The Relationship between Sphenoid Sinus, Carotid Canal, and Optical Canal in Paranasal Sinus Computed Tomography in Children.

Objectives The authors examined the structural differences in the paranasal sinus region at sphenoid sinus in the pediatric population. Methods Paranasal sinus computed tomography (PNSCT) images of 86 pediatric subjects (30 males, 56 females) were included. In 13 to 15 years of age group ( n =34) and ≥16 years of age group ( n =52), sphenoid sinus pneumatization (SSP), optic canal and carotid canal classifications and dehiscence evaluation were performed. Results In both sexes, type 1 and type 2 SS pneumatization were observed more frequently on both the right and left sides. On the right side, type 2> type 1; on the left side type 1> type 2 optic canals were detected in both gender. Type 3 optic canals were detected in 8.8 to 14.7% of the 13 to 15 years of age group; and 11.5 to 17.3% of ≥16 years of age group. Type 4 optic canals were detected in 2.9% of the 13 to 15 years of age group and 1.9% of the ≥16 years of age group bilaterally. Optic canal dehiscence was detected in 26.5% of the 13 to 15 years of age group and 17.3% of the ≥16 years of age group. Type 1 and type 2 carotid canals are most common in children, the percentages for type 3 carotid canals were 1.8 to 3.6% in children. Conclusion In pneumatized SS, optic canal classifications got increased values which showed protrusion into the sphenoid sinus wall. Therefore, in children, the surgeons must be very careful for optic canal being nearer to the sphenoid sinus walls.

Evaluation of peripheral olfactory pathways in chronic autoimmune thyroiditis.

PURPOSE: In this study, we aimed to radiologically evaluate the olfactory bulb (OB) volume and olfactory sulcus (OS) depth of adult patients diagnosed with chronic autoimmune thyroiditis. METHODS: Sixty-eight patients over 18 years of age with Hashimoto's thyroiditis and 66 healthy controls with normal thyroid function tests were included in the study. OB volume and OS depth measurements were performed using cranial magnetic resonance imaging (MRI) obtained from coronal T2-weighted images. The relationship between thyroid function tests, autoantibodies, and measurements of the OB and OS were evaluated. RESULTS: The right and left OB volumes were significantly lower in the patients with Hashimoto's thyroiditis than in the control group (p < 0.05). No significant difference was found between the patient and control groups in terms of OS depth (p > 0.05). There were significantly negative correlations among TSH, thyroid antibodies, and the bilateral OB volume measurements. In the Bonferroni post hoc analysis, when people with euthyroid Hashimoto's thyroiditis and the control group were compared, there was no statistically significant difference between bilateral OB volumes and thyroid function tests. CONCLUSION: Diminished bilateral OB volumes were found in our patients with chronic autoimmune thyroiditis. Interestingly, the OB volumes were not affected in patients with euthyroid Hashimoto's thyroiditis. When a decrease in OB volume is detected on MRI, it should be kept in mind that odor dysfunction in hypothyroid patients with Hashimoto's thyroiditis may occur and patients should be clinically evaluated.

A Comparison of Diagnostic Accuracy of Superior Semicircular Canal Dehiscence in MDCT and MRI, and Coexistence with Tegmen Tympani Dehiscence.

