Multi-parameter-based radiological diagnosis of Chiari Malformation using Machine Learning Technology.

BACKGROUND: The known primary radiological diagnosis of Chiari Malformation-I (CM-I) is based on the degree of tonsillar herniation (TH) below the Foramen Magnum (FM). However, recent data also shows the association of such malformation with smaller posterior cranial fossa (PCF) volume and the anatomical issues regarding the Odontoid. This study presents the achieved result regarding some detected potential radiological findings that may aid CM-I diagnosis using several machine learning (ML) algorithms. MATERIALS AND METHODS: Midsagittal T1-weighted MR images were collected in 241 adult patients diagnosed with CM, eleven morphometric measures of the posterior cerebral fossa were performed. Patients whose imaging was performed in the same centre and on the same device were included in the study. By matching age and gender, radiological exams of 100 clinically/radiologically proven symptomatic CM-I cases and 100 healthy controls were assessed. Eleven morphometric measures of the posterior cerebral fossa were examined using 5 designed ML algorithms. RESULTS: The mean age of patients was 29.92 ± 15.03 years. The primary presenting symptoms were headaches (62%). Syringomyelia and retrocurved-odontoid were detected in 34% and 8% of patients, respectively. All of the morphometric measures were significantly different between the groups, except for the distance from the dens axis to the posterior margin of FM. The Radom Forest model is found to have the best 1.0 (14 of 14) ratio of accuracy in regard to 14 different combinations of morphometric features. CONCLUSION: Our study indicates the potential usefulness of ML-guided PCF measurements, other than TH, that may be used to predict and diagnose CM-I accurately. Combining two or three preferable osseous structure-based measurements may increase the accuracy of radiological diagnosis of CM-I.

Sudden-onset paraplegia during pregnancy caused by haemorrhage in a spinal cord haemangioblastoma: A case report.

Spinal cord haemangioblastomas are rare central nervous systems tumours, and haemorrhage.It is an uncommon occurance. We report a 28-year-old pregnant patient who presented with paraplegia due to acute haemorrhage of a spinal haemangioblastoma. Magnetic resonance imaging showed extensive syrinx cavities, an intramedullary lesion at the T4-T5 spinal cord level e, and a subarachnoid haemorrhage. Digital subtraction angiography showed the feeding artery and dilated tortuous draining vein within the dural sac. The lesion was deemed a haemangioblastoma. The histopathological examination confirmed the diagnosis. Postoperatively, the paraplegia improved and the patient was able to walk within 2 weeks. Imaging is important for early diagnosis to prevent patients persistent neurological deficits.

Comparison of radiological and clinical characteristics of COVID-19 positive and negative ischemic stroke patients undergoing revascularization: A single-centre Turkish study.

OBJECTIVE: We aimed to compare the radiological and clinical characteristics of COVID-19-positive and -negative acute ischemic stroke (AIS) patients who underwent revascularization and to evaluate whether COVID-19 has an effect on revascularization and outcome in AIS patients with COVID-19 infection. METHODS: Consecutive COVID-19 positive and negative AIS patients who underwent intravenous thrombolysis and/or endovascular therapy in our hospital between March 2020 and February 2022 were included in this study. Our study is retrospective and 23 COVID-19 positive patients and 108 COVID-19 negative patients were compared in terms of radiological and clinical characteristics. RESULTS: Hypertension was lower in the COVID-19 positive ischemic stroke group (p=0.029). Admission NIHSS score was higher in COVID-19 positive patients (p=0.041). ASPECTS was found to be lower in COVID-19 positive ischemic stroke patients (p=0.019). The rate of hyperdense artery sign differed between groups (p=0.014) and was higher in the COVID-19 positive ischemic stroke group. The incidence of multi-vessel occlusion was found to be significantly higher in the COVID-19-positive ischemic stroke group (p=0.002). In terms of prognostic features, only the 3-month good outcome rate was statistically significantly lower in the COVID-19-positive ischemic stroke group (p=0.011). CONCLUSION: This study found that radiologically, COVID-19 may be associated with lower ASPECTS in ischemic stroke patients receiving revascularization treatment and may predispose to multivessel occlusion and hyperdense artery sign. Clinically, COVID-19 may be associated with a more severe initial presentation and worse prognosis at 3 months in ischemic stroke patients undergoing revascularization, but may not affect long-term mortality.

Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase.

BACKGROUND: The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization. METHODS: This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed. RESULTS: The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities. CONCLUSIONS: Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.

Angiographic Morphology of Anterior Communicating Artery Aneurysms and Their Association with Rupture Risk.

AIM: To estimate the rupture risk of anterior communicating artery (AComA) and AComA-related aneurysms according to their localization, angiographic architecture, and morphological features. MATERIAL AND METHODS: In this study, 124 patients with AComA and AComA-related anterior system aneurysms were retrospectively evaluated. The aneurysms were classified according to their morphological appearance and angiographic architecture. The size, size ratio, angiographic architecture, and aneurysmal dome orientation of ruptured and non-ruptured aneurysms were compared using digital subtraction angiography (DSA) 3D images. RESULTS: There was a significant relationship between rupture risk and the size ratio (p=0.043), morphological properties of the aneurysm (p < 0.001), aneurysm dome orientation (OR 1.29, 95% CI 1.32-6.818), and aneurysm type according to the angiographical architecture (p < 0.005). CONCLUSION: In determining the rupture risk of AComA and AComA-related aneurysms, size alone is not a sufficient parameter with aneurysm morphology proving to be more efficacious. Grouping of aneurysms according to angioarchitecture, and its significant correlation with aneurysm rupture, may help to understand the underlying mechanisms in the formation and rupture of aneurysms. From this, more specific treatment protocols can be created, helping to improve the clinical evaluation of AComA aneurysms.

Acute subdural hematomas caused by ruptured aneurysms: experience from a single Turkish center.

AIM: Although an aneurysmal rupture typically presents on computed tomography (CT) imaging as only a subarachnoid hemorrhage (SAH), it may be associated with spontaneous (nontraumatic) subdural hemorrhage (sSDH). The purpose of this paper is to discuss the clinical and radiological characteristics, as well as a potentially dangerous situation in the diagnosis and the management of this life-threatening condition. MATERIAL AND METHODS: The Department of Neurosurgery at Inonu University (Turgut Ozal Medical Center) (TOMC) maintains a prospective database of all patients treated for intracranial aneurysms since 1999. Using this database, we obtained patients with ruptured aneurysms who presented with sSDH on CT imaging. RESULTS: 687 patients with radiographically documented ruptured aneurysms were admitted from January 2000 through January 2009. Of these, eleven patients presented with sSDH. The incidence of aneurysmal rupture with sSDH is 1.6 % in our series. CONCLUSION: Acute sSDH on cranial CT should be considered for an urgent workup of a ruptured aneurysm, even in the absence or presence of SAH finding. CT angiography has advantages over cerebral digital substraction angiography (DSA) and may be a reasonable alternative to latter modality in the diagnosis, triage, and treatment planning in patients with sSDH.

Advantages of early intervention with arterial embolization for intra-abdominal solid organ injuries in children.

PURPOSE: Active bleeding due to abdominal trauma is an important cause of mortality in childhood. The aim of this study is to demonstrate the advantages of early percutaneous transcatheter arterial embolization (PTAE) procedures in children with intra-abdominal hemorrhage due to blunt trauma. METHODS: Children with blunt abdominal trauma were retrospectively included. Two groups were identified for inclusion: patients with early embolization (EE group, n=10) and patients with late embolization (LE group, n=11). Both groups were investigated retrospectively and statistically analyzed with regard to lengths of stay in the intensive care unit and in the hospital, first enteral feeding after trauma, blood transfusion requirements, and cost. RESULTS: The duration of stay in the intensive care unit was greater in the LE group than in the EE group (4 days vs. 2 days, respectively). The duration of hospital stay was greater in the LE group than in the EE group (14 days vs. 6 days, respectively). Blood transfusion requirements (15 cc/kg of RBC packs) were greater in the LE group than in the EE group (3 vs. 1, respectively). The total hospital cost was higher in the LE group than in the EE group (4502 USD vs. 1371.5 USD, respectively). The time before starting enteral feeding after first admission was higher in the LE group than in the EE group (4 days vs. 1 day, respectively). CONCLUSION: Early embolization with PTAE results in shorter intensive care and hospitalization stays, earlier enteral feeding, and lower hospital costs for pediatric patients with intra-abdominal hemorrhage due to blunt trauma.

