Classification and volumetric study of the sphenoid sinus on MDCT images.

PURPOSE: We aimed to determine the position and size of the sphenoid sinus (SS) in our study and compare the results of the measurements relative to age, gender, and the presence of pituitary adenoma using multidetector computerized tomography (MDCT). METHODS: We retrospectively evaluated the paranasal sinus computerized tomography (CT) images of 200 individuals (age range of all the individuals 4-84 years; 101 females, 99 males; age range of individuals with pituitary adenoma 15-63 years; 15 females, 9 males) with 24 pituitary adenomas. The shape of SS were identified and classified, volume were measured by MDCT also for individuals with pituitary adenoma. RESULTS: It was determined that the volume averages were significantly affected by the type of SS. Among all the individuals studied, the sellar type of SS was most frequently observed (41.5%), followed by the postsellar type (38.5%), and the least observed was the presellar type (9%). The volume of the SS is bigger in males than females although the volume is not affected by the presence of pituitary adenomas. The development of the SS continues until the age of nine. CONCLUSION: The morphology and morphometry of the SS show individual differences. These anatomic variations are important for decision making and application for surgical interventions (especially transsphenoidal surgery).

The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans.

INTRODUCTION: The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. OBJECTIVE: The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning. METHODS: This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625mm of 250 adults. RESULTS: The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p<0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p<0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p<0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05±7.71°. CONCLUSIONS: Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.

Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches.

INTRODUCTION: Radiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit. OBJECTIVE: The goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry. METHODS: This retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations. RESULTS: Lamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14mm, 147.88° and 9.6mm, 152.72°, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3mm, 7.2cm2, 6.89cm2, 4.51cm2 and 12.46cm2 respectively. The orbital height and width were measured as 35.9mm and 39.2mm respectively. The mean orbital cavity depth was 46.3mm from optic foramen to the orbital entrance and the orbital volume was 19.29cm3. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types. CONCLUSION: Precise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.

Evaluation of the facet joints with magnetic resonance images in the patients with disc degeneration and spondylolisthesis.

PURPOSE: We aimed to research in detail the morphology of the facet orientation (FO) and tropism (FT) in degenerative diseases. METHOD: This study consisted of patients with disc degeneration (DD) and with lumbar spondylolisthesis (LS) as well as a control group without these two diseases. The group of patients with DD was separated by DD grades. Vertebral body and intervertebral discs' (IVDs) morphometric values, facet joint osteoarthritis (OA) grading, FO and FT were examined in all the groups. All measurements were applied to MRIs of 353 patients. RESULT: There was a significant difference in facet angle values between the groups at L4-L5 (FO: p = 0.001). There was a significant negative correlation between FO at L4-L5 and L4 vertebral body anterior posterior diameter and L5 mid-vertebral body height, in 353 patients (p = 0.003; p = 0.010). Facet joint OA grading scores were lower in the control group than in the disc degeneration patient (DDP) and LS groups (p < 0.05). Sagittal FO was seen with the increase of facet joint OA scores at L4-L5 in the control and DDP groups (control: p = 0.001; DDP: p = 0.40). CONCLUSION: Facet joints can show different orientation values in LS and DDP groups at L4-L5. The presence of FT is a risk factor for an LS patient at L4-L5. Sagittal FO is seen with vertebral slip at L5-S1. FO is affected by the morphometric changes of the vertebral body at L4-L5. Discussions in this regard need to be resolved through further research.

Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery.

