A comprehensive MRI analysis of osteoid osteomas in patients with diverse radiological features across various regions.

BACKGROUND: Magnetic resonance imaging (MRI), which does not involve ionizing radiation, is the preferred imaging modality for diagnosing osteoid osteoma (OO), an ailment more common in children and young adults. PURPOSE: This study aims to perform a literature review and delineate the MRI findings of OO lesions in patients exhibiting varying radiological features across different regions. MATERIALS AND METHODS: A retrospective study included 63 patients diagnosed with OO through MRI, assessed independently by two blinded radiologists using both standard and dynamic contrast-enhanced MRI techniques. After excluding 7 patients with prior biopsy, surgery, or RFA, the study included 56 patients with 57 lesions. RESULTS: Of 57 lesions evaluated, 50 were in long, and 7 in flat bones. One patient presented with two separate nidi within the intertrochanteric region. Most of the lesions, 49 (86%), were extra-articular, while 8 (14%) were intra-articular. The nidus was intracortical in 45 (78.9%) patients, intramedullary in 5 (8.8%), subperiosteal in 5 (8.8%), and endosteal in 2 (3.5%). Average nidus diameter was 7.02 ± 2.64 mm (3-12.6 mm). Central nidal calcification was present in 68.4% (n = 39) cases. Contrast enhancement was intense at 90.5%, moderate at 9.5%. Reactive sclerosis around the nidus was severe (50.9%), moderate (22.8%), and mild (26.3%). Bone marrow edema was severe (70.2%), moderate (14.0%), and mild (15.8%). Soft tissue edema was identified in 77.2% of all lesions. CONCLUSION: To minimize delays in diagnosis and treatment, radiologists should become acquainted with the typical OO MRI findings and the atypical MRI findings that might be mistaken for other conditions.

Gerdy's tubercle as a novel anatomical landmark for the proximal tibial cut in total knee arthroplasty.

OBJECTIVES: This study aimed to explore the use of Gerdy's tubercle (GT) as an innovative and dependable anatomical landmark for the proximal tibial cut in total knee arthroplasty (TKA) in cases with extensive knee degeneration. MATERIALS AND METHODS: One hundred dry tibia bones and 10 formalin-fixed cadaveric knee specimens of both sexes were examined. A Zimmer NexGen tibial cutting guide and a Mitutoyo digital caliper were utilized to align the guide with the tibia's mechanical axis. The procedure was replicated on cadaver knees using a standardized medial parapatellar arthrotomy approach. Measurements included the distance from GT superior border to the resection line and the length of the tibia. A radiological study involving magnetic resonance imaging examinations of 48 patients, which were evaluated focusing on the upper border of GT and the least degenerated segment of the posterolateral part of the lateral tibial condyle, was conducted. RESULTS: Anatomical measurements of GT and proximal tibial areas in 110 specimens showed slight but consistent variations with cadaver measurements. Magnetic resonance imaging analysis of 48 patients revealed notable sex differences in the distance between the superior border of GT and the tibia's posterolateral surface. There was also a significant negative correlation between the distance from GT to the posterolateral corner and cartilage thickness. CONCLUSION: Proper alignment in TKA is crucial for success, but identifying an extra-articular landmark for horizontal tibial resection remains challenging, particularly in severely arthritic knees. This study introduces GT as a novel anatomical landmark for TKA, offering a more reliable reference for achieving desired joint levels in knees with significant degenerative changes.

Efficacy of radiological depth of invasion measurements on magnetic resonance images acquired at different magnetic field strengths and imaging sequences in predicting cervical lymph node metastasis and other outcomes in tongue cancer.

