Members Publications

Safety and efficacy of low profile flow diverter stents for intracranial aneurysms in small parent vessels: systematic review and meta-analysis.

Elek, Alperen, Karagoz, Sidar, Dindar, Gülfem Nur, Yucel, Semra, Cinar, Celal, Kusbeci, Mahmut, et al. · Journal of neurointerventional surgery · 2026

BACKGROUND: This meta-analysis aims to evaluate the clinical and angiographic outcomes of low profile flow diverters (FDs) used in treating intracranial aneurysms in small parent vessels (≤3.5 mm). METHODS: A systematic review was conducted using Medline, Scopus, and Web of Science databases from inception to October 2024. Studies reporting clinical and angiographic outcomes for Silk Vista Baby, Flow Re-direction Endoluminal Device Junior (FRED Jr), and p48 MW Flow Modulation Device were included. Favorable outcomes were defined as those reported directly in studies or as a modified Rankin Scale score of 0-2. RESULTS: 33 studies involving 998 patients with 1049 aneurysms were analyzed. Favorable neurological outcomes were reported in 94% of cases overall, with unruptured aneurysms achieving better outcomes (97.1%) than ruptured aneurysms (80%). Procedure related complications were observed in 15.7% of cases, with a lower rate in unruptured aneurysms (12.7%) compared with ruptured aneurysms (20%). Complete or near complete occlusion was achieved in 79.5% of aneurysms from 28 studies, with similar rates for both unruptured (73.6%, from 14 studies) and ruptured (74%, from 13 studies) aneurysms. Among devices, the FRED Jr showed the highest favorable outcome rate (97.6%), while the p48 MW device had the highest complication rate (17.2%). Adjunctive coiling did not significantly affect neurological outcomes but was associated with a slightly lower complication rate (12.1%). CONCLU

Flow diversion for distal cerebral aneurysms: a systematic review and meta-analysis.

Günkan, Ahmet, Vilardo, Marina, Scarramal, João Paulo Liute, Elek, Alperen, Bocanegra-Becerra, Jhon E, Cardoso, Leonardo Januario Campos, et al. · Journal of neurointerventional surgery · 2026

BACKGROUND: Flow diverters (FDs) are increasingly used off-label for distal cerebral aneurysms (DCAs), those located at or beyond the anterior cerebral artery (ACA) A2, middle cerebral artery M2, and posterior cerebral artery P2 segments. However, data on their safety and efficacy remain limited. This systematic review and meta-analysis synthesizes current evidence on FD treatment for DCAs. METHODS: A comprehensive search was performed across PubMed, Scopus, and Web of Science, including studies with ≥5 patients reporting FD treatment of DCAs. Efficacy outcomes included adequate and complete aneurysm occlusion and retreatment rates. Safety outcomes included good functional outcome (modified Rankin Scale (mRS) score 0-2), procedure-related morbidity, mortality, complications, in-stent stenosis, and covered branch occlusion at follow-up. Pooled analyses with 95% confidence intervals (CI) were conducted using a random-effects model. RESULTS: Eighteen studies (441 patients, 70% women; mean age: 57.2±13.6 years) with 445 DCAs were included. Most aneurysms were unruptured (93.7%) and located in the ACA territory (78.4%). Adequate and complete occlusion at last follow-up were 90% (95% CI, 86 to 95) and 79% (95% CI, 74 to 85), respectively. The retreatment rate was 1.6% (95% CI, 0.2 to 3). Good functional outcome was achieved in 97% (95% CI, 95 to 99). Procedure-related complications occurred in 9% (95% CI, 5 to 13), with morbidity and mortality of 1.5% and 0.6%, respectively. In-ste

Short to mid-term outcomes of flow re-direction endoluminal device X (FRED(TM) X) in the management of intracranial aneurysms: a meta-analysis.

Elek, Alperen, Dindar, Gülfem Nur, Karagöz, Sidar, Yücel, Semra, Teomete, Eda, Çınar, Celal, et al. · Diagnostic and interventional radiology (Ankara, Turkey) · 2026

This meta-analysis evaluates the clinical and angiographic outcomes of the flow re-direction endoluminal device X (FRED(TM) X) in treating intracranial aneurysms. A systematic review was performed across Medline, Scopus, and Web of Science databases from inception to March 2025. Eligible studies included those reporting clinical and angiographic results of FRED X treatment. Favorable outcomes were defined as those stated explicitly in the studies or a modified Rankin scale score of 0-2. Pooled estimates were calculated using a random-effects model in R. A total of nine studies encompassing 780 patients with 869 aneurysms were included. The weighted mean age was 56.28 years, with 19.1% of patients being men. Most aneurysms were saccular (85.7%), unruptured (92.52%), and located in the anterior circulation (73.6%), primarily in the internal carotid artery. The average aneurysm size was 13.12 mm. All studies employed dual antiplatelet therapy, with antiplatelet response testing performed in eight studies. The mean clinical follow-up period was 9.27 months. The meta-analysis demonstrated favorable neurological outcomes in 97.71% of cases and complete or near-complete occlusion in 86.9%. Procedure-related complications were reported in 9.28% of cases, while in-stent thrombosis or intimal hyperplasia occurred in 4.29%. Overall mortality was low at 0.60%. Subgroup analysis revealed that unruptured aneurysms had a 100% rate of favorable neurological outcomes and an 84.76% rate of com

Efficacy and Safety of Flow Diversion for Distal Anterior Cerebral Aneurysms: A Systematic Review and Proportional Meta-Analysis.