Use of angiographic embolization in trauma-induced pediatric abdominal solid organ injuries.

BACKGROUND: Knowledge of the utility of angiographic embolization (AE) in pediatric cases of blunt abdominal solid organ trauma injuries is limited. The current study is an examination of AE as an effective and reliable method to control bleeding in patients with persistent bleeding due to blunt trauma-induced abdominal solid organ injury. METHODS: This was a retrospective examination of patients <17 years of age who had experienced blunt abdominal solid organ injury and who presented at a single institution within 4 years. A statistical analysis of the data was performed. RESULTS: The mean length of intensive care unit stay was 4 days for those who underwent embolization (n=11), and the mean length of hospital stay was 12 days. The average pre-AE blood loss, as measured by the decrease in hematocrit (%) from admission to embolization, was -7.33+-5.3% (p<0.001). The average post-AE blood loss, as measured by the change in hematocrit 72 hours post AE, was 2+-0.97% (p>0.05). All of the patients were discharged with a full recovery. CONCLUSION: AE was a safe and effective method to control solid organ hemorrhage in pediatric patients with blunt abdominal injuries.

Single-voxel magnetic resonance spectroscopy of brain tissue adjacent to arachnoid cysts of epileptic patients.

Intracranial arachnoid cysts (ACs) are usually asymptomatic, benign developmental anomalies. The most frequent clinical manifestations are cranial expansion, hydrocephaly, headache, epileptic seizures, psychomotor retardation, and aphasia. It is unknown whether there is a correlation between intracranial AC and epileptic seizures without obvious intracranial pressure signs. In vivo magnetic resonance spectroscopy is a technique used for the noninvasive investigation of the various metabolites of cerebral biochemical reactions. Magnetic resonance spectroscopy is also being used increasingly commonly in epileptogenic situations as a noninvasive technique. The purpose of this study was to evaluate the proton magnetic resonance spectroscopic pattern of the contents of tissue adjacent to AC and to determine whether there are any characteristic spectral patterns that may be helpful in evaluating whether these lesions are epileptogenic foci. In conclusion, although the number of cases was limited, this finding may be seen as indicating that there is no association between AC and epilepsy.

Isolated internal auditory artery aneurysm.

Anticoagulant therapy is effective and prevents death in more than 95% of patients with pulmonary embolism following deep vein thrombosis. We report a patient who developed deep vein thrombosis following rupture of a dissecting aneurysm of the internal auditory artery. The parent artery was occluded before anticoagulant therapy as a prophylactic measure to prevent intracranial haemorrhage. We discuss some of the clinical features, therapeutic difficulties, and pitfalls in the management of internal auditory artery aneurysm complicated by deep vein thrombosis.

Management of non-vascular complications following renal transplantation using percutaneous approach.

