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Item Multicenter Multireader Evaluation of an Artificial Intelligence-Based Attention Mapping System for the Detection of Prostate Cancer With Multiparametric MRI(AMER ROENTGEN RAY SOC, 2020-01-01) Mehralivand, Sherif; Harmon, Stephanie A.; Shih, Joanna H.; Smith, Clayton P.; Lay, Nathan; Argun, Burak; Bednarova, Sandra; Baroni, Ronaldo Hueb; Canda, Abdullah Erdem; Ercan, Karabekir; Girometti, Rossano; Karaarslan, Ercan; Kural, Ali Riza; Pursyko, Andrei S.; Rais-Bahrami, Soroush; Tonso, Victor Martins; Magi-Galluzzi, Cristina; Gordetsky, Jennifer B.; Silvestre e Silva Macarenco, Ricardo; Merino, Maria J.; Gumuskaya, Berrak; Saglican, Yesim; Sioletic, Stefano; Warren, Anne Y.; Barrett, Tristan; Bittencourt, Leonardo; Coskun, Mehmet; Knauss, Chris; Law, Yan Mee; Malayeri, Ashkan A.; Margolis, Daniel J.; Marko, Jamie; Yakar, Derya; Wood, Bradford J.; Pinto, Peter A.; Choyke, Peter L.; Summers, Ronald M.; Turkbey, BarisOBJECTIVE. The purpose of this study was to evaluate in a multicenter dataset the performance of an artificial intelligence (AI) detection system with attention mapping compared with multiparametric MRI (mpMRI) interpretation in the detection of prostate cancer. MATERIALS AND METHODS. MRI examinations from five institutions were included in this study and were evaluated by nine readers. In the first round, readers evaluated mpMRI studies using the Prostate Imaging Reporting and Data System version 2. After 4 weeks, images were again presented to readers along with the AI-based detection system output. Readers accepted or rejected lesions within four AI-generated attention map boxes. Additional lesions outside of boxes were excluded from detection and categorization. The performances of readers using the mpMRI-only and AI-assisted approaches were compared. RESULTS. The study population included 152 case patients and 84 control patients with 274 pathologically proven cancer lesions. The lesion-based AUC was 74.9\% for MRI and 77.5\% for AI with no significant difference (p = 0.095). The sensitivity for overall detection of cancer lesions was higher for AI than for mpMRI but did not reach statistical significance (57.4\% vs 53.6\%, p = 0.073). However, for transition zone lesions, sensitivity was higher for AI than for MRI (61.8\% vs 50.8\%, p = 0.001). Reading time was longer for AI than for MRI (4.66 vs 4.03 minutes, p < 0.001). There was moderate interreader agreement for AI and MRI with no significant difference (58.7\% vs 58.5\%, p = 0.966). CONCLUSION. Overall sensitivity was only minimally improved by use of the AI system. Significant improvement was achieved, however, in the detection of transition zone lesions with use of the AI system at the cost of a mean of 40 seconds of additional reading time.Item A joint convolutional-recurrent neural network with an attention mechanism for detecting intracranial hemorrhage on noncontrast head CT(NATURE PORTFOLIO, 2022-01-01) Alis, Deniz; Alis, Ceren; Yergin, Mert; Topel, Cagdas; Asmakutlu, Ozan; Bagcilar, Omer; Senli, Yeseren Deniz; Ustundag, Ahmet; Salt, Vefa; Dogan, Sebahat Nacar; Velioglu, Murat; Selcuk, Hakan Hatem; Kara, Batuhan; Ozer, Caner; Oksuz, Ilkay; Kizilkilic, Osman; Karaarslan, ErcanTo investigate the performance of a joint convolutional neural networks-recurrent neural networks (CNN-RNN) using an attention mechanism in identifying and classifying intracranial hemorrhage (ICH) on a large multi-center datasetItem Inter-vendor performance of deep learning in segmenting acute ischemic lesions on diffusion-weighted imaging: a multicenter study(NATURE PORTFOLIO, 2021-01-01) Alis, Deniz; Yergin, Mert; Alis, Ceren; Topel, Cagdas; Asmakutlu, Ozan; Bagcilar, Omer; Senli, Yeseren Deniz; Ustundag, Ahmet; Salt, Vefa; Dogan, Sebahat Nacar; Velioglu, Murat; Selcuk, Hakan Hatem; Kara, Batuhan; Oksuz, Ilkay; Kizilkilic, Osman; Karaarslan, ErcanThere is little evidence on the applicability of deep learning (DL) in the segmentation of acute ischemic lesions on diffusion-weighted imaging (DWI) between magnetic resonance imaging (MRI) scanners of different manufacturers. We retrospectively included DWI data of patients with acute ischemic lesions from six centers. Dataset A (n=2986) and B (n=3951) included data from Siemens and GE MRI scanners, respectively. The datasets were split into the training (80\%), validation (10\%), and internal test (10\%) sets, and six neuroradiologists created ground-truth