Interrelationship between liver hemodynamics and tumor metabolism in liver metastases: diagnostic value of Doppler perfusion index revisited.

It should be expected that the hepatic blood flow increase in the cases with liver metastasis. We aimed to find out if there is a correlation between Doppler parameters and hepatic metabolic activity in oncology patients. 35 patients with hepatic metastases who were identified by 18F-fluorodeoxyglucose positron emission tomography scan and assessed with Doppler ultrasound were included in this prospective study. Patients with hepatic disease, cardiac dysfunction, dehydration, history of alcoholism, intake of antihypertensive or vasoactive medication were excluded. Volume flow of the proper hepatic artery and the portal vein were measured in the hepatoduodenal ligament by Doppler sonography. Doppler perfusion index (the ratio of the hepatic artery flow to the total liver blood flow) and flow volumes of 31 age matched subjects were compared. Both flow of the proper hepatic artery and portal vein were found to be significantly higher in patients with liver metastasis. The mean Doppler perfusion index value was 0.2 ± 0.13 in hepatic metastases whereas 0.13 ± 0.05 in control group. Doppler perfusion index was significantly higher in liver metastases (p=0.008). A positive correlation was found between the maximum standardized uptake value of the liver and flow volume of the proper hepatic artery (r=0.774, p=0). Blood flow of the proper hepatic artery and Doppler perfusion index correlates with hepatic standardized uptake value. Flow measurements of the liver may become an important parameter for selecting patients for further positron emission tomography scan and following-up the response after systemic and local therapeutic procedures.

Effect of complete denture wearing on deglutition time: a cine-magnetic resonance imaging study.

Purpose of the study was to evaluate the effect of complete denture wearing on deglutition time (DT), hyoid bone and larynx movements in edentulous patients with real-time balanced turbo field echo cine-magnetic resonance imaging. Subjects were examined by cine-magnetic resonance imaging in supine position during swallowing water. Two sets of images for 23 edentulous (with/without wearing complete dentures) and one for 23 dentulous patients were obtained. Radiographic outputs representing three consecutive deglutition stages (oral, pharyngeal and oesophageal) were provided to perform measurements. Deglutition time significantly increased when edentulous patients wore their dentures (mean 0·75 s increased to 1·17 s), whereas dentulous patients' DT was about 0·91 s (P ≤ 0.05). The duration of deglutition is crucial because prolonged pharyngeal transit times increases the risk of aspiration. Within the limitations of the study, complete denture wearing could increase the shortened DT of the edentulous patients.

Cerebrospinal fluid flow imaging by using phase-contrast MR technique.

Cerebrospinal fluid (CSF) spaces include ventricles and cerebral and spinal subarachnoid spaces. CSF motion is a combined effect of CSF production rate and superimposed cardiac pulsations. Knowledge of CSF dynamics has benefited considerably from the development of phase-contrast (PC) MRI. There are several disorders such as communicating and non-communicating hydrocephalus, Chiari malformation, syringomyelic cyst and arachnoid cyst that can change the CSF dynamics. The aims of this pictorial review are to outline the PC MRI technique, CSF physiology and cerebrospinal space anatomy, to describe a group of congenital and acquired disorders that can alter the CSF dynamics, and to assess the use of PC MRI in the assessment of various central nervous system abnormalities.

Corpus callosum: normal imaging appearance, variants and pathologic conditions.

Various types of lesions can occur within the corpus callosum (CC) which is a white matter tract communicating corresponding regions of the cerebral hemispheres. Magnetic resonance imaging is the modality of choice for the evaluation of the CC. In addition, diffusion weighted imaging and diffusion tensor imaging can provide additional information about the CC. The aim of this study is to illustrate the imaging features of the corpus callosum and its pathologies.

Case report. Isolated complete congenital sternal cleft in an adult: MDCT imaging findings.

Sternal cleft is a very rare midline defect. Incomplete forms are more common than complete ones. In this challenging anomaly, the underlying mediastinal structures (especially the heart and great vessels) can easily be injured by external trauma. In addition, the deformity is cosmetically unpleasant and quite alarming to the young patient and the patient's family. In this report, we describe the multidetector CT (MDCT) images that demonstrate the complete sternal cleft.

