MRI radiomics based machine learning model of the periaqueductal gray matter in migraine patients.

Background and purpose:

The aim of the study was to investigate the question: Can MRI radiomics analysis of the periaqueductal gray region elucidate the pathophysiological mechanisms underlying various migraine subtypes, and can a machine learning model using these radiomics features accurately differentiate between migraine patients and healthy individuals, as well as between migraine subtypes, including atypical cases with overlapping symptoms?

The study analyzed initial MRI images of individuals taken after their first migraine diagnosis, and additional MRI scans were acquired from healthy subjects. Radiomics modeling was applied to analyze all the MRI images in the periaqueductal gray region. The dataset was randomized, and oversampling was used if there was class imbalance between groups. The optimal algorithm-based feature selection method was employed to select the most important 5-10 features to differentiate between the two groups. The classification performance of AI algorithms was evaluated using receiver operating characteristic analysis to calculate the area under the curve, classification accuracy, sensitivity, and specificity values. Participants were required to have a confirmed diagnosis of either episodic migraine, probable migraine, or chronic migraine. Patients with aura, those who used migraine-preventive medication within the past six months, or had chronic illnesses, psychiatric disorders, cerebrovascular conditions, neoplastic diseases, or other headache types were excluded from the study. Additionally, 102 healthy subjects who met the inclusion and exclusion criteria were included. 

The algorithm-based information gain method for feature reduction had the best performance among all methods, with the first-order, gray-level size zone matrix, and gray-level co-occurrence matrix classes being the dominant feature classes. The machine learning model correctly classified 82.4% of migraine patients from healthy subjects. Within the migraine group, 74.1% of the episodic migraine-probable migraine patients and 90.5% of the chronic migraine patients were accurately classified. No significant difference was found between probable migraine and episodic migraine patients in terms of the periaqueductal gray region radiomics features. The kNN algorithm showed the best performance for classifying episodic migraine-probable migraine subtypes, while the Random Forest algorithm demonstrated the best performance for classifying the migraine group and chronic migraine subtype.

A radiomics-based machine learning model, utilizing standard MR images obtained during the diagnosis and follow-up of migraine patients, shows promise not only in aiding migraine diagnosis and classification for clinical approach, but also in understanding the neurological mechanisms underlying migraines. 

Multiple primary intraosseous meningioma mimicking fibrous dysplasia: a case report.

Primary intraosseous meningioma (PIM) is a rare subtype of primary extradural meningiomas. These rare ectopic meningiomas have been usually reported in the frontotemporal regions of the calvarium, orbits, and anterior cranial fossa. We report a case with bilateral tumors located in frontoparietal regions of calvarium. Our initial diagnosis was fibrous dysplasia but the lesions were seen to expand under follow-up. One was resected and the histopathological diagnosis was PIM. This is the second reported case of multiple PIM.

Proton magnetic resonance spectroscopic analysis of changes in brain metabolites following electroconvulsive therapy in patients with major depressive disorder.

Objectives: The aim of this study was to evaluate the metabolic changes in the anterior cingulate cortex (ACC) induced by electroconvulsive therapy (ECT) in patients with MDD via 1H-MRS.Methods: The study was conducted on 13 MDD patients receiving ECT treatment and 14 healthy controls matched in terms of age, gender and education. The patients underwent six sessions of ECT. 1H-MRS imaging and psychometric evaluations obtained before 1st and after the 6th sessions. The control group also went through the same procedures except for ECT. N-Acetyl aspartate (NAA), choline (Cho) and creatine (Cr) metabolite levels and the creatine to metabolite ratios were measured.Results: There was no significant difference in the ACC metabolite levels of the patients and those of the controls at the baseline. ECT associated with a statistically significant decrease in the NAA/Cr ratio in ACC. All of the patients had responded to ECT treatment as measured with the clinical scales.Conclusions: The results has suggested that indirect proof of an increase in energy metabolism without any evidence of impaired neuronal viability in the ACC induced by ECT. The relative increase in Cr levels following ECT in MDD seems to be associated with improvement in clinical severity.Key pointsECT is one the most effective method in the treatment of acute MDD.The mechanism of ECT's antidepressant activity remains unclear but it is thought to be related to the regulation of prefrontal cortical or cingulate areas.In this study the patients underwent six sessions of ECT and after 1H-MRS imaging.The study revealed that baseline levels of metabolites in patients with MDD were not significantly different than those of control group.