Objective Tegmen tympani dehiscence in temporal multidetector computed tomography (MDCT) and superior semicircular canal dehiscence may be seen together. We investigated superior semicircular canal dehiscence in temporal MDCT and temporal magnetic resonance imaging (MRI). Methods In this retrospective study, 127 temporal MRI and MDCT scans of the same patients were reviewed. In all, 48.8% ( n = 62) of cases were male, and 51.2% ( n = 65) of cases were female. Superior semicircular canal dehiscence and superior semicircular canal-temporal lobe distance were evaluated by both MDCT and MRI. Tegmen tympani dehiscence was evaluated by MDCT. Results Superior semicircular canal dehiscence was detected in 14 cases (5.5%) by temporal MDCT and 15 cases (5.9%) by temporal MRI. In 13 cases (5.1%), it was detected by both MDCT and MRI. In one case (0.4%), it was detected by only temporal MDCT, and in two cases (0.8%), it was detected by only temporal MRI. Median superior semicircular canal-to-temporal distance was 0.66 mm in both males and females in temporal MDCT and temporal MRI. In both temporal MDCT and temporal MRI, as superior semicircular canal-to-temporal lobe distance increased, the presence of superior semicircular canal dehiscence in temporal MDCT and temporal MRI decreased. Tegmen tympani dehiscence was detected in eight cases (6.3%) on the right side and six cases (4.7%) on the left side. The presence of tegmen tympani dehiscence in temporal MDCT and the presence of superior semicircular dehiscence in MDCT and MRI increased. Conclusion Superior semicircular canal dehiscence was detected by both MDCT and MRI. Due to the accuracy of the MRI method to detect superior semicircular dehiscence, we recommend using MRI instead of MDCT to diagnose superior semicircular canal dehiscence. Moreover, there is no radiation exposure from MRI.

Does Mastoid Pneumatization Affect Facial Canal Dimensions and Distances of Facial Tympanic Segment-Scutum and Lateral Semicircular Canal-Scutum?

OBJECTIVES: In the present study, we investigated whether mastoid pneumatization affects facial canal dimensions and distances of facial tympanic segment and scutum, and lateral semicircular (LSS) canal and scutum. METHODS: One hundred sixty-one temporal multidetector computed tomography scans were reviewed. Patients with unilateral sclerotic mastoid pneumatization (no aeration) (group 1, n = 81) and unilateral total mastoid pneumatization (100.0% aeration) (group 2, n = 80) were included. Facial canal dimensions at the labrythine, tympanic, and mastoid segments; facial canal dehiscence and length; and facial tympanic segment-scutum and LSS canal-scutum distances were evaluated. RESULTS: In the present study, facial canal dimensions of labyrinthine, tympanic, and mastoid segments in total pneumatized mastoid group were significantly lower than sclerotic mastoids on axial and coronal images (P < 0.05). Facial tympanic segment and scutum distance of the sclerotic mastoid group was significantly lower than those of the total pneumatized mastoid group (P < 0.05). However, LSS canal-scutum distance was not different between both groups (P > 0.05). The LSS canal-scutum distance of the females was lower than those of the males (P < 0.05). Facial canal dehiscence ratio was 11.3% and 11.1% in sclerotic and total pneumatized mastoids, respectively. The mean ± SD length of the dehiscence was 2.46 ± 1.29 mm in pneumatized mastoids and 1.92 ± 0.68 mm in sclerotic mastoids. CONCLUSIONS: In cholesteatoma cases, scutum erosion may occur. Because facial tympanic segment and scutum distance decreased in sclerotic mastoids compared with completely pneumatized ones, maximum care must be taken in the operations for avoiding to damage facial canal and nerve. Revision cases may be more difficult because of distorted anatomy. However, in pneumatized mastoids, the mean length of the facial canal was more than 2 mm, which must be kept in mind during operations.

Sonoelastographic Evaluation of the Lower Lateral Nasal Cartilage Lateral Crus, Auricular Conchal Cartilage, and Costal Cartilage.

We investigated the sonoelastographic features of the lower lateral nasal cartilage lateral crus (LLNC-LC), auricular conchal cartilage (ACC), and costal cartilage (CC). In this prospective study, group 1 consisted of 60 participants (30 males and 30 females) between 18 and 35 years of age. Group 2 consisted of 60 participants (30 males and 30 females) between 35 and 50 years of age. Strain elastography (SE) and shear wave elastography (SWE) were performed. For all LLNC-LCs and ACCs, type I SE was detected more in group 2, type II SE was detected more in group 1, and type III SE was detected more in group 1 (p < 0.05). For CC, type I SE was detected more in both groups (p < 0.05). For LLNC-LC, type I SE was detected more in males compared with females in both groups (p < 0.05). For all LLNC-LC, ACC and CC, the SWE modulus of group 2 was significantly higher than that of group 1 (p < 0.05). In older participants, the SWE modulus increased. We recommend using ACC mainly in rhinoplasty operations for primary and revision cases as its SWE modulus is similar to that of the LLNC-LC. However, due to the higher SWE modulus of CC, CC grafts should not be used as the first choice in rhinoplasties, especially in the reconstruction of the nasal tip contour, but may be used in nasal dorsum augmentation.

