye Özet Camptocormia diğer adıyla bent spine sendromu (BSS); ayaktayken ortaya çıkan, yatar pozisyonda düzelen, gövdenin anormal fleksiyon duru- mudur. BSS; psikiyatrik, kas-iskelet ve nörolojik hastalıklarla birlikte görülebilmektedir. Müsküler kökenli BSS genelde yaşlı hastalarda progresif ortaya çıkan geç başlangıçlı primer idiyopatik aksiyel myopati ile ilişkilidir fakat bu tanıyı düşünmeden önce BSS’ ye neden olabilecek sekonder nedenler dikkatlice değerlendirilmelidir.Bunlar arasında inflamatuar myopatiler, geç başlangıçlı müsküler distrofiler, endokrin ve metabolik myopatiler ve Parkinson hastalığı başta olmak üzere bazı nörolojik hastalıklar yer almaktadır. Bizim olgumuzda 82 yaşında parkinson nedeniyle takip edilen erkek hastada klinik şüphe üzerine çekilen MR incelemesinde paravertebral kaslarda T1A ve T2A incelemelerde yağlı dejenerasyon lehine sinyal değişiklikleri izlendi. BSS, patolojik olarak düzensiz dejenere lifler, endomisyal fibröz doku ve yağ dokusu içeren görünüme sahiptir. BSS, nadir görülmesinden dolayı çok bilinmeyen bir hastalık tablosu olup klinik bulgular ve MR incelemede, paravertebral kaslarda atrofik değişiklikler ve yağlı dejenerasyon izlenmesi ile tanısı konur.

P - 061 LATERAL PATELLAR DİSLOKASYON MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI İLYAS DÜNDAR 1, MESUT ÖZGÖKÇE 1, HARUN ARSLAN 1, İBRAHİM AKBUDAK 2 1 Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Van, Türkiye 2 Batman Bölge Devlet Hastanesi, Batman, Türkiye S48 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Amaç: Lateral Patellar Dislokasyon medial patellar retinakulumun yıkıcı hasarı sonucunda patellanın laterale doğru yer değiştirmesini ifade eder. Bu olguda klinik tanısı zor olan ve bilinmediği zaman tanı almayan Lateral Patellar Dislokasyon’nun Manyetik Rezonans Görüntüleme bulgularını sunmayı ve farkındalık oluşturmayı amaçladık. Gereç ve Yöntemler: 17 yaşında erkek hasta yaklaşık 10 gün önce düşme sonrası gelişen sol dizde ağrı ve şişlik şikayeti ile ortopedi kliniğine başvurdu. Hasta diz Manyetik Rezonans Görüntüleme çekilmek üzere tarafımıza yönlendirildi. Bulgular: Çekilen sol diz Manyetik Rezonans Görüntüleme’de aksiyel yağ baskılı proton dansite ve sagittal T1 ağırlıklı görüntülerde patella medial faset ve femur lateral kondilde kontüzyona bağlı ödematöz sinyal değişiklikleri görüldü. Aksiyel yağ baskılı proton dansite görüntülerde patella medial faset düzeyinde kortikal devamsızlık, kartilaj defektleri (siyah ok) ve medial retinakulumda zorlamaya bağlı sinyal artışları-düzensizlikler (beyaz ok) izlendi. Ayrıca sagittal yağ baskılı proton dansite görüntülerde eklem aralığında belirgin sıvı artışı (siyah oklar) ve eklem çevresinde yumuşak doku planlarında yaygın ödem (beyaz ok) izlendi. Bulgular eşliğinde Lateral Patellar Dislokasyon tanısı konuldu. Sonuç: Lateral Patellar Dislokasyon genelde sporcularda rotasyonel travmalarda gelişir. Patella medial fasette ve lateral femoral kondil ante- rolateralinde impaksiyon sonucu kontüzyon veya osteokondral kırık ortaya çıkabilir. Transient natürü nedeniyle klinik tanısı zordur. Kemik ve yumuşak doku lezyonlarının ayrıntılı olarak tanımlanabilmesi için Manyetik Rezonans Görüntüleme en iyi görüntüleme yöntemi olarak öne çıkmaktadır.

P - 062 PEDİATRİK ÇAĞDA METAKARP VE TİBİA TUTULUMU YAPAN LANGERHANS HÜCRELİ HİSTİOSİTOZİS OLGUSU LEVENT KARAKAŞ 1, AYŞEGÜL AĞIRMAN 2, MERT GENÇTÜRK 2, NİL ÇOMUNOĞLU ÜSTÜNDAĞ 3 1 Tekirdağ Çerkezköy Devlet Hastanesi, Radyoloji Bölümü, Tekirdağ, Türkiye 2 Yedikule Surp Pirgiç Ermeni Hastanesi, Radyoloji Bölümü, İstanbul, Türkiye 3 İstanbul Üniversitesi Cerrahapaşa Tıp Fakültesi, Patoloji Anabilim Dalı, İstanbul, Türkiye Özet Amaç: Metakarp ve tibia tutulumu yapmış Langerhans Hücreli Histiositoz (LHH) olgusunun radyolojik bulgularını sunmak. Gereç ve Yöntemler: 13 yaşındaki bayan olgu,sol elde ve sol dizde ağrı ön tanısı başvuran olguda sol ele yönelik yapılan direkt grafi incelemesinde 3.metakarpta periostta kalınlaşma ve periost reaksiyonu bulguları mevcuttur.16 dedektörlü bilgisayarlı tomografi(BT) cihazında 1 mm aksiyel kesitler ile bu kesitler üzerinden yapılmış koronal ve sagital reformat imajlar incelendiğinde metakarpta ekspansiyon,periostta kalınlaşma ve kesintili tarzda periost reaksiyonu izlenmiştir.1,5T Magnetik Rezonans(MR) cihazında sol ele yönelik T1A TSE, PD TSE ve yağ baskılı(YB) T1A TSE pre ve postkontrastlı aksiyel, koronal ve sagital planlarda inceleme yapılmıştır.Ayrıca sol dize yönelik standart incelemeye ek olarak kontrastlı T1A YB kontrastlı imajlar eklenmiştir.Metakarpta diafizde ekspansiyon periostta kalınlaşma ve çevre yumuşak dokularda ödem,ayrıca diafizde ve çevre dokularda kontrastlanma izlenmiştir.Tibia proksimalinde anteriorda metafiz ve diafizde ödem,periost kalınlaşması subperiosteal rezorbsiyon ve kontrastlanma mevcuttur.3.metakarptan yapılan biyopsi sonucu LHH tanısı bildirilmiştir. Bulgular: LHH, kemik iliği kökenli Langerhans hücresinin anormal çoğalmasıyla karakterize,nedeni bilinmeyen bir hastalıktır.Milyonda 1-2 oranın- da görülmektedir.Bu yelpazedeki eozinofilik granülomada(EG) sadece kemik tutulumu görülür.Hastalığın monofokal veya monostatik tipi olgu- ların %65’ini oluşturur. Olguların %35’i ise multifokaldir.En fazla etkilenen aksiyel iskelettir.Bu hastalık grubunda uzun kemiklerde en sık tutulan yer diafizdir.Çocuklarda diafiz %60,metafiz %36,epifiz bölgesi %4 oranında etkilenir.Erişkinlerde ise,epifiz bölgesi hemen hemen hiç etkilenmez. Epifiz tutulduğunda,kondroblastom ve subakut osteomiyelitten ayrımlanması güçtür.Diafizde lokalize olan bazı lezyonlar,Ewing sarkom ve oste- omiyelit ile radyolojik olarak karışabilir.Bizim olgumuzun tibiasında olduğu gibi nadiren epifizyometafizyel geçiş gösterebilir. Sonuç: Pediatrik yaş grubunda özellikle uzun kemikleri tutan, periost reaksiyonu ile atipik paternde kitle imajı olmaksızın görülen ve yumuşak doku tutulumuyla kontrastlanmanın eşlik ettiği durumlarda LHH ayrıcı tanıda düşünülmelidir.

P - 063 PROLİFERATİF MİYOZİT: ÜST EKSTREMİTENİN NADİR PSÖDOSARKOMATÖZ LEZYONU ESRA KAHVECİ 1, ZEYNEP MARAŞ ÖZDEMİR 1, LEYLA KARACA 1, AYŞEGÜL SAĞIR KAHRAMAN 1, NUSRET AKPOLAT 2, RESİT SEVİMLİ 3 1 İnönü Üniversitesi Tip Fakültesi Hastanesi, Radyoloji Anabilim Dali, Malatya, Türkiye 2 İnönü Üniversitesi Tip Fakültesi Hastanesi, Patoloji Anabilim Dali, Malatya, Türkiye 3 İnönü Üniversitesi Tip Fakültesi Hastanesi, Ortopedi Anabilim Dali, Malatya, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S49

Özet Proliferatif miyozit, ani başlangıçlı ve hızlı büyümesiyle sarkomu taklit eden nadir, iyi huylu bir tümördür. Hastalar tipik olarak ortalama 50 yaşında, sıklıkla proksimal ekstremitelerde veya omuzda bulunan bir soliter kitle ile başvururlar. Bu sunumda sol kolda ani büyüyen şişlik şikayeti ile gelen 62 yaşında tru-cut biyopsi ile histopatolojik tanısı bulunan kadın olgu üzerinden manyetik rezonans görüntüleme ve ultrasonografinin proliferatif miyozit ön tanısındaki önemi sunulmuştur.

P - 064 NADİR BİR OLGU: PRİMER MEME ANJİOSARKOMU GÜL ÇOLAKOĞLU 1, AYSUN ÇAKIR 1, ÖZLEM SEZGİN OKÇU 2, AYŞENUR OKTAY 2 1 Sağlık Bilimleri Üniversitesi İzmir Tepecik Eğitim ve Araştirma Hastanesi, Radyoloji Kliniği, İzmir, Türkiye 2 Ege Üniversitesi Tip Fakültesi, Radyoloji Anabilim Dalı, İzmir, Türkiye Özet Giriş: Anjiosarkomlar damar duvarındaki endotelyal hücrelerden köken alan nadir görülen malign tümörlerdir. En sık meme olmak üzere kalp, karaciğer, deri, kemik ve yumuşak dokularda gelişebilir. Memenin anjiosarkomları primer olabileceği gibi radyoterapiye sekonder de gelişebilir. Primer meme anjiosarkomu tüm malign meme tümörlerinin %0.04ünü oluşturur ve 3-4. dekattaki genç kadınlarda görülür. Hızlı büyüyen, ciltte hiperemi yapan, ele gelen ağrısız kitlelerdir. Bu bildiride primer meme anjiosarkomunun tanısı alan olgunun görüntüleme özellikleri tartışılmıştır. Olgu Sunumu: Sağ memede sertlik sebebiyle başvuran 36 yaşındaki kadın hastaya yapılan meme ultrasonografisinde meme dokusunda sınır- lanabilen kitlesel lezyon izlenmemiştir. Mamografisinde tip D meme paterni mevcut olup grup oluşturan kuşkulu kalsifikasyon odakları kitlesel oluşum saptanmamıştır. Meme MRG incelemesinde sağ meme alt orta kadranda fibroglandüler dokudan sınırları net ayrılamayan yaklaşık 4x5 cm lik T1de hipointens T2de fibroglandüler dokuya oranla hafif hiperintens alan dinamik serilerde erken dönemde yoğun kontrastlanma göster- mekte olup malignite açısından yüksek kuşkulu olarak değerlendirilmiştir. Tru-cut biyopsi sonrası olgunun patolojik tanısı anjiosarkom ile uyumlu olarak değerlendirilmiştir. Radyoterapi öyküsü olmayan olguda tanı primer meme anjiosarkomu olarak kabul edilmiştir. Tartışma: Primer ve sekonder meme anjiosarkomu nadirdir. Genç hastalarda ultrasonografide kitle formasyonu oluşturmayan meme dokusunun yapısını bozan, mammografi bulguları nonspesifik olan, MRI da T1A hipointens, T2A hiperintens belirsiz sınırlı hızlı kontrastlanan hemorajik içeriği bulunan kitlelerde ayrıcı tanıda anjiosarkom düşünülmelidir.

P - 065 PERİKALLOZAL LİPOM ADEM YOKUŞ Van Eğitim ve Araştırma Hastanesi, Van, Türkiye Özet Giriş: İntrakranial lipomlar nadir görülür ve genellikle asemptomatiktir. Bununla beraber lokalizasyonuna göre klinik belirti verebilirler. Bu sunumda baş ağrısı şikayeti ile başvuran ve perikallozal lipom tanısı konan olgunun Manyetik Rezonans Görüntüleme (MRG) bulgularını sunmayı amaçladık. Gereç ve Yöntemler: Baş ağrısı şikayeti olan 14 yaşındaki kadın olguya MRG tetkiki yapıldı. Bulgular: Hastanın yapılan MRG tetkikinde perikallozal alanda yaklaşık 45 mm uzunluğunda, en kalın yerinde 6 mm çapında ölçülen T1 ve T2 ağırliklı görüntülerde hiperintens lipom ile uyumlu lezyon izlendi. Ayrıca korpus kallozum hafif hipoplastik görünümdeydi. Sonuç: İntrakranyal lipomlar oldukça nadir görülen ve genellikle insidental olarak saptanan benign kitlelerdir. Genel olarak semptom vermezler. Semptomatik olduklarında yerleşim yerine göre değişmekle birlikte baş ağrısı, baş dönmesi, nöbet, ataksi, işitme azlığı veya kaybı gibi belirtiler görülebilir. İntrakranial lipomların beyinde en sık görüldüğü bölge perikallozal alandır. Diğer sık görüldüğü lokasyonlar sırasıyla kuadrigeminal sisterna, suprasellar sisterna ve serebellopontin köşelerdir. İntrakranyal lipomlar en sık korpus kallozum disgenezisi olmak üzere septum pellusidum agenezisi, kranyum bifidum, spina bifida, ensefalosel, myelomeningosel, hipoplastik vermis ve kortikal malformasyonlar gibi santral sinir sistemi anomalileri eşlik edebilir. Kranyal BT ve MRG bulguları karakteristik ve patognomiktir. BT’de lipomlar homojen yapıda, düzgün sınırlı, kontrast tutmayan, hipodens kitle olarak görülürler. MRG’de ise T1 ağırlıklı sekanslarda belirgin hiperintens, T2 ağırlıklı sekanslarda hiperintens, kontrast tutmayan, homojen yapıda kitlelerdir. Yağ baskılı sekanslarda sinyal kaybı gözlenir, ancak FLAIR sekanlarda sinyal kaybı görülmez. Ayrıca intrakranyal lipomlar dermoid kistler ve teratomlar ile karışabilir. Dermoid kistler ve teratomlar MR incelemelerinde sinyal yoğunluğu lipomların tersine sıklıkla heterojen olarak görülür. Perikallozal lipomlar iki alt gruba ayrılırlar. Tubulonodüler tip; daha sık görülen bu tip 2 cm’den küçük nodüler lezyonlarla karakterizedir, posterior veya sıklıkla anterior lokalizasyonda bulunur. Anterior yerleşimli olan tipinde; lipomun kendisinden ziyade eşlik eden frontofasiyal anomaliler semptomlardan sorumludur ve nispeten daha kötü olan formu budur. Eğrisel (curvilinear) tip lipomlar ise; daha nadir görülür, genellikle posteriorda yerleşen, 1 cm’den ince, ekstansif uzanan, asemptomatik kitlelerdir. Bu S50 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı tip lipomlarda korpus kallozum hipoplazik olabilmektedir. Bizim olgumuz eğrisel tip lipom ile uyumlu olup korpus kallozum dizgenezisi eşlik etmektedir. Genellikle tedavi gerektirmemekte ya da semptomatik tedavi ile hastalar takip edilmektedir. İlerleyen semptomatik olgularda; kitlenin büyümesi, intrakraniyal basınç artışı ve hidrosefali gelişmesi halinde cerrahi düşünülmelidir.

P - 066 UVEAL MELANOMA: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI GÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, MUSTAFA YEŞİLYURT, GÖKHAN POLAT, MECİT KANTARCI, AKIN LEVENT Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Uvea melanomu erişkinlerde en sık görülen birincil göz içi kanser türüdür. Uveal melanoma açık tenli ve açık renkli gözlü bireylerde daha sık görülür.Görülme sıklığı USA de milyonda 7 ‘dir. Etyolojide genetik predispozisyon, okulomelanositik lezyonlar, açık renkli iris, sigara suçlanmaktadır.Sıklıkla altıncı dekantta ortaya çıkar. Çoğunlukla tesadüfen yakalanır, genellikle asemptomatik olup mevcut semptomlar; görme keskinliğinde azalma, görme alanında kayıp, retina dekolmanına bağlıdır. Tüm uveal melanomların yaklaşık% 90ı koroidi tutar, geri kalanı siliyer cisim veya irisde ortaya çıkar. Zamanında tedavi edilmediğinde, hastalarda total görme kaybı gelişebilir. Tümör genişleyip bruch membranını rüptüre edince mantar benzeri bir kitle görünümü ortaya çıkar ve sekonder eksudatif retina dekolmanı sık eşlik etmektedir. Oküler tümörün başarılı bir şekilde ortadan kaldırılmasına rağmen, hastaların% 50sine kadar metastatik hastalık gelişir, bu metastatik hastalık genellikle karaciğer içerir. Metastazları hedefleyen etkili bir terapinin henüz mevcut olmadığı için semptomların başlamasından 1 yıl içinde ölümcüldür. Bulgular: 65 yaşında erkek hasta; sağ gözünde 2 günden beri yabancı cisim hissi, baş ağrısı, bir aydan beri farkettiği görme azalması yakınmalarıyla göz polikliniğne basvurdu. Çekilen orbita MRG’de; sağ glob süperomedial konturunda T1A kesitlerde hiperintens,T2A ve FIR sekansta hipointens, kontrastlı kesitlerde belirgin kontrast tutulumu gösteren yklaşık 11x8 mm boyutlarında nodüler tarzda glob içine uzanan sklera invazyonu olmayan kitle tespit edildi. Uveal melanom olduğu düşünüldü. Tartışma: Uveal melanom düşünülen hastalarda ayırıcı tanıda; geniş koroidal nevus, lokalize koroidal hemanjiom, metastatik tümör, retina dekolmanı, posterior sklerit düflünülmesi gereken patolojilerdir. Tanıda US çok önemli yer tutar basit, ucuz olması açısından ilk başvurulan tetkiktir. Kitlenin büyüklüğünü, lokalizasyonunu verir. BT ve MRG kitle büyüklüğü lokalizasyonu yanısıra; sklera invazyonu, periokuler yayılımını daha ayrıntılı değerlendirir. Uveal melanom en sık karaciğer olmak üzere, akciğer, kemik, optik sinir ve meninksine metastaz yapmaktadır. Uveal melanom tanısı alan hastalarda özellikle bu organlara yönelik metastaz taraması yapılmalıdır.

P - 067 OLGU SUNUMU: FATAL DEV KRANİOFARİNGİOMA İBRAHİM SÜLKÜ, ÇİĞDEM ÖZER GÖKASLAN, EMİN DEMİREL Afyon Kocatepe Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Afyonkarahisar, Türkiye Özet Kraniofaringiomalar, Rathke kesesi artıklarındaki skuamöz epitelden gelişen, genellikle sellar/suprasellar bölgeye yerleşen benign tümörlerdir. Yerleşim yerleri itibari ile genellikle endokrin disfonksiyonlar ve görme bozuklukları ile prezente olurlar. Önemli nörovasküler yapılara kom- şulukları gösterirler. Bizim olgumuzda hasta, başta görme bozuklukları olmak üzere eşlik eden hormonal disfonksiyon bulguları ile başvurdu. Yapılan MR tetkikinde sellar ve suprasellar bölgeyi tamamen dolduran, sol orbital apekse ve interhemisferik fissüre uzanan, mesencephalon ve ponsu ekspanse eden, komşuluğunda yer alan bilateral internal karotid arterlerin kavernöz ve supraklinoid segmentlerini saran yaklaşık 7x6x6 cm boyutlarda, içerisinde kalsifikasyon odakları bulunan, heterojen kontrastlanan dev boyutlu kitle saptandı.

P - 068 OLGU SUNUMU: KARSİNOMA EX PLEOMORFİK ADENOM TANILI HASTADA PERİNÖRAL KAFA TABANI YAYILIMI İBRAHİM SÜLKÜ, ÇİĞDEM ÖZER GÖKASLAN, EMİN DEMİREL Afyon Kocatepe Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Afyonkarahisar, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S51

Özet Pleomorfik adenom, tükürük bezi tümörleri arasında en sık rastlanılandır. Pleoformik adenom vakalarında cerrahi tedaviden sonra nüks rastlanmakta ve 1-45 yıl arasında nüks ortaya çıkabilmektedir. Bu tümörlerde malign transformasyon nadir bir durum olup olguların yaklaşık %2.5-3’ünde görülmektedir. Karsinoma ex-pleomorfik adenom olarak adlandırılan malign tip sıklıkla uzun süreli veya nüks durumlarında görü- lebilmektedir. Bizim olgumuzda pleomorfik adenom cerrahisi sonrası 3.yılda operasyon bölgesinde karsinoma ex pleomorfik adenom saptandı. Yapılan takiplerde sellar ve suprasellar bölgeyi dolduran, bilateral internal karotid arterlerin kavernöz segmentlerini tamamen saran, sol orbital apekse uzanan ve sol superior oftalmik veni basılayan perinöral yayılımlı metastatik kitle saptandı.

