Researcher: Gürses, Bengi
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Gürses, Bengi
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Publication Metadata only Conventional vs invert-grayscale X-ray for diagnosis of pneumothorax in the emergency setting(W B Saunders Co-Elsevier Inc, 2017) Unek, Orkun; Eren, Hakan Sevki; N/A; Musalar, Ekrem; Ekinci, Salih; Arş, Eda; Gürses, Bengi; Aktaş, Can; Doctor; Doctor; Doctor; Faculty Member; Faculty Member; N/A; N/A; N/A; School of Medicine; School of Medicine; Koç University Hospital; Koç University Hospital; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; 113169; 24297Introduction: Pneumothorax is a pathologic condition in which air is accumulated between the visceral and parietal pleura. After clinical suspicion, in order to diagnose the severity of the condition, imaging is necessary. By using the help of Picture Archiving and Communication Systems (PACS) direct conventional X-rays are converted to gray-scale and this has become a preferred method among many physicians. Methods: Our study design was a case-control study with cross-over design study. Posterior-anterior chest Xrays of patients were evaluated for pneumothorax by 10 expert physicians with at least 3 years of experience and who have used inverted gray-scale posterior anterior chest X-ray for diagnosing pneumothorax. Results: The study included posterior anterior chest X-ray images of 268 patients of which 106 were diagnosed with spontaneous pneumothorax and 162 patients used as a control group. The sensitivity of Digital-conventional X-rays was found to be higher than that of inverted gray-scale images (95% CI (2,08-5,04), p < 0,01). There was no statistically significant difference between the gold standard and digital-conventional images (95% CI (0,45-2,17), p = 0,20), while the evaluations of the gray-scale images were found to be less sensitive for diagnosis (95% CI (3,16-5,67) p < 0,01). Conclusion: Inverted gray-scale imaging is not a superior imaging modality over digital-conventional X-ray for the diagnosis of pneumothorax. Prospective studies should be performed where diagnostic potency of inverted gray-scale radiograms is tested against gold standard chest CT. Further research should compare inverted gray-scale to lung ultrasound to assess them as alternatives prior to CT.Publication Metadata only Optimizing the personalized care for the management of rectal cancer: a consensus statement(Aves, 2022) Aytaç, Erman; Özer, Leyla; Baca, Bilgi; Uluç, Başak Oyan; Abacioğlu, Mehmet Ufuk; Gönenç, Murat; Aygün, Cem; Yıldız, Mehmet Erdem; Ünal, Kemal; Er, Özlem; Beşe, Nuran; Ceyhan, Güralp Onur; Özbek, Uğur; Tozun, Nurdan; Erdamar, Sibel; Yakıcıer, Cengiz; Saruç, Murat; Özben, Volkan; Esen, Eren; Vardareli, Erkan; Güner, Levent; Hamzaoğlu, İsmail; Karahasanoğlu, Tayfun; N/A; Balık, Emre; Kapran, Yersu; Taşkın, Orhun Çığ; Bölükbaşı, Yasemin; Çil, Barbaros Erhan; Baran, Bülent; Erkol, Burçak; Yaltı, Mehmet Tunç; Attila, Tan; Gürses, Bengi; Bilge, Orhan; Mandel, Nil Molinas; Selek, Uğur; Kayserili, Hülya; Özoran, Emre; Buğra, Dursun; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Doctor; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Teaching Faculty; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; N/A; N/A; N/A; N/A; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; 18758; 168101; 166686; 216814; 169993; 167583; N/A; 221690; 118342; 113169; 176833; 194197; 27211; 7945; 307296; 1758Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acibadem Mehmet Ali Aydınlar and Koc Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.Publication Metadata only Reply to letter to the editor(Springer, 2022) Altınmakas, Emre; Doğan, Hakan; Taşkın, Orhun Çığ; Özoran, Emre; Buğra, Dursun; Adsay, Nazmi Volkan; Balık, Emre; Gürses, Bengi; Other; Researcher; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 143682; 327614; 166686; 307296; 1758; 286248; 18758; 113169N/APublication Metadata only Centrally-necrotic/hyalinizing