Morphometric analysis of hippocampus and intracranial formations based on their stages in patients diagnosed with major cognitive disorder.

BACKGROUND: Alzheimer's disease (AD) is a major cognitive disorder classified as a common type of dementia. Magnetic resonance imaging (MRI) is the most practical method for diagnostic purposes in AD. The aim of the study was to determine the volume of the hippocampus and intracranial structures in AD using MRI. METHODS: A total of 102 patients with AD were classified based on the mini mental test scores as early, moderate, and advanced stage. The control group included 35 healthy subjects. MRI were compared between the patients and control groups based on the calculations made utilizing volBrain software. Intracranial volumetric parameters were also compared between the three stages of AD. RESULTS: The white matter volumes, total hippocampus, total cerebrum, right cerebrum, left cerebrum, truncus encephalic, total nucleus caudatus and total corpus amygdaloideum were significantly increased in the AD. The white matter volumes, right hippocampus, left hippocampus, total cerebrum, left cerebrum, and right cerebellum were significantly increased in the patients in the early stage compared to the patients in the advanced stage AD. DISCUSSION: The most efficient volumetric study in AD could be performed by obtaining long-term periodic morphometric data of an early diagnosed and regularly followed-up patient population.

Anomalous Origin and Course of Right Vertebral Artery With Aberrant Right Subclavian Artery.

ABSTRACT: Origin and course anomalies of the vertebral arteries are rare. They are considered a congenital anomaly that occurs in the early stages of embryonic development. Thanks to magnetic resonance angiography, these anomalies can be diagnosed easily. Detecting these anomalies is especially important before endovascular interventional procedures. In this case report, we present magnetic resonance angiography findings of a patient with extraforaminal vertebral artery that originated from right common carotid artery and also with aberrant right subclavian artery.

The radiological distance between the lumbar pedicle and laminar edges.

INTRODUCTION: Lumbar foraminal inner zone herniations are challenging cases, for which there are variety of approaches. However, there is no information about the distance between these herniations and the edges of the respective lamina. The aim of this study was to measure the distance between the inferomedial aspect of lumbar pedicles and laminar edges. MATERIALS AND METHODS: The lumbar CT images of 30 cases were reviewed. The distances between the edges of the lamina and the inferomedial aspects of the respective pedicles were measured. The study was performed on L3, L4, and L5 lumbar vertebrae on both sides. RESULTS: The mean distance between the upper edge of the lamina and the inferomedial aspect of the respective pedicle was found to be 10.8 ± 3.5, 11.6 ± 2.4, and 14.1 ± 2.3 mm on the left side, and 11.1 ± 4.4, 12.0 ± 2.5, and 13.8 ± 3.2 mm on the right side of L3, L4, and L5 vertebrae. The mean distance between the inferior edge of the lamina and the inferomedial aspect of the respective pedicle was found to be 23.8 ± 4.2, 19.3 ± 3.5, and 11.6 ± 2.9 mm, on the left side, and 23.9 ± 3.2, 19.1 ± 3.7, and 12.4 ± 2.8 mm on the right side of L3, L4, and L5 vertebrae. There was no statistically significant difference between values of the left and right sides (p > 0.05). CONCLUSION: This study revealed that distance between the inferomedial aspect of lumbar pedicles and the superior edge of the same lamina was shorter than the distance between the inferomedial aspect of lumbar pedicles and the inferior edge of the same lamina at L3 and L4 level. It was concluded that this shorter distance could be taken into consideration during surgery on inner zone 1 foraminal herniations.

Cerebrospinal fluid-dissemination of a ovarian clear cell carcinoma: A leptomeningial carcinomatosis with diagnostic challenges.