Critical Stenosis of the Internal Carotid Artery: Variability in Vertebral Artery Diameters and Areas of Cerebral Chronic Infarction in Computed Tomography.

OBJECTIVES: We investigated unilateral and bilateral cervical internal carotid artery (ICA) stenosis according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST). METHODS: We retrospectively investigated ICA stenosis on Head&Neck Computed Tomography Angiography (CTA); and their simultaneous brain computed tomography images were also evaluated. In unilateral ICA stenosis group (n=36), 17 of them had right ICA stenosis and 19 left ICA stenosis. In bilateral stenosis group, there were 24 patients. ICA stenosis was evaluated according to NASCET and ECST methods. We also evaluated vertebral artery dimension, plaque density and cerebral infarct (Cerebral kortex, white matter, basal ganglion-thalamus). RESULTS: Unilateral ICA stenosis according to the NASCET was 70.64% to 73.68% (right-left) and according to the ECTS was 65.52% to 71.15% (right-left). For bilateral stenosis, ICA stenosis according to the NASCET was 67.70 to 67.91 (right-left); according to the ECTS was 62.45% to 62.15% (right-left). Vertebral artery dimensions were 3.26 to 3.72 mm (right-left) in unilateral ICA stenosis; and 3.52 to 3.71 mm (right-left) in bilateral ICA stenosis. In bilateral stenosis group, mixt plaque; and in unilateral stenosis group, hard plaque was detected. In unilateral stenosis, white matter and basal ganglion-thalamus infarcts; in bilateral ICA stenosis, cerebral cortical infarct was detected. Left-vertebral artery diameter increased in higher L-ECTS ICA stenosis (unilateral) group. CONCLUSION: Increase in left vertebral artery diameter in unilateral L-ECTS ICA stenosis may be related to increase of the collateral flow by vertebral arteries to support brain blood-flow.

Olfactory Fossa and New Angle Measurements: Lateral Lamella-Cribriform Plate Angle.

OBJECTIVES: The authors investigated the olfactory fossa (OF) in patients with unilateral nasal septal deviation (NSD) and presented the lateral lamella-cribriform plate angle (LLCPA). METHODS: Paranasal sinus computed tomography images of 300 adult subjects with unilateral NSD (111 males, 189 females) were evaluated retrospectively. Septal deviation angle (SDA), Keros Classification, OF depth and width, LLCPA; and orbital plate and cribriform plate (OPCP) distance were measured. RESULTS: The OF depth values (ipsilateral, contralateral) were found as Keros III >Keros II >Keros I (Padjusted <0.0175). The OF width values (ipsilateral) were detected as Keros I >Keros II and Keros I >Keros III (Padjusted <0.0175). In patients with higher SDA values, ipsilateral OF depth values decreased (P <0.05). The LLCPA and OPCP values were higher in Keros I and lower in Keros III (P <0.05). CONCLUSION: In patients with lower LLCPA and OPCP, endoscopic sinus surgery will be more dangerous for trauma to lateral lamella and intracranial penetration.

Evaluation of Olfactory Sensation, Acoustic Rhinometry, and Quality of Life of the Patients With Nasal Septal Deviation.