P - 069 NADİR BİR OLGU: İNTERHEMİSFERİK FİSSÜR EPİDERMOİD KİSTİ FATMA DURMAZ, HARUN ARSLAN, SÜMEYRA DEMİRKOL ALAGÖZ, MESUT ÖZGÖKÇE Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Van, Türkiye Özet Amaç: İntrakranial epidermoid kistler benign, yavaş büyüyen konjenital inklüzyon kistleridir. Primer intrakranial tümörlerin %0.2-1.8’ini oluştu- rur ve en sık serebellopontin köşe sisterninde yerleşir. İnterhemisferik fissürden kaynaklanana epidermoid kist nadirdir. Frontal bölgede interhemisferik yerleşimli epidermoid kist olgusunu Beyin MR bulguları ile beraber sunmayı amaçladık. Gereç ve Yöntemler: 28 yaşında erkek hasta uzun süredir olan baş ağrısı şikayetiyle başvurdu. Nörolojik muayene ve laboratuar bulgularında özellik izlenmedi. Kliniğimizde yapılan kontrastlı beyin MRG’de frontal bölgede interhemisferik alanda, solda parankime ve korpus kallozum korpusuna bası yapan, hafif heterojen, T1AG’de BOS ile izo-hiperintens, T2AG’de BOS ile izointens, FLAIR’de tam baskılanmayan, IVKM sonrası kontrast tutmayan, Difüzyon ağırlıklı görüntülerde kısıtlanma gösterenkistik lezyon izlendi.Mevcut bulgularla Epidermoid Kist tanısı kondu. Bulgular: İntrakranial epidermoid kistler benign,yavaş büyüyen konjenital inklüzyon kistleridir.Primer intrakranial tümörlerin %0.2-1.8’ini oluş- turur.En sık serebellopontin köşe sisterninde yerleşir (%40-50), buranın schwannom ve menegiomdan sonra en sık üçüncü kitlesidir.Ardından suprasellar sisterna, silviyan sisterna ve pineal bölge gelir.İnterhemisferik fissürden kaynaklanan epidermoid kist nadir olup, tüm intrakranial lokasyonların yaklaşık %4’ünü oluşturur.Klinik bulgular lezyonun kitle etkisine ve lokalizasyonuna bağlıdır.Sıklıkla asemptomatiktir, semptomatik olgularda işitme kaybı ve baş ağrısı görülür.Supratentoryal lezyonlarda nöbet sıklığı artmıştır.MR hastalığın tanısı, tedavi planı ve takibi açısından seçilmesi gereken görüntüleme yöntemidir.Epidermoid kistlerin çoğunlu T1 ve T2’de BOS’a göre izointens yada hafif hiperintenstir.FLAIR’de tam olarak baskılanmaz ve düfüzyon ağırlıklı görüntülerde kısıtlanır.Çoğunlukla kontrastlanma izlenmez, yaklaşık %25 vakada minimal rim tarzında kontrastlanma izlenebilir. Sonuç: Epidermoid kistlerin tanısında, özellikle bazı sekanslarda araknoid kist ile karışması nedeniyle, MR seçilmesi gereken görüntüleme yönte- midir.Özellikle difüzyon ağırlıklı görüntüler ayırıcı tanı yapmada faydalıdır.İnterhemisferik yerleşimli kistik lezyonların ayırıcı tanısında epidermoid kist akılda tutulmalıdır.

P - 070 ABDOMİNAL AORT STENOZUNA SEKONDER GELİŞEN HİPERTANSİF HASTADA PRES SENDROMU MEHMET KARAGÜLLE 1, SAMET ŞİMŞEK 1, SÜLEYMAN ÖNCÜ 1, FATMA ZEYNEP ARSLAN 2, İSMAİL ŞERİFOĞLU 1 1 Bağcılar Eğitim Araştirma Hastanesi, İstanbul, Türkiye 2 Konya Eğitim Araştırma Hastanesi, Konya, Türkiye Özet Giriş: Posterior reversible ensefalopati sendromu (PRES); nöbet, baş ağrısı, görme bozuklukları ve konfüzyon gibi bulgular ile karakterize bir antite olup tanısı klinik ve radyolojik bulguların bir araya getirilmesi ile konulur. Bilinen en sık nedenleri; hipertansiyon, sitotoksik ilaçlar, preeklampsi, eklampsi, böbrek yetmezliği ve bazı sistemik hastalıklardır. Olgu Sunumu: Bizim olgumuzda 14 yaşında erkek hasta 2 aydır aralıklı baş ağrıları nedeniyle hastanemize başvurdu. Hipertansiyon saptanan hastada antihipertansif tedavi başlandı. Tedaviye rağmen tansiyon kontrolü sağlanamaması üzerine renal arter stenozu açısından renal renkli dopler inceleme istendi. RDUS incelemede renal arter stenozu saptanmadı ancak infrarenal düzeyde abdominal aortta anlamlı darlık saptandı. Sonrasında çekilen BTA incelemede infrarenal düzeyde aortta belirgin darlık izlendi. Hastanın yatışı esnasında nöbet geçirmesi üzerine çekilen kranial BT’de her iki paryetooksipital lobda kortikosubkortikal alanlarda hipodansite ve sonrasında kranial MR’da solda belirgin olmak üzere her iki paryetooksipital lobda kortikosubkortikal alanlarda ve korona radiyatada T2A/FLAİR incelemede sinyal artışı izlendi.Bunun üzerine PRES tanısı konuldu. Sonuç: PRES’in patofizyolojisi tam bilinmemekle beraber hipertansiyon sonucu değişik mekanizmalarla gelişen vazojenik veya sitotoksik ödem- den kaynaklandığı düşünülmektedir. PRES’te en iyi görüntüleme yöntemi FLAİR sekansı ve difüzyon ağırlıklı görüntülemedir(DAG). FLAİR S52 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı sekanslarda paryetal ve oksipital bölgede kortikal subkortikal alanlarda, bilateral bazal gangliyonlar,pons ve serebellar bölgelerde sinyal artışı izlenmektedir. DAG ile sitotoksik ve vazojenik ödem ayrımı yapılabilir. Ayrıca DAG iskemi ile komplike olan PRES olgularını ayırt etmemizi sağlar. PRES, tanı ve tedavide gecikme sonrası iskemi ve kalıcı nörolojik defisitlere yol açabilmesi nedeniyle etyolojik faktörleri ve klinik şüphesi bulunan hastada kranial MR çekilerek erken tanı alması önem arzetmektedir.

P - 071 İZOLE TROKLEAR SİNİR PARALİZİSİ: MR BULGUSU FATMA UYSAL, MUSTAFA REŞORLU Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi, Çanakkale, Türkiye Özet Amaç: Troklear sinir paralizisi okuler hareketleri etkileyen en sık izole kranial nöropatidir. Hastalarda aşağı bakış sırasında, özellikle de merdiven inerken veya eğilirken çift görme şikayeti mevcuttur. Troklear sinir paralizisinin %5’i izoledir. En sık neden konjenital olup, edinsel nedenler arasında sıklıkla travma olmak üzere hemoraji, tümör, vasküler malformasyon, enfeksiyon ve demiyelinizan hastalık gibi bir çok nedeni olup iskemik nedenlere bağlı olgular nadirdir. Bu olgu sunumunda beyin sapı iskemisine bağlı gelişen izole troklear sinir paralizisine ait MR görüntülerini sunduk. Olgu Sunumu: 53 yaşında erkek hasta yaklaşık 2-3 haftadır merdiven inip çıkarken çift görme şikayeti nedeniyle başvurdu. Göz polikliniğindeki kranial sinir muayenesinde sol gözde aşağı bakışta hafif kıstlılık mevcutken hasta bu esnada çift görme şikayeti olduğunu belirtti. Diğer kranial sinirlerin muayenesi olağandı. İzole troklear sinir paralizisi saptanan olguya orbita MR istendi. Özgeçmişinde hipertansiyon, koroner arter has- talığı mevcuttu. Orbita MRG’de pons sol parasantral alanda T1 ağırlıklı aksiyal görüntülerde belirgin hipointens ve T2 ağırlıklı aksiyal-sagittal görüntülerde hiperintens görünüm ile karakterize kronik laküner infarkt alanı izlendi. Hastada pons iskemisine sekonder troklear liflerin tutulumuna bağlı ipsilateral 4. kranial sinir paralizisi düşünüldü. Tartışma: Obliquus süperior kasının motor siniri olan troklear sinirin motor çekirdeği mezensefalonda bulunur ve nükleusu karşı taraf gözü aşağı-dışa baktırır. Troklear nükleus inferior kollikulus seviyesinde mezensefalon tegmentum düzeyinde bulunur ve lifleri aquaduk kanalı çevresin- de posterolaterale ilerleyerek superior medullar velum düzeyinde çaprazlaşır ve kontralateral superior oblik kasını innerve eder. Troklear sinir paralizisi okuler hareketleri etkileyen en sık izole kranial nöropatidir. Troklear sinir paralizisinde göz aşağı-dışa bakamaz, bu hareket esnasında hastanın gözü içe kayar ve vertikal diplopi meydana gelir. Hastalar sıklıkla merdiven inip çıkarken yada kitap okurken çift görmeden şikayet ederler. Sonuç: Pozisyonel vertikal çift görme şikayeti olan hastalarda troklear sinir felci ve nadir bir nedeni olan beyin sapı iskemi de düşü- nülmelidir.

P - 072 ERİŞKİN HASTADA DYKE DAVİDOFF MASSON SENDROMU SİNAN ÜLGEN, AYŞE EDA PARLAK, MEHTAP BARÇ ERGÜN, ABDULLAH ŞÜKÜN, BERNA AK YILDIZ Sağlik Bilimleri Üniversitesi Antalya Eğitim ve Araştırma Hastanesi, Antalya, Türkiye Özet Dyke Davidoff Masson sendromu nadir görülen bir durumdur. Sendrom klinik olarak yüzde asimetri, hemipleji yada hemiparezi, mental retardasyon, sensorinöral işitme kaybı, psikiyatrik bozukluklar yada epilepsi ile karakterizedir. Radyolojik olarak serebral hemiatrofi, tek taraflı kranial kemiklerde kalınlaşma, paranasal sinüslerde genişleme ve artmış havalanma görülür. Depresyon ve anksiyete bozukluğu bulunan 39 yaşında bir kadın hastada MRI görüntülerinde sol frontal bölgede ılımlı atrofi, komşu kranial kemikte kalınlaşma ve frontal sinüs sol tarafında genişleme mevcut olup hastanın klinik ve radyolojik bulguları dyke davidoff masson sendromunu desteklemektedir.

P - 073 BETA-TALASEMİ MAJÖR TANILI HASTADA HİPOFİZDE DEMİR BİRİKİMİ: MRG BULGULARI HASAN ERDOĞAN, MEHMET SEDAT DURMAZ, FATMA ZEYNEP ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, SERDAR ARSLAN Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S53

Özet Beta-talasemi majör, hemoglobinin yapısındaki ß-zincirinde kalıtsal bozukluk ve bunun bağlı inefektik eritropoez ile karakterize hemolitik bir anemi türüdür. Beta-talasemi majörün konvansiyonel tedavisi düzenli kan tranfüzyonudur. Fakat bu durum çeşitli organlarda demir birikimine yol açmaktadır. Anterior hipofizde demir birikimi, bu hastalarda görülen en sık endokrin komplikasyon olup, gecikmiş puberteye ve hipogonadot- ropik hipogonadizme neden olur. Manyetik rezonans görüntüleme (MRG) demirin paramanyetik etkisi sayesinde organlardaki demir birikimini göstermede etkilidir. Bu sunumda beta-talasemi majör tanısı olan 22 yaşındaki erkek olgunun hipofiz MRG bulguları sunulmuştur.

P - 074 TERM YENİDOĞANDA HİPOKSİK İSKEMİK ENSEFALOPATİ: MRG BULGULARI HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, FATMA ZEYNEP ARSLAN, MEHMET SEDAT DURMAZ, MERAL BÜYÜKTERZİ Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Hipoksik iskemik ensefalopati (HİE), intrapartum serebral hipoksi veya geç antepartum serebral hipoksi ve iskeminin neden olduğu, akut, ilerleyici ensefalopati tablosudur. HİEyi en erken gösteren radyolojik görüntüleme yöntemi difüzyon manyetik rezonans görüntüleme (MRG)dir. Bu sunumda uzamış doğum eylemi öyküsü olan ve HİE saptanan 7 günlük term bebekte beyin MRG bulguları sunulmuştur.

P - 075 HİPOKAMPÜS YERLEŞİMLİ DNET OLGUSU: MRG BULGULARI HASAN ERDOĞAN, FATMA ZEYNEP ARSLAN, SERDAR ARSLAN, MEHMET SEDAT DURMAZ, SEDA SOĞUKPINAR KARAAĞAÇ Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Disembriyoplastik nöroepitelyal tümör (DNET), çocuk ve genç erişkinlerde görülen, nadir, genellikle benign, glial-nöral kortikal bir neoplazmdır. Tipik olarak dirençli nöbetlere sebep olurlar. DNET, supratentorial korteksin herhangi bir bölgesinde olabilir, fakat temporal lobda daha sık görülür. DNETli hastalarda total rezeksiyon etkili bir tedavi yöntemidir. Bu sunumda 38 yaşında dirençli nöbetleri olan erkek olguda, hipokampal yerleşimli DNETin manyetik rezonans görüntüleme (MRG) bulguları sunulmuştur.

P - 076 İSKEMİK STROKE SONRASI SANTRAL DİABETUS İNSİPUTUS VAKA TAKDİMİ FATMA ZEYNEP ARSLAN, SERDAR ARSLAN, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, VEFA ÖNER Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Beyin iskemik enfarktüsünü takiben santral diyabet insipidus nadir görülen bir durum olarak tanımlanmıştır. Posterior hipofizier alanı etkileyen iskemi de idiyopatik santral diabetes insipidusun olası bir nedeni olarak kabul edilmiştir. Biz MRG incelemede Sağ ICA kavernozal segmentte ve inceleme alanına giren petrozal segmentlerde sinyal- void kaybı ve total oklüzyona bağlı yaygın iskemik enfarkt saptanan, Desmopressin tedavisi gerektiren santral diabetes insipidusa bağlı geçici poliüri gelişen hastamızın bulgularınız sunduk.

P - 077 NADİR BİR OLGU: HİPERGLİSEMİYE BAĞLI HEMİKORE MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, SERDAR ARSLAN, HASAN ERDOĞAN, ZEYNEP ARSLAN Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye S54 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Hiperglisemiye bağlı hemikore genelde uzun süre iyi kontrol edilemeyen, sıklıkla diyabetli ileri yaşta kadın hastalarda görülen, MRG T1 ağırlıklı görüntülerde bazal ganglia parlamalarının nadir sebeplerinden biridir. Kliniğinde koreiform hareketlerle giden non-ketotik hiperglisemiye bağlı hemikore ve hemiballizmin nasıl geliştiği tam olarak bilinmemektedir. Bununla ilgili bazı hipotezler ortaya atılmıştır. Bunların arasında bazal gangliyonlarda GABA’nın azalması, hiperglisemiye bağlı striatumda dopaminerjik aktivitenin artması, hipervisköziteye bağlı kan-beyin bariyerinin hasarlanması ve striatumda oluşabilecek peteşiyal kanamalar ya da enfarktlar vardır. Kan şekerinin regülasyonu sonrasında önce klinik daha sonraki takiplerinde görüntüleme bulgularında düzelme izlenebilmektedir. Biz de benzer bir vakayı sunmayı amaçladık. 15 yıldır tip 2 diyabetes mellitus tanısıyla insülin tedavisi alan 65 yaşındaki erkek hasta kliniğe bilinç bulanıklığı, denge kaybı ile başvuruyor. Yapılan laboratuar tetkiklerinde kan şekeri 500 mg/dl, HbA1c %17 saptandı. Çekilen beyin MRG incelemede bilateral puta- mende T1 ağırlıklı görüntülerde sinyal intensite artışları saptandı. T2 ağırlıkı görüntülerde bu bölgeler kısmen hipointens izlendi. Hastanın hikayesinden diyabetinin kontrolsüz olduğu öğrenildi. Anamnezinde bilinen başka bir hastalığının olmadığı ve toksik hasara maruz kalmadı- ğı öğrenildi. Bu bulgular eşliğinde hastada non ketotik hiperglisemiye bağlı nörolojik bulguların geliştiği düşünüldü. Kan şekeri regülasyonu sonrasında hastanın klinik bulgularında hızla düzelme saptandı. Non-ketotik hiperglisemiye bağlı hemikore genelde uzun süre iyi kontrol edilemeyen diyabetli hastalarda görülür. Radyolojik incelemede ise T1 ağırlıklı görüntülerde striatumda hiperintensite görülmesi tipiktir. Ayırıcı tanıda bazal ganglia düzeylerine hasar veren ve toksik etki yapan metabolizmalar düşünülmelidir. Hastanın anamnezi ile maruzi- yetleri ve bilinen hastalıkları değerlendirilerek ayırıcı tanı yapılmalı ve takip edilmelidir.

P - 078 SEPTO-OPTİK DİSPLAZİ: VAKA TAKDİMİ FATMA ZEYNEP ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, SERDAR ARSLAN, HASAN ERDOĞAN, HATİCE KIVRAK Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Giriş: Septo-optik displazi (SOD), Morsier sendromu olarak da adlandırılan nadir olarak karşılaşılan bir hastalıktır. Optik sinirde hipoplazik görünüm, septum pellusidumun MRG incelemede izlenememesi ve hipotalamo-hipofizier disfonksiyon ile karakterizedir. Kadın ve erkekler eşit olarak etkilenmektedir. Etkilenen hastalarda şizensefali birlikteliği sıklıkla karşımıza çıkmatadır. Klinik olarak hipotalamo-hipofizier yetmezlik, neonatal hipoglisemi eşlik eden kortikal displazilere bağlı olarak bilişsel fonksiyonlarda zayıflık izlenebilir. Olgu Sunumu: 1 yaşındaki kadın olgu erkek hasta sağ gözde görme kaybı, sol gözde bulanık görme şikayeti ile kliniğimize başvurdu. Hastamıza çekilen beyin MRG incelemede; bilateral optik sinir özellikle süperior orbital fissür düzeyinde ve kiazma seviyesine kadar normalden ince izlendi. Optik kiezma izlenmedi ve nörohipofiz bezine ait T1Ada sinyal artışı net olarak ayırt edilemedi. Ayrıca hastamızda hipofiz infindibulumu normalden ince izlenmekteydi. Bilgisayarlı tomografide (BT); genişlemeiş lateral ventriküller, septum pellusidumun izlenmemesi, eşlik eden şizensefaliye ait görünüm ve sığ optik foraminaya ait görünüm izlenebilir. Tanı için en etkili tetkik beyin MRG’dir. BT’de izlenilen bulgulara ek olarak MRG’de; nörohipofiz bezine ait sinyalin net olarak seçilememesi, eşlik eden kortikal displazilere ait korteks görünümü, hipoplastik optik kiazma izlenebilir. Sonuç: Sonuç olarak (SOD); nadir olarak izlenilen, radyologların çok aşina olmadığı önemli bir antitedir.

P - 079 KAPİLLER TELENJEKTAZİ TANISINDA SWI SEKANSININ ÖNEMİ: OLGU SUNUMU MEHMET SEDAT DURMAZ, SERDAR ARSLAN, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, ZEYNEP ARSLAN, İSMET TOLU Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye Özet Kapiller telenjektazi (KT) küçük, dilate, normal beyin parankimi içerisinde ince duvarlı dilate kapiller topluluğu tarafından oluşturulan vasküler malformasyonlardır. En sık pons, serebellum ve spinal kord yerleşimi gösterirler. Kanama beklenen bir komplikasyon olmamakla birlikte kaver- nomalara eşlik edebilirler. Kanama olmadığı sürece ödem ve kitle etkisi saptanmaz. BT incelemede özellikle kontrast madde uygulanmazsa genellikle seçilemezler, zayıf hipodens olarak izlenebilirler. MRG’de T2A ve FLAIR sekanslarda bazen hiperintens odaklar şekilde görülebilirler. Kontrastlı MRG serilerinde silik kontrastlanır. Santralinde kontrast tutan lineer drenaj veni görülebilir. T2* GRE ve SWI sekanslarda belirgin hipointens karakterde olmakla birlikte özellikle eşlik eden kavernöz malformasyonları tanımlamada faydalı sekanslardır. KT ayırımın zor olduğu durumlarda SWI ve T2* GRE gibi MR sekansları yararlıdır. Serebral hemisferde yerleşim gösteren KT ile uyumlu lezyonun MRG, MR spektroskopi, perfüzyon ve SWI görüntüleme bulgularını sunmayı amaçladık. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S55

Başağrısı şikayeti ile başvuran 24 yaşındaki erkek hastaya beyin MRG tetkiki yapıldı. Solda bazal ganglionlar komşuluğundan periventriküler alana uzanım gösteren T1 sekanslarda hipointens, T2 ve FLAIR sekanslarda zayıf hiperintens lezyonda kontrast tutulumu mevcuttu, ancak lezyon düzgün sınırlı olup perilezyonel ödem izlenmedi. MR spektroskopi ve perfüzyon MRG tetkikleri istendi. Lezyonda artmış perfüzyon mevcuttu. Lezyon büyük büyütmede incelendiğinde T2 sekanslarda noktasal sinyal alanları ve kontrastlı incelemede bu alanlarda daha fazla kontrastlanma dikkat çekti. Çekilen SWI sekansında lezyonun belirgin hipointens izlenmesi üzerine KT tanısı kondu. T2 ve FLAIR sekanslarda hiperintens odaklar izlenmesi, lezyon çevresinde ödem izlenmemesi KT’yi düşündürmelidir. MR spektroskopi ve perfüzyon incelemeleri gereksiz olup kafa karışıklığına neden olur. SWI sekansında belirgin hipointens karakterde olması tanı koydurucudur.

P - 080 LİPOMYELOMENİNGOSEL MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI MEHMET SEDAT DURMAZ, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, SERDAR ARSLAN, ZEYNEP ARSLAN, İSMET TOLU Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet Lipomyelomeningosel görülme sıklığı yaklaşık 1/4000 doğum olup, kız çocuklarında daha sık izlenir. Lipomyelomeningosel, gerçek bir myelomeningosel veya açık spinal disrafizm değildir. Okült spinal dısrafizmler grubunda incelenen kompleks nöral tüp gelişim kusurudur. Anomali, omurilik üzerine yaptığı kitle etkisi ve omuriliği germesine bağlı klinik tablolar yaratır. Morfolojik olarak, konus medullaris ve kauda ekuina lifleri ile olan anatomik ilişkisine göre lipomyelomeningoselin dorsal, kaudal ve tranzisyonel olarak üç farklı tipi tanımlanmıştır. Bu sunumda kaudal tip lipomyelomeningoselin MRG bulgularını mevcut literatür bilgileri eşliğinde sunmayı amaçladık. Yürüyememe şikayeti ile gelen 19 yaşındaki erkek hastaya çekilen lumbosakral MRG’de, lumbosakral bölgede orta hatta olan, T1 ve T2 sekanslarda hiperintens olarak izlenen lipom kitlesinin spina bifida kemik defektinden geçerek durayı katettiği ve omuriliğin distal bölümü olan konus medüllaris ile devamlılık gösterdiği izlendi. Konus medullaris aşağı yerleşimli olup posteriorda gergindi. Lipom devamlılığında kauda equina liflerinin devamlılığı izlenmemiş olup lipomyelomeningosel içinde sonlanmaktaydı. Lumbosakral vertebralarda posteriorda füzyon defekti (spina bifida) mevcuttu. Lipom posteriorda cilattına doğru uzanım göstermekte olup omuriliğin distali olan konus, filum terminale ve kauda ekuina liflerini etkilemekteydi. MRG bulguları ile kaudal tip lipomyelomeningosel tanısı kondu. MRG tüm kapalı spinal disrafizm bozukluklarında olduğu gibi lipomyelomeningosel tanısında da en sık kullanılan ve en geçerli yöntemdir. MRG incelemesinin aksiyal, koronal ve sagittal planlarda görüntüleri lipomyelomeningoselin omurilik ile olan ilişkisini her üç planda ortaya koyabilmesi açısından önemlidir. MRG’de aşağı yerleşimli konus, dorsale doğru lipoma uzanan kauda equina lifleri, sinir köklerinin lipom içinde ve dışında seyri, lipomun dorsalde ekstradural alana geçişi, vertebra posterior elemanlarında füzyon defekti gösterilebilir.

