Exploiting lamina terminalis appearance and motion in prediction of hydrocephalus using convolutional LSTM network.

BACKGROUND: Evaluation of the lamina terminalis (LT) is crucial for non-invasive evaluation of the CSF diversion for the treatment of hydrocephalus. Together with deep learning algorithms, morphological and physiological analyses of the LT may play an important role in the management of hydrocephalus. AIM: We aim to show that exploiting the motion of LT can contribute to the evaluation of hydrocephalus using deep learning algorithms. METHODS: The dataset contains 61 True-fisp data with routine sequences 37 of which are labeled as 'hydrocephalus' and the others as 'normal condition'. A fifteen-year experienced neuroradiologist divided data into two groups. The first group, 'hydrocephalus', consists of patients with typical MRI findings (ventriculomegaly, enlargement of the third ventricular recesses and lateral ventricular horns, decreased mamillo-pontine distance, reduced frontal horn angle, thinning/elevation of the corpus callosum, and non-dilated convexity sulci), and the second group contains samples that did not show any symptoms or neurologic abnormality and labeled as 'normal condition'. The region of interest was determined by the radiologist supervisor to cover the LT. To achieve our purpose, we used both spatial and spatio-temporal analysis with two different deep learning architectures. We utilized Convolutional Neural Networks (CNN) for spatial and Convolutional Long Short-Term Memory (ConvLSTM) models for spatio-temporal analysis using an ROI around LT on sagittal True-fisp images. RESULTS: Our results show that 80.7% classification accuracy was achieved with the ConvLSTM model exploiting LT motion, whereas 76.5% and 71.6% accuracies were obtained by the 2D CNN model using all frames, and only the first frame from only spatial information, respectively. CONCLUSION: We suggest that the motion of the LT can be used as an additional attribute to the spatial information to evaluate the hydrocephalus.

Fiber dissection and 3-tesla diffusion tensor tractography of the superior cerebellar peduncle in the human brain: emphasize on the cerebello-hypthalamic fibers.

Experimental studies in various species using tract-tracing techniques showed clear evidence of the presence of cerebello-hypothalamic projections. However, these connections were not clearly described in humans. In the present study we aimed to describe the direct cerebello-hypothalamic connections within the superior cerebellar peduncle (SCP) using fiber dissection techniques on cadaveric brains and diffusion tensor tractography (DTI) in healthy adults. Fiber dissection was performed in a stepwise manner from lateral to medial on 6 cerebral hemispheres. The gray matter was decorticate and fiber tracts were revealed. The SCP was exposed and the fibers were traced distally using wooden spatulas. The MRI examinations were performed in seven cases using 3-tesla 3T unit. The direct cerebello-hyothalamic pathways were exposed using high-spatial-resolution DTI. The present study using both fiber dissection and DTI in adult human showed direct cerebello-hypothalamic fibers within the SCP. The SCP fibers course anterolateral to the cerebral aqueduct reaching the level of the red nucleus of the midbrain. The majority of the fibers crosses over and reached the contralateral diencephalic structures and some of these fibers terminated at the contralateral anterior hypothalamic area. Some of the uncrossed SCP fibers reached the ipsilateral diencephalic structures and terminated at the ipsilateral posterior hypothalamic area. We further reported the close relationship of the SCP with the MCP, lateral lemniscus, red nucleus and substantia nigra. In the DTI evaluations of the SCP we exposed unilateral left cerebello-hypothalamic fibers in five cases and bilateral cerebello-hypothalamic fibers in two cases. The present study demonstrates the direct cerebello-hypothalamic connections within the SCP for the first time using fiber dissection and DTI technique in the human brain. The detailed knowledge of the cerebello-hypothalamic fibers can outline the unexplained deficit that may occur during regional surgery.

Neurochemical-structural changes evaluation of brain in patients with obstructive sleep apnea syndrome.

PURPOSE: To evaluate neurochemical and structural changes in the patients with newly diagnosed obstructive sleep apnea syndrome (OSAS) by MR spectroscopy (MRS), T2 relaxometry, and diffusion weighted imaging (DWI). MATERIAL AND METHODS: Following the acquisition of routine cranial MR, MRS, T2 relaxometry, and DWI images; spectroscopic metabolite ratios and DWI-T2 relaxometry findings of the thalami, hippocampi, frontal white matter (FWM) and frontal cortex of 24 OSAS patients and 9 controls were statistically compared. The relationship between two groups was evaluated with Mann-Whitney test. RESULTS: Spectroscopic measurements in the frontal cortex and frontal white matter of the OSAS patients revealed significantly lower NAA/Cr ratios than those of the control group (P=0.004 and P=0.006, respectively). The measurements in the frontal white matter of the OSAS patients exhibited significantly lower NAA/Cho ratios compared with those of the control group (P=0.005). Thalamic Cho/Cr ratios of the patient group were significantly higher than those of the control group (P=0.002). In terms of the ADC-T2 relaxometry values, there was no significant relationship between the patient and the control groups (P>0.05). CONCLUSION: MRS is a useful and non-invasive modality in showing neurochemical changes in various regions of the brain but our data does not show any change on diffusion weighting or T2 quantification in the OSAS group. DWI and T2 relaxometry appear to be not effective techniques to evaluate the brain structural changes of the patients with newly diagnosed OSAS.

Ultrasound-guided percutaneous drainage of neonatal pyometrocolpos under local anesthesia.

Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.