OBJECTIVES: We investigated the correlation between magnetic resonance imaging (MRI) parameters and tumor pathological depth of invasion (pDOI), between pDOI and radiological DOI (rDOI), between rDOI and duration between biopsy and MRI, and between rDOI and duration between MRI and surgery to determine the efficacy of rDOI in identifying small lesions and other conditions. STUDY DESIGN: We examined 36 adult patients who had been diagnosed histopathologically with cancer of the tongue and had undergone a glossectomy. Using 1.5 Tesla (T) and 3.0T MRI, we measured rDOI at the deepest infiltration point on 4 MRI sequences. We calculated the correlations between rDOI and the variables examined by Spearman rho analysis and evaluated the diagnostic performance of rDOI by receiver operating characteristic curve analysis. RESULTS: Axial T2-weighted images using 1.5T MRI provided the closest approximation of pDOI. Although the correlation between rDOI and pDOI was significant, rDOI showed poor or acceptable discrimination in identifying small lesions and other conditions. There were no significant correlations between rDOI and the time between biopsy and MRI or between MRI and surgery. CONCLUSIONS: The correlation between rDOI and pDOI is significant, but rDOI is ineffective in predicting malignancy and other conditions. Axial T2-weighted images using 1.5T MRI provide the closest approximation of pDOI.

Association between abdominal muscle activity and lumbar muscle morphology, and their role in the functional assessment of patients with low back pain: A cross-sectional study.

OBJECTIVES: The study aims to investigate the relationship between abdominal muscle activity and the cross-sectional area (CSA) of the lumbar muscles and assess their role in the functional assessment of patients with chronic non-specific low back pain (CNSLBP). METHODS: 142 patients with CNSLBP were included in this study. Disability levels were evaluated with the Roland-Morris Low Back Pain and Disability Questionnaire. The functional assessments of the participants were evaluated with a 6-minute walk test. Abdominal muscle activity was measured using a pressure biofeedback unit. The CSA of the bilateral multifidus, erector spinae, and psoas muscles were measured T2-weighted MRI images at the L2-L5 levels. RESULTS: Significant correlations were found between the abdominal muscle activity during the posterior pelvic tilt movement and the CSA of the erector spinae muscle at the L4 and L5 levels, and the psoas muscle at the L2-L5 levels (correlation coefficient range from 0.32 to 0.48). Abdominal muscle activity yielded a significant additional contribution to the variance on the functional assessment (R2 change=0.101). CONCLUSIONS: The relationship of abdominal muscle activity with lumbar muscles and the contribution of muscle activities to functional assessment should be considered in the management of patients with CNSLBP.

Which one is better for predicting extraprostatic extension on multiparametric MRI: ESUR score, Likert scale, tumor contact length, or EPE grade?

PURPOSE: To evaluate the European Society of Urogenital Radiology (ESUR) score, the Likert scale, tumor contact length (TCL) > 1 cm, and EPE (extraprostatic extension) grade in predicting EPE at multiparametric magnetic resonance imaging (mp-MRI). METHODS: Seventy-nine patients who underwent 3-T MRI and were histopathologically confirmed by microblocks were enrolled in this retrospective study. The index lesions were interpreted by two experienced radiologists. Apparent diffusion coefficient (ADC) values were also noted. Weighted κ statistics were used to compare interreader agreement. Univariate logistic regression analysis was performed to define independent predictors of EPE status. Multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed to compare the MRI-based methods and clinical variables (ISUP grade, prostate volume and PSA density) + MRI-based methods for pathologic EPE prediction by using the area under the curve (AUC) value. RESULTS: The mean age was 64.5 years ± 6.2. 33/79 (41.8%) patients had pathologic EPE. As ESUR score showed weak interreader agreement (κ = 0.537), Likert scale, TCL, and EPE grade showed moderate agreement (κ = 0.608, κ = 0.747, κ = 0.647 respectively). Univariate ROC analysis result showed that all MRI-based score systems, mean ADC value, the ISUP grade, prostate volume, PSA density were the best variables in predicting EPE. ROC analysis results of four MRI-based methods showed good diagnostic performance. At multivariate analysis, all clinical models showed excellent diagnostic performance. CONCLUSION: All four MRI-based methods had good diagnostic performance. Furthermore, consisting of both qualitative and quantitative parameters and being less reader experience dependent, EPE grade was a promising method in predicting EPE. All clinical models showed excellent diagnostic performance.

Fracture Detection in Wrist X-ray Images Using Deep Learning-Based Object Detection Models.