OBJECTIVES: Nasal septum deviations are deformities that occur in the cartilage and bones of the septum. The aim of the present study is to evaluate the patients with septum deviation according to the acoustic rhinometry measurements in terms of changes in smell function and the effects on quality of life. METHODS: Twenty patients with septum deviation between the ages18 to 75 years old and 20 subjects without septum deviation were included in the study. Control group consisted of the 20 subjects with no septal deviation. After ENT examinations, acoustic rhinometry measurements, the SF-36 quality of life scale, and the Brief Smell Identification Tests were applied to all patients. Type of septum deviation is classified according to Mladina classification by anterior rhinoscopy examination, nasal endoscopy, and paranasal computed tomography. RESULTS: The study indicated that the most common deviation type was Mladina Type 3 (65%). Bilateral total smell score of the women in the septum straight group is significantly lower than the men in terms of total smell scores by gender (P < 0.05). The total smell score values in septum group were significantly lower than those of the control group (P < 0.05). According to the individual smell values, cinnamon, banana, and soap odors of the septum deviation group were seen to be significantly lower than the septum straight group (P < 0.05). CONCLUSION: The results of the study indicated that olfactory dysfunction occurs in patients with septum deviation. Therefore, treatment of septum deviation is necessary for the improvement of nasal obstruction besides the treatment of the smell dysfunction.

Evaluation of arthroscopic rotator cuff repair results in patients with anterior greater tubercle cysts.

PURPOSE: The purpose of this study was to investigate the clinical results of arthroscopic rotator cuff repair in patients with anterior greater tubercle cyst in magnetic resonance imaging (MRI). METHODS: The cyst-present group comprised 38 patients with anterior greater tubercle cyst in MRI, and age- and sex-matched 30 patients without cyst in humeral head were included in the control group. The cystic group was divided into two groups, smaller than 5 mm (21 patients) and larger than 5 mm (17 patients), according to the cyst size. A total of three groups were created. In the evaluation of clinical outcomes, modified University of California at Los Angeles (UCLA) and the Western Ontario Rotator Cuff Index (WORC) were used. The visual analog scale (VAS) was used to assess pain. One-way analysis of variance was used to compare VAS, UCLA, and WORC scores among the groups. RESULTS: There was a statistically significant difference in the clinical results of VAS, UCLA, and WORC among the cystic and noncystic groups in the anterior greater tubercle ( p < 0.05). There was also a statistically significant difference in the clinical results of UCLA, WORC, and VAS scores according to the cyst sizes in the anterior greater tubercle cyst group ( p < 0.05). CONCLUSION: Anterior greater tubercle cysts have negative effects on rotator cuff repair results. If the anterior greater tubercle cyst size is greater than 5 mm, the negative effects of rotator cuff repair results are more pronounced. An understanding of anterior greater tubercle cysts has a critical importance for rotator cuff surgery planning.

Is there a relationship between Onodi cell and optic canal?

OBJECTIVES: We investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT). METHODS: In this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated. RESULTS: The prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I > Type II > Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p < 0.05). Optic canal types were detected as Type IV > Type I > Type II > Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p < 0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells. CONCLUSION: Identification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi-optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage.

Carotid canal and optic canal at sphenoid sinus.

In the present study, we investigated the relationship between sphenoid sinus, carotid canal, and optic canal on paranasal sinus computed tomography (PNSCT). This study was performed retrospectively. PNSCT images of 300 adult subjects (159 male, 141 female). Sphenoid sinus (pneumatisation, dominancy, septation, inter-sinus septa deviation), anterior clinoid process pneumatisation, Onodi cell, carotid and optic canals (width, dehiscence, classification) were measured. In males, type 3 pneumatised sphenoid sinus (in both sides) and in females type 2 pneumatised sphenoid sinus (right side) and type 3 pneumatised sphenoid sinus (left side) were detected more. Anterior clinoid pneumatisation was present 47.2% in males and 39.7% in females. In male group, more septation (i.e. 22.6%, ≥ 3 septa) in sphenoid sinus were detected. Onodi cell was present 26.6 and 19.1% in males and females, respectively. Carotid canal protrudation to the sphenoid sinus wall was present 23.9-32.1% in males and 35.5-36.2% in females. Dehiscence in carotid canal was detected more in females (34%) compared to males (22%). Optic canal protrudation was 33.3 and 30.5% in males and females. Type 4 optic canal was detected more in both gender. Optic canal dehiscence was detected 11.3 and 9.9% in males and females. Carotid and optic canal diameters were higher in males. In pneumatised sphenoid sinuses and in females, type 3 carotid canal (Protrudation to SS wall) (bilaterally) and type 1 optic canal type (No indentation) (ipsilateral side) were detected more. In elderly patients, carotid and optic canal width increased. When carotid canal protrudation was detected, there was no indentation in optic canals In pneumatised SS, carotid canal protrudation was observed with a greater risk in surgery. However, type 1 (non indentation) optic canal was present in highly pneumatised SS with lower risk for the surgery. In women, the risk of carotid canal protruding (about 1/3) is greater than that of males, and carotid canal dehiscence rates are also higher in females. Therefore, physicians should be very careful during the preparatory stages of the sphenoid sinus surgery. Otherwise, it may not be possible to prevent lethal carotid artery bleeds.

