Hydatid disease of the liver with portal vein invasion mimicking portal vein thrombosis.

Hydatid cyst disease is a zoonosis caused by the parasite Echinococcus. It may infest any organ of the body, but it most frequently involves the liver, lungs, and nervous system. Portal vein involvement by hydatid cyst disease is extremely rare with only five cases published in the English literature to our knowledge. We present the ultrasonography (US) and computed tomography (CT) findings of a 77-year-old male with hydatid disease of the liver with portal vein invasion mimicking portal vein thrombosis. Colour Doppler US confirmed the lack of blood flow within the portal vein and stigmata of cavernomatosis. CT clearly demonstrated a communication between the multiloculated lesion and the portal vein and the multiple daughter vesicles obstructing the portal vein. The consideration of this complication will make it possible to distinguish this entity from portal vein thrombosis and, thus, the management of the patients with hydatid cyst disease particulary in endemic regions.

MRI findings and utility of DWI in the evaluation of solid parathyroid lesions.

PURPOSE: To evaluate the MRI findings of solid parathyroid lesions and to elaborate on a possible improvement of MRI detection of parathyroid lesions by the use of additional DWI. MATERIALS AND METHODS: MRI and DWI properties of pathologically proven 20 solid parathyroid lesions were retrospectively reviewed. Mean ADC values (b50 + b400 + b800/3) of parathyroid lesions were compared with that of normal appearing thyroid parenchyma (TP), sternocleidomastoid muscle (SCM) and jugulodigastric lymph nodes (JDLN). RESULTS: Of lesions, 4 were parathyroid hyperplasia, 13 parathyroid adenoma and 3 parathyroid adenocarcinoma. All parathyroid lesions were very bright on fat-saturated T2W images. Parathyroid hyperplasia and adenoma were small sized, homogenous, well-defined and low on T1W, high on T2W and avidly enhancing. Parathyroid carcinoma was large sized, ill-defined and very heterogeneous on MRI including DWI. Means ADC values of parathyroid hyperplasia, adenoma, and adenocarcinoma, TP, SCM and JDLN were measured as 2.3 ± 0.14 × 10-3, 1.7 ± 0.45 × 10-3, 1.5 ± 1.48 × 10-3, 0.87 ± 0.40 × 10-3, 0.55 ± 0.21 × 10-3 and 0.96 ± 0.33 × 10-3 mm2/s, respectively. All parathyroid lesions had high diffusion properties comparing other soft tissue structures of head and neck region. By increasing strength (b value) of diffusion tensor on DWI, solid parathyroid lesions still kept their brightness comparing other soft tissue structures of head and neck region because of their high T2 properties. CONCLUSION: Solid parathyroid lesions had higher diffusion properties comparing other soft tissues structures of head and neck region. This feature makes them easily differentiate from nearby structures on fat-saturated T2W and DWI.

Meandering right pulmonary vein associated with retrocaval ureter and vertebral fusion anomalies.

We present multimodality imaging of a meandering right pulmonary vein in a 29-year-old female patient. It was associated with right retrocaval ureter causing hydronephrosis and stone formation, vertebral fusion anomalies and corrected cardiac anomalies (patent ductus arteriosus and ventricular septal defect). To the best of our knowledge, only a few meandering right pulmonary vein have been presented in the literature until now and this is the first reported case that is associated with retrocaval ureter and vertebral fusion anomalies.

Magnetic resonance spectroscopy features of Heschl's gyri in patients with unilateral acoustic neuroma: preliminary study.

RATIONALE AND OBJECTIVES: To evaluate neurochemical alterations in Heschl's gyri and determine the most affected side in case of unilateral acoustic neuroma using magnetic resonance spectroscopy (MRS). MATERIALS AND METHODS: Fifteen patients with unilateral acoustic neuroma were studied. Following routine cranial MRI sequences, MRS of Heschl's gyri on tumor and nontumor sides was obtained. MRS metabolite values of both Heschl's gyri were statistically compared. RESULTS: The values of N-acetylaspartate (NAA) and Cr on nontumor side Heschl's gyrus (HG) were significantly lower than that on tumor side. CONCLUSIONS: We found nontumor side HG more affected with lower NAA and Cr values, suggesting neuronal damage and decreased energy metabolism compared to the tumoral side.

