Sinonazal indiferansiye karsinom

Özet

Sinonazal indiferansiye karsinom (SNUC), nazal kavite veya sinüslerden kaynaklanabilen, hızlı lokal yayılım gösterebilen yüksek dereceli malignitedir; sıklıkla etmoid ve üst nazal kavite çevresinde büyük bir kitle halinde tanınır. BT, kemik yıkımını, tümörün sinüslerden orbita ve ön kafa tabanına uzanımını ve cerrahi açıdan kritik sınırları haritalar; kontrastlı seri nekrotik alanlar ile solid tümör dokusunu ayırt etmeye yardım eder. Görüntü özellikleri başka sinonazal malignitelerle örtüştüğünden SNUC tanısı histopatolojiyle doğrulanır. Orbital veya intrakraniyal yayılımın gözden kaçması hastalık kapsamını eksik göstererek evreleme ve tedavi planlamasını etkileyebilir.

Faz ve pencere

Kontrastsız tanısal

Kemik algoritmalı ince kesitlerde nazal kavite/etmoid merkezli yumuşak doku kitlesi, lamina papyracea ve etmoid çatıdaki destrüksiyon, sinüs duvarları ve kafa tabanı ilişkisi değerlendirilir.

Kontrastlı tanısal

İntravenöz kontrast sonrası yumuşak doku serisinde kitlenin değişken, çoğu kez heterojen kontrastlanması; santral nekrotik/az kontrastlanan alanlar ile orbita, pterigopalatin fossa ve intrakraniyal komşuluğa uzanım incelenir. İntravenöz kontrast sonrası kitlenin heterojen kontrastlanması incelenir; SNUC'nin radyolojik özellikleri diğer sinonazal malignitelerle örtüşür, kesin tanı için histopatoloji gereklidir.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Kemik (G 1800 / M 400).

BT bulguları

• Nazal kavite veya etmoid hücrelerde merkezlenen, çoğu kez sınırları belirsiz ve hacim kaplayan yumuşak doku kitlesi.
• Tümör birden fazla sinüs boşluğunu doldurabilir; opasifikasyonun ötesinde komşu kemik sınırlarını aşan doku devamlılığı aranır.
• Lamina papyracea, etmoid çatı/kribriform plak veya diğer sinüs duvarlarında düzensiz kemik yıkımı.
• Kontrastlı incelemede solid bileşen değişken ve heterojen kontrastlanabilir; santral nekroz kontrastlanmayan alan şeklinde görülebilir.
• Orbital yağ, ekstraoküler kaslar veya orbital apeks yönüne uzanım kompartıman dışı yayılımı gösterir.
• Etmoid çatıdan ön kafa çukuruna geçiş, dural veya intrakraniyal yumuşak doku uzanımıyla birlikte görülebilir.
• Nazofarenkse veya pterigopalatin fossaya doğrudan uzanım, sinonazal malignitelerin olası yayılım yolları arasında değerlendirilir.

Normalde

Lamina papyracea ve ön kafa tabanı kemik sınırlarını değerlendirirken dehisans olabileceğini göz önünde bulundur. Karşı tarafı ve komşu kesitleri kıyaslayarak kitle dokusunun hava hücrelerini doldurup kemik korteksi aştığı yerleri, ayrıca orbital yağ ve ön kafa çukuru planlarının korunup korunmadığını incele.

Ayırıcı tanı

Sinonazal skuamöz hücreli karsinom

benzer infiltratif yumuşak doku ve destrüksiyon yapabilir; BT ile güvenilir histolojik ayrım yapılamaz.

Olfaktör nöroblastom

üst nazal kavite/etmoid çatı merkezli olabilir; kafa içi uzanım ve kitle bileşenleri örtüşebilir, doku tanısı gerekir.

Sinonazal lenfoma

yumuşak doku kitlesi oluşturabilir ve komşu kemiklerde erozyon yapabilir; kesin ayırım histopatolojik ve immünohistokimyasal incelemeyle yapılır.

İnvaziv fungal rinosinüzit

sinüs dışı yağ planlarına ilerleyebilir; klinik bağlam ve doku örneklemesi ayırıcıdır.