INTRODUCTION: The course of the infraorbital canal may leave the infraorbital nerve susceptible to injury during reconstructive and endoscopic surgery, particularly when surgically manipulating the roof of the maxillary sinus. OBJECTIVE: We investigated both the morphometry and variations of the infraorbital canal with the aim to show the relationship between them relative to endoscopic approaches. METHODS: This retrospective study was performed on paranasal multidetector computed tomography images of 200 patients. RESULTS: The infraorbital canal corpus types were categorized as Type 1: within the maxillary bony roof (55.3%), Type 2: partially protruding into maxillary sinus (26.7%), Type 3: within the maxillary sinus (9.5%), Type 4: located anatomically at the outer limit of the zygomatic recess of the maxillary bone (8.5%). The internal angulation and the length of the infraorbital canal, the infraorbital foramen entry angles and the distances related to the infraorbital foramen localization were measured and their relationships with the infraorbital canal variations were analyzed. We reported that the internal angulations in both sagittal and axial sections were mostly found in infraorbital canal Type 1 and 4 (69.2%, 64.7%) but, there were commonly no angulation in Type 3 (68.4%) (p<0.001). The length of the infraorbital canal and the distances from the infraorbital foramen to the infraorbital rim and piriform aperture was measured as the longest in Type 3 and the smallest in Type 1 (p<0.001). The sagittal infraorbital foramen entry angles were detected significantly smaller in Type 3 and larger in Type 1 than that in other types (p=0.003). The maxillary sinus septa and the Haller cell were observed in 28% and 16% of the images, respectively. CONCLUSION: Precise knowledge of the infraorbital canal corpus types and relationship with the morphometry allow surgeons to choose an appropriate surgical approach to avoid iatrogenic infraorbital nerve injury.

Sphenoethmoid Cell: The Battle for Places Inside of the Nose Between a Posterior Ethmoid Cell and Sphenoid Sinus: 3D-Volumetric Quantification.

BACKGROUND: Sphenoethmoid cells may be above the sphenoid sinus with/ or without con-tact to optical nerve. Although sphenoethmoid cells are theoretically considered to possibly influence the sphenoid sinus volume, we could not find any study in the literature on this issue. AIMS: The aim of our study was to detect sphenoethmoid cells and measure the sphenoid sinus vol-ume using multiplanar computerized tomography and also investigate the correlation between the presence of sphenoethmoid cells and the sphenoid sinus volume. METHODS: Retrospectively 141 patients who had available paranasal computerized tomography images were included in this study. The sphenoid sinus volumes of each patient were calculated individually for each side, and the relationship between the presence of sphenoethmoid cell and sphenoid sinus volume was investigated. RESULTS: Sphenoethmoid cells were detected at 106 (37.5%) of the total 282 sides in 141 patients. No gender difference was observed. The total sphenoid sinus volume was significantly lower in the group of patients who had bilateral sphenoethmoid cells than in the sphenoethmoid cell negative group. In patients with a unilateral sphenoethmoid cell, a significant decrease in the sphenoid sinus volume was observed only for the side where the sphenoethmoid cell was located. CONCLUSION: It was observed that the sphenoethmoid cells caused a significant reduction in the sphe-noid sinus volume on the side where they were located. In the case of low sphenoid sinus aeration, the sphenoethmoid cell should be kept in mind. Further studies with an extended patient series are required to explore this issue.

[Co-occurrence of Carpenter syndrome and double outlet right ventricle]. / Carpenter sendromu ve çift çikisli sag ventrikül birlikteligi.

Carpenter syndrome (Acrocephalopolysyndactyly type 2, OMIM 201000) is a rarely seen autosomal recessive disorder. In addition to abnormalities such as acrocephaly, craniosynostosis, facial asymmetry, polydactyly and syndactyly, obesity, hypogonadism, mental retardation, and corneal opacity, it may frequently be accompanied by congenital heart diseases such as ventricular septal defect, patent ductus arteriosus and pulmonary stenosis. Double outlet right ventricle is a defect in which both major arteries originate in the morphological right ventricle. To the best of our knowledge, this is the first report in the literature of double outlet right ventricle disease in combination with Carpenter syndrome.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning / Papel das células de Onodi na esfenoidite: resultados da tomografia computadorizada com reconstrução multiplanar

