Hakan Ilaslan - Academia.edu (original) (raw)

Papers by Hakan Ilaslan

Orthopedics, 2006

This article prospectively determines through magnetic resonance imaging (MRI) the incidence of i... more This article prospectively determines through magnetic resonance imaging (MRI) the incidence of isolated teres minor atrophy and its gender and age distribution, and documents associated findings related to the rotator cuff, labroligamentous complex, and quadrilateral space. Two hundred seventeen consecutive shoulder MRI examinations performed over a 3-month period were prospectively reviewed and evaluated for isolated teres minor atrophy. Twelve (5.5%) patients had non-compressive isolated teres minor atrophy. Ninety-two percent (n=11) of these patients had rotator cuff or labroligamentous complex tears. No patients had an associated mass within the quadrilateral space. The average patient age was 60 years and 11 of the 12 patients were male. Isolated teres minor atrophy on MRI is most commonly seen in older patients who do not fit the expected clinical presentation of quadrilateral space syndrome. The anatomical relationship of the teres minor nerve to the joint capsule and the frequency of associated shoulder injuries in these patients raises the possibility of an association between humeral decentering and teres minor atrophy. Quadrilateral space syndrome would appear to be a very rare cause of isolated teres minor atrophy.

Contemporary Diagnostic Radiology, 2018

Osteoid osteoma is a benign, monostotic bone tumor accounting for 11% of all benign bone tumors a... more Osteoid osteoma is a benign, monostotic bone tumor accounting for 11% of all benign bone tumors and 3% of all primary bone tumors.1,2 Osteoid osteoma is up to three times more prevalent in males than in females, most commonly between the ages of 10 and 30 years.1,2

JBJS Case Connector, 2016

Case: Denosumab, an inhibitor of RANKL (receptor activator of nuclear factor k-B ligand), was rec... more Case: Denosumab, an inhibitor of RANKL (receptor activator of nuclear factor k-B ligand), was recently introduced for the treatment of giant-cell tumor of bone (GCTB). We describe the clinical, radiographic, and histological features of a GCTB of the spine in a 24-year-old woman that progressed after neoadjuvant treatment with denosumab. Disappearance of the multinuclear osteoclastic giant cells was accompanied by newly formed woven bone, which was deposited in interconnected strands with a prominent fibrovascular stroma that was histologically and radiographically similar to that of an osteoblastoma. Conclusion: Pathologists, radiologists, and surgeons should be aware of this post-treatment transformation to avoid misdiagnosis. Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work.

Pediatric and Adult MRI Atlas of Bone Marrow, 2016

Bone marrow involvement is frequently seen in patients with systemic disorders. Some of these dis... more Bone marrow involvement is frequently seen in patients with systemic disorders. Some of these disorders have unique MRI imaging appearance which may be sufficient to make a diagnosis of the particular entity while others require correlation with clinical history and extramedullary findings.

concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitatio... more concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Tumors and Tumor-Like Lesions of Bone, 2015

When evaluating a bone tumor, a systematic approach should be used taking into consideration the ... more When evaluating a bone tumor, a systematic approach should be used taking into consideration the clinical and laboratory findings along with the imaging appearance to arrive at a differential diagnosis. Attention should be paid to the age of the patient and the location of the lesion, and comparison with prior examinations should be made when possible. Awareness of the spectrum of non-neoplastic reactive, metabolic, inflammatory, and infectious as well as iatrogenic and developmental lesions must also be taken into account as these can mimic a primary bone tumor. Radiographs are the mainstay and most cost-effective imaging modality for the evaluation of bone tumors. CT and MRI are particularly useful in areas of complex anatomy and for staging.

PURPOSE Radiographic change in cartilage tumor calcifications is considered a sign of chondrosarc... more PURPOSE Radiographic change in cartilage tumor calcifications is considered a sign of chondrosarcoma. During total knee arthroplasty (TKA) enchondromas may be disrupted by an intramedullary (IM) guide rod. Our purpose was to describe the expected radiographic changes in enchondromas after TKA. METHOD AND MATERIALS Medical records search between 2000-2013 identified 214 of 9,167 TKA patients seen at our institution with radiographic reports mentioning enchondroma. Study group had enchondromas in the operated knee while the controls had enchondromas in the non-operated knee. Both groups had pre- and postop radiographs. Tumor size, location (eccentric/central), calcification pattern and changes were judged in consensus by 2 MSK radiologists for preop, early postop and longest followup postop radiographs. RESULTS Study group was 36 patients (16 men, mean age 72) with 39 enchondromas (31 femur, 8 tibia). 15 controls (6 male, mean age 71) with 15 enchondromas (13 femur, 2 tibia). Mean tim...

$Research paper thumbnail of Identifying serious causes of back pain: Cancer, infection, fracture$

Cleveland Clinic Journal of Medicine, 2008

■ ■ Most patients with back pain have a benign condition, but tumors, infections, and fractures m... more ■ ■ Most patients with back pain have a benign condition, but tumors, infections, and fractures must be considered during an initial evaluation because overlooking them can have serious consequences. This article discusses the presentation and diagnostic strategies of these serious causes of back pain.