Behçet's Disease Presenting with Acute Transverse Myelitis: MRI Findings and Review of the Nosology. A Case Report.

Spinal cord involvement, either isolated or together with brain, in Behçet's disease (BD) has been reported. In these cases the existence of the disease was previously known or the classical triad of disease such as oral and genital ulcers with uveitis/iritis was present. Here we describe a 22-year-old man in whom acute transverse myelitis diagnosed with MRI was the first finding of BD.

Craniospinal involvement in a patient with isolated bone marrow mastocytosis. A case report.

Central nervous system involvement in systemic mastocytosis (SM) is very rare. This case report describes the computed tomography and magnetic resonance (MR) imaging findings of central nervous system involvement in a patient with isolated bone marrow mastocystosis. Bone marrow infiltration in SM caused cranial nerve dysfunction and meningeal irritation secondary to narrowing of cranial apertures and meningeal involvement, respectively. MR imaging is the modality of choice in both detection and follow-up of SM and also useful for differential diagnosis and detection of complications.

Efficacy of in vivo 31Phosphorus Magnetic Resonance Spectroscopy in Differentiation and Staging of Adult Human Brain Tumors.

The aim of this study was to evaluate the efficacy of (31)P magnetic resonance spectroscopy ((31)P-MRS) in the differentiation and staging of brain tumors. Fifteen volunteers and 44 patients with brain tumors (14 meningiomas, 13 low- and 17 high-grade gliomas) were prospectively evaluated by (31)P-MRS. The pH (r=0.493, p<0.001), [Mg(+2)] (r=0.850, p<0.001) PME/α-ATP (r=0.776, p<0.001), PDE/α-ATP (r=-0.569, p<0.001) and (PCr+ß-ATP)/Pi ratios were well correlated with tumor differentiation. High-grade gliomas had significantly higher pH (r=0.912, p<0.001) and [Mg(+2)] (r=0.855, p<0.001) and PME/α-ATP (r=0.894, p<0.001) ratio, and lower PCr/α-ATP (r=-0.959, p<0.001), Pi/α-ATP (r=-0.788, p<0.001) and PDE/α-ATP ratios (r=-0.968, p<0.001) than those of low-grade gliomas. Changes in (31)P-MRS parameters by the degree of malignancy are good indicators of increased anaerobic metabolism and hypoxia of tumoral tissue to compensate intratumoral energy deficiency. (31)P-MRS parameters are very useful for grading and differentiation of brain tumors.

Transient splenial lesion of the corpus callosum in clinically mild influenza-associated encephalitis/encephalopathy.

BACKGROUND: Reversible lesions in the splenium of the corpus callosum (SCC), caused by various agents such as influenza, rotavirus, Escherichia coli, mumps, and adenovirus, were previously defined in a handful of cases. We present 5 cases with transient diffusion restriction of the SCC associated with influenza A virus infection. MATERIALS AND METHODS: Five patients with influenza-associated encephalitis/encephalopathy and sudden-onset neurologic symptoms following a prodromal flulike episode were examined by MR and diffusion-weighted imaging (DWI). RESULTS: Three patients, who had drowsiness and new-onset convulsions, recovered spontaneously without any medication. In the other 2 seizure-free patients, 1 had trigeminal neuralgia and headache and the other had facial numbness and left upper monoparesis. All patients had round well-defined ovoid hyperintense splenial lesions (14.94 +/- 1.87 mm) on DWI with a significantly low apparent diffusion coefficient (ADC) of 0.41 +/- 0.05 x 10(-3) mm(2)/s compared with 0.84 +/- 0.01 x 10(-3) mm(2)/s of normal-appearing white matter. In the patient with a motor deficit, additional lesions were found in the cerebral deep white matter. The high signal intensity of the splenial and deep white matter lesions on DWI completely disappeared on follow-up studies, and ADC values also improved, returning to those of normal-appearing white matter on days 8-11. Clinically, all patients completely recovered on days 4-9. CONCLUSION: A transient lesion of the SCC is a significant but nonspecific finding. It is probably due to edematous and/or inflammatory changes of the SCC. It may be the only detectable change in patients with good prognosis, indicating a clinically mild form of encephalitis/encephalopathy.

