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Schurink NW, van Kranen SR, van Griethuysen JJM, Roberti S, Snaebjornsson P, Bakers FCH, de Bie SH, Bosma GPT, Cappendijk VC, Geenen RWF, Neijenhuis PA, Peterson GM, Veeken CJ, Vliegen RFA, Peters FP, Bogveradze N, El Khababi N, Lahaye MJ, Maas M, Beets GL, Beets-Tan RGH, Lambregts DMJ. Development and multicenter validation of a multiparametric imaging model to predict treatment response in rectal cancer. Eur Radiol 2023; 33:8889-8898. [PMID: 37452176 PMCID: PMC10667134 DOI: 10.1007/s00330-023-09920-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To develop and validate a multiparametric model to predict neoadjuvant treatment response in rectal cancer at baseline using a heterogeneous multicenter MRI dataset. METHODS Baseline staging MRIs (T2W (T2-weighted)-MRI, diffusion-weighted imaging (DWI) / apparent diffusion coefficient (ADC)) of 509 patients (9 centres) treated with neoadjuvant chemoradiotherapy (CRT) were collected. Response was defined as (1) complete versus incomplete response, or (2) good (Mandard tumor regression grade (TRG) 1-2) versus poor response (TRG3-5). Prediction models were developed using combinations of the following variable groups: (1) Non-imaging: age/sex/tumor-location/tumor-morphology/CRT-surgery interval (2) Basic staging: cT-stage/cN-stage/mesorectal fascia involvement, derived from (2a) original staging reports, or (2b) expert re-evaluation (3) Advanced staging: variables from 2b combined with cTN-substaging/invasion depth/extramural vascular invasion/tumor length (4) Quantitative imaging: tumour volume + first-order histogram features (from T2W-MRI and DWI/ADC) Models were developed with data from 6 centers (n = 412) using logistic regression with the Least Absolute Shrinkage and Selector Operator (LASSO) feature selection, internally validated using repeated (n = 100) random hold-out validation, and externally validated using data from 3 centers (n = 97). RESULTS After external validation, the best model (including non-imaging and advanced staging variables) achieved an area under the curve of 0.60 (95%CI=0.48-0.72) to predict complete response and 0.65 (95%CI=0.53-0.76) to predict a good response. Quantitative variables did not improve model performance. Basic staging variables consistently achieved lower performance compared to advanced staging variables. CONCLUSIONS Overall model performance was moderate. Best results were obtained using advanced staging variables, highlighting the importance of good-quality staging according to current guidelines. Quantitative imaging features had no added value (in this heterogeneous dataset). CLINICAL RELEVANCE STATEMENT Predicting tumour response at baseline could aid in tailoring neoadjuvant therapies for rectal cancer. This study shows that image-based prediction models are promising, though are negatively affected by variations in staging quality and MRI acquisition, urging the need for harmonization. KEY POINTS This multicenter study combining clinical information and features derived from MRI rendered disappointing performance to predict response to neoadjuvant treatment in rectal cancer. Best results were obtained with the combination of clinical baseline information and state-of-the-art image-based staging variables, highlighting the importance of good quality staging according to current guidelines and staging templates. No added value was found for quantitative imaging features in this multicenter retrospective study. This is likely related to acquisition variations, which is a major problem for feature reproducibility and thus model generalizability.