demarcated (CND) carcinomas of the pancreas: a clinico-pathologically distinct group with divergent metaplastic patterns and high-grade characteristics(Elsevier, 2022) Bagci, Pelin; Altinmakas, Emre; Pehlivanoglu, Burcin; Bozkurtlar, Emine; Reid, Michelle; Cheng, Jeanette; Luchini, Claudio; Scarpa, Aldo; Basturk, Olca; N/A; Cengiz, Duygu; Saka, Burcu; Bozkurt, Emre; Armutlu, Ayşe; Meriçöz, Çisel Aydın; Alper, Emrah; Tellioğlu, Gürkan; Gürses, Bengi; Adsay, Nazmi Volkan; Other; Faculty Member; Doctor; Teaching Faculty; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; 296729; 222921; N/A; 133567; 162418; 220444; 230736; 113169; 286248N/APublication Metadata only Extramural venous invasion (EMVI) revisited: a detailed analysis of various characteristics of EMVI and their role as a predictive imaging biomarker in the neoadjuvant treatment response in rectal cancer(Springer, 2022) N/A; Altınmakas, Emre; Doğan, Hakan; Taşkın, Orhun Çığ; Özoran, Emre; Buğra, Dursun; Adsay, Nazmi Volkan; Balık, Emre; Gürses, Bengi; Other; Researcher; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 143682; 327614; 166686; 307296; 1758; 286248; 18758; 113169Purpose: To assess whether size, diameter, and large vein involvement of MR-detected extramural venous invasion (MREMVI) have an impact on neoadjuvant therapy response in rectal adenocarcinoma. Methods: 57 patients with locally advanced rectal adenocarcinoma scanned with MRI before and after neoadjuvant therapy were included. Two abdominal radiologists evaluated the images with special emphasis on EMVI, on initial staging and after neoadjuvant treatment. The sensitivity and specificity of MRI for detection of rest EMVI were determined. The association of various MR-EMVI characteristics including number, size, and main vein involvement with treatment response was investigated. In subjects with discordance of radiology and pathology, elastin stain was performed, and images and slides were re-evaluated on site with a multidisciplinary approach. Results: At initial evaluation, 17 patients were MR-EMVI negative (29.8%) and 40 were MR-EMVI positive (70.2%). Complete/near-complete responders had less number (mean 1.45) and smaller diameter of MR-EMVI (mean 1.8 mm), when compared with partial responders (2.54 and 3.3 mm; p < 0.005). The sensitivity of MRI for rest EMVI detection was high, specificity was moderate, and in one patient elastin stain changed the final decision. In five patients with rest MR-EMVI positivity, carcinoma histopathologically had a distinctive serpiginous perivascular spread, growing along the track of vascular bundle, although it did not appear in intravascular spaces. Conclusion: This study demonstrates that not only the presence, but also size and number of EMVI that may be significant clinically and thus these parameters also ought to be incorporated to the MRI evaluation and prognostication of treatment response. From pathology perspective, tumors growing alongside major vessels may also reflect EMVI even if they are not demonstrably "intravascular." [GRAPHICS] .Publication Open Access Evaluation of iron deposition in the adrenal glands of beta thalassemia major patients using 3-Tesla MRI(Kowsar Publishing Corporation, 2016) Güzelbey, Tevfik; Özveren, Olcay; Sarsılmaz, Ayşegül; Karasu, Ebru; N/A; N/A; Gürses, Bengi; Öztürk, Erman; Faculty Member; Doctor; School of MedicineBackground: Beta-thalassemia major (beta-TM) patients need blood transfusions, which result in iron deposition. To regulate chelation therapy, iron load has to be measured. With MRI, the amount of signal loss and T2* decay time shortening are used for iron quantification. Objectives: The aim was to measure adrenal iron load with T2* relaxometry using MRI, and to compare it with liver and cardiac iron and serum ferritin, and to find out whether adrenal iron could be predicted from those parameters. Patients and Methods: Between October 2014 and March 2015, MRI was performed in 21 patients with beta-TM, recieving