P - 081 QUADRİGEMİNAL SİSTERN YERLEŞİMLİ LİPOM: OLGU SUNUMU MEHMET SEDAT DURMAZ, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, SERDAR ARSLAN, ZEYNEP ARSLAN, İSMET TOLU Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Konya, Türkiye Özet Lipomlar en sık görülen iyi huylu tümörlerdendir ve vücudun birçok yerinde izlenebilir. Ancak, beyin lipomları oldukça nadirdir. Tüm beyin tümörlerinin %0,46-%1’ini teşkil eder. Görülme sıklığı otopsi serilerinde %0,08-%0,2 arasında değişir. Beyin lipomları geçmişte iyi huylu tümör olarak tanımlanmıştır ancak günümüzde doğumsal malformasyon olarak kabul edilmektedir. Genellikle radyolojik incelemelerde rastlantısal olarak saptanır, büyük kısmı orta hatta yakın beyin yapılarında yerleşir ve bazen eşlik eden anomaliler izlenebilir. Beyin lipomlarının yaklaşık %50’si perikallozal sisternada yerleşir. Diğer yerleşim yerleri sıklık sırasıyla ambient ve quadrigeminal sistern (%25), suprasellar-interpedinküler sistern (%15), serebellopontin açı sisternası (%10), süperior serebellar ve silvian sistern (%5)’dir. Nadir olarak serebral hemisferlerin yüzeyinde de bulunabilir. Bu sunumda quadrigeminal sistern yerleşimli kalsifiye lipomun bilgisayarlı tomografi (BT), kontrastlı manyetik rezonans görüntüleme (MRG), MR spektroskopi ve perfüzyon MRG bulgularını sunmayı amaçladık. Başağrısı şikayeti ile başvuran hastaya çekilen beyin BT’de quadrigeminal sistern yerleşimli kalsifik komponenti de olan kitle izlendi. Bu aşamada lipom tanısı için yeterli bulgular mevcut olduğu halde, (kitlenin dansite değerleri lipom ile uyumlu olarak -40 ile -100 HU arasındaydı) kalsifiye kitle tanısıyla kontrastlı MRG tetkiki sonra- sında MR spektroskopi ve perfüzyon MRG tetkikleri, lipom tanısı akla gelmediği için gereksiz bir şekilde önerilmiştir. MRG’de kitlede kontrast tutulumu, perfüzyon MRG’de perfüzyon artışı izlenmedi. Spektroskopi incelemesinde kitlede lipid-laktat piki mevcuttu, diğer metabolitler izlenmedi. Beyin lipomları genellikle asemptomatiktir ve farklı nedenlerle yapılan beyin görüntülemesi sırasında tesadüfen bulunur. Beyin lipomlarının BT bulguları tanı koydurucudur. BT’de tanısal bulgular saptanırsa ileri incelemeye (MRG, MR spektroskopi, perfüzyon MRG gibi) gerek yoktur. S56 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı P - 082 AKCİĞER KANSERİNDE KAUDA EKUİNA METASTAZLARI, MRG BULGULARI MEHMET FATİH İNECİKLİ, MEHMET BEYAZAL, FATMA BEYAZAL ÇELİKER Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, Türkiye Özet Amaç: Akciğer kanserleri metastazları yüksek olasılıkla görülmektedir. Sıklıkla sürrenal gland, karaciğer, beyin ve kemiklere metastaz olmaktadır. Spinal kanalda ve özellikle kauda equina liflerine metastaz oldukça nadirdir. Bu bildiriyi sunmamızdaki amaç, akciğer kanserlerinde spinal kanal ve kauda equina liflerine metastazın gerçekleşebileceğine dikkat çekmektir. Gereç ve Yöntemler: 52 yaşında erkek hasta. Akciğer karsinomu (Ca) tanılı olgu. Bilateral alt extremitede önce uyuşma, sonrasında kas gücü kaybı gelişmiş. Daha ilerleyen zamanlarda yürüyememe durumu oluşmuş. Yapılan klinik muayenede belirgin kas gücü kaybı saptanıyor. Elde olunan kontrastlı Lumbal MR tetkikinde, intradural alanda cauda equina liflerinde multiple sayıda metastatik implant odakları saptanıyor. Sonuç: Akciğer kanserlerinde kauda equina liflerine metastazlar, görülme sıklığı az olmakla birlikte mümkündür. İmplant odaklarının etkilediği liflerin innerve ettiği odaklarda bulgular ortaya çıkar. Akciğer Ca tanılı olgularda, özellikle alt extremite ve pelvik bölgede patolojik bulgular varsa, spinal bölgede intradural cauda equina metastazları akılda tutulmalıdır.

P - 083 OLDUKÇA BÜYÜK BOYUTLARDA VE YAYGIN SEREBRAL ARTERİOVENÖZ MALFORMASYON OLGUSU LEVENT KARAKAŞ1, EVREN ALDEMİR2, ZİVER AYATA3 1 Tekirdağ Çerkezköy Devlet Hastanesi, Tekirdağ, Türkiye 2 Özel Egepol Hastanesi, İzmir, Türkiye 3 Özel Ege Yaşam Hastanesi, İzmir, Türkiye Özet Amaç: Sol serebral hemisferin büyük kısmını dolduran arteriovenöz malformasyon(AVM), eşlik eden diğer parankimal ve ekstraksiyel kompo- nentleriyle radyolojik olarak sunulmuştur. Sol orta kranial fossada 12 mm çapa ulaşan anevrizmatik dilatasyon göstermiştir. Sol serebral hemisferde Galen Veni’ne drene olduğu yerde en geniş yeri 10 mm çapa ulaşan dilatasyon göstermiştir. Süperiorda daha belirgin olmak üzere oftalmik venlerin de olaya katılması ve sol orta kranial fossada anevrizmatik dilatasyon görülmesi olguyu daha da atipik kılmaktadır. Olgumuz öncelikle Bilgisayarlı Tomografiyle görüntülenmiş olup AMV’nin yaygın yerleşimi nedeniyle subaraknoid kanama ayırıcı tanıda düşünülmüştür. Amacımız, oldukça büyük boyutlardaki ve yaygın yerleşimli serebral AVM olgusunun radyolojik bulgularını sunmaktır. Gereç ve Yöntemler: Şiddetli başağrısı ve progresif sağ hemipeji ile afazi ayrıca görme bulanıklığı bulgularıyla başvuran 48 yaşındaki erkek olgu. Laboratuvar bulguları normaldir. Görüntülemede, 16 dedektörlü bilgisayarlı tomografi (BT) cihazında 1 mm aksiyel kesitler ile bu kesitler üze- rinden yapılmış koronal ve sagital reformat imajlar incelenmiştir. 1,5 T Magnetik Rezonans (MR) cihazında 3, 5mm kesit kalınlığındaki, aksiyel T1, T2, FLAIR, SWI, koronal T2 ve sagital T1 imajlar incelenmiştir. Bulgular: Serebral AVM’ler, insidental olabileceği gibi intraserebral kanama, epilepsi ve başağrısı gibi nörolojik bulgular oluşturan patolojiler olarak, nöroradyoloji pratiğinde önemli yer tutarlar. Kapiller Telenjiektazi’den, atipik lokalizasyonlarda intraserebral hematom oluşturan intraksiyel ve kortekse bası oluşturan ekstraksiyel dev vasküler malformasyonlara uzanan oldukça geniş bir yelpazede görülebilirler. Anatomik yapılarla ilişkinin doğru saptanması, tedavi seçimi ve takip peryodunu belirlemede oldukça ödemlidir. Sonuç: Serebral arteriovenöz malformasyonlar sıklıkla insidental olarak saptanmakla birlikte bizim olgumuzda da olduğu gibi bazı durumlarda kronik semptomlarla progresif klinik seyir göstermekte ve oldukça büyük boyutlarda karşımıza çıkabilmektedir. Radyolojik parametrelerin doğru yorumlanması için genel nöroradyolojik görüntüleme algoritmasına uyulmalı ve girişim planı açısından raporda vasküler yapılar ayrıntılı tanımlan- malı ayrıca varsa ek radyolojik bulgular da belirtilmelidir.

P - 084 BİR OLGU EŞLİĞİNDE AKUT İSKEMİK İNME NEDENİ OLARAK İNTERNAL KAROTİD ARTER DİSEKSİYON GÖRÜNTÜLEME BULGULARI S. ŞENNUR BİLGİN Medipol Üniversitesi Tıp Fakültesi Hastanesi, İstanbul, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S57

Özet Amaç: Karotid arter diseksiyonu iskemik inme gelişiminde önemli rol oynar. Sıklıkla sağlıklı bireylerde spontan, şiropraktik manevralar ya da boyun manipülasyonları gibi travmalarla veya yatrojenik olarak ortaya çıkabilir. (1, 2) Biz bu posterde akut iskemik inme ile başvuran hastada iskemik inme nedeni olarak saptanan karotid arter diseksiyonu manyetik rezonans görüntüleme (MRG) ve manyetik rezonans anjiografi(MRA) görüntülerini sunmayı amaçladık. Gereç ve Yöntemler: 59 yaşında erkek hasta, konuşma bozukluğu bulgusuyla başvurduğu nöroloji polikliniğinden akut iskemi ön tanısı ile öncelikle diffüzyon MR görüntüleme için bölümümüze yönlendirilmiştir. Diffüzyon ağırlıklı görüntülerde sol frontal lobda medial serebral arter sulama alanında akut parsiyel enfarkt saptandı. Alınan T2 ağırlıklı aksiyal görüntülerde internal karotid arter ekstrakranyal segment distalinde duvar hematomu görülmesi üzerine optimal değerlendirilmesi için hastaya kranyal MRG ve servikal T2 A ve yağ baskılı T1 A ağırlıklı aksiyal sekanslar ile birlikte kranyal ve servikal MRA incelemeleri gerçekleştirilmiştir. Travma anamnezi olmayan hastada yapılan manyetik rezonans anjiografi ve boyuna yönelik alınan T2 ve yağ baskılı T1 ağırlıklı aksiyal görüntü- lerde sağ internal karotid arter ekstrakranyal segment distalinde duvar hematomunun eşlik ettiği %90-95 luminal daralma ile karakterize kısa segment diseksiyon tespit edildi. Sonuç: Diseksiyon her yaşta ortaya çıkabilir ancak genç hastalarda en sık inme nedenidir (45 yaş altı inmelerde % 20-25 arasında). Akut iskemik inmede neden olarak diseksiyon saptanması tedavi planlaması açısından çok önemlidir MRG, ekstrakranyal diseksiyonu tanımlamada daha yararlıdır. MRG mural hematomu göstererek diseksiyonu kanıtlar. MRA da noninvaziv bir yöntem olarak vasküler patolojilerin saptanmasında oldukça önemlidir (5). Yapılan bu incelemeler akut iskemik inme etyolojisini belirlemede, tedavi planlamasında ve komplikasyonların önlenmesinde oldukça önemlidir.

P - 085 TRAVMATİK LENS DİSLOKASYONU GİZEM TİMOÇİN, LÜTFULLAH SARI, ALPAY ALKAN Bezmialem Vakıf Üniversitesi Hastanesi, Radyoloji Anabilim Dalı, İstanbul, Türkiye Özet Göz küresi yaralanmaları ile acil servise başvuru tüm travmaların yaklaşık %3’üdür. Travma sonucunda kanama, retina veya koroid dekolmanı, göz küresi rüptürü ve lens dislokasyonu gözlenebilmektedir. Dislokasyon lensin zonüler liflerinde yırtılma sonucunda meydana gelir. Yine homosistinüri, Marfan, Ehlers Danlos ve Weil Marchesani sendromu gibi herediter hastalıklarda da dislokasyon görülebilir. Bu olgu sunumunda MRG (magnetik rezonans görün- tüleme) ve BT (bilgisayarlı tomografi) ile travma sonucunda vitreus posterioruna lens dislokasyonu saptanan bir olgu sunulmuştur.

P - 086 SLE’Lİ HASTADA SSS TUTULUMUNUN KRANYAL MRG BULGULARI MÜZEYYEN KALKAN, VASFİYE BÜRCEK, ALİ KOÇ, YASEMİN OKATAN Kayseri Eğitim ve Araştırma Hastanesi, Kayseri, Türkiye Özet Santral sinir sistemi lupusu, genellikle anjiyopatik orijinli olarak kabul edilir. Bunun dışında, doğrudan nöral otoimmun hasar, demyelinasyon ve tromboembolizm; SSS hastalığına neden olan diğer mekanizmalardır. Serebral iskemi ve enfarkt; antifosfolipid antikor sendromuna sekonder koagülopati, steroidlere bağlı akselere ateroskleroz, vaskülit veya Libman-Sacks hastalığının sebep olduğu kardiyojenik tromboemboliye bağlı gelişebilir. Nöroloji kliniğinde serebrovasküler hastalık tanısıyla takip edilen, 48 yaşında SLE’li bayan hastaya beyin MRG incelemesi yapıldı. Beyin MRG’de sağ frontotemporal bileşke, sağ temporal lob insular kesimde ve sol oksipital lob perikalkarin alanda kortikal-subkortikal beyaz cevheri içine alan, T1A heterojen hipo, T2A heterojen hiperintens, erken ve geç subakut enfarkt ile uyumlu lezyon alanları izlendi. Ayrıca splenium sol lateral kesimi ve perisplenial beyaz cevherde korpus kallozuma vertikal oryante hiperintens plak görünümleri mevcuttu.

P - 087 İZOLE BULBUS TUTULUMLU POSTERİOR REVERSİBL ENSEFALOPATİ SENDROMU: OLGU SUNUMU YUNUS EMRE ORUK 1, VELİ SÜHA ÖZTÜRK 1, EMİR HÜSEYİN NEVAİ 2, YELDA ÖZSUNAR DAYANIR 1 1Adnan Menderes Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Aydın, Türkiye 2Ağrı Patnos Devlet Hastanesi, Radyoloji Kliniği, Ağrı, Türkiye S58 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Giriş: Posterior reversible ensefalopati sendromu (PRES) baş ağrısı, konfüzyon, görme bozuklukları ve nöbetler ile karakterize, birçok etyolojik nedeni bulunan, sıklıkla geri dönüşümlü bir klinik durumdur. En yaygın sebep hipertansiyondur ve sıklıkla pariyeto-oksipital bölgelerde simetrik tutuluma neden olur. PRES’ in sadece bulbusa izole olması ise çok atipiktir. Olgu Sunumu: Preeklampsi tanısı bulunan 35 yaşındaki 27 hafta 4 günlük gebe olgumuz, görme bulanıklığı, baş ağrısı ve tansiyon yüksekliği şikâyetleri ile kurumumuza başvurdu. Özgeçmişinde hipertansiyon ve diyabeti bulunan olgunun kan basıncının normal değerlere düşürüleme- mesi üzerine sezaryen (C/S) planlandı. C/S sonrası sağ gözde midriazis gelişen olgunun elde olunan Beyin MRG tetkikinde, bulbus anterior kesiminde 2,5 cm uzunluğunda bir segmentte T2A ve FLAİR sekanslarda vazojenik ödem ile uyumlu sinyal artışı ve T1A sekansta sinyal kaybı izlendi. Difüzyon ağırlıklı görüntülerde difüzyon kısıtlılığı izlenmemekle birlikte, ADC görüntülerde bu alanda sinyal artışı mevcuttu. Postoperatif dönemde kan basıncı değerleri kontrol altınan ve 6. günde şikâyetleri büyük oranda gerileyen hastamızın bu dönemde çekilen Beyin MRG tetkiki önceki tetkiki ile karşılaştırıldığında bulbusda izlenen ödem bulgularının gerilediği saptandı. Tartışma: PRES, hipertansif ensefalopati, eklampsi, trombotik trombositopenik purpura ve immünsupresif ilaçlar ile tetiklenebilir. Ayırıcı tanıda iskemik inme, serebral venöz tromboz, vaskülit, reversibl postiktal ödem, mitokondriyal ensefalopatiler, ADEM, ensefalit, progresif multifokal lökoensefalopati ve prion hastalıkları göz önünde bulundurulmalıdır. Vertebrobaziler sistem nispeten adrenerjik sempatik innervasyondan yok- sundur ve posterior beyin bölgeleri, akut kan basıncının yükselmesi ile otoregülasyon mekanizmasına daha duyarlı hale gelir. Bizim olgumuzda bulbusta izlenen ödem bulguları ve MRG görüntülemede bulguların hızla gerilemesi PRES tanısını desteklemektedir. Sonuç: PRES in çeşitli radyolojik ve klinik bulguları olabilmektedir. Hipertansiyon ve eklampsi gibi tansiyon yüksekliği ile seyreden hastalığı bulunan olgularda, atipik MRG bulgularında dahi posterior reversible ensefalopati sendromu akılda bulundurulmalıdır. Diğer ön tanılar ile ayırıcı tanı yapılabilmesi noktasında klinik ve radyolojik takip oldukça yol gösterici olabilir.

P - 088 ERİŞKİNDE TETHEDERED KORD: 2 FARKLI OLGU MEHMET KARAGÜLLE 1, FATMA ZEYNEP ARSLAN 2, VEFA ÖNER 2, ZEYNEP KESKİN 2, DENİZ EKİNCİ 1, ÖZNUR FUNDA GELENGEÇ 1 1Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye 2Konya Eğitim ve Araştırma Hastanesi, Konya, Türkiye Özet Tethered kord sendromu (TKS), servikal ve torasik tutulum nadir olarak görülse de genellikle konus medullaris ve kauda ekinanın traksiyonu sonucu ortaya çıkan, progresif nörolojik defisitlerle karakterize klinik tablodur. TKS, kısa ve kalın filum terminale, diastometamyeli, meningom- yelosel, lipomyelomeningosel, spinal lipom ve dermal sinüs ile görülebildiği gibi tümör, araknoidit, travma ve spinal kanala yapılan cerrahi işlemler sonrası görülen yapışıklıklar nedeniyle de görülebilir. Kadınlarda erkeklere oranla daha sıktır. Genellikle çocukluk çağında görülmekle beraber yetişkinlerde de ortaya çıkabilir. TKS, yetişkinlerde asemptomatik olabilir ancak spinal travma, aşırı egzersiz ve tekrarlayan fleksiyon ekstansiyon hareketleri gibi durumlar semptomatik hale gelmesine yol açabilir. Klinik olarak belde, anorektal bölgede ve bacaklarda ağrı, güçsüzlük ve duyu kaybı, üriner ve fekal inkontinans, cilt lezyonları, skolyoz ve ayak bileği deformiteleri görülebilir. Bizim ilk olgumuz üriner inkontinans şikayetiyle gelen 49 yaşında kadın hastaydı. Çekilen spinal MR incelemesinde; lomber düzeyde skolyoz, T10 vertebrada kelebek vertebra görünümü, torakal vertebra düzeyinden L2 vertebraya kadar uzanan diastometamyeli ve Spinal kordun L5 vertebra seviyesinde sonlandığı görülmekteydi. İkinci olgumuz üriner inkontinans şikayetiyle başvuran 57 yaşında erkek hastaydı. Spinal MR incelemesinde L2-L3 intervertebral disk düzeyinde 1 cm uzunluğunda syringomyeli, L5-S1 düzeyinde spondilolistezis ve spinal kordun S1 vertebra düzeyinde sonlandığı izlendi. TKS, normalde L2 vertebra düzeyinde sonlanan conus medullarisin L2 vertebra seviyesinin altında kalması ile kordun gerilmesi ve hareketinde azalma sonucunda nöronal fonksiyonlarda bozulma ve omurilikte ilerleyici iskemi oluşturmasıyla karakterize bir hastalıktır. Nörolojik defisitin ilerleyici olması ve nörojenik mesane tablosunun irreversible olması nedeniyle USG, MR gibi görüntüleme yöntemleri ve klinik bulgularla erken teşhis konulması hastalarda tedavi ve rehabilitasyon açısından oldukça önemlidir.

P - 089 SEREBRAL KAVERNÖZ MALFORMASYONUN MR BULGULARI İLE DEĞERLENDİRİLMESİ. OLGU ÖRNEĞİ MEHMET FATİH İNECİKLİ 1, FATMA BEYAZAL ÇELİKER 1, MAKSUDE ESRA KADIOĞLU 1, SİBEL GÖK İNECİKLİ 2, MEHMET BEYAZAL 1 1 Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, Türkiye 2 Rize İl Sağlık Müdürlüğü, Rize, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S59

Özet Amaç: Serebral kavernöz malformasyonlar (kavernöz anjiom, kavernom), vasküler yapıların nadir görülen hamartomudur. Serebral kavernöz malformasyonlar (SKM), tamamen kollajenden ibaret olan glial veya nöral doku içermeyen tek tabaka endotelyal hücrelerle örtülü sinüzoidal hücrelere benzer yapılardan oluşmaktadır. Eşlik eden besleyici arter ve drene edici ven yoktur. SKM, intrakranial vasküler malformasyonların %5-16’sını oluştururlar. Klinikte hemoraji, baş ağrısı, epilepsi, ilerleyici nörolojik defisit görülebilir. Serebral hemisferde yerleşimli olanlar genellikle asemptomatik lezyonlar olup genellikle başka bir nedenle yapılan kranial MR görüntülemelerinde rastlantısal olarak saptanırlar. Asemptomatik olguların MR ile izlenmeleri önerilirken, semptomatik olanlar cerrahi olarak çıkarılmalıdır. Bu bildiride, SKM’lerin MR bulgularını ve özelliklerini sunmayı amaçladık. Gereç ve Yöntemler: 55 yaşında erkek hasta. Bayılma, kasılma, bilinç kaybı ve senkop tanıları ile başvurdu. Sağ oksipital lobda kalkarin fissüre yakın lokalizasyon 11x12 mm boyutlarında T1A majlarda santrali beyaz cevher ile izointens, periferi hipointens, düzensiz konturlu, T2A ve FLAIR ağırlıklı imajlarda santrali beyaz cevhere göre izo-hipointens, periferal hipointens rimi bulunan patlamış mısır topu görünümünde lezyon saptandı. SWI sekansında belirgin hipointens izlendi. DWI sekanslarında b:1000 değerlerinde kısıtlanma saptanmadı, DWI sekanslarında da hipointens sinyali mevcuttu. Kontrastlı imajlarda santralinde punktat tarzda minimal kontrastlanma dikkati çekmekteydi. MR Perfüzyon sekanslarında düşük değerler mevcuttu. MR Spektroskopi tetkikinde NAA, Cre ve Cho düzeylerinde düşüş saptandı. Cho/Cre, Cho/NAA oranları 2nin altında idi. MR spektroskopi bulguları malign lezyonlar için spesifik değildi. Sonuç: SKM, T1 ve T2 ağırlıklı MRG’de karakteristik olarak merkezde methemoglobine bağlı yüksek sinyalli bir alan ve çevresinde kalsifikasyon ve fibrozise bağlı düşük sinyalli alanlar gösterirler. T2A kesitlerde tipik olarak çevresinde halka tarzında düşük yoğunluk alanı bulunmakta olup lezyona komşu dokuda ortaya çıkan hemosiderin birikimidir. SWI sekanslarında hipointens izlenmesi, hemorajik alanları temsil edebilir. Belirgin besleyici ater ve drenaj venleri olmayışı nedeniyle perfüzyon değerleri düşüktür. Belirgin nöronal dokuları içermemeleri nedeniyle MR spektroskopi verileri spesifik bir özellik göstermemektedir. Ancak özellikle kanama ya da enfarkt oluşumu, klinik bulguları beirginleştirir. Her ne kadar genellikle rastlantısal olarak izlense de klinik veriler doğrultusunda ayrıcı tanıda göz önünde bulundurulmalıdır.