OBJECTIVE: Non-vascular complications following renal transplantation can cause graft failure. In this study, we present our two-year experience with percutaneous treatment for non-vascular complications following renal transplantation. PATIENTS AND METHODS: A total of 30 patients who underwent percutaneous radiological treatment between March 2014 and July 2016 were included in the study. RESULTS: Following renal transplantation, a total of 36 percutaneous radiological procedures which includes hydronephrosis secondary to ureteral stricture (n. 15), clinical symptom-producing lymphocele due to pressure (14) and creatinine elevated nondilated grafts (n. 7) after excluding other reasons of creatinine elevation, were performed. Six patients received percutaneous treatment for both ureteral stricture and lymphocele. The patients underwent balloon dilatation and double- J ureteral stent due to ureteral stricture. The mean pre- and post-procedural creatinine levels were 4.36 ± 2.84mg/dL and 2.17 ± 1.24 mg/dL respectively (p=0.004), indicating a significant difference. For lymphocele treatment, sclerosing agents were injected and lymphatic leakage areas were injected with percutaneous glue. The mean pre- and post-procedural creatinine values were 2.97 ± 1.78 mg/dL and 1.75 ± 1.18 respectively (p=0.002), indicating a significant difference. Nephrostomy catheters were placed for patients with elevated creatinine levels and non-dilated collecting system. The mean pre- and post- nephrostomy creatinine levels were 3.55 ± 2.36 mg/dL and 2.57 ± 1.82 mg/dL respectively (p>0.05), indicating no statistically significant difference. CONCLUSION: The results of our study suggest that percutaneous treatment is an effective method for the treatment of non-vascular complications following renal transplantation, and, therefore, should be the first option for the preservation of graft functions. KEY WORDS: Percutaneous treatment, Renal transplantation.

A Novel Technique in the Treatment of Lymphoceles After Renal Transplantation: C-Arm Cone Beam CT-Guided Percutaneous Embolization of Lymphatic Leakage After Lymphangiography.

BACKGROUND: We aimed to evaluate the efficacy of percutaneous embolization after lymphangiography using C-arm cone-beam computed tomography (CBCT) performed at the site of lymphatic leakage in patients with postrenal transplant lymphocele. METHODS: Between July 2014 and August 2017, 13 patients not responding to percutaneous ethanol sclerotherapy and conservative treatment for recurrent lymphocele after renal transplant were included. The mean age of the patients was 56.38 ± 9.91 (range, 36-70) years, and it comprised 9 men and 4 women. All patients underwent intranodal lymphangiography. C-arm CBCT-guided percutaneous embolization was performed in patients with confirmed lymphatic leakage. Patients who had no lymphatic leakage underwent drainage with fibrin glue injection. RESULTS: Lymphatic leakage was observed in 9 patients after lymphangiography, and they underwent CBCT-guided percutaneous N-butyl-2-cyanoacrylate embolization. The volume of lymphatic drainage reduced to less than 10 mL in 8 patients. One patient who was not responding to embolization was treated surgically, after percutaneous drainage and fibrin glue injection. Lymphatic leakage was not observed in 4 patients after lymphangiography. Of these, 3 patients showed a reduction in the amount of lymphatic drainage after lymphangiography. All 4 patients underwent percutaneous drainage and fibrin glue injection. One patient did not respond to the treatment and was treated surgically. Prelymphangiography and postlymphangiography and embolization, the volume of lymphatic drainage was 113.07 ± 21.75 mL, and 53.84 ± 30.96 mL, respectively, and statistically significant decrease was detected (P < 0.005). CONCLUSIONS: Lymphangiography and CBCT-guided percutaneous embolization procedures might be an effective treatment method for patients with lymphocele refractory to treatment.

Magnetic resonance spectroscopy study of proton metabolite level changes in sensorimotor cortex after upper limb replantation-revascularization.

We aimed to investigate the changes in proton metabolite levels at the motor and somatosensory cortex by magnetic resonance spectroscopy (MRS) after upper extremity replantation or revascularization. Nine patients who referred to our clinic suffering from major total (two) and subtotal (seven) amputation of the upper extremity were enrolled in this study. Mean time value between the injury and operation was 5.1 h. Mean follow-up period or mean time between the injury and MRS analysis was 26.2 months (ranging from 7 to 41 months). Voxels (TR: 2000; TE: 136 ms) were placed onto locations in the bilateral precentral and postcentral cortex area of the cerebral hemispheres that represent the upper extremity. Contralateral sides of the brain hemisphere that represent the injured extremity were accounted as control groups. Metabolite ratios [NAA (N-acetyl aspartate)/Cr (creatine) and Cho (choline)/Cr] of the motor and somatosensory cortex were calculated. The NAA/Cr and Cho/Cr metabolite ratios between the two groups were found to be insignificant, and these results may indicate that there is no remarkable somatosensorial cortex disruption or demyelination in these patients. Fifty-six percent of patients were found as functional according to Chen's scale.