Ultrasound Quarterly, 2001

Urinary tract infection (UTI) in infants and children demands rapid differentiation between upper... more Urinary tract infection (UTI) in infants and children demands rapid differentiation between upper UTI (pyelonephritis) and lower UTI (cystitis) for prompt treatment to be initiated so that renal damage is minimized. This pictorial review presents a wide gamut of structural and functional abnormalities of the urinary tract that may predispose infants and children to UTI, including vesicoureteral reflux, upper urinary tract obstruction (ureteropelvic junction obstruction), lower urinary tract obstruction (primary megaureter, ureterovesical junction obstruction, posterior urethral valve, ectopic ureterocele with or without associated duplex collecting system), neurogenic problems (dysfunctional voiding), calculi, and parenchymal scars. Sonography (ultrasound [US]) is the imaging modality of choice for assessment of renal size, growth (serial sonograms), texture, and blood flow. Other modalities used to work-up UTI in the pediatric patient include fluoroscopic voiding cystourethrogram, nuclear voiding cystourethrogram, and nuclear renal scintigraphy (NRS). Excretory urography is no longer recommended in the routine evaluation of childhood UTI because information regarding anatomy and function (qualitative and quantitative) can be better assessed with US and NRS, respectively. Computed tomography and magnetic resonance imaging are primarily reserved for complex cases in which a definitive diagnosis cannot be made with routine imaging. Algorithms for work-up of UTI in various pediatric age groups are presented.

Bone Cancer, 2015

Abstract Primary bone sarcomas are relatively rare and comprise only a small percentage of bone n... more Abstract Primary bone sarcomas are relatively rare and comprise only a small percentage of bone neoplasms. Accurate diagnosis, critical to appropriate management, is achieved on a consistent basis with the close correlation of microscopic findings with imaging diagnosis. Initial radiologic evaluation of primary bone sarcomas is usually with radiographs. On the basis of the patient’s age, location of the tumor, and matrix of the lesion, the radiologist can more often than not provide an accurate, narrow differential diagnosis. Staging for primary bone sarcomas is done most commonly with a combination of computed tomography (CT) to assess for pulmonary metastases and magnetic resonance imaging (MRI) for local staging. The utility of positron emission tomography in combination with computed tomography (PET/CT) is currently under evaluation for routine clinical use. Some studies have shown improved detection of metastases with PET/CT as opposed to CT alone. Routine use of PET/CT, however, would result in increased ionizing radiation dose to young children who may present with primary Ewing sarcoma or osteosarcoma. The advent of PET/MRI may provide an alternative method of staging with less ionizing radiation than PET/CT, but at a higher financial cost. Further research is needed to assess the utility and cost-effectiveness in using such modalities routinely in primary bone sarcoma staging.

Turkish Neurosurgery, 2010

AIM: Sacroiliac joint dysfunction is a disorder presenting with low back and groin pain. It shoul... more AIM: Sacroiliac joint dysfunction is a disorder presenting with low back and groin pain. It should be taken into consideration during the preoperative differential diagnosis of lumbar disc herniation, lumbar spinal stenosis and facet syndrome. MATERIAL and METHODS: Four cases with sacroiliac dysfunction are presented. The clinical and radiological signs supported the evidence of sacroiliac dysfunction, and exact diagnosis was made after positive response to sacroiliac joint block. RESULTS: A percutaneous sacroiliac fixation provided pain relief in all cases. The mean VAS scores reduced from 8.2 to 2.2. CONCLUSION: It is concluded that sacroiliac joint dysfunction diagnosis requires a carefull physical examination of the sacroiliac joints in all cases with low back and groin pain. The diagnosis is made based on positive response to the sacroiliac block. Sacroiliac fixation was found to be effective in carefully selected cases.

Seminars in ultrasound, CT, and MR, 2011

Sarcomas are the most common nonhematologic primary malignancies of bones in the pelvis. Chondros... more Sarcomas are the most common nonhematologic primary malignancies of bones in the pelvis. Chondrosarcoma, osteosarcoma, and Ewing's sarcoma are the most common sarcomas to originate from the pelvic bones. Various imaging modalities such as magnetic resonance imaging and computed tomography play an important role in the detection, characterization, and staging of these lesions. Biopsy, usually performed with imaging guidance, is essential for the histologic diagnosis of these tumors and for planning therapeutic options. Despite considerable advances in treatment options, sarcomas in the pelvic bones generally are associated with poorer outcomes than sarcomas in the appendicular skeleton because of the larger size of the lesions at the time of discovery and the difficulty of obtaining a wide surgical resection margin. In this review, we discuss the various types of pelvic bone sarcomas and the role of imaging in patients with these lesions.