İnverted papillom

lateral nazal duvar ve orta meatus merkezli lobüle kitle ile fokal hiperostoz gösterebilir; yaygın infiltratif yıkım farklı bir davranış düşündürür.

Tuzaklar

• Tek taraflı sinüs opasifikasyonunu tümör diye adlandırma; SNUC lehine olan bulgu, komşu anatomik sınırlara uzanan solid kitle ve kemik destrüksiyonudur.
• Kemik yıkımını yalnız tek seviyede arama; ince aksiyel ve koronal kemik rekonstrüksiyonlarında lamina papyracea ile etmoid çatıyı baştan sona izle.
• Görüntüleme bulguları farklı sinonazal malignitelerle örtüşebilir; kesin tanıda histopatolojik inceleme ve immünohistokimya kriter standarttır.
• Orta hat üst nazal kitlelerinde ensefalosel gibi konjenital lezyonlar ayırıcı tanıda değerlendirilmeli; yanlış cerrahi girişimi önlemek için preoperatif diferansiyel tanı şarttır.

Kendini dene

1. BT'de nazal kavite ve etmoid sinüsleri dolduran, etmoid kompleks ve kribriform plakta kemik erozyonu gösteren kitle MR'da heterojen kontrastlanarak ön kafa tabanına uzanabilir. BT hangi sonucu destekler?

   • Agresif sinonazal malignite
   • Antrokoanal polip
   • Retansiyon kisti
   • Koanal atrezi
   Cevabı göster

   Agresif sinonazal malignite. Solid infiltratif kitle, kemik yıkımı ve orbital kompartıman uzanımı agresif malignite davranışını destekler; bu görünüm tek başına SNUC histolojisini kanıtlamaz.

2. Aynı BT görünümünde tümörün SNUC mi başka bir sinonazal karsinom mu olduğunu kesinleştiren nedir?

   • Histopatolojik inceleme
   • Kontrastsız kemik penceresi
   • Hava-sıvı seviyesi
   • Septum deviasyonu
   Cevabı göster