Abstract Introduction Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. Objective To evaluate the effect of Onodi cells on the frequency of sphenoiditis. Methods A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. Results Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n = 73) were ipsilaterally (n = 21) or bilaterally (n = 52) Onodi-positive, whereas 39.7% (n = 48) were Onodi-negative (n = 35) or only contralaterally Onodi-positive (n = 13). Of the control group, 48.3% (n = 240) were Onodi-positive and 51.7% (n = 257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p < 0.05). Conclusion The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Resumo Introdução As células de Onodi são as células etmoidais mais posteriores, que se prolongam superolateralmente ao seio esfenoidal. Essas células também se encontram em íntima relação com o seio esfenoidal, o nervo óptico e a artéria carótida. Para análise de variações anatômicas antes da implantação de qualquer modalidade terapêutica relacionada ao seio esfenoidal, a avaliação radiológica é obrigatória, Objetivo Nosso objetivo foi avaliar o papel das células de Onodi na frequência de esfenoidite. Método Em nosso estudo, foi feita uma análise retrospectiva em 618 pacientes adultos que se submeteram à tomografia computadorizada de alta resolução entre janeiro de 2013 e janeiro de 2015. Avaliamos a prevalência de células de Onodi e de esfenoidite. Investigamos se a presença de células de Onodi leva a um aumento na prevalência de esfenoidite. Resultados A positividade para células de Onodi foi observada em 326 de 618 pacientes e sua prevalência foi de 52,7%. No grupo de estudo, 60,3% (n = 73) eram CO-positivas: ipsilateral (n = 21) ou bilateralmente (n = 52); e 39,7% (n = 48) eram CO-negativas (n = 35) ou apenas contralateralmente CO-positivas (n = 13). No grupo de controle, 48,3% (n = 240) eram CO-positivas; e 51,7% (n = 257) eram CO-negativas. Observamos que a coexistência de CO ipsilateralmente aumentava em 1,5 vez a associação com esfenoidite e esse achado foi estatisticamente significante (p < 0,05). Conclusão A prevalência de esfenoidite parece ser maior em pacientes com células de Onodi, mas não é possível afirmar que elas são isoladamente o fator causador dessa doença. Novos estudos precisam ser feitos para uma investigação dos fatores contributivos relacionados à esfenoidite.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning.

INTRODUCTION: Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. OBJECTIVE: To evaluate the effect of Onodi cells on the frequency of sphenoiditis. METHODS: A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. RESULTS: Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n=73) were ipsilaterally (n=21) or bilaterally (n=52) Onodi-positive, whereas 39.7% (n=48) were Onodi-negative (n=35) or only contralaterally Onodi-positive (n=13). Of the control group, 48.3% (n=240) were Onodi-positive and 51.7% (n=257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p<0.05). CONCLUSION: The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Hydatid Cyst of the Posterior Cervical Region.

Hydatid cyst is an endemically seen parasitic disease and caused by the larval form of Echinococcus parasites. The disease is mostly seen in liver and lung, and the other involvement is rarely seen. Head and neck involvement is extremely rarely seen and its frequency in the literature is reported as less than 1%. It is usually asymptomatic and the symptoms are related to the compression to the adjacent structures. In this paper, the authors report a patient of hydatid cyst localized in the posterior cervical region.

Appendix Invagination Mimicking Ileocecal Intussusception in a Pediatric Patient: A Case Report.

BACKGROUND: Appendix invagination is a rare cause of right lower quadrant abdominal pain. Clinical findings are not specific and can mimic a wide range of diseases. CASE REPORT: An 8-year-old girl was admitted with abdominal pain lasting for 2 weeks. Clinical and radiologic findings suggested ileocecal intussusception initially. A failed hydrostatic reduction attempt and subsequent abdominal ultrasound and computed tomography studies showed that the underlying pathology was invagination of the vermiform appendix. The patient was managed conservatively and spontaneous reduction was observed during follow-up. She underwent appendectomy 9 months later due to chronic appendicitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Appendix invagination should be kept in mind while evaluating patients with suspected ileocecal intussusception. In distinguishing between these two conditions, a blind-ending invaginating segment is an important clue in favor of appendix intussusception.

Splenic artery embolization with Ankaferd blood stopper in a sheep model.

PURPOSE: Splenic artery embolization is a minimally invasive therapeutic procedure utilized in a number of disorders. Ankaferd blood stopper (ABS) is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We aimed to investigate the safety and efficiency of ABS for splenic artery embolization in a sheep model. METHODS: Seven adult female sheep were included in the study. Selective celiac angiography was performed using a 5F diagnostic catheter and then a 2.7F hydrophilic coating microcatheter was advanced coaxially to the distal part of the main splenic artery. Under fluoroscopic guidance, 6 mL mixture composed of half-and-half ABS and contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration and stagnation of the flow. Control celiac angiograms were obtained immediately after the embolization. After the procedure, the animals were observed for one day and then sacrificed with intravenous sodium thiopental. RESULTS: Technical success rate was 100%. None of the animals died or experienced a major systemic adverse event during the procedure. All of the spleens appeared dark on macroscopic examination due to excessive thrombosis. Microscopically, the majority of the splenic sinusoids (90%-95%) were necrotic. CONCLUSION: In our study, splenic artery embolization by ABS was found to be safe and effective in the short-term. Further studies are needed to better understand the embolizing potential of this novel hemostatic agent.