Vilardo, Marina, Günkan, Ahmet, Dmytriw, Adam Andrew, Elek, Alperen, Scarramal, João Paulo Liute, Bocanegra-Becerra, Jhon E, et al. · AJNR. American journal of neuroradiology · 2026

BACKGROUND: Flow diverters (FDs) are increasingly used off-label for the treatment of distal anterior cerebral artery aneurysms (DACAAs), located at or beyond the A2 segment of the anterior cerebral artery (ACA). However, data on safety and efficacy remain limited. PURPOSE: To evaluate the safety and efficacy of FDs for the treatment of DACAAs through a systematic review and meta-analysis. DATA SOURCES: PubMed, Scopus, and Web of Science were systematically searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. STUDY SELECTION: Studies were eligible if they reported on ≥5 patients treated with FDs for DACAAs and provided angiographic and clinical outcome data. DATA ANALYSIS: Efficacy outcomes included adequate and complete aneurysm occlusion rates and re-treatment rates. Safety outcomes included good functional outcome (mRS 0-2), procedure-related morbidity and mortality, procedure-related complications, in-stent stenosis, and covered branch occlusion. Pooled estimates with 95% CIs were calculated by using a random-effects model. DATA SYNTHESIS: Eleven retrospective studies comprising 326 patients (71% women; mean age, 59.4 ± 4.4 years) with 328 DACAAs were included. Most aneurysms were unruptured (95.7%) and located in the A2 or A2-A3 segments (89%). Adequate and complete occlusion at last follow-up were 89% (95% CI, 82-96) and 77% (95% CI, 69-85), respectively. The re-treatment rate was 1% (95% CI, 0-3). Good functional outcome

Thermal Ablation for Giant Hepatic Hemangiomas: A Meta-Analysis with Subgroup Analysis of Microwave and Radiofrequency Ablation Techniques.

Elek, Alperen, Günkan, Ahmet, Ohannesian, Victor Arthur, Chadli, Norhane, Oran, Ismail · Cardiovascular and interventional radiology · 2026

PURPOSE: This meta-analysis aims to evaluate thermal ablation for giant hepatic hemangiomas (GHHs) and compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA). METHODS: A systematic review and meta-analysis followed the Cochrane Collaboration Handbook and PRISMA 2020 guidelines. Eligible studies reporting on patients with GHHs (≥ 4 cm) treated with MWA or RFA were identified through Medline, Scopus, and Web of Science databases. Primary outcomes included technical success (complete and accurate execution of the intended MWA or RFA procedure as per the study protocol), safety outcomes, clinical success, and radiological success. Statistical analyses were performed using a random-effects model, with heterogeneity assessed via the I(2) statistic. RESULTS: Fourteen studies (925 patients; 33.6% men; mean age: 46.6 years) with 1,010 GHHs were included. The overall technical success rate for thermal ablation was 99.95%, with a major complication rate of 2.21%. Clinical success, defined as symptom resolution or significant improvement, was achieved in 99.85% of patients, while radiological success, defined as at least a 50% reduction in lesion size, was observed in 89.81%. Minor complications were reported in 48.88%, and total complications in 52.43%, while procedure-related morbidity was low at 0.34%. In the subgroup analysis, radiological success was 95.6% in the MWA group and 86.3% in the RFA group (p = 0.073). Major complication rates were 1.99

Silk Vista Baby for intracranial aneurysms: systematic review and proportional meta-analysis.

Vilardo, Marina, Scarramal, João Paulo Liute, Cardoso, Leonardo Januario Campos, Günkan, Ahmet, Elek, Alperen, Ribeiro Gonçalves, Ocílio, et al. · Journal of neurointerventional surgery · 2026

BACKGROUND: The Silk Vista Baby (SVB) is a low profile flow diverter increasingly used to treat intracranial aneurysms (IAs), especially those in small caliber distal vessels. However, the available evidence remains limited and heterogeneous in terms of design, patient selection, use of adjunctive coiling, and follow-up protocols. PURPOSE: To systematically evaluate the safety and efficacy of SVB for IA treatment. DATA SOURCES: PubMed, Scopus, and Web of Science were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)guidelines. STUDY SELECTION: Studies were included if they reported ≥5 patients with IAs treated with SVB, and provided clinical and angiographic outcome data. DATA ANALYSIS: Efficacy endpoints included adequate/complete occlusion and retreatment rates. Safety outcomes included good functional outcome (modified Rankin Scale score of 0-2), procedure related complications, morbidity, mortality, in-stent stenosis, and covered branch occlusion. Pooled proportions with 95% CIs were calculated using a random effects model. RESULTS: 14 observational studies (13 retrospective; one prospective) including 653 patients (65.4% women; mean age 55.3±4.4 years) with 673 aneurysms were included. Most aneurysms were unruptured (59.6%). Adequate and complete occlusion at the last follow-up was 82.68% (95% CI 75.52 to 89.85) and 71.39% (95% CI 60.78 to 82.00), respectively. Retreatment occurred in 1.46% (95% CI 0.00 to 3.16). Good function

Mechanical thrombectomy versus medical management for pediatric ischemic stroke: a systematic review and meta-analysis of comparative studies.

Elek, Alperen, Bilgin, Cem, Ghozy, Sherief, Kadirvel, Ramanathan, Brinjikji, Waleed, Kallmes, David F · Journal of neurointerventional surgery · 2026

BACKGROUND: Ischemic stroke is an important cause of morbidity and mortality in children, yet no clinical trials have evaluated mechanical thrombectomy (MT) in this population. Consequently, in contrast to adults, pediatric MT remains an off-label intervention. This meta-analysis aimed to assess its safety and efficacy and compare outcomes with medical management (MM). METHODS: MEDLINE, Scopus, and Web of Science were searched to identify original studies reporting outcomes of MT, with or without intravenous thrombolysis (IVT) in pediatric ischemic stroke. In studies that concurrently reported MT±IVT and MM±IVT within the same study, outcomes from the MM arms were also extracted for comparative analysis. RESULTS: Eighteen studies encompassing 612 pediatric patients were included. The pooled successful recanalization rate (thrombolysis in cerebral infarction (TICI) 2b-3) after mechanical thrombectomy was 88.9% (95% confidence interval (CI) 85.65 to 92.06), and 43.9% (95% CI, 38.67 to 49.09) achieved complete recanalization (TICI 3). Favorable functional outcomes (modified Rankin Scale (mRS) 0-2) occurred in 78.6% (95% CI, 69.58 to 87.61) of patients, with mortality and symptomatic intracranial hemorrhage (sICH) rates of 3.9% (95% CI, 1.88 to 5.92) and 1.3% (95% CI, 1.07 to 2.58), respectively. Shift analysis demonstrated a significant overall improvement in functional outcomes with MT±IVT compared with MM±IVT (common (OR), 0.43; 95% CI, 0.30 to 0.63; P<0.001). CONCLUSION: Our

Follow-Up Results of Partially Thrombosed Intracranial Aneurysms with Cross-Sectional Imaging: The Case for Introducing a New Grading System.

Oran, Ismail, Cınar, Celal, Elek, Alperen, Oztürk, Egemen, Bozyel, Baran · AJNR. American journal of neuroradiology · 2026

BACKGROUND AND PURPOSE: Current angiographic grading systems assess parent vessel reconstruction and aneurysmal contrast filling. They, however, overlook extra-luminal space, which is crucial for assessing long-term stability of treatment and correlating radiologic findings with neurologic outcomes in partially thrombosed intracranial aneurysms (PTIAs). To address this gap, we categorized patients using cross-sectional imaging (CSI) according to post-treatment size changes, independent of angiographic results. METHODS: We retrospectively reviewed patients with PTIAs treated exclusively with flow diverters (FDs) and followed for at least 12 months with MRI/CT. Patients were divided into three groups: Group I-progressive reduction of the thrombosed mass; Group II-stable size; Group III-interval growth. For comparison, all cases were also assessed using the O'Kelly-Marotta (OKM) classification. RESULTS: Thirty-four PTIAs were analyzed, with a mean follow-up of 50.9 months. Posterior circulation location was independently associated with worse outcomes in the CSI-based grouping (OR = 10.84, p = 0.015). Neurological outcomes improved in 17 patients (48.6%), worsened in 2 (5.7%), and remained stable in 15 (42.9%). Functional improvement (mRS) was significantly associated with the CSI-based grouping (OR = 0.15, p = 0.04), but not with OKM (OR = 9.74, p = 0.215). At last imaging, 32 patients were OKM D and 2 OKM C; transition C→D was independently associated with better CSI-based gro

Shifting Towards Empagliflozin First-Line Therapy in Glycogen Storage Disease Type Ib: A Nationwide Real-World Study.

Uçar, Sema Kalkan, Mungan, Neslihan Önenli, Gökçay, Gülden Fatma, Zeybek, Ayşe Çiğdem Aktuğlu, Kılavuz, Sebile, Güneş, Seda, et al. · Journal of inherited metabolic disease · 2026

Neutrophil dysfunction and neutropenia are burdensome findings in glycogen storage disease type Ib (GSDIb). Treatment with granulocyte-colony stimulating factor (G-CSF) often corrects neutropenia but fails to improve clinical symptoms like inflammatory bowel disease (IBD). Recently, empagliflozin (EMPA) was shown to correct the neutrophil dysfunction and its clinical consequences. It is increasingly used as first-line monotherapy, but long-term, real-world data are lacking. This nation-wide retrospective study investigated 42 GSD1b patients (36 children) treated with EMPA as first-line monotherapy and compared them with those receiving combination therapy with G-CSF and treatment-naïve patients (I:EMPA first-line monotherapy [n = 9]; II:G-CSF monotherapy [n = 7]; III:EMPA plus G-CSF [n = 16]; and IV: neither EMPA nor GCSF [n = 10]). Pediatric (P) patients were evaluated separately. In pediatric patients receiving EMPA as first-line monotherapy (P-I) and those with EMPA plus G-CSF (P-III), the frequency of infections, hospital admissions, and IBD was significantly lower than in patients receiving GCSF-monotherapy (P-II) or no treatment (P-IV). Additionally, significantly improved weight gain was observed in P-I. While clinical improvement related to correction of neutrophil dysfunction was seen with EMPA first-line monotherapy (P-I), significant improvement in absolute neutrophil count (ANC) and hemoglobin levels was only seen in P-III with additional G-CSF treatment. In three

Evaluating Microsoft Bing with ChatGPT-4 for the assessment of abdominal computed tomography and magnetic resonance images.

Elek, Alperen, Ekizalioğlu, Duygu Doğa, Güler, Ezgi · Diagnostic and interventional radiology (Ankara, Turkey) · 2025

PURPOSE: To evaluate the performance of Microsoft Bing with ChatGPT-4 technology in analyzing abdominal computed tomography (CT) and magnetic resonance images (MRI). METHODS: A comparative and descriptive analysis was conducted using the institutional picture archiving and communication systems. A total of 80 abdominal images (44 CT, 36 MRI) that showed various entities affecting the abdominal structures were included. Microsoft Bing's interpretations were compared with the impressions of radiologists in terms of recognition of the imaging modality, identification of the imaging planes (axial, coronal, and sagittal), sequences (in the case of MRI), contrast media administration, correct identification of the anatomical region depicted in the image, and detection of abnormalities. RESULTS: Microsoft Bing detected that the images were CT scans with 95.4% accuracy (42/44) and that the images were MRI scans with 86.1% accuracy (31/36). However, it failed to detect one CT image (2.3%) and misidentified another CT image as an MRI (2.3%). On the other hand, it also misidentified four MRI as CT images (11.1%) and one as an X-ray (2.7%). Bing achieved an 83.75% success rate in correctly identifying abdominal regions, with 90% accuracy for CT scans (40/44) and 77.7% for MRI scans (28/36). Concerning the identification of imaging planes, Bing achieved a success rate of 95.4% for CT images and 83.3% for MRI. Regarding the identification of MRI sequences (T1-weighted and T2-weighted), the

Comprehensive evaluation of management strategies and rupture status in partially thrombosed aneurysms: a systematic review and meta-analysis.

Elek, Alperen, Allahverdiyev, Irshad, Ozcinar, Kenan Kerem, Yazici, Adem C, Cinar, Celal, Kusbeci, Mahmut, et al. · Journal of neurointerventional surgery · 2025

BACKGROUND: This meta-analysis aims to evaluate and compare the clinical and angiographic outcomes of different management strategies for partially thrombosed intracranial aneurysms (PTIAs). METHODS: A systematic review was conducted using MEDLINE, Scopus, and Web of Science databases up to September 2024. Studies providing clinical and angiographic outcomes of PTIAs were included. Favorable outcomes were defined as those reported directly in the studies or, when the modified Rankin Scale (mRS) was available, as an mRS score of 0-2. Statistical analysis was conducted using R, with pooled estimates under a random-effects model. RESULTS: Eighteen studies involving 362 patients with 363 PTIAs were analyzed. Favorable neurological outcomes were observed in 76% of patients, while 20% experienced procedure-related complications. Recurrence occurred in 36% of cases, and retreatment was required in 23%. Mortality was low at 0.8%. Subgroup analysis revealed that reconstructive approaches were associated with higher rates of favorable outcomes (72%) and lower complication rates (21%) compared with deconstructive methods (60% and 28%, respectively). Among the reconstructive techniques, flow diverter stenting showed the highest rate of favorable outcomes (82%), while simple coiling had the lowest (71%). Additionally, unruptured PTIAs had a significantly better prognosis, with 69% achieving favorable outcomes, fewer complications (22% vs 51% for ruptured), and lower mortality (0.8% vs 27%

Flow-diverting stents in the management of extracranial carotid artery aneurysms.

Cinar, Celal, Akgul, Erol, Elek, Alperen, Kusbeci, Mahmut, Ozturk, Egemen, Onan, Hasan Bilen, et al. · Diagnostic and interventional radiology (Ankara, Turkey) · 2025

PURPOSE: This study aims to investigate the indications and therapeutic efficacy of flow-diverting stents (FDSs) in the management of extracranial carotid artery aneurysms (ECAAs) and dissections. METHODS: A retrospective analysis was conducted on 18 patients treated for ECAAs with an FDS between 2010 and 2024. Patient demographics, aneurysm characteristics, procedural details, and clinical and radiologic follow-up outcomes were extracted from medical records. Procedures were performed under general anesthesia using standard endovascular techniques. Patients received preoperative and postoperative antiplatelet therapy and were fully anticoagulated during the procedure. Follow- up assessments included digital subtraction angiography or computed tomography angiography at 6-12 months and clinical evaluations to monitor symptom resolution and complications. RESULTS: Eighteen patients, with an average age of 46.44 ± 17.54 years, underwent 19 endovascular interventions. Technical success was achieved in all cases. Single stent deployment was used in 15 aneurysms, and telescopic stent deployment in 7. Total occlusion of the aneurysm was achieved in 94.4% of cases. One patient required retreatment due to the separation of two overlapped telescopic stents. All patients were discharged within 2 days post-procedure, with symptomatic patients experiencing the complete resolution of symptoms. No complications or adverse events were reported during the follow-up period. CONCLUSION: The end

Reply: evaluating Microsoft Bing with ChatGPT-4 for the assessment of abdominal computed tomography and magnetic resonance images.

Elek, Alperen, Ekizalioğlu, Duygu Doğa, Güler, Ezgi · Diagnostic and interventional radiology (Ankara, Turkey) · 2025

Evaluating the Efficacy of Perplexity Scores in Distinguishing AI-Generated and Human-Written Abstracts.

Elek, Alperen, Yildiz, Hatice Sude, Akca, Benan, Oren, Nisa Cem, Gundogdu, Batuhan · Academic radiology · 2025

RATIONALE AND OBJECTIVES: We aimed to evaluate the efficacy of perplexity scores in distinguishing between human-written and AI-generated radiology abstracts and to assess the relative performance of available AI detection tools in detecting AI-generated content. METHODS: Academic articles were curated from PubMed using the keywords "neuroimaging" and "angiography." Filters included English-language, open-access articles with abstracts without subheadings, published before 2021, and within Chatbot processing word limits. The first 50 qualifying articles were selected, and their full texts were used to create AI-generated abstracts. Perplexity scores, which estimate sentence predictability, were calculated for both AI-generated and human-written abstracts. The performance of three AI tools in discriminating human-written from AI-generated abstracts was assessed. RESULTS: The selected 50 articles consist of 22 review articles (44%), 12 case or technical reports (24%), 15 research articles (30%), and one editorial (2%). The perplexity scores for human-written abstracts (median; 35.9 IQR; 25.11-51.8) were higher than those for AI-generated abstracts (median; 21.2 IQR; 16.87-28.38), (p=0.057) with an AUC=0.7794. One AI tool performed less than chance in identifying human-written from AI-generated abstracts with an accuracy of 36% (p>0.05) while another tool yielded an accuracy of 95% with an AUC=0.8688. CONCLUSION: This study underscores the potential of perplexity scores in detec

Integration of Large Language Models in Oncological Monitoring.

Elek, Dr Alperen · Academic radiology · 2025

Nutritional management and geno-phenotyping of clinical nutrition in patients with glycogen storage diseases type VI and IX.

Kalkan Uçar, Sema, Elek, Alperen, Yazıcı, Havva, Atik Altınok, Yasemin, Yüksel Yanbolu, Ayşe, Erdem, Fehime, et al. · European journal of clinical nutrition · 2025

BACKGROUND/OBJECTIVES: Glycogen storage diseases type VI (GSD-VI) and type IX (GSD-IX) are rare inherited metabolic disorders caused by enzyme deficiencies that disrupt glycogen metabolism. The aim of this study was to analyze the clinical features, nutritional management and geno-phenotyping of clinical nutrition in a cohort of patients with GSD-VI and GSD-IX. SUBJECTS/METHODS: A retrospective cohort study was conducted with 16 patients with GSD-VI and GSD-IX. Demographic characteristics, clinical and laboratory findings, and nutritional treatment outcomes were collected and analyzed. RESULTS: The mean patient age was 10.57 years (±4.81). The distribution of the diagnoses was as follows: GSD-IXa (3), GSD-IXb (6), GSD-IXc (1), and GSD-VI (6). The average age at diagnosis was 36.5 months (±42.2) (13-114 months) in the GSD-VI group. Among the GSD-IX subgroups, the mean age at diagnosis varied: 23.3months (±4.16) for GSD-IXa, 35.7months (±17.5) for GSD-IXb, and 78months for GSD-IXc. Over the course of the study (4.5 ± 1.77 years), protein intake in GSD VI patients increased by 1.05 g/kg/day (91.3% increase), while in GSD IX patients, it rose by 1.09 g/kg/day (94% rise). Uncooked cornstarch (UCS) started at 1 g/kg/day for GSD-VI and 0.85 g/kg/day for GSD-IX, later reduced to 0.71 g/kg/day (29% decrease) and 0.52 g/kg/day (60% reduction), respectively. CONCLUSION: Overall, this paper provides valuable insights into managing GSDVI and GSDIX patients, emphasizing the role of a high-

Visual Art-Based Training Improves Medical Students' Radiologic Labeling Skills by Improving Their Contrast Sensitivity: A Prospective, Controlled Study.

Yucel, Semra, Cevahir, Taylan Tugay, Elek, Alperen, Acar, Selin, Sucubulak, Cemre, Yildiz, Hatice Sude, et al. · Medical science educator · 2025

BACKGROUND: Observational skills, including radiologic perceptual abilities, are critical for medical professionals. Numerous studies have shown the positive impact of various visual art courses on observational skills. Some institutions have even incorporated art courses into their curriculum for this purpose. However, the underlying reason for this improvement remains unclear. AIM: This prospective, controlled study aims to determine the positive impact of a virtual art evaluation course on medical students' radiologic labeling skills and to uncover the underlying reason. MATERIALS AND METHODS: This study examines whether a 12-week art evaluation course with monitored attendance enhances medical students' ability to detect brain abnormalities in MRI scans. Medical students participated in pre- and post-tests identifying abnormalities, while a control group received no intervention. The art course focused on elements such as composition and balance. MRI characteristics, such as the contrast-to-noise ratio (CNR), were measured to assess image quality. To evaluate test difficulty and student performance, the Discrimination Index (DI) was calculated. RESULTS: No significant difference was found in pre-test scores between the study and control groups (p = 0.35). A significant increase in post-test scores was observed in the study group (9.52 ± 3.11 vs. 10.69 ± 2.72, p = 0.04), compared to controls (8.69 ± 3.03 vs. 9.30 ± 2.88, p = 0.19). A moderate positive correlation was found

Endovascular treatment of small-parent artery aneurysms: mid-term results of the silk vista baby flow diverter.

Cinar, Celal, Elek, Alperen, Kusbeci, Mahmut, Ozturk, Egemen, Utli, Cemre Yanbol, Oran, Ismail · Neuroradiology · 2025

PURPOSE: We aim to retrospectively evaluate patients treated with SVB at our single center, assessing its efficacy, radiologic and clinical outcomes, and complication profile. METHOD: This retrospective, single-center study included patients with small parent artery aneurysms treated with SVB. Patients were monitored for procedural success, aneurysm occlusion, and complications, with radiologic and clinical follow-up conducted. RESULTS: The study included 64 patients with 66 small parent artery aneurysms treated using SVB FDs. Among these patients, 26 (40.6%) presented with subarachnoid hemorrhage (SAH). The mean index aneurysm size was 5.7 ± 5.25 mm. The cohort consisted of 15 males (23.4%) and 49 females (76.6%), with a mean age of 54.23 ± 14.95 years (range: 5-80 years). SVB was used as a standalone treatment in 42 patients (65.6%), while adjunctive materials were applied in 22 cases (34.4%)-coils in 16 (24.2%) and a regular stent in 6 (9.1%). A total of 71 SVB stents were deployed for 66 aneurysms, achieving a 100% technical success rate. In 30 patients with multiple aneurysms, additional aneurysms were addressed during the same session along with the index aneurysm. The mean duration of clinical and radiological follow-up was 10.5 ± 7.94 months. Among a total of 7 patients (10.9%) with ischemic complications, 3 (4.7%) were related to SVB implantation. Index aneurysm occlusion was accomplished in 93.3% of cases at the last follow-up. Favorable neurological outcomes (mRS 0

Endovascular Occlusion of Intracranial Pial Arteriovenous Fistula: Technical Aspects.

Cinar, Celal, Kusbeci, Mahmut, Elek, Alperen, Ozturk, Egemen, Oran, Ismail · Turkish neurosurgery · 2025

AIM: To evaluate pial arteriovenous fistulas (AVFs), focusing on the radio-anatomic architecture and contemporary endovascular devices and techniques. MATERIAL AND METHODS: Sixteen patients with congenital pial AVFs who underwent endovascular treatment between 2002 and 2023 at a single institution were included in this review. This retrospective study was approved by the Institutional Review Board. The study was descriptive and involved no statistical comparisons. RESULTS: The study included 16 patients (6 female patients, 10 male patients) with a mean age of 19.93 ± 21.1 years (range: 1?63 years). Nine (56.25%) were pediatric patients, six (37.5%) of whom were younger than 5 years. Five patients (31.25%) had more than one feeding artery, whereas 11 (68.75%) had a single feeding artery. One patient had two separate fistulas. All fistulas were successfully occluded without complications. Four patients (25%) were treated with glue alone, four (25%) with coils alone, five (31.25%) with a non-adhesive liquid agent alone, and three (18.75%) with a combination of coils and a non-adhesive liquid agent. Venous sinus thrombosis occurred in two patients (12.5%) in the early postoperative period; both cases resolved without permanent deficits. CONCLUSION: Pial AVF is a rare intracranial vascular malformation. Endovascular treatment using liquid embolic agents, coils, or a combination of these techniques is effective.

Safety and Effectiveness of Image-Guided Therapies for Giant Hepatic Hemangiomas: A Systematic Review and Meta-Analysis of 2,617 Patients.

Günkan, Ahmet, Elek, Alperen, Ohannesian, Victor Arthur, Mendes, Lucas Lima, Pehlivan, Umur Anil, Fouad, Mohamed E M, et al. · Journal of vascular and interventional radiology : JVIR · 2025

PURPOSE: To evaluate the safety and effectiveness of image-guided therapies-including transarterial chemoembolization (TACE), radiofrequency (RF) ablation, microwave ablation, and percutaneous sclerotherapy-for the treatment of giant hepatic hemangiomas (GHHs). MATERIALS AND METHODS: A comprehensive search was performed across PubMed, Scopus, and Web of Science, including studies with ≥5 patients that reported image-guided treatment of GHHs. Primary outcomes included technical success, adverse events (AEs; classified according to the Society of Interventional Radiology [SIR] system), clinical success (symptom relief without additional intervention), and radiologic success (≥50% size reduction and/or lack of enhancement on follow-up imaging). A subgroup analysis was performed for GHHs of ≥10 cm. Outcomes were analyzed using a random-effect meta-analysis. RESULTS: Twenty-eight studies (2,617 patients; 32.5% men; mean age, 46.1 years [SD ± 3.2]) with 2,996 GHHs, ranging from 4 to 30 cm, were included. Of these, 22 were noncomparative, and 6 compared either 2 image-guided therapies or surgery, reporting outcomes for TACE (n = 13), RF ablation (n = 7), microwave ablation (n = 6), and percutaneous sclerotherapy (n = 4). The pooled technical success rate was 99.9%. Grade 2-4 AEs occurred in 1.64%, with TACE having the lowest rate (0.2%) and RF ablation the highest (2.1%). Clinical success at final follow-up was 99.9%, while radiological success was 85.7%. Grade 2-4 AEs were signific

Hemorheological changes induced by Flow-diverting stents at the aneurysm neck in cerebral circulation.

Ergin, Osman, Olcay, Ali Bahadir, Elek, Alperen, Oran, Ismail · Neuroradiology · 2025

PURPOSE: This study investigates the hemodynamic effects of flow diverter stent (FDS) implantation on intracranial aneurysms, focusing on shear stress and shear strain rates at the neck region between the stent struts. MATERIALS AND METHODS: Patient-specific geometries were reconstructed from Digital Subtraction Angiography (DSA) cone-beam source images and processed to accurately model arterial anatomy and aneurysm morphology. FDS designs with 48- and 64-wire configurations were modeled while maintaining consistent porosity (65%) across all stents. Blood flow simulations were performed using computational fluid dynamics (CFD) to analyze shear stress and strain rates between the stent struts after FDS implantation. RESULTS: CFD analysis using DSA images from five patients-three with distal internal carotid artery sidewall aneurysms and two with middle cerebral artery bifurcation aneurysms-demonstrated that, prior to stent implantation, shear stress and strain rate values at the aneurysm inlet were generally below established thresholds throughout the cardiac cycle. Following FDS implantation, those values measured between stent struts increased significantly, with some patients exceeding thresholds either throughout the entire cycle or only during systole. Both 48- and 64-wire FDS models exhibited significantly higher shear forces compared to the non-stent models; however, no significant differences were observed between the two stent designs. Aneurysm volume showed a statist

Percutaneous Sclerotherapy Versus Transarterial Chemoembolization for Giant Hepatic Hemangiomas: A Systematic Review and Meta-analysis.

Elek, Alperen, Günkan, Ahmet, Ohannesian, Victor Arthur, Lima Mendes, Lucas, Albayrak, Emin, Cam, Isa, et al. · Cardiovascular and interventional radiology · 2025

PURPOSE: This study aims to systematically evaluate the efficacy and safety of different bleomycin administration routes for treating GHHs, with a subgroup analysis comparing Transarterial chemoembolization (TACE) and percutaneous sclerotherapy (PS). METHODS: A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science from inception through May 6, 2025. Studies included reporting clinical and radiological outcomes after PS and TACE for GHHs (≥ 4 cm). Primary outcomes included technical success (complete and accurate application as predetermined in the study protocol), safety outcomes, clinical (symptom relief without additional intervention), and radiological success (≥ 50% size reduction and/or lack of enhancement on follow-up imaging). The outcomes were analyzed using a random-effects meta-analysis 106 1586. RESULTS: A total of 17 studies, including 1692 patients (1586 treated with TACE and 106 with PS) and 1825 GHHs, were included. Among these, 13 studies assessed TACE, and four studies evaluated PS. The overall technical success rate was 100%, with pooled clinical and radiological success rates of 96.93% and 81.75%, respectively. In subgroup analyses, both TACE and PS achieved 100% technical success. TACE showed slightly higher clinical success, at 99.9%, compared to PS at 89.73%, although the difference was not statistically significant (p = 0.15). Radiological success was comparable (TACE: 81.9%, PS: 81.29%). Major complications were rare (0.27%,

Reply: challenges of applying large language models to image-based interpretation in abdominal radiology.

Elek, Alperen, Ekizalioğlu, Duygu Doğa, Güler, Ezgi · Diagnostic and interventional radiology (Ankara, Turkey) · 2025

Identification of non-coding RNA signatures in idiopathic pulmonary fibrosis.

Elek, Alperen, Bozgeyik, Esra, Caska, Halil, Gocer, Zekihan, Bozgeyik, Ibrahim · Irish journal of medical science · 2024

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a deadly, chronic, progressive, irreversible interstitial lung disease characterized by the formation of scar tissue resulting in permanent lung damage. The average survival time following diagnosis is only 3-5 years, with a 5-year survival rate shorter than that of many cancers. Alveolar epithelial cell injury followed by irregular repair is the primary pathological process observed in patients with IPF. An evident characteristic of IPF is the development of fibroblastic foci representing active fibrotic areas. Most of the cells within these foci are believed to be myofibroblasts, which are thought to be the primary source of abnormal extracellular matrix production in IPF. The lung phenotype in IPF is characterized by significantly different processes from healthy lungs, including irregular apoptosis, oxidative stress, and epithelial-mesenchymal transition (EMT) pathways. AIMS: The exact cause of IPF is not fully understood and remains mysterious. It is not suppressing that non-coding RNAs are involved in the development and progression of IPF. Accordingly, here we aimed to identify non-coding RNA molecules during TGFβ-induced myofibroblast activation. METHODS: Differential expression and functional enrichment analysis were employed to reveal the impact of non-coding RNAs during TGFβ-associated lung fibrosis. RESULTS: Remarkably, LOC101448202, CZ1P-ASNS, LINC01503, IER3-AS1, MIR503HG, CLMAT3, LINC02593, ACTA2-AS1, LOC102723

Successful treatment of a basilar artery fenestration aneurysm using a kissing flow diverter stent.

Elek, Alperen, Cınar, Celal, Küsbeci, Mahmut, Oran, Ismail · British journal of hospital medicine (London, England : 2005) · 2024

Doppler ultrasound-guided gyrectomy in the management of arterialised developmental venous anomalies.

Elek, Alperen, Ozgiray, Erkin, Cınar, Celal, Küsbeci, Mahmut · British journal of hospital medicine (London, England : 2005) · 2024

Acute left non-haemorrhagic adrenal infarction in pregnancy: magnetic resonance imaging findings.

Elek, Alperen, Ekizalioğlu, Duygu D, Yeniel, Ahmet Ö, Güler, Ezgi · British journal of hospital medicine (London, England : 2005) · 2024

The fate and function of non-coding RNAs during necroptosis.

Bozgeyik, Esra, Elek, Alperen, Gocer, Zekihan, Bozgeyik, Ibrahim · Epigenomics · 2024

Necroptosis is a novel form of cell death which is activated when apoptotic cell death signals are disrupted. Accumulating body of observations suggests that noncoding RNAs, which are the lately discovered mystery of the human genome, are significantly associated with necroptotic signaling circuitry. The fate and function of miRNAs have been well documented in human disease, especially cancer. Recently, lncRNAs have gained much attention due to their diverse regulatory functions. Although available studies are currently based on bioinformatic analysis, predicted interactions desires further attention, as these hold significant promise and should not be overlooked. In the light of these, here we comprehensively review and discuss noncoding RNA molecules that play significant roles during execution of necroptotic cell death.

Comprehensive Evaluation of Serpentine Aneurysms: a Systematic Review and Meta-analysis with a Subanalysis for Treatment Approaches.

Cinar, Celal, Elek, Alperen, Allahverdiyev, Irshad, Ozcinar, Kenan Kerem, Yazici, Adem C, Kusbeci, Mahmut, et al. · Clinical neuroradiology · 2024

PURPOSE: This systematic review and meta-analysis aimed to systematically evaluate and enhance the understanding of optimal management strategies for serpentine aneurysms. METHODS: A systematic search was conducted in Medline, Scopus, and Cochrane databases up to July 8, 2024, using relevant keywords. Studies included were case series, prospective or retrospective cohorts, or randomized controlled trials with data on clinical and angiographic outcomes of intracranial serpentine aneurysms. Data extraction and quality assessment were performed independently by two authors. Statistical analysis was conducted using R, with pooled estimates under a random-effects model. RESULTS: Ten studies comprising 70 patients with 71 serpentine aneurysms were included. The majority (92.9%) were giant aneurysms. The overall rate of procedure-related complications was 33%, morbidity was 13%, and mortality was 13%. Good neurological outcomes were achieved in 76% of cases. For unruptured aneurysms, the complication rate was 34%, while no complications were observed in ruptured aneurysms. Comparative analysis between ruptured and unruptured aneurysms showed no significant differences in outcomes or complications. The technical success rate was 91%. Reconstructive methods showed a slightly higher rate of good neurological outcomes (77%) compared to deconstructive methods (70%), though complication rates were similar. CONCLUSION: Both reconstructive and deconstructive endovascular treatments for serp

Long-Term Outcomes of Transarterial Chemoembolization of Giant Liver Hemangiomas with Lipiodol-Bleomycin Emulsion.

Küsbeci, Mahmut, Elek, Alperen, Oztürk, Egemen, Bozkaya, Halil, Cınar, Celal, Parıldar, Mustafa, et al. · Cardiovascular and interventional radiology · 2024

PURPOSE: To evaluate the safety, efficacy, and long-term outcomes of transarterial chemoembolization (TACE) with bleomycin-Lipiodol for giant liver hemangiomas. MATERIALS AND METHODS: Single-center retrospective study from 1998 to January 2020, including patients with giant liver hemangiomas treated with bleomycin-Lipiodol TACE and followed up >36 months. The exclusion criteria were defined as patients who had been treated but had no available follow-up above 3 years and patients who had previously been treated with any other treatment method. Clinical success was defined as the disappearance of symptoms and radiological success (responded vs. non-responded groups) as a more than 50% decrease in the volume of the giant hemangioma in follow-up CT or MRI compared to the baseline images. RESULTS: A total of 121 patients were included. The mean maximum diameter of the hemangiomas decreased from 122 (range: 40-300) to 73 mm (range: 15-240), and the mean volume reduced from 984.4 (range: 30-7312) to 286.6 cm(3) (range: 1-3835). There were 106 patients in the responded group, while only 15 patients were in the non-responded group. No significant difference was found in size and volume change percentages across these two groups based on gender, age, lesion size, lesion volume, lesion number, and second TACE. When the follow-up period was stratified in 5-year periods, the maximum volume decrease was observed in the first 5-year period and then remained constant up to > 15 years. CONCL

Radiologic and pathologic correlation of a renal venous hemangioma.

Elek, Alperen, Kwon, Jung Woo, Ertugrul, Sena, Oren, Nisa Cem · International cancer conference journal · 2023

Renal hemangiomas, including the rare subtype of venous hemangioma, are typically non-cancerous, often asymptomatic, and usually discovered incidentally during imaging studies. Here, we report a unique case of a 59-year-old African-American female with a renal venous hemangioma that initially mimicked papillary-type renal cell carcinoma (RCC-pt) on imaging studies. The patient's presentation included a long history of rectal bleeding and an incidental discovery of a hypoattenuating mass in the left kidney during a contrast-enhanced CT scan. Renal MRI revealed a 3.5 cm left renal lower pole mass, presenting as heterogeneously hyperintense on T1-weighted images and hypointense on T2-weighted images, with gradual mild enhancement post-contrast. Subsequent total nephrectomy confirmed the histopathological diagnosis of a venous hemangioma. This case underlines the need for recognizing unique imaging features of renal venous hemangiomas, contributing to the differential diagnosis of T2 dark hypoenhancing renal masses. Correct interpretation may prevent unnecessary invasive procedures and operations, thereby improving patient management and outcomes.

The Role of Large Language Models in Radiology Reporting.

Elek, Alperen · AJR. American journal of roentgenology · 2023

Improving Accuracy in ChatGPT.

Elek, Alperen · AJR. American journal of roentgenology · 2023

MicroRNAs and cardiac fibrosis: A comprehensive update on mechanisms and consequences.

Gocer, Zekihan, Elek, Alperen, Caska, Halil, Bozgeyik, Ibrahim · Pathology, research and practice · 2023

Fibrosis is a pathological wound-healing mechanism that results by the overactivation of fibroblasts. Fibrosis can become obstructive and deleterious during regeneration of various body tissues including cardiac muscle. This ultimately results in the development of cardiac fibrosis, characterized by an excessive buildup of extracellular matrix proteins. Thus, it could lead to arrhythmias and heart failure which creates a leading public health burden worldwide. MiRNAs are small non-coding RNAs with great potential for diagnostic and therapeutic purposes. Mounting evidence indicates that miRNAs are involved in the deregulation of tissue homeostasis during myocardial fibrosis. For instance, miRNAs that are implicated in the regulation of TGF-beta signaling pathway have been reported to be significantly altered in myocardial fibrosis. Accordingly, in this comprehensive review, we discuss and highlight recent available data on the role of miRNAs during myocardial fibrosis, providing valuable insights into the miRNA modulation of cardiac fibrosis and miRNAs targets that can be used in the future therapeutic interventions to cardiac fibrosis.