Cribriform Plate, Crista Galli, Olfactory Fossa and Septal Deviation.

OBJECTIVES: In the present study, we investigated the relationship between olfactory fossa, cribriform plate, crista galli and nasal Septal Deviation (SD). Keros classification of olfactory fossa was also performed. METHODS: This study was performed retrospectively. Computerized Tomography (CT) images of 200 adult subjects were observed. Unilateral nasal Septal Deviation (SD) cases were included into the study. On coronal CT scans, SD side and location, SD angle, cribriform plate width, olfactory fossa depth (Keros classification) and width, area of the olfactory fossa, crista galli length, width and pneumatization were evaluated. RESULTS: Anterior and anteroposterior deviations were detected mainly. In females, 64.0% and in males, 45.3% of the SDs were located anteriorly. In males, anteroposterior SDs (40.0%) were detected more than females. In anteroposterior SDs, SD angle was higher than anterior SDs. With higher SD angle, crista galli width and height decreased. Cribriform plate width, olfactory fossa height, width and area values of contralateral side were significantly higher than those of the ipsilateral side. For Keros classification, in male group, type 1 (53.3%) and in females, type 2 (57.6%) was detected at ipsilateral side. For contralateral side, type 2 Keros was detected in both genders. Complete crista galli pneumatization was observed in 4.0% and partial pneumatization was detected in 12.0%. In 84% of the patients, there is no Crista galli pneumatization. With the presence of pneumatized crista galli, contralateral Keros values decreased. Crista galli height and contralateral olfactory fossa width showed positive correlation. In older patients, cribriform plate width decreased. CONCLUSION: In our study, there was no Keros type 3 olfactory fossa. In males' contralateral side of SD; and in females both ipsilateral and contralateral side of SD, Keros type 2 olfactory fossa were detected. Therefore, during sinus surgery, surgeons should work carefully not to made intracranial penetration.

The Diagnostic Value of CT-guided Percutaneous Co-axial Trans-thoracic Biopsy (PCTTB) and Evaluation of the Pathologic Examination.

BACKGROUND: We investigated thoracic masses with Computed Tomography (CT)- guided Percutaneous Co-Axial Trans-Thoracic Biopsy (PCTTB). METHODS: The retrospective data of 86 patients to whom CT-guided PCTTB had been applied were obtained. Eighty-four cases and their pathologic results were included in the study. Localization and appearance of the lesions, pathologic results, and complications were evaluated. RESULTS: Diagnostic sensitivity of CT-guided PCTTB was 97.6%. In 60.7% of the cases, malign lesions and, in 39.3% of the cases, benign lesions were diagnosed. The mass size was on average greater than 2 cm, and one mass was detected as being more than ≥2 masses. Mainly, irregular contours were observed. Most of the malign tumors were primary malign tumors on both sides (91.7% on the right side and 88.9% on the left side). Squamous Cell Carcinoma (SCC) was the most often detected malign tumor on the right side, and adenocarcinoma was the most often detected malign tumor on the left side. In masses localized on the left inferior lobe, metastasis was often detected. When the number of the mass was ≥2 and the mass had the appearance of consolidation, metastasis was usually detected. Small and large masses were mainly localized on right and left upper lobes. In the small mass group, 75.0% of the cases were benign, and, in the large mass group, 64.5% of the cases were malign (p=0.031, χ2=4.666). Pneumothorax was the most commonly occurring complication (23.8%). In masses localized on the right lower lobe, the pneumothorax ratio increased in benign masses compared to malign masses. The hemorrhage detection rate was 13.0%, and hemoptysis occurred in 14.2% of the cases. Hemorrhage was detected during 11.8% of the large mass biopsies. In females, hemorrhage occurred more often than in males (p=0.026, r= 0.244). CONCLUSION: CT-guided PCTTB is a safe method to utilize for lung biopsies. Co-axial method increased the diagnostic accuracy of CT-guided percutaneous trans-thoracic biopsies. A single cut also decreased the complication rates.