Quantitative Assessment of Left Ventricular Function and Myocardial Mass: A Comparison of Coronary CT Angiography with Cardiac MRI and Echocardiography.

BACKGROUND: The purpose of this study was to compare the left ventricular parameters obtained from multi-detector row computed tomography (MDCT) studies with two-dimensional echocardiography (2DE), and magnetic resonance imaging (MRI), which is accepted as the gold standard in the evaluation of left ventricular functions. The study also aimed to evaluate whether or not there is a relationship between the MR-Argus and CMR tools software programs which are used in post-process calculations of data obtained by MRI. MATERIAL/METHODS: Forty patients with an average age of 51.4±14.9 years who had been scanned with cardiac MDCT were evaluated with cardiac MRI and 2DE. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), and myocardial mass values calculated by MDCT, MRI, and 2DE were compared with each other. Two different MR software programs were used to compare left ventricular functions. The CMR tools LV tutorials method is accepted as the gold standard because it can be used in three-dimensional functional evaluation. The Pearson Correlation and Bland-Altman analysis were performed to compare the results from the two MR methods (MR-Argus and CMR tools) and the results from both the MDCT and the 2DE with the CMR tools results. RESULTS: Strong positive correlations for EF values were found between the MDCT and CMR tools (r=0.702 p<0.001), and between the MR-Argus and CMR tools (r=0.746 p<0.001). The correlation between the 2DE and CMR tools (r=0.449 p<0.004), however, was only moderate. Similar results were obtained for the other parameters. The strongest correlation for ESV, EDV, and EF was between the two MR software programs. The correlation coefficient between the MDCT and CMR tools is close to the correlation coefficient between the two software programs. While the correlation between 2DE and CMR tools was satisfactory for ESV, EDV, and CO values, it was at a moderate level for the other parameters. CONCLUSIONS: Left ventricular functional analysis can be performed easily and reliably with cardiac MDCT used for coronary artery evaluation and it also gives more accurate results than 2DE.

A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience.

PURPOSE: We aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts. METHODS: Percutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates. RESULTS: Out of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374). CONCLUSION: This novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations.

Amyand's Hernia: Ultrasonography Findings.

BACKGROUND: Amyand's hernia is described as the presence of an appendix vermiformis in the inguinal hernia sac. The incidence of Amyand's hernia is approximately 1% of all inguinal hernias. Amyand's hernia is diagnosed intraoperatively or preoperatively with radiologic examinations. CASE REPORT: Two cases of Amyand's hernia, with and without acute appendicitis, are reported here. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Amyand's hernia is a rare entity, and physical signs, laboratory results, and symptoms are not always helpful in diagnosis. Preoperative diagnosis of Amyand's hernia is not straightforward, and is generally an incidental finding during surgery. Imaging modalities, including ultrasound, can be very useful for making this rare diagnosis.

Synovial Hemangioma of the Knee Joint: Magnetic Resonance Imaging Findings.

BACKGROUND: Synovial hemangioma is benign tumor of the joints and is seen relatively rare. The most affected joint is knee but should also be seen in other joints. The disease is usually symptomatic. They are classified as juxta-articular haemangioma, intra-articular haemangioma or an intermediate type of hemangioma with intra- and extraarticular components. CASE REPORT: A 19-years-old male patient presented with swollen and painful knee. The laboratory findings and physical examination were normal. MRI demonstrated a large lesion that was filling the suprapatellar bursa. CONCLUSIONS: All radiologic examinations should be used in diagnosis but magnetic resonance imaging is the non-invasive method and excellent modality in the evaluation of soft tissues. In this paper, a 19-year-old male patient with the diagnosis of synovial hemangioma is reported and its radiologic findings are mentioned.