Menstrual Cycle-Related Changes in Women with Schizophrenia: A Resting-State fMRI Study.

INTRODUCTION: Different influences of ovarian hormones in schizophrenia (SCZ) have been reported, but no study to date has assessed their effects on the brain dynamics at rest. The present study aimed to examine the hormonal and clinical changes related to the menstrual cycle and alterations in the resting-state functional connectivity (RS-FC) depending on cycle phase and/or hormonal fluctuations in SCZ. METHOD: This study was conducted based on both between- and within-subject experimental designs, including 13 clinically stable female patients with SCZ (32 ± 7.7 years) and 13 healthy women (30 ± 7.3 years). RS-functional magnetic resonance imaging (fMRI) scanning, as well as hormonal and clinical assessments, was applied to each participant twice during two cycle phases: early follicular and mid-luteal. RESULTS: A difference in mid-luteal progesterone levels was found between groups, with a large effect size (Cohen's d) of 0.8 (p < 0.05). Also, the estradiol levels negatively correlated with the negative symptom severity of the patients during their mid-luteal phase. In the patients, estrogen positively correlated with the auditory network connectivity in the left amygdala during the early follicular phase. In the controls, progesterone had positive correlations with the connectivity of the posterior default mode and the left frontoparietal networks in the bilateral precuneus during the early follicular phase and had a negative correlation with the executive control network connectivity in the mid-luteal phase. CONCLUSION: The present study showed hormonal differences between groups and suggested that the levels of cycle-dependent hormones might be associated with the changes in clinical symptom severity and the RS-FC in the groups. Our RS-fMRI findings warrant further investigation.

Limited positive predictive value of diffusion tensor tractography in determining clinically relevant white matter damage in brain stem cavernous malformations: A retrospective study in a single center surgical cohort.

PURPOSE: Diffusion tensor tractography (DTT) might reflect the postoperative clinical outcome of the patients with brain stem (BS) tumors correlating well with the neurological symptoms, but cavernous malformation (CM) is a hemorrhagic tumor prone to artifacts that may limit DTT. We set out to determine the correlation of DTT findings with the neurological examination before and after surgical resection in patients with BSCMs. MATERIALS AND METHODS: DTT findings were evaluated bilaterally for fiber tract displacement or deviation, deformation and interruption in every patient before and after the surgery. Neurological examination was performed at admission, discharge and outpatient follow-up visit. The sensitivity, specificity, positive and negative predictive values of DTT were calculated both pre- and post-operatively. RESULTS: There were 25 patients (9 men 16 women) with a mean age of 39.5±13.9 years. The mean size of the CMs was 6909±8374mm3 (range: 180-38,220mm3) The mean follow-up time was 42.7±23.2 months (range: 8 to 112 months). Preoperatively, the sensitivity, specificity, positive and negative predictive values of DTT for corticospinal tracts (CST) and medial lemnisci (ML) were 100%, 60%, 38.4%, 100% and 87.5%, 11.7%, 31.8%, 66.6%, respectively. Postoperatively, the sensitivity, specificity, positive and negative predictive values of DTT for CSTs and ML were 100%, 64.7%, 40%, 100% and 100%, 0%, 33.3%, 66.6%, respectively. CONCLUSION: Positive findings on DTT such as fiber tract deviation, deformation, disruption or interruption should be taken cautiously before drawing conclusions of a clinically relevant damage of white matter tracts.

The incidence and most common levels of thoracic degenerative disc pathologies.

OBJECTIVES: In this study, we aimed to describe and characterize the incidence of thoracic degenerative disc pathologies, bulging/herniation, and the most common affected levels. PATIENTS AND METHODS: Between January 2008 and May 2012, a total of 195 patients (109 females, 86 males; mean age 43.5 years; range, 15 to 74 years) who were admitted with the complaint of dorsalgia and underwent magnetic resonance imaging (MRI) of the thoracic vertebral column were included in the study. Data including MRI findings, endplate and disc degeneration, disc height loss, bulging, and disc herniation were retrospectively analyzed. RESULTS: Of 3,348 patients, 195 patients had disc bulging/herniation. When 12 levels in 195 cases were taken into consideration, disc pathologies were found in 412 (18%) levels among the total of 2,340 intervertebral disc levels. Bulging was present in 11% (244/2,340) of the levels. Disc herniation was present in 7% (168/2,340) of the levels. The most commonly affected site was T7-8, followed by T8-9 and T11-12. CONCLUSION: Thoracic disc pathologies are still a significant diagnostic challenge. Our study results show that the incidence of these pathologies is higher than expected.

Evaluation of Iron Deposition in the Adrenal Glands of ß Thalassemia Major Patients Using 3-Tesla MRI.

