Distinguishing Pituitary Metastasis and Pituitary Neuroendocrine Tumors through Conventional MR Imaging and Clinical Features.

BACKGROUND AND PURPOSE: Given their overlapping features, pituitary metastases frequently imitate pituitary neuroendocrine tumors in neuroimaging studies. This study aimed to distinguish pituitary metastases from pituitary neuroendocrine tumors on the basis of conventional MR imaging and clinical features as a practical approach. MATERIALS AND METHODS: In this 2-center retrospective study, backward from January 2024, preoperative pituitary MR imaging examinations of 22 pituitary metastases and 74 pituitary neuroendocrine tumors were analyzed. Exclusion criteria were as follows: absence of a definitive histopathologic diagnosis, history of pituitary surgery or radiation therapy before MR imaging, and pituitary neuroendocrine tumors treated with medical therapy. Two radiologists systematically evaluated 13 conventional MR imaging features that have been reported more commonly as indicative of pituitary metastases and pituitary neuroendocrine tumors in the literature. Age, sex, history of cancer, and maximum tumor size constituted the clinical/epidemiologic features. The primary cancer origin for this study was also noted. Univariable and multivariable logistic regression was used for the selection of variables, determining independent predictors, and modeling. Interobserver agreement was evaluated for all imaging parameters using the Cohen κ statistic or intraclass correlation coefficient. RESULTS: A total of 22 patients with pituitary metastases (8 women; mean age, 49.5 [SD, 13] years) and 74 patients with pituitary neuroendocrine tumors (36 women; mean age, 50.1 [SD, 11] years) were enrolled. There was no statistically significant distributional difference in age, sex, or maximum tumor size between the 2 groups. Lung cancer (9/22; 41%) was the most commonly reported primary tumor, followed by breast (3/22; 13.6%) and unknown cancer (3/22; 13.6%). Logistic regression revealed 3 independent predictors: rapid growth on control MR imaging, masslike or nodular expansion of the pituitary stalk, and a history of cancer. The model based on these 3 features achieved an area under the curve, accuracy, sensitivity, specificity, and Brier score of 0.987 (95% CI, 0.964-1), 97.9% (95% CI, 92.7%-99.8%), 95.5% (95% CI, 77.2%-99.9%), 98.6% (95% CI, 92.7%-100%), and 0.025, respectively. CONCLUSIONS: Two conventional features based on pituitary MR imaging with the clinical variable of history of cancer had satisfying predictive performance, making them potential discriminators between pituitary metastases and pituitary neuroendocrine tumors. In cases in which differentiation between pituitary metastases and pituitary neuroendocrine tumors poses a challenge, the results of this study may help with the diagnosis.

The effect of emotional faces on reward-related probability learning in depressed patients.

BACKGROUND: Existing research indicates that individuals with Major Depressive Disorder (MDD) exhibit a bias toward salient negative stimuli. However, the impact of such biased stimuli on concurrent cognitive and affective processes in individuals with depression remains inadequately understood. This study aimed to investigate the effects of salient environmental stimuli, specifically emotional faces, on reward-associated processes in MDD. METHODS: Thirty-three patients with recurrent MDD and thirty-two healthy controls (HC) matched for age, sex, and education were included in the study. We used a reward-related associative learning (RRAL) task primed with emotional (happy, sad, neutral) faces to investigate the effect of salient stimuli on reward-related learning and decision-making in functional magnetic resonance imaging (fMRI). Participants were instructed to ignore emotional faces during the task. The fMRI data were analyzed using a full-factorial general linear model (GLM) in Statistical Parametric Mapping (SPM12). RESULTS: In depressed patients, cues primed with sad faces were associated with reduced amygdala activation. However, both HC and MDD group exhibited reduced ventral striatal activity while learning reward-related cues and receiving rewards. LIMITATIONS: The patients'medication usage was not standardized. CONCLUSIONS: This study underscores the functional alteration of the amygdala in response to cognitive tasks presented with negative emotionally salient stimuli in the environment of MDD patients. The observed alterations in amygdala activity suggest potential interconnected effects with other regions of the prefrontal cortex. Understanding the intricate neural connections and their disruptions in depression is crucial for unraveling the complex pathophysiology of the disorder.

