A Comparison of Pre- and Post-Treatment Cranial MRI Characteristics in Patients with Pediatric Epilepsy Receiving Levetiracetam.

Background and Objectives: This study was performed for the purpose of assessing whether antiepileptic levetiracetam treatment produces a change in brain volumes in children with epilepsy. To that end, we compared the volumes of the basal ganglia (caudate nucleus, putamen, globus, hip-pocampus, and thalamus) at magnetic resonance imaging (MRI) before and after treatment (months 18-24) in pediatric epilepsy patients using levetiracetam. Materials and Methods: This retrospective study involved a volumetric comparison of patients presenting to the Balikesir University Medical Faculty pediatric neurology clinic between 01.08.2019 and 01.11.2023 and diagnosed with epilepsy, and who underwent cranial MRI before and 18-24 months after treatment at the radiology department. The demographic and clinical characteristics (age, sex, family history of epilepsy, type of epilepsy, and EEG features (normal, abnormal, epileptiform)) of the patients included in the study were recorded. Results: The comparison of basal ganglia volumes at cranial MRI before and at months 18-24 of treatment revealed significant differences in the left caudate nucleus, right putamen, left putamen, left globus pallidus, right thalamus, left thalamus, and right hippocampal regions. Conclusions: In conclusion, differing findings are encountered at cranial imaging in patients with epilepsy, depending on the seizure frequency, activity, and the type of antiepileptic drugs used. This study compared basal ganglia volumes on cranial MRIs taken before and 18-24 months after treatment in pediatric epilepsy patients using levetiracetam. A significant increase was observed in the volumes of basal ganglia (caudate nucleus, putamen, globus pallidus, hippocampus, and thalamus) on the MRIs of pediatric epilepsy patients using levetiracetam.

Association between atopy, mastoid pneumatization and tympanometric findings.

The purpose of this study was to reveal whether the presence of atopy plays any unfavorable role in the development of a healthy middle ear as evaluated by tympanometry or in the degree of mastoid pneumatization as measured by mastoid volume. 33 atopic patients with positive skin prick test results (atopic group) and 30 healthy subjects (control group) were included in this study. Tympanometric tests were performed in all participants, and the results were classified as type A to C. Mastoid cell volumes were measured by three-dimensional temporal computed tomography. Both the right and left mastoid volumes were significantly lower in the atopic group than in the control group. Tympanogram types among all participants showed that the number of individuals with abnormal tympanograms was significantly higher in the atopic group than in the control group. Moreover, the presence of atopy was found to be associated with an almost 4.5-fold increased risk of having an abnormal tympanogram. Individuals with abnormal tympanograms (type BB or CC) demonstrated significantly lower right and left mastoid volumes than did individuals with normal type A tympanograms. Atopic individuals demonstrated significantly lower right and left mastoid volumes than did subjects in the control group. This study suggests a direct association between atopy and mastoid cell volumes. It was found that the mastoid cell systems of atopic individuals are less pneumatized, and tympanometric measurements are worse in atopic subjects. Therefore, the authors suggest that when a medical or surgical treatment is planned for ear disease in atopic individuals, atopy is an important factor that should be taken into consideration.

Maxillary Sinus Aeration in Allergic Rhinitis.

OBJECTIVE: We aimed to investigate the relationship between allergic rhinitis, which is an important reason of nasal obstruction, and maxillary sinus aeration. PATIENTS AND METHODS: Three hundred fifteen patients who have a complaint of nasal obstruction and scheduled to undergo skin prick test (SPT) with a suspicion of allergic rhinitis (AR) were enrolled for this study. Thirty-two patients with positive SPT result and 30 patients with a negative SPT result were determined as group 1 and 2 (control group), respectively. A 3-dimensional reconstruction of computed tomography images of the 62 patients was used to assess and calculate maxillary sinus volumes (MSVs). RESULTS: Total maxillary sinus volumes were measured as 21.87 cm(3) and 30.15 cm(3) in group 1 and group 2, respectively. A statistically significant difference was observed between the MSVs of the groups (P < 0.001). CONCLUSION: Total maxillary sinus volumes were found to be significantly smaller for patients with a positive SPT compared to patients with a negative SPT. Thus, we may conclude that AR has a negative impact on maxillary sinus aeration.

Variations of the popliteal artery branching with multidetector CT angiography.