The effect of obesity on brain diffusion alteration in patients with obstructive sleep apnea.

PURPOSE: We investigated diffusion alterations in specific regions of the brain in morbid obese, obese, and nonobese OSA patients and searched whether there is a correlation between BMI and ADC values. MATERIALS AND METHODS: DWIs of 65 patients with OSA were evaluated. The patients were classified according to BMI as morbid obese (n = 16), obese (n = 27), and nonobese (control, n = 22) groups. ADC measurements were performed from 24 different regions of the brain in each patient. The relationship of BMI with ADC values was searched. RESULTS: The ADC values in hypothalamus, insular cortex, parietal cortex, caudate nucleus, frontal white matter, and posterior limb of internal capsule were all increased in obese patients (n = 43) compared to control group. The ADC values of midbrain, hypothalamus, orbitofrontal cortex, and parietal cortex were significantly increased in morbid obese compared to obese patients. In obese patients, the degree of BMI was positively correlated with ADC values of orbitofrontal cortex, parietal cortex, and hypothalamus. CONCLUSION: We observed increasing brain vasogenic edema with increasing BMI, suggesting that the main reason of brain diffusion alteration in patients with OSA could be obesity related.

The infragluteal sulcus: a histologic and ultrasonographic study.

UNLABELLED: The buttocks are a major component of sexual attraction, and they have their place in the concept of beauty in most cultures and ethnic groups. The infragluteal sulcus, an important part of the gluteal region, determines the attractiveness of the buttocks. For that reason, any small change in the infragluteal sulcus makes a major cosmetic difference in the morphology of the buttock. In recent years, some flaps such as the infragluteal flap, the transverse upper gracilis flap, and the transverse musculocutaneous gracilis flap have become popular because of reduced donor area morbidity and their availability for hiding incision scars. In these cases, there may be distortion of the gluteal morphology and infragluteal sulcus. In this study, the anatomic and histologic features of the tissues that form the infragluteal sulcus were analyzed for their contribution to successful reconstruction of the infragluteal sulcus. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

MR spectroscopy features of brain in patients with mild and severe obstructive sleep apnea syndrome.

PURPOSE: We investigated whether there are differences in metabolite ratios of different brain regions between mild and severe obstructive sleep apnea (OSA) patients. MATERIALS AND METHODS: A total of 17 mild OSA and 14 severe OSA patients were enrolled. N-acetyl aspartate (NAA)/creatine (Cr), choline (Cho)/Cr and NAA/Cho ratios were calculated by using multivoxel magnetic resonance spectroscopy (MRS) (TR: 1500, TE: 135 ms) from hippocampus, putamen, insular cortex, thalamus and temporal white matter. The relationship between the two groups was evaluated with Mann-Whitney U test. RESULTS: NAA/Cr ratios obtained from hippocampus was found to be significantly increased in severe OSA patients compared to mild OSA patients (P=.004). Cho/Cr ratios obtained from hippocampus and putamen in severe OSA patients were significantly increased when compared to mild OSA patients (P=.003 and P=.004, respectively). In addition, NAA/Cho ratios of putamen were significantly decreased in severe OSA patients when compared to mild OSA (P=.032). CONCLUSION: MRS identified hypoxia-related metabolite and microstructural changes in hippocampus and putamen. The metabolite changes of increase in NAA/Cr and Cho/Cr ratios and decrease in NAA/Cho ratio were more pronounced with increasing severity of OSA syndrome.

Brain diffusion changes in obstructive sleep apnoea syndrome.