P - 090 GÖZ TUTULUMU İLE PREZENTE ERDHEIM-CHESTER HASTALIĞI ÖMER KAYA 1, GÖKHAN SÖKER 2, İLKER BOĞA 3, ORKUN AKMAN 4 1 Ceyhan Devlet Hastanesi, Radyoloji Bölümü, Adana, Türkiye 2 Sağlık Bilimleri Üniversitesi Adana Şehir Eğitim ve Araştırma Hastanesi, Adana, Türkiye 3 Hacettepe Üniversitesi Tıp Fakültesi, Dahiliye Anabilim Dalı, Ankara, Türkiye 4 Hacettepe Üniversitesi Tıp Fakültesi, Patoloji Anabilim Dalı, Ankara, Türkiye Özet Erdheim-Chester hastalığı nadir bir ksantogranülamatöz hastalık olup histiosit ve lipid yüklü makrofajların kemik, kalp, akciğer, böbrekler ve retroperiton gibi birçok alanı infiltrasyonu ile karakterizedir. Orbita tutulumu vakaların yaklaşık %25’inde görülmekte olup daha nadirdir. Orbita tutulumunda ayırıcı tanıda Langerhans hücreli histiyositoz, psödotümör orbita gibi klinik durumlar girmekte olup radyolojik görün- tülemede sıklıkla intrakonal kitle görünümü mevcuttur. Genellikle retroorbital yağ doku, optik sinir, ekstraoküler kasların tutulumu görülür. Radyolojik görüntüleme tanıya yardımcı olmakla birlikte çoğunlukla tanısı için patolojik değerlendirme gerekmektedir. Bu çalışmada, orbita tutulumu ile prezente olmuş ve ek olarak bir kaç başka sistemik tutulum da gösteren Erdheim-Chester hastalığı olgusu tartışılacak ve radyolojik, patolojik, klinik özellikleri tartışılacaktır.

P - 091 9. KRANİYAL SİNİR FELCİ İLE SEYREDEN SPONTAN UNİLATERAL İNTERNAL KAROTİD ARTER DİSEKSİYONU GÖKHAN KAHRAMAN, MERT BAYRAMOĞLU, FERİDE KURAL RAHATLI, TÜLİN YILDIRIM, AHMET MUHTEŞEM AĞILDERE Başkent Üniversitesi Tıp Fakültesi, Ankara Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye Özet Giriş: Spontan internal karotid arter diseksiyonunun klinik prezentasyonu oldukça değişkendir. ICA diseksiyonu ile birlikte periferik kraniyal sinir felci nadir görülmektedir. Bu olgu bildirisinde 9. kraniyal sinir felci ile birlikte seyreden spontan internal karotid arter (ICA) diseksiyonu olgusunun boyun MR Anjiografi bulgularını sunmaktayız. Olgu Sunumu: 41 yaşında erkek hasta ani gelişen yüz sağ tarafında ağrı, dil sağ yarısında uyuşma, yutma güçlüğü sebebiyle hastanemize başvurdu. Beyin MRG, difüzyon MRG, boyun MRA tetkikleri yapıldı. Difüzyon MRGde akut enfarkt saptanmadı. Boyun MRA’da sağ ICA’de orijin düzeyinden S60 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

1,5 cm distalde kalem ucu tarzında sonlanan total oklüzyon, ICA içerisinde T1ve T2 ağırlıklı imajlarda hiperintens olarak izlenen geç subakut dönemde trombüse ait görünüm, ICA lateral kesiminde T1 ve T2 ağırlıklı serilerde hipointens izlenen kresent sign görünümü saptandı. Sağ orta ve anterior serebral arterlerde kollateral doluşa sekonder patensi izlendi. Hastaya antikoagulan tedavisi başlandı. 5 ay sonra çekilen kontrol boyun MRA tetkikinde sağ internal karotid arter patent olarak izlendi. Hastanın dilde uyuşma, yutma güçlüğü şikâyetlerinin kaybolduğu öğrenildi. Sonuç: Ani gelişen tek taraflı baş-boyun ağrısı, horner sendromu gibi semptomları bulunan hastalarda intenal karotid arter diseksiyonu akla gelmelidir. Difüzyon MRG serebrovasküler olay ekartasyonunda faydalı iken beyin MRG ve boyun MRA diseksiyon tanısını koymakta eşlik eden tortiozite, anevrizma gibi olası patolojileri saptamakta faydalıdır.

P - 092 IGG4 İLE İLİŞKİLİ HİPOFİZİT VE ORBİTAL TUTULUM: İKİ OLGU SUNUMU GÖKHAN KAHRAMAN, MERT BAYRAMOĞLU, FERİDE KURAL RAHATLI, TÜLİN YILDIRIM, AHMET MUHTEŞEM AĞILDERE Başkent Üniversitesi Tıp Fakültesi, Ankara Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye Özet IgG4 ile ilişkili hipofizit ve orbital tutulum oldukça nadir görülmektedir. IgG4 ile ilişkili hipofizit ve orbital tutulumu olan bir erişkin ve bir pediatrik vaka sunmayı amaçlamaktayız. IgG4 ile ilişkili hipofizit nadir görülen inflamatuar bir durumdur ve hipofiz tümörlerini taklit edebilir. Hipofiz bezinde kalınlık artışı, superior konturunda bulging, infindibulumda nodülerite ile karaterizedir. IgG4 ile ilişkili orbital inflamasyonda bilateral lakrimal glandlarda inflamasyon ve sıklıkla inferior rektus kasında olmak üzere ekstraoküler kaslarda kalınlık artış izlenebilir. Tiroid oftalmopatisinden ayrı- mında tiroid fonksiyon testlerinim normal olması önemli olmakla beraber tanıda serum IgG4 düzeylerinin yüksek olması yardımcıdır. Radyolojik olarak tanısının koyulması uygun ve etkin tedavide değerlidir. 45 yaşında kadın hastanın hipofiz MRG’sinde hipofiz bez yüksekliğinde artış, hipofiz süperior konturunda suprasellar sisterne doğru bulging, infundibulumda kalınlaşma ve nodüler görünüm izlenmiştir. Orbital MRG’sinde sağda propotozis, sağ inferior, medial, lateral, süperior rektus kaslarında kalınlaşma, sol lateral ve süperior rektus kaslarında minimal kalınlaşma sap- tanmıştır. 13 yaşında erkek çocuk hastanın orbita MRG’sinde sol süperior rektus kasında belirgin kalınlaşma, kontrastlanma, ödem, inflamasyon, komşuluğundaki lakrimal bez boyutlarında artış, retroorbital yağ dokusunda inflamasyon bulguları izlenmiş olup hipofiz tutulumu saptanmamıştır.

P - 093 KAPİTELLAR OSTEOKONDRİTİS HÜSEYİN ALPER KIZILOĞLU, RECEP SADE, RÜSTEM BERHAN PİRİMOĞLU Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Osteokondral defektler eklem yüzeyinde kartilaj ve kartilaja komşu subkondral kemik dokusunun fokal hasarını tanımlar. Osteokondral defektler bir grup hastalığı tanımlar ve bu grupta osteokondritis dissekans, osteokondral fraktür ve panner hastalığını kapsar. Dirsekte osteokondral lezyonlar sıklıkla aşırı kullanım öyküsü olan adölesanlarda karşımıza çıkan idiyopatik bir eklem patolojisidir. Dirsek ekleminde en sık kapitellum etkilenir. Patogenezi tam olarak bilinmemekle birlikte, radyokapitellar ekleme uygulanan tekrarlayıcı mikrotravmalar ile kapitellumun kanlanmasındaki zayıflığın kombinasyonu sonucu geliştiği öngörülmektedir. Sıklıkla 11-15 yaş arası çocuklarda karşılaşılır. Klinik olarak dirsek eklemi lateralinde ağrı, şişlik hassasiyet şeklinde bulgu verir. MRG inceleme dirsekte osteokondral lezyonları değerlendirmede oldukça kullanışlı bir yöntemdir. MRG inceleme kapitellum lezyonlarını radyografi normalken veya minimal bulgu gösteriyorken ortaya koyabilmektedir. MRG bize lezyon boyutu, lokalizasyonu ve stabilizyonu açısından oldukça kullanışlı bilgiler vermektedir. Biz olgumuzda adölesan erkek hastada grafi bulguları oluşmuşken meydana gelen kapitellar osteokondral lezyonun MRG ile değerlendirilmesini sunmayı amaçladık. Olgu Sunumu: 17 yaşında vücüt geliştirme sporuyla ilgilenen ve sağ dirseğinde ağrı, hassasiyet şikayetleriyle FTR kliniğine başvuran hastaya gerekli muayenede şişlik ve dirsek lateroposterior kesminde hassasiyet bulgularıyla bursit ve osteokondral defekt ön tanısıyla önce direk radyografi çalışılmıştır. Radyolografide distal humerusta kapitellar eklem yüzeyinde coğrafik sınırlı radyolusent görünüm izlenmiştir. Daha sonra hastaya kapitellar osteokondrit ön tanısıyla ve benzer lezyonların ayırıcı tanısı açısından kontrastsız dirsek MRG incelemesi yapılmıştır. MRG incelemede distal humerus kapitellumunde kortikal devamlılık gösteren sınırları T1 AG serilerde daha net ayırt edilebilen subkortikal alana uzanım gösteren eklem yüzeyinde düzensizliğe neden olan T1AG serilerde düşük sinyalli, proton dansite serilerde yüksek sinyalli heterojen çoğrafik sınırlı alanlar izlenmiştir. Hastaya kapitellar osteokondritis tanısı doğrulandı ve stabil lezyon kararı verilerek konservatif tedavi ile takip edilmiştir. Tartışma: Kapitellar osteokondritis adölesan ve genç yetişkinlerde lateral dirsek ağrısının nadir nedenlerinden birisidir. Konservatif tedavide aktivite modifikasyonu ve kas güçlendirici egzersizlerden oluşur, bu şekilde yaklaşık olarak %50 oranında nonoperatif osteokondral defekt stabilizasyonu sağlanır. Cerrahi girişimler unstabil osteokondral defektlere ve konservatif tedaviye yanıt vermeyen stabil defektlere uygulanır. MRG inceleme dirsek ve diğer bölgelerde osteokondral defektleri tanımlayabilir, stabil ve unstabil şeklinde klasifiye edebilir varsa ek bulguları gösterebilir. Genel sinyal intensite değişikliği T1AG serilerde subkondral alana uzanım gösteren düşük sinyalli alanlar şeklinde T2AG serilerde yüksek sinyalli olarak izlenir. T2 AG görüntülerde unstabil osteokondral defektlerin tanımlanmış dört bulgusu bulunmaktadır : Lezyon ile alttaki Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S61 kemik dokuda yüksek sinyalli ince bir hat bulunması, lezyon altında hiperintens ayrı bir alan(kist) varlığı, osteokondral lezyon içerisinden devam eden yüksek sinyalli kartilaj-defekt altındaki kemiğe uzanan transvers seyirli çizgi varlığı ve osteokondral lezyon seviyesinde artiküler yüzeyde fokal defekt varlığı. Bazı osteokondral lezyonlar T1AG görüntülerde düşük sinyalli izlenirken, T2AG gradient eko görüntülerde sinyal değişikliği göstermemektedir, bu grup lezyonlar MRG özeliklerine göre stabil olarak yorumlanır ve konservatif tedavi ile spontan iyileşir. Osteokondral lezyonlar artroskopik ve radyolojik olarak stabil-unstabil ayrımı açısından çeşitli tiplemelere ayrılmaktadır. Sonuç: biz bu olgumuzda dirsek ayrısının nadir nedenlerinden biri olan kapitellar osteokondritisin tanımlanması tedavisini şekillendirmesi açısın- dan stabilizasyonun değerlendirilmesini vurgulamayı amaçladık.

P - 094 YENİDOĞAN VE İNFANT DÖNEMİ ABDOMİNAL KİTLELERİN TANISINDA MANYETİK REZONANS GÖRÜNTÜLEMENİN YERİ KAYHAN KARAKUŞ Cumhuriyet Üniversitesi, Çocuk Radyolojisi Bilim Dalı, Sivas, Türkiye Amaç: Bu çalışmada yenidoğan ve infant döneminde abdominal MRG ile saptanan intraabdominal lezyonların MRG bulguları, önemli tanısal ipuçları ve tanısal tuzakları sunulmaktadır. Gereç ve Yöntemler: Haziran 2012-Ocak 2018 tarihleri arasında farklı ön tanılar ile abdomen MRG yapılmış olan yenidoğan ve infant yaş grubundaki yirmi altı olgunun PACS sisteminden görüntüleme bulguları, hasta dosyaları arşivinden klinik ve laboratuar bulguları geriye dönük olarak tarandı. Onyedi olguya abdominal MRG öncesi US inceleme yapıldı. Sekiz olguda MRG’de kontrast madde kullanıldı. Onbeş olguda konvansiyonel MRG’ye difüzyon ağırlıklı görüntüleme ilave edildi. Bulgular: Yaş ortalaması 82.73±92.72 gün (en küçük 1 gün, en büyük 300 gün) olan 13 kız, 13 erkek toplam 26 olgu incelendi. Olgularda saptanan patolojiler over kisti (n=5), enterik duplikasyon kisti (n=3), megasistis (n=1), mezenterik kist (n=1), diafragmatik mezotelyal kist (n=1), tailgut kisti (n=1), intraabdominal abse (n=1), vulvar kist (n=1), abdominoskrotal hidrosel (n=1), periumblikal kist (n=1), inmemiş testis(n=2), inguinal herni (n=1), konjenital mezoblastik nefroma (n=1), posterior üretral valv (n=1), adrenal hemoraji (n=3), tip 1 sakrokoksigeal teratom (n=1) ve tip 3 sakrokoksigeal teratom (n=1) olarak belirlendi. MRG öncesi US inceleme yapılan onyedi olgunun dördünde US’nin tanıya katkısı olmadı. Sonuç: Yenidoğan ve infant döneminde farklı lokalizasyonlarda yerleşebilen, orijini, klinik ve radyolojik bulguları farklı çok sayıda abdominal kitle nedeni vardır. Radyolojik tanıda US kolay ulaşılması, iyonizan radyasyon içermemesi nedeniyle ilk tercih edilen inceleme yöntemi olmakla beraber US’nin tanıda yetersiz kaldığı durumlarda problem çözücü olarak yumuşak doku rezolüsyonu yüksek olan ve iyonizan radyasyon içermeyen MRG güvenle kullanılmaktadır. İntraabdominal lezyonların görüntüleme bulgularının ve ayırıcı tanılarının bilinmesi, günlük rutinde doğru tanı ve tedavi için radyolog ve klinisyenlere yardımcıdır.

P - 095 NADİR TUTULUM YERİ OLAN HUMERUSDA EOZİNOFİLİK GRANULOM SERHAT KAYA, RÜSTEM BERHAN PİRİMOĞLU, GÖKHAN TONKAZ, GÖKHAN POLAT, RECEP SADE, AKIN LEVENT Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Amaç: Langerhans hücreli histiositoz kemik iliğindeki histosit hücrelerin anormal proliferasyonu sounucu ortaya çıkan nadir bir hastalıktır. Eozinofilik granulom bu hastalığın bir alt tipi olup genellikle tek veya birden fazla kemikte tutuluma neden olan benign bir hastalıktır. Kafatası, vertebra, femur en sık tutulan kemiklerdendir. Biz pediatrik bir vakada nadir tutulum yeri olan humerusda eozinofilik granulom tanısını sunmayı amaçladık. Gereç ve Yöntemler: 9 yaşında kol ağrısı olan hastaya 1,5 Tesla MRG cihazı ile(Magnetom Avanto, Siemens Healtcare) ile çekim yapıldı. 9 yaşında sağ kolda ağrı ve ele gelen şişlik nedeniyle ortopedi polikliniğine başvurdu. Yapılan muayanede hasta direkt grafi çekildi. Direkt grafisinde sağ humerus orta kesimde kemikte periost reaksiyonuna neden olan litik lezyon izlendi. Hastaya MRI çekildi. Çekilen MRI da sağ humerusda orta diafizer kesimde yaklaşık 23x10x10 mm ebatlı boyutlu korteksde belirgin ekspansiyona ve periost reaksiyonuna neden olan T1 AG serilerde hipointens T2 AG serilerde hiperintens postkontrast serilerde kontrast tutmayan kemikte belirgin destrüksiyona neden olmayan kitle lezyon izlendi. Bulgular: Hastada öncelikli olarak eoznifolik granulom düşünüldü. Hastaya ortopedi tarafından biyopsi yapılıp patoloji sonucu langerhans hücreli histiositoz olarak doğrulandı. Sonuç: Eozinofilik granülom nadir görülen bir hastalıktır. Genellikle kafatası ve uzun kemikleri tutar. Geçiş zonu dar olup nonagresif özellikler sergiler. En yaygın belirti lezyonun bulunduğu yerde ağrıdır. Bulunduğu kemiklerde patolojik kırıklara neden olabilir. Benign kemik tümörlerinde akılda tutulması gereken hastalıklardan biridir. S62 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı P - 096 HİPOTONİK SEREBRAL PALSİYİ TAKLİT EDEN JOUBERT SENDROMU GÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, GÖKHAN POLAT, FAHRİ AYDIN, RECEP SADE, AKIN LEVENT Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Joubert sendromu serebellar vermis hipoplazisi veya aplasia ile karakterize otozomal resesif geçişli bir konjenital hastalıktır. Hastalığın insidansının 1/80.000 ila 1/100.000 arasında olduğu tahmin edilmektedir . Joubert sendromunun üç klasik karakteristik özelliği hipotoni, gelişme geriliği ve serebellar malformasyondur. Polidaktili, oküler koloboma, retinal distrofi, kistik displazi veya nefronofitizis gibi renal hastalıklar ve hepatik fibrosiz Joubert sendromunda izlenen diğer bulgulardır. Bazılarının doğumda belirgin olmadığının bilinmesi tarama açısından önemlidir. Hastalar kas tonusunda düzensizlik, anormal göz hareketi ve trunkal ataksiden muzdariptir. Pons ve medullanın çeşitli malformasyonları solunum bozukluklarından sorumludur. Purkinje benzeri nöron heterotopileri semptomları açıklayabilir. Gereç ve Yöntemler: Biz serebral palsi nedeniyle takipli 10 yaşındaki bir kız hastayı sunuyoruz. Gelişme geriliği, mental retardasyon, hipotoni, ataksi gibi klinik bulguları olan hastadan beyin MRG istendi. MRG de; her iki süperior serebellar pedinkülde kalınlık artışı, belirgin uzamış görünüm ve molar diş görünümü izlendi. 4. ventrikülde yarasa kanadı görünümünün varlığı dikkati çekmektedir. Her iki serebellar hemisfer arasında da vermiyen ageneziyi düşündüren patomorfolojik değişikler izlendi. Mevcut patomorfolojik değişikliklerin varlığı MRG de öncelikle joubert sendromunu düşündürdü. Bulgular: Joubert sendromunda temel radyolojik bulgular; vermisin tam veya parsiyel yokluğu, hipoplastik serebeller pediküller ve buna bağlı 4. ventrikül deformitesidir. Joubert sendromunda pons ve inferior kollikulus arasındaki beyin sapı bölgesinde disgenezise bağlı ponto-mezansefalik birleşkede uzama, incelme ve interpediküler fossada derinleşme izlenir. Ayrıca süperior serebeller pediküllerde kalınlaşma ile 4. ventrikülde lobulasyon ve genişlemeye neden olan vermis hipoplazisi görülür. Bu üç bulgu aksiyal MR görüntülerde ‘molar diş’ ve ‘yarası kanadı’ görünümüne neden olur. Sonuç: Joubert sendromunun klinik bulguları serebral palsiye benzerliği gecikmiş veya yanlış tanıya neden olabilir. Joubert sendromu nadir olsa da hipotonik CPnin ayırıcı tanısında dikkate alınmalıdır. Ataksi, nistagmus, hipotoni ve gelişime geriliği olan herhangi bir hasta için nöroradyolojik bulguları değerlendirmek için görüntüleme yapılmalıdır. Joubert sendromu tanısı konulan hastalarda ise ilişkili anomalilerin değerlendirilmesi için tarama faydalıdır.

P - 097 TUBEROZSKLEROZLU HASTADA UNUTULMAMASI GEREKEN LEZYON: RENAL ANJİOMYOLİPOM GÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, MUSTAFA YEŞİLYURT, GÖKHAN POLAT, RECEP SADE, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Anjiyomyolipomlar(AML) matür yağ dokusu, düz kas hücre demetleri ve kalın duvarlı kan damarlarının değişen oranda karışımlarından oluşan nadir görülen benign mezenkimal tümörlerdir. En yaygın olarak böbreklerde görülür. Bu tümörler genellikle hamartom olarak kabul edilmektedir. Histogenezleri tartışmalı olan bu tümörlerin düz kas ve yağ hücrelerine diferansiye olan puliripotent hücrelerden geliştiğine inanılmaktadır. Olgu Sunumu: 15 yaşında gelişim geriliği ve tüberoz skleroz nedeniyle takip edilen erkek hasta karın ağrısı olması üzerine çekilen MRG de AML tanısı konulmuş. Biz bu sunumda AML’nin abdomen MRG bulgularını vurgulamayı amaçladık. MRG de sol böbrek üst polde yaklaşık olarak 1 cm ebatlı T1 AG lerde seçilebilen T2 yağ baskılı görüntülerde ise hafif derecede yağ baskılama özelliği gösteren IV kontrast madde enjeksiyonu sonrası alınan görüntülerde kısmı kontrastlanma paterni gösteren öncelikle yağdan fakir anjiomyolipom lehine değerlendirilen lezyon izlendi. Tartışma: AML ortalama görülme yaşı 41 olmakla birlikte literatürde 6-80 yaşları arasında görüldüğü bildirilmektedir. Kadınlarda erkelerden daha fazla görülmektedir. Renal AML olgularının yaklaşık yarısı izole olarak bulunurken diğer yarısı tüberoz sklerozun deri ya da beyin bulguları ile birlikte bulunur. Sonuç: Tüberoz skleroz tanısı olan hastalarda AML açısından araştırma yapılmalıdır.

P - 098 NADİR BİR TİROİD MALİGNİTESİ: DİFFÜZ BÜYÜK B HÜCRELİ NONHODGKİN LENFOMA GÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, FAHRİ AYDIN, GÖKHAN POLAT, MECİT KANTARCI, AKIN LEVENT Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S63

Özet Giriş: Primer tiroid lenfoma (PTL), tiroid bezinin seyrek görülen malignitesidir. Erken teşhis, diğer tiroid malignitelerden farklı olarak cerrahi müdahaleye gerek kalmadan başarılı tedavi oranlarının artmasını sağlar. Mevcut etkin tedavinin temel taşı, sistemik kemoterapi ve bölgesel radyoterapi kombinasyonudur. Olgu Sunumu: 15 yaşında kız hasta son bir ay içerisinde hızlı büyüme gösteren, nefes darlığına yol açan, boyun orta hatta ağrısız kitle ile çocuk polikliniğe başvurdu. Çekilen boyun ultrasonografisinde, bilateral tiroid loblarında ve istmus normalden büyük heterojen parankim yapısında izlendi. Parankime yönelik yapılan doppler incelemede parankimal kanlanmada heterojen artış dikkati çekti. Görünümler öncelikle tiroid mali- nitesi lehine değerlendiridi. Kitlenin fikse olması ve büyüklüğü göz önünde bulundurularak boyun Manyetik Rezonans görüntülemede (MRG) yapıldı. MRG de her iki tiroid lobu ve isthmus normalden büyük olup T1 ve T2 AG lerde diffüz heterojen sinyal intensiteleri gösterdi. Her iki tiroid lobu ve isthmus global olarak büyümüş olup trakeayı çepeçevre sarmakta ve heterojenitenin retrosternal uzanımı izlendi. Tiroid glandı T1 AG lerde izo - hipointens, T2 AG lerde hiperintens sinyal karakteristlikleri sergiledi. Postkontrast serilerde her iki tiroid lobu ve isthmus belirgin yoğun ve heterojen kontrastlanma paterni gösterdi. Nefes darlığı ilerleyen hastaya trekastomi takılması planlandı. İşlem sırasında kitleden biyopsi alındı. Biyopsi sonucu Diffüz Büyük B hücreli Lenfoma geldi. Hastaya kemoterapi planlandı. Tartışma: PTL, tiroid malignitelerinin % 5inden azından ve tüm lenfomaların % 2. 5inden sorumludur. Çoğu PTL, non-Hodgkin lenfomalarıdır. Bu olgu sunumuna benzer şekilde, PTLnin% 50-80i Diffüz büyük B hücreli lenfomalardır ve % 20- 30u, ekstranodal marjinal tipten çoğunun mukoza ilişkili lenfoid doku (MALT) lenfomalarıdır. Diğer nadir alt tipler arasında foliküler lenfoma (% 12), Hodgkin hastalığı (% 7), küçük lenfositik lenfoma (% 4) ve Burkitt lenfoma (% 4). Otoimmün kronik lenfositik tiroiditi (Hashimoto tiroiditi) varlığı, iyi bilinen bir risk faktörüdür ve genel popülasyona kıyasla PTLyi geliştirme riski 40-80 kat artmıştır. Kadın hastalarda PTL daha sıktır ve yaşamın yedinci dekasında hızlı ve ağrısız bir servikal kitle olarak daha sık rastlanmaktadır. PTL, vakaların% 80inde (genellikle bir ila üç ay içinde) tiroid nodülünün hızlı bir şekilde büyümesiyle kendini gösterir ve sıkıştırıcı belirtiler (dispne, disfaji, stridor, öksürük, ses kısıklığı ve nadiren Horner sendromu veya Superior Vena Kava sendromu) eşlik edebilir. PTLde terapötik yaklaşım tartışmalıdır, çünkü nadir bir hastalıktır ve bu nedenle ileriye dönük büyük ölçekli bir çalışma yoktur. Günümüzde çoğu yazar multidisipliner bir yaklaşım önermektedir. Hastalığın lokal kontrolü, radyoterapi, cerrahi veya her ikisi ile sağlanabilir. Kemoterapi, gizli veya yaygın hastalığın kontrolünde, uzun vadeli sonucu iyileştirmek için kullanılır. Cerrahi, bu hastalık için ilk tedavi seçeneği değildir ve seçilen vakalar için ayrılmalıdır. Her bir vaka, kabul edilmiş bir terapötik yaklaşım olmadığından ayrı ayrı değerlendirilmeli ve ele alınmalıdır. Sonuç: Özellikle hızlı büyüyen tiroid kitlelerinde primer tiroid lenfoması nadir görülüyor olsa da akla getirilmesi gereken bir tanıdır.

P - 099 JOUBERT SENDROMU: OLGU SUNUMU MESUT ÇETİN, ADEM AĞYAR Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye Özet Jobert sendromu (JS) hipotoni, ataksi, serebellum ve beyin sapının nöropatolojik anomalileri ile birlikte nadir görülen otozomal resesif bir send- romdur. 17 aylık kız hasta başını dik tutamama ve başının büyük olması şikayetleri ile hastanemiz çocuk sağlığı ve hastalıkları kliniğine getirildi. Hastadan beyin ve difüzyon MRG istendi. Çekilen MRG de karakteristik görüntüleme bulgusu olan serebellar vermis hipoplazisi ve beyin sapında ‘’molar diş’’ bulgusu izlendi. Ayırıcı tanıda Dandy-Walker malformasyonu ve Down sendromu önemli yer teşkil etmektedir. Joubert sendromunun klinik bulguları oldukça heterojendir. Serebellar vermis hipogenetiktir. Vermiste izlenen minimal doku nedeniyle serebellar hemisferler orta hatta karşı karşıya gelmektedir. Her iki süperior serebellar pedünkül dorsal orta beyinde çaprazlaşmazlar ve orta beyinden serebelluma horizontal bir şekilde uzanırlar. Tüm bu bulgular aksiyal kesitte molar diş görünümüne neden olmaktadır. Geniş spektrumlu heterojenik bul- gularından dolayı, gerçekte var olduğundan daha az oranda JS tanısı konulmaktadır. Bu nedenle klinik olarak JS düşünülen hastaların radyolojik bulguları dikkatle değerlendirilmelidir.

P - 0100 HERLYN WERNER WUNDERLİCH SENDROMU FAHRİ AYDIN, BERHAN PİRİMOĞLU, GÖKHAN POLAT, RECEP SADE, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Uterus didelfis, hemivajina obstrüksiyonu ve renal agenezi birlikteliği Herlyn Werner Wunderlich(HWW) Sendromu olarak bilinmektedir. HWW obstrükte tarafta hematometrokolpos ve buna bağlı gelişen abdominal ağrı ile klinik olarak kendini göstermektedir. Genellikle postpubertal-pubertal dönemdeki adelosanlarda kendini göstermekle birlikte nadiren prepubertal dönemde de bulgu verebilir. S64 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Olgu Sunumu: 13 yaşında kız hasta hastanemize şiddetli sağ alt kadran ağrısı şikayeti ile başvuruyor. Hastanın bölümümüzde çekilen MRG görü- nütülerinde sağda renal agenezi ve sağ tarafta hematokolpos gelişmiş uterus didelfis ile uyumlu görünümler mevcuttu. Tartışma: HWW nadir görülen ürogenital trakt anomalisidir. Klasik triadı uterus didelfis, hemivajina obstrüksiyonu ve renal agenezidir. Müllerian kanalların orta hatta göçü ve füzyonu yaklaşık intrauterin 8. haftada meydana gelir. Müllerian kanal anomalileri aynı üreterik tomurcuktan köken almaları nedeni ile böbrekler, overler, uterus, serviks ve proksimal vajeni birlikte etkileyebilir. Sonuç: Akut başlangıçlı şiddetli karın ağrısı ile başvuran pubertal-postpubertal bayanlarda pelvik bölgede hematokolpos yönünden şüphe uyan- dıracak komplike içerikli kistik lezyon tesbitinde, uterus ve böbrekler değerlendirilmeli ve nadir de olsa Herlyn Werner Wunderlich Senromu akla gelmelidir.

P - 0101 NADİR BİR VARYANT : MEDİAN SAKRAL ARTER ORJİNLİ BİLATERAL AKSESUAR RENAL ARTER AYŞE GÜL ALIMLI1, MESUT SİVRİ2, NAZLI GÜLSÜM AKYEL2, MEHMET TİFTİK2, TÜLİN HAKAN DEMİRKAN2 1Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları, Hematoloji, Onkoloji Eğitim ve Araştırma Hastanesi, Pediatrik Radyoloji Bilim Dalı, Ankara 2Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları, Hematoloji, Onkoloji Eğitim Ve Araştırma Hastanesi Radyoloji Anabilim Dalı, Ankara, Türkiye Özet Aksesuar renal arter populasyonda yaklaşık %25 sıklıkla izlenen yaygın bir varyasyondur. Sıklıkla abdominal aorta (%70) orjinlidir. Nadiren çölyak trunkus, süperior mezenterik arter, inferior mezenterik arter, ilyak arterden de köken alabilir. Ancak median sakral arter orjinli aksesuar renal arter oldukça nadirdir. Bu bildiride hipertansiyon nedeni ile manyetik rezonans anjiografi tetkiki elde olunan aorta orjinli aksesuar renal arterleri yanı sıra median sakral arter orjinli sağ böbrek ve sol böbrek alt polü besleyen aksesuar renal arterleri tespit edilen 17 yaşındaki erkek hasta tartışılmıştır.

P - 0102 KAYBOLAN HERNİ FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Disk hernilerinde etiyoloji genellikle mekanik nedenlidir. Anulus fibrosus liflerinde parsiyel ya da tam kat yırtık söz konusudur. Disk her- nileri patolojik olarak prolapsus, ekstrüde disk ve sekestrasyon olarak üç gruba ayrılır. Olgu Sunumu: 15 yaşında kız hasta bel ağrısı ile hastanemize başvuruyor. Departmanımızda çekilen lomber MR incelemesinde T12 ver- tabra posterior komşuluğunda disk intensitesinde lezyon saptadı. Radyolojik bulgular lezyonun disk herniasyonuna sekonder geliştiğini gös- termekteydi. Hastanın 2 ay sonra çekilen kontrol MR incelemesinde lezyonun tamamen regrese olduğu ve kontrol tetkikinde izlenmediği görülmüştür. Tartışma: Disk hernisi farklı radyolojik tablolarda ortaya çıkabilmektedir. Protrüzyon, sekestrasyon ve lateral disk temel radyolojik bulgulardır. Protrüzyon diskte gelişen kabarıklıklıktır. Sekestrasyonda esktrude disk ana diskten koparak ekstradural alana serbest bir parça olarak ayrılır. Lateral disk ise diskin laterala doğru yer değiştirip tekal aralığı terk eden sinir köküne bası yapmasıdır. Sonuç: Bizim vakamızda bulunan “kaybolan herni” literatürde oldukça nadir bahsedilen operasyon edilmeden spontan olarak gerileyen herniyi temsil etmektedir. Spontan disk regresyonunun makrofajlar tarafından meydana gelen fagositik bir inflamatuar süreç olduğu bildirilmektedir.

P - 0103 MYOZİTİS OSSİFİKANSA BENZEYEN SESSİL OSTEOKONDROM FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S65

Özet Giriş: Osteokondromlar kemiğin en sık görülen bening tümörleridir. Erkeklerde biraz daha sıktır. Klasik olarak diz çevresinde tibia distali, femur proksimalinde ve omuzda humerus proksimalinde yerleşim gösterirler. Osteokondromun karakteristik bulgusu lezyon seviyesinde kemik korteks ve medullanın devamlılık göstermesi ve hyalin kartilaj kep bulundurmasıdır. Genellikle asemptomatik mobil kitle şeklinde kendini gösterirler. Olgu Sunumu: 15 yaşında kız hasta sağ kalçada ağrı ve şişlik şikayeti ile hastanemize başvurmuştur. Hastanın travma öyküsü bulunmamaktadır. Departmanımızda çekilen MRG incelemesinde hastanın sağ femur proksimal seviyesinde ince kontrastlanan kıkırdak kep bulunduran pedinküle kitle lezyon izlendi. Hastanın direk grafisinde bu düzeyde kalsifikasyon barındıran opasite alanı izlenmştir. Tartışma: Osteokondromlar özellikle ilk iki dekatta ortaya çıkan epifizyal büyüme kıkırdağından gelişen tümörlerdir. Sıklıkla diz çevresine yerleşir. Lezyonlar kemik korteksi ile devamlılık gösterirler. Çok nadir olmakla birlikte malign transformasyon gösterebilmektedirler. Malign transformasyon daha çok herediter multiple egzositoz ilişkili osteokondrom vakalarında bildirilmiştir. Sonuç: Osteokondromlar farklı varyantlarda ortaya çıkabilmektedir. Bizim vakamızda olduğu gibi nadiren görülen sessile osteokondromlar direkt grafide myozitis ossifikasyon ile karışabilmektedir.

P - 0104 JUVENİL REKÜRREN PAROTİTİS MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY, GÖKHAN POLAT, SERHAT KAYA, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: JRP, puberte öncesi en az iki defa tekrarlayan tek taraflı veya bilateral parotis bezi şişmesi ile karakterize, non-obstrüktif, non-supuratif inflamatuar hastalık olarak tanımlanır. Hastalığın insidansı bilinmemekle birlikte, tükrük bezlerinin kabakulak sonrası ikinci sırada görülebilen hastalığıdır. İlk atak genellikle 3-6 yaş arasındadır(6 ay-16 yaş) ve erkeklerde daha sık görülür. JRPnin tanısı genellikle tekrarlayan tek taraflı veya bilateral parotid şişme ve sialektazinin gösterilmesine dayanır. JRP tanısında araştırmacı araç olarak konvansiyonel siyalografi, dijital siyalografi, US, MR ve sialendoskopiyi kullanır. Olgu Sunumu: 16 yaşında kadında hasta hastanemize her iki kulağının altında parotis lojunda ağrılı şişlik şikayeti ile başvurdu. Anamnezinde önceden de bu şekilde ataklar geçirdiğini belirtmiştir. Departmanımızda hastaya çekilen boyun MRG’de her iki parotis bezinde boyut artışı ve fokal sinyal artışları görüldü. Tartışma: Renkli Doppler US, manyetik rezonans siyalografi ve sialoendoskopi gibi modern, minimal invaziv tanı araçlarının kullanımı, JRP tanı ve tedavisinde yeni bir bakış açısı oluşturmaktadır. JRP, çocuklarda non-obstrüktif, inflamatuar bir parotis hastalığıdır ve MR sialografi ana kanalı ve intraglandüler dalları iyi gösterir. Klasik klinik bulguları olan çocuklarda US tek başına tanısaldır ve MR siyalografi gerekli değildir. Bununla birlikte, MR bulguları, atipik olgularda ve tek taraflı olgularda yararlı olabilir. Sonuç: MR ve MR sialografi tanı noktasında US nin yerine geçmese ve hasta yönetimini değiştirmese de, hastalığın fazına bağlı olarak parotis bezinde sialektazi ve sinyal yoğunluğu değişiklikleri gibi bulguları doğru bir şekilde gösterebilirler(akut evre ve kronik evre açısından). MR ve MR sialografi artık inflamatuar tükürük bezi hastalığının görüntülemesinde yaygın olarak kullanıldığından, radyologlar JRPnin MR görüntüsüne aşina olmalıdır.

P - 0105 NADİR BAŞ AĞRISI NEDENİ;NÖROBLASTOMUN KALVARİAL METASTAZI MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Nöroblastom erken çocukluk çağı tümörleri içerisinde en sık görülenidir. Adrenal medulla veya sempatik gangliyonlardan kaynaklanırlar. Disemine nöroblastomlarda beyin parankimi ve leptomeningeal tutuluma ait intraaksiyel ve ekstraaksiyel metastazlar görülebilir. Nöroblastomun kranial metastazlarında BT ve düz röntgenogramlarda kemik yapıda fokal litîk ve blastik lezyonların kalvaryumun hem iç hem de dış tabulasını tuttuğu gözlenir. Bu lezyonlar sıklıkla iyi sınırlı ve sklerotik kenarlıdır. Sütürlerde açılmaya neden olmaları tipiktir. Olgu Sunumu: 14 yaşında erkek hasta uzun süredir devam eden fakat son birkaç saattir artan baş ağrısı şikayeti ile acil servise başvurdu. Öz geçmişinde nöroblastom nedeniyle opere olduğu öğrenildi. FM de baş çevresinin büyük olduğu gözlenen hastaya kranial BT ve MR görüntüleme planlandı. S66 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Tartışma: Nöroblastomlarda serebral metastaz en sık epîdural aralığa olmaktadır. BT ve MRGde karakteristik olarak bikonveks, beyin parankîmini iç tabuladan uzaklaştıran kitle görünümü İle tanınırlar. Nöroblastomlarm kranyal metastazları en sık epidural mesafeye, daha nadir olarak dura veya leptomeningeal yapılara olmaktadır. Sonuç: Leptomeningeal metastazlar BT ve MR görüntülemede sulkal-sisternal, epandimal-subepandimal ve tentoryal diffüz kontrast tutulumu şeklinde izlenirken, dural metastazlar kalvaryum İle durayı birbirinden ayıran, epidural mesafeyi dolduran, venöz sinüslere İnvazyon gösterebilen kitleler şeklinde karşımıza çıkmaktadır. Ancak daha nadir olmakla birlikte direkt olarak serebral parankime metastaz yapmış olgular bildirilmiştir.

P - 0106 KUADRİPLEJİYE NEDEN OLAN METASTATİK EMBRİONAL TÜMÖR MUTLU AY, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, MEHMET ALPEREN TEZCAN, GÖKHAN POLAT, ALPER KIZILOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Embrional tümürler 3 yaş altı pediatrik hastalarda en sık beyin tümörleridir. Histolojik olarak undiferansiye küçük yuvarlak hücreli tümör- ler olarak tanımlanırlar. En sık görüleni medulloblastomdur. Primer nöroektodermal tümör(PNET), Atipikal teratoid/rabdoid tümör(ATRT), medulloependimom, epandimoblastomi medullomyoblastom ve melanotik medulloblastom da embrional tümörlerdir. Hepsi agresif seyretmek- te ve santral sinir sistemi dışına yayılma eğilimi göstermektedirler. Embrional tümörler genellikle supretentorial yerleşimli olup daha az oranda infratentorial ve nadiren spinal tutulum gösterirler. Kitle etkisiyle; intrakranial basınç artışı, hemiparazi, serebellar bulgular ve kranial sinir felçleri gibi bulgular oluşabilmektedir. Olgu Sunumu: 15 yaş erkek hasta tüm ekstremitelerde güçsüzlük ve ağrı, servikal ağrı şikayetleriyle beyin cerrahi kliniğine başvurdu. Çekilen MRG’de kranioservikal bileşkede ekstrameduller yerleşimli T1AG’lerde heterojen izointens, T2 AG’lerde heterojen hiperintens lezyon imajı izlenmiş olup postkontrast serilerde heterojen kontrastlanma göstermektedir. Ayrıca kitlenin spinal kord ve medulla oblongataya bası oluştur- duğu, nöral foramene uzanım gösterdiği izlenmektedir. Tartışma: Medulloblastomlar 4. ventrikül tepesinden kaynaklanan ve öne ventrikül içine doğru büyüyen düzgün sınırlı, T1 AG’lerde hipointens ve T2 AG’lerde orta derece intensite özellikleri gösterir. FLAIR kesitlerde gri cevher ile izointens izlenmekte difüzyon AG’lerde lezyonlar hiperintens izlenmektedir. Supratentorial PNET’ler genellikle fronto parietal bölge kaynaklı, hemoraji, kalsifikasyon ve geniş kistik komponentler içeren büyük iyi sınırlı kitleler olarak izlenmektedir. Sonuç: Atipik teratoid rabdoid tümörler %50 oranında posterior fossadan, %40 oranında supratentorial alandan kaynaklanan kistik, nekrotik, kalsifik ve hemorajik odaklar içeren medulloblastom ve PNET’lerden net ayrımı yapılamayan lezyonlardır. Tanı anında 1/3 oranında leptomeningeal yayılım mevcuttur. Kontrastlı tetkiklerde lezyonlar heterojen kontrastlanma göstemektedir. MR Spektroskopide kolin piki ve artmış kolin/ aspartat oranı hiperselülariteyi düşündürmektedir.

P - 0107 NÖROBEHÇETİN NADİR YERLEŞİMİ; SERVİKAL TUTULUM MUTLU AY, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, MEHMET ALPEREN TEZCAN, GÖKHAN POLAT, ALPER KIZILOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Nöro Behçet hastalığı, Behçet hastalığının santral sinir sistemi tutulumuna verilen isimdir. Tüm Behçet hastalığı vakalarının %4-49’unda santral sinir sistemi tutulumu mevcuttur. Baş ağrısı, kişilik değişiklikleri, duysal bozukluklar, dizartri ve serebellar bulgular ile prezente olabilir. Vakaların %3’ünde tanı anında santral sinir sistemi bulguları mevcuttur. Fokal ve multifokal tutulumlar nöro-Behçet’in sık görülen SSS tutulum şeklidir, meningoensefalit ve sinüs ven trombozu daha nadirdir. Beyin sapı fokal lezyonların en sık görüldüğü alandır. Bazal ganglionlar 1/3 ora- nında bilateral tutulur. Serebral beyaz cevher tutulumu ve servikotorakal spinal kord tutulumu nadirdir. Olgu Sunumu: 5 yıldır Behçet hastalığı olduğu bilinen 17 yaşında erkek hasta kol ve bacaklarda güçsüzlük şikayetiyle başvurdu. Kliniğimizde çekilen MRG’de servikal alanda intrameduller patolojik heterojen intensiteler izlendi. Radyolojik bulgular eşliğinde lezyon primer nöro-Behçet hastalığı olarak değerlendirildi. Tartışma: Nöro Behçet lezyonları tipik olarak T1 AG’lerde hipointens, T2 AG’lerde ve FLAIR kesitlerde hiperintenstir. Lezyonlar tipik olarak orta derece yamalı kontrast tutulumu ve hafif difüzyon kısıtlılığı gösterebilirler. Lezyonlara akut evrede genellikle vazojenik ödem eşlik eder ve olduğundan büyük görünebilir. Akut fazda lezyonlar kitle etkisi oluşturmaktadır. İleri dönemlerde lezyonlar küçülüp akut fazdaki kontrastlanma özelliklerini kaybeder ve bazı lezyonlar hemosiderin birikimine bağlı mikrohemoraji gibi görünebilmektedir. Ayırıcı tanıda multipl skleroz, nöro- sarkoidoz, primer santral sinir sistemi lenfoması akla gelmesi gereken patolojilerdir. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S67 P - 0108 HAYATİ TEHDİT OLUŞTURAN BİR VAKA; PEDİATRİK HASTADA NEKROTİZAN PANKREATİT MUTLU AY, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, MEHMET ALPEREN TEZCAN, GÖKHAN POLAT, BERHAN PİRİMOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Akut pankreatitlerin ödematöz ve nekrotizan olmak üzere iki tür akut pankreatit vardır. Vakaların %90 gibi büyük bir kısmı ödematöz pankreatitdir. Nekrotizan pankreatit akut pankreatitin hayatı tehdit eden ağır formudur. Safra taşları, akut pankreatitlerin en sık sebebini oluşturmaktadır. Görüntüleme yöntemleri komplikasyonların tespiti ve tedavinin yönlendirilmesinde önemli rol oynar. Mortalite oranları steril nekrotizan pankreatitlerde %14 iken enfekte olması halinde %20-30’lara ulaşmaktadır. Enfekte bir nekrotizan pankreatit eğer direne edilmezse %100 ölümcüldür. Olgu Sunumu: 9 yaş erkek hasta bir haftadır devam eden şiddetli karın ağrısı ve kusma ile başvurdu. Yapılan ultrasonunda pankreas gövde ve kuyruk kesimlerinde kistik ve nekrotik değişiklikler izlendi. Tartışma: Akut pankreatit ve komplikasyonlarının tanısında tercih edilen görüntüleme yöntemi bilgisayarlı tomografidir. Erken aşamalarda SIRS ve multi organ yetmezliği bulguları pankreatitin ağırlığını değerlendirmede önemlidir, görüntüleme yöntemleri erken aşamada henüz morfolojik bozuklukları yansıtamayacağı için yetersiz kalmaktadır. BT’de nekrotik komponentler, kontrast tutmayan hipodens alanlar olarak izlenmektedir. Nekrotizan pankreatitler; parankimal, peripankreatik ve kombine olmak üzere alt gruplara ayrılır. Nekrotizan pankreatitte iki tür kolleksiyon vardır ilk 4 hafta akut nekrotizan kolleksiyon (ANC), 4 haftadan sonra duvarla çevrili kolleksiyon (WON) alarak adlandırılır. WON duvarı kontrast tutar.

P - 0109 BİLATERAL İLERİ DERECEDE KORTİKAL ATROFİ İZLENEN STURGE WEBER VAKASI MUTLU AY, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, MEHMET ALPEREN TEZCAN, GÖKHAN POLAT, BERHAN PİRİMOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Sturge Weber Sendromu (SWS), 50.000 doğumda bir görülür. Ensefalotrigeminal anjiomatozis olarak da adlandırılır. Yüzde porto şarabı lekesi ve pial anjiomlarla karakterize bir fokomatozdur. Diğer fokomatozlardan farklı olarak SWS sporadiktir ve kesin bir gen bulunamamıştır. Kliniğe konvülsiyon, intrakraniyal kalsifikasyonlar, kontralateral hemiparezi ve ipsilateral vasküler anomaliler eşlik eder. Fasiyal hemanjiomlar genellikle tek taraflı ve intrakranial patoloji ile ipsilateral olmakla birlikte bilateral de olabilmektedir. Olgu Sunumu: 3 yaş kız hasta, 2 yıldır epilepsi nedeniyle takip edilmekte olup atak ile acile başvurdu. Çekilen tomografisinde ileri derecede kortikal atrofi bulguları ve giruslarda kalsifikasyonlar izlendi. MR görüntülemede koroid pleksuslarda asimetrik hipertrofi ve leptomeningeal pial anjiomlar izlendi. Görüntüleme bulguları eşliğinde hastaya Sturge Weber tanısı konuldu. Tartışma: SWS’nin BT bulguları arasında; kortikal atrofi kalsifikasyon ve ipsilateral koroid pleksus hipertrofisi bulunmaktadır. BT’de kortikal ve subkortikal kalsifikasyonlar tren rayı görünümü oluşturabilir. MR bulguları T1 AG’lerde etkilenen alanlar izointens izlenmektedir. Kortikal atrofi izlenir. Kontrastlı T1 AG’lerde ipsilateral koroid pleksus hipertrofisi ve leptomeningeal kontrast tutulumu izlenmektedir. T2 AG’lerde anjiomlara bağlı beyaz cevherde hipointens alanlar izlenmektedir, anormal venöz kollateraller sinyal kaybı olarak izlenmektedir.

P - 0110 PEDİATRİK OLGUDA ANEVRİZMAL KEMİK KİSTİ MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY, GÖKHAN POLAT, ALPER KIZILOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Anevrizmal kemik kistleri iskelet sisteminin benign ve nadir karşılaşılan lezyonlarıdır; tüm kemik tümörlerinin yaklaşık olarak %1ni oluştu- rurlar. Anevrizmal kemik kisti, kemiği ekspanse, hatta bazen tamamen harap eden kistik, vasküler tümör benzeri bir oluşumdur. Klinik karakteri, S68 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı sessiz bir lezyondan bir sarkomu taklit eden agresif davranışa kadar değişik bir spektrum gösterir. Anevrizmal kemik kistinin patogenezi tam olarak bilinmemekle beraber genel düşünce travma veya prekürsör bir lezyon ile başlayan bir vasküler anomali olduğu yolundadır. Olgu Sunumu: 10 yaşındaki erkek hasta 1 aydır sol omzunda şişlik ve ağrı yakınması ile başvurdu FM de sol humerus proksimal ucunda yerleşen yaklaşık 7x4 cm çapında kitle izlendi Palpasyonda ısı artışı, duyarlılık yada kızarıklık saptanmadı Humerusu görüntülemeye yönelik yapılan röntgen incelemesinde, sol humerus başında, yaklaşık 10x4 cm boyutlarında kitle izlendi. Tartışma: Anevrizmal kemik kisti, tüm iskelette görülebilmesine karşın, sıklıkla uzun kemiklerde (%65) gözlenir. Kadınlarda (% 58) erkeklere nazaran daha sık görülür. Olguların %80 i yirmi yaşından önce görülmektedir ve otuz yaşından sonra görülmesi nadirdir. Anevrizmal kemik kis- tini tanımak için kullanılan görüntüleme yöntemleri X-ray, bigisayarlı tomografi (BT), magnetik rezonans görüntüleme (MRG) ve arteriografidir. MRG ile lezyondaki internal septalar bal peteği (‘honeycomp) görünümünde izlenir ve sıvı-sıvı seviyesi mevcuttur. Septaların görüntülenmesi olguyu diğer kistik içi sıvı dolu olgulardan ayırmakta yardımcı olur.

P - 0111 SUPRATENTORİAL VE İNFRATENTORİAL MRG BULGULARINI BİRARADA BULUNDURAN JOUBERT SENDROMU MUSTAFA YEŞİLYURT, RECEP SADE, BERHAN PİRİMOĞLU, GÖKHAN POLAT, MECİT KANTARCI, MUTLU AY, GÖKHAN TONKAZ, SERHAT KAYA Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Kalıtım olarak otozomal resesif geçiş gösterir. JS asıl olarak vermian ageneziye eşlik eden epizodik hiperpne,okulomotor apraksi, ataksi ve kognitif bozuklukları gibi klinik bulgular ile tanımlanır: Eşlik edebilecek diğer klinik durumlar oküler anomaliler, multikistik displastik böbrek,hepatik fibrozis, polidaktili ve nefronofitizistir. JS’unda beyin sapının orta hat yapıları, hem yapısal hem de fonksiyonel defektlere sahiptir. Nöropatolojik çalışmalar serebellar vermis agenezisini, birçok beyin sapı nükleuslarının hipoplazisi veya fragmentasyonunu ve pontomezensefalik bileşkedeki yapıların displazik olduğunu göstermiştir. Olgu Sunumu: 9 yaşında kız hasta nöromotor gelişme geriliği ile hastanemiz çocuk servisine yatırılmıştır Departmanımızda hastaya çekilen beyin MRG’de vermian agenezi ve korpus kallosum agenezisi görülmüştür. Tartışma: Klinik olarak Joubert Sendromu düşünülen olgularda tanı görüntüleme bulguları ile konur. Görüntüleme yöntemi olarak ise kranial MR kullanılır. Yine tanıya yardımcı olması açısından batın USG de multikistik displastik böbrek görülebilir. Kranial MRG de; Vermian Agenezi/ Hipoplazi, ventrikül genişlemesi, Superior serebellar pedinkülde morfolojik değişiklik (kalınlaşması/uzaması/incelmesi) ve bunlara sekonder molar diş görünümü ve yarasa kanadı görünümü aranmalıdır. Eşlik edebilen diğer bulgular; Corpus Callosum disgenezi/agenezi, Septum pellusidum agenezisi, KIBA ya neden olmayacak düzeyde lateral ventrikülde genişleme Tanıyı Joubert Sendromu lehine düşündükten sonra orta hat defektlerinin eşlik edip etmediğine bakılmalıdır. Nörogörüntüleme açısından ayırıcı tanıda; Dandy-Walker Send/Variantı, Septo-optik Displazi, Rhombensefalosinapsis düşünülmelidir.

P - 0112 STURGE-WEBER SENDROMLU PEDİATRİK OLGUNUN İNTRAKRANİAL GÖRÜNTÜLEME BULGULARININ YAŞLA DEĞİŞİMİ MUSTAFA YEŞİLYURT, RECEP SADE, BERHAN PİRİMOĞLU, GÖKHAN POLAT, MECİT KANTARCI, EMİNE İZGİ, FAHRİ AYDIN, SERHAT KAYA Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Herediter geçişi belirsiz, malignite riski olmayan, lokal morbiditeye yol açan multisistemik vaskuler hamartomdur. 1/20000-50000 insi- dansa sahiptir. Tanı genelde fasyal anjıom (porto şarabı lekesi-nevus flammeus) nedeniyle belirgindir. Nörolojik semptom fasyal anjıomla aynı tarafta yer alan ve genelde parietooksipital bölgeyi tutan leptomeningeal hemanjiom ile ilgilidir. En sık görülen klinik tablo çocuklukta nöbetler olup, vakaların% 71-89unda görülür ve genellikle tıbbi tedaviye dirençlidir. Olgu Sunumu: 25 yaşındaki annenin 1.gebeliğinde 1.yaşayan olarak normal yoldan doğan erkek bebeğin yüzünde porto-şarabı lekesi olması nedeniyle ileri tetkikine ve takibine karar verildi 1 yaşındayken sol ağız ve sol kolda atma ve titreme tarzında nöbeti olunca tekrar hastaneye başvurmuşlar.Doğum sonrası çekilen BT de çok anlamlı bulgu olmamasına rağmen 1 yaşında çekilen beyin BT de kortikal atrofi ve kalsifikasyon- ların görülmesiyle sturge –weber sendromu tanısı almış ve takibe girmiştir. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S69

Tartışma: 1/20000-50000 insidans ile nisbeten sık görülen bir sendrom. İlerleyen dönemlerde nöbet şeklinde kendini göstermektedir. Doğumda fasyal anjiom bulgusu olan bebeklerde tanı kranial görüntüleme bulguları ile konulmaktadır. Görüntüleme açısından ayırıcı tanıya intraserebral AV malformasyonlar, TORCH enfeksiyonları ve Gobbi sendromu girer. BT de kortikal-subkortikal kalsifikasyon, koroid pleksusta genişleme ve parankimal volum kaybı görülürken MRG de bunlara ek olarak leptomeningeal kontrastlanma görülür.

P - 0113 PEDİATRİK OLGUDA TİP 1 KİST HİDATİĞİN DİFFÜZYON MR GÖRÜNTÜSÜ MUSTAFA YEŞİLYURT, RECEP SADE, BERHAN PİRİMOĞLU, GÖKHAN POLAT, MECİT KANTARCI, GÖKHAN TONKAZ, EMİNE İZGİ, MUTLU AY*, FAHRİ AYDIN Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Karaciğer kistleri genel popülasyonda% 5lik bir prevalansla ortaya çıkmaktadır. Hidatik kist hastalığının tanısı epidemiyolojik ve klinik bulgulara ve radyolojik çalışmalara ve immünolojik testlere dayanır. İnsan kist hidatikleri, olası anafilaktik şok, yeni kistlerin yayılması ve bakteriyel enfeksiyon ile kist rüptürü gibi hayatı tehdit eden komplikasyonlara neden olabilir. Bununla birlikte, enfeksiyon gibi komplikasyon olmadıkça basit kistler asemptomatiktir. Bu nedenle, basit kistleri hidatik kistlerden ayırt etmek çok önemlidir. Kist tipine bağlı olarak çok çeşitli tedavi seçenekleri vardır; Bu nedenle, benign kistin ekinokokkoz, kistadenom ve kistadenokarsinom gibi zararlı kistlerden ayırt edilmesi önemlidir. Olgu Sunumu: 11 yaşında kadın hasta hastanemize karın ağrısı şikayeti ile başvurdu. Departmanımızda hastaya çekilen difüzyon ve batın MRG de tip 1 kist hidatik ile uyumlu görünümler izlenmiş ve laboratuar olarak kist hidatik olduğu kanıtlanmıştır. Tartışma: Manyetik rezonans görüntüleme, kliniğimizde MRun kontrast rezolüsyonu ve noniyonize olmasından dolayı kistik lezyonların karakterizasyonu için tercih edilen bir yöntemdir. Bununla birlikte, tip 1 hidatik kistleri basit kistlerden ve tip IV hidatik kistlerden karaciğerindeki diğer katı lezyonlardan ayırmak imkansızdır. Bu koşullarda, karaciğerdeki kistik lezyonları ayırt etmek için BT veya MRG yapılabilir. Difüzyon ağırlıklı görüntüleme, konvansiyonel MR görüntüleme tekniklerinden farklıdır; difüzyon veya Brownian su hareketi olarak bilinen randomize moleküler hareketi hassas bir şekilde algılayabilir.

P - 0114 PERİANAL RABDOMYOSARKOM EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Rabdomyosarkom iskelet kasına farklılaşan mezenkimal hücrelerden kaynaklanan oldukça agresif nadir görülen malign bir tümördür. Bu olgu sunumu ile amacımız, anal bölge kitlelerin ayırıcı tanısında, ender rastlanması ve oldukça kötü seyir göstermesi nedeniyle, perianal rabdomyosarkom tanısının gözden kaçırılmaması gerekliliğini vurgulamaktır. Olgu Sunumu: 3 yaşındaki erkek hasta perianal bölgede kitle şikayeti ile pediatri kliniğine başvurdu. Hastanın muayenesinde 8x9 cm ebatlı palpasyonla sert kıvamda kitle mevcuttu. Yapılan US de ; skrotum inferioru ile anal kanal arasında yaklaşık 8x7x6 cm ölçülen heterojen ekojenitede, doppler US de belirgin vaskülerite gözlenen yer yer milimetrik kistik alanlar içeren kitlesel görünüm dikkati çekmiştir. Hastanın BT sinde bu böl- gede testis ile ilişkisi saptanmayan yumuşak doku dansitesinde kitle lezyon izlendi. Hastanın MR ında T1 AG hetereojen hipointens T2 AG heterojen hiperintens olan lezyon kontrastlı görüntülerde belirgin kontrast tutmakta idi. Lezyonun histopatolojisi rabdomyosarkom olarak gelmiştir. Tartışma: Çocukluk çağında en sık görülen malign yumuşak doku tümörü olan rabdomyosarkom, bu yaş grubundaki tüm solid tümörlerin %5-8ini oluşturmaktadır. Erişkinlerde ise bu oran %1 dir. Çocukluk çağında perianal bölge lokalizasyonlu rabdomyosarkom oldukça nadir olup, tüm rabdomyosarkomların %2sini oluşturmaktadır. En sık baş ve boyunda (%40), genitoüriner sistemde (%20), ekstemitelerde (%20) ve gövdede (%10) bulunurlar. Retroperitoneal bölge (karın arka duvarı) ve diğer bölgeler (%10)’unu oluşturur. Ekstremite lezyonları ileri yaş çocuklarda daha sıktır ve alveolar histolojik yapıya sahiptirler. Embriyonal en sık görülen tip (% 60) olup baş-boyun ve paratestiküler bölgelerde ortaya çıkarken, botryoid tip sıklıkla genitoüriner sistemin mukozal yüzeylerini tutar. Pleomorfik rabdomyosarkom ise daha çok erişkinlerde, ekstremitelerin büyük kaslarında görülür.

P - 0115 İKİNCİ BRANKİAL KLEFT KİSTİ: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI S70 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

GÖKHAN TONKAZ, SERHAT KAYA, BERHAN PİRİMOĞLU, MUTLU AY*, FAHRİ AYDIN, SUAT EREN, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Brankial arkların embriyonik dönemde anormal gelişmesi sonucunda kist, sinüs veya fistül şeklinde brankial anomaliler gelişir. Brankial anomaliler köken aldığı yere göre isimlendirilir. En sık rastlanan anomali ikinci brankial yarık kistleridir ve tüm brankial yarık anomalilerinin % 95ini oluşturur. Brankial kleft kistleri (BKK) genellikle boyun lateralinde, sternokleidomastoid kasının anteriorunda görülmektedir. Konjenital bir anormallik olmasına rağmen, genellikle küçük travma veya enfeksiyondan sonra erken yetişkinlikte (ikinci ve üçüncü dekatda) farkedilirler. Cinsiyet tercihi yoktur. Klinik olarak ağrısız sternokleidomastoid kasın anterior sınırında şişlik olabilir. Üst solunum yolu enfeksiyonu sırasında ikincil enfeksiyonlar veya inflamasyon sonucu akut boyut artışı oluşabilir. Radyolojik görüntülemede, BKK tipik olarak, ince belirgin kontrastlanan kapsül ve homojen sıvı içeriğine sahip yuvarlak veya oval kitleler halinde bulunurlar. İkinci BKK için tedavi cerrahi eksizyondur. Olgu Sunumu: 17 yaşında kız hasta boyun sağ tarafında bir aydır şişlik şikayetiyle Kulak Burun Boğaz polikliniğine başvurdu. Fizik muayenesinde boyun sağ üst juguler bölgesine uyan lokalizasyonda palpasyonla hafif ağrılı, mobil düzgün sınırlı kitle izlendi.MRGde sağ sevikal jugulodigastrik zincire yakın yerleşimli T2 AG lerde hiperintens, T1 AG lerde izo - yer yer hipointens diffüzyon kısıtlılığı göstermeyen, postkontrast serilerde kısmen periferik halkasal kontrastlanma gösteren yaklaşık 25x20 mm ebatlı kistik lezyon saptandı. Kitle rezeke edildi. Histolojik incelemede BKK ile uyumlu geldi. Tartışma: Genç erişkin dönemde (16-40 yaş) boyunda kitle etiyolojilerini sıklık oranına göre sıraladığımızda infeksiyöz, doğumsal ve neoplastik şeklindedir. BKK embriyolojik gelişim sırasında brankial yarıkların tam kapanmaması nedeniyle oluşan konjenital boyun lezyonlarıdır ve genellikle genç erişkinlerde tanı alır. Hastaların birçoğu ağrısız kitlenin büyüyüp belirginleşmesi ile hastaneye başvurur. Kitlede bu ani değişikliğin nedeni sıklıkla faranjit, otitis media veya diş enfeksiyonu gibi akut bir üst solunum yolu enfeksiyonudur. Büyüme sonucu oluşan kitle etkisiyle damar sinir paketi gibi vital yapılara bası yapabilir.Ayırıcı tanı metastatik skuamöz hücreli karsinom, lenfadenit, lenfoma, servikal dermoid kist, kistik higroma ve parotis patolojisini içerir. BKK’nin en sık tedavi seçeneği cerrahi eksizyondur ve komplikasyon oranı düşüktür.Cerrahinin en önemli nedeni nadir de olsa BKK’nın malignleşme potansiyelidir. Sonuç olarak, genç erişkin yaş grubunda boyun kitlelerinde benign etiyolojiler ön planda düşü- nülmelidir ve MRG lezyonun natür tayininde yardımcı bir araçtır.

P - 0116 MRG BULGULARI İLE ADRENOLÖKODİSTROFİ OLGUSU ERTAN HAZAR 1, CENK ERASLAN 1, ÖMER KİTİŞ 1, CEM ÇALLI 1, EBRU CANDA 2 1 Ege Üniversitesi, Radyoloji Anabilim Dalı, İzmir, Türkiye 2 Ege Üniversitesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Metabolizma Bölümü, İzmir, Türkiye Özet Giriş: Adrenolökodistrofi X kromozomu geçişli genetik bir hastalıktır.Patogenezde uzun zincirli yağ asitlerinin peroksizomlarda yıkılamaması sorumludur.Hastalık santral sinir sisteminde demiyelinizasyon ile birlikte adrenal bez ve testis disfonksiyonu yapabilir.Neonatal,çocukluk,adölesan ve erişkin dönemde görülebilir.Neonatal ve çocukluk çağı ALD si oldukça kötü prognozludur.X kromozom geçişi nedeni ile erkekler hasta,kadınlar taşıyıcı konumdadır.İnsidans yaklaşık 1/50.000 dir. Gereç ve Yöntemler: 5 yaşında erkek olgu. Konuşma bozukluğu,gözde kayma,denge kaybı gibi nörolojik şikayetler üzerine çocuk kliniğine baş- vurmuş. MRG de bilateral paryetal ve oksipital bölgede periventriküler beyaz cevherden subkortikal beyaz cevhere uzanan T1A hipointens,T2A da konfluens gösteren hiperintens alanlar ve bu alanlar içerisinde rim tarzında çizgisel demarkasyon gösteren kontrastlanmalar izlendi. Kontrastlanan alanlar posterior talamik ve internal kapsüle,kaudalde piramidal traktusa uzanım göstermekteydi. Subkortikal u lifleri korunmuştu. DAG de belirgin bir difüzyon kısıtlılığı izlenmedi.ADC de vazojenik ödem alanı hafif hiperintens alanlar olarak izlendi. MR Spektroskopide de NAA de azalma, yer yer laktat piklerinde artış izlendi. Bulgular: Peroksizomal bir lökodistrofi olan bu hastalıkta uzun zincirli yıkılamayan yağ asit birikimlerine bağlı etkilenen alanda demiyelinizasyon, akson kaybı, gliozis ve skar gelişmektedir. Histopatolojik olarak tutulan alan 3 zon olarak sınıflandırılmıştır. Santral zon gliozis ve skarı,İntermediate zon perivaskuler aktif enflamasyonu,dış zon ise aktif demiyelinizasyon alanını temsil eder. ALD için tipik kontrastlanma paterninden intermediate zon sorumludur. Subkortikal U lifler genellikle korunur. Santral zon T1A da hipointens, T2A da hiperintens izlenir. İntermediate ve periferal zon T2A da genellikle düşük sinyalli izlenir.MRS de nöron markırı NAA de azalma,laktat pikinde artış beklenir. BT de ise periatrial bilateral beyaz cevherde hipodens alanlar ve postkontrast çizgisel kontrastlanma olarak görülür. Hastalığın tanısında görüntülemeye ek olarak uzun zincirli yağ asit ölçümleri, adrenal veya testis disfonksiyonu olan hastada ACTH ve diğer hormon ölçümleri ve moleküler genetik testler kullanılır. Sonuç: X kromozomu ile kalıtılan genetik temelli ALD özellikle neonatal ve çocukluk çağında prognozu oldukça kötüdür. Klinik tabloda nöro- lojik yıkım, bu duruma eşlik edebilecek adrenal ve testiküler yetmezlik tablosu akıla ALD yi getirmelidir. MRG de paryetal ve oksipital rim tarzı kontrastlanma tipiktir. Ayırıcı tanıda radyolojik olarak asetil coA oksidaz eksikliği, klinik olarak ise krabbe, zellweger, mitekondrial hastalıklar yer almaktadır. Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S71 P - 0117 PREPUBERTAL OLGUDA BİLATERAL TESTİKÜLER ADRENAL REST TÜMÖRÜ: USG VE MRG BULGULARI BERHAN PİRİMOĞLU, GÖKHAN TONKAZ, RECEP SADE, SERHAT KAYA, MUTLU AY*, GÖKHAN POLAT, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Testiküler adrenal rest tümör (TART), konjenital adrenal hiperplazili (KAH) erkek hastalarda yüksek ACTH düzeylerine bağlı olarak, testislerde gelişebilen benign tümörlerdir. Embriyogenez sürecinde, skrotuma testisin inişi sırasında testise yerleşen kalıntı adrenal hücrelerinden ya da testisdeki puripotent kök hücrelerinden geliştiğini ileri süren iki farklı hipotez vardır. Konjenital adrenal hiperplazi (KAH) steroid sentez yolundaki enzimlerden birinin eksikliği sonucu ortaya çıkan, bir grup adrenal steroid sentez bozukluğu hastalığıdır.Olguların % 90’ından fazla- sında 21-hidroksilaz enzim eksikliği vardır. TART sıklıkla bilateral yerleşimlidir (%83) ve çoğunluğu (%76) erişkin yaşta tanı almaktadır. KAH’li hastalarda, yüksek seyreden adrenal androjen düzeyleri nedeniyle hipofizyal-gonadal aksın baskılanması, küçük testis boyutlarına ve infertiliteye sebep olur. Yine TART, obstrüktif azospermi ve oligospermiye yol açarak infertiliteye sebep olur. KAH’lı erkek hastaların yaşam boyunca %8,2’ sinde testiküler kitle gelişebildiği saptanmıştır .Tedavi almayan hastalarda ve sıklıkla genç erişkin dönemde görülür. Olgu Sunumu: 2 aylıktan beri KAH tanısı olan ve son 6 aydır testiste ağrı şikayeti ile hastanemize başvuran 6 yaşındaki erkek hasta ultrasonografi (US) ve manyetik rezonans görüntüleme (MRG) bulguları ile birlikte değerlendirildi.USG’de her iki testiste hilustan parankime uzanan, multifokal, yer yer akustik gölgelenme gösteren hipoekoik lezyonlar izlendi. MRG’de ise yine hilustan parankime uzanan, T1 ağırlıklı görüntüde izointens-hiperintens, T2 ağırlıklı görüntüde hipointens bilateral özellikte solid kitle lezyonlar izlendi. Tipik görünümleri, bilateral olmaları, testis tümör markerlarının negatif olması ve KAH öyküsü olması nedeniyle lezyonlar TART olarak düşünüldü. Steroid tedavisi sonrası 6 ay sonraki kontrollerinde USG’de lezyonların boyut ve sayısında azalma azalma izlendi. Tartışma: Lezyonlar genellikle rete testiste yerleşimlidir ve parankime doğru uzanım gösterirler. Ayırıcı tanıda;testis kanseri, testis apsesi, Leydig hücre hiperplazisi yer alır. Ancak TART tanısı tipik öykü, bilateral olma ve karakteristik US ve MRG bulguları ile konulabilir. Bununla birlikte tüm bu US ve MRG bulguları uygun klinik ve endokrin profil eşlik etmeden diğer testis malignitelerinden ayrımı kesin olarak sağla- yamaz.

P - 0118 GUILLAIN-BARRE SENDROMU SEMPTOMLARIYLA BAŞVURAN PEDİATRİK SPİNAL LENFOMA OLGUSU ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Spinal lenfoma lenfomalar içerisinde nadir görülmekle beraber sıklıkla vertebra korpusunu ve epidural kompartmanı tutar. İntramedüller tutulum çok daha nadir görülür. Olgu Sunumu: Hastanemize 10 gün önce başlayan alt ekstremitelerde ilerleyici güçsüzlükle başvuran 14 yaşındaki erkek hastanın muayenesinde duyu kaybı yoktu. Elektrofizyolojik incelemelerde akut jeneralize polinöropati olarak değerlendirilen hastada Guillain-Barre Sendromu tanısı kondu. 1 haftalık intravenöz immunglobulin tedavisine rağmen semptomları gerilemeyen hastaya manyetik rezonans görüntüleme (MRG) yapılmasına karar verildi. MRG’de T1 ağırlıklı görüntülerde izointens, T2 ağırlıklı görüntülerde hipointens, homojen kontrastlanan, spinal kanala uzanım gösteren intramedüller kitle saptandı. Ayrıca eşlik eden servikotorakal siringohidromyeli kavitesi gözlendi. Operasyon sonrası patoloji sonucu lenfoblastik lenfoma gelen hastaya kemoterapi ve radyoterapi tedavisi başlandı. Sonuç: Guillain-Barre Sendromu benzeri bulgular, ağrı, güçsüzlük ve duyusal şikayetler ile başvuran hastalarda olası spinal kitleler akılda tutul- malıdır ve tanıda spinal MRG standarttır.

P - 0119 ÇOCUKLARDA İNMENİN NADİR NEDENİ: SEREBRAL VENÖZ TROMBOZ ALPEREN TEZCAN, RECEP SADE, MECİT KANTARCI, BERHAN PİRİMOĞLU, GÖKHAN POLAT Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye S72 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Giriş: Serebral venlerin ve sinüslerin trombozu nadir; ancak tanısı atlanan veya geç konan önemli bir serebrovasküler hastalıktır. Her yaş grubunda görülmekle birlikte, daha çok genç ve orta yaşlardaki bireyleri ve çoğunlukla da kadınları etkiler. Klinik prezentasyonları değişken ve sıklıkla dramatiktir. Genellikle intrakranial hipertansiyona bağlı baş ağrıları, fokal defisit, nöbetler veya konfüzyonel durum tablolarının birisiyle akut olarak başlamaktadırlar. Tanıda manyetik rezonans (MR) venografi standarttır. Olgu Sunumu: Çocuk acil polikliniğine daha önceden derin ven trombozu nedeniyle takip edilen, anlamsız bakış ve kusma şikayeti ile başvuran, bilinci uykuya meyilli, her iki pupil dilate olan 16 yaşında kadın hastanın beyin bilgisayarlı tomografisinde (BT) sol temporoparietal lob yerleşimli intraparankimal hematom alanı ve çevresinde ödem etkisi izlendi. Ayrıca sol transvers sinüs trasesinde dansite artımı mevcut olması üzerine çekilen kontrastlı MR venografide sol transvers sinüs, sigmoid sinüs ve internal juguler ven proksimalinde trombüse bağlı dolum defekti ve buna sekonder gelişmiş hemorajik venöz enfarkt saptandı. Bunun üzerine hastaya uygun antikoagülan ve destek tedavisi başlandı. Sonuç: Akut serebrovasküler olayların nadir rastlanan bir sebebi olsa da bu olguda olduğu gibi, venöz tromboz ciddi bir mortalite ve morbidite nedeni olabileceğinden hiperkoagülabilite durumlarında mutlaka serebral venöz tromboz da ayırıcı tanıda akla gelmelidir. Tanıda kontrastlı MR venografi esastır.

P - 0120 PEDİATRİK KALÇA AĞRISI: SİNOVYAL OSTEOKONDROMATOZİSLİ İKİ OLGU AYŞE GÜL ALIMLI 1, NAZLI GÜLSÜM AKYEL 2, MESUT SİVRİ 2, TÜLİN HAKAN DEMİRKAN 2 1 Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Pediatrik Radyoloji, Ankara, Türkiye 2 Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Radyoloji, Ankara, Türkiye Özet Sinovyal osteokondromatozis (SO) sinovyal dokuda metaplazi sonucu gelişen eklem mesafesinde genellikle benzer boyutlu kalsifiye kartilajinöz oluşumlarla karakterize bir hastalıktır. Sıklıkla diz, kalça ve el bileği olmak üzere tek eklem tutulumu yapar. Erişkin hastalığı olup genelde 3-4. dekadda tanı alır. Bu bildiride kalça ağrısı ile başvuran ve SO tanısı konulan iki pediatrik olgu Manyetik Rezonans Görüntüleme (MRG) ve direk grafi bulguları eşliğinde tartışılmıştır.

P - 0121 UNUTULMAMASI GEREKEN BİR PEDİATRİK RENAL PATOLOJİ: MULTİKİSTİK DİSPLASTİK BÖBREK VE MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI GÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, RECEP SADE, MUSTAFA YEŞİLYURT, MUTLU AY*, FAHRİ AYDIN, SUAT EREN, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Multikistik displastik böbrek (MKDB), böbreğin kalıtsal olmayan gelişimsel anomalisidir ve çocuklarda kistik hastalıkların en sık nedenidir. MKDB’de, bir biriyle bağlantılı olmayan, çok sayıda ve değişik büyüklüklerde kistler vardır, böbrek parankimi yoktur. İnsidans 4300 canlı doğum- da 1dir ve prenatal ultrasonda en sık saptanan anomalilerden biridir. En çok sol tarafı etkiler ve erkeklerde daha sık görülür. MCDK nispeten asemptomatiktir ve genellikle antenatal görüntülemede tespit edilir. MCDKnın postnatal tespiti daha az yaygındır (%20). Postnatal dönemde tanımlanamayabilir ve çocukluk çağında tam involusyonu takiben renal agenezinin bir nedeni olabilir. MCDKnin en önemli klinik özelliği fonksiyonel olarak soliter kontralateral böbreğin bulunmasıdır, bu nedenle eşzamanlı anomalilerin saptanması ve yönetimi değerlendirmenin temeli haline gelmiştir. Multikistik displastik böbrek tedavisinde seçenekler böbreği çıkarmak, takip veya görmezden gelme seçenekleri mevcuttur. Olgu Sunumu: 2 yaşında kız hasta karın ağrısı şikayetiyle hastanemize başvuruyor. USG ve MRG’ de sağ böbrek parankimi seçilemedi. Böbrek lojunda bir biriyle ilişkisiz multıple sayı ve ebatta kistler izlendi. MKDB tanısı konulan hastaya konservatif takip planlandı. Tartışma: MKDB’li klasik klinik prezentasyonunda hastaların; 1/3’ü yenidoğan döneminde asemptomatik palpabl kitle, 1/3’ünde kusma veya anoreksik çocuk tablosu ve geri kalan 1/3’ü ise idrar yolu enfeksiyonları yada otopsi araştırmalarında tesadüfi olarak saptanırken, adölesan veya erişkinlerde ise MKDB daha çok karın ağrısı, karında kitle, hematüri ve hipertansiyon ile ilişkili olmuştur. Kontralateral böbreğin anormalileri hastaların yaklaşık %40’a varan oranda bulunur. Bunlar vezikoüreteral reflü, üreteropelvik bileşke darlığı, üreterovezikal bileşke darlığı, ektopik üreter ve üreterosel şeklindedir.Özellikle dikkat edilmesi gereken diğer bir husus ise MKDB’li hastalarda az görülmesine rağmen hipertansiyon açısından periodik olarak kan basıncı izlenmelidir.Hastaların tanı ve takibi genellikle US ile yapılır. Ultrasonografide değişik boyutlarda ve toplayıcı Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S73 sistemle ilişkisiz kistler, renal parankimin gösterilememesi MKDB tanısını düşündürmektedir. Kesin tanı, perfüzyon ve fonksiyon yokluğunu teyit eden sintigrafi ile yapılır. Bir çok MKDB zamanla küçülmekte veya kaybolmaktadır. Asemptomatik olan hastalar konservatif takip edilebilirler. Semptomatik olanlarda ise klinik, laboratuvar ve radyolojik bulgulara göre takip yapılmasının uygundur. Sonuç: Sonuç olarak USG’nin yanında iyonize olmayan radyasyon görüntüleme modalitesi olan MRG pediatrik popülasyonda önemli bir husus- tur. MKDB kistleri T2 AG de açıkça gösterilmektedir. Uygun vaka seçimlerinde MRG, tanıda operatör bağımlı USG’nin toplayıcı sistemle ilişkisiz kistleri göstermede yetersiz olduğu durumlarda kullanılabilir. USG ve MRG tek taraflı MKDB ile karşı taraf böbrek ve üriner sistem malfromas- yonlarını tanımlamada güvenli bir şekilde kullanılabilir.

P - 0122 FASET EKLEMİN NADİR GRANÜLOMATÖZ ENFEKSİYONU: POTT HASTALIĞI ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Pott hastalığı, tüberküloza bağlı kas ve iskelet sistemi tutulumu saptanan olguların yaklaşık üçte birini oluşturur. Pott hastalığı hematojen olarak veya plevral hastalığın lenfatik yolla yayılımı sonucunda gelişebilir. Çocukluk çağında torakal vertebra, erişkinlerde ise lomber vertebra tutulumu daha sıktır. Olgu Sunumu: Pediatri kliniğimize daha önceden tüberküloz öyküsü olan bel ağrısı ve yüksek ateş ile başvuran 17 yaşındaki erkek hastanın yapılan manyetik rezonans görüntülemesinde lomber 4/5 vertebra faset ekleminde T1’de heterojen hipointens, T2’de heterojen hiperintens, post-kontrast kesitlerde heterojen kontrast tutulumu bulunan lezyon izlendi. Akut faz reaktanları yükselmiş olan hastanın patolojisi granüloma- töz enflamasyon olarak tanımlandı. Radyolojik ve laboratuar sonuçlarına göre lezyon faset eklemin tüberkülozu olarak değerlendirildi. Sonuç: Basil ile önceden enfekte olduğu bilinen bir çocukta, eklem lezyonlarının gelişmesi ya da inatçı, açıklanamayan eklem lezyonlarının varlı- ğında tüberküloz akla gelmelidir. Lezyonun gösterilmesinde MRG yol gösterici olabilir.

P - 0123 ULNAR ARTER ANEVRİZMASI ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: Ulnar arter anevrizması nadir olarak görülen bir anevrizmadır, genellikle arterin distaline yerleşim gösterir. Travmatik, aterosklerotik ve enfeksiyöz nedenlerle gelişebilir, parmak iskemisine neden olabildiği için tanı ve tedavisi önemlidir. Olgu Sunumu: 12 yaşında erkek hasta, üç aydır sağ el bileğinde giderek büyüyen ağrılı şişlik şikayeti ile hastanemize başvurdu. Fizik muayenede sağ el bileğinin 3 cm distalinde, 1,5x1 cm boyutunda pulsatil kitle tespit edildi. . Anamnezinde ek hastalık, anevrizma bölgesinde tıbbi girişim, travma ya da delici-kesici alet yaralanması öyküsü yoktu. Hastaya anevrizma ön tanısıyla manyetik rezonans anjiografi (MRA) çekildi ve MRA’da sağ el bileği seviyesinde ulnar arter trasesi boyunca lokalize yaklaşık 10x12 mm ebatlı sakküler anevrizmaya ait görünüm izlendi. İzole ulnar arter anevrizması tanısıyla cerrahi girişim yapıldı ve anevrizma dokusunun histopatolojik incelemesinde gerçek anevrizma olduğu saptandı. Sonuç: Üst ekstremite arter anevrizmalarının tutulan arterlerin sıklık sırasına göre dağılımı subklavian, aksiller, brakial ve daha az sıklıkla da radial ve ulnar arterlerdir. Anevrizma gelişiminde sıklıkla travma (künt ya da kesici), iatrojenik (arteriyel monitorizasyon ya da kateterizasyon) daha az olarak enfeksiyon (staphylococcus aureus), poliarteritis nodosa, Marfan sendromu, konjenital arteriyel patolojiler rol oynar. Pulsatil kitle tespit edilmesi ile tanı klinik olarak da konabilir. Arteriyel doppler ultrasonografi, manyetik rezonans anjiografi (MRA) ya da selektif üst ektstremite anjiografi ile tanısı kesinleştirilir. MRA operatör bağımlı ve invaziv olmaması nedeniyle daha çok tercih edilmektedir.

P - 0124 AKUT BATIN TABLOSU İLE GELEN İMPERFORE HYMEN OLGUSU MEHMET KARAGÜLLE1, FATMA ZEYNEP ARSLAN2, SÜLEYMAN ÖNCÜ1, CANAN KOCAOĞLU2, GÜL ESER2, SAMET ŞİMŞEK1 1 Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye 2 Konya Eğitim ve Araştırma Hastanesi, Konya, Türkiye S74 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet İmperfore hymen, vajinal çıkışta bulunan hymen zarının normal santral açıklığının bulunmadığı konjenital bir durumdur. Tahmin edilen insidansı her 1000 kadında 1 olarak raporlanmıştır.biz olgumuzda imperfore hymenin MR görüntülerini sunmayı amaçladık. 12 yaşında kadın hasta akut batın tablosu düşündüren şiddetli karın ağrısı ile gece acil servise başvurdu. Anamnezinde primer amenore öyküsü mevcuttu. Hastaya yapılan USG’de mesane posteriorunda, pelvisi dolduran homojen yapıda yoğun koleksiyon alanı izlendi. Pelvik MR incelemesinde uterus ve vajende T1AG hiperintese, T2AG hipointense sinyal özelliğinde, postkontrast serilerde kontrast tutmayan hemorajik mayi lehine koleksiyon izlenmiş olup imperfore hymen lehine değerlendirildi. Cerrahi sonrası tanı imperfore hymen olarak doğrulandı. İmperfore hymen nadir görülmesine karşın vajinal çıkış anomalileri arasında en sık görülenidir. Genelde izole olmakla birlikte bazı konjenital ürogenital sistem anomalileri ile birlikte görülebilmektedir. Büyük oranda sporadik saptanmasına karşın litaretüre bakıldığında çok az sayıda genetik geçişli olgularda bildirilmiştir. İmperfore hymen puberte dönemine kadar bulgu vermese de nadiren biriken uterovajinal sekresyonlara bağlı prepubertal tanı konulabilir. Genelde hastalar adölesan dönemde amenore, siklik karın ağrısı, kitle ve kitle basısına sekonder idrar yapamama semptomları ile gelmektedir. Tanı USG ve klinik bulgular ile konulmakla birlikte ayırıcı tanısı, cerrahi öncesi anatominin değerlendirilmesi ve eşlik eden anomaliler ve komplikasyonlar açısından MRG çok faydalı bilgiler vermektedir. İmperfore hymen ayırıcı tanısında; transvers vajinal septum, distal vajinal atrezi ve labial adezyon akılda tutulmalıdır.

P - 0125 HİPOKSİ SONRASI GEÇ DÖNEM LÖKOENSEFALOPATİ : ÇOCUK OLGU NAZLI GÜLSÜM AKYEL, TÜLİN HAKAN DEMİRKAN, MESUT SİVRİ, AYŞE GÜL ALIMLI Sağlık Bilimleri Üniversitesi, Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Ankara, Türkiye Özet Hipoksi sonrası geç dönem lökoensefalopati (HSGL) nadir görülen, serebral hipoksik hasar sonrasında gelişen beyaz cevher hasarıdır. Yüzde 60 alev, grade I inhalasyon yanığı ve duman zehirlenmesi ile hastanemize kabul edilen 4 yaşında erkek hastanın manyetik rezonans görüntülemesin- de (MRG) derin asfiksi lehine değerlendirilen bilateral diffüz kortikal difüzyon kısıtlanması, simetrik kaudat nükleus ve globus pallidus sinyalleri mevcut idi. Takibinde yaklaşık 2 ay sonra yapılan MRGde yaygın lökoensefalopati ve parankimal hematomlar gelişti. Bilgimiz dahilinde literatürde HSGL tanımlanan çocuk olgu bulunmamaktadır.

P - 0126 GİANT SAFRAKESELİ ÇOCUK OLGU TÜLİN HAKAN DEMİRKAN, GÜLŞAH BAYRAM, NAZLI GÜLSÜM AKYEL, AYŞEGÜL ALIMLI, HAVVA AKMAZ ÜNLÜ, MEHMET TİFTİK Dışkapı Çocuk Sağlığı ve Hastalıkları Hematoloji ve Onkoloji Eğitim Araştırma Hastanesi, Ankara, Türkiye Özet Normal safra kesesi boyutu 7.5-10 cm arasındadır. Büyük safra kesesi sık raslanılan bir durumdur. Ancak giant safra kesesi nadiren rapor edilmiş- tir. Genellikle nedeni altta yatan bir obstruksiyona baglı olarak (tümör veya safra kessi taşına) gelişmektedir. Ancak nadiren bir taş veya tümör olmadan da izlenebilmektedir. Bizim olgumuzda 6 yaşında erkek hasta olup, multilobüle kontrlu, batın sağ kesimini büyük oranda dolduran giant kese izlenmekteydi. Hastanın operasyon sonrasıda bu bulgular teyit edildi. Nadir olması nedeniyle sunuldu.

P – 0127 MİLD ENCEPHALİTİS WİTH A REVERSİBLE SPLENİAL LESİON: OLGU SUNUMU ATAKAN KIRTEKE, MESUT ÇETİN, ADEM AĞYAR Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye Özet MERS baş ağrısı,bilinç bozukluğu nöbetler ile gidebilen hafif dereceli bir santral sinir sistemi bozukluğu olmakla birlikte çeşitli enfeksiyonlar(H. influenza,rotavirüs,kızamık virüsü,mikoplazma pnömonisi,legionella pnömonisi gibi), yüksek irtifa sonucu meydana gelen serebral ödem(high altitude cerebral edema), hiponatremi ve hipoglisemi gibi metabolik bozukluklar ve antiepileptik ilaç tedavisi gibi nedenlerle meydana geldiği bildirilmiştir. MRG’de tipik özellikleri T2 ağırlıklı görüntülerde ve FLAİR görüntülerde hiperintens,T1 ağırlıklı görüntülerde ise hiper-izointens görünmeleridir. Ayrıca postkontrast T1 ağırlılı görüntülerde kontrast tutulumu görülmezken; DAG’de kısıtlanma izlenir. MERS lezyonun yerleşim yerine göre 2 gruba ayrılır. Tip 1 Korpus Kallosumun Splenium kesimini tutarken;Tip 2 serebral beyaz cevherde simerik tutulum veya korpus Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S75 kallosumun anterior kesimini tutar. Hastanemiz çocuk acil servisine nöbet geçirme şikayetiyle başvuran 14 yaşındaki erkek hastaya Radyoloji kliniğine Beyin MRG çekimi için gönderilmiştir.Çekilen Beyin MRG tetkikinde Korpus Kallosum Splenium kesiminde T2 ağırlıklı görüntülerde izo-hiperintens,T1 ağırlıklı görüntülerde izo-hipointens, DAGde kısıtlanma gösteren lezyon izlenmiştir.Klinik muayene verileriyle beraber hastaya MERS tanısı konulmuştur. Kendine özgü radyolojik bulguların doğru ve hızlı bir şekilde tanınması, MERS tanı ve prognozun katkı sağlayacaktır.

P - 0128 NADİR BİR AKSİLLER LENFADENOPATİ NEDENİ: PULMONER NODÜLLERİN EŞLİK ETTİĞİ LHH OLGUSU AYŞE GÜL ALIMLI Sağlik Bilimleri Üniversitesi, Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Pediatrik Radyoloji, Ankara, Türkiye Özet Langerhans hücreli histiositozis (LHH) en sık infant ve çocuklarda görülen nadir bir histiositik hastalıktır. Genellikle osteolitik kemik lezyonu ile karakterizedir. Cilt, lenf nodları, karaciğer, dalak, oral mukoza, akciğer, merkezi sinir sistemi de tutulabilir. Bu bildirinin amacı aksiller kitle ile başvuran, pulmoner nodüllerin de eşlik ettiği LHH tanısı alan 4 aylık erkek hastayı manyetik rezonans görüntüleme, B mod ultrason ve shear wave elastografi bulguları ile birlikte tartışmaktır.

P - 0129 BİR AKUT RENAL YETMEZLİK KOMPLİKASYONU: PRESS GÖKHAN POLAT, HAYRİ OĞUL, RECEP SADE, SUAT EREN, AKIN LEVENT, MECİT KANTARCI Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye Özet Giriş: PRES (posterior reversibl ensefalopati sendromu) akut ya da subakut nörolojik semptomlara neden olan reversibl bir durumdur. PRES’e en çok sebep olan durumlar hipertansif ensefalopati, eklampsi, siklosporin-A nörotoksisitesi epilepsi sonrası postiktal durumlardır. Başağrısı, konfüzyon, bulantı, kusma ve görme bozuklukları semptomları arasındadır ve nöbet gibi ciddi durumlarada neden olabilir. Akut renal yetmezlik sonucu gelişen hipertansif durumlar ve elektrolit değişimleri PRES sebebi olabilirler. Olgu Sunumu: 9 yaşında erkek hasta hastanemize kusma,öksürük ve ayaklarında başlayan ödem şikayetiyle başvurmuştur.Hastanın yapılan laboratuar tetkikleri sonucunda akut böbrek yetmezliği tanısı konmuştur.Takibinde fokal konvülziyonu olan hastaya çekilen beyin MRG sonucunda PRES tanısı konmuştur. Tartışma: PRES etyolojisindeki sebepler serebrovasküler endotelial disfonksiyon, kan-beyin bariyerinin geçirgenliğinde artış, vazojenik ödem ve mikrohemorajiye neden olarak PRES tablosunun oluşmasına neden olurlar. PRES tanısında anamnez ve radyolojik inceleme çok önemlidir. Erken ve doğru tanı koymak tedavi ile klinik seyirin düzeltilmesinde elzemdir. Radyolojik olarak bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG)’de genellikle oksipital ve pariyetal loblarda özellikle subkortikal beyaz cevherde, bazen de kortekste büyük oranda simetrik yerleşimli ödem olarak izlenir.Daha ciddi olgularda bu bulgular ilerleyerek frontal ve temporal loblarda, derin beyaz cevherde, pons- ta, serebellumda ve diğer bölgelerde görülebilir. PRES radyolojik ve klinik olarak geri dönüşümlü bir tanı olup beyin perfüzyonunu koruyacak tedaviyöntemleri ile hastalarda belirgin düzelme izlenebilir.Bu nedenle erken tanı ve tedavi önem arzetmektedir.

P – 0130 VAN DER KNAAP HASTALIĞI: OLGU SUNUMU MESUT ÇETİN, ADEM AĞYAR Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye Özet Van der Knaap hastalığı, çok ender görülen bir megalensefalik lökoensefalopati hastalığıdır. Makrosefali doğumda olabileceği gibi yaşamın ilerleyen safhalarında belirginleşmektedir. Beyin MRG görüntülemelerindeki bariz bulgulara rağmen, klinik bulgulardaki yavaş ilerleyici seyir dikkat çekicidir.9 yaşında erkek hasta dirençli nöbet şikayeti sebebiyle çocuk nöroloji polikliğine başvuruyor.Hastadan beyin ve difüzyon MRG tetkiki istendi.Çekilen beyin MRG de her iki serebral hemisferde diffüz, bilateral simetrik periventriküler ve subkortikal derin beyaz cevherde T2A ve FLAİR görüntülerde sinyal artımları, bilateral anterior temporal ve frontoparyetal bölgelerde BOS intensitesinde subkortikal kistler izlendi. Makrosefali, psikomotor gerilik ve beyin MRG’de beyaz cevher tutulumu saptandığı durumlarda ayırıcı tanıda, Canavan hastalığı, Alexander hastalığı, glutarik asidüri, GM1 ve GM2 gangliozidoz kesinlikle düşünülmelidir. S76 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı P - 0131 PAROTİS BEZİ LİPOMU: SONOGRAFİK VE SONOELASTOGRAFİK BULGULAR VE HİSTOPATOLOJİK KORELASYON MEHTAP BALABAN, BURAK YAĞDIRAN, MESUT AY, FURKAN NALBANT, ALİ İPEK Ankara Atatürk Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Türkiye Özet Amaç: Tükrük bezinin nadir görülen non-epitelial tümörü olan intraglandüler lipom olgusunun ultrasonografi (US), renkli Doppler US (RDUS) ve sonoelastografi (SEL) bulgularının tanımlanması ve histopatolojik korelasyonu. Gereç ve Yöntemler: Son bir yıldır sol yanağında ağrısız şişlik şikayeti ile Kulak-Burun-Boğaz polikliniğine muayene olan 37 yaşındaki bayan olgu sonografik değerlendirme için departmanımız ultrasonografi (US) ünitesine yönlendirildi. Bulgular: Lineer prob ile yapılan yüzeyel US incelemede sol parotis bezi süperfisiyal lobu içerisinde 31,5x15 mm boyutlarda, RDUS’de vasküla- rizasyonu izlenmeyen, düzgün konturlu, kompresibl, hipoekoik solid lezyon tanımlandı. Lezyona eş zamanlı yapılan kompresyon SEL incelemede lezyonun ekstraglandüler yağ doku ile benzer özellikte diffüz kırmızı renkte belirgin yumuşak kodlandığı izlendi. Tüm bu bulgular eşliğinde intraglandüler lipom olarak raporlanan lezyonun total eksizyonel biyopsi sonucu adipöz doku ile uyumlu geldi. Sonuç: Lipomlar matür yağ hücrelerinden köken alan ve en sık görülen mezenkimal kaynaklı tümörlerdir. %13 oranında baş ve boyun bölgesinde görülmekle birlikte vücudun her yerinde görülebilmektedir. Tüm tükrük bezi tümörlerinin %1-4’ünü oluşturmaktadır. Ancak parotis bezinde nadir görülmektedir. Yapılan 6 yıllık bir çalışmada 212 tanesi parotis bezinden olmak üzere toplam 341 adet kitlenin sadece 5 tanesi histopatolojik olarak lipom tanısı almıştır. Erkeklerde 5-10 kat daha sık olup ortalama görülme yaşı 5.-6. dekaddır. Ayırıcı tanıda mikst tümör, anjiolipom, liposarkom, fokal yağlı infiltrasyon ve siyalolipom gibi diğer yağ içeren lezyonlar vardır. Etyolojide obezite, diyabet, ailesel yatkınlık, steroid ve insülin tedavisi, travma ve endokrin hastalıklar düşünülebilir. Cerrahinin planlanması açısından kitle karakterizasyonu önemli olup nadir görül- melerine rağmen ayırıcı tanıda akılda tutulması gereken benign lezyonlardır.

P - 0132 MICHEL VE MONDINI ARACILIĞIYLA İÇ KULAK ANOMALİLERİ HALİME ÇEVİK, PELİN KOÇDOR Okan Üniversitesi Tıp Fakültesi Hastanesi, İstanbul, Türkiye Özet Konjenital senserinöral işitme kaybı olguların %20’sinin nedeni kemik labirent gelişim bozukluklarıdır. Bu olguların %7-31’inde iç kulak anomalileri görülür. Michel aplazisi ve Mondini deformitesi olan iki olgunun görüntüleme bulguları aracığıyla ile iç kulak anomalilerini gözden geçirmeyi amaçladık. İlk olgumuzda temporal kemik MR incelemede unilateral koklea, vestibul, semisirkuler kanallar yoktu. 8.kranial sinir izlenmedi. Michel aplazisi lehine değerlendirildi. İkinci olgumuzun Temporal kemik BT ve MR incelemesinde bilateral kistik koklea ve vestibül tek boşluk olarak görüldü. Superior semisirküler kanallar hipoplazik olup lateral ve posterior semisirküler kanal izlenmedi. Mondini tip 1 malformasyon olarak değerlendirildi. İç kulak embriyogenezinin farklı aşamalarındaki duraklamalar sonucunda anomaliler oluşmakta ve sınıflamalar da genellikle buna göre yapılmaktadır. Üçüncü haftada otik plakod oluşumundaki duraklama Michel aplazisine neden olmaktadır. Membranöz ve kemik labirent anomalilerinin en ağırıdır. Herhangi bir iç kulak yapısının oluşmaması ile karakterizedir. Yedinci haftada 1-1,5 dönüsünü tamamlayan kokleanın gelişimi bu aşamada durakladığında Mondini deformitesine neden olabilir. Mondini deformitesi duraklama haftasına bağlı olarak tip 1 ve tip 2 olmak üzere iki tiptir. Tip 1 deformite kistik kokleavestibüler malformasyon olarak bilinir. Klasik form olan Tip 2 de ise kokleadaki kistik apekse ek olarak vestibulde dilatasyon ve geniş vestibuler akuadukt da yer almaktadır. Mondini deformiteli ve ortak kavite gibi konjenital iç kulak anomalilerinde koklear implantasyon uygulamaları ile başarılı sonuçlar elde edilebilmektedir. SNİK ön tanılı olgularda iç kulak anomalilerinin tanısı ve koklear implant açısından değerlendirilmelerinde apılan temporal kemik BT ve MR ile yüksek çözürlüklü görüntüler katkı sağlamaktadır.

S - 133 MİYOKARD İSKEMİSİNİ TAKLİD EDEN BİR KARDİYAK KİST HİDATİK OLGUSU FATMA ZEYNEP ARSLAN 1, MEHMET KARAGÜLLE 2, SÜLEYMAN ÖNCÜ 2, TUĞBA POLAT 2, CANDAN VARLIK 2 1Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye 2Bağcılar Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İstanbul, Türkiye Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S77

Özet Hidatik kistler Echinococcusun neden olduğu enfeksiyondan kaynaklanır ve vücudun herhangi bir yerinde kist oluşumu ile sonuçlanabilir. Kist hidatik hayvancılığın yaygın olduğu bölgelerde ve ülkemizde endemik olarak sıklıkla görülmektedir. En çok tutulumun izlendiği organ karaciğerdir; akciğerler,böbrek, santral sinir sistemi ve dalak yine etkilenen organ ve yapılardır. Kist hidatik hastalığında kalp tutulumu çok nadirdir ve tüm kist hidatik olgularının neredeyse %1,5undan azında görülür. Kalp tutulumu olunca kist genellikle intramyokardiyal sol ventrikül serbest duvarı, interventrikiUer septum, bazen de sağ ventrikül ve sağ atriyumda yerleşir. Kardiyak kist hidatik yüksek sıklıkta intrakardiyak rüptür ve yaşamı tehdit edici ani komplikasyonlarla karakterizedir. Miyokard Iskemisini Taklid Eden anginal karakterde göğüs ağrısı ve EKGsinde miyokard iskemisi bulguları nedeniyle incelenen 37 yaşındaki erkek hastaya iki-boyutlu ekokardiyografi, torakal MRG tetkikinde kardiyak kist hidatik tanısı koyulan hastamızı sunmayı amaçladık.

P - 0134 ADÖLESAN HASTADA DEV MEME KİTLESİ: GİANT JUVENİL FİBROADENOM MEHMET KARAGÜLLE1, ÖZNUR FUNDA GELENGEÇ1, ESRA BİLGİ1, DENİZ EKİNCİ1, FATMA ZEYNEP ARSLAN2, GÜL GİZEM KAYA1 1Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye 2Konya Eğitim ve Araştırma Hastanesi, Konya, Türkiye Özet Jüvenil fibroadenom, fibroadenomların bir varyantı olup genelde 10-18 yaş arasında görülür. İnsidansı tüm fibroadenomların %0.5-2’sidir. Biz bu olguda patolojik olarak jüvenil fibroadenom tanısı almış vakanın görüntüleme özelliklerini sunmayı amaçladık. 13 yaşında kadın hasta sol memede şişlik nedeniyle başvurdu. Fizik muayenesinde sol memede palpasyonla ağrısız, büyük boyutlarda ele gelen kitle ve yüzeyel vasküler yapılarda belirginleşme tespit edildi. Yapılan meme USG incelemesinde sol memede 71x54 mm boyutlu, içerisinde kistik açıklıklar bulunan, heterojen, hipoekoik solid kitle izlendi. Sonrasında çekilen MR incelemede T1A hipointense, T2A ara sinyal intensitesinde, içerisinde kistik açıklıkları bulunan, İVKM sonrası giderek artan tarzda (tip 1 patern) kontrast tutan 124x78 mm boyutunda solid kitle izlendi. Tru-cut biyopsi sonrası histokimyasal olarak jüvenil fibroadenom tanısı konuldu. Fibroadenom, bağ dokusunun aşırı proliferasyonundan kaynaklanan, karakteristik olarak stromal ve epitelyal hücreler içeren memenin en sık görülen beningn lezyonudur. Çocuk ve ergenlerde görülen firoadenomlara jüvenil fibroadenomlar denir. Eğer bu kitleler 5 cm’den büyükse veya 500 gr’dan ağır ise dev jüvenil fibroadenom denilmektedir. İnsidansı tüm fibroadenomların %0.5-2’si kadardır. Lezyonlar genellikle tek taraflı, ağrısız ve hızlı büyüyen kitle şeklindedir. Hızlı büyümeleri meme dokusunun gelişimini engellemekte, deride konjesyon ve ülsere neden olabilmektedir.MR incelemesinde hızlı büyümesi nedeniyle santralinde kistik açıklıklar görülebilen, T1A hipointense, T2A ara sinyal intensitesinde İVKM sonrası diffüz homojen kontrastlanan dev boyutlarda solid kitle izlenmektedir. Ayırıcı tanısında fizyolojik hipertrofi, abse gibi inflamatuar süreçler ve filloides tümör akılda tutulmalıdır. Hastalarda duygusal ve psikolojik sorunlara yol açması nedeniyle erken tanı ve tedavisi önemlidir.

P - 0135 AKSİLLER PREZENTASYONLU OKKULT NÖROENDOKRİN MEME KARSİNOMU MEHMET ALİ NAZLI, YEŞİM KARAGÖZ, CEYDA TURAN BEKTAŞ, FADİME DİDEM CAN TRABULUS, ESRA CANAN KELTEN, ŞEFİKA AKSOY Sağlık Bilimleri Üniversitesi İstanbul Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye Özet Memenin okkült karsinomları çok nadir görülmekte olup literatürde %0.3-1.0 oranları verilmekte, radyolojik görüntülemelerin gelişmesi ve özellikle dinamik meme MR incelemelerden sonra görüleme sıklığı daha da azalmıştır. Memenin primer nöroendokrin karsinomları çok nadir görülmekte olup sıklığı %0.1 altındadır. Biz bu sunumda aksiller tutulum şeklinde prezentasyon gösteren okkült nöroendokrin karsinom tanılı hastamızın radyolojik inceleme bulguları ve patolojik tanı kriterleri ışığında okkült meme karsinomlarına radyolojik yaklaşımı sunmayı amaçladık.

P - 0136 KRANİYUMUN SOLİTER PLAZMOSİTOMU: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI MUSTAFA KOÇ Fırat Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Elazığ, Türkiye S78 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

Özet Amaç: Kraniyumun soliter plazmositomu oldukça nadir bir görülmektedir. Geniş bir patolojik spektruma sahip olup benign ve malign (multipl myeloma) formları bulunabilir. Klinik özellikleri karışıktır. Doğru tanı için radyolojik inceleme, immünoglobülin, biyokimya, idrar Bence Jones proteini testi ve kemik iliği değerlendirmesi içeren, kapsamlı bir inceleme ve analiz gereklidir. Bu yazıda kraniyumun soliter plazmositomunun manyetik rezonans görüntüleme (MRG) bulguları sunuldu. Gereç ve Yöntemler: Frontal bölgede ele gelen şişlik şikâyeti ile kliniğe başvuran 48 yaşında kadın hastada, klinik olarak belirgin bir nörolojik disfonksiyon saptanmadı. Olgunun mevcut patolojisini değerlendirmek için, radyolojik olarak İ.V. kontrastlı kraniyal MRG incelemesi yapıldı. Bulgular: Kraniyal MRG incelemede, frontal bölgede intra ve ekstradural alana ve cilt altına uzanan, kemik yapıda destrüksiyona neden olan, T1 ve Flair sekanslarda nispeten izointens, kontrast madde sonrası yoğun kontrastlanan, yaklaşık 8x6 cm boyutta kitlesel lezyon izlendi. Cerrahi olarak tedavi edilen olguda, histopatolojik bulgular kraniyumun soliter plazmositomu ile uyumlu değerlendirildi. Sonuç: Miyelom kemik iliği retikülositlerinden köken alan malign bir tümördür. Tümör hücreleri gittikçe artan bir plazmosit karakteristiğine sahip olduğundan, hastalık plazma hücresi miyelomu olarak bilinir. Çoğunlukla 40 yaşın üzerinde görülür. Vücudun herhangi bir bölgesinde kemik destrüksiyonu oluşturabilir. İzole kraniyumda meydana gelen tümörler kraniyal plazma hücreli tümörler olarak bilinirler. Klinik özelliklerinin karmaşık olması ve kolayca tespit edilememesi, yanlış tanı oranının yüksek olmasına neden olmaktadır. Doğru tanı için kapsamlı bir inceleme ve analiz gereklidir. Bilgisayarlı tomografi ve özellikle MRG bulguları doğru tanıya katkı sunmaktadır.

P - 0137 POEMS SENDROMLU OLGUDA BEYİN MR BULGULARI FATMA AKTAŞ, ERKAN GÖKÇE Gaziosmanpaşa Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, İstanbul, Türkiye Özet Amaç: Polinöropati, organomegali, endokrinopati, monoklonal gamopati, cilt değişiklikleri ile karakterize olan POEMS sendromu nadir görülen sistemik bir hastalıktır. Klinik bulguları mikroanjiopati, neovaskülarizasyon ve artan vazopermalbilite ile ilişkilidir. Bu çalışmanın amacı POEMS sendromlu bir hastanın kranyal MR bulgularını tartışmaktır. Gereç ve Yöntemler: POEMS tanısı ile takip edilen 58 yaşında erkek hastada sol gözde görme bulanıklığı gelişti.Fizik muayenesinde şüpheli papilödem olması nedeniyle Kontrastlı kranyal MR incelemesi yapıldı. Bulgular: Kranyal MR incelemesinde bilateral optik sinir çevresi BOS mesafesinde artış ve optik sinirin globa girdiği lokalizasyonda papilödemle uyumlu kabarıklaşma mevcuttu. T2A ve FLAİR serilerde sol transvers sinüste hiperintensite izlendi. Ayrıca gliotik beyaz cevher lezyonları ve kortikal kronik enfarkt mevcuttu. Kontrastlı serilerde sol transvers sinüste trombüs ile uyumlu dolum defekti ve difüz pakimeningeal kalınlaşma ve kontrastlanma dikkati çekti. Sonuç: POEM sendromu arteriyal ya da venöz trombüse bağlı oluşan serebral enfarklara eşlik edebilir. Bu bulgular vasküler endotelyal büyüme faktörünün (VEGF) artmış konsantrasyonuna bağlıdır. Pakimeningeal tutulumunda POEM sendromuna eşlik edebilir. Bunun nedeni olarak da enflamasyon olmaksızın meningoendotelyal hücrelerde hiperplazi, neovaskülarizasyon ve tıkanıklığa bağlı damar yapılanması sorumlu tutulmak- tadır.

P - 0138 NADİR BİR AKSİLLER LENFADENOPATİ NEDENİ: PULMONER NODÜLLERİN EŞLİK ETTİĞİ LHH OLGUSU AYŞE GÜL ALIMLI Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Pediatrik Radyoloji Kliniği, Ankara, Türkiye Özet Langerhans hücreli histiositozis (LHH) en sık infant ve çocuklarda görülen nadir bir histiositik hastalıktır. Genellikle osteolitik kemik lezyonu ile karakterizedir. Cilt, lenf nodları, karaciğer, dalak, oral mukoza, akciğer, merkezi sinir sistemi de tutulabilir. Bu bildirinin amacı aksiller kitle ile başvuran, pulmoner nodüllerin de eşlik ettiği LHH tanısı alan 4 aylık erkek hastayı manyetik rezonans görüntüleme, B mod ultrason ve shear wave elastografi bulguları ile birlikte tartışmaktır.