Metastases from ovarian cancer to the central nervous system (CNS) are rare, in particular, isolated leptomeningeal metastases (LM) are extremely rare. The gold standard in the diagnosis of leptomeningeal carcinomatosis (LC) is the detection of malignant cells in cerebrospinal fluid (CSF) cytology. A 58-year-old woman diagnosed with ovarian cancer 2 years ago underwent lumbar puncture and CSF cytology in recent months due to new weakness, loss of strength in the lower extremities, and speech disorders. Magnetic resonance imaging CNS was simultaneously visualized and linear leptomeningeal enhancement was demonstrated. CSF cytology showed tumor cells as isolated cells or small clusters of tumor cells with large, partially vacuolated, and abundant cytoplasm, mostly with centrally located nuclei. Given her history of high-grade clear cell ovarian cancer,CSF cytology was positive for malignant cells and a diagnosis of leptomeningeal carcinomatosis was made by the neuro-oncology multidisciplinary tumor board. Since LM also implies a systemic disease, the prognosis is very poor, CSF cytology will play an important role in rapid diagnosis and will be useful both in the right choice of treatment and in the early initiation of palliative care.

Investigation of Patients With Eye Closure Sensitive Epilepsy With Magnetic Resonance Spectroscopy.

Introduction and aim: A proportion of patients diagnosed with genetic generalized epilepsy (GGE) experience eye-closure sensitivity (ECS), the underlying pathogenesis of which is unknown. In this study, we compare magnetic resonance spectroscopy (MRS) findings of healthy volunteers with patients diagnosed with GGE, with and without ECS, to detect possible explanatory differences between groups. Materials and methods: A total of 33 patients diagnosed with GGE: 17 with ECS and 16 without, and 12 healthy volunteers are included. MRS measurements of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) were made of bilateral occipital lobes and thalamus, and values of patients with GGE were compared with those of normal controls, and within subgroups with different clinical variables, using appropriate statistical tests. Results: Left occipital NAA and NAA/Cr levels were found to be significantly higher in the ECS group than in the control group. In the ECS epilepsy group, a significant moderate positive correlation was noted between left thalamic Cr and duration of drug therapy (r = .539, P = .047) and left thalamic Cr and age at epilepsy onset (r = .564, P = .036). Additionally, left thalamic NAA and NAA/Cr levels were observed to be lower in GGE patients compared to healthy subjects, although not to a statistically significant degree. Conclusion:The differences in MRS-measurable metabolites in the left occipital lobe in those with ECS epilepsy suggest an association between the ECS mechanism and the left occipital lobe. Our results also support the multifocal thalamocortical pathway disorder in the pathophysiology of GGE based on the observation of cellular dysfunction in the thalamus.

Demonstration With Three-Dimensional Volumetric Magnetic Resonance Sequences of Deep Peroneal Nerve Compression on Os Intermetatarseum Syndrome.

ABSTRACT: The os intermetatarseum is a rare accessory bone of the foot. It is commonly asymptomatic, as are other such accessory bones of the foot. Nevertheless, when it becomes symptomatic, it can cause "os intermetatarseum syndrome." Reported here is a case of os intermetatarseum syndrome, which is extremely rarely seen. To the best of the authors' knowledge, there are very few cases of os intermetatarseum syndrome in the literature.

Illumination of The Relationship between Ureter and Intervertebral Disc by Computed Tomography.

AIM: To show the relationship of lumbar intervertebral discs with the ureters by using computerized tomography (CT). MATERIAL AND METHODS: Eighty patients (male/female: 42/38) with a mean age of 45 years were included in this retrospective study. An imaginary line passing through the tangential to the posterior cortex of the vertebral body was drawn at the intervertebral disc level (line a). Perpendicular to this line were two lines (line b) drawn from the ureters.The lines of the cortex, where ?line a? was cut (point c), were also drawn from the contralateral ureter (line d). The distances between ?lines b and d? were measured. Another line was drawn from both ?c? points to the ipsilateral ureters (line x). The angle between ?lines a and x? was measured (angle x). RESULTS: The right kidney hilus was inferior to the left kidney hilus. A significant negative correlation was observed between line band lumbar level (r=?0.95). The average length of ?line b? at the lower lumber levels was 2.1 cm. Moreover, a positive correlation was found between ?angle x? and lumbar level (p < 0.05). The ?angle x? increased from 38° to 80° with the decrease in lumbar levels. In addition, the ?angle x? was significantly higher in male patients (p < 0.05) than in female patients. No significant correlation was found between ?line d? and lumbar level. CONCLUSION: CT is an illumination modality that could elucidate the relationship between intervertebral disc and ureter preoperatively and could visualize the retroperitoneum.