OBJECTIVE: To date the anatomy of the popliteal artery variations using multidetector-row computed tomography angiography (MD CTA) was not assessed. The objective of this study is to establish 3D CT anatomy of the popliteal artery variations. MATERIALS AND METHODS: A total of 126 lower limbs that underwent CTA using 64-detector MDCT were retrospectively reviewed. The anatomical variations of the distal popliteal artery branching were assessed. RESULTS: Ninety-seven lower limbs (83.6%) had the usual branching pattern (type 1 A) with tibialis anterior artery (TA) arising first followed by the tibial-peroneal trunk, which then gives rise to the tibialis posterior artery (TP) and peroneal artery. Variations in popliteal branching pattern were seen in 19 (16.4%) limbs. The commonest variation was first branch of the TP in 5 (4.4%) of the limbs (type 1 C) or high origin with anterior course of popliteus muscle of the TA in 5 (4.4%) limbs (type 2 A II). CONCLUSION: Many variations exist in the running patterns of the branching pattern of the popliteal artery. Knowledge of the branching pattern of the popliteal artery will be beneficial to radiologist for the evaluation of CT angiograms and interventional vascular procedures, and to vascular surgeons for various surgical approaches. MD CTA provides noninvasive means of assessing distal popliteal artery variations.

Extraordinary cerebral venous drainage pathway with mastoid emissary and posterior external jugular veins detected by contrast-enhanced neck computed tomography.

An extraordinary cerebral venous drainage pathway and dilated vein at the left posterior cervical region were detected with routine contrast-enhanced neck computed tomography exam. The left sigmoid sinus was drained by dilated mastoid emissary vein (MEV). The MEV continued as posterior auricular and posterior external jugular veins (PEJVs). The left PEJV directly drained into subclavian vein. Atretic right transverse sinus, left facial vein forming the external jugular vein, atresia and hypoplasia of upper internal jugular veins at the right and left sides, respectively, were the other uncommon findings in our case. Detecting venous variations may prevent complications during surgical and interventional procedures, so the radiologists should examine the superficial cervical veins closely.

Primary acquired nasolacrimal duct obstruction: is it really related to paranasal abnormalities?

PURPOSE: To investigate whether there is an association between primary acquired nasolacrimal duct obstruction and paranasal computed tomography (CT) findings. MATERIALS AND METHODS: The study cohort consisted of paranasal CT images from 40 patients being treated for unilateral primary nasolacrimal duct obstruction (PANDO) and the reformatted coronal temporal CT images of 71 control subjects who attended the ENT clinic with the complaint of vertigo and tinnitus. A radiologist masked to the clinical situation of participants, investigated the paranasal CT findings of the PANDO and control patients retrospectively. The side, localization, and angle of the septal deviation as well as the thickness and lateralization angle of the inferior turbinate's were recorded. Additionally maxillary and ethmoid sinusitis, concha bullosa, Agger nasi cell formation, and osteomeatal complex status were evaluated. RESULTS: No significant difference was found between the paranasal abnormality incidence in the PANDO and non-PANDO sides of the patients or the control group. Only the side of the septal deviation correlated with the side of the PANDO (p = 0.008). CONCLUSIONS: The incidence of PANDO may not be directly related to paranasal abnormalities. Further large-scale studies should be performed to clarify the relationship between paranasal abnormalities and PANDO.

Rare cause of bilateral groin swelling: Round ligament varicosities.

Round ligament varicosity (RLV) is rare and almost all cases are pregnant women. RLV appears as a unilateral or bilateral groin swelling. Pain and tenderness may present. Clinical evaluation is inadequate for exact diagnosis because inguinal hernia has similar findings. Ultrasonography (US) is essential when a groin swelling is detected in a pregnant woman. We present gray scale US and colour Doppler US findings of a 32-week pregnant woman with bilateral RLVs at the inguinal canal, parauterine area and in the myometrium.

Fatty degeneration of multifidus muscle in patients with chronic low back pain and in asymptomatic volunteers: quantification with chemical shift magnetic resonance imaging.

