Can the sigmoid notch sign be used on cranial computed tomography to differentiate between thrombosis and hypoplasia of the cerebral transverse venous sinus?

OBJECT: In patients with headache, the distinction between transverse sinus (TS) atresia/hypoplasia and TS thrombosis in cranial magnetic resonance venography (MRV) may be misleading. In this study, we aimed to distinguish TS thrombosis from atretic or severely hypoplastic TS, with the help of cranial computed tomography (CT). METHOD: Non-contrast cranial CT scans of 51 patients with no or severely thin signal on MRV were analyzed retrospectively using the bone window. Absence or asymmetry of the sigmoid notches on the CT predicted atretic or severe hypoplastic TS, and symmetry predicted thrombotic TS. Afterwards, it was investigated whether the patient's other imaging findings and confirmed diagnoses matched with the predictions. FINDINGS: Of the 51 patients included in the study, 15 were diagnosed with TS thrombosis, and 36 were diagnosed with atretic/hypoplastic TS. All 36 of the congenital atresia/hypoplasia diagnoses were correctly predicted. Thrombosis was predicted correctly in 14 of 15 patients with TS thrombosis. In cranial CT, the symmetry or asymmetry of the sigmoid notch sign was examined, and it was found that the evaluation predicted with 93.3% sensitivity (95% confidence interval (CI): 68.05-99.83) and 100% specificity (95% CI: 90.26-100.00) the distinction between TS thrombosis and atretic/hypoplastic sinus. CONCLUSION: Symmetry or asymmetry of the sigmoid notch on CT is a reliable method that can be used to differentiate congenital atresia/hypoplasia from the TS thrombosis in patients with very thin or absent TS signal on the cranial MRV.

Absence of CSF flow within the cerebral aqueduct in spontaneous intracranial hypotension: a report of two cases.

Spontaneous intracranial hypotension (SIH) is a potentially debilitating condition resulting from a low cerebrospinal fluid (CSF) volume secondary to spinal CSF leakage. Characteristic clinical and radiological imaging findings are helpful in diagnosis. Herein, we present and discuss the magnetic resonance imaging (MRI) and CSF flow study of two patients with SIH and no CSF flow within the cerebral aqueduct, which is extremely rare in the literature.

Fetal posterior cerebral artery duplication, true fetal posterior cerebral artery variation and trifurcation anterior cerebral artery association.

We would like to present a case with fetal posterior cerebral artery duplication and anterior cerebral artery trifurcation, which we detected using magnetic resonance angiography. We believe this is the first case defined in the literature. Embryological explanation of posterior cerebral artery variations is discussed in light of the literature.

Correlation Between Medial Meniscal Extrusion Determined by Dynamic Ultrasound and Magnetic Resonance Imaging Findings of Medial-Type Knee Osteoarthritis in Patients With Knee Pain.

OBJECTIVES: The aim of our study was to investigate the relationship between medial meniscal extrusion (MME) determined by dynamic ultrasound (US) and magnetic resonance imaging findings of medial-type knee osteoarthritis (OA). METHODS: Single knees of 102 patients with knee pain were assessed by radiography, dynamic US, and magnetic resonance imaging. All knee radiographs were interpreted and grouped according to the Kellgren-Lawrence (KL) scale. Medial meniscal extrusion in non-weight-bearing and weight-bearing positions and the difference of these values (ΔMME) were measured by dynamic US. The medial tibiofemoral compartments of all knees were evaluated and grouped according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Mean values of non-weight-bearing MME, weight-bearing MME, and ΔMME ± standard deviations for groups formed according to the KL scale and WORMS system were compared. RESULTS: We demonstrated that different from non-weight-bearing MME, weight-bearing MME was significantly correlated with not only high grades but also lower grades of cartilage damage and subchondral bone marrow lesions in medial-type knee OA. Although the difference in non-weight-bearing MME between cartilage status groups 1 and 2 was not significant (P = .071), there were significant differences in of weight-bearing MME between groups 1 and 2, between groups 2 and 3, and between groups 3 and group 4 (P = .003, .002, and .032, respectively). CONCLUSIONS: We found statistically significant associations between MME values and the severity of the OA findings according to both the KL scale and WORMS system. We offer dynamic US as an initial tool for the diagnosis and a screening method to estimate the severity of knee OA.