Posterior shoulder labrocapsular structures in all aspects; 3D volumetric MR arthrography study.

Pathologies of the posterior labrocapsular structures of the shoulder joint are far less common than anterior labrocapsuloligamentous lesions. Most of these pathologies have been associated with traumatic posterior dislocation. A smaller portion of the lesions include posterior extension of superior labral anteroposterior lesions, posterior superior internal impingement, and damage to the posterior band of the inferior glenohumeral ligament. Labrocapsular anatomic variations of the posterior shoulder joint can mimic labral pathology on conventional MR and occasionally on MR arthrographic images. Knowledge of this variant anatomy is key to interpreting MR images and studying MR arthrography of the posterior labrocapsular structure to avoid misdiagnosis and unnecessary surgical procedures. In this article, we review normal and variant anatomy of the posterior labrocapsular structure of the shoulder joint based on MR arthrography and discuss how to discriminate normal anatomic variants from labrocapsular damage.

Preliminary study: myocardial T1 relaxation time in patients with ischemic findings and normal findings on coronary angiography.

OBJECTIVE: The aim of this study is to evaluate the myocardium structure in patients with chest pain who were determined to have moderate and/or high risk for cardiac ischemic heart disease (IHD) but who had normal findings on conventional coronary angiography by using native cardiac magnetic resonance imaging (CMRI) T1 mapping and comparing with healthy volunteers. METHODS: A total of 50 patients and 30 healthy volunteers who underwent CMRI were included in our prospective study. Patients whose clinical findings were compatible with stable angina pectoris, with moderate and/or high risk for IHD, but whose conventional coronary angiography was normal, were our patient group. Native T1 values were measured for 17 myocardial segments (segmented based on American Heart Association recommendations) by two radiologists independently. The data obtained were statistically compared with the sample t-test. RESULTS: Myocardial native T1 values were found to be significantly prolonged in the patient group compared with the control group (p<0.05). Inter-observer reliability for native T1 value measurements of groups was high for both patient and control groups (α = 0.92 for the patient group and 0.96 for the control group). CONCLUSION: Findings suggestive of ischemia were detected by T1 mapping in the myocardium of our patients. For this reason, it is recommended that this patient group should be included in early diagnosis and close follow-up assessments for IHD.

Lamina Measurements with Computed Tomography for C2 Translaminar Screw Fixation in Pediatric and Adult Cases.

AIM: To measure C2-related morphometric parameters in a Turkish population. MATERIAL AND METHODS: The computed tomography (CT) images of three groups (Group 1: paediatric cases aged 1-6 years, Group 2: age7-16 years, and Group 3: adult cases), who had cervical spine CT were used to measure some morphometric parameters for safe C2 translaminar screw fixation. The measured parameters included thickness, height and length of the C2 lamina on both sides and the C2 lamina-midline angle. RESULTS: C2 lamina thickness at the thinnest point on the right and left sides was found to be 4.4 ± 0.5 mm and 4.6 ± 0.5 mm in Group 1, 5.3 ± 0.8 mm and 5.6 ± 0.8 mm in Group 2, and 6.8 ± 1.4 mm and 7.0±1.5 mm in Group 3, respectively (p > 0.05). The height of the C2 lamina at the thinnest point on the right and left sides was found to be 5.8 ± 0.8 mm, and 5.8 ± 0.7 mm in Group 1,10.4 ± 1.4 mm and 10.6 ± 1.4 mm in Group 2, and 10.6 ± 1.8 mm, and 10.7 ± 1.5 mm in Group 3, respectively (p > 0.05). The mean length of the C2 lamina was found to be 20.6 ± 2.4 mm in Group 1, 31.4 ± 4.1 mm in Group 2, and 36.7 ± 3.3 mm in Group 3 (p < 0.05). There was no significant difference between Group 2 and Group 3 in respect of mean lamina angle (44º vs 45º) but it was lower in Group 1 (35º). CONCLUSION: This study revealed the appropriateness of C2 anatomy for safe C2 translaminar screw fixation.