FAM160B1 deficit associated with microcephaly, severe intellectual disability, ataxia, behavioral abnormalities and speech problems.

Intellectual disability (ID) varies in severity and is often associated with a variety of other clinical features. In consanguineous populations ID is usually inherited in an autosomal recessive fashion. Many genes are known for the condition, but many more are yet to be identified. By linkage analysis and exome sequencing we identified homozygous early truncating variant c.115G > T (p.Glu39*) in FAM160B1 in a 38-year-old woman with severe ID, microcephaly, behavioral abnormalities, speech problems, mild ataxia and mild facial dysmorphism. Recently homozygous missense c.248 T > C (p.Leu83Pro) was reported to underlie the ID syndrome in a 7-year-old boy and his two younger siblings. Some findings for those siblings overlap with those for our patient, but our patient does not have cutis laxa. Our findings confirm FAM160B1, with unknown function, as a syndromic ID gene and indicate that FAM160B1 is not essential for survival but is vital for proper functioning of the nervous system, delineate the FAM160B1-related ID, and describe the disease in a much older age.

Bilateral sudden sensorineural hearing loss caused by leptomeningeal carcinomatosis: case report and review.

Leptomeningeal carcinomatosis is a rare condition characterized by diffuse infiltration of the meninges after the metastasis of the solid tumors. Bilateral sudden hearing loss is a rare initial symptom. In this article, we report a 44-year-old male patient with bilateral sudden hearing loss and dizziness. Magnetic resonance imaging showed involvement of the bilateral vestibulocochlear nerves. Malignant cells were detected in cerebrospinal fluid cytology. To the best of our knowledge, leptomeningeal carcinomatosis due to duodenum adenocarcinoma has not been reported before in the English literature. Leptomeningeal carcinomatosis should be kept in mind in patients who have bilateral sudden sensorineural hearing loss.

Differentiation of lymphoma versus sarcoidosis in the setting of mediastinal-hilar lymphadenopathy: assessment with diffusion-weighted MR imaging.

OBJECTIVES: To determine the performance of diffusion-weighted magnetic resonance imaging in differentiating lymphoma from sarcoidosis in mediastinal-hilar lymphadenopathy. MATERIALS AND METHODS: Forty-four mediastinal-hilar lymphadenopathy were examined in 27 patients with T1- and T2-weighted conventional images. Then, two diffusion-weighted images were obtained with b = 0 and 1000 s/mm2 values and apparent diffusion coefficients (ADCs) were calculated. The statistical significance of differences between measurements was tested using the Student-t test. RESULTS: The ADC value in the lymphoma group was lower than in the sarcoidosis group, and the difference was statistically significant (p < 0.001). By using the cut-off value of 1.266 x 10(-3) mm2/s, ADC had a sensitivity of 100%, specificity of 81%, positive predictive value of 100%, and negative predictive value of 77% for the differentiation of lymphoma and sarcoidosis. With the cut-off value of 1,97 x 10(-3) mm2/s, ADC had a sensitivity of 50%, specificity of 99.4%, positive predictive value of 68%, and negative predictive value of 91%. CONCLUSIONS: Diffusion-weighted imaging may be useful besides other modalities in differentiating lymphoma from sarcoidosis in mediastinal-hilar lymphadenopathy.

Preoperative evaluation of myometrial invasion in endometrial carcinoma: diagnostic performance of 3T MRI.