masks. Models A and B were the proposed neural networks trained on datasets A and B. The models subsequently fine-tuned across the datasets using their validation data. Another radiologist performed the segmentation on the test sets for comparisons. The median Dice scores of models A and B were 0.858 and 0.857 for the internal tests, which were non-inferior to the radiologist's performance, but demonstrated lower performance than the radiologist on the external tests. Fine-tuned models A and B achieved median Dice scores of 0.832 and 0.846, which were non-inferior to the radiologist's performance on the external tests. The present work shows that the inter-vendor operability of deep learning for the segmentation of ischemic lesions on DWI might be enhanced via transfer learningItem Brain MRI Findings in Patients in the Intensive Care Unit with COVID-19 Infection(RADIOLOGICAL SOC NORTH AMERICA, 2020-01-01) Kandemirli, Sedat G.; Dogan, Lerzan; Sarikaya, Zeynep T.; Kara, Simay; Akinci, Canan; Kaya, Dilaver; Kaya, Yildiz; Yildirim, Duzgun; Tuzuner, Filiz; Yildirim, Mustafa S.; Ozluk, Enes; Gucyetmez, Bulent; Karaarslan, Ercan; Koyluoglu, Isil; Kaya, Hande S. Demirel; Mammadov, Orkhan; Ozdemir, Ilkay Kisa; Afsar, Nazire; Yalcinkaya, Beyza Citci; Rasimoglu, Sevdinaz; Guduk, Duygu E.; Jima, Ararso Kedir; Ilksoz, Aylin; Ersoz, Vildan; Eren, Meltem Yonca; Celtik, Nilufer; Arslan, Serdar; Korkmazer, Bora; Dincer, Saban S.; Gulek, Elif; Dikmen, Ibrahim; Yazici, Murathan; Unsal, Serkan; Ljama, Taner; Demirel, Ismail; Ayyildiz, Aykut; Kesimci, Isil; Deveci, Sahika Bolsoy; Tutuncu, Melih; Kizilkilic, Osman; Telci, Lutfi; Zengin, Rehile; Dincer, Alp; Akinci, Ibrahim O.; Kocer, NaciItem Management of symptomatic radiation necrosis after stereotactic radiosurgery and clinical factors for treatment response(KOREAN SOC THERAPEUTIC RADIOLOGY \& ONCOLOGY, 2020-01-01) Sayan, Mutlay; Mustafayev, Teuta Zoto; Balmuk, Aykut; Mamidanna, Swati; Kefelioglu, Erva Seyma Sare; Gungor, Gorkem; Chundury, Anupama; Ohri, Nisha; Karaarslan, Ercan; Ozyar, Enis; Atalar, BanuPurpose: Approximately 10\% of patients who received brain stereotactic radiosurgery (SRS) develop symptomatic radiation necrosis (RN). We sought to determine the effectiveness of treatment options for symptomatic RN, based on patient-reported outcomes. Materials and Methods: We conducted a retrospective review of 217 patients with 414 brain metastases treated with SRS from 2009 to 2018 at our institution. Symptomatic RN was determined by appearance on serial magnetic resonance images (MRIs), MR spectroscopy, requirement of therapy, and development of new neurological complaints without evidence of disease progression. Therapeutic interventions for symptomatic RN included corticosteroids, bevacizumab and/or surgical resection. Patient-reported therapeutic outcomes were graded as complete response (CR), partial response (PR), and no response. Results: Twenty-six patients experienced symptomatic RN after treatment of 50 separate lesions. The mean prescription dose was 22 Gy (range, 15 to 30 Gy) in 1 to 5 fractions (median, 1 fraction). Of the 12 patients managed with corticosteroids, 6 patients (50\%) reported CR and 4 patients (33\%) PR. Of the 6 patients managed with bevacizumab, 3 patients (50\%) reported CR and 1 patient (18\%) PR. Of the 8 patients treated with surgical resection, all reported CR (100\%). Other than surgical resection, age >= 54 years (median, 54 yearsItem Micro-dose Paranasal Computed Tomography is Valuable When Evaluating Diseases of the Paranasal Sinuses(GALENOS YAYINCILIK, 2019-01-01) Ozbayrak, Mustafa; Ertas, Burak; Ulus, Ozden Sila; Ozdilek, Alper; Karaarslan, ErcanAim: We explored whether a reduction in the radiation dose affected the quality of diagnostic images generated using third-generation dual-source computed tomography (CT) running advanced third-generation iterative reconstruction software. Methods: From February to May 2015, 72 consecutive patients aged 16 to 64 years with clinically suspected sinusitis were randomly and prospectively enrolled and divided into two groups (standard or micro-dose CT). Anatomical landmarks and mucosal structures were independently evaluated by a radiologist and an otorhinolaryngologist using a four-point grading scale. Mean scores were calculated and compared. Results: All images were of diagnostic quality. The mean effective radiation dose was significantly lower in patients evaluated via the micro-dose