Diagnostic performance of thorax CT in mildly symptomatic COVID-19 patients: The importance of atypical CT findings.

OBJECTIVE: Computed tomography of the thorax (Thorax CT) is frequently used to diagnose viral pneumonia in moderate to severe COVID-19 patients, but its diagnostic performance in mildly symptomatic COVID-19 patients is still unclear. Assessing the diagnostic performance of thorax CT in mildly symptomatic COVID-19 patients was the purpose of our study. METHODS: Mildly symptomatic and clinically stable, suspected COVID-19 patients scanned with Thorax CTs between March 11, 2020, and April 13, 2020, were included in this study. The sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, and the respective accuracies were calculated for diagnostic purposes. RESULTS: Among the 1119 patients enrolled in our study, abnormal thorax CT scans were 527 out of which 363/527 (68.9%) had typical CT features for COVID-19. According to analysis of typical COVID findings, sensitivity, specificity, positive predictive values, negative predictive value, and the accuracy of Thorax CTs with were 51.45%, 86.07%, 78.24%, 64.55%, and 68.99%, respectively. When typical CT findings and atypical CT findings were combined for the statistical analysis, the sensitivity, specificity, and accuracy observed 68.84%, 74%, and 71.49%. CONCLUSION: Diagnosing pneumonia can be challenging in mildly symptomatic COVID-19 patients since the Reverse Transcription Polymerase Chain Reaction test results, when compared with symptoms are not always evident. According to our study, thorax CT sensitivity was higher when atypical COVID-19 CT findings were included compared to those with typical COVID-19 CT findings alone. Our study which included the largest number of patients among all other similar studies indicates that not only typical but also atypical CT findings should be considered for an accured diagnosis of COVID-19 pneumonia.

Chest computed tomography findings of 1271 patients with COVID-19 pneumonia and classifications with different age groups: a descriptive study from Istanbul, Turkey.

OBJECTIVE: The objectives of this study were to describe lung computed tomography findings of patients with COVID-19 diagnosed by real-time reverse transcription polymerase chain reaction test, investigate whether the findings differ regarding age and gender, and evaluate the diagnostic performance of chest computed tomography based on the duration of symptoms at the time of presentation to the hospital. METHODS: From March 11 to May 11, 2020, 1271 consecutive patients (733 males and 538 females) were included in this retrospective, cross-sectional study. Based on age, patients were divided into five separate subgroups. Then based on the duration of symptoms, patients were divided into five separate phases. The presence of lung lesion(s) and their characteristics, distribution patterns, and the presence of concomitant pleural thickening/effusion and other findings (malignancy, metastasis, chronic obstructive pulmonary disease, interstitial lung disease, bronchiectasis, bronchiectasis, cardiomegaly, pericardial effusion) were evaluated by five radiologists independently. RESULTS: The "normal lung computed tomography finding" was the most common chest CT finding (37%), followed by ground-glass opacity (31%). Regardless of the shape of the lesion, the distribution features were significant (peripheral, subpleural, and lower lobe distribution) (p<0.05). The presence of pleural thickening posteriorly and adjacent to the lesion was statistically different in groups 1-3 (p<0.05). Other concomitant pathologies, except pulmonary congestion, did not suppress the typical findings of COVID-19. CONCLUSION: Chest computed tomography findings were mostly normal in the early phase (P1). Therefore, it may be appropriate to perform the first computed tomography screening of COVID-19 after 6 days to decrease the radiation exposure.