PURPOSE: To evaluate the diagnostic accuracy of 3T MRI in preoperative staging of myometrial invasion. METHODS: Twenty-eight women with histological diagnosis of endometrial carcinoma were included in this prospective study. After T2-W SS-TSE and DWI, dynamic series of T1-W THRIVE images were obtained (0-180 s) followed by a T1-W THRIVE sequence in the late phase (5th min). For detection of deep myometrial infiltration: sensitivity, specificity, PPV, NPV, and accuracy were calculated on T2-W, postcontrast early arterial and late phase T1-W, and DWI. For the quantitative analysis of DWI, ADC values of the tumor were calculated and correlated with histologic grade. For the quantitative evaluation of dynamic series, SI-time curves were obtained and the maximum relative enhancement, wash-in rate, time-to-peak, and wash-out rate of masses and myometrium were compared. RESULTS: T2-W and early phase contrast-enhanced sequences obtained sensitivity 100 %, specificity 76 %, PPV 58 %, NPV 100 %, and accuracy 82 %; late-phase contrast-enhanced images obtained sensitivity 100 %, specificity 81 %, PPV 64 %, NPV 100 %, and accuracy 86 %; DWI obtained lower accuracy [sensitivity 71 %, specificity 62 %, PPV 38 %, NPV 87 %, and accuary 57 %] than T2-W and postcontrast images. The MRE of carcinomas were significantly lower than those of the myometrium. This analysis showed a significant improvement in tumor versus myometrium contrast during the late phase. On DWI, the mean ADC value of tumor was 1.02 ± 0.48 × 10(-3). There was no statistically significant correlation between tumor grades and ADCs. CONCLUSIONS: As the 3T MRI scanner allows high-resolution images, accurate assessment of myometrial infiltration can be done especially with postcontrast late phase images.

Solitary angiokeratoma of the tongue in an adult patient treated with intensity modulated radiation therapy.

A solitary mucosal angiokeratoma is an extremely rare presentation. In this report, we present a 67-year-old woman with a 3 cm solitary angiokeratoma involving the tongue, who was treated with intensity modulated radiation therapy after declining surgery. The patient is alive and free of disease at 1.5 years following radiation therapy.

Treatment for painful bone marrow edema by open wedge tibial osteotomy.

We evaluated the results of patients who had undergone medial open wedge proximal tibial osteotomy, with painful bone marrow edema in the medial tibial plateau. The study included 21 patients who had presented with knee pain and whose MRIs showed bone marrow edema in medial plateau. The degree of osteoarthritis was evaluated radiologically according to the Kellgren-Lawrence criteria; 6 cases were Grade 1, 11 cases were Grade 2, and 3 cases were Grade 3. Preoperative varus angle was a mean of 2.19° (0-4). The bone marrow edema was classified according to the width of the lesions extending into the joint surface subchondral area on MRI T2 sequences. Open wedge osteotomy was performed in all patients. The postoperative results were evaluated by X-ray, MRI, and WOMAC (Western Ontario and McMaster Universities) knee scores. The preoperative 2.19° varus angle was evaluated postoperatively as valgus 6.57° (4-8°) (p < 0.05). The postoperative WOMAC knee scores revealed a significant decrease in pain (p < 0.05). In conclusion, we are of the opinion that medial open wedge proximal tibial osteotomy is an effective treatment in patients who have painful bone marrow edema in medial tibia plateau.

Malignant versus benign mediastinal lesions: quantitative assessment with diffusion weighted MR imaging.

OBJECTIVES: We aimed to evaluate the performance of diffusion-weighted magnetic resonance imaging in differentiating malignant from benign mediastinal lesions. METHODS: Fifty-three mediastinal lesions were examined with T1- and T2-weighted (W) conventional images. Then, two diffusion-weighted images were obtained with b = 0 and 1000 s/mm² values and apparent diffusion coefficients (ADC) were calculated. The statistical significance of differences between measurements was tested using the Student-t test. RESULTS: The mean ADC of malignant lesions was significantly lower than that of the benign masses (p < 0.001). The cut-off value of ≤ 1.39 × 10(-3) mm²/s indicated a malignant lesion with a sensitivity of 95% and specificity of 87%. CONCLUSION: Diffusion-weighted imaging may be helpful in differentiating benign from malignant mediastinal masses.

A rare tumor of nasal bone in a child: osteoblastoma.