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Affiliation(s)
- Niels W Schurink
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Simon R van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frans C H Bakers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Shira H de Bie
- Department of Radiology, Deventer Ziekenhuis, Schalkhaar, The Netherlands
| | - Gerlof P T Bosma
- Department of Interventional Radiology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Vincent C Cappendijk
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | | | - Cornelis J Veeken
- Department of Radiology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Roy F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Femke P Peters
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nino Bogveradze
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Department of Radiology, Acad. F. Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
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Chen Y, Yang P, Fu C, Bian Y, Shao C, Ma C, Lu J. Variabilities in apparent diffusion coefficient (ADC) measurements of the spleen and the paraspinal muscle: A single center large cohort study. Heliyon 2023; 9:e18166. [PMID: 37519768 PMCID: PMC10372245 DOI: 10.1016/j.heliyon.2023.e18166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Evaluation of the variabilities in apparent diffusion coefficient (ADC) measurements of the spleen (ADCspleen) and the paraspinal muscles (ADCmuscle) to identify the reference organ for normalizing the ADC from the abdominal diffusion weighted imaging (DWI). Methods Two MRI scanners, with 314 abdominal exams on the GE and 929 on the Siemens system, were used for MRI examinations including DWI (b-values, 50 and 800 s/mm2). For a subset of 73 exams on the Siemens system a second exam was conducted. Four regions of interest (ROIs) in each exam were placed to measure the ADCspleen and the bilateral ADCmuscle. ADC variability between patients (on each scanner separately), ADC variability due to ROI placement between the two ROIs in each organ, and variability in the subset between the first and second exams were assessed. Results The ADCspleen was more scattered and variable than the ADCmuscle in the comparability (n = 929 and 314 for two MRI scanners, respectively) and repeatability (n = 73) datasets. The Bland-Altmann bias and limits of agreement (LoAs) for the ADCspleen (ICC, 0.47; CV, 0.070) and ADCmuscle (ICC, 0.67; CV, 0.023) in the repeatability datasets (n = 73) were -0.1 (-25.7%-25.6%) and -0.3 (-8.8%-8.1%), respectively. For the Siemens system, the Bland-Altmann bias and LoAs for the ADCspleen (ICC, 0.72; CV, 0.061) and ADCmuscle (ICC, 0.53; CV, 0.030) in the comparability datasets (n = 929) were 2.1 (-20.0%-24.2%) and 0.7 (-10.0%-11.4%), respectively. Similar findings have been found in the GE system (n = 314). The CVs for the ADCmuscle measurements were lower than those of the ADCspleen both in the repeatability and the comparability analyses (all p < 0.001). Conclusion Paraspinal muscles demonstrate better reference characteristics than the spleen in estimating ADC variability of abdominal DWI.
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Affiliation(s)
- Yukun Chen
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Panpan Yang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Caixia Fu
- Application Developments, Siemens Shenzhen Magnetic Resonance Ltd., Siemens Healthineers, Shenzhen, 518057, China
| | - Yun Bian
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
- College of Electronic and Information Engineering, Tongji University, Shanghai, 201804, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
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Bai Y, Pei Y, Liu WV, Liu W, Xie S, Wang X, Zhong L, Chen J, Zhang L, Masokano IB, Li W. MRI: Evaluating the Application of FOCUS-MUSE Diffusion-Weighted Imaging in the Pancreas in Comparison With FOCUS, MUSE, and Single-Shot DWIs. J Magn Reson Imaging 2023; 57:1156-1171. [PMID: 36053895 DOI: 10.1002/jmri.28382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is a useful technique to detect pancreatic lesion. In DWIs, field-of-view optimized and constrained undistorted single-shot (FOCUS) can improve the spatial resolution and multiplexed sensitivity-encoding (MUSE) can gain a high signal-to-noise ratio (SNR). Based on the advantage of FOCUS and MUSE, a new DWI sequence-named FOCUS-MUSE DWI (FOCUS combined with MUSE)-was developed to delineate the pancreas. PURPOSE To investigate the reliability of FOCUS-MUSE DWI compared to FOCUS, MUSE and single-shot (SS) DWI via the systematical evaluation of the apparent diffusion coefficient (ADC) measurements, SNR and image quality. STUDY TYPE Prospective. SUBJECTS A total of 33 healthy volunteers and 9 patients with pancreatic lesion. FIELD STRENGTH/SEQUENCE A 3.0 T scanner. FOCUS-MUSE DWI, FOCUS