Thin-section axial multidetector computed tomography and multiplanar reformatted imaging of children with suspected foreign-body aspiration: Is virtual bronchoscopy overemphasized?

PURPOSE: To determine the added value of multidetector computed tomography (MDCT)-assisted virtual bronchoscopy (VB) to axial MDCT and multiplanar reformatted (MPR) imaging with respect to conventional bronchoscopy in the evaluation of children with suspected foreign-body aspiration (FBA). MATERIAL AND METHODS: Twenty-one consecutive children (14 male, seven female, age 8 months-7 years, mean age 3.5 years) presenting with the suspicion of FBA were examined with 16-slice MDCT using 100-120 kV, 30-50 mA, 1-mm section thickness, 1.2 pitch ratio, and 0.6-1.0-mm reconstruction interval. Before CT examinations, chest radiographies were also obtained in all cases. VB and MPR imaging were carried out after MDCT examinations. RESULTS: Nine foreign bodies were identified by gold-standard conventional bronchoscopy. VB, thin-section axial MDCT, and MPR images identified eight of nine foreign bodies. CT scans with MPR images and VB did not reveal a chronic foreign body; and, in one patient, endobronchial mucous was diagnosed as the foreign body. The sensitivity, specificity, and accuracy of thin-section axial MDCT and MPR images alone in the diagnosis of FBA were 88.9%, 91.7%, and 90.5%, respectively. Results were the same as those obtained when VB was also included. CONCLUSION: MDCT with VB and axial/MPR images provide equally valuable information in children with suspected foreign-body aspiration and prevent unnecessary conventional bronchoscopic examinations. However, VB increases total examination time and cost, and it does not provide additional information over MPR images in the evaluation of foreign-body aspiration.

A rare cause of flank mass: psoas abscess due to extensive primary thoracolumbar tuberculous spondylodiskitis.

Psoas abscess secondary to tuberculous spondylodiskitis is usually a complication of thoracolumbar vertebrae disease. The psoas abscess may be difficult clinically to diagnose because of its rarity, insidious onset of the disease, and nonspecific clinical presentation. We report multidetector CT and MR imaging findings of a psoas abscess secondary to primary tuberculous spondylodiskitis of the spine from the T3 to L2 vertebrae, which presented as a flank mass.

Real time balanced turbo field echo Cine-MRI in the analysis of deglutition events and transit times.

Investigation of swallowing is an important part of oral diagnosis. It usually plays a role in the aetiology of some orofacial deformities and open-bite as well as in the relapse of treated open-bite patients. In recent years, the movements of the anatomical structures that participate in deglutition have been investigated by several methods such as cineradiography, electromyography, electropalatography, electromagnetic articulography and ultrasonography. However, all these techniques have various disadvantages. Recently, dynamic magnetic resonance imaging has become available in the evaluation of swallowing function. In this study we intended to present this new technique to the dental literature and aimed to obtain dynamic images of the deglutition process. We also compared the timing of events in subjects with anterior open-bite and normal overbite during swallowing 10 mL water.

Symptomatic epidural gas after open diskectomy: CT and MR imaging findings.

We report a case of symptomatic epidural gas accumulation after open diskectomy, causing lumbar radiculopathy. Surgery had been performed in a 44-year-old man for disk extrusion; however, he was readmitted to the hospital with increased lower back pain 5 months after the operation. CT and MR studies demonstrated accumulation of gas in the lumbar epidural space compressing the dural sac and nerve root. Symptoms disappeared after surgical removal of the gas.

Comparison of contrast-enhanced T1-weighted and 3D constructive interference in steady state images for predicting outcome after hearing-preservation surgery for vestibular schwannoma.