OBJECTIVE: To evaluate and compare the fatty degeneration of multifidus muscles by chemical shift magnetic resonance imaging (MRI) in patients with chronic low back pain and in asymptomatic volunteers. MATERIALS AND METHODS: Sixty-five patients with lumbar disc pathology were selected prospectively for this study. The control group consisted of 25 asymptomatic volunteers. The patients were grouped according to the fatty degeneration of multifidus muscles by a semiquantitative method (grade 0-4) on axial T2 weighted imaging. Chemical shift MRI was performed in the axial plane using a double-echo fast low-angle shot (FLASH) sequence. Fatty degeneration was calculated through signal intensity suppression rate (SISR) and signal intensity index (SII). RESULTS: The semiquantitative grading of fatty degeneration of the multifidus muscle was 0 in 25 of 65 patients (patient group 0), 1 in 20 patients (patient group 1), 2 in 20 patients (patient group 2). Neither grade 3 nor grade 4 were detected in patient groups. For the control group, patient group 0, patient group 1, and patient group 2, median SISR values were 5.00, -9.00, -17.50, and -22.50 %, respectively. SII median values were -4.20 % for the control group, 7.00 % for patient group 0, 12.50 % for patient group 1, and 19.50 % for patient group 2. SISR values in the multifidus muscle calculated for the patient groups were significantly lower than those calculated for the control group. SII values in patients groups were significantly higher than in the control group. CONCLUSIONS: Chemical shift MRI may be a useful method to quantitatively evaluate the fatty degeneration in multifidus muscle in patients with low back pain.

Is there a Correlation between Hepatic Venous Indices and Main Pulmonary Artery Diameter?

OBJECTIVE: To search whether there is a correlation between middle hepatic venous indices (HVIs) obtained by pulsed waved doppler ultrasonography (PW-DUS) and the main pulmonary artery (mPA) diameter, calculated by computed tomography (CT). STUDY DESIGN: A descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Radiology, Balikesir University School of Medicine, Turkey, from February to December 2020. METHODOLOGY: After excluding the cases with suspected COVID-19 from the cases sent to the Radiology Department for chest CT exams with the mPA included in the cross-sections, the volunteers were evaluated with PW-DUS. The study group consisted of 66 cases. Two radiologists measured the velocity values of the A, S, and D waves in the recorded PW Doppler spectra. HVIs (A/S, A/S+D, A/A+S+D) were calculated. The mPA diameter was calculated in the axial plane from the pulmonary trunk, 1cm proximally to the bifurcation manually on the workstation. The correlation between the HIVs and mPA diameter was evaluated. Interoperator reliability was also analysed. RESULTS: Thirty-nine males (59%) and 27 (41%) females were included in the study group. The mean HVI values were 0.50 ±0.20, 0.28 ±0.12, and 0.21 ±0.07 for A/S, A/A+S, and A/A+S+D, respectively. The mean mPA diameter was 24.0 ±3.3 mm. Correlation analysis determined that the HVIs were positively correlated with mPA diameter (r=0.730-0.765-0.751, p<0.001). Inter-observer correlation coefficients were found to be compatible between two radiologists. CONCLUSION: A significant and strong correlation was found between HVIs and mPA diameter. The mPA diameter that reflects the pulmonary artery systolic pressure (PAP) increased as the HVIs increased. Therefore, PW-DUS may be helpful to evaluate PAP as a quantitative method that is cost-effective, easily accessible and radiation-free. KEY WORDS: Hepatic veins, Pulmonary artery, Multidetector computed tomography, Pulmonary hypertension, Pulsed doppler ultrasonography.

Sonographic findings in a case of polyneuropathy associated with POEMS syndrome.

Polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes (POEMS) syndrome is a rare multi-system disease. We describe the ultrasonography (US) and color Doppler ultrasonography (CDUS) findings of peripheral neuropathy in a patient with POEMS syndrome. In US examination, peripheral nerves were found to be diffusely thickned in both upper limbs. CDUS imaging showed arterial blood flow with low systolic peaks on the nerves.

Trumpet maneuver in the sonographic diagnosis of an external laryngocele.

Laryngocele is an uncommon disease defined as an abnormal dilatation or herniation of the laryngeal saccule, forming an air-filled cavity. Radiologic evaluation of a suspected laryngocele generally includes plain radiographs, CT, and MRI. There are very few reports in the literature on sonographic findings of laryngocele. Trumpet maneuver has been reported in CT examination for the diagnosis of laryngocele. However, to the best of our knowledge, the use of trumpet maneuver in the sonographic diagnosis of laryngocele has not been previously described. This report presents the sonographic findings of an external laryngocele while performing the trumpet maneuver.

Continuous-type splenogonadal fusion associated with an ipsilateral testicular atrophy: sonographic findings.

Splenogonadal fusion is a rare congenital anomaly in which the spleen is abnormally connected to the gonad. Two types of splenogonadal fusion have been described: continuous and discontinuous. Splenogonadal fusion is frequently associated with cryptorchidism and/or congenital orofacial/limb anomalies. We describe the ultrasound findings in a case of continuous-type splenogonadal fusion associated with ipsilateral testicular atrophy with correlation with MRI.

Posterior Border Distance: An Effective Diagnostic Measurement for Carpal Tunnel Syndrome Using Ultrasonography.