Benign osteoblastoma is an uncommon bone tumor, representing 1% of all benign tumors and 3% of all primary bone tumors. Intranasal or paranasal osteoblastoma is particularly rare. Osteoblastoma occurs more frequently in males, at a peak age between 10 and 20 years. We report an osteoblastoma of the nasal septum in an 11-year-old boy who presented with swelling of the nasal septum. The diagnosis and management of this unusual lesion, as well as the histopathology and imaging characteristics, are reviewed. Magnetic resonance imaging (MRI) revealed a solid midline nasal mass originating from the septum with intense contrast enhancement. There was no evidence of osteoid or chondroid matrix mineralization on computed tomography (CT). Biopsy was performed. Histologically, the tumor contained abundant plump osteoblast-like cells, with eosinophilic cytoplasm and large nuclei that were frequently juxtaposed to the newly formed osteoid. Conservative excision was performed. The literature concerning occurrence of osteoblastoma in this unusual location is reviewed.

Diffusion weighted MR imaging in the differential diagnosis of haemangiomas and metastases of the liver.

BACKGROUND: The purpose of the study was to evaluate the value of diffusion-weighted imaging in the differential diagnosis of haemangiomas from metastases of the liver. PATIENTS AND METHODS.: We analyzed 69 lesions in 38 patients (33 haemangiomas; 36 metastases) in the retrospective study. Diffusion-weighted imaging was performed using a breath-hold single-shot echo-planar spin echo sequence with three b factors (0, 500 and 1000 sec/mm(2)), and apparent diffusion coefficients (ADCs) were calculated. For the quantitative evaluation, signal intensity of the lesions, lesion-to-liver signal intensity ratios, ADC of the lesions, and lesion-to-liver ADC ratios were compared between the groups. The statistical significance was determined by student's-t test. RESULTS: With the b factor 500 sec/mm(2), no statistical significance was achieved (p>0.05). With the b factor of 1000 sec/mm(2), both the signal intensity and lesion-to-liver signal intensity ratio of the metastases were significantly higher than those for haemangiomas (p<0.001). The cut-off value at 2.6 yielded a sensitivity of 86% and a specificity of 82% for the lesion-to-liver signal intensity ratio. The ADC, and lesion-to-liver ADC ratio of the metastases were significantly lower than those of haemangiomas (p<0.001). With cut-off value of 1.7, ADC ratio had a sensitivity of 88% and a specificity of 72% for ADC lesion/liver. CONCLUSIONS: Diffusion-weighted imaging with high b value may help in the differential diagnosis of metastases from haemangiomas of the liver.

A case of Jarcho-Levin syndrome associated with bilateral cystic renal disease and wilms tumor: MR imaging findings.

Jarcho-Levin syndrome (JLS) is a congenital disorder characterized by a variety of vertebral and costal anomalies that result in thoracic deformity. Hitherto, a plethora of associated anomalies have been described in several reports. In this report, the authors describe a case of JLS who has Wilms tumor and bilateral cystic renal disease. To the authors' knowledge, there is only a single case of JLS who presented with multiple renal cortical cysts, but none with an associated Wilms tumor in the literature. Additional anomalies seen in the present case that are related with this syndrome are also discussed.

More than Ophelia syndrome: Multiple paraneoplastic syndromes in pediatric Hodgkin lymphoma.

Demirsoy U, Alparslan B, Sen MC, Anik Y, Akansel G, Görür G, Gürel B, Aksu G, Çorapçioglu F. More than Ophelia syndrome: Multiple paraneoplastic syndromes in pediatric Hodgkin lymphoma. Turk J Pediatr 2019; 61: 139-141. Paraneoplastic syndromes in Hodgkin lymphoma (HL) can be seen with different symptoms and organ findings within a significant time before definite diagnosis of the primary disease. Achalasia, Holmes-Adie pupil, and limbic encephalitis are rarely reported paraneoplastic components in pediatric HL. In this report, we present an 11-year-old girl who had all these three paraneoplastic components synchronously before HL was identified.

Diffusion-weighted imaging in the differential diagnosis of cystic lesions of the pancreas.