Magnetic resonance spectroscopy of premalignant and malignant endometrial disorders: a feasibility of in vivo study.

OBJECTIVE: To assess the potential clinical utility of in vivo proton magnetic resonance spectroscopy (MRS) in patients with various endometrial lesions. METHODS: Twelve patients with untreated uterine bleeding were included in this study. In-vivo proton MRS was performed using a 1.5 T MR scanner. The metabolite levels were classified into three classes in comparison with the noise level by visual examination. All the patients have endometrial biopsy. For each type of lesions, chemical compound were described. RESULTS: Pathological examination resulted in three endometrial cancer, two simple hyperplasias, one complex hyperplasia, two partial hydatiform mole, two proliferative endometrium and two secretory endometrium. In women with endometrial carcinoma, high choline and lipid signals were detected, whereas no creatine and no lactate signals were found. In women with endometrial hyperplasia, choline signal was detectable in all cases but one case showed lactate signal in addition to choline. In women with partial hydatidiform mole, the only detectable signal was choline. Lipid signals were detected in none of the cases with endometrial hyperplasia and partial hidatidiform mole. In women with either secretory or proliferative endometrium, choline and lactate signals were detectable in all cases but one case showed solely choline. Lipid signals were not detected in any of subjects with secretory or proliferative endometrium. CONCLUSION: The observed difference is the presence of lipid signal only in endometrial carcinoma.

Early- and late-state subacute sclerosing panencephalitis: chemical shift imaging and single-voxel MR spectroscopy.

BACKGROUND AND PURPOSE: Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. Our aim was to determine the metabolic abnormalities of brain in early- and late-stage SSPE by using MR spectroscopy and to assess areas of involvement in the early stages when MR imaging findings were normal. METHODS: Children with stage II (n = 3) or III (n = 3) SSPE and 10 healthy, age-matched children underwent MR imaging, multivoxel MR spectroscopy, and short-echo single-voxel MR spectroscopy (SVS). Areas of involvement in the brain were determined with chemical shift imaging. For SVS, 2 x 2 x 2-cm voxels were placed in the frontal subcortical white matter (FSWM) and parieto-occipital white matter (POWM). N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, myo-inositol (Ins)/Cr, and NAA/Cho ratios were calculated. RESULTS: Comparisons of NAA/Cr, Cho/Cr, Ins/Cr and NAA/Cho ratios between patients and control subjects showed significant differences in FSWM and POWM (P <.01). In patients with SSPE, NAA/Cr ratios in POWM were significantly less than those in FSWM (P <.01). NAA/Cr ratios in patients with stage II SSPE and those in the control group were not significantly different; this may reflect the absence of neuronal loss. Decreased NAA/Cr, increased Cho/Cr and Ins/Cr ratios, and increased lactate and lipid peaks were found in patients with stage III SSPE. CONCLUSION: MR spectroscopy showed findings suggestive of inflammation in stage II and findings of demyelination, gliosis, cellular necrosis, and anaerobic metabolism in stage III. MR spectroscopy could be a promising technique for early diagnosis and treatment planning in cases of SSPE.

Intraventricular solitary fibrous tumor: an unusual tumor with radiological, ultrastructural, and immunohistochemical evaluation: case report.