blood transfusions and chelation therapy. The control group (n = 11) included healthy volunteers with no known history of adrenal, hematologic, chronic disease, and blood transfusion. Results: Among patients, there was no significant correlation between plasma ferritin and adrenal T2*. Significant difference was detected among T2* values of adrenals between the patient and control groups. There was no significant correlation between adrenal gland and liver T2* in beta-TM patients, moderate correlation was detected between adrenal T2* and cardiac T2*. Conclusion: Adrenal iron in beta-TM can be reliably measured in 3 Tesla MRI. The results highlight the absence of correlation between adrenal iron deposition both with serum ferritin and hepatic iron.Publication Open Access Multiparametric MRI of rectal cancer-repeatability of quantitative data: a feasibility study(Aves, 2020) Gürses, Bengi; Altınmakas, Emre; Böge, Medine; Aygün, Murat Serhat; Bayram, Onur; Balık, Emre; Faculty Member; Other; Faculty Member; School of Medicine; N/A; N/A; N/A; N/A; N/A; 18758Purpose: in this study, we aimed to analyze the repeatability of quantitative multiparametric rectal magnetic resonance imaging (MRI) parameters with different measurement techniques. Methods: all examinations were performed with 3 T MRI system. In addition to routine sequences for rectal cancer imaging protocol, small field-of-view diffusion-weighted imaging and perfusion sequences were acquired in each patient. Apparent diffusion coefficient (ADC) was used for diffusion analysis and k(trans) was used for perfusion analysis. Three different methods were used in measurement of these parameters; measurements were performed twice by one radiologist for intraobserver and separately by three radiologists for interobserver variability analysis. ADC was measured by the lowest value, the value at maximum wall thickness, and freehand techniques. K-trans was measured at the slice with maximum wall thickness, by freehand drawn region of interest (ROI), and at the dark red spot with maximum value. Results: a total of 30 patients with biopsy-proven rectal adenocarcinoma were included in the study. The mean values of the parameters measured by the first radiologist on the first and second measurements were as follows: mean lowest ADC, 721.31 +/- 147.18 mm(2)/s and 718.96 +/- 135.71 mm(2)/s; mean ADC value on the slice with maximum wall thickness, 829.90 +/- 144.24 mm(2)/s and 829.48 +/- 149.23 mm(2)/s; mean ADC value measured by freehand ROI on the slice with maximum wall thickness, 846.56 +/- 136.31 mm(2)/s and 848.23 +/- 144.15 mm(2)/s; mean k(trans) value on the slice with maximum wall thickness, 0.219 +/- 0.080 and 0.214 +/- 0.074; mean k(trans) by freehand ROI technique (including as much tumoral tissue as possible), 0.208 +/- 0.074 and 0.207 +/- 0.069; mean k(trans) measured from the dark red foci, 0.308 +/- 0.109 and 0.311 +/- 0.105. Intraobserver agreement was very good among diffusion and perfusion parameters obtained with all three measurement techniques. Interobserver agreement was very good, except for one of the measurement techniques. As far as interobserver variability is considered, only ADC value measured on the slice with maximum wall thickness differed significantly. Conclusion: multiparametric MRI of rectum, using ADC as the diffusion and k(trans) as the perfusion parameter is a repeatable technique. This technique may potentially be used in prediction and evaluation of neoadjuvant treatment response. New studies with larger patient groups are needed to validate the role of multiparametric MRI.Publication Open Access Multiparametric MRI in rectal cancer(Aves, 2019) N/A; N/A; Gürses, Bengi; Böge, Medine; Altınmakas, Emre; Balık, Emre; Faculty Member; Other; Faculty Member; School of Medicine; N/A; N/A; N/A; 18758MRI has a pivotal role in both pretreatment staging and posttreatment evaluation of rectal cancer. The accuracy of MRI in pretreatment staging is higher compared