Hospitals, especially their emergency services, receive a high number of wrist fracture cases. For correct diagnosis and proper treatment of these, images obtained from various medical equipment must be viewed by physicians, along with the patient's medical records and physical examination. The aim of this study is to perform fracture detection by use of deep-learning on wrist X-ray images to support physicians in the diagnosis of these fractures, particularly in the emergency services. Using SABL, RegNet, RetinaNet, PAA, Libra R-CNN, FSAF, Faster R-CNN, Dynamic R-CNN and DCN deep-learning-based object detection models with various backbones, 20 different fracture detection procedures were performed on Gazi University Hospital's dataset of wrist X-ray images. To further improve these procedures, five different ensemble models were developed and then used to reform an ensemble model to develop a unique detection model, 'wrist fracture detection-combo (WFD-C)'. From 26 different models for fracture detection, the highest detection result obtained was 0.8639 average precision (AP50) in the WFD-C model. Huawei Turkey R&D Center supports this study within the scope of the ongoing cooperation project coded 071813 between Gazi University, Huawei and Medskor.

Posterior Circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECT) for the Evaluation of Cerebellar Infarcts.

BACKGROUND: Patients with cerebellar ischemic stroke may be misdiagnosed and may exhibit a delayed time to acute stroke treatment compared with patients with anterior circulation ischemic stroke. The posterior circulation Alberta stroke program early computed tomography score (pc-ASPECT) score has been used to evaluate hyperacute stroke, much as the ASPECT in anterior circulation stroke recently. Our main objective was to evaluate the associations of the clinical and etiological characteristics of ischemic cerebellar infarction patients on admission with their pc-ASPECT scores, as well as the correlations of the pc-ASPECT score with morbidity and mortality rates. MATERIALS AND METHODS: We include 114 patients with cerebellar infarction who underwent 1 year of follow-up into the study. RESULTS: Patients with a pc-ASPECT score <7 were more likely to present with impaired consciousness ( P <0.001), multiple posterior circulation infarcts ( P <0.001), hydrocephalus ( P <0.001), lesions of the vermis ( P =0.028), and peduncle ( P =0.024), perfusion deficits in the total of posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery ( P <0.05), and basilar artery stenosis ( P =0.005), ischemia in additional anatomical structures in the posterior circulation ( P <0.001) compared with those with a score ≥7. CONCLUSIONS: Although the pc-ASPECT score alone is insufficient in some cases like vertebral artery dissection, using it together with the National Institutes of Health Stroke Scale (NIHSS) score and clinical findings may be beneficial during the hyperacute period of cerebellar ischemia. Presentation with impaired consciousness, basilar artery pathologies, vermian ischemia, and ischemia in additional anatomical structures in the posterior circulation other than the cerebellum appeared as important clinical and radiologic parameters predicting long-term prognosis.

Irregularity in Plantar Fascia, Muscle Edema and Tendon Thickness in Patients with High-Risk for Diabetic Foot.

AIM: To investigate the alterations in the plantar fascia (PF), intrinsic muscles, and tendons in the feet of patients at high risk for developing diabetic foot. METHODS: The healthy feet of 22 patients with type 2 diabetes, who had developed diabetic foot ulcers on a single foot without any pathology on the contralateral extremity, and those of 22 healthy volunteers were evaluated by magnetic resonance imaging. The volume of the Achilles tendon (AT), the surface area of the PF, the thickness of AT, flexor hallucis longus, flexor digitorum longus, tibialis posterior, and peroneus longus tendons, irregularity in the PF, and edema of intrinsic foot muscles were examined. RESULTS: Nineteen patients (86%) had irregularity in the PF, whereas none of the healthy controls had any (p<0.001). Intrinsic muscle edema was more common in the group with diabetes (p=0.006). The volume of AT and the surface area of PF were decreased in patients with peripheral arterial disease (PAD) (p<0.05). Patients with diabetes mellitus but without PAD had a larger surface area of PF than that of controls (p<0.05). There were no differences in the volume of AT, the surface area of the PF, and other tendon thickness between the groups. CONCLUSION: Irregularity in the PF and muscle edema may indicate a high risk for the diabetic foot. The presence of PAD may lead to regression in the structure of AT and PF.

[Comparison of magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy with standard systematic biopsy: A single center experience.] / Comparación de la resonancia magnética biopsia próstata transrectal guiada por ultrasonido con fusión de resonancia magnética con la biopsia próstata sistemática: resultados de un solo centro.

