Hipoglisemik beyin değişikliği

Özet

Hipoglisemi, bilinç bozukluğu, nöbet veya tek taraflı güçsüzlükle inme taklidi yapabilir; uzamış ağır glukoz düşüklüğü seçilmiş beyin bölgelerinde kalıcı hasar bırakabilir. Kontrastsız BT çoğu erken olguda normaldir, ancak ilerleyen hasarda bilateral hipodansite ve şişlik gösterebilir; duyarlılığı MR difüzyondan düşüktür. Simetrik kortikal, bazal gangliyon veya iç kapsül örüntüsü metabolik etiyolojiyi düşündürür; görünüm her zaman simetrik ya da klasik olmadığından glukoz ölçümüyle korelasyon gerekir. Hipoglisemi akut iskemi ile karıştırılarak yanlış tedaviye yol açabilir; bu nedenle klinik değerlendirme ile birlikte rutin kan glukoz ölçümü şarttır.

Okuma sırası

1. Kaudat ve lentiform çekirdekler. Bazal gangliyon düzeyinde kaudat başı ile putamen ve globus pallidusun atenüasyonunu iki hemisferde eşleştirin; homojen olmayan solukluğu fark edin.
2. Posterior internal kapsül. İç kapsülün posterior bacağını ve yukarıdaki korona radiatayı izleyin; ince çizgisel düşük atenüasyonun damar alanına oturup oturmadığını değerlendirin.
3. Korteks ve hipokampus. Daha üst kesitlerde korteks ve medial temporal hipokampusları tarayarak derin gri cevher bulgusuna eşlik eden vasküler olmayan dağılımı arayın.
4. Serebral sulkuslar ve arter alanları. Son olarak sulkus ve ventrikül konturlarında ödem etkisini, ayrıca tek taraflı ana arter alanına özgü bir lezyon bulunup bulunmadığını kontrol edin.

Faz ve pencere

Kontrastsız tanısal

Erken inceleme normal olabilir; görünür değişiklik varsa iki taraflı korteks, bazal gangliyon, hipokampus veya beyaz cevherde düşük atenüasyon ve bazen şişlik görülür. Tutulum vasküler alanı aşabilir; bu patoloji için kontrastlı faz gerekmez ve BT'nin normal olması hipoglisemik hasarı dışlamaz.

Önerilen pencereler: Beyin (G 80 / M 40).

BT bulguları

• Bilateral bazal gangliyon hipodansitesi — kaudat, putamen veya globus pallidus çevre parankime göre düşük atenüasyon gösterir.
• İki taraflı kortikal hipodansite — kortikal şerit ve gri-beyaz bileşke vasküler sınırlara uymadan etkilenebilir.
• Posterior iç kapsül tutulumu — iç kapsül ve komşu korona radiata boyunca diffüzyon ağırlıklı görüntülemede yüksek sinyal veya kısıtlama görülebilir.
• Hipokampal hipodansite — medial temporal yapılar tek veya iki taraflı tutulabilir ve rutin kesitlerde gözden kaçabilir.
• Arter sulama alanını aşan simetrik dağılım — lezyonlar tek bir ACA, MCA ya da PCA sulama alanına oturmaz.
• Kortikal şişlik ve sulkus silinmesi — yaygın veya bölgesel ödem eşlik edebilir; erken BT'de belirgin olmayabilir.
• Görece az etkilenen posterior fossa — serebellum ve beyin sapı tutulumu diğer bölgelere göre daha nadirdir, ancak özellikle orta serebellar pedunkul veya pons gibi alanlarda lezyon görülebilir ve bu durum hipoglisemik ensefalopatiyle çelişmez.

Normalde

Hipoglisemik ensefalopatide BT'de iki taraflı bazal gangliyonlarda simetrik hipodansite görülebilir. İki tarafı aynı düzeyde karşılaştırıp asimetrik odak aramanın yanında, lezyonların aynı anda iki hemisferde ve arter sınırlarını aşan bir dağılımda olup olmadığını değerlendirin.

Ayırıcı tanı

Global hipoksik-iskemik hasar

küresel hipoperfüzyon ve yaygın beyin ödemi ile karakterizedir; kalp durması veya uzun süreli hipoksi öyküsü tanıyı destekler.