DWI, MUSE DWI, SS DWI. ASSESSMENT For volunteers, ADC and SNR were measured by two readers in the pancreatic head, body, and tail. For all subjects, the diagnostic image quality score was assessed by three other readers on above four DWIs. STATISTICAL TESTS Paired-sample T-test, intraclass correlation (ICC), Bland-Altman method, Friedman test, Dunn-Bonferroni post hoc test and kappa coefficient. A significance level of 0.05 was used. RESULTS FOCUS-MUSE DWI had the best intersession repeatability of ADC measurements (head: 59.53, body: 101.64, tail: 42.30) among the four DWIs, and also maintained the significantly highest SNR (reader 1 [head: 19.68 ± 3.23, body: 23.42 ± 5.00, tail: 28.85 ± 4.96], reader 2 [head: 19.93 ± 3.52, body: 23.02 ± 5.69, tail: 29.77 ± 6.33]) except for MUSE DWI. Furthermore, it significantly achieved better image quality in volunteers (median value: 4 score) and 9 patients (most in 4 score). DATA CONCLUSION FOCUS-MUSE DWI improved the reliability of pancreatic images with the most stable ADC measurement, best image quality score and sufficient SNR among four DWIs. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yu Bai
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yigang Pei
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | | | - Wenguang Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Simin Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xiao Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Linhui Zhong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Juan Chen
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Lijuan Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Ismail Bilal Masokano
- Radiology Department, the Xiangya Third Hospital, Central South University, Changsha, Hunan, China
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Kulali F. Diffusion-weighted imaging versus non-contrast magnetic resonance imaging in the diagnosis of acute appendicitis during pregnancy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:56-60. [PMID: 36629644 PMCID: PMC9937627 DOI: 10.1590/1806-9282.20220578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/15/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic performance of diffusion-weighted imaging compared to non-contrast magnetic resonance imaging in the differential diagnosis of acute appendicitis in pregnant patients. METHODS A total of 72 pregnant patients with the suspicion of acute appendicitis who underwent magnetic resonance imaging combined with diffusion-weighted imaging examinations were enrolled in this retrospective study. Magnetic resonance imaging images (non-contrast and diffusion-weighted imaging sequences) were evaluated. Moreover, apparent diffusion coefficient ratios were estimated. The diagnostic performances of magnetic resonance imaging and diffusion-weighted imaging findings were statistically analyzed on the basis of surgical and follow-up results. RESULTS Of 72 pregnant patients, 10 (14%) had acute appendicitis on magnetic resonance imaging and diffusion-weighted imaging. Among 10 patients with acute appendicitis, three (3/10) had perforation. diffusion-weighted imaging findings had higher sensitivity (90 versus 60%), negative predictive value (98.41 versus 93.94%), and accuracy (98.61 versus 94.44%) ratios compared to non-contrast magnetic resonance imaging in the diagnosis of acute appendicitis. There was one false-negative result on diffusion-weighted imaging. Diffusion restriction facilitated the detection of appendicitis. The apparent diffusion coefficient ratios were lower in acute appendicitis than in the normal appendix (0.70±0.19 versus 0.96±0.16) (p<0.05). CONCLUSION With a shorter scan time and higher diagnostic accuracy, diffusion-weighted imaging can be useful for the early diagnosis of acute appendicitis and for planning appropriate management.
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Affiliation(s)
- Fatma Kulali
- University of Health Sciences, Umraniye Training and Research Hospital, Radiology Department – Istanbul, Turkey.,Corresponding author:
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Xie S, Masokano IB, Liu W, Long X, Li G, Pei Y, Li W. Comparing the clinical utility of single-shot echo-planar imaging and readout-segmented echo-planar imaging in diffusion-weighted imaging of the liver at 3 tesla. Eur J Radiol 2020; 135:109472. [PMID: 33370640 DOI: 10.1016/j.ejrad.2020.109472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/26/2020] [Accepted: 12/08/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare the clinical utility of single-shot echo-planar imaging (SS-EPI) using different breathing schemes and readout-segmented EPI (RS-EPI) in the repeatability of apparent diffusion coefficient (ADC) measurements, signal-to-noise ratio (SNR) and image quality. METHODS In this institutional review board-approved prospective study, hepatic DWIs (b = 50, 