Ulnar hemimelia: a report of four cases.

Ulnar hemimelia is a very rare skeletal abnormality characterized by the total or partial absence of the ulna. It is reported to occur in approximately 1 per 150,000 live births. Some shortening of the forearm, radial bowing, and tendency of the hand to drift to the ulnar side of the wrist usually accompany ulnar hemimelia. Other skeletal anomalies such as humeroradial synostosis, radial head dislocation, carpal or metacarpal coalition, and digital abnormalities may also be seen in cases of ulnar hemimelia. The patients may be asymptomatic in the presence of an isolated mild ulnar deficiency. On the other hand, cases of prominent ulnar deficiency accompanied by complex upper limb abnormalities leading to severe disability may also be observed. We herein present four patients with varying degrees of ulnar hemimelia. Our first case had an isolated ulnar hemimelia, whereas the other three had additional upper limb abnormalities of different types.

Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome.

OBJECTIVE: To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome. METHODS: This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI. After an average period of 17.0±7.2 months, repeat MRI was taken in 40 patients who received only conservative care during follow-up. Changes in the volume of herniated disc was measured. The patients were assigned into 3 groups as follow: (1) non-regression, (2) partial-regression, and (3) complete resolution. Numeric Rating Scale (NRS) pain score, the Oswestry Low Back Pain Disability Index (ODI) and muscle weakness were evaluated. RESULTS: Based on disc volume of the T2-weighted MR images; four patients (10%) did not show any regression, six patients (15%) had a partial regression, and 30 patients (75%) had a complete resolution. Patients with complete resolution showed a significant improvement in the NRS pain score and the ODI score (p<0,001) over time. In patients with partial regression, only the ODI score improved significantly (p=0,043). Non-regression group did not show any improvement in any clinical outcome measure (p>0,05). Changes in the NRS scores over time were significantly higher in complete resolution group compared to non-regression group (p=0.016). CONCLUSION: The majority of the patients with extruded lumbar disc herniation might have reduction in size of herniated disc in the long run along with improvement in symptoms and function with conservative care.

Magnetic resonance imaging for diagnosis of bipartite patella: usefulness and relationship with symptoms.

PURPOSE: Bipartite patella is a rare developmental variation of the knee cap. We aimed to identify the magnetic resonance imaging (MRI) features of bipartite patella and evaluate the association with clinical symptoms. MATERIAL AND METHODS: MRI exams of 61 patients with bipartite variant were evaluated for types of bipartite patella, oedema around the synchondrosis, bipartite fragment height (FH), distance between the fragment and the patella (FPD), and signal characteristics within the synchondrosis. The study was designed with two observers in order to achieve intra- and interobserver compliance. Any other major knee pathologies that can cause pain were also recorded. RESULTS: Of the 61 participants the average age was 40.1 ± 14.3 years, 44 were males, and 17 were females. Fifty-nine of the bipartite fragments were located at the superolateral quadrant of the patella. There was oedema at the bipartite area in 35 patients. Ten of these patients had no major MRI diagnosis other than oedema, and they were classified as the symptomatic group. The age of the patients in the symptomatic group was statistically lower than in the asymptomatic group (p < 0.05). There was no statistically significant difference between the groups in terms of male and female distributions, signal types across the synchondrosis, and FH or FPD measurements (p > 0.05). High concordance correlation coefficients were observed on measurements. CONCLUSIONS: MRI of the knee is highly accurate in evaluation of bipartite patella. To our knowledge; a detailed MRI analysis, like in our study, has not previously been performed, and our report is unique in showing that the symptomatic occurrence of bipartite patella is statistically higher in young patients.

Focal Nodulary Hyperplasia of the Liver Due to Congenital Portosystemic Shunt: A Rare Condition Mimicking Hepatocellulary Carcinoma.

Congenital portosystemic shunts are rare vascular malformations that lead to several complications including liver tumors, pulmonary hypertension, and metabolic encephalopathy. We describe a rare case of a 17-year-old girl with an extrahepatic portosystemic shunt presenting recurrent syncope episodes and a liver mass mimicking hepatocellulary carcinoma.