Akut arteriyel infarkt

çoğunlukla tek taraflı ve arter alanına uygun kortikal-subkortikal hipodansitedir; hipoglisemik lezyonlar sıklıkla vasküler olmayan ya da bilateral dağılım gösterir.

Nöbet ilişkili değişiklikler

periyiktal dönemde kortikal şişlik ve sinyal bozulmaları yapabilir; nöbetin zamanlaması ve EEG bulguları hipoglisemiyle ayrımda yardımcı olur.

Ensefalit

viral veya otoimmün süreçlerde temporal korteks ve hipokampus tutulabilir; CSF incelemesi ve kontrastlı görüntüleme bulguları metabolik olmayan etiyolojiyi düşündürür.

Tuzaklar

• İlk kontrastsız BT normalse hipoglisemik ensefalopatiyi dışlama; BT erken dönemde duyarsız olabilir ve klinik glukoz bilgisi görüntülemeden önce gelebilir.
• Tek taraflı hipoglisemik lezyonu sırf asimetrik diye infarkt kabul etme; lezyonun bir arter alanına uyup uymadığını ve ölçülmüş glukoz değerini birlikte ele al.
• İki taraflı bazal gangliyon hipodansitesini otomatik olarak anoksi sayma; korteks, hipokampus ve beyaz cevher dağılımı ile arrest ve metabolik öyküyü karşılaştır.

Kendini dene

1. Bilinç bulanıklığı olan hastada iki taraflı putamen ve posterior internal kapsülde hipodansite, tek arter alanına uymuyor. En olası neden?

   • Hipoglisemik ensefalopati
   • Tek taraflı MCA infarktı
   • Kronik subdural hematom
   • Kalsifiye meningiom
   Cevabı göster

   Hipoglisemik ensefalopati. Bilateral derin gri cevher ve kapsüler dağılım, vasküler sınırları aşınca metabolik hasarı düşündürür; düşük glukoz öyküsü tanıyı destekler. MCA infarktı tek taraflı arter alanına uyar; subdural hematom ekstraaksiyel koleksiyondur; meningiom fokal kitle görünümündedir.

2. Hipoglisemi şüphesi sürüyor ancak ilk kontrastsız BT normal. En uygun yorum hangisidir?

   • Erken BT normal olabilir
   • Hipoglisemik hasar dışlandı
   • Kesin olarak embolik inme
   • Beyin görüntülemesi tanısız
   Cevabı göster

   Erken BT normal olabilir. Erken hipoglisemik beyin hasarında kontrastsız BT duyarsız ve normal olabilir. Bu görüntü tek başına embolik inmeyi kanıtlamaz ya da metabolik hasarı dışlamaz; klinik ve laboratuvar korelasyonu ve gerektiğinde daha duyarlı MR değerlendirmesi gerekir.

Bu konunun yer aldığı turlar

• İnme BT'si: erken iskemi, damar ve taklitçiler

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 9 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. Acute symptomatic hypoglycaemia mimicking ischaemic stroke on imaging: a systemic reviewpmc.ncbi.nlm.nih.gov
2. Hypoglycemic Encephalopathypmc.ncbi.nlm.nih.gov
3. [Hypoglycemic Hemiplegia].pubmed.ncbi.nlm.nih.gov
4. Predictors of consciousness improvement in patients with hypoglycemic encephalopathy.pubmed.ncbi.nlm.nih.gov
5. PET/CT in congenital hyperinsulinism: transforming patient's lives by molecular hybrid imaging.pubmed.ncbi.nlm.nih.gov
6. Neonatal hypoglycemic brain injury is a cause of infantile spasms.pubmed.ncbi.nlm.nih.gov
7. Early diffusion MR imaging findings and short-term outcome in comatose patients with hypoglycemia.pubmed.ncbi.nlm.nih.gov
8. Decreased cholinergic receptor expression in the striatum: motor function deficit in hypoglycemic and diabetic rats.pubmed.ncbi.nlm.nih.gov
9. Magnetic resonance imaging characteristics of persistent vegetative state due to prolonged hypoglycemia.pubmed.ncbi.nlm.nih.gov
10. Magnetic resonance imaging brain yield in developmental delay: A developing country perspective.pubmed.ncbi.nlm.nih.gov
11. Reversible Focal Splenial Lesion on Diffusion-Weighted MRI in Sulfonylurea Intoxication.pubmed.ncbi.nlm.nih.gov
12. Surgical outcomes for medically refractory epilepsy secondary to posterior cortex ulegyria as sequelae of perinatal insults.pubmed.ncbi.nlm.nih.gov
13. Dynamic magnetic resonance imaging findings in the early stages of neonatal hypoglycemic brain injury.pubmed.ncbi.nlm.nih.gov
14. Electroclinical spectrum of childhood epilepsy secondary to neonatal hypoglycemic brain injury in a low resource setting: A 10-year experience.pubmed.ncbi.nlm.nih.gov
15. Challenges in the management of epilepsy associated with posterior gliosis secondary to perinatal brain injury.pubmed.ncbi.nlm.nih.gov
16. Atypical Hypoglycemia-Induced Stroke Mimic: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
17. Hypoglycemic hemiparesis as stroke mimic with transient splenial lesion and internal capsule involvement: A reversible clinico-radiological concurrence.pubmed.ncbi.nlm.nih.gov
18. Migraine - a borderland disease to epilepsy: near it but not of it.pubmed.ncbi.nlm.nih.gov
19. Stepwise clinical and diagnostic strategy for coma of unknown origin.pubmed.ncbi.nlm.nih.gov
20. Improved detection and localization of insulinoma using small field-of-view diffusion-weighted MRI: A case report.pubmed.ncbi.nlm.nih.gov
21. Tissue clock-guided prediction and intervention of futile recanalization: towards precision therapy in mechanical thrombectomy.pubmed.ncbi.nlm.nih.gov
22. Diffuse Cortical, Basal Ganglia, and Bilateral Middle Cerebellar Peduncle Diffusion Restriction in Severe Alcohol-Related Hypoglycemic Encephalopathy: A Case Report.pubmed.ncbi.nlm.nih.gov
23. Myoclonus in Pediatric Metabolic Diseases: Clinical Spectrum, Mechanisms, and Treatable Causes-A Systematic Review.pubmed.ncbi.nlm.nih.gov
24. Clinical and genetic spectrum of pediatric mitochondrial disorders in China: insights from a 47-case genetically confirmed cohort.pubmed.ncbi.nlm.nih.gov
25. Clinical Utility of Circulating Biomarkers for Diagnosis and Prognosis of Acute Stroke in the Emergency Department: A Narrative Review from Current Evidence to Clinical Implementation.pubmed.ncbi.nlm.nih.gov
26. Cerebral Kounis Syndrome-A Rare Case Report of Cerebral Vasospasm Following Anaphylaxis.pubmed.ncbi.nlm.nih.gov
27. Impact of Glycemic Trajectory and Variability on Ischemic Stroke Prognosis and Exploration of Its Mechanisms: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
28. Hypoglycemic Encephalopathy in a Patient With Diabetes Mellitus: A Case Report.pubmed.ncbi.nlm.nih.gov
29. Clinical characteristics and associated factors of pediatric acute necrotizing encephalopathy: a retrospective study.pubmed.ncbi.nlm.nih.gov
30. Neuroimaging for differential diagnosis of transient neurological attacks.pubmed.ncbi.nlm.nih.gov
31. Moyamoya Vasculopathy with Atypical Cogan's Syndrome: A Case Report.pubmed.ncbi.nlm.nih.gov
32. The Epidemiology and Clinical Presentation of the Acute Imbalance Syndrome (AIS)-A Systematic Review and Meta-Analysis.pubmed.ncbi.nlm.nih.gov
33. Reversible coma and elevated central venous pressure: warning signs of acute superior vena cava graft thrombosis following Warden procedure: a case report.pubmed.ncbi.nlm.nih.gov
34. Diabetic striatopathy: an updated overview of current knowledge and future perspectives.pubmed.ncbi.nlm.nih.gov
35. Neurologic sequelae of phosphide poisoning: A case report.pubmed.ncbi.nlm.nih.gov
36. Clinicoradiological Spectrum of L-2-Hydroxy Glutaric Aciduria: Typical and Atypical Findings in an Indian Cohort.pubmed.ncbi.nlm.nih.gov
37. Vascular Cognitive Impairment and Dementia.pubmed.ncbi.nlm.nih.gov
38. Generative pre-trained transformer (GPT)-4 support for differential diagnosis in neuroradiology.pubmed.ncbi.nlm.nih.gov
39. Diagnosis and treatment of Watershed strokes: a narrative review.pubmed.ncbi.nlm.nih.gov
40. Severe Diabetic Ketoacidosis With Fatal Cerebral Edema in an Adult.pubmed.ncbi.nlm.nih.gov
41. Hypoglycemia-Induced Irreversible Brain Injury: A Case Report.pubmed.ncbi.nlm.nih.gov
42. Rare Pediatric Posterior Stroke Case Report with Discussion of Brainstem Lesions.pubmed.ncbi.nlm.nih.gov
43. Brain Magnetic Resonance Imaging of Children With Molybdenum Cofactor Deficiency.pubmed.ncbi.nlm.nih.gov
44. A Case of Central Pontine Myelinolysis Unrelated Serum Sodium Level in Traumatic Brain Injury Patient.pubmed.ncbi.nlm.nih.gov
45. Neuroimaging in Tremor.pubmed.ncbi.nlm.nih.gov
46. Different diseases, same circuits: lessons from rare and overlooked causes of disorders of consciousness.pubmed.ncbi.nlm.nih.gov
47. Organization, fine structure, and stereotaxic maps of the human Bed nucleus of the Stria terminalis.pubmed.ncbi.nlm.nih.gov
48. The SLC-ome of membrane transport: From molecular discovery to physiology and clinical applications.pubmed.ncbi.nlm.nih.gov
49. Multiomics Analysis-Based Biomarkers in Diagnosis of Polycystic Ovary Syndrome.pubmed.ncbi.nlm.nih.gov
50. Effect of blending Jersey and Holstein-Friesian milk on Cheddar cheese processing, composition, and quality.pubmed.ncbi.nlm.nih.gov
51. Neuroimaging of neonatal brain post therapeutic hypothermia: a practical guide to the non-pediatric neuroradiologist.pubmed.ncbi.nlm.nih.gov
52. Mitochondrial dysfunction in neonatal brain injury: from molecular mechanisms to therapeutic interventions.pubmed.ncbi.nlm.nih.gov
53. Ischemic stroke can have a T1w hyperintense appearance in absence of intralesional hemorrhage.pubmed.ncbi.nlm.nih.gov
54. Preventing dementia by preventing stroke: The Berlin Manifesto.pubmed.ncbi.nlm.nih.gov
55. Alternating Hemispheric Episodes in Bilateral Rasmussen Encephalitis: The Crucial Role of Sequential Multimodal Neuroimaging.pubmed.ncbi.nlm.nih.gov
56. Reversible Lesions of the Genu of the Corpus Callosum and White Matter Detected by MRI in a Neonate With Apnea: A Case Report.pubmed.ncbi.nlm.nih.gov
57. Post-stroke headache: a review of epidemiology, pathophysiology, and clinical management.pubmed.ncbi.nlm.nih.gov
58. A Case of LGI1-Antibody Limbic Encephalitis Presenting With Faciobrachial Dystonic Seizures.pubmed.ncbi.nlm.nih.gov
59. Research progress on abdominal epilepsy in children.pubmed.ncbi.nlm.nih.gov
60. Early Clinical, Laboratory, and Imaging Correlates of Neurological Dysfunction in Adults Presenting to the Emergency Department with Sepsis: A Single-Center Retrospective Study.pubmed.ncbi.nlm.nih.gov
61. Prevalence and patterns of abnormal metabolic screening in pediatric acute encephalopathy: a PICU study from Egypt.pubmed.ncbi.nlm.nih.gov
62. Pediatric endocrine disorders: a review of intracranial findings and appropriate imaging.pubmed.ncbi.nlm.nih.gov
63. Neurocognitive impairments and brain abnormalities resulting from opioid-related overdoses: A systematic review.pubmed.ncbi.nlm.nih.gov
64. Classic neuroimaging findings of nonketotic hyperglycemia on computed tomography and magnetic resonance imaging with absence of typical movement disorder symptoms (hemichorea-hemiballism).pubmed.ncbi.nlm.nih.gov
65. Diabetic Striatopathy in an Elderly Female With Poorly Controlled Type 2 Diabetes: A Case Report.pubmed.ncbi.nlm.nih.gov
66. Two advanced-aged patients with diabetic striatopathy: a case report and literature review.pubmed.ncbi.nlm.nih.gov
67. Role of Clinical and Multimodality Neuroimaging in the Evaluation of Brain Death/Death by Neurologic Criteria and Recent Highlights from 2023 Updated Guidelines.pubmed.ncbi.nlm.nih.gov
68. Expanding the spectrum of Sideroblastic Anemia with B-cell Immunodeficiency, Periodic Fever and Developmental Delay (SIFD) syndrome: a case report with new clinical insights and novel genetic variant.pubmed.ncbi.nlm.nih.gov
69. Non-diabetic hypoglycemia: bridging gaps in diagnosis and treatment: a position statement report by the Arabic Association for the Study of Diabetes and Metabolism (AASD).pubmed.ncbi.nlm.nih.gov
70. Stroke Mimics in the Acute Setting: Role of Multimodal CT Protocol.pubmed.ncbi.nlm.nih.gov
71. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association.pubmed.ncbi.nlm.nih.gov
72. Acute Necrotizing Encephalitis Due to Influenza B in a Child: A Case Report.pubmed.ncbi.nlm.nih.gov
73. Metformin-associated Encephalopathy in Hemodialysis.pubmed.ncbi.nlm.nih.gov
74. Diazoxide-Responsive Congenital Hyperinsulinism in a Preterm Infant With Homozygous <i>ABCC8</i> Mutation: A Case Report.pubmed.ncbi.nlm.nih.gov
75. Ketone Bodies Derived From Medium-Chain Triglycerides Support Brain Metabolism and Function Under Hypoglycemia in Type 1 Diabetes Mellitus.pubmed.ncbi.nlm.nih.gov
76. Long-Term Follow-Up of Patients With Mitochondrial Carbonic Anhydrase VA Deficiency. A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
77. Brain lesions in pediatric abusive head trauma: prevalence, pathophysiology, patterns, and a classification system.pubmed.ncbi.nlm.nih.gov
78. 5-Fluorouracil-induced acute leukoencephalopathy: Case report and literature review.pubmed.ncbi.nlm.nih.gov
79. Mechanical stress from the hyoid bone as a potential etiology of bony-related ischemic stroke secondary to carotid artery dissection: A case report and systematic review.pubmed.ncbi.nlm.nih.gov
80. Evolutionary implications of <i>NOTCH2NLC</i> mutations: brain structural changes in neuronal intranuclear inclusion disease revealed by comprehensive morphometry.pubmed.ncbi.nlm.nih.gov
81. Subtyping schizophrenia via machine learning by using structural neuroimaging.pubmed.ncbi.nlm.nih.gov
82. Update of the recommendations of the Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group for the approach to COVID-19 in Intensive Care Medicine.pubmed.ncbi.nlm.nih.gov
83. Assessing subcortical, brainstem and cerebellar metabolic patterns using [18F]FDG PET-CT imaging in dementia with Lewy bodies.pubmed.ncbi.nlm.nih.gov
84. Functional remapping in networks of the Parkinsonian brain: A preclinical neuroimaging perspective with clinical correlates.pubmed.ncbi.nlm.nih.gov
85. Mapping Fetal Brain Development of 10 Weeks' Gestational Age with 9.4T Postmortem MRI and Histologic Sections.pubmed.ncbi.nlm.nih.gov
86. Beta-ketothiolase deficiency with progressive basal ganglia and extra basal ganglia involvement: CT-MRI correlation in a pediatric metabolic encephalopathy: A case report.pubmed.ncbi.nlm.nih.gov
87. Diabetic striatopathy presenting as stroke-mimicking hemiparesis without involuntary movements: A case report.pubmed.ncbi.nlm.nih.gov
88. Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI.pubmed.ncbi.nlm.nih.gov
89. Aphasic Syndromes in Cerebral Venous and Dural Sinuses Thrombosis-A Review of the Literature.pubmed.ncbi.nlm.nih.gov
90. A Drug Safety Briefing (II) in Transplantation from Real-World Individual Pharmacotherapy Management to Prevent Patient and Graft from Polypharmacy Risks at the Very Earliest Stage.pubmed.ncbi.nlm.nih.gov
91. Pathophysiology-driven neuroimaging: decoding brain injury in sepsis.pubmed.ncbi.nlm.nih.gov
92. Severe hypoglycemic coma with radiological evidence of hypoglycemic encephalopathy due to impaired awareness to hypoglycemia: a case report.pubmed.ncbi.nlm.nih.gov
93. Hypoxic-Ischemic Encephalopathy and Beyond: A Pictorial Review of Neuroimaging Findings in Neonatal Encephalopathy.pubmed.ncbi.nlm.nih.gov
94. Adult-onset leukodystrophies: a practical guide, recent treatment updates, and future directions.pubmed.ncbi.nlm.nih.gov
95. Neuronal intranuclear inclusion disease caused by NOTCH2NLC gene expansion: a case report and literature review.pubmed.ncbi.nlm.nih.gov
96. Recurrent Takotsubo Cardiomyopathy With Variable Patterns and Psychiatric Comorbidities: A Case Report and Comprehensive Literature Review.pubmed.ncbi.nlm.nih.gov
97. An Unusual Vascular Catastrophe: Atheromatous Aortic Dissection With Renal Artery Thrombosis and Cortical Laminar Necrosis Post Cerebral Ischemia.pubmed.ncbi.nlm.nih.gov
98. Medication-induced changes on magnetic resonance imaging of the brain.pubmed.ncbi.nlm.nih.gov
99. Magnetic resonance imaging pattern recognition of metabolic and neurodegenerative encephalopathies in dogs and cats.pubmed.ncbi.nlm.nih.gov
100. Stroke: Epidemiology, Risk Factors, Signaling Pathways, and Clinical Management.pubmed.ncbi.nlm.nih.gov
101. Protocol to optimize the Rice-Vannucci rat pup model of perinatal asphyxia to ensure predictable hypoxic-ischemic cerebral lesions.pubmed.ncbi.nlm.nih.gov
102. EPIDEMIOLOGY, DIAGNOSIS, MANAGEMENT AND PREVENTION OF STROKE: A NARRATIVE REVIEW.pubmed.ncbi.nlm.nih.gov
103. Pictorial Review on Imaging Findings in Cerebral CTP in Patients with Acute Stroke and Its Mimics: A Primer for General Radiologists.pubmed.ncbi.nlm.nih.gov
104. Diagnosis and management of the neurological complications of falciparum malaria.pubmed.ncbi.nlm.nih.gov
105. A systematic approach to MR spectroscopy of the brain: Indications, protocol, metabolites, and spectral analysis in neurologic diseases.pubmed.ncbi.nlm.nih.gov
106. Adaptive immune dysregulation drives new-onset refractory status epilepticus.pubmed.ncbi.nlm.nih.gov
107. Anti-Inflammatory and Antioxidant Strategies in Epilepsy: From Molecular Mechanisms to Threshold Management.pubmed.ncbi.nlm.nih.gov
108. Magnetic Resonance Imaging of the Neonatal Brain: Modalities, Scoring Systems, and Clinical Applications.pubmed.ncbi.nlm.nih.gov
109. Choking leading to cardiac arrest and subsequent atypical radiological features of brain damage: A case report.pubmed.ncbi.nlm.nih.gov
110. Neonatal herpes simplex virus encephalitis: a single-center retrospective study of 14 cases.pubmed.ncbi.nlm.nih.gov
111. Computed tomography perfusion stroke mimics on RAPID commercial software: A case-based review.pubmed.ncbi.nlm.nih.gov
112. What does a migraine aura look like?-A systematic review.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.