We compared contrast-enhanced T1-weighted and 3D constructive interference in steady state (CISS) sequences for demonstrating possible prognostic factors in hearing-preservation surgery for vestibular schwannoma. We studied 22 patients with vestibular schwannomas having hearing-preservation surgery. Postoperatively six (27%) had a facial palsy and eight (36%) had hearing loss. There was a significant correlation between the size of the tumour and facial palsy (r=-0.72). Both techniques adequately demonstrated all tumours. Involvement of the fundus of the internal auditory canal (IAC) and a small distance between the lateral border of the tumour and the fundus were correlated significantly with hearing loss (r=-0.81 and -0.75, respectively). The 3D-CISS sequence, by virtue of its high contrast resolution was superior to T1-weighted images ( P<0.05) for detection of the fundal involvement. The direction of displacement of the facial nerve did not correlate with facial palsy or hearing loss. We think that 3D-CISS images better show the features influencing surgical outcome, but that contrast-enhanced T1-weighted images are required for diagnosis.

Schwannoma of the lateral ventricle: eight-year follow-up and literature review.

Intracerebral and intramedullary schwannomas are uncommon; but, in general, spinal intramedullary schwannomas are more frequent than intracerebral schwanomas. We present a case of right lateral ventricle schwannoma in a 21-year-old man and review the associated literature. The 21-year-old right-handed man presented with loss of the left-eye vision approximately 8 months before referral to an ophthalmologist. The patient was immediately subjected to computed tomography (CT) scan, which showed an enhanced lesion with cystic component in the right occipital horn of the lateral ventricle. And consecutively, he was admitted to our department. The tumor was evacuated via craniotomy with marked improvement in his clinical state. The postoperative course was uneventful and postoperative CT control showed no residue. On MRI control no recurrence was noted after a follow-up period of 8 years. Intracerebral schwannoma is a rare, benign neoplasm. It is usually located superficially or adjacent to a ventricle. Characteristic imaging features include cyst formation, calcification, and evidence of peritumoral edema or gliosis. The recognition of this benign and potentially curable neoplasm and its differentiation from other neoplasms, some of which have less favourable outcomes, is of obvious importance.

The value of ultrasonography in interrupted inferior vena cava with azygos continuation.

The cardiosplenic syndromes represent a complex set of abnormalities of the thorax and viscera resulting from abnormal folding of the embryo during early development. Anomalies of venous development include interruption of inferior vena cava (IVC), and in combination with situs inversus referred to as the polysplenia syndrome. We present a 23-year-old male previously diagnosed as having a persistent left IVC on venography whereas ultrasonographic examination clearly demonstrated interrupted IVC with azygos continuation along with situs inversus.

Comparison of In-111 octreotide and Tc-99m (V) DMSA scintigraphy in the detection of medullary thyroid tumor foci in patients with elevated levels of tumor markers after surgery.

PURPOSE: In this retrospective study, the authors evaluated the utility of In-111 octreotide (OctreoScan) and Tc-99m (V) DMSA scintigraphy for the localization of recurrent metastatic tumor foci in patients with medullary thyroid cancer (MTC) and compared the findings with those of conventional radiologic imaging methods. METHODS: The scintigraphic images were compared with computed tomography (CT) and magnetic resonance imaging (MRI) and ultrasonography (US) in 14 patients (8 men, 6 women; age range, 22 to 74 years) with elevated calcitonin and carcinoembryonic antigen levels after total thyroidectomy. All scintigraphic image findings were evaluated qualitatively as mild uptake (+) and moderate to marked uptake (++). RESULTS: In-111 octreotide may be superior to Tc-99m (V) DMSA for the detection of tumor foci of patients with MTC on a patient basis (78.5% versus 57.1%) and on a lesion basis (44.1% versus 30.2%). The sensitivity rate for In-111 octreotide (78.5%) was also similar to that of CT and MRI on a patient basis. Conversely, the combined use of Tc-99m (V) DMSA and In-111 octreotide revealed the best sensitivity rate (85.7%) on a patient basis, whereas the combined use of CT and MRI showed the best sensitivity rate (81.3%) on a lesion basis. CONCLUSIONS: These findings suggest that In-111 octreotide is superior to Tc-99m (V) DMSA and has a similar sensitivity rate to CT and MRI for the diagnosis of recurrent or metastatic MTC. Although the combined use of In-111 octreotide and Tc-99m (V) DMSA was most sensitive, the combined use of CT and MRI with radionuclide imaging methods may better detect more metastatic tumor foci.