Rapid resolution of protracted febrile myalgia syndrome with anakinra: Report of two cases.

Protracted febrile myalgia syndrome (PFMS) is a very rare but severe manifestation of familial Mediterranean fever (FMF) which is characterized by severe debilitating pain in large muscle groups that may last for several weeks. Colchicine is ineffective and treatment is largely supportive. Demonstration of crucial role of interleukin-1 (IL-1) in the pathogenesis of FMF has increased the use of IL-1 blockers in colchicine resistant or intolerant patients. Herein, we reported successful use of an IL-1 inhibitor, anakinra, in treatment of two patients with PFMS.

Real-time sonoelastography of the quadriceps tendon in patients undergoing chronic hemodialysis.

OBJECTIVES: This study aimed to compare sonoelastographic findings for the quadriceps tendon in patients with chronic renal failure who were in a dialysis program to findings in a control group. METHODS: Fifty-three randomly allocated patients (mean age, 54.3 years; range, 27-86 years) with chronic renal failure who were in a dialysis program 3 days a week between January and May 2012 were included. The measurements were performed in both knees of 53 patients undergoing dialysis and 25 individuals in the control group. The tendons were classified as follows: type 1, very stiff tissue (blue); type 2, stiff tissue (blue-green); and type 3, intermediate tissue (green-yellow) according to color mapping. RESULTS: The mean quadriceps tendon thicknesses in the patient group were 4.9 mm (range, 1.9-6.5 mm) for the right knee and 4.9 mm (1.4-6.5 mm) for the left knee; the values in the control group were 5.4 mm (3.6-7.0 mm) for the right knee and 5.4 mm (3.4-7.0 mm) for the left knee. The mean elasticity scores in the patient group were 3.14 (1.03-5.23) for the right knee and 3.33 (1.29-5.00) for the left knee; in the control group, the values were 3.79 (1.73-5.23) and 3.69 (1.23-5.53) for the right and left knees, respectively (right knee, P = .025; left knee, P = .018; Mann-Whitney U test). The quadriceps tendons were significantly thinner in the patient group (right knee, P = .054; left knee, P = .015; Mann-Whitney U test). CONCLUSIONS: Quadriceps tendons in patients with chronic renal failure are thinner and have lower elasticity scores compared to controls.

Real-time sonoelastography of Achilles tendon in patients with ankylosing spondylitis.

OBJECTIVE: Real-time sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on tissue elasticity and stiffness. We determined the efficacy of SE for assessing Achilles tendon abnormalities in patients with ankylosing spondylitis (AS). MATERIALS AND METHODS: Forty-one consecutive AS patients and 32 asymptomatic healthy subjects were enrolled. Achillodynia was scored on a 0- to 100-mm visual analog scale. A high-resolution ultrasound machine equipped with an elastography-compatible linear probe was used to perform bilateral B-mode ultrasound, Doppler ultrasound, and SE examinations of Achilles tendons. Tendons were divided into proximal, middle, and distal segments. B-mode examinations included tendon thicknesses, echotextures, and enthesopathic findings. SE using color-coded images was performed in the same areas. Normal consistent tendon structures were coded as blue or green, and moderately (yellow) or severely (red) softened areas were considered pathological. RESULTS: The distal third of the Achilles tendons was the most commonly affected part in the AS patients compared with healthy subjects (p = 0.001), whose middle third was more commonly affected. Achillodynia intensity tended to be higher in patients with pathological B-mode or SE examination findings (p = 0.09 and p = 0.07 respectively). Softening detected by SE in the distal third was associated with enthesopathy findings such as calcaneal bone erosions (Fisher's X (2), p = 0.07) and tendinous enlargement (Fisher's X (2), p = 0.001). B-mode and SE findings had moderate to good correlation in the assessment of Achilles tendon abnormalities. CONCLUSIONS: Sonoelastography may be useful for the evaluation of tendon abnormalities in patients with AS; in addition; it may be useful for the evaluation of other inflammatory rheumatic conditions.