Olfactory bulbus volume and olfactory sulcus depth in psychotic patients and patients with anxiety disorder/depression.

OBJECTIVES: In the present study, we investigated olfactory bulb (OB) volume and olfactory sulcus (OS) depth of the psychotic patients (predominantly schizophrenia) and patients with anxiety disorder/depression. METHODS: This study was conducted retrospectively. Group 1 consisted of 30 psychotic patients (predominantly schizophrenia) (19 males and 11 females). Group 2 consisted of 37 patients with anxiety disorder/depression (10 males, 27 females). Group 3 consisted of 30 non-psychotic and non-anxiety disorder/depression subjects (9 males and 21 females). OB volume and OS depth measurements were performed on Cranial MRI. RESULTS: OB volume (right and left) of the psychotic; and anxiety disorder/depression groups were significantly lower than those of the control group (padjusted < 0.0175). OS depth (Left) value of anxiety disorder/depression group was significantly lower than those of the control group (padjusted < 0.0175). In psychotic and anxiety disorder/depression groups, left OS depth values were significantly lower than those of the right side (p < 0.05). In each of the males and females of the anxiety disorder/depression group, left OS depth values were significantly lower than those of the right side (p < 0.05). In psychotic group, OS depth (left) values get lower in older patients (p < 0.05). CONCLUSION: Decreased OB volume in the psychotic patients and decreased OB volume and OS depth in anxiety disorder/depression patients were detected. Lower OB volume and OS depth are related to the olfactory loss/or olfactory impairment. Physicians should be aware of the olfactory deficits in psychotic patients (mainly schizophrenia) and patients with anxiety disorder/depression. When reduced OB volume is detected on MRI, psychosis, schizophrenia or depression should also be kept in mind and the patients should be evaluated in detail for these diseases.

Olfactory bulbus volume and olfactory sulcus depth in migraine patients: an MRI evaluation.

OBJECTIVES: To compare the measurements of olfactory bulb volume and olfactory sulcus depth in patients with migraine and a control group. METHODS: The study included the cranial MRI (1.5 T) images of 200 adults diagnosed with migraine and a control group of 100 subjects without migraine. The control group mainly consisted of the patients with non-migraneous headache. The measurements were obtained from coronal T2-weighted images for standard olfactory bulb (OB) volume and olfactory sulcus (OS) depth. RESULTS: The OB volume and OS depth values were lower in the migraine group than in the control group. In the migraine group, left OB volume of the males was significantly lower than those of the females. In both the migraine and control groups separately, the left-side OB volume values and the right side OS depth values were significantly greater than those of the contralateral side. There were positive correlations between right and left OB volume, and right and left OS depth values. No change was seen in OB volume and OS depth values according to gender. In older patients, a decrease was determined in the right and left OB volume, and the left-side OS depth values. There was a negative correlation between osmophobia and OB volume values. In migraine patients with osmophobia, the OB volume values were significantly decreased. CONCLUSION: OB volume values were lower in migraine patients. When osmophobia was present, the OB volume was lower than that of the non-osmophobia migraine patients. Olfactory function monitoring with olfactory tests and olfactory volume monitoring on MRI can be recommended for all migraine patients to diagnose olfactory dysfunction earlier, especially those with osmophobia. Because their OB volume values were detected as lower than those of the migraine patients without osmophobia, it may be thought that blood flow changes and osmophobia may affect the olfactory bulb volume shrinkage in migraine patients.