   Histopatolojik inceleme. SNUC'nin görüntü bulguları diğer sinonazal malignitelerle örtüşür; tümör alt tipi histopatolojiyle belirlenir. BT kemik ve lokal yayılımı haritalar, histolojiyi belirlemez.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. SMARCB1 (INI1)-deficient sinonasal carcinoma with yolk sac differentiation, a case of long-term clinical remission after multiple rounds of radiotherapy–a case report and literature reviewpmc.ncbi.nlm.nih.gov
2. Intracranially Extended Sinonasal Undifferentiated Carcinoma: A Case Report and Literature Reviewpmc.ncbi.nlm.nih.gov
3. Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literaturepmc.ncbi.nlm.nih.gov
4. Metastatic Sinonasal Undifferentiated Carcinoma to the Temporal Bone: A Case Report and Literature Reviewpmc.ncbi.nlm.nih.gov
5. A Durable Response in Sinonasal Undifferentiated Carcinoma Treated With Subtotal Resection and Ultra-Early Postoperative Chemoradiotherapy: A Case Reportpmc.ncbi.nlm.nih.gov
6. Neuroendocrine Carcinoma and Sinonasal Undifferentiated Carcinoma.pubmed.ncbi.nlm.nih.gov
7. Radiologic overview of sinonasal lesions.pubmed.ncbi.nlm.nih.gov
8. Management of sinonasal undifferentiated carcinoma with intracerebral invasion: Clinical experience at a single institution and review of the literature.pubmed.ncbi.nlm.nih.gov
9. SMARCB1 (INI1)-deficient sinonasal carcinoma with yolk sac differentiation, a case of long-term clinical remission after multiple rounds of radiotherapy-a case report and literature review.pubmed.ncbi.nlm.nih.gov
10. SMARCA4-deficient Sinonasal Carcinoma.pubmed.ncbi.nlm.nih.gov
11. Clinical management of emerging sinonasal malignancies.pubmed.ncbi.nlm.nih.gov
12. Current management of sinonasal undifferentiated carcinoma.pubmed.ncbi.nlm.nih.gov
13. Intracranially Extended Sinonasal Undifferentiated Carcinoma: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
14. ACR appropriateness criteria ® nasal cavity and paranasal sinus cancers.pubmed.ncbi.nlm.nih.gov
15. Utility of FDG PET/CT in the Characterization of Sinonasal Neoplasms: Analysis of Standardized Uptake Value Parameters.pubmed.ncbi.nlm.nih.gov
16. Relationship between 18 FDG-PET and different types of sinonasal malignancies.pubmed.ncbi.nlm.nih.gov
17. Oncocytic Schneiderian papilloma-associated adenocarcinoma and KRAS mutation: A case report.pubmed.ncbi.nlm.nih.gov
18. SMARCB1-deficient sinonasal carcinoma: a case report and literature review.pubmed.ncbi.nlm.nih.gov
19. Case Report: Sinonasal plasmablastic lymphoma in a human immunodeficiency virus-negative elderly woman diagnosed by immunohistochemistry.pubmed.ncbi.nlm.nih.gov
20. Leiomyosarcoma of the maxillary sinus presenting with epiphora: a case report.pubmed.ncbi.nlm.nih.gov
21. A Durable Response in Sinonasal Undifferentiated Carcinoma Treated With Subtotal Resection and Ultra-Early Postoperative Chemoradiotherapy: A Case Report.pubmed.ncbi.nlm.nih.gov
22. Chronic Invasive Fungal Sinusitis Concerning for Sinonasal Malignancy With Unique Intracranial Extension.pubmed.ncbi.nlm.nih.gov
23. Small ethmoid mucocele with intracranial extension associated with fibrous dysplasia: A rare case report.pubmed.ncbi.nlm.nih.gov
24. Unusual Manifestations of Sinonasal Osteomas: A Narrative Review.pubmed.ncbi.nlm.nih.gov
25. Nasopharyngeal carcinoma masquerading as a primary sinonasal mass: a case report.pubmed.ncbi.nlm.nih.gov
26. Clinicopathological Patterns, Associations, and Management of Orbital Involvement in Sinonasal Malignancies: A Retrospective Study.pubmed.ncbi.nlm.nih.gov
27. Beyond the Middle Ear: A Thorough Review of Cholesteatoma in the Nasal Cavity and Paranasal Sinuses.pubmed.ncbi.nlm.nih.gov
28. Diagnosis of Mucormycosis: Current Situation, Challenges and Future Prospects.pubmed.ncbi.nlm.nih.gov