Evaluation of Arachnoid Granulations in Cranial Dural Sinuses with Contrast-Enhanced 3-Dimensional T1-Weighted Magnetic Resonance Imaging.

OBJECTIVE: Several studies in the literature have used contrast-enhanced magnetic resonance imaging to investigate arachnoid granulations protruding into the cranial dural sinuses. The current study aimed to investigate the protrusion of arachnoid granulations into the superior sagittal sinus, transverse sinus, straight sinus, and confluence of sinuses and determine the frequency of brain herniation into giant arachnoid granulations using contrast-enhanced 3-dimensional T1-weighted magnetic resonance imaging. MATERIALS AND METHODS: Images of 550 patients with intra-sinus arachnoid granulations who underwent contrast-enhanced 3-dimensional T1-weighted thin-slice magnetic resonance imaging were retrospectively re-evaluated. Only 300 patients with at least 1 intra-sinus arachnoid granulation were included in the study. The protrusion of arachnoid granulations into superior sagittal sinus, transverse sinus, straight sinus, and confluence of sinuses was investigated. In addition, large arachnoid granulations and brain herniations into arachnoid granulations were also noted. RESULTS: A total of 889 focal filling defects of arachnoid granulations, at least 1 in the dural sinus, were detected. Of the filling defects of arachnoid granulations, 183 were in the right transverse sinus, 222 in the left transverse sinus, 265 in superior sagittal sinus, 185 in straight sinus, and 34 in confluence of sinuses. Brain herniation into arachnoid granulations was detected in 8 (2.7%) of the patients included in the study. All the filling defects detected in the dural sinuses on post-contrast 3-dimensional T1-weighted images were isointense with cerebrospinal fluid and had round, oval, or lobulated contours. A positive weak correla- tion was found between patient age and the size and number of arachnoid granulations (r = 0.181, P < .01 and r=0.207, P < .001, respectively). It was observed that the size and number of arachnoid granulations increased as the age of the patients increased. CONCLUSIONS: The distribution, shape, number, and size of intra-sinus arachnoid granulations can vary considerably. Brain herniation into arachnoid granulation can also be seen. Three-dimensional cranial magnetic resonance imaging sequences can be safely used in the evaluation of arachnoid granulations.

The utility of quantitative MRI parameters in discriminating progressive supranuclear palsy from Parkinson's disease.

OBJECTIVE: We sought to re-evaluate the utility of all the quantitative neuroimaging parameters attributed to progressive supranuclear palsy (PSP) in discrimination between PSP and Parkinson' s disease (PD) subjects in our cohort. We aimed to propose some practical clinical remarks in this field. METHODS: In our retrospective study, 19 patients with 'probable' PSP and 37 patients with PD were enrolled. The radiological measurements of PSP, described in the previous reports, have been calculated in all subjects. The comparisons between the groups were performed and the measures regarding the accuracy of these parameters in the differentiation of PSP from PD subjects were analyzed. RESULTS: We found that the values of magnetic resonance parkinsonism index-2 (MRPI-2), pontine-to-midbrain area (P/M) ratio, P/M 2 ratio, and 3rdV/bifrontal width ratio had high AUC values and very good discriminative powers. The analyses revealed that; for the discrimination of PSP from PD subjects, a 3rdvent/bifrontal width cut-off value of 0.30 had 42.1 % sensitivity and 97.3 % specificity; a P/M cut-off value of 6.03 had a 52.6 % sensitivity and 97.3 % specificity; and an MRPI-2 cut-off value of 7.43 had 57.9 % sensitivity and 97.3 % specificity. Remarkably, we also found that the presence of high values for both P/M and 3rdV/bifrontal ventricle rate had a positive predictive value of 100% for the diagnosis of PSP. CONCLUSION: Our study results support the utility of previously defined neuroimaging parameters in distinguishing PSP and PD subjects. Besides, combined use of a high P/M ratio and 3rdV/bifrontal width may be practical and present strictly high evidence for the diagnosis of PSP.

Evaluation of the frequency of tentorial hypoplasia and accompanying gyral herniation using MRI.