OBJECTIVE: The purpose of our study was to evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of pancreatic cysts. SUBJECTS AND METHODS: Forty-two cysts (16 simple cysts, seven pseudocysts, five abscesses, three hydatid cysts, two serous cystadenomas, three mucinous cystadenomas, two mucinous cystadenocarcinomas, four cystic degenerated adenocarcinomas) were included in this prospective study. Single-shot spin-echo echo-planar DWI was performed with three b factors (0, 500, and 1,000 s/mm(2)), and apparent diffusion coefficients (ADCs) were calculated. On DWI, the signal intensity of the cysts was visually compared with the signal intensity of the pancreas parenchyma. For the quantitative evaluation, cyst-to-pancreas signal intensity ratios, ADC of the lesions, and cyst-to-pancreas ADC ratios were compared. RESULTS: On visual evaluation, all cystic lesions were hyperintense on DWI with b factors of 0 and 500 s/mm(2). On DWI with a b factor of 1,000 s/mm(2), all abscesses and hydatid and neoplastic cysts were hyperintense, whereas most of the simple and pseudocysts were isointense. Quantitatively, with b factors of 0 and 500 s/mm(2), no statistical significance was achieved. With a b factor of 1,000 s/mm(2), the cyst-to-pancreas signal intensity ratios of the abscesses and hydatid and neoplastic cysts were significantly higher than those of the simple cysts and pseudocysts. Setting the cutoff value of signal intensity ratio at 1.9, the cyst-to-pancreas signal intensity ratio had a sensitivity of 70% and a specificity of 90% for differentiating abscesses, hydatid cysts, and neoplastic cysts from simple cysts and pseudocysts. The ADC and the ADC ratios of the abscesses, hydatid cysts, and neoplastic cysts were significantly lower than those of the simple cysts and pseudocysts. CONCLUSION: DWI may help in the differential diagnosis of pancreatic cysts.

Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses.

OBJECTIVE: To evaluate the value of dynamic MR imaging in the differential diagnosis of adrenal adenomas and malignant tumors, especially in cases with atypical adenomas. MATERIALS AND METHODS: Sixty-four masses (48 adenomas, 16 malignant tumors) were included in this prospective study. Signal loss of masses was evaluated using chemical shift MR imaging. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, with the acquisition starting simultaneously with i.v. contrast administration (0-100 s) followed by a T1-weighted FFE sequence in the late phase (5th minute). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained according to the SIs on the 0th, 25th, 50th 75th and 100th second. Also, the wash-in rate, maximum relative enhancement, time-to-peak, and wash-out of contrast at 100 s of masses in both groups were calculated. The statistical significance was determined by Mann-Whitney U test. To evaluate the diagnostic performance of the quantitative tests, receiver operating characteristic (ROC) analysis was performed. RESULTS: Chemical shift MR imaging was able to differentiate 44 out of 48 adenomas (91.7%) from non-adenomas. The 4 adenomas (8.3%) which could not be differentiated from non-adenomas by this technique did not exhibit signal loss on out-of-phase images. With a cut-off value of 30, SI indices of adenomas had a sensitivity of 93.8%, specificity of 100% and a positive predictive value of 100%. On visual evaluation of dynamic MR imaging, early phase contrast enhancement patterns were homogeneous in 75% and punctate in 20,83% of the adenomas; while patchy in 56.25% and peripheral in 25% of the malignant tumors. On the late phase images 58.33% of the adenomas showed peripheral ring-shaped enhancement and 10.41% showed heterogeneous enhancement. All of the malignant masses showed heterogeneous enhancement. At the 25th second, the SIs and wash-in rates of the adenomas were significantly higher than those of the malignant masses (p=0.010). Time-to-peak enhancement of the malignant masses was significantly longer than that of the adenomas. With a cut-off value of 52.85 s, the time-to-peak enhancement had 87.5% sensitivity and 80% specificity. CONCLUSION: Chemical shift MR has a high sensitivity and specificity in the differential diagnosis of adenomas and malignant adrenal masses. However, taking into consideration only the atypical adenomas, chemical shift MRI is of no diagnostic value. Although the diagnostic value of dynamic MRI is lower than chemical shift MRI, in the atypical cases contrast enhancement patterns and time-to-peak and wash-in rates derived from SI-time curve of dynamic MRI give are contributory to the results of chemical shift MRI.