OBJECTIVE: To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms of cancer detection rates. PATIENTS AND METHODS: The data of the patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI and underwent MRI-TRUS fusion biopsy with simultaneous 12-core standard systematic biopsy from June 2016 to June 2019 in our tertiary center were retrospectively reviewed. Clinical, radiological and pathological data were recorded. Statistical difference among the groups was determined by using McNemar tests. RESULTS: A total of 344 patients were included in the study. As a result of transrectal targeted and systematic combined biopsy, 117 patients were diagnosed with prostate cancer. Benign pathology rates in patients with PI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were 93.8%, 68.5%, and 46.4%, respectively. Patients were divided into two groups as ISUP grade 1 and ISUP grade ≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy compared with the systematic biopsy (12.5% vs. %6.4, p=0.007 and 17.4% vs. 8.7%, p<0.001, respectively). Targeted biopsy CDRs were found significantly higher in the high PSA density group (24.5% vs. 41.4%, p=0.001) unlike the systematic biopsy. CONCLUSION: Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making a biopsy decision for patients with PI-RADS 3 lesions. PSA density can be used as a criterion for patient selection for targeted biopsy.

OBJETIVO: Comparar la biopsia sistemática próstata con fusión de resonancia transrectal vs la biopsia prostática sistemática, en términos de detección de cáncer de próstata.PACIENTES Y MÉTODOS: Los datos de pacientes con RNM y PIRADS (Prostate Imaging Reporting and Data System) 3 o más y que recibieron una biopsia prostática transrectal con biopsia simultanea de 12 cilindros sistemática entre junio 2016 y junio 2019 en nuestro centro académico fueron retrospectivamente revisados. Los datos radiológicos, clínicos y patológicos fueron también revisados. La diferencia estadística entre los grupos fue determinada utilizando los tests de McNemar. RESULTADOS: Un total de 344 pacientes fueron incluidos en el estudio. Como resultado de la biopsia transrectal sistemática y dirigida, 117 pacientes fueron diagnosticados de cáncer de próstata. Las tasas de patología benigna en pacientes con PIRADS 3, PIRADS 4 y PIRADS 5 fueron de 93,8%, 68,5%, y 46,4%, respectivamente. Los pacientes fueron divididos en 2 grupos como ISUP grado 1 y ISUP grado 2 o más, las tasas de detección de cáncer fueron superiores en los pacientes que recibieron una biopsia transrectal dirigida vs sistemática (12,5% vs. 6,4%, p=0,007 y 17,4% vs. 8,7%, p<0,001, respectivamente). La detección de cáncer por biopsia dirigida fue superior en pacientes con alta densidad de PSA (24,5% vs. 41,4%, p=0,001) a diferencia de la biopsia sistemática.CONCLUSIÓN: La biopsia transrectal dirigida fue superior a la biopsia sistemática en el diagnóstico de cáncer de próstata. Los clínicos deberían ser más selectivos al tomar la decisión de qué biopsia hacer en un paciente con PIRADS 3. La densidad de PSA se puede utilizar como criterio para realizar una biopsia dirigida.

Comparison of magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy with standard systematic biopsy: a single center experience / Comparación de biopsia de próstata por fusión de imágenes por resonancia magnética-ultrasonido transrectal con biopsia sistemática estándar: experiencia en un solo centro

Objetive: To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms ofcancer detection rates. Patients and methods: The data of the patientswho had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI andunderwent MRI-TRUS fusion biopsy with simultaneous12-core standard systematic biopsy from June 2016to June 2019 in our tertiary center were retrospectivelyreviewed. Clinical, radiological and pathological datawere recorded. Statistical difference among the groupswas determined by using McNemar tests. Results: A total of 344 patients were included in thestudy. As a result of transrectal targeted and systematiccombined biopsy, 117 patients were diagnosed withprostate cancer. Benign pathology rates in patients withPI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were93.8%, 68.5%, and 46.4%, respectively. Patients weredivided into two groups as ISUP grade 1 and ISUP grade≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy comparedwith the systematic biopsy (12.5% vs. %6.4, p=0.007and 17.4% vs. 8.7%, p<0.001, respectively). Targetedbiopsy CDRs were found significantly higher in the highPSA density group (24.5% vs. 41.4%, p=0.001) unlikethe systematic biopsy. Conclusions: Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making abiopsy decision for patients with PI-RADS 3 lesions. PSAdensity can be used as a criterion for patient selectionfor targeted biopsy.(AU)