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is a disorder characterized by repeated apnoeic episodes during sleep. Neurocognitive changes secondary to OSAS are likely to occur due to hypoxia in certain brain locations. Advances in magnetic resonance imaging technology, such as diffusion-weighted imaging (DWI), enable non-invasive and accurate identification of OSAS-induced changes. OBJECTIVE: We aimed to use DWI to investigate changes in the brain secondary to hypoxia in OSAS. METHODS: Eighty-eight patients underwent polysomnography and were classified as non-OSAS, mild-moderate OSAS and severe OSAS sufferers. DWI was used to evaluate 14 areas of the brain, and apparent diffusion coefficients (ADCs) were calculated. We investigated whether there were differences in the ADC values in specific areas of the brain between the non-OSAS and OSAS patients. RESULTS: We measured the ADC values of the 68 newly diagnosed OSAS patients (21 mild, 15 moderate and 32 severe) and of 20 healthy controls. There were significant increases in the ADC values in the hippocampus, amygdala and putamen in OSAS patients. Compared to the non-OSAS subjects, the ADC values of the putamen in severe OSAS patients, those of the hippocampus in moderate or severe OSAS patients and those of the amygdala in moderate OSAS patients were significantly increased. A negative correlation between the lowest oxygen saturation during sleep and the ADC values of the hippocampus and amygdala was found. CONCLUSIONS: Increased ADC levels in the hippocampus, amygdala and putamen in OSAS patients indicate hypoxia and likely cause vasogenic oedema in specific regions of the brain.

CT angiography evaluation of unusual transorbital penetrating injury: a toothbrush.

Orbital penetrating injuries may cause significant harm to optic nerves and eyeball as well as to the brain and cerebral vasculature. Defining surrounding neurovascular structures by CT angiography (CTA) is important for surgical removal. We present an uncommon case of a 3-year-old child with a penetrating orbital injury caused by a toothbrush. To the best of our knowledge, there is no report orbital injury with a toothbrush so far.

MRI findings in thoracic outlet syndrome.

We discuss MRI findings in patients with thoracic outlet syndrome (TOS). A total of 100 neurovascular bundles were evaluated in the interscalene triangle (IS), costoclavicular (CC), and retropectoralis minor (RPM) spaces. To exclude neurogenic abnormality, MRIs of the cervical spine and brachial plexus (BPL) were obtained in neutral. To exclude compression on neurovascular bundles, sagittal T1W images were obtained vertical to the longitudinal axis of BPL from spinal cord to the medial part of the humerus, in abduction and neutral. To exclude vascular TOS, MR angiography (MRA) and venography (MRV) of the subclavian artery (SA) and vein (SV) in abduction were obtained. If there is compression on the vessels, MRA and MRV of the subclavian vessels were repeated in neutral. Seventy-one neurovascular bundles were found to be abnormal: 16 arterial-venous-neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial-venous, 3 arterial-neurogenic, and 8 venous-neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the CC, mostly secondary to position, and very rarely compressed in the RPM. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory.

Maple syrup urine disease: diffusion-weighted MRI findings during acute metabolic encephalopathic crisis.

Maple syrup urine disease (MSUD) is caused by a genetic defect of branched-chain amino acids, which include leucine, isoleucine and valine. We report diffusion-weighted imaging (DWI) findings in a newborn child with MSUD who presented with acute metabolic encephalopathic crisis. DWI (b = 1,000 s/mm(2)) showed high signal localized within the myelinated white matter (WM) areas including the cerebellar white matter, pons, bulbus, cerebral peduncles, lentiform nucleus, posterior limbs of the internal capsules, corona radiata and bilateral perirolandic cortex. The apparent diffusion coefficient values of these regions were markedly low in the affected areas. The presence of these findings was considered cytotoxic or intramyelinic edema evidenced by restricted water diffusion. In conclusion, our findings suggest that during the acute phase and early encephalopathic crisis stage of MSUD, DWI can demonstrate the involvement of myelinated WM in newborns.