OBJECTIVE AND IMPORTANCE: Intracranial solitary fibrous tumors have been described previously, but intraventricular solitary fibrous tumors are extremely rare. We present what is, to our knowledge, the first reported case of solitary fibrous tumor in the third ventricle. CLINICAL PRESENTATION: A 63-year-old man presented with weakness of his lower extremities and headaches. Computed tomography and magnetic resonance imaging of the brain revealed an enhancing mass in the posterior part of the third ventricle. INTERVENTION: The tumor originated from the wall of the left internal cerebral vein and extended to the posterior part of the third ventricle. Nearly total excision was performed via an infratentorial-supracerebellar approach. CONCLUSION: The differential diagnosis of intracranial solitary fibrous tumors includes fibroblastic meningioma, meningeal hemangiopericytoma, neurofibroma, and schwannoma. The differential diagnosis in the present case was greatly helped by the immunohistochemical and ultrastructural findings, along with a disease-free 3.5-year follow-up. These findings are presented with reference to previous reports.

Delayed myelination in a rhizomelic chondrodysplasia punctata case: MR spectroscopy findings.

Rhizomelic chondrodysplasia punctata is a member of genetic peroxisomal disorders. Delayed myelination, which is probably related to the inadequacy of plasmalogens biosynthesis, is an important feature of this disorder. Direct assessment of neuropathologic aspects of RCDP syndrome such as neuronal degeneration and delayed myelination is possible with MR spectroscopy. In this report, MR spectroscopy findings (decreased Cho/Cr and increased Ins-Gly/Cr ratios and increased levels of mobile lipids) of a rhizomelic chondrodysplasia punctata case supporting delayed myelination are presented. This is the second report of MR spectroscopy examination of the specific brain metabolic changes associated with rhizomelic chondrodysplasia punctata.

Proton MR spectroscopy features of normal appearing white matter in neurofibromatosis type 1.

To determine whether differences exist between neurofibromatosis type 1 (NF1) patients with or without focal lesions and healthy normal volunteers in the metabolite ratios of normal appearing white matter, 27 patients with NF1 (with parenchymal lesion, MR positive, n: 17; without parenchymal lesions, MR negative, n: 10) and 20 healthy volunteers underwent MRI and short TE (31 ms) proton MR spectroscopy (MRS). In 17 patients with parenchymal lesions, 61 focal lesions were detected by MRI. MRS was performed from normal appearing frontal and posterior parietal white matter (FWM and PWM) in NF1 and from control groups. NAA/Cr, Cho/Cr and MI/Cr ratios were calculated. Significant increase in Cho/Cr and MI/Cr ratios were found in FWM and PWM in MR negative and positive groups when compared to control group. NAA/Cr ratio in MR positive group was significantly decreased in FWM compared to control group. There were no significant differences between FWM and PWM in all metabolite ratios of MR negative group. MI/Cr ratio in MR positive group was significantly elevated in PWM compared to FWM. Metabolite changes detected by MRS could indicate demyelination and gliosis in normal appearing white matter in all NF1 patients, and additionally neuroaxonal damage in the FWM of NF1 patients with focal lesions. For that reason, in the clinical evaluation and follow-up of these patients MRS features of normal appearing white matter should be considered in addition to focal lesions.

Occupational prolonged organic solvent exposure in shoemakers: brain MR spectroscopy findings.

Our purpose was to investigate, by magnetic resonance (MR) spectroscopy, the metabolite changes in the brains of subjects in the shoemaking industry who had been chronically exposed to organic solvents. A total of 49 male subjects and 30 age-matched healthy volunteers underwent detailed neurological and psychiatric examinations. All subjects had long-echo [repetition time (TR) 2000 ms, echo time (TE) 136 ms] single-voxel MR spectroscopy. Voxels (15 x 15 x 15 mm(3)) were placed in the parietal white matter, thalamus, and basal ganglia. N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were calculated. There was no significant difference between the study subjects and the control group in NAA/Cr ratios obtained from thalamus, basal ganglia, and parietal white matter. Cho/Cr ratios in thalamus, basal ganglia, and parietal white matter were found to be significantly increased compared to controls. There was a positive correlation between basal ganglia Cho/Cr ratio and duration of exposure (r = 0.63). MR spectroscopy should be performed to reveal metabolite changes and determine the degree of brain involvement in solvent-related industry workers.