Gradual Loss of Social Group Support during Competition Activates Anterior TPJ and Insula but Deactivates Default Mode Network.

Group forming behaviors are common in many species to overcome environmental challenges. In humans, bonding, trust, group norms, and a shared past increase consolidation of social groups. Being a part of a social group increases resilience to mental stress; conversely, its loss increases vulnerability to depression. However, our knowledge on how social group support affects brain functions is limited. This study observed that default mode network (DMN) activity reduced with the loss of social group support from real-life friends in a challenging social competition. The loss of support induced anterior temporoparietal activity followed by anterior insula and the dorsal attentional network activity. Being a part of a social group and having support provides an environment for high cognitive functioning of the DMN, while the loss of group support acts as a threat signal and activates the anterior temporoparietal junction (TPJ) and insula regions of salience and attentional networks for individual survival.

The effects of sexual abuse on female adolescent brain structures.

Objective: Sexual abuse (SA) is known for its effects on brain structures in adolescents. We aimed to explore if SA has any effect on limbic and prefrontal cortex (PFC) structures. We hypothesized that children with SA would have a thinner PFC with larger amygdala and hippocampus that lead to aberrations in threat detection, orientation and response circuit; that would be highly adaptive in a dangerous environment in the short term. Method: We included 57 SA and 33 healthy control (HC) female participants. In addition to psychiatric evaluation, we acquired 3 T MR images from all participants. We compared prefrontal cortical thicknesses, hippocampus and amygdala volumes between groups. Results: The age and education levels of study groups were matched, however, IQ scores and socioeconomic status (SES) scores of the SA group were lower than the controls. Total CTQ scores of the SA group were higher than the HC. Nevertheless, the mean value of sexual abuse scores was above the cut-off scores only for the SA participants. SA participants had larger right and left hippocampus and right amygdala volumes than the controls. SA group had reduced inferior frontal gyrus cortical thickness (T=3.5, p<0.01, cluster size=694 mm2, x=51 y=-30 z=6) than HC group. None of the structural findings were correlated with total or sexual abuse CTQ scores. Conclusion: Children with SA history has structural abnormalities in threat detection, orientation and response circuit. SA victims with no psychiatric diagnosis have a high probability of psychiatric problems with a possible contribution of these aberrations. SA cases that do not have a diagnosis must not be overlooked as they may have structural changes in emotion related brain regions. Careful follow-up is needed for all of all SA cases.

The Reflection of Self-Esteem on the Brain Structure: A Voxel Based Morphometry Study in Healthy Young Adults.

Introduction: Low self-esteem is a known risk factor for mental illnesses. Neuroimaging studies have identified evidence for a functional association between default mode network (DMN) and self-esteem levels. However, it is not clear whether there is a similar association between trait self-esteem and the structures composing DMN. This study aimed to investigate the relationship between the DMN associated brain structures and trait self-esteem. Methods: We obtained 3T structural magnetic resonance imaging (MRI) data of 75 healthy subjects and detected anatomical regions correlated with their Rosenberg Self-Esteem scores via voxel-based morphometry (VBM). Results: We found positive associations between self-esteem and regional grey matter volumes in the right temporoparietal junction/inferior parietal lobule (BA 39), cortical midline regions at precuneus/dorsal cingulate cortex (BA 31), rostral and dorsal anterior cingulate cortices (BA 32). Conclusion: The results of the current study support the fMRI studies suggesting self-esteem levels associated with DMN. Further neuroimaging studies should consider the functional and structural coupling of the default mode network during the execution of the functions related to self-esteem.

Dysembryoplastic neuroepithelial tumors of childhood: Ege University experience.