300, 600 s/mm2) were performed in 22 volunteers on 3.0 T MRI using SS-EPI with free-breathing diffusion-weighted imaging (FB-DWI), breath-hold (BH-DWI), respiratory-triggered (RT-DWI) and navigator-triggered (NT-DWI), and readout-segmented EPI (RS-DWI). ADC and surrogate SNR (sSNR) were measured in nine anatomic locations in the right lobe, and image quality was assessed on all FB-DWI, BH-DWI, RT-DWI, NT-DWI, and RS-DWI sequences. The sequence with the optimal clinical utility was decided by systematically comparing the ADC repeatability, sSNR and image quality of the above DWIs. RESULTS In all the five sequences, NT-DWI had the most reliable intra-observer agreement (intraclass correlation coefficient (ICC): 0.900-0.922; all P > 0.05), and a better interobserver agreement (ICC: 0.853-0.960; all p > 0.05) than RS-DWI (ICC:0.881-0.916; some P < 0.05). NT-DWI had the best ADC repeatability in the nine locations (mean ADC absolute differences: 38.47-56.38 × 10-6 mm2/s, limits of agreement (LOA): 17.33-22.52 × 10-6 mm2/s). Also, NT-DWI had the highest sSNR (Reader 1: 50.58 ± 20.11 (Superior), 74.06 ± 28.37 (Central), 80.99 ± 38.11(Inferior)); Reader 2: 48.07 ± 23.92 (Superior), 68.23 ± 32.91 (Central), 76.78 ± 33.07 (Inferior)) in three representative sections except for RS-DWI. Furthermore, NT-DWI had a better image quality than RS-DWI (P < 0.05) and was superior to FB-DWI and BH-DWI in sharpness of the liver (at b = 300 s/mm2) (P < 0.05) CONCLUSION: RS-DWI has the best SNR. However, NT-DWI can provide sufficient SNR, excellent image quality, and the best ADC repeatability on 3.0 T MRI. It is thus the recommended sequence for the clinical application of hepatic DWI.
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Affiliation(s)
- Simin Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Ismail Bilal Masokano
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Wenguang Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Xueying Long
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Guijin Li
- Siemens Healthcare Ltd, Guangzhou Branch, 510620, China
| | - Yigang Pei
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Postdoctoral Fellow, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
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Kulali F, Kulali SF, Semiz-Oysu A, Kaya-Tuna B, Bukte Y. Role of Interface Sign and Diffusion-Weighted Magnetic Resonance Imaging in Differential Diagnosis of Exophytic Renal Masses. Can Assoc Radiol J 2019; 70:147-155. [PMID: 30955927 DOI: 10.1016/j.carj.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/06/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We aimed to investigate the role of interfaces of exophytic solid and cystic renal masses on magnetic resonance imaging (MRI) and the added value of diffusion-weighted imaging in differentiating benign from malignant lesions. METHODS The Institutional Review Board approved this retrospective study, and informed consent was waived. A total of 265 patients (109 [41%] women and 156 [59%] men) with a mean age of 57 ± 12 (standard deviation) years were enrolled in this study. Preoperative MRI (n = 238) examinations of patients with solid or cystic renal masses and MRI (n = 27) examinations of patients with Bosniak IIF cysts without progression were reviewed. Solid/cystic pattern, interface types and apparent diffusion coefficient (ADC) values were recorded by 2 radiologists. The diagnostic performance of combining normalized ADC values with interface sign were evaluated. RESULTS Among 265 renal lesions (109 cystic and 156 solid), all malignant lesions (n = 192) had a round interface. No malignant lesions showed an angular interface. For prediction of benignity in cystic lesions, sensitivity (82.86% vs 56.16%), negative predictive value (92.50% vs 85.71%), and accuracy (94.50% vs 87.92%) ratios of angular interface were higher compared to all (solid plus cystic) lesions. The best normalized ADC cutoff values for predicting malignancy in lesions with round interface were as follows: for all (solid plus cystic), ≤ 0.75 (AUROC = 0.804); solid, ≤ 0.6 (AUROC = 0.819); and cystic, ≤ 0.8 (AUROC = 0.936). CONCLUSIONS Angular interface can be a predictor of benignity for especially cystic renal masses. The evaluation of interface type with normalized ADC value can be an important clue in differential diagnosis especially in patients avoiding contrast.
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Affiliation(s)
- Fatma Kulali
- Radiology Department, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey.
| | | | - Aslihan Semiz-Oysu
- Radiology Department, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Burcu Kaya-Tuna
- Radiology Department, Gebze Fatih State Hospital, Kocaeli, Turkey
| | - Yasar Bukte
- Radiology Department, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
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