Skeletal Radiology, 2006

Objective: To determine the imaging incidence, distribution, and prognosis of primary and seconda... more Objective: To determine the imaging incidence, distribution, and prognosis of primary and secondary osseous lymphoma from a consective, single-institution patient population seen over a 5-year period. Design and patients: Of 1098 newly diagnosed consecutively seen patients with lymphoma between 1996 and 2000, 975 comprised the study group. From the electronic medical records and imaging studies, age, gender, date of diagnosis of lymphoma, bone involvement, location in bone, multifocality in bone, histopathologic type of the lesion and patient survival were recorded. Primary lymphoma of bone was defined as osseous disease with or without regional node involvement and no evidence of systemic disease for 6 months. Secondary osseous lymphoma was considered present when osseous lymphoma was associated with systemic disease or the appearance of systemic disease within 6 months of osseous disease. Results: Ninety-eight patients had osseous lymphoma (10%, 95% confidence interval [CI] 8.2, 11.9). Ages ranged from 9 to 92 years (mean 54) and gender 6:4 (M:F). Ten patients (1%) had primary lymphoma of bone. Eighty-eight patients (9%) had secondary lymphoma of bone. The vertebral column was the favored site for secondary osseous lymphoma. At 5 years, there were no deaths in the primary osseous lymphoma group and a 51% mortality rate in the secondary osseous lymphoma group. Conclusions: Primary lymphoma of bone remains a rare primary malignancy, favors the appendicular skeleton, and has a significantly better 5-year prognosis than secondary lymphoma of bone.

Skeletal Radiology, 2009

Objectives The objective of this study was to evaluate by cross-sectional imaging the prevalence ... more Objectives The objective of this study was to evaluate by cross-sectional imaging the prevalence and degree of cortical scalloping by small eccentric chondromas correlated with histologic diagnosis and patient history. Materials and methods From 122 patients with histologically proven enchondromas and two patients without histology but with radiologic and clinical follow-up, 11 patients with small, eccentrically located chondromas in the long bones had crosssectional imaging available. The lesions were evaluated for location, size, presence, and degree of cortical scalloping. The patient's medical charts and microscope slides were reviewed for relevant clinical history, clinical management, and histology. Results The chondromas ranged in size from 1.6 to 3.8 cm (mean 2.3 cm). Two lesions were located in the proximal femoral diaphysis, two in the distal femoral diaphysis, six in the distal femoral metaphysis, and one in the proximal tibial epimetaphysis. The lesions were curetted due to diagnostic uncertainty, continued pain, marked radiologic cortical penetration, or due to patient insistence on biopsy. All 11 lesions were benign, nine histologically, and two by stability over 4 and 7 years. The prevalence of cortical scalloping among eccentric chondromas was 100%. Cortical scalloping or occupancy ranged from 50 to 100% (mean 75%). Conclusions All small eccentric chondromas in this study were associated with an appearance of cortical scalloping of varying degree. All curetted lesions were histologically bland without nuclear atypia. Based on the benign histology of nine lesions and lack of growth of two lesions over several years, the degree of cortical scalloping is felt to be a result of lesion location within the endosteum rather than biological activity or malignancy.

Skeletal Radiology, 2008

Objectives Our objectives were to determine retrospectively the prevalence, patients' demographic... more Objectives Our objectives were to determine retrospectively the prevalence, patients' demographics, mechanism of injury, combination of torn ligaments, associated intra-articular and extra-articular injuries, fractures, bone bruises, femoral-tibial alignment and neurovascular complications of knee dislocations as evaluated by magnetic resonance (MR) imaging. Materials and methods From 17,698 consecutive knee examinations by magnetic resonance imaging (MRI) over a 6-year period, 20 patients with knee dislocations were identified. The medical records of these patients were subsequently reviewed for relevant clinical history, management and operative findings. Results The prevalence of knee dislocations was 0.11% [95% confidence interval (95% CI) 0.06-0.16)]. There were 16 male patients and four female patients, with ages ranging from 15 years to 76 years (mean 31 years). Fifteen patients had low-velocity injuries (75%), of which 11 were amateur sports related and four were from falls. Four patients (20%) had suffered high-velocity trauma (motor vehicle accidents). One patient had no history available. Anatomic alignment was present at imaging in 16 patients (80%). Eighteen patients had three-ligament tears, two had four-ligament tears. The four-ligament tears occurred with low-velocity injuries. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were torn in every patient; the lateral collateral ligament (LCL) was torn in 50%, and the medial collateral ligament (MCL) in 60%. Intraarticular injuries included meniscal tears (five in four patients), fractures (eight in seven patients), bone bruises (15 patients), and patellar retinaculum tears (eight partial, two complete). The most common extra-articular injury was a complete biceps femoris tendon tear (five, 25%). There were two popliteal tendon tears and one iliotibial band tear. One patient had received a vascular injury following a motor vehicle accident (MVA) and had been treated prior to undergoing MRI. Bone bruises (unrelated to fractures), fourligament tears, biceps femoris tears, and popliteus tendon tears were encountered only in the low-velocity knee dislocations. Twelve were treated surgically, five conservatively, and three had been lost to follow-up. The biceps femoris tendon was repaired in every patient who was treated surgically. Conclusions Knee dislocations occurred more commonly in low-velocity injuries than in high-velocity injuries, predominantly affecting amateur athletes. Biceps femoris tendon tears were the most common extra-articular injury requiring surgery. Neurovascular injury (5%) was uncommon. At imaging, femoral-tibial alignment was anatomic in the majority of patients.