Objetivo: Comparar la biopsia sistemática próstata con fusión de resonancia transrectal vs labiopsia prostática sistemática, en términos de detecciónde cáncer de próstata. Pacientes y métodos: Los datos de pacientes conRNM y PIRADS (Prostate Imaging Reporting and DataSystem) 3 o más y que recibieron una biopsia prostáticatransrectal con biopsia simultanea de 12 cilindros sistemática entre junio 2016 y junio 2019 en nuestro centroacadémico fueron retrospectivamente revisados. Los datos radiológicos, clínicos y patológicos fueron tambiénrevisados. La diferencia estadística entre los grupos fuedeterminada utilizando los tests de McNemar. Resultados: Un total de 344 pacientes fueron incluidos en el estudio. Como resultado de la biopsiatransrectal sistemática y dirigida, 117 pacientes fuerondiagnosticados de cáncer de próstata. Las tasas de patología benigna en pacientes con PIRADS 3, PIRADS 4y PIRADS 5 fueron de 93,8%, 68,5%, y 46,4%, respectivamente. Los pacientes fueron divididos en 2 gruposcomo ISUP grado 1 y ISUP grado 2 o más, las tasas dedetección de cáncer fueron superiores en los pacientesque recibieron una biopsia transrectal dirigida vs sistemática (12,5% vs. 6,4%, p=0,007 y 17,4% vs. 8,7%,p<0,001, respectivamente). La detección de cáncerpor biopsia dirigida fue superior en pacientes con altadensidad de PSA (24,5% vs. 41,4%, p=0,001) a diferencia de la biopsia sistemática. Conclusion: La biopsia transrectal dirigida fuesuperior a la biopsia sistemática en el diagnóstico decáncer de próstata. Los clínicos deberían ser más selectivos al tomar la decisión de qué biopsia hacer en unpaciente con PIRADS 3. La densidad de PSA se puedeutilizar como criterio para realizar una biopsia dirigida.(AU)

Diagnostic accuracy of 68 Ga-PSMA PET/MRI and multiparametric MRI in detecting index tumours in radical prostatectomy specimen.

OBJECTIVE: To evaluate the diagnostic accuracy of the 68 gallium (68 Ga) prostate-specific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) and multiparametric MRI (mpMRI) by region-based comparison of index tumour localisations using histopathological tumour maps of patients who underwent radical prostatectomy because of clinically significant prostate cancer. PATIENTS AND METHODS: The study included 64 patients who underwent radical prostatectomy after primary staging with mpMRI and 68 Ga-PSMA PET/MRI. Diagnostic analysis was performed by dividing the prostate into four anatomic regions as left/right anterior and left/right posterior. The extension of the lesions in mpMRI and the pathological uptake in 68 Ga-PSMA PET/MRI were matched separately for each region with the extension of the index tumour into each region. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and the accuracy of mpMRI and 68 Ga-PSMA PET/MRI are shown as 55.7%, 91.8%, 80.6%, 77.2%, 78.1%, and 60.8%, 94.3%, 86.8% 79.8%, 83.5%, respectively. 68 Ga-PSMA PET/MRI has higher sensitivity and specificity compared with mpMRI. However, no statistically significant difference was found (P = .464). Combined imaging had significantly higher diagnostic accuracy compared with mpMRI and 68 Ga-PSMA PET/MRI (change in AUC: 0.084 and 0.046, P < .001 and P = .028, respectively), while no statistically significant difference was found between mpMRI and 68 Ga-PSMA PET/MRI (change in AUC: 0.038, P = .246). CONCLUSION: 68 Ga-PSMA PET/MRI had higher clinical diagnostic accuracy in prostate cancer compared with mpMRI. Diagnostic accuracy was significantly increased in the combined use of both imaging modalities.

Headache features of cerebellar ischemic strokes: Clinical and radiological-experiences of a single center.