Evaluation of the Brachial Plexus With Shear Wave Elastography After Radiotherapy for Breast Cancer.

OBJECTIVES: The aim of this study was to analyze the elasticity characteristics of the brachial plexus by shear wave elastography (SWE) in patients receiving radiation therapy (RT) for breast cancer and to compare them with their contralateral brachial plexus to evaluate whether elasticity properties can be used as supporting findings for the early diagnosis of brachial plexus involvement in patients receiving RT. METHODS: A prospective analysis with electromyography and SWE was performed on 23 brachial plexuses of patients receiving RT for breast cancer and their contralateral brachial plexuses. An electromyographic device was used for nerve conduction studies. Evaluations were done by the same investigator, and superficial electrodes were used in the recordings. A quantitative analysis of the brachial plexus with SWE was performed, with values in kilopascals on a color scale ranging from 0 (red, soft) to 150 (dark blue, hard) kPa. RESULTS: Mean SWE values ± SD were 51.0 ± 14.0 kPa for the ipsilateral brachial plexuses of patients receiving RT and 18.0 ± 4.2 kPa for the contralateral brachial plexuses. Statistically significant differences were observed between the groups in the analysis of SWE values (P < .001). No significant correlation was found between the nerve conduction parameters and elastographic values (P > .05). CONCLUSIONS: Shear wave elastography showed that the brachial plexuses of patients receiving RT were stiffer than the unaffected brachial plexuses. Brachial plexus stiffening may be associated with fibrotic processes.

Magnetic resonance imaging and computed tomography for diagnosing semicircular canal dehiscence.

OBJECTIVES: We investigated the semicircular canal (SC) dehiscence using temporal computed tomography (CT) and magnetic resonance (MR) imaging. METHODS: We retrospectively reviewed 114 (228 ears) consecutive MR images and CT scans of the temporal bones for dehiscence of the SCs. In the 1.5 Tesla (T) MR imaging, T1 and T2-weighted images were obtained. Dehiscence of the SCs was defined by absence of high attenuation bone coverage on the CT scans, and absence of low-signal bone margins on the MR images. RESULTS: Superior SC dehiscence was detected in 4 (1.8%) ears using CT scans and 5 (2.2%) ears using MR imaging. Posterior SC dehiscence was detected in 4 (1.8%) ears using CT scans and 4 (1.8%) ears using MR imaging. In the non-dehiscent cases, there was hypointense bone coverage between the canal and the cerebrospinal fluid (CSF). However, in the cases of semicircular canal dehiscence, hypointense bone tissue did not appear between the canal and the CSF in the MR imaging. CONCLUSION: If there is clinical doubt about the presence of SC dehiscence, we recommend that MR imaging be conducted first. When dehiscence is not seen in the MR, a CT examination should be performed. MR imaging is preferred primarily, because it does not contain ionizing radiation.

Investigation of the calcification at the petroclival region through Multi-slice Computed Tomography of the skull base.

