Chronic Cholecystitis Radiology: Insights & Images
Chronic Cholecystitis Radiology: Insights & Images Welcome to our article on chronic cholecystitis radiology. In this comprehensive guide, we will explore the key imaging features that aid in the accurate diagnosis and management of this condition. By delving into various imaging modalities such as ultrasound, CT scan, and MRI, we aim to provide valuable insights and examples to help you understand the radiological assessment and diagnostic process.
At [Acibadem Healthcare Group], we understand the importance of gallbladder imaging in the evaluation of chronic cholecystitis. Our team of experts utilizes the latest advancements in diagnostic imaging techniques to ensure precise and reliable results. Whether it’s analyzing ultrasound features, CT scan findings, or MRI evaluations, our radiologists provide accurate and comprehensive reports to guide patient treatment.
Throughout this article, we will discuss the specific ultrasound features that aid in the diagnosis of chronic cholecystitis, including gallbladder wall thickening, gallstones, pericholecystic fluid, and the sonographic Murphy’s sign. Furthermore, we will explore the key CT scan findings, such as wall thickening, pericholecystic fat stranding, and the identification of complications like gallbladder empyema or abscess. Lastly, we will delve into the MRI evaluation, highlighting gallbladder wall thickness, T2 hyperintensity, and the presence of gallstones or biliary sludge.
Get Free Consultation
ACIBADEM Health Point: The Future of Healthcare
We believe that everyone deserves access to quality healthcare, which is why we have established multiple branches in strategic locations. Whether you're in need of routine check-ups, specialized treatments, or emergency care, ACIBADEM Health Point is here for you.Join us as we uncover the intricate details of radiological diagnosis and radiographic assessment in chronic cholecystitis. By integrating the imaging findings with clinical correlation, we emphasize the importance of a multidisciplinary approach to ensure optimal patient care and management.
Stay tuned as we explore advancements in chronic cholecystitis radiology and discuss potential future directions. Together, we will discover the latest developments in diagnostic imaging and their impact on improving the accuracy and efficiency of diagnosing and managing chronic cholecystitis.
Introduction to Chronic Cholecystitis
Chronic cholecystitis is a commonly encountered condition that affects the gallbladder, causing inflammation and dysfunction over a prolonged period. It is important to understand the fundamental aspects of this condition, including its etiology, clinical presentation, and the role of diagnostic imaging in establishing an accurate radiological diagnosis.
ACIBADEM Health Point: Your Health is Our Priority!
ACIBADEM Health Point, we are dedicated to providing exceptional healthcare services to our patients. With a team of highly skilled medical professionals and state-of-the-art facilities, we strive to deliver the highest standard of care to improve the health and well-being of our patients. What sets ACIBADEM Health Point apart is our patient-centered approach. We prioritize your comfort, safety, and satisfaction throughout your healthcare journey. Our compassionate staff ensures that you receive personalized care tailored to your unique needs, making your experience with us as seamless and comfortable as possible.Chronic cholecystitis is primarily caused by the presence of gallstones that lead to recurrent episodes of inflammation in the gallbladder. Other contributing factors can include bile stasis, bacterial infection, and anatomical abnormalities. The condition often presents with symptoms such as right upper quadrant abdominal pain, nausea, vomiting, and indigestion. However, clinical presentations can vary, and certain cases may remain asymptomatic.
In order to confirm the diagnosis of chronic cholecystitis and assess its severity, diagnostic imaging plays a crucial role. Radiological evaluation allows for a comprehensive examination of the gallbladder, aiding in the identification of specific imaging features that are characteristic of chronic cholecystitis. This information is invaluable in determining appropriate management strategies for affected individuals.
Gallbladder Imaging Techniques
In cases of suspected chronic cholecystitis, various imaging techniques are used to evaluate the gallbladder. Ultrasound, CT scan, and MRI are among the key modalities utilized for diagnostic imaging. Each technique has its advantages and limitations, offering unique insights into the condition.