The prevalence of headache in stroke has been reported between 8% and 34%. Determining the prevalence, features, and effects on prognosis of cerebellar ischemic strokes that presented with headache solely and/or with other cerebellar signs were the aims of our study.All patients diagnosed with cerebellar ischemia were included. Electronic medical records were reviewed. Patients have been followed up for 6th month. Descriptive statistics were generated. A total of 4763 patients were evaluated retrospectively, 200 patients had cerebellar ischemia and 22 patients of these cerebellar ischemias (11%) had a headache at initial presentation. Ataxia, dysarthria, dysmetria were the most common neurological findings. There was no significant difference whether ischemic lesion single or multiple and whether above or below 1.5 cm diameter. Ischemic lesions generally were in cortical/ juxtacortical layer. According to vascular perfusion areas, 54.5% patients' ischemia was located in PICA (posterior inferior cerebellar artery) territory. Patients presenting with a headache, predominantly had left hemispheric (vermian > hemispheric > pedincular) involvement. Although these patients generally had high modified Rankin Scale scores at the first evaluation, they had low NIHSS (National Institutes of Health Stroke Scale) scores (0-5), and nearly all patients recovered, with low mRS at the 6-month follow-up.Cerebellar ischemic strokes with headache presentation are significantly prevalent in patients with left hemispheric, cortical/juxtacortical, PICA perfusion territory ischemias and are associated with low morbidity unless there was a conscious disorder. We believe this is one of the first studies that evaluated the clinical and radiological parameters of cerebellar stroke patients with headache.

Shear Wave Elastography Evaluation of Meniscus Degeneration with Magnetic Resonance Imaging Correlation.

RATIONALE AND OBJECTIVES: The objective of the study was to assess the diagnostic efficiency of shear wave elastography in the grading of meniscal degeneration compared to magnetic resonance imaging (MRI) as a reference standard. MATERIALS AND METHODS: Fifty patients were included in the study (who had bilateral knee MRI). Tissue elasticity was measured in the coronal plane from the meniscus body in kilopascal. Nonparametric testing (Mann-Whitney U) was utilized to assess the differences between mean elasticity of the meniscus tissue, gender. The inter-intraobserver agreement was determined by the intraclass correlation coefficient. The correlations between the mean elasticity of the meniscus versus age, height, and body mass index were calculated via the "Pearson Correlation Coefficient Test." The relationship between MRI meniscal degeneration grading and elastography elasticity module was determined via the "Spearman Correlation Test." A p value less than 0.05 was considered statistically significant. RESULTS: Inter-intraobserver intraclass correlation coefficient of the lateral and medial meniscus mean stiffness values were good or excellent (>0.8). A statistically significant increase in stiffness of meniscus tissue was observed with an increase in age (p = 0.003 for medial menisci, 0.006 for lateral menisci). Tissue stiffness was higher in the medial meniscus than the lateral meniscus (p < 0.001). A positive correlation was observed between the MRI meniscal degeneration grade and tissue stiffness (p < 0.05). Additionally, mean stiffness values from lateral and medial menisci were higher in the group with degeneration (p < 0.0001). CONCLUSION: Meniscus stiffness is increased with aging. There was a statistically significant positive correlation between meniscal stiffness and degeneration grading in MRI.

Evaluation of schwannoma using the 3D-SPACE sequence: comparison with the 3D-CISS sequence in 3T-MRI

Background/aim: The purpose of this study is to compare the diagnostic accuracy and interobserver reliability of the T2-weighted 3D-SPACE (three-dimensional sampling perfection with application-optimized contrasts by using different flip angle evolutions) sequence in comparison with T2-weighted 3D-CISS (three-dimensional constructive interference in steady state) sequences for diagnosis of schwannomas. Materials and methods: Forty patients with cerebellopontine angle (CPA), internal acoustic canal (IAC), and cochlear schwannoma who had undergone magnetic resonance imaging (MRI) using the 3D-CISS and 3D-SPACE sequences were identified. The sequences were retrospectively evaluated by two radiologists for the qualitative analyses, which were subsequently compared using the Mann­Whitney U test. Following this, kappa values were used for interobserver agreement. P < 0.05 was considered to be of statistical significance. Results: The interobserver agreement was found to be excellent between the two observers for the interpretation of all qualitative analyses for both sequences (kappa value > 0.8). The 3D-SPACE sequences demonstrated significantly better qualitative scores and fewer artifacts compared with the 3D-CISS sequences (p < 0.05). Conclusion: Our results demonstrate that 3D-SPACE is superior to 3D-CISS in the imaging process of the schwannoma in terms of image quality, description of the relationship between the lesion and cranial nerve, signal differentiation between lesion and cistern, and signal differentiation between the lesion and adjacent brain.