Purpose The cerebellar tentorium, the second-largest dural reflection in the brain, separates supratentorial and infratentorial structures. This study aimed to determine the frequency of tentorial hypoplasia (TH) and gyral herniation and their relationship with clinical findings. Methods The standard brain MRIs were examined retrospectively. The presence of TH and laterality were investigated. If hypoplasia was accompanied by a gyrus extending inferior to the line where the tentorium should be located, this was recorded as tentorial hypoplasia-herniated gyrus (TH-HG), while the cases with hypoplasia alone were noted as isolated TH. It was also determined which gyrus or gyri were herniated. The clinical findings of the patients were obtained, and the correlation between HG was explored. Results Standard brain MRIs of the 2051 patients were evaluated. Two hundred ten patients were excluded from the study due to different intracranial disorders, and 1841 patients, 739 (40.1%) males, and 1102 (59.9%) females, were included. Isolated TH or TH-HG was present in 56 patients, resulting in a prevalence of 3.04%. Of the patients with TH or TH-HG, 15 were men, and 41 were women. TH and TH-HG were significantly more common in women (p=0.038). TH-HG was unilateral in 22 (39.2%) patients and bilateral in 21 (37.5%). Left TH was found in 11 (19.6%) patients, left TH-HG in 29 (51.7%), right TH in eight (14.2%), and left TH-HG in 35 (62.5%). Conclusion Hypoplasia of the tentorium is a rare and unknown anomaly that can be easily diagnosed using MRI, and different gyral herniations may accompany TH.

Evaluation of Renal Artery Variations in Horseshoe Kidneys with Computed Tomography.

OBJECTIVE: Horseshoe kidney is the most common renal fusion anomaly, accounting for 90%. The study aims to explore the variations in the renal arteries of individuals with horseshoe kidney anomalies and contribute to the classification in the literature. MATERIALS AND METHODS: Computed tomography images of 145 individuals who had intravenous contrast-enhanced abdominal computed tomography for any reason and had horseshoe kidney anomalies were analyzed retrospectively, and the presence, origin, and number of accessory renal arteries were evaluated. Then, classification was performed according to the origin of the accessory arteries. RESULTS: In 145 individuals, 44 different combinations of the accessory artery according to the origin and number were obtained. Most common accessory artery combination was type 2a (M1). According to our classification, 13.1% of the patients were type 1, 57.2% were type 2, 17.2% were type 3, 10.3% were type 4, and 1.4% were type 5. CONCLUSION: The classifications of arterial variations in horseshoe kidney anomalies did not match each other in previous studies and did not comprise all patients because they were conducted with a small number of cases. A more comprehensive new classification was created in our study according to accessory artery origins with the help of previous studies.

Time-resolved MR angiography of the intracranial venous system: an alternative MR venography technique.

OBJECTIVES: To compare time-resolved imaging of contrast kinetics (TRICKS) magnetic resonance angiography (MRA) with two-dimensional time-of-flight (TOF) magnetic resonance venography (MRV), and three-dimensional contrast-enhanced (CE) MRV in the visualisation of normal cerebral veins and dural venous sinuses. METHODS: This prospective study consisted of 35 consecutive patients. All patients were examined with TOF MRV, TRICKS MRA and CE MRV; a single dose of intravenous contrast material was administered for the last two sequences. The image quality of these techniques was assessed and compared qualitatively (by a semiquantitative scoring system) and quantitatively (by calculating signal-to-noise ratios [SNRs] and contrast-to-noise ratios [CNRs]). RESULTS: Left transverse sinus, left sigmoid sinus, bilateral thalamostriate veins and Trolard veins were better visualised by TRICKS MRA and CE MRV compared with TOF MRV (P < 0.05). For left thalamostriate vein visualisation, TRICKS MRA was inferior to CE MRV (P < 0.05). With quantitative analysis the SNRs and CNRs were highest at TRICKS MRA, which was followed by CE MRV and TOF MRV (P < 0.05). CONCLUSIONS: Despite its limited spatial resolution, TRICKS MRA is comparable to static CE MRV and better than TOF MRV in the visualisation of normal dural sinuses and cerebral veins. KEY POINTS: • Time resolved magnetic resonance angiography can image the intracranial venous system dynamically • It seems comparable to contrast-enhanced MRV techniques in venous visualisation • The optimal phase for venous structures can be chosen from the dynamic data set • The diagnostic performance in venous thrombosis requires further research.