Ultrasound
Ultrasound is often the initial imaging modality employed in the evaluation of chronic cholecystitis. It is a non-invasive and widely available technique that can provide valuable information about the gallbladder. The following ultrasound features are commonly observed in cases of chronic cholecystitis:
- Gallbladder wall thickening
- Gallstones
- Presence of pericholecystic fluid
- Sonographic Murphy’s sign
CT Scan
CT scan is another commonly used imaging modality for evaluating chronic cholecystitis. While it involves exposure to ionizing radiation, it can offer detailed cross-sectional images of the gallbladder and surrounding structures. The CT scan findings that aid in diagnosing chronic cholecystitis include:
- Gallbladder wall thickening
- Pericholecystic fat stranding
- Identification of complications like gallbladder empyema or abscess
MRI
MRI evaluation plays a significant role in the assessment of chronic cholecystitis. Unlike ultrasound and CT scan, MRI does not involve ionizing radiation, making it a safer option for certain patients. The specific MRI features that assist in diagnosing chronic cholecystitis include:
- Gallbladder wall thickness
- T2 hyperintensity
- Presence of gallstones or biliary sludge
By analyzing the ultrasound features, CT scan findings, and MRI evaluation, radiologists can accurately diagnose chronic cholecystitis and guide appropriate patient management.
Ultrasound Evaluation
Ultrasound is often the initial imaging modality used in the evaluation of patients with suspected chronic cholecystitis. This section will delve into the specific ultrasound features that aid in the diagnosis, including gallbladder wall thickening, gallstones, the presence of pericholecystic fluid, and the sonographic Murphy’s sign.
Gallbladder Wall Thickening
One of the key ultrasound features observed in chronic cholecystitis is gallbladder wall thickening. This can be visualized as an increase in the thickness of the gallbladder wall compared to normal. It is typically seen as a hypoechoic or isoechoic thickening on ultrasound.
Gallstones
Gallstones, also known as cholelithiasis, are another common finding in chronic cholecystitis. On ultrasound, these appear as hyperechoic structures within the gallbladder lumen. The size, number, and distribution of gallstones can vary and may assist in confirming the diagnosis.
Pericholecystic Fluid
Pericholecystic fluid accumulation, also known as cholecystic effusion, can be visualized on ultrasound as an anechoic or hypoechoic collection surrounding the gallbladder. The presence of pericholecystic fluid may indicate inflammation or infection in chronic cholecystitis.
Sonographic Murphy’s Sign
Sonographic Murphy’s sign is a helpful diagnostic feature observed during ultrasound evaluation for chronic cholecystitis. It involves the patient experiencing increased tenderness and pain upon ultrasound probe pressure applied over the inflamed gallbladder. This sign, when present, supports the diagnosis of chronic cholecystitis.
| Ultrasound Features | Diagnostic Significance |
|---|---|
| Gallbladder wall thickening | Aids in confirming the diagnosis of chronic cholecystitis |
| Gallstones | Presence indicates cholelithiasis and supports the diagnosis |
| Pericholecystic fluid | Suggests inflammation or infection in chronic cholecystitis |
| Sonographic Murphy’s sign | Supports the diagnosis of chronic cholecystitis |
CT Scan Findings
CT scan is a widely utilized diagnostic imaging tool in the evaluation of chronic cholecystitis. It provides detailed images that help in identifying specific abnormalities and complications associated with this condition. By analyzing CT scan findings, radiologists can make accurate radiological diagnoses that guide further management.
Key CT scan findings indicative of chronic cholecystitis include:
- Gallbladder wall thickening: CT scans can reveal thickening of the gallbladder wall, a characteristic feature of chronic cholecystitis. This thickening is often accompanied by fibrosis and inflammation.
- Pericholecystic fat stranding: Inflammation in the gallbladder can extend to the surrounding fat, causing fat stranding. CT scans capture this as increased attenuation around the gallbladder.
- Gallstones: CT scans can detect the presence of gallstones, which contribute to the development of chronic cholecystitis. These stones appear as radiopaque structures within the gallbladder.
- Complications: CT scans can identify complications related to chronic cholecystitis, such as gallbladder empyema (pus-filled gallbladder) or abscess. These complications may require prompt intervention.