BACKGROUND: Dysembryoplastic neuroepithelial tumors (DNETs) are rare, low-grade tumors of the central nervous system (CNS) of childhood. It is an important cause of intractable epilepsy, and it is surgically curable. We aimed to review our institutional experience with DNET in children. METHODS: Medical records of children aged less than 18 years of age diagnosed with DNET between 2009 and 2020 at Ege University Hospital were reviewed. Clinical features of the patients including age, gender, initial symptoms, duration of symptoms, medical treatments, age at the time of surgery, tumor location, degree of surgical resection, and outcome of the patients were documented. RESULTS: We reviewed the records of 17 patients with DNETs. Twelve of them were male (70%), 5 of them female (30%). The median age was 11 years (19 months-17 years). The major symptom was a seizure in all of the patients. Thirteen patients presented with complex partial seizures, whereas 2 had a simple partial seizure, and 2 generalized tonic-clonic seizures. Seven patients had drug resistant epilepsy and had received at least two anti-epileptic drugs before surgery. The median duration of symptoms was 6.6 months (0-48 months). In surgery, total surgical resection was performed in 15 patients, and 2 patients underwent partial resection. From these 15 patients, seven patients underwent lesionectomy of the tumor while the other eight patients had extended lesionectomy. The mean follow-up time was 107 months (54-144 months), the seizure control was achieved in 14 patients (82.4%) after surgery, but 3 patients experienced tumor recurrence in the follow-up. CONCLUSION: In DNETs, the complete total resection of the lesion is generally associated with seizure-free outcomes. In the patients with partial resection and lesionectomy, MRI follow-up is recommended for recurrence.

A transcranial magnetic stimulation study for the characterization of corticospinal pathway plasticity in children with neurological disorders.

We aimed to investigate cortical and radicular TMS-evoked motor evoked potentials (MEPs) in children with neurological disorders (n = 57, mean age: 5.45 years) and agematched healthy controls (n = 46). Four TMS parameters were analyzed: MEP amplitudes, the latencies of MEP, the latency jump (cortical MEP latency at rest - cortical active-MEP latency at with slightly contracted targeted muscle), and central motor conduction time. Children with neurological disorders were categorized according to the two major types of neuronal plasticity; excessive plasticity: 29 children with cerebral palsy and impaired plasticity: 28 children with neurodegenerative diseases, stroke, and central nervous system infections. The active-MEP abnormalities (absent and prolonged latencies) were correlated with the location of cortical involvement on MRI patterns. We obtained a significantly increased rate of abnormal cortical active-MEPs in children with impaired plasticity (21/28, 75%) compared with excessive plasticity (18/29, 62%). The rate of absent MEP response is three times more in children with impaired plasticity (43%) than in children with excessive plasticity (14%). A more reduced latency jump was measured in children with impaired plasticity compared to children with excessive plasticity. TMS-evoked active-MEPs and latency jumping are valuable parameters for characterizing neuronal plasticity in children with neurological disorders.

A longitudinal study of lateral ventricle volumes in deficit and non-deficit schizophrenia.

Although it is generally accepted that negative symptoms of schizophrenia are associated with larger lateral ventricles, this general assumption could not be validated in patients with primary negative symptoms. To elucidate this issue, we conducted a five-year longitudinal study, including deficit (n = 13) and non-deficit (n = 26) schizophrenia patients with healthy controls (n = 18). Analysis with linear mixed effects modeling showed that both the left and the right lateral ventricles of the deficit patients enlarged more than the non-deficit patients. Our results suggest that structural alterations in deficit patients might follow a different trajectory than those in non-deficit patients.

Resting state functional connectivity in adolescent synthetic cannabinoid users with and without attention-deficit/hyperactivity disorder.

OBJECTIVE: Synthetic cannabinoids (SCs) have become increasingly popular in recent years, especially among adolescents. The first aim of the current study was to examine resting-state functional connectivity (rsFC) in SC users compared to controls. Our second aim was to examine the influence of comorbid attention-deficit/hyperactivity disorder (ADHD) symptomatology on rsFC changes in SC users compared to controls. METHODS: Resting-state functional magnetic resonance imaging (fMRI) analysis included 25 SC users (14 without ADHD and 11 with ADHD combined type) and 12 control subjects. RESULTS: We found (i) higher rsFC between the default mode network (DMN) and salience network, dorsal attention network and cingulo-opercular network, and (ii) lower rsFC within the DMN and between the DMN and visual network in SC users compared to controls. There were no significant differences between SC users with ADHD and controls, nor were there any significant differences between SC users with and without ADHD. CONCLUSIONS: We found the first evidence of abnormalities within and between resting state networks in adolescent SC users without ADHD. In contrast, SC users with ADHD showed no differences compared to controls. These results suggest that comorbidity of ADHD and substance dependence may show different rsFC alterations than substance use alone.

Brain areas associated with resilience to depression in high-risk young women.