BACKGROUND: Beta-thalassemia major (ß-TM) patients need blood transfusions, which result in iron deposition. To regulate chelation therapy, iron load has to be measured. With MRI, the amount of signal loss and T2* decay time shortening are used for iron quantification. OBJECTIVES: The aim was to measure adrenal iron load with T2* relaxometry using MRI, and to compare it with liver and cardiac iron and serum ferritin, and to find out whether adrenal iron could be predicted from those parameters. PATIENTS AND METHODS: Between October 2014 and March 2015, MRI was performed in 21 patients with ß-TM, recieving blood transfusions and chelation therapy. The control group (n = 11) included healthy volunteers with no known history of adrenal, hematologic, chronic disease, and blood transfusion. RESULTS: Among patients, there was no significant correlation between plasma ferritin and adrenal T2*. Significant difference was detected among T2* values of adrenals between the patient and control groups. There was no significant correlation between adrenal gland and liver T2* in ß-TM patients, moderate correlation was detected between adrenal T2* and cardiac T2*. CONCLUSION: Adrenal iron in ß-TM can be reliably measured in 3 Tesla MRI. The results highlight the absence of correlation between adrenal iron deposition both with serum ferritin and hepatic iron.

The Daily Resistive Index measurement useful tool in the estimation of the optimal time interval between two Shock Wave Lithotripsy sessions.

OBJECTIVE: : To monitor the impact of Shock Wave Lithotripsy (SWL) on the renal resisive index (RI) and to investigate the potential of the RI measurement for the estimation of the optimal duration between 2 SWL sessions. MATERIAL AND METHODS: Thirty patients with single pelvis renalis stone were included. Participitants were grouped according to their age as group 1 (<40 years, mean age 36.2+/-3.9 years) and group 2 (>/=40 years, mean age 55.4+/-6.5 years). RI measurement was performed in of all patients prior to SWL. After SWL, RI was monitored daily until RI returned to their pre-SWL values. RESULTS: The mean stone size was 2 8.97+/-3.62 in group 1 and 10.08+/-4.67 mm in group 2 (p=0.077). Following SWL, the RI value of both goups increased and the higher RI value was measured at the 24th hour as compared with their pre-SWL values (p<0.001). In day 2 RI of the groups declined, but the differences were still statistically different from their pre-SWL RI values (p<0.001). However, on the third day, RI of group 1 was close to their pre-SWL level (p=0.143). But, in group 2, RI value returned to their pre-SWL limits on day 4 (p=0.229). CONCLUSIONS: RI measurement gives important data regarding SWL related acute renal trauma and should be used as an US marker for recovery after SWL.

Respiratory epithelial adenomatoid hamartoma: a rare nasopharyngeal mass lesion.

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare and nonneoplastic lesion of upper respiratory tract characterized by an abnormal mixture of tissues which are peculiar to the involved anatomic region. The most common site reported is nasal cavity and its nasopharyngeal origin is extremely rare. The lesion can be confused with a variety of benign and malignant entities. In this article, we report a 22-year-old female case of REAH of posterior nasopharyngeal wall. The clinical and radiological features of the lesion are discussed in the light of literature data.

Brucellar spondylodiscitis: comparison of patients with and without abscesses.

Brucellosis is an important cause of spondylodiscitis in endemic areas. Brucellar spondylodiscitis is a serious complication because of its association with abscess formation. Prospective studies comparing patients with and without abscesses are lacking. The objective of this study was to determine the frequency and demographic, clinical, laboratory, and radiological features of brucellar spondylodiscitis and to compare patients with and without abscesses regarding treatment and outcome. Out of 135 consecutive patients with brucellosis, 31 patients with spondylodiscitis were recruited for the study. Patients were grouped according to magnetic resonance imaging findings. The frequency of spondylodiscitis was 23.0 %. Sites of involvement were lumbar (58.1 %), lumbosacral (22.6 %), cervical (9.7 %), thoracolumbar (6.5 %), and thoracic (3.2 %). Abscesses occurred in 19 (61.3 %) patients and were associated with low hemoglobin levels. Medical treatment included a combination of streptomycin (for the first 3 weeks), doxycycline, and rifampin. The total duration of treatment was 12-39 (mean 17.0 ± 8.5 SD) weeks. By 12 weeks of treatment, evidence of clinical improvement (67 vs. 28 %) and radiological regression (92 vs. 50 %) was significantly greater in patients without abscesses. The duration of treatment was longer if an abscess was present. Two female patients with abscesses required surgical intervention. Both patients presented with high fever, neurologic deficit, and high Brucella standard tube agglutination test titers. Each patient should be evaluated individually, based on clinical findings, laboratory data, and radiological results, when undergoing treatment for brucellar spondylodiscitis. If abscesses are found, a longer course of treatment and even surgical intervention may be needed.

Primary osteosarcoma arising from subcutaneous tissue: 5-year follow-up.

Extraskeletal osteosarcomas are extremely rare, high-grade neoplasms. Approximately 300 cases have been reported in the literature, with a 5-year survival of around 25%-37%. Extraskeletal osteosarcomas frequently arise from lower-extremity, deep soft tissue planes, including hemorrhagic, necrotic areas. While primary osteosarcomas have been observed in the first two decades of life, osteosarcomas arising from the skeletal system are rarely observed before 40 years of age. We present radiological findings of an osteosarcoma case arising from cruris subcutaneous tissue in a young adult (31 years old) at diagnosis and at the follow-up period during a 5-year monitoring process. Additionally, we reviewed the literature regarding this case.

CT and MRI findings of developmental abnormalities and ectopia varieties of the thyroid gland.

Ectopic thyroid tissue may be observed anywhere from the tongue base to the lower neck. It is rarely seen in the mediastinum and abdominal cavity. Computed tomography and magnetic resonance imaging are very sensitive for detection and localization of ectopic thyroid tissue. This pictorial essay presents the radiological characteristics of developmental abnormalities and ectopia varieties of the thyroid gland.

A new variation: An anterior cruciate ligament attached to the accessory ossicle.

Anatomic variations of the anterior cruciate ligament (ACL) are very rare. The prevalence of congenital aplasia or hypoplasia of the ACL is 0.017 per 1,000 live births. The normal ACL consists of the anteromedial (AMB) and posterolateral bundles (PLB). Together, they attach to a fossa on the posteromedial aspect of the lateral femoral condyle. The PLB fibrils are smaller and shorter than those of the AMB. We report an ACL variation that had not been previously described, in which the PLB was attached to an intraarticular accessory ossicle, without causing knee instability. The large accessory ossicle caused pain. We reviewed the anatomy, anomalies, and variation in the ACL.

Partial achilles tendon rupture presenting with giant hematoma; MRI findings of 4 year follow up.

In the young population, spontaneous rupture of Achilles tendon is very rare. The big hematoma is also rare finding of the Achilles tendon partial rupture. It is usually seen with complete rupture. We presented imaging findings of 4 years follow up of the spontaneous partial rupture of Achilles tendon presenting with giant expanding hematoma and mimicking complete rupture radiologically. We discussed the alterations of tendon signal intensity and result of conservative therapy after partial rupture with big hematoma in the long term. A 29 year-old man, applied with pain and swelling in the retrocalcaneal region of left ankle. He did not have chronic metabolic disease. He was not active in physical activities. X-ray radiograms were normal. At magnetic resonance images (MRI), there was an intratendinous big hematoma, subcutanous fat planes were edematous around tendon. The diagnosis was partial rupture and giant hematoma. Hematoma was drained. The conservative treatment was applied and his complaints disappeared. After treatment, approximately 4 years later, control MRI showed thickened and hypointense tendon in all images.

Intraventricular glioblastoma multiforme: a pediatric case report.

SUMMARY: Glioblastoma multiforme (GBM) is the most common lethal primary central nervous system tumor in adults. GBM is rarely seen in childhood and adolescence as primary intraventricular tumors. Few cases of solitary intraventricular GBM in adolescence have been reported to date. We report a 16-year-old boy with progressive disorientation, diffuse headache, vomiting, and increased intracranial pressure. Computed tomography and magnetic resonance imaging confirmed that the tumor filled posterior body and occipital horn of the left lateral ventricle and also invaded the surrounding parenchyma. Incomplete removal of the lesion was achieved and a pathologic diagnosis of GBM was carried out. We present a case with an uncommon subtype of glial tumor (GBM) in childhood located in a very rare site. The clinical course, radiologic findings, and possible treatment regimens are reviewed.

[Differential diagnosis in cervical lymphadenopathies: efficacy of B-mode, color and power Doppler ultrasonography]. / Servikal lenfadenopatilerin ayirici tanisinda B-mod, renkli ve power Doppler ultrasonografinin etkinligi.

OBJECTIVES: Our purpose was to investigate cervical lymphadenopathies by using color Doppler spectral analysis and power Doppler ultrasonography methods as well as B-mode ultrasound and to classify them as malignant or benign lesions and to compare the results with the histopathological findings. PATIENTS AND METHODS: Sixty-nine lymph nodes of 69 patients were evaluated with color and power Doppler ultrasonography as well as B-mode ultrasonography. The shape and dimensions of the lymph nodes were assessed with B-mode ultrasonography; their vascularization pattern with power Doppler sonography and with color Doppler spectral analysis. Vascular pattern was evaluated according to the vascularization of the lymph node. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. We measured resistive index, pulsatility index, peak systolic velocity, and end diastolic velocity. Results of Doppler analysis were compared with clinical findings and histopathologic results. Nodes were grouped as metastasis, lymphoma, tuberculosis, and reactive benign lymphadenopathies with respect to ultrasonographic results. RESULTS: Forty-four of 69 lymph nodes were found to be malignant histopathologically. In color Doppler analysis, most malign metastatic lymphadenopathies showed peripheral (76.4%), and the rest of them (23.6%) showed peripheral and hilar (mix) vascularization. Most benign lymphadenopathies (88%) and lymphomatous lymphadenopathies (85%) had hilar vascularization. In tuberculous lymphadenopathies, 50% of them showed avascular pattern and the rest of them had variable type of vascularization. A resistive index = or > 0.7 indicated a malignant metastatic lymphadenopathy and a resistive index <0.5 was consistent with benign lesions. In lymphomatous and tuberculous lymphadenopathies resistive index values were between 0.6-0.7. The sensitivity of the resistive index for distinguishing inflammatory from neoplastic lymphadenopathies was 84.6%, the specificity 100% and the diagnostic accuracy 95.7% (p<0.001). CONCLUSION: In addition to B-mode ultrasonography findings, vascularity pattern assessment and spectral analytical measurements with color and power Doppler ultrasonography has an important contribution for the differential diagnosis of cervical lympadenopathies.

Third accessory (supernumerary) intrathoracic right rib.

Intrathoracic ribs are very rare congenital anomaly. We report a case of a third accessory intrathoracic rib located anterior to the normally developed right third rib in a 37-year-old man. Chest X-ray was not diagnostic. Multidetector computed tomography with 3D reconstructions was required for definitive diagnosis. These anomalies are usually clinically silent and detected incidentally by imaging studies. They should be kept in mind in the differential diagnosis of thoracic pathologies.

A rare cause of exophthalmos: cemento-ossifying fibroma.

Cemento-ossifying fibroma is a benign fibroosseous lesion that contains fibrous tissue and calcified tissue resembling bone, cementum or both. It is frequently seen in the mandibula and maxilla, but it may rarely affect the ethmoid sinus. In this report, we presented computed tomography findings of an ossifying fibroma of the ethmoid sinus associated with exophthalmos. A 25-year-old woman presented with complaints of exophthalmos, headache, and nasal congestion of six-month history. Physical examination showed a firm mass on the right side of the nasal septum and right-sided exophthalmos. Eye movements, vision, and the fundus were normal. Axial and coronal computed tomography scans showed a well-delineated, round mass, 4x4.5x3 cm in size, in the right ethmoid sinus, extending from the right orbital rim to the right nasal cavity. Near-total excision of the mass was performed by a lateral rhinotomy and medial maxillotomy approach. Based on histologic and radiological findings, the diagnosis was made as ossifying fibroma.

[Frequency of vascular variations and anomalies accompanying intracranial aneurysms]. / Intrakranyal anevrizmalara eslik eden vasküler varyasyon ve anomalilerin sikligi.

PURPOSE: Investigation of the sites of intracranial aneurysms and incidence of associated congenital variations or anomalies. MATERIALS AND METHODS: One hundred and ninety cerebral angiography examinations that were positive for aneurysm were evaluated retrospectively. Fourteen cases with vasospasm were excluded and the remaining 176 patients were assessed for the location of the aneurysm and co-incidental vascular variations and/or anomalies. There were two observers in the study, one of whom was an experienced vascular radiologist. RESULTS: The most frequent locations of aneurysms were the supraclinoid internal carotid artery (32%, n=74), anterior communicating artery (30%, n=68), and middle cerebral artery bifurcation (23%, n=52). Twenty-eight patients (17%) had multiple aneurysms. Ninety-one (52%) patients had a vascular anomaly or variation. Hypoplasia or agenesis of A1 segment of the anterior cerebral artery was found in 48 patients, an azygous anterior cerebral artery in 1, a frontoorbital artery in 1, a duplicated middle cerebral artery in 1, early bifurcation of the middle cerebral artery in 9, persistent fetal origin of the posterior cerebral artery in 26, fenestration of P1 segment of posterior cerebral artery in 1, agenesis of P1 segment of posterior cerebral artery in 1, fenestration of vertebral artery in 1, double trunk visualization of superior cerebellar artery in 2 patients. CONCLUSION: Due to an increased hemodynamic stress, congenital anomalies of the intracranial arteries predispose to the formation of saccular aneurysms. Nomalies such as A1 hypoplasia or agenesis, azygous anterior cerebral artery, accessory middle cerebral artery and persistent trigeminal artery are detected more frequently in patients with cerebral aneurysms compared to the normal population. The location of aneurysms and the frequency of arterial variations and anomalies in this study correlated well with data found in previous studies.