Additionally, CT scan allows for a comprehensive assessment of the biliary system, providing valuable information about the common bile duct, liver, and surrounding structures. This enables radiologists to evaluate for any associated pathology or complications that may affect the course of treatment.
| CT Scan Findings | Description |
|---|---|
| Gallbladder wall thickening | Thickening of the gallbladder wall, often accompanied by fibrosis and inflammation. |
| Pericholecystic fat stranding | Inflammation extending to the surrounding fat, resulting in increased attenuation around the gallbladder. |
| Gallstones | Radiopaque structures within the gallbladder, contributing to the development of chronic cholecystitis. |
| Complications | Identification of complications such as gallbladder empyema or abscess, requiring prompt intervention. |
MRI Evaluation
Magnetic resonance imaging (MRI) plays a vital role in the evaluation and diagnosis of chronic cholecystitis. By utilizing advanced imaging techniques, MRI provides valuable insights into the gallbladder and surrounding structures, allowing for a comprehensive assessment of this condition.
Gallbladder Wall Thickness
One of the key MRI findings in chronic cholecystitis is gallbladder wall thickening. This is commonly seen in patients with the condition and is a reliable indicator of inflammation. MRI allows for precise measurements of the gallbladder wall thickness, aiding in the diagnosis and monitoring of chronic cholecystitis.
T2 Hyperintensity
T2 hyperintensity refers to the increased signal intensity observed on MRI images. In chronic cholecystitis, the gallbladder wall often exhibits T2 hyperintensity due to the accumulation of inflammatory cells. This characteristic finding helps differentiate chronic cholecystitis from other gallbladder disorders.
Gallstones and Biliary Sludge
The presence of gallstones or biliary sludge can be effectively detected using MRI. This imaging modality allows for the visualization and characterization of these abnormalities within the gallbladder, providing valuable information for the diagnosis and management of chronic cholecystitis.
| Advantages of MRI Evaluation in Chronic Cholecystitis | Limitations of MRI Evaluation in Chronic Cholecystitis |
|---|---|
|
|
MRI evaluation is an essential component of the diagnostic imaging process for chronic cholecystitis. By providing detailed visualization of the gallbladder and its associated abnormalities, MRI assists healthcare professionals in making accurate radiological diagnoses and facilitating appropriate management strategies.
Radiological Diagnosis of Chronic Cholecystitis
In the diagnostic journey of chronic cholecystitis, radiological assessment plays a pivotal role in establishing an accurate diagnosis. By carefully analyzing the imaging findings obtained from ultrasounds, CT scans, and MRIs, healthcare providers can gain valuable insights into this condition and guide appropriate management decisions.
Let’s explore the criteria used to establish a definitive radiological diagnosis of chronic cholecystitis and understand the importance of a comprehensive diagnostic imaging approach.
Ultrasound Findings
Ultrasound imaging serves as the initial modality for evaluating patients suspected to have chronic cholecystitis. Key ultrasound features that aid in the diagnosis include:
- Gallbladder wall thickening
- Presence of gallstones
- Pericholecystic fluid
- Sonographic Murphy’s sign
These ultrasound findings support the radiological diagnosis of chronic cholecystitis and help differentiate it from other gallbladder pathologies.
CT Scan Findings
CT scan offers detailed visualization of the gallbladder and its adjacent structures. The following CT scan findings contribute to the radiological diagnosis of chronic cholecystitis:
- Gallbladder wall thickening
- Pericholecystic fat stranding
- Identification of complications (e.g., gallbladder empyema or abscess)
By analyzing these CT scan findings, radiologists can provide valuable insights into the presence and severity of chronic cholecystitis.
MRI Evaluation
MRI provides a comprehensive evaluation of chronic cholecystitis by assessing various parameters. The MRI features used in radiological diagnosis include:
- Gallbladder wall thickness
- T2 hyperintensity
- Presence of gallstones or biliary sludge
These MRI findings contribute to the accurate diagnosis and characterization of chronic cholecystitis, guiding appropriate treatment decisions.
By integrating the imaging findings from ultrasound, CT scan, and MRI, radiologists can establish a definitive radiological diagnosis of chronic cholecystitis. This comprehensive approach ensures a thorough assessment of the gallbladder and aids in the formulation of an effective management plan.
| Imaging Modality | Key Findings |
|---|---|
| Ultrasound | Gallbladder wall thickening, gallstones, pericholecystic fluid, sonographic Murphy’s sign |
| CT Scan | Gallbladder wall thickening, pericholecystic fat stranding, identification of complications (e.g., gallbladder empyema or abscess) |
| MRI | Gallbladder wall thickness, T2 hyperintensity, presence of gallstones or biliary sludge |
The collective interpretation of these imaging findings enables clinicians to make an accurate radiological diagnosis, providing the foundation for optimal patient care in chronic cholecystitis cases.
Radiographic Assessment of Complications
Chronic cholecystitis, a condition characterized by inflammation of the gallbladder, can sometimes lead to various complications. The use of diagnostic imaging plays a crucial role in identifying these complications and aiding in accurate patient management. This section will focus on the radiographic assessment of complications associated with chronic cholecystitis, providing valuable insights into their identification and potential treatment.
Gallbladder Empyema
Gallbladder empyema, a severe form of acute cholecystitis, involves the accumulation of pus within the gallbladder. Radiographic assessment, including ultrasound, CT scan, or MRI, can help detect characteristic findings such as thickened gallbladder walls, intraluminal debris, and loculated fluid collections. These imaging features aid in confirming the diagnosis and guiding appropriate interventions.
Perforation
Perforation of the gallbladder is a rare but potentially life-threatening complication of chronic cholecystitis. Radiological evaluation plays a vital role in its diagnosis and management. Imaging modalities such as CT scan or MRI can reveal signs such as free intraperitoneal fluid, pneumoperitoneum, or abscess formation. These findings contribute to prompt identification and appropriate surgical intervention.
Gallstones in the Common Bile Duct
In some cases of chronic cholecystitis, gallstones may migrate from the gallbladder to the common bile duct, leading to obstructive symptoms and potential complications. Radiographic assessment, including ultrasound or endoscopic retrograde cholangiopancreatography (ERCP), can help detect the presence of gallstones within the common bile duct. These imaging techniques aid in diagnosis, preoperative planning, and guiding therapeutic interventions.
| Complication | Radiographic Assessment |
|---|---|
| Gallbladder Empyema | Thickened gallbladder walls, intraluminal debris, loculated fluid collections |
| Perforation | Free intraperitoneal fluid, pneumoperitoneum, abscess formation |
| Gallstones in the Common Bile Duct | Gallstones observed on ultrasound or confirmed through ERCP |
Clinical Correlation and Management
When it comes to chronic cholecystitis, accurate diagnosis and effective management rely not only on radiological findings but also on clinical correlation. Integrating radiological data with clinical information plays a crucial role in ensuring optimal patient care and treatment outcomes.
The healthcare professionals at Acibadem Healthcare Group understand the significance of a multidisciplinary approach in diagnosing and managing chronic cholecystitis. Through collaboration between radiologists, gastroenterologists, and surgeons, they provide comprehensive care that takes into account both radiological and clinical aspects.
Let us take a closer look at a case study from Acibadem Healthcare Group, highlighting the importance of clinical correlation in the management of chronic cholecystitis:
Case Study: Clinical Correlation in Chronic Cholecystitis
Patient: [Patient’s Name]
Symptoms: Recurrent right upper quadrant pain, postprandial distress, and fatty food intolerance
Diagnostic Imaging:
- Ultrasound: Gallbladder wall thickening, small gallstones, and pericholecystic fluid present
- CT Scan: No significant abnormalities detected
- MRI: Gallbladder wall thickening and T2 hyperintensity observed
Clinical Correlation:
- Given the patient’s symptoms and the presence of gallbladder wall thickening, small gallstones, and pericholecystic fluid on ultrasound, a diagnosis of chronic cholecystitis was made.
- The absence of significant abnormalities on the CT scan does not exclude chronic cholecystitis, as this modality may have limited sensitivity in detecting subtle changes.
- The MRI findings of gallbladder wall thickening and T2 hyperintensity further supported the diagnosis of chronic cholecystitis.
Management:
- Based on the diagnosis of chronic cholecystitis, the patient was recommended for a cholecystectomy (surgical removal of the gallbladder) to alleviate their symptoms and prevent potential complications.
- The multidisciplinary team at Acibadem Healthcare Group, comprising experienced radiologists, gastroenterologists, and surgeons, ensured comprehensive preoperative evaluation and postoperative care.
This case study exemplifies how the integration of radiological findings with clinical data leads to an accurate diagnosis and guides the appropriate management of chronic cholecystitis. By combining expertise and resources, Acibadem Healthcare Group aims to provide exceptional patient-centered care for individuals with this condition.
Advancements in Chronic Cholecystitis Radiology
The field of chronic cholecystitis radiology continues to evolve with advancements in technology and diagnostic imaging modalities. These advancements have significantly improved the accuracy and efficiency of diagnosing and managing chronic cholecystitis.
Improved Imaging Modalities
New imaging modalities have revolutionized the diagnosis of chronic cholecystitis, allowing for a more comprehensive evaluation of the gallbladder and surrounding structures. These modalities include:
- High-resolution ultrasound: Provides detailed visualization of gallbladder wall thickening, gallstones, and other relevant features.
- Multi-detector computed tomography (CT): Offers enhanced spatial resolution and precise evaluation of gallbladder anatomy, as well as the identification of complications.
- Magnetic resonance imaging (MRI): Enables the assessment of gallbladder wall thickness and other qualitative and quantitative parameters with excellent soft tissue contrast.
Computer-Aided Diagnosis
Computer-aided diagnosis (CAD) systems have emerged as valuable tools in chronic cholecystitis radiology. These systems utilize artificial intelligence algorithms to analyze medical images and assist radiologists in making accurate diagnoses. By incorporating machine learning and pattern recognition techniques, CAD systems can help detect subtle abnormalities and aid in the identification of critical findings, leading to improved diagnostic accuracy and efficiency.
Interventional Techniques
In addition to diagnostic imaging, interventional radiology plays a crucial role in the management of chronic cholecystitis. Minimally invasive procedures such as image-guided percutaneous cholecystostomy and percutaneous cholecystolithotomy offer alternative treatment options for patients who are not suitable candidates for surgery. These techniques minimize the risks associated with traditional surgical interventions and promote faster recovery.
Integration of Quantitative Imaging
The integration of quantitative imaging techniques has opened new avenues for evaluating chronic cholecystitis. By analyzing various imaging biomarkers, such as gallbladder wall thickness, vascularity, and perfusion, radiologists can obtain valuable quantitative information beyond visual assessment. These quantitative measurements help in monitoring disease progression, assessing treatment response, and predicting outcomes.
With these advancements in chronic cholecystitis radiology, clinicians and radiologists can now make more accurate diagnoses, develop personalized treatment plans, and improve patient outcomes. The ongoing developments in diagnostic imaging continue to shape the field, promising even more significant advancements and better management of this condition in the future.
Future Directions
As research and technology continue to advance, the field of chronic cholecystitis radiology holds great potential for improved diagnosis and treatment. Exciting developments and emerging trends are shaping the future of diagnostic imaging for chronic cholecystitis. Two particular areas of interest are the role of artificial intelligence (AI) and enhanced imaging techniques.
The Role of Artificial Intelligence
Artificial intelligence has the potential to revolutionize the field of chronic cholecystitis radiology. By leveraging machine learning algorithms, AI can analyze vast amounts of medical data and assist radiologists in making more accurate and efficient diagnoses. With AI-powered tools, radiologists can benefit from enhanced image interpretation, automated measurements, and intelligent pattern recognition.
Moreover, AI algorithms can aid in the development of predictive models to forecast disease progression and outcomes. By identifying subtle patterns and correlations in imaging data, AI can help clinicians tailor treatment plans and interventions specific to each patient’s needs. This personalized approach has the potential to optimize patient care and improve treatment outcomes.
Enhanced Imaging Techniques
In addition to AI, advancements in imaging techniques are also shaping the future of chronic cholecystitis radiology. Researchers and engineers are constantly working towards enhancing the resolution, contrast, and sensitivity of imaging modalities such as ultrasound, CT scan, and MRI.
These improvements allow for a more accurate and detailed evaluation of gallbladder pathologies, enabling radiologists to make precise diagnoses. For example, the development of novel MRI sequences and contrast agents can provide enhanced visualization of gallbladder wall thickness, inflammation, and microvascular perfusion.
Furthermore, the integration of functional imaging techniques, such as diffusion-weighted imaging and spectroscopy, holds promise in assessing tissue characteristics and differentiating between inflammatory and neoplastic gallbladder diseases.
Conclusion
In conclusion, diagnostic imaging plays a vital role in the accurate diagnosis and management of chronic cholecystitis. Through various imaging modalities such as ultrasound, CT scan, and MRI, radiologists can identify specific features and findings that aid in the radiological diagnosis of this condition.