Magnetic Resonance Imaging of Idiopathic Intracranial Hypertension: Before and After Treatment.

BACKGROUND: This study aimed to identify the reversibility of MRI findings indicative of increased intracranial hypertension in idiopathic intracranial hypertension (IIH) patients after treatment. METHODS: This retrospective, observational study included demographic and clinical data from 10 patients with IIH and 10 controls. Brain MRI findings in IIH patients were recorded twice: once when patients had papilledema and again after resolution of papilledema. Neuroradiologists graded MRI findings in both groups based on an imaging grading scale. RESULTS: After resolution of papilledema, all patients showed improvement in 2 or more of the MRI characteristics of IIH. This was especially the case for the height of the midsagittal pituitary gland and optic nerve sheath thickness (ONST), which were significantly different in all pairwise group comparisons. Sellar configuration, globe configuration, and horizontal orbital optic nerve tortuosity were different between the IIH pre-treatment group and controls, but not between controls and the IIH post-treatment group. We found no difference in optic nerve head hyperintensity or optic nerve thickness among the 3 groups. CONCLUSIONS: We demonstrated that several morphometric MRI characteristics in IIH are reversible to a certain extent after treatment. Enlarged subarachnoid spaces filled with cerebrospinal fluid seem to remain reduced, and the ONST and height of the pituitary gland are not fully normalized after treatment.

Assessing the risk of asymptomatic dysplasia in parents of children with developmental hip dysplasia.

OBJECTIVE: The aim of this study was to investigate whether being the parents of children with developmental hip dysplasia (DDH) is a risk factor for asymptomatic dysplasia. METHODS: Asymptomatic parents of children who were diagnosed with DDH were assessed for presence of dysplasia by examining their anteroposterior pelvis radiographs at the neutral position. Eighty-six hips of 43 participants were included in the study group and 98 hips of 49 participants were included in the control group. Presence of hip dysplasia over the anteroposterior pelvis radiographs was analyzed for Wiberg's angle, acetabular index of the weight-bearing zone (the Tönnis angle), acetabular depth/width index, femoral head coverage ratio (FHCR) and femoral neck/shaft angle. RESULTS: The mean acetabular depth/width ratio was 44.3% in the study group and 53.5% in the control group. And, the mean FHCR was 80% in the study group and 82% in the control group. There was a statistically significant difference between the two groups in terms of mean acetabular depth/width ratio (p < 0.05) and FHCR (p < 0.05). In addition, 21 participants in the study group and 2 in the control group had a pathological acetabular depth/width ratio. And, the number of participants with a pathological FHCR was 22 in the study group and 13 in the control group. A statistically significant difference was found between the two groups regarding the number of pathological measurements of acetabular depth/width ratio (p < 0.05) and FHCR (p < 0.05). CONCLUSION: Having a parent with DDH is a definitive risk factor for the development of hip dysplasia in childhood. In addition, being a parent of a child with DDH is a risk factor for asymptomatic dysplasia. These parents should be screened by roentgenogram. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Treatment-related alterations of imaging findings in osteoid osteoma after percutaneous radiofrequency ablation.

OBJECTIVES: We aimed to report the long-term outcomes of osteoid osteoma patients and to determine CT and dynamic contrast-enhanced MR imaging characteristics of radiofrequency ablation (RFA) treatment related changes of osteoid osteoma between follow-up periods. MATERIALS AND METHODS: Thirty patients (seven female, 23 male) who underwent CT-guided RFA of osteoid osteoma were included. Follow-up imaging examinations were divided into two subgroups; first (1-3 months) and second (> