Browsing by Author "Basara, I"

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    THE ROLE OF DIFFUSION WEIGHTED IMAGING IN THE ASSESSMENT OF AXILLARY LYMPH NODES
    Basara, I; Örgüç, S; Coskun, T
    Objective: Several studies have shown that diffusion weighted imaging (DWI) can serve as a powerful tool for differentiating benign from malignant breast lesions. In addition to this use, DWI may also be used in the assessment of axillary lymph nodes, since they show similar tissue characteristics to the primary tumor. Materials and Methods: We applied dynamic contrast enhanced breast magnetic resonance imaging and DWI to 110 female patients and 214 breasts. Apparent diffusion coefficient (ADC) values of 187 lymph nodes (142 benign and 45 malignant) in 177 axillae were measured. Malignant lymph nodes were diagnosed histopathologically, benign lymph nodes were diagnosed clinically and with imaging findings. Results: The mean ADC values were 1.00x10-3 mm(2)/s for the malignant, and 1.39x10(-3) mm(2)/s for the benign lymph nodes. The ADC values of malignant lymph nodes were significantly lower than the benign ones (p=0.001). When 1.22x10(-3) mm(2)/s was accepted as the cut-off ADC value, a sensitivity of 75.6% and a specificity of 71.1% were detected. Conclusion: Our preliminary data suggest that ADC measurements might be useful in differentiating malignant from benign axillary lymph nodes in the preoperative period. Further studies on a larger scale will increase confidence in the results of DWI.
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    Contribution of Advanced Magnetic Resonance Imaging Techniques in Diagnosis of Breast Lesions
    Basara, I; Orguc, S; Coskun, T
    Objectives: To determine the diagnostic contribution of diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) identified either with mammography, ultrasonography or conventional enhanced magnetic resonance imaging (MRI) to cases with palpable breast lesions or for routine control Design: Prospective study Setting: Department of Radiology, Celal Bayar University, Turkey Subjects and Methods: Fifty female patients who applied to the clinic between November 2009 and April 2010 with different indications were included. We applied conventional breast MRI with the routine sequences. We added DWI and BREASE (MRS). After MRI examination postprocessing applications were applied. Intervention: Analysis of contribution of advanced techniques in breast lesions diagnosis Main Outcome Measure: Determining the value of DWI and MRS of breast lesions, which may be useful in improving the specificity Results: Fifty-two breast lesions in 37 cases were evaluated. In DWI when cut off apparent coefficient diffusion (ACD) value was accepted as 1.44 x 10.3 mm(2)/sn, the sensitivity was found to be 91.3% and the specifity was 62.1% in discriminating malignant and benign lesions. When the lesions which have choline peak at 3.2 ppm were accepted as malignant and lesions which do not have choline peak were accepted as benign lesions in spectroscopic examination, the specifity was 80%, the sensitivity was 31.8%, negative predictive value (NPV) was 44.4% and positive predictive value (PPV) was found to be 70%. Conclusions: Our specifity was compatible with that in the literature but sensitivity and negative ppv were lower than reported in the literature. According to ADC values, the findings in our study were compatible with the literature.
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    Chronic Hematoma Mimicing Recurrent Breast Carcinoma and Contribution of Magnetic Resonance
    Basara, I; Örgüc, S; Tireli, M
    Local recurrence of breast carcinoma after breast conservative therapy is an unwanted situation with a high possibility. Paranchymal distortion and edema secondary to surgery and radiotheraphy results in difficulties in the mammographic and ultrasonographic evaluation of the breast. After treatment of breast carcinoma, sensitivity of mammography decreases below the normal population. Breast magnetic resonance imaging (MRI) can be helpful in the discrimination of scar tissue in the region of operation from local recurrence. Advanced MRI applications such as diffusion weighted imaging (DWI) and proton (H-1) MR spectroscopy also have contribution in diagnosis. In this case report we aimed to determine the contribution of MRI and advanced MRI techniques to a lesion which was detected by conventional methods in an operated breast carcinoma patient.
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    Contribution of Kinetic Characteristics of Axillary Lymph Nodes to the Diagnosis in Breast Magnetic Resonance Imaging
    Örgüç, S; Basara, I; Pekindil, G; Coskun, T
    Objective: To assess the contribution of kinetic characteristics in the discrimination of malignant-benign axillary lymph nodes. Material and Methods: One hundred fifty-five female patients were included in the study. Following magnetic resonance imaging (MRI) examinations post-processing applications were applied, dynamic curves were obtained from subtracted images. Types of dynamic curves were correlated with histopathological results in malignant cases or final clinical results in patients with no evidence of malignancy. Sensitivity, specificity, positive likehood ratio (+LHR), negative (-LHR) of dynamic curves characterizing the axillary lymph nodes were calculated. Results: A total of 178 lymph nodes greater than 8 mm were evaluated in 113 patients. Forty-six lymph nodes in 24 cases had malignant axillary involvement. 132 lymph nodes in 89 patients with benign diagnosis were included in the study. The sensitivity of type 3 curve as an indicator of malignancy was calculated as 89%. However the specificity, +LHR, -LHR were calculated as 14%, 1.04, 0.76 respectively. Conclusion: Since kinetic analysis of both benign and malignant axillary lymph nodes, rapid enhancement and washout (type 3) they cannot be used as a discriminator, unlike breast lesions. MRI, depending on the kinetic features of the axillary lymph nodes, is not high enough to be used in the clinical management of breast cancer patients.
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    Ewing's sarcoma metastasis into the breast
    Örgüç, S; Basara, I; Poçan, T; Özgüven, AA; Özkol, M
    The metastasis of extramammary malignancies into the breast is very unusual. Lymphoma, malignant melanoma, and rhabdomyosarcoma are the most common tumors that metastasize into breast tissue. The histological spectrum of breast masses in children and adolescents is different from that of adults. Imaging findings are useful for performing a diagnosis, but in a patient with a known malignancy, any enlarging breast mass, even one with a benign radiological appearance, should be investigated with a biopsy. In this article, we present the imaging findings of a 12-year-old female patient with breast metastasis of Ewing's sarcoma.
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    Axillary Schwannoma Mimicking Lymphadenopathy: Two Different Case Reports
    Örgüç, S; Basara, I; Özkarakas, P; Poçan, T; Aydede, H
    Schwannomas are essentially benign tumors originating from schwann cells of peripheral, cranial or sympathetic nerves. They are not aggressive, encapsulated and grow slowly. Malignant transformation can rarely be seen. Even though they can be localized in any where in the body, cutaneous nerves of the head-neck region and flexor parts of the extremities are most commonly involved. Schwannomas are usually solitary, however multiple schwannomas can rarely be seen in the peripheral nervous system including cranial nerves, spinal nerve roots, brachial-lumbosacral plexus and peripheral nerves. In these two cases, we aimed to report ultrasonography (US), magnetic resonance imaging (MRI) and pathology findings of different axillary schwannomas mimicking lymphadenopathy, and discuss the differential diagnosisin the light of the literature. In these patients, the lesions were noted to be in direct continuity with a cord-like structure resembling a nerve. US and MRI findings were compatible with the literature. Radiologic findings were confirmed by pathologic examination. As seen in our cases, a detailed differential diagnosis should be considered in every axillary lesion including frequently seen axillary lymphadenopathies.
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    Single voxel in vivo proton magnetic resonance spectroscopy of breast lesions: experience in 77 cases
    Basara, I; Örgüç, S; Coskun, T
    PURPOSE We aimed to determine the value of in vivo single voxel proton magnetic resonance spectroscopy (MRS) in characterizing breast lesions. MATERIALS AND METHODS Breast MRS was performed in 77 patients. Choline resonance peak at 3.2 parts per million (ppm) was defined positive when it was at least two times higher than baseline. MRS findings were compared with the final diagnosis of cases for two different values (3.23 and 3.28 ppm). RESULTS Thirty-one malignant and 13 benign lesions had choline peaks. Sensitivity was 84%, specificity was 64%. Positive likelihood ratio (LHR) was 2.32, negative LHR was 0.25. Twenty-two malignant and 5 benign lesions had a peak at 3.23 ppm. Nine malignant and 8 benign lesions had a peak at 3.28 ppm. When 3.23 ppm was accepted as positive; sensitivity, specificity, and positive and negative LHRs were 79%, 82%, 4.4, and 0.26, respectively. CONCLUSION MRS provides additional parameters on evaluation of breast lesions. However, MRS of breast has some false negative results, thus it is still insufficient in clinical diagnosis.
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    Three-dimensional vascular mapping of the breast by using contrast-enhanced MRI: association of unilateral increased vascularity with ipsilateral breast cancer
    Örgüç, S; Basara, I; Coskun, T; Pekindil, G
    PURPOSE We aimed to retrospectively compare three-dimensional vascular maps of both breast obtained by dynamic magnetic resonance imaging (MRI) and determine the association of one-sided vascular prominence with ipsilateral breast cancer. MATERIALS AND METHODS MRI was performed using gadolinium in 194 cases. Two readers scored vascular density using maximum intensity projections (MIPs). Dynamic fat-saturated T1-weighted gradient-echo MIPs were acquired. Two readers evaluated the MIPs, and vessels greater than 2 mm in diameter and longer than 3 cm were counted. The difference in vessel numbers detected in the two breasts determined the score. RESULTS A total of 54 patients had malignant lesions (prevalence, 28%), including invasive ductal carcinoma (n=40), invasive mixed ductal-lobular carcinoma (n=5), invasive lobular carcinoma (n=3), ductal carcinoma in situ (n=3), mucinous carcinoma (n=1), medullary carcinoma (n=1), and leukemic metastasis (n=1). In 62 patients, there were benign lesions (fibroadenomas, fibrocysts), and four patient had inflammation (granulomatous mastitis in two patients, breast tuberculosis in two patients). There were 78 normal cases. When a difference of at least two vessels was scored as vascular asymmetry, the sensitivity, specificity, positive likelihood ratio (+LR), and negative (-LR) of unilaterally increased vascularity associated with ipsilateral malignancy were 69%, 92%, 8.72, and 0.34, respectively. When four infection and three post-operative cases with vascular asymmetry were excluded; prevalence, specificity, and +LR increased to 29%, 97%, and 22.8, respectively, with the same sensitivity and -LR. Differences in mean vascularity scores were evaluated with regard to tumor size. T1 and T2 tumors were not significantly different from each other. The mean score of T3 tumors differed significantly from T1 and T2 tumors. CONCLUSION MRI vascular mapping is an effective method for determining breast tissue vascularization. Ipsilateral increased vascularity was commonly associated with malignant breast lesions.
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    Oil Cyst Mimicking Intracystic Neoplasm
    Orguc, S; Basara, I; Coskun, T; Kandiloglu, AR
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    Giant Breast Involvement in Acute Lymphoblastic Leukemia: MRI Findings
    Basara, I; Orguc, S
    Breast metastases in cases of leukemia are rare. We aimed to report the conventional-advanced magnetic resonance imaging (MRI) findings of unilateral breast involvement of acute lymphoblastic leukemia (ALL) and review the literature. A 32-year-old woman was first diagnosed with ALL in treated in 2004. She did not continue the follow-up after 2008. She was presented with a giant, progressive right breast palpable mass in 2010. Mass, contralateral breast tissue were evaluated with MRI, diffusion weighted imaging and MR spectroscopy. With MRI findings, lesion was evaluated as malignant, tru-cut biopsy revealed recurrence of ALL. Lymphoma, malignant melanoma, rhabdomyosarcoma are most common tumors metastase to breast. Breast metastases of leukemia are rare and occur primarily in patients with acute myeloid leukemia. Secondary ALL breast involvement is uncommon. In a patient with malignancy, any enlarging breast mass, even with benign radiologic appearance, should be investigated carefully and metastasis should not be forgotten.
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    Diffusion-weighted MR imaging of the breast: comparison of apparent diffusion coefficient values of normal breast tissue with benign and malignant breast lesions
    Orguc, S; Basara, I; Coskun, T
    INTRODUCTION The specificity of conventional magnetic resonance (MR) imaging is lower than its high sensitivity. Diffusion-weighted imaging (DWI), based on alterations in the microscopic motion of water molecules, promises improved specificity for breast MR imaging. In this study, we aimed to determine the diagnostic potential of DWI to differentiate between benign and malignant breast lesions and normal breast tissue. METHODS Dynamic contrast-enhanced breast MR imaging and DWI were applied to 108 women. Apparent diffusion coefficient (ADC) values were obtained for normal breast tissue (n = 183), benign lesions (n = 66) and malignant lesions (n = 58). The results were compared with the patients' final diagnoses. RESULTS Mean ADC values for benign and malignant breast lesions were 1.04 x 10(-3) +/- 0.29 x 10(-3) mm(2)/s and 2.00 x 10(-3) +/- 0.55 x 10(-3) mm(2)/s, respectively (p = 0.001, Student's t-test), while that for normal breast tissue was 1.78 x 10(-3) +/- 0.33 x 10(-3) mm(2)/s. With a cut-off value of 1.46 x 10(-3) mm(2)/s for ADC in receiver operating characteristic analysis, 95% sensitivity and 85% specificity were achieved for differentiating between benign and malignant lesions. CONCLUSION DWI of the breast can help differentiate benign and malignant breast lesions from normal breast tissue. DWI, which can be easily introduced into standard breast MR imaging protocols without increasing imaging times, promises to increase the accuracy of breast MR imaging without contrast media. However, its clinical value will depend on the standardisation of b-values and other technical parameters in larger future study series.
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    DIAGNOSTIC VALUES OF MAMMOGRAPHY, ULTRASONOGRAPHY AND DYNAMIC ENHANCED MAGNETIC RESONANCE IMAGING IN BREAST LESIONS
    Basara, I; Örgüc, S; Coskun, T
    Purpose: Convantional mammography (MM) and ultrasonography (US) are the first and easily performed diagnostic techniques in characterization of breast lesions. Convantional enhanced magnetic resonance imaging (MRI) is used as a problem solving tool to identify and characterize breast lesions in selected cases. In this study, we aimed to determine diagnostic values of these techniques when they used either on by their own or together. Patients and Methods: We included 50 female patients who applied to Celal Bayar University Radiology- Mammography Department between November 2009- April 2010 with different indications. In this study, we evaluated 52 different breast lesions. Results: Prevalance of malign breast lesions were calculated and all the breast lesions were classified according to Breast Imaging Reporting and Data System (BI- RADS) characteristics. For every diagnostic technique, sensitivity, specificity, negative predictive and positive predictive values were found. Additionally, every diagnostic techniques were compared between each other, sensitivities and specificities were calculated. Conclusion: After all results dynamic enhanced MRI, was evaluated as superior than the other techniques. However, the difficulties such as cost, attainability, contrast material usage and evaluation, breast MRI should be used as a problem solving technique together with MM and US techniques.
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    RADIOLOGICAL FINDINGS OF CHRONIC MOREL LAVALLEE SYNDROME: CASE REPORT
    Örgüç, S; Basara, I; Özkarakas, P; Yoleri, L
    Morel Lavallee Syndrome is defined as a soft tissue injury consisting of a closed internal degloving of the subcutaneous tissue creating a cavity filled with bloody serous liquid. This syndrome is usually not recognized by general or orthopedic surgeons and is therefore frequently missed or diagnosed late. If Morel Lavallee Syndrome is clinically misdiagnosed, findings appear as a chronic growing painful mass. With these symptoms, it can mimic hemangioma, synovial sarcoma, post traumatic fat necrosis or hematoma. However, if there is a history of trauma, characteristic magnetic resonance imaging findings can be helpful in the diagnosis of these cases. In the literature, sporadic cases have been reported without a clear etiopathogenic explanation.
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    FINDINGS OF EXTENSIVE COSTAL AND STERNAL METASTASIS OF A PATIENT WITH BREAST CARCINOMA BY DYNAMIC, DIFFUSION WEIGHTED AND THREE DIMENSIONAL BREAST MAGNETIC RESONANCE IMAGING
    Örgüç, S; Basara, I; Aras, F
    Breast magnetic resonance imaging (MRI) is used in local staging of breast carcinoma with high sensitivity and accuracy. During this technique bony structures of the thorax such as sternum and anterior ribs are also evaluated. Direct graphy and computed tomography are not diagnostic in the patients with costal metastasis which have medullary bone infiltration without pathological fracture. Dynamic breast MRI can determine bone metastasis without cortical destruction. Especially multiplanary maximum intensity projection (MIP) images which are obtained from postcontrast substructed images are helpful in determining bone metastasis. Coronal MIP images can show infiltration of bony costas. Chondromateus costas are usually preserved. Bone syntigraphy is accepted as the gold standard for determining bone metastasis, however the spatial resolution of MRI is higher than scintigraphy. In breast carcinoma cases, bone, pleura, peritonum and liver metastasis are seen commonly and these localizations must be evaluated carefully with breast MRI. MIP and diffusion weighted images provide diagnostic contributions.
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    Kidney metastasis of invasive ductal breast carcinoma mimicking renal cell carcinoma
    Akin, Y; Basara, I
    A 56-year-old female patient was admitted to the urology outpatient clinic with severe macroscopic hematuria. She was diagnosed with right kidney cancer after clinical and radiological evaluations. Pathology reported a metastasis of invasive ductal breast carcinoma in the right kidney after laparoscopic radical right nephrectomy was performed. After physical and radiological evaluations, she was referred to the Department of General Surgery, and was treated with radical mastectomy and axillary lymph node dissection for breast cancer. She was later referred to the Department of Medical Oncology at our institute for chemotherapy. We aimed for clinicians to be more aware of metastasis to the kidney, and perform regular and thorough breast examination for women every year. Saudi Med J 2012; Vol. 33(12): 1346-1349