protocol (group 2) than in those evaluated using the standard protocol (group 1) (p<0.05). The mean anatomical scores showed that all landmarks were very well-defined, with the exceptions of the uncinate attachment point and the ethmoid foramen (used to identify the ethmoid artery). The Wilcoxon signed rank test revealed no significant difference between the mean scores of the two observers for either group (p>0.05). Conclusion: The radiation dose to the paranasal sinus delivered during CT in patients with suspected sinusitis can be reduced to 0.003 mSv using third-generation dual-source CT running advanced iterative reconstruction software.Item Giant Extraarticular Pigmented Villonodular Tenosynovitis(GALENOS PUBL HOUSE, 2013-01-01) Ulus, Sila; Karaarslan, Ercan; Ozger, Harzem; Alpan, Bugra; Bilgic, BilgeItem A rare case of paratesticular leiomyoma in a child(AVES, 2019-01-01) Arslan, Aydan; Ulus, Sila; Ince, Umit; Tekant, Gonca; Karaarslan, ErcanLeiomyomas are benign, slow-growing, smooth muscle tumors, which can occur at many locations in the body. The male genitourinary tract is seldom affected and scrotal leiomyomas are extremely rare. Most of the scrotal leiomyomas are localized in the testis, epididymis, spermatic cord, subcutaneous tissue, tunica albuginea, and scrotal skin and only a few of them are reported in the origin of isolated tissue without paratesticular structures in the paratesticular region. We are presenting a case of solitary paratesticular leiomyoma in a child, which is very rare in terms of lesion location and patient age, and describing the imaging features of this lesion.Item A Review on Cutaneous and Musculoskeletal Manifestations of CLOVES Syndrome(DOVE MEDICAL PRESS LTD, 2022-01-01) Durmaz, Emel Ozturk; Demircioglu, Deniz; Dikmen, Pinar Yalinay; Alanay, Yasemin; Alanay, Ahmet; Demirkesen, Cuyan; Tokat, Fatma; Karaarslan, ErcanCLOVES syndrome is a novel sporadic mosaic segmental overgrowth syndrome, currently categorized under the canopy of PROS (PIK3CA-related overgrowth spectrum) disorders. All PROS disorders harbor heterozygous postzygotic activating somatic mutations involving the PIK3CA gene. As an upstream regulator of the PI3K/AKT/mTOR signal transduction pathway, activating mutations of PIK3CA gene commence in uncontrolled growth of cutaneous, vascular (capillaries, veins, and lymphatics), adipose, neural, and musculoskeletal tissues. The excessive growth is segmental, patchy, asymmetric, and confined to body parts affected by the mutation. The term `CLOVES' is an acronym denoting congenital lipomatous overgrowth, vascular malformations, epidermal nevi and spinal (scoliosis) and/ or skeletal anomalies. The syndrome is characterized by an admixture of overgrown tissues, derived mainly from mesoderm and neuroectoderm. Among PROS disorders, CLOVES syndrome represents the extreme end of the spectrum with massive affection of almost the entire body. The syndrome might judiciously be treated with medications hampering with the PI3K/AKT/mTOR signal transduction pathway. This article aims at reviewing the cutaneous and musculoskeletal manifestations of CLOVES syndrome, as the paradigm for PROS disorders. CLOVES syndrome and other PROS disorders are still misdiagnosed, underdiagnosed, underreported, and undertreated by the dermatology community.Item Whole-Body MRI Screening in Asymptomatic Subjects(INT SCIENTIFIC INFORMATION INC, 2016-01-01) Ulus, Sila; Suleyman, Erdogan; Ozcan, Umit Aksoy; Karaarslan, ErcanBackground: The aim of this study is to describe the technique and to evaluate the results of whole-body magnetic resonance imaging in an asymptomatic population. Material/Methods: Between March 2009 and December 2011, 118 consecutive subjects undergoing thorough medical check-up were prospectively included in the study. MRI was performed with a 205-cm moving table, parallel imaging and automatic image composing software. Results: In 83 subjects (70\%), 103 benign lesions were detected. Two malignant (adrenal and renal carcinoma) lesions and one precancerous (pancreatic mucinous carcinoma) lesion were detected. The most common lesions were renal cysts, liver hemangiomas, liver cysts, thyroid nodules, and uterine leiomyomas. Conclusions: WB-MRI is able to cover area from head to toes in one diagnostic work-up, and besides the anatomic regions evaluated by conventional radiological modalities, i.e. brain parenchyma, bones and extremities, can be evaluated in one examination.