Previous structural brain-imaging studies in first-degree relatives of depressed patients showed alterations that are generally accepted as vulnerability markers for depression. However, only half of the relatives had depression at follow-up, while the other half did not. The aim of this study was to identify the brain areas associated with resilience to depression in high-risk subjects with familial depression. We recruited 59 young women with a history of depressed mothers. Twenty-nine of them (high-risk group [HRG]) had no depression history, while 30 (depressive group) had at least 1 depressive episode in adolescence. The brain structures of the groups were compared through voxel-based morphometry and analysis of cortical thickness. Individual amygdala nuclei and hippocampal subfield volumes were measured. The analysis showed larger amygdala volume, thicker subcallosal cortex and bilateral insula in the women in the HRG compared with those in the depressive group. In addition, we detected more gray matter in the left temporal pole in the HRG. The larger gray matter volume and increased cortical thickness in the key hub regions of the salience network (amygdala and insula) and structurally connected regions in the limbic network (subcallosal area and temporal pole) might prevent women in the HRG from converting to depression.

Computed tomography vs. magnetic resonance imaging in unstable cervical spine injuries.

BACKGROUND: This study aimed to investigate the role of computed tomography (CT) in identifying missed unstable blunt cervical injuries. METHODS: Patients admitted to the emergency department between June 2014 and June 2018 with a diagnosis of blunt cervical trauma were included in this study. All participants underwent cervical magnetic resonance imaging (MRI) after an initial cervical CT investigation. All imaging results were reviewed, and decisions were taken by the consensus of a team consisting of an emergency medicine specialist, a neuroradiologist, and a neurosurgeon. Other variables included age, sex, the Glasgow Coma Scale, medical comorbidities, multi-trauma, neurological deficits, accompanying intracranial hemorrhage, extremity fractures, and the mechanism of the injury. RESULTS: Data for 195 patients were analyzed. The mean (±standard deviation) age of the participants was 47.34±21.90 years, and 140 (71.8%) were males. Eighteen patients (9.2%) were below age <18. The most frequent mechanism of injury was fall from height (n=100; 51.3%). Using MRI as the gold standard, the sensitivity of CT in diagnosing unstable cervical injury was 77.7% (95% CI [67.1-86.1]), while its specificity was 100.0% (95% CI [59.0-100.0]). CONCLUSION: Although computed tomography is relatively good in diagnosing unstable cervical injuries, its sensitivity in detecting positive cases is not as successful. Thus, the use of MRI in patients with an unstable injury seems to be warranted.

A transcranial magnetic stimulation study for the investigation of corticospinal motor pathways in children with cerebral palsy.

The aim of this study is to perform transcranial magnetic stimulation (TMS)-based investigation of corticospinal motor pathways in children with cerebral palsy (CP) secondary to hypoxic-ischemic encephalopathy (HIE). TMS parameters including motor evoked potentials (MEPs) and central motor conduction time (CMCT) were recorded in 38 children with CP and 46 age-matched healthy controls. The z-score of MEPs were analyzed with respect to the types of MRI patterns of cortical involvement in children with CP. MEP latency values were correlated with the weight and height of children and to reflect the maturation of the corticospinal pathway. TMS evoked MEPs with prolonged onset latencies in 64% of children with CP while 10% of the CP group failed to elicit MEPs. Related with the MRI pattern, multicystic encephalomalacia (89%) was associated with the highest rates of abnormal cortical MEPs, as followed by periventricular leukomalacia (80%), basal ganglia involvement (66%) and focal cortical involvement (60%) patterns. Children with CP as compared with healthy controls had similar CMCT values on the upper and lower extremities in children with all cortical MR patterns. MEP abnormalities with TMS were consistent with the extent of motor cortex lesions on MRI patterns in CP children with HIE.

Structural connectivity in adolescent synthetic cannabinoid users with and without ADHD.