Color Doppler ultrasonographic flow parameters in the differentiation of benign and malignant causes of omental thickening.

OBJECTIVE: The purpose of the study was to determine if color Doppler ultrasonographic (US) quantitative flow parameters are valuable to differentiate malignant peritoneal or omental involvement from benign causes. MATERIALS AND METHODS: Twenty-six consecutive patients with peritoneal or omental thickening detected by gray scale US, computed tomography, and magnetic resonance underwent color Doppler US examinations. All the Doppler signal waveforms were recorded, and resistive (RI) and pulsatility indices (PI) were calculated automatically by the US machine. In the statistical analysis of RI and PI, unpaired t test was used. A P < 0.05 was considered significant. RESULTS: Nineteen of 20 malignant and 5 of 6 benign lesions had detectable color Doppler US pulsatile flow signals. The mean RI and PI values were 0.6260 and 1.36, respectively, for the benign group and 0.5384 and 1.4147, respectively, for the malignant group. For malignant lesions, mean RI was lower (P = 0.0796), and mean PI was higher (P = 0.9183) than benign lesions. However, these differences were not statistically significant. CONCLUSIONS: Overlapping RI and PI values in benign and malignant omental lesions limit the clinical value of flow parameters in the differentiation of benign and malignant involvement of the omentum.

Unusual magnetic resonance image of an insulinoma with extensive desmoplastic reaction.

CONTEXT: Unlike other islet-cell tumors, insulinomas are usually benign. Most insulinomas have a high signal intensity on T2-weighted images and a low signal intensity on T1-weighted images, and are hyperintense on immediate post-gadolinium images. However, in rare cases, insulinomas may be hypointense on T2-weighted images and on immediate post-gadolinium images, mimicking a ductal adenocarcinoma. CASE REPORT: We present a case of a surgically proven insulinoma which was hypointense on both T2-weighted and immediate post-gadolinium T1-weighted images, but hyperintense on late phase T1-weighted images. Histopathological examination of the surgical specimen revealed a prominent desmoplastic reaction which accounted for the low signal on T2-weighted images and the contrast enhancement pattern. Delayed contrast enhancement reflects the desmoplastic component of this tumor. CONCLUSIONS: Insulinomas with an extensive desmoplastic reaction may appear hypointense on T2-weighted images with minimal enhancement on immediate post-gadolinium images. Late phase fat-suppressed T1-weighted post-gadolinium images may be useful in the detection of such tumors.

An unusual presentation of brucellar septic arthritis involving the knee joint with extraarticular hardware: a case report.

Brucellosis is a zoonotic infection with a wide spectrum of clinical presentations. We present a rare case of brucellosis with osteoarticular involvement complicated by a femoral intramedullary nail protruding the suprapatellar pouch. Although Brucella melitensis is a rare cause of brucellar septic arthritis, it should not be excluded from the list of suspected organisms in endemic areas for the disease.

Response to rituximab and prednisolone for opsoclonus-myoclonus-ataxia syndrome in a child with ganglioneuroblastoma.

Opsoclonus-myoclonus-ataxia (OMA) syndrome is a rare neurobehavioral paraneoplastic disorder in children with neuroblastic tumors. The neurologic symptoms are generally treated with a number of immunosupressive and immunomodulating agents. A 4-year-old previously healthy male patient was admitted to the authors' center with progressive ataxia, gait disturbance, difficulty of speech, and opsoclonus. He had a diagnosis of ganglionueroblastoma at the thoracal paraspinal region. Following surgery, the patient received IVIG and prednisolone but his cerebellar symptoms progressed. Rituximab therapy was started and continued for total 8 weeks without any side effect. The authors observed excellent neurologic response in the patient at the 4th week of treatment. Rituximab is a new, promising, and safe therapy for OMA syndrome in children with neuroblastoma.