OBJECTIVES: The aim of this paper was a retrospective investigation of calcification at the petroclival region using Multi-slice Computed Tomography (MSCT). METHODS: One hundred thirty skull bases were reviewed. The images were acquired with a 64 slice CT (MSCT). At first images were taken at the axial plane; and then coronal and sagittal reconstructions of raw data were performed. Later investigations were carried out on these 3-dimensional images (3-D imaging). Petrosphenoidal ligament (PSL) (Gruber's ligament) and posterior petroclinoid ligament (PPCL) calcifications were evaluated as "none, partial or complete calcification" for the right and left sides. RESULTS: In the right PSL, there were partial calcifications in 9.8% and complete calcifications in 2.3%. Calcification ratio was 9.8% partial and 2.9% complete in the left PSL. In the right side, there were 26.6% partial and 5.2% complete calcifications of PPCL. In the left side, there were 29.5% partial and 4.6% complete PPCL calcifications. PPCL calcification was detected more in males compared to females in the right and left sides. In older patients, left PSL; right and left PPCL calcification were detected more. CONCLUSION: PPCL calcifications cannot be differentiated from PSL calcifications in MSCT slices. The distinction can be easily done in 3-D views. The presence of ossified ligaments may make surgeries in this region difficult, and special care has to be taken to avoid injuries to structures which pass under these ossified ligaments. Particularly in elderly patients, the appropriate surgical instrument for the PSL calcifications should be prepared preoperatively. If PSL is calcified, 6th cranial nerve palsy may not occur even though increased intracranial pressure syndrome is present. Whereas, in lateral trans-tentorial herniations, 3rd cranial nerve palsy occurs in earlier periods when PSL is calcified. Moreover, in subtemporal and transtentorial petrosal approaches, knowing the PSL calcification preoperatively is important to avoid damaging the 6th cranial nerve during surgery.

The Presence of Clival Foramen Through Multidetector Computed Tomography of the Skull Base.

OBJECTIVES: Technological advancements in the diagnostic radiology recently permitted reviewing the normal anatomy through multidetector computed tomography (MDCT) imagination. The aim of this paper is retrospectively investigation of the clival foramen and canal through MDCT. MATERIALS AND METHODS: One hundred eighty-six MDCT scans were reviewed. First, images were taken at axial plane, and then coronal and sagittal reconstructions of raw data were performed. Later investigations were carried out on these three-dimensional images (3-D imaging). The images were evaluated as clival foramen "present" or "absent." RESULTS: In our 186 patients, evaluation of MDCT showed that clival foramen was absent in 66.7% (n = 124) of patients. Only 33.3% (n = 62) of patients had a clival foramen. In 3-D images, clival canal and clival foramen were shown more clearly compared with the MDCT. CONCLUSIONS: Knowledge of the clival canal might be useful in patients of questionable clival fracture or during neurosurgical operations in this region. During life the canal contained a vein connecting the basilar plexus with the venous plexus of the vertebral canal, and inferior petrosal sinuses. Before the surgical interventions in the clival region, the presence of the clival canal and foramen should also be known due to its vascular contents. By multidetector computed tomography and 3-D images, clival canal and foramen may be viewed preoperatively.

Is There a Relationship Between Optic Canal, Foramen Rotundum, and Vidian Canal?

OBJECTIVES: In this retrospective study, we investigated the relationship between paranasal sinus, optic canal, foramen rotundum, and vidian canal measurements. METHODS: Computed tomographic (CT) images of 320 adult subjects and 640 sides (right and left) were used. Paranasal sinus dimensions, optic canal (OC), foramen rotundum (FR), vidian canal (VC), bilateral FR (FRFR), bilateral vidian canal (VCVC), VC-foramen rotundum (VCFR), and VC-optic canal (VCOC) distances were measured. RESULTS: Right VCFR (6.06 mm), and right and left VCOC values (20.34 and 20.31 mm) of the males were significantly higher than those of the females (5.50, 18.91, and 18.80 mm, respectively). Foramen rotundum, OC, and VC values were positively correlated with each other. There was also positive correlation between FR width and maxillary sinus height. Increase of OC width was related to increase in FR width and area, VCVC distance; and decrease in maxillary sinus width. There was positive correlation between FRFR, VCVC, VCFR, and VCOC distance values. There was negative correlation between VC width and area; VCVC, VCFR, and VCOC distance; and maxillary sinus, ethmoid sinus, and sphenoid sinus measurement values. As these sinuses pneumatized more, VC width and area values decreased. CONCLUSION: As a conclusion, the paranasal sinus, OC, VC, and FR values showed relationship with each other. Before performing craniofacial and/or skull base surgeries, CT view should be taken to evaluate the localization and the course and dimensions of the OC and vidian nerve. It should be kept in mind that in the presence of more pneumatized paranasal sinuses in CT views, VC dimensions decreased.