Synthetic cannabinoids (SC) have become increasingly popular in the last few years, especially among adolescents. Given ADHD is overrepresented in patients with substance use across adolescents compared to the general population, the current study aims were two-fold: i) examine structural brain network topology in SC users compared to healthy controls and, ii) examine the influence of ADHD on network topology in SC users. Diffusion-weighted magnetic resonance imaging scans were acquired from 27 SC users (14 without ADHD and 13 with ADHD combined type) and 13 controls. Structural networks were examined using network-based statistic and connectomic analysis. We found that SC users without ADHD had significantly weaker connectivity compared to controls in bilateral hemispheres, most notably in edges connecting the left parietal and occipital regions. In contrast, SC users with ADHD showed stronger structural connectivity compared to controls. In addition, adolescent SC users with ADHD, but not without ADHD, displayed reduced network organization, indicated by lower clustering coefficient and modularity, suggesting that poor structural network segregation and preserved structural network integration. These results suggest that comorbidity of ADHD and substance dependence may show different structural connectivity alterations than substance use alone. Therefore, future connectivity studies in the substance use population should account for the presence of ADHD in their samples, which may be associated with disparate connectivity profiles.

Surgicoanatomical aspect in vascular variations of the V3 segment of vertebral artery as a risk factor for C1 instrumentation.

OBJECT: Awareness of vascular anomalies in V3 segment of vertebral artery (VA) is crucial to avoid iatrogenic injuries during surgical procedure. This study aimed to analyze the incidence of V3 segment vascular variations and demonstrate the importance of deciding the surgical strategy for C1 screw placement. METHODS: Prevalence of vascular variations and morphometric measurements of the VA in the region of the craniocervical junction in 200 cases based on three-dimensional computed tomographic angiography (3D-CTA) scans were studied. RESULTS: The VA has a variable course through C2 before it passes above its groove on the posterior arch of C1. Following the vascular variations of V3 segments of VA were persistent including first intersegmental artery (FIA), fenestration (FEN) of the VA, high-riding (HRVA and the posterior inferior cerebellar artery (PICA) branch originating from the C1/2 part of VA. HRVA was observed in 10.1% of patients, FIA in 1.8%, FEN in 1.3%, and PICA in 1.3%. One hundred and twenty-three (24.1%) patients were identified to have HRVA, 6% present on both sides. CONCLUSION: The VA with FIA and FEN were rare in this study as many as a 10% the VA present over the starting point for C1 lateral screw. With respect to the vascular anatomy of V3 and more frequent left-sided VA dominancy, standard screw insertion should be started from the right side. Routine preoperative 3D-CTA evaluation is mandatory to prevent the VA injury when C1-C2 instrumentation is planned.

MRI evaluation of progressive supranuclear palsy: differentiation from Parkinson's disease and multiple system atrophy.

OBJECTIVES: To evaluate the magnetic resonance imaging (MRI)-derived parameters in differentiation of patients with progressive supranuclear palsy (PSP) from patients with Parkinson's disease (PD), multiple system atrophy (MSA), and control subjects was aimed. METHODS: Thirty-three patients [mean age, 65.21 ± 4.75 years; PSP (n = 9), MSA (n = 8), PD (n = 6), and control subjects (n = 10)] who have undergone cranial MRI were included in this retrospective study. MRI-derived parameters including areas of midbrain and pons, midbrain area-to-pons area (M/P) ratio, widths of middle cerebellar peduncle (MCP) and superior cerebellar peduncle (SCP), MCP/SCP ratio, magnetic resonance parkinsonism index (MRPI), cerebral interpeduncular angle, and length of midbrain tegmentum were compared in patients with PSP, PD, MSA, and control subjects through the analysis of variance and Kruskal-Wallis tests with Bonferroni correction and Mann-Whitney U test. RESULTS: The length of midbrain tegmentum, midbrain area, SCP, and M/P ratio were found to be lower, while cerebral interpeduncular angle and MRPI were higher in patients with PSP. Pons area, MCP width, and MCP/SCP ratio were found to be lower in patients with MSA. For PSP, cerebral interpeduncular angle has a sensitivity of 100% and specifity of 90%, and MRPI had a sensitivity of 88.9% and specifity of 100% for PSP. DISCUSSION: Several MRI-derived parameters can be used in differentiation of patients with PSP from patients with PD, MSA and control subjects. The cerebral interpeduncular angle and MRPI, which demonstrated higher values in patients with PSP, were more significant for PSP than the other parameters.

The Ponticulus Posticus as Risk Factor for Screw Insertion into the First Cervical Lateral Mass.