Successful Surgical Therapy of Gross Thoracolumbar Kyphosis in Boy with Achondroplasia.

We present a case of successful treatment of severe spinal deformity in a 4-year-old boy with achondroplasia. Using posterior segmental instrumentation with a sliding growing rod system, we were able to achieve reduction of thoracolumbal kyphosis from 45 to 11.3 degrees. Post surgery, the patient's spinal hump was completely corrected.

Radiologic Anatomy of the Lumbar Interlaminar Window and Surgical Considerations for Lumbar Interlaminar Endoscopic and Microsurgical Disc Surgery.

OBJECTIVE: The interlaminar window is the most important corridor during both interlaminar approaches to intervertebral discs. The aim of this study was to measure radiologic parameters related to endoscopic and microsurgical interlaminar discectomy. METHODS: Measured parameters included lateral recess line (LRL) width, distance between LRL and endplates of upper intervertebral disc, superior and lateral angles of interlaminar window, interlaminar height, and interpedicular distance via optimized coronal oblique projection computed tomography images. Measurements were performed at L2, L3, L4, and L5 levels. RESULTS: LRL was found to be 16.3 ± 3.4 mm, 17.3 ± 3.3 mm, 21.7 ± 3.4 mm, and 27.7 ± 4.0 mm at L2, L3, L4, and L5. The distances between LRL and both upper endplates decreased from L2 to L5. Distance between LRL and upper endplate of same vertebra and between LRL and lower endplate of upper vertebra was measured. Interlaminar window height decreased from L2 to L5 levels (from 14.0 ± 4.1 mm to 11.1 ± 2.4 mm). CONCLUSIONS: This study showed that width of LRL increases in lower lumbar segments, and height of interlaminar window increases in upper lumbar segments. This study also revealed that intervertebral disc is located cranial to LRL at L2-3, L3-4, and L4-5 levels and is located caudal to LRL at L5-S1 level. The results of this study may help surgical planning in both endoscopic and microscopic interlaminar surgery.

Diffusion-weighted Magnetic Resonance Imaging in the Differential Diagnosis of Benign and Metastatic Malignant Pleural Thickening.

PURPOSE: Imaging plays a critical role not only in detection but also in characterization of pleural thickening as benign or malignant. The aim of the study was to investigate the value of diffusion-weighted (DW) imaging in the differential diagnosis of benign and metastatic malignant pleural thickening. MATERIALS AND METHODS: Thirty-four patients with 64 pleural foci of nodular thickening (47 metastatic malignant and 17 benign) were included in this prospective study. DW imaging was performed using a breath-hold single-shot spin-echo echo-planar sequence. Two different apparent diffusion coefficient (ADC1,2) maps were obtained with different b factors (ADC1 reconstructed from b factors of 0 and 650 mm/s and ADC2 reconstructed from b factors of 0 and 1000 mm/s), and ADCs were calculated. Quantitatively, ADCs were compared between the groups, and the optimal cutoff value was found by using receiver operating characteristic curve analysis. RESULTS: Quantitatively, differences in signal intensities on DW trace images with b factors of 650 and 1000 mm/s were not statistically significant. The ADC1 and ADC2 of the metastatic malignant thickening were significantly lower than those of benign ones [mean ADC1 was 1.37±0.65×10 mm/s for metastatic malignant thickening and 2.11±0.69×10 mm/s for benign thickening (P=0.045); ADC2 was 1.06±0.56×10 mm/s for metastatic malignant thickening and 1.56±0.71×10 mm/s for benign thickening (P=0.038)]. However, because of the ADC overlap between malignant and benign disease, a sufficiently discriminative cutoff value could not be defined by the receiver operating characteristic curve analysis. CONCLUSION: Despite fair sensitivity and specificity, DW imaging may serve as a complementary tool that improves the differential diagnosis of pleural thickening.