with posttreatment evaluation. This occurs due to similar signal intensities of tumoral and posttreatment fibrotic, necrotic, and inflamed tissue. This limitation occurs with conventional MRI of the rectum with morphologic sequences. There is a need towards increasing the accuracy of MRI, especially for posttreatment evaluation. The term multiparametric MRI implies addition of functional sequences, namely, diffusion and perfusion to the routine protocol. This review summarizes the technique, potential implications and previously published studies about multiparametric MRI of rectal cancer.Publication Open Access Dealing with the gray zones in the management of gastric cancer: the consensus statement of the İstanbul Group(Aves, 2019) Aytaç, Erman; Çiçek, Bahattin; Erdamar, Sibel; Güven, Koray; Karahasanoğlu, Tayfun; Atalar, Banu; Tozun, Nurdan; Arıcan, Ali; Hamzaoğlu, İsmail; Baca, Bilgi; Saruç, Murat; Göksel, Süha; Demir, Gökhan; Ağaoğlu, Fulya; Yakıcıer, Cengiz; Özbek, Uğur; Özben, Volkan; Özyar, Enis; Güner, Ahmet Levent; Er, Özlem; Bölükbaşı, Yasemin; The İstanbul Group; N/A; N/A; N/A; N/A; N/A; Gürses, Bengi; Falay, Fikri Okan; Selçukbiricik, Fatih; Rozanes, İzzet; Mamuş, Ayşe Ezgi; Buğra, Dursun; Aslan, Fatih; Kaban, Kerim; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; N/A; N/A; N/A; N/A; 27211; N/A; N/A; N/A; N/AThe geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes. The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized a consensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practice for this challenging disease. The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determined in the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions. The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patient selection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues in the management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results section with related data.Publication Open Access Intraductal papillary mucinous neoplasm of the pancreas associated with neuroendocrine tumor: a case report(Elsevier, 2017) Vural, M.; Yilmaz, S.; Goksel, S.; N/A; N/A; Gürses, Bengi; Böge, Medine; Bilge, Orhan; Faculty Member; Faculty Member; School of Medicine; N/A; N/A; 176833Introduction: Intraductal papillary mucinous neoplasm is an uncommon cystic tumor of pancreas that can be associated with ductal adenocarcinoma. Coexistence of pancreatic IPMN and neuroendocrine tumor is very rare. Here, we report the imaging features of mixed type intraductal papillary mucinous neoplasia of the pancreas with high grade dysplasia together with neuroendocrine carcinoma and perform review of the literature. Presentation: A 68-year old patient has been evaluated for possible IPMN that was suspected during ultrasound. MRI revealed main and side branch duct dilatations. At the head, a contrast enhancing nodular lesion was identified. Due to the presence of high risk stigmata according to guidelines, surgery was performed. Histopathological examination revealed an unusual association, including mixed type IPMN and neuroendocrine carcinoma. Discussion: The concomitant occurrence of pancreatic IPMN and neuroendocrine tumor has been reported in case studies and brief reviews. Yet, the imaging findings and underlying molecular mechanisms of this entity has not been fully understood. In addition to this unusual association, pancreatic intraepithelial neoplasia was also detected in the present case. Although majority of neuroendocrine tumor associated ipmns were reported to be having low grade dysplasia, our patient had high grade dysplasia. Further studies and reviews with larger groups are needed to establish imaging features and underlying molecular mechanisms of this rare association. Conclusion: Although the major concern during work-up of IPMN is presence of associated pancreatic ductal adenocarcinoma, the possibility of neuroendocrine tumor, in the presence of a hypervascular solid foci on imaging studies should be kept in mind.