Purpose The purpose of this study was to define posterior border distance (PBD), which represents an ultrasonographic diagnosing method of carpal tunnel syndrome (CTS), and to determine the reliability of PBD in comparison with electromyography (EMG) results. Methods Thirty-three patients (mean age: 51.8 ± 9.5 years; 27 females and six males) with CTS were included in this study. Ultrasonography (US) and EMG were performed under blinded conditions. PBD was evaluated by measuring the length of the perpendicular line between the posterior border of the median nerve and the line between the hook of the hamate and trapezoid tubercle. The cross-sectional area, anteroposterior (AP), and transverse diameter of the median nerve were measured. Control US was performed in 20 patients who were available at the first year postoperative follow-up and the results compared with preoperative US values. Correlation analyzes were performed to determine the relationship between electrodiagnostic results and ultrasonographic measurements. Results According to the results of preoperative and postoperative first-year US, there were statistically significant differences in the results of PBD (preoperative: 3.309±1.7472 mm, postoperative: 2.290±0.7867 mm p: 0.013) and AP diameter of the median nerve (preoperative: 3.012±0.7865 mm, postoperative: 2.680±0,5578 mm p: 0.017). There was no statistically significant difference in transverse diameter (preoperative: 6.585±1.9505 mm, postoperative: 6.955±2.2128 mm) and cross-sectional area (preoperative: 14.33±6.513 mm2, postoperative: 11.20±5.830 mm2) results (p>0.05). The cut-off value of PBD was ≥3.6 mm, it yielded 81.48% specificity and 83.33% sensitivity in the diagnosis of CTS. PBD was correlated with motor and sensory latency, anteromedial, and transverse diameter of the median nerve (p<0.05). There was no correlation between EMG values and the results of the cross-sectional area, transverse diameter, and AP diameter of the median nerve (p>0.05). Conclusion PBD is suggested as a reliable ultrasonographic measurement method for the diagnosis of CTS.

Detection of Dental Pathologies in Routine Paranasal CT Scans: A Retrospective Study.

INTRODUCTION: Multidetector Computed Tomography (MDCT) is a widespread method for evaluating paranasal sinuses and nasal cavity in daily practice. The maxillary teeth are in field of view in a paranasal sinus CT scan and it is possible to detect dental pathologies with CT. AIM: To determine the incidence of maxillary teeth pathologies in routine paranasal sinus CT scans. MATERIALS AND METHODS: A retrospective study was conducted. Consecutive 395 paranasal sinus CT scans were evaluated. All CT images were obtained with a 64 detector-CT. Patients with previous facial trauma, operation, invasive tumors and repeated exams were excluded. Detected findings were classified as "tooth loss, dental restorations or procedures and dental pathologies (carious lesions, dental developmental anomalies, periapical lesions and periodontal diseases). The proportion of findings was reported as simple percentiles. RESULTS: Three hundred and eighty-four CT scans were included in the study. Dental restorations or procedures were determined in 129 (33.5%) patients. A total of 34 (8.8%) patients had normal teeth count and morphology. A total of 264 (64.3%) patients had at least one tooth loss. A total of 195 (51%) patients had at least one or more dental pathology. Number of dental carious lesions, dental developmental anomalies, periapical lesions and periodontal disease were 104 (27.0%), 78 (14.3%), 46 (11.9%), 44 (11.4%), respectively. CONCLUSION: Dental pathologies were encountered in more than half of the patients. Detecting dental pathologies may prevent tooth loss and improve oral health. The radiologist should keep in mind dental pathologies while evaluating paranasal sinus CT in daily practice.

Comparative analysis of the effects of brimonidine and dorzolamide on ocular blood flow velocity in patients with newly diagnosed primary open-angle glaucoma.

The aim of this study was to evaluate the effects of brimonidine 0.2% and dorzolamide 2% on the ocular blood flow velocity in patients with newly diagnosed primary open-angle glaucoma (POAG). Forty-four (44) patients with newly diagnosed POAG were included in a prospective, comparative, randomized clinical study. Twenty-six (26) healthy volunteers, whose age and gender matched, were recruited to compare the baseline hemodynamic characteristics of the patients. After a complete eye examination, baseline blood flow velocity measurements of the retrobulbar vessels were made with color Doppler ultrasonography. Patients were randomly assigned to receive either brimonidine 0.2% or dorzolamide 2% for a 3-month period. Blood flow velocity measurements were repeated after 3 months. Both brimonidine and dorzolamide significantly reduced the intraocular pressure. The baseline ophthalmic artery pulsatility index was higher in patients with POAG than control subjects. Whereas there was a significant increase in peak systolic velocity of the central retinal artery, no significant change was observed in the other vessels with brimonidine and dorzolamide treatment. There was little difference, in terms of ocular blood flow velocity, between newly diagnosed glaucoma patients and control subjects. Both topical brimonidine and dorzolamide significantly reduced the intraocular pressure without altering ocular blood flow velocity in patients with newly diagnosed POAG.