Frequency of Ipsilateral Axillary Lymphadenopathy After the Inactivated COVID-19 Vaccine.

OBJECTIVE: During COVID-19 vaccine development studies, vaccines' efficacy and safety profiles should be carefully investigated. Only a few studies have shown that the COVID-19 vaccine can cause axillary lymphadenopathy on the injection arm. This study aimed to investigate the incidence of axillary lymphadenopathy and imaging findings using B-mode and Doppler ultrasonography (US) examinations in volunteers who had recently been vaccinated against COVID-19. METHODS: The ipsilateral and contralateral axillae of 101 volunteers who received the COVID-19 vaccine were evaluated using B-mode and Doppler US examinations. The volunteers were asked when and to which arm the vaccine had been applied, and the type and dose of the vaccine were recorded. It was also questioned whether the individual experienced any side effects after vaccination, such as pain, tenderness, fever, and redness at the injection site. In addition, the demographic data of the participants, such as age and gender, were recorded. RESULTS: The B-mode US examinations revealed that the long- and short-axis diameters, size, cortical thickness, and asymmetric cortical thickening of the left axillary lymph nodes were significantly higher compared to the right side in individuals having received the CoronaVac vaccine (p<0.05). When the individuals were evaluated separately according to gender, the frequency of cortical thickness and asymmetric cortical thickening in the left axillary lymph nodes was higher than on the right side in both males and females (p=0.011). CONCLUSION: It should be kept in mind that ipsilateral reactive lymphadenopathy may develop after the COVID-19 vaccine. This knowledge can prevent unnecessary axillary lymph node biopsies.

An extrahepatic hydatid cyst with the fat-fluid level.

A hydatic cyst is a zoonosis caused by the larva of a tapeworm Echinococcus granulosus. The liver is the most commonly affected organ. Soft tissue localization has been reported in 2.3% of cases. Herein, we present a patient with a fat-containing hydatid cyst located in the left thigh. There are only a few reports in the literature on the presence of the fat-fluid level within a hydatid cyst. Previous studies have suggested that fat-containing hydatid cysts occur due to their cysto-biliary communication in the liver. In our case, we describe a fat-containing hydatid cyst in the extrahepatic location and discuss the pathophysiologic mechanism of fat inside it.

Normative Measurements and Apparent Diffusion Coefficient Values of Parotid Lymph Nodes on Magnetic Resonance Imaging.

OBJECTIVE: To determine the morphological features and apparent diffusion coefficient (ADC) values of normal intraparotid lymph nodes (IPLNs) obtained from the MRI examination. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Radiology, Ankara, Turkey, from January 2018 to December 2021. METHODOLOGY: The study included 232 patients who underwent neck MRI examination. The long axis diameter (LAD) was measured as the largest diameter of the IPLN, and the short axis diameter (SAD) was measured perpendicular to the LAD. ADC measurements were undertaken by placing the largest region of interest suitable for the size of the IPLNs. RESULTS: A total of 394 lymph nodes were evaluated. The median LAD and SAD of the lymph nodes were 5.50 (2.50) mm and 3.50 (2.00) mm, respectively. The LAD was 9 mm or lower in 95.7% of the lymph nodes; the SAD was 6 mm or lower in 94.7%. The ADC map was evaluated in 275 IPLNs, with the median ADC value being calculated as 0.77(0.18)x10-3 mm2/s. The ADC value was 1.05x10-3 mm2/s or lower in 96.3% of the lymph nodes. CONCLUSION: A SAD of 6 mm; and a LAD of 9 mm could be used as normalcy criteria in IPLNs. Normal IPLNs may have an ADC of 1.05x10-3 mm2/s or lower. Considering that benign IPLNs may have low ADC values, those can prevent false-positive results in terms of malignancy. KEY WORDS: Parotid glands, Lymph nodes, Magnetic resonance imaging, Apparent diffusion coefficient.