29. Clinical and imaging manifestations of metastases from rare sites.pubmed.ncbi.nlm.nih.gov
30. Sinonasal Mucosal Epithelioid Melanoma with Rapid Skull-Base and Orbital Progression.pubmed.ncbi.nlm.nih.gov
31. Imaging Features of Pediatric Primary Orbital Lymphomas: A Rare Case With Histopathological Correlation and Systematic Literature Review.pubmed.ncbi.nlm.nih.gov
32. Diagnostic Insights and Surgical Outcomes of Glomangiopericytoma: A Tertiary Center Case Series.pubmed.ncbi.nlm.nih.gov
33. Use of gadolinium-based contrast agents in head and neck cancer diagnosis, staging, and monitoring: current applications and future perspectives.pubmed.ncbi.nlm.nih.gov
34. Kadish C/Hyams II Esthesioneuroblastoma With Atypical Immunophenotype Mimicking NK/T-Cell Lymphoma: Endoscope-Assisted Transcranial Resection and Adjuvant Intensity-Modulated Radiotherapy.pubmed.ncbi.nlm.nih.gov
35. Leptomeningeal carcinomatosis in sinonasal NUT carcinoma: a case report and review of intracranial involvement.pubmed.ncbi.nlm.nih.gov
36. Prostate Cancer Recurrence Mimicking a Primary Paranasal Sinus Tumor on ¹⁸F-FDG PET/CT During Treatment for Metastases After 10 Years of Remission.pubmed.ncbi.nlm.nih.gov
37. Sinonasal extramedullary plasmacytoma: A case report of unilateral nasal obstruction with epistaxis.pubmed.ncbi.nlm.nih.gov
38. Clinical and imaging characteristics of phosphaturic mesenchymal tumors: a case series analysis.pubmed.ncbi.nlm.nih.gov
39. Sphenoid fungal rhinosinusitis across the disease spectrum: a case series of non-invasive fungal ball and fatal acute invasive fungal rhinosinusitis.pubmed.ncbi.nlm.nih.gov
40. Cavernous venous malformation of the frontal sinus: CT and MRI imaging findings.pubmed.ncbi.nlm.nih.gov
41. Orbital rhabdomyosarcoma in an adult: a misleading presentation.pubmed.ncbi.nlm.nih.gov
42. A Rare Presentation of Teratocarcinosarcoma as a Carinal Mass With Review of Literature.pubmed.ncbi.nlm.nih.gov
43. Imaging features of lacrimal gland disease.pubmed.ncbi.nlm.nih.gov
44. Sinonasal mucosal melanoma of the maxillary sinus: Diagnostic challenges and therapeutic insights from a case report.pubmed.ncbi.nlm.nih.gov
45. Outcomes in Orbit-Sparing Versus Orbit-Sacrificing Surgery for Sinonasal Malignancies With Orbital Involvement: A Systematic Review and Meta-Analysis.pubmed.ncbi.nlm.nih.gov
46. Craniofacial surgery for removing tumors in advanced stages that invade the anterior skull base.pubmed.ncbi.nlm.nih.gov
47. Combined Interhemispheric and Endoscopic Endonasal Resection of a Rare Olfactory Schwannoma with Preservation of Olfactory Function.pubmed.ncbi.nlm.nih.gov
48. SMARCB1-deficient sinonasal carcinoma in a pediatric patient: Imaging findings and differential diagnosis of a rare entity.pubmed.ncbi.nlm.nih.gov
49. A Huge Intraosseous Hemangioma in the Maxillary Sinus Misdiagnosed as Osteosarcoma: A Case Report.pubmed.ncbi.nlm.nih.gov
50. Computed Tomography Findings in Pathology-Confirmed Rhino-Orbital Mucormycosis During the COVID-19 Era: A Retrospective Cross-Sectional Study.pubmed.ncbi.nlm.nih.gov
51. Nasoethmoid Ancient Schwannoma with Bilateral Intracranial Extension: A Case Report with Review of the Literature.pubmed.ncbi.nlm.nih.gov
52. Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Anterior Cranial Fossa.pubmed.ncbi.nlm.nih.gov
53. Evaluation of Bone Remodeling in Chronic Maxillary Sinusitis: A Comparative Study on CT and MRI Modalitiespubmed.ncbi.nlm.nih.gov
54. What's that smell? A pictorial review of the olfactory pathways and imaging assessment of the myriad pathologies that can affect them.pubmed.ncbi.nlm.nih.gov
55. PET-CT in Clinical Adult Oncology-V. Head and Neck and Neuro Oncology.pubmed.ncbi.nlm.nih.gov
56. Diffuse Large B-Cell Lymphoma of the Ethmoid Sinus With Orbital Invasion: A Case Report.pubmed.ncbi.nlm.nih.gov
57. Diagnosis of Sinonasal Carcinoma in the Emergency Department: A Case Report Highlighting Red Flag Symptoms.pubmed.ncbi.nlm.nih.gov
58. Ethmoidal synovial sarcoma presenting with epistaxis and nasal deformity: A case report.pubmed.ncbi.nlm.nih.gov
59. Diagnostic value of serum survivin, Ki-67 and thymidine kinase in dogs with nasal cavity disease.pubmed.ncbi.nlm.nih.gov
60. Rhinosinusitis: Evidence and experience - 2024.pubmed.ncbi.nlm.nih.gov
61. Radiooncological View on Therapy Outcome after Multidisciplinary Treatment of Sinonasal Tumors.pubmed.ncbi.nlm.nih.gov
62. Acute Invasive Fungal Rhino-Orbital Sinusitis: Current Concepts and Controversies.pubmed.ncbi.nlm.nih.gov
63. Chronic Invasive Fungal Rhinosinusitis Managed With Surgical Debridement and Topical Amphotericin B Without Systemic Antifungal Therapy: A Report of Two Cases.pubmed.ncbi.nlm.nih.gov
64. Management of Maxillary Sinus Inverted Papilloma Using Endoscopic Modified Medial Maxillectomy (EMMM) and Direct Approach to the Anterior and Lateral Maxillary Sinus (DALMA) With Nasolacrimal Duct Preservation: A Case Report.pubmed.ncbi.nlm.nih.gov
65. Sinonasal Inverted Papillomas: Predictors of Recurrence and Malignant Transformation.pubmed.ncbi.nlm.nih.gov
66. Enhancing Approaches to Inverted Papilloma Through Computed Tomography-Based Hyperostosis Analysis.pubmed.ncbi.nlm.nih.gov
67. Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches.pubmed.ncbi.nlm.nih.gov
68. ESR Essentials: imaging in nasal obstruction and epistaxis-practice recommendations by the European Society of Head and Neck Radiology.pubmed.ncbi.nlm.nih.gov
69. Cadaveric Study of the Juvenile Grey Heron's (Ardea cinerea) Nasal Cavity and Associated Structures Through Computed Tomography and Anatomical Sections.pubmed.ncbi.nlm.nih.gov
70. Sinonasal Inflammation or Neoplasm: Raise the Red Flagsǃ-A Pictorial Review.pubmed.ncbi.nlm.nih.gov
71. Cocaine- and Levamisole-Induced Vasculitis: Defining the Spectrum of Autoimmune Manifestations.pubmed.ncbi.nlm.nih.gov
72. Radiologic Features for Differentiating Sinonasal Inverted Papilloma and Squamous Cell Carcinoma Arising From Inverted Papilloma Without Bone Destruction.pubmed.ncbi.nlm.nih.gov
73. Neuroendocrine tumor G1 in sphenoid sinuses: A case report.pubmed.ncbi.nlm.nih.gov
74. Rare Presentation of Sinonasal Synovial Sarcoma With Frontal Sinus and Limited Intracranial Extension Associated With Probable Paraneoplastic Vasculitis: A Case Report.pubmed.ncbi.nlm.nih.gov
75. Primary Gingival Squamous Cell Carcinoma With Secondary Extension Into the Maxillary Sinus, Orbit, and Skull Base: A Case Report.pubmed.ncbi.nlm.nih.gov
76. Juvenile Nasopharyngeal Angiofibroma in an Adult Patient: A Rare Presentation with Fahr Syndrome and Multiple Comorbidities-A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
77. Synchronous Sinonasal Inverted Papilloma With Nasolacrimal Squamous Cell Carcinoma: An Uncommon Case Report of Malignant Transformation of Inverted Papilloma.pubmed.ncbi.nlm.nih.gov
78. Immune biomarker landscape and fusion partner-phenotype associations in thoracic and head-and-neck NUT carcinoma.pubmed.ncbi.nlm.nih.gov
79. DNA methylation analysis with nasal brushing for early diagnosis of sinonasal malignant tumours.pubmed.ncbi.nlm.nih.gov
80. Radiation-Induced Malignancies of the Head and Neck: A Single-Center Population Study and Survival Outcomes.pubmed.ncbi.nlm.nih.gov
81. Peri-Implant Gingival Undifferentiated SWI/SNF Complex-Deficient Tumor with Molecularly Confirmed Biallelic SMARCA4 Inactivation: Diagnostic Pitfalls and Genomic Characterization.pubmed.ncbi.nlm.nih.gov
82. SMARCB1 (INI1)-Deficient Undifferentiated Rectal Carcinoma Mimicking Sarcoma: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
83. Lacrimal Sac and Nasolacrimal Duct Tumors Mimicking Chronic Inflammation: A Systematic Review.pubmed.ncbi.nlm.nih.gov
84. ITAC and Non-ITAC Sinonasal Adenocarcinoma: Classification, Etiopathogenesis, Diagnosis and Therapy Focusing on Interdisciplinarity.pubmed.ncbi.nlm.nih.gov
85. Diffusion-Weighted MRI in Sinonasal Tumors: Diagnostic Insights From a Tertiary Center.pubmed.ncbi.nlm.nih.gov
86. Sinonasal osteosarcoma of the ethmoid bone with decade-later recurrence presenting as early orbital apex syndrome: an 18-year case report.pubmed.ncbi.nlm.nih.gov
87. Metastatic Sinonasal Undifferentiated Carcinoma to the Temporal Bone: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
88. Advanced tumour-induced osteomalacia secondary to sinonasal phosphaturic mesenchymal tumour.pubmed.ncbi.nlm.nih.gov
89. Diagnostic confirmation of adult sinonasal rhabdomyosarcoma through comprehensive immunohistochemical profiling: a case report.pubmed.ncbi.nlm.nih.gov
90. Multiparametric magnetic resonance imaging in differentiating benign and malignant sinonasal masses: A prospective study and literature review.pubmed.ncbi.nlm.nih.gov
91. Orbital NUT carcinoma with intracranial extension.pubmed.ncbi.nlm.nih.gov
92. Sudden-onset, non-traumatic large volume pneumocephalus following presentation of acute bacterial meningitis.pubmed.ncbi.nlm.nih.gov
93. Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base.pubmed.ncbi.nlm.nih.gov
94. Epistaxis and Destructive Computed Tomographic Features in Canine Nasal Transitional Carcinoma: Frequent Cribriform Plate Destruction but Uncommon CT-Detected Brain Parenchymal Involvement.pubmed.ncbi.nlm.nih.gov
95. Chinese expert consensus on imaging examination and diagnosis of nasal cavity and paranasal sinus tumors.pubmed.ncbi.nlm.nih.gov
96. Biphenotypic Sinonasal Sarcoma with Orbital Invasion: A Literature Review and Modular System of Surgical Approaches.pubmed.ncbi.nlm.nih.gov
97. The Transorbital Approach: A Comprehensive Review of Targets, Surgical Techniques, and Multiportal Variants.pubmed.ncbi.nlm.nih.gov
98. MRI and PET Alterations in Adult Skull Base Tumors: A Narrative Review of Proton Versus Photon Radiotherapy.pubmed.ncbi.nlm.nih.gov
99. The contemporary management of cancers of the sinonasal tract in adults.pubmed.ncbi.nlm.nih.gov
100. Special Considerations in Pediatric Endoscopic Skull Base Surgery.pubmed.ncbi.nlm.nih.gov
101. Critical anatomical variants in preoperative computed tomography of paranasal sinuses in a tertiary care center: a cross-sectional study.pubmed.ncbi.nlm.nih.gov
102. Do Variations in Frontal Recess Anatomy Predispose to Mucocele Formation?pubmed.ncbi.nlm.nih.gov
103. Anatomical Variations of the Nasal Cavities and Paranasal Sinuses: A Systematic Review.pubmed.ncbi.nlm.nih.gov
104. Role of Radiotherapy in an Inflammatory Pseudotumor of the Maxillary Sinus and Imaging Findings: A Case Report.pubmed.ncbi.nlm.nih.gov
105. From inflammatory initiation to fibrotic remodeling: mechanisms and precision therapeutic strategies in otorhinolaryngologic involvement of IgG4-related disease.pubmed.ncbi.nlm.nih.gov
106. Pre-treatment and post-treatment nasopharyngeal carcinoma imaging: imaging updates, pearls and pitfalls.pubmed.ncbi.nlm.nih.gov
107. The Differential Diagnosis of Congenital Developmental Midline Nasal Masses: Histopathological, Clinical, and Radiological Aspects.pubmed.ncbi.nlm.nih.gov
108. PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms.pubmed.ncbi.nlm.nih.gov
109. A Rare Case of Sinonasal Ewing Sarcoma With Radiologic-Pathologic Correlation.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.