BACKGROUND: Awareness of the osseous anomaly of ponticulus posticus (PP) is crucial in avoiding vertebral artery (VA) injuries during C1 instrumentation. The aim of this study was to investigate PP and its relationship with the VA with three-dimensional computed tomography angiography. METHODS: PP and the VA were investigated as intraoperative landmarks. The intersection of the VA to the posterior arch of C1 and the medial line and the posterior arch and VA curve around lateral masses were measured as intraoperative references. RESULTS: PP was identified in 14.3% of samples. The anomaly was more common in women and on the right side. Of cases, 48.2% had PP bilaterally. In PP cases, the VA had variable courses through C2 before it passed under its bony bridges on the posterior arch of C1. Mean distances were found at the intersection of the VA to the posterior arch of C1 and the medial line to be larger and the posterior arch of C1 and the VA curve around lateral masses to be narrower than normal cases. Dual computed tomography scan data from C1 with PP were used to create three-dimensional patient-specific life-sized cervical spine models. Models revealed how the bone bridge affected the VA. The feasibility (>4 mm) of a safe lateral mass screw fixation was not influenced by PP anomalies. CONCLUSIONS: The presence of the PP loop can limit space available for placement of the screw through the bony elements of C1. Standard screw techniques are contraindicated owing to the unacceptable high risk of VA injury.

Hippocampal shape alterations in healthy young women with familial risk for unipolar depression.

BACKGROUND: Although reduced hippocampal volume (HCV) is a common finding in depression, it is unclear whether the structural alterations leading to reduction of HCV are pre-existing risk factors before the onset of clinical symptoms or a cumulative process that begins with the onset of clinical symptoms. The aim of the present study was to understand the anatomical status of the hippocampus prior to the clinical symptoms in subjects with high familial risk for depression. METHODS: Twenty-seven young women (mean age: 22.3 ±â€¯2.1 years) who were at high risk for familial unipolar depression and 26 age- and gender-matched healthy controls (mean age: 22.1 ±â€¯2.1 years) with low familial risk for depression were included in the study. Total hippocampal volumes were measured by manual tracing. For 3D shape differences, the spherical harmonic basis functions (SPHARM) software was used. The segmented images were parameterized, and the point-to-point based group difference was compared by the Hotelling's T-squared test with total brain volume and Beck Depression Scale as covariates. RESULTS: Although there was no difference in overall HCVs, shape analyses revealed a contracted area on the Cornu Ammonis (CA) 1 region of the right hippocampus head in the high-risk group compared to the low-risk group. Cross-sectional design and small sample size, including only females, were the main limitations of this study. CONCLUSION: This study with shape analyses provided data suggesting that local structural hippocampal alterations in the CA1 region might be associated with depression vulnerability in women at high risk.

Investigating Connectivity of Orbitomedial Prefrontal Region in a Patient with Traumatic Brain Injury. / Bir Travmatik Beyin Hasari Olgusunda Orbitomedial Prefrontal Bölge Baglantilarinin Incelenmesi.

The majority of the research studying the prefrontal region has focused on gray matter injury. However, recent studies show that damage to white matter also contributes to the development of cognitive impairment after traumatic brain injury (TBI). Through the use of diffusion tensor imaging (DTI), it is now possible to assess the white matter fiber pathways between brain regions. With Diffusion Tensor Tractography (DTT), fibers of interest can be three dimensionally reconstructed and associated measurements can be performed. In this paper, we present the case of an individual that suffered from panic attacks, behavioral changes, auditory hallucinations and disturbing bodily sensations after traumatic brain injury. The patient was evaluated with a detailed clinical and neuropsychological assessment, magnetic resonance imaging (MRI) and DTI. MRI revealed cystic encephalomalasia with a diameter of 3.4 cm in the left orbitomedial frontal region. With DTT, major white matter tracts of the traumatized area were compared with symmetrical tracts in the contralateral side. Streamline count for the right inferior fronto-occipital fasciculus (iFOF) was 54 while no streamlines could be found for the left iFOF. For the left uncinate fasciculus and the left cingulum, streamline counts were significantly lower compared with the right side (62% and 34% lower; respectively). White matter damage in TBI can cause dysfunction of different brain regions through disruption of connections with the traumatized area. In this case report, we emphasized that symptoms were not limited with dysfunction of the traumatized region and the regular functions of other brain regions were also affected via the disturbance of connection pathways.