Doppler ultrasonography findings in ocular Behçet's disease.

The aim of this prospective study was to determine and compare the orbital Doppler ultrasonography parameters of patients with Behçet's disease (with or without ocular involvement) with those of healthy subjects. We evaluated ophthalmic artery (OA), central retinal artery, posterior ciliary artery (PCA), central retinal vein, and superior ophthalmic vein (SOV) flow velocities and resistance indices (RIs). Detection of the decreased flow velocities in the OA and SOV and the increased RI in the OA and PCA might allow the identification of active period of patients with Behçet's disease.

Morphometric Evaluation of Bony Nasolacrimal Canal in a Caucasian Population with Primary Acquired Nasolacrimal Duct Obstruction: A Multidetector Computed Tomography Study.

OBJECTIVE: The bony nasolacrimal duct (BNLD) morphology as a contributory factor in primary acquired nasolacrimal duct obstruction (PANDO) is still controversial. The objectives of this study were to evaluate the morphometric differences of BNLDs in unilateral PANDO patients between PANDO and non-PANDO sides, as compared with the control group using multidetector computed tomography (CT). MATERIALS AND METHODS: Bilateral BNLDs in 39 unilateral PANDO patients and 36 control subjects were retrospectively reviewed. CT images with 0.5-mm thickness were obtained with a 64-slice scanner. The length, volume, coronal orientation type, sagittal orientation angle of BNLD, and relative lacrimal sac-BNLD angle were assessed. The entrance, minimum and distal end transverse diameters (TD) of BNLD was investigated. RESULTS: The mean minimum and distal end BNLD TDs measurements were significantly narrower in PANDO patients, both in PANDO and non-PANDO sides, as compared with the control group (p < 0.001 and p = 0.040, respectively); however, there were no significant differences between PANDO and non-PANDO sides within PANDO patients. The length, entrance TD, volume, coronal orientation type, sagittal orientation angle of BNLD, and relative lacrimal sac-BNLD angle were not significantly different between PANDO patients and control subjects, as well as between PANDO and non-PANDO sides within PANDO patients. CONCLUSION: The narrow mean minimum and distal end BNLD TD in PANDO patients, in both PANDO and non-PANDO sides, may be associated with PANDO development. The lack of difference between PANDO and non-PANDO sides within PANDO patients and some overlap between PANDO patients and control subjects suggest that narrow BNLD is not the sole factor.

Evaluation of Lacrimal Gland Dimensions and Volume in Turkish Population with Computed Tomography.

INTRODUCTION: Computed tomography (CT) is a widespread method for evaluating head and neck pathologies. The lacrimal glands (LGs) are usually visible in routine head and neck CT scans. LG pathologies usually manifests with changes in gland sizes, so it is important to know the normal values of the LG dimensions and volume. The LG sizes may change with age, gender and race. The normal values of LG dimensions and volume in Turkish population was not reported before. AIM: The aim of this study was to evaluate the dimensions and volumes of the LGs by CT in a Turkish population. MATERIALS AND METHODS: Two hundred seventeen consecutive paranasal CT scans of subjects evaluated retrospectively. Measurements of LG dimensions were performed in axial and coronal paranasal CT images. The LG volume was calculated with Aquarius software by outlining the gland in all consecutive axial images. RESULTS: Four hundred orbits of 200 subjects were included to the study. The mean axial LG length in right and left orbits were 16.2±2.0 mm and 16.0±2.0 mm and the mean axial width of the right and left orbits were 4.1±0.7 mm and 4.0±0.7 mm. The right and left LG mean values for coronal length and width were equal 18.3 ±2.2 mm and 4.1±0.7mm respectively. The mean LG volume was 0.617±0.210 cm(3) in right and 0.597±0.197 cm(3) in the left orbits. There were statistically significant differences in the axial width and volume of the LG according to sides, however there was no significant difference according to gender. Age and LG measurements were negatively correlated. CONCLUSION: Our study may serve as a guide to determine the average values of the LG measurements in Turkish population and find out the orbital pathologies that involves the LG.