By employing ultrasound, clinicians can assess gallbladder wall thickening, the presence of gallstones, and pericholecystic fluid. CT scans provide valuable information on gallbladder wall thickness, pericholecystic fat stranding, and potential complications. Meanwhile, MRI evaluation offers insights into gallbladder wall thickness, T2 hyperintensity, and the presence of gallstones or biliary sludge.
However, it is essential to emphasize that accurate radiological diagnosis requires a multidisciplinary approach, integrating clinical data with imaging findings. The collaboration between radiologists, gastroenterologists, and surgeons ensures comprehensive patient care, leading to optimal diagnosis, treatment, and management of chronic cholecystitis.
With advancements in diagnostic imaging techniques and technologies, the field of chronic cholecystitis radiology continues to evolve. Exciting developments, such as artificial intelligence and enhanced imaging methods, have the potential to further improve the accuracy and efficiency of diagnosing and managing this condition in the future.
FAQ
What is chronic cholecystitis?
Chronic cholecystitis is a condition characterized by prolonged inflammation of the gallbladder, usually resulting from gallstones and leading to various symptoms and complications.
Why is diagnostic imaging important in chronic cholecystitis?
Diagnostic imaging plays a crucial role in accurately diagnosing chronic cholecystitis by visualizing the gallbladder and evaluating its structure and surrounding tissues, helping to guide appropriate management decisions.
What are the common imaging techniques used for gallbladder evaluation?
Ultrasound, CT scan, and MRI are commonly used imaging techniques for evaluating the gallbladder in cases of suspected chronic cholecystitis.
What are some ultrasound features indicating chronic cholecystitis?
Ultrasound features indicating chronic cholecystitis include gallbladder wall thickening, the presence of gallstones, pericholecystic fluid accumulation, and a positive sonographic Murphy's sign.
What are the key CT scan findings in chronic cholecystitis?
Key CT scan findings in chronic cholecystitis include gallbladder wall thickening, pericholecystic fat stranding, and identification of complications such as gallbladder empyema or abscess.
How does MRI contribute to the evaluation of chronic cholecystitis?
MRI provides valuable insights into the evaluation of chronic cholecystitis by assessing gallbladder wall thickness, T2 hyperintensity, and the presence of gallstones or biliary sludge.
How is chronic cholecystitis diagnosed radiologically?
Radiological diagnosis of chronic cholecystitis involves integrating the imaging findings from ultrasound, CT scan, and MRI, considering specific criteria to establish a definitive diagnosis.
What complications can be detected through radiographic assessment in chronic cholecystitis?
Radiographic assessment in chronic cholecystitis can detect complications such as gallbladder empyema, perforation, or the presence of gallstones in the common bile duct.
How does clinical correlation contribute to the management of chronic cholecystitis?
Clinical correlation plays a crucial role in the accurate diagnosis and management of chronic cholecystitis by integrating radiological findings with clinical data, facilitating multidisciplinary care.
What are the advancements in chronic cholecystitis radiology?
Advancements in chronic cholecystitis radiology include improved technology and imaging modalities that have enhanced the accuracy and efficiency of diagnosis and management.
What are the future directions in chronic cholecystitis radiology?
The future of chronic cholecystitis radiology holds promising avenues with the potential integration of artificial intelligence and emerging imaging techniques for improved diagnosis and treatment.
What is the significance of diagnostic imaging in chronic cholecystitis?
Diagnostic imaging is significant in chronic cholecystitis as it allows for accurate diagnosis, assessment of disease severity, and appropriate management decisions for optimal patient care.
ACIBADEM Healthcare Group Hospitals and Clinics
With a network of hospitals and clinics across 5 countries, including 40 hospitals, ACIBADEM Healthcare Group has a global presence that allows us to provide comprehensive healthcare services to patients from around the world. With over 25,000 dedicated employees, we have the expertise and resources to deliver unparalleled healthcare experiences. Our mission is to ensure that each patient receives the best possible care, supported by our commitment to healthcare excellence and international healthcare standards. Ready to take the first step towards a healthier future? Contact us now to schedule your Free Consultation Health session. Our friendly team is eager to assist you and provide the guidance you need to make informed decisions about your well-being. Click To Call Now !*The information on our website is not intended to direct people to diagnosis and treatment. Do not carry out all your diagnosis and treatment procedures without consulting your doctor. The contents do not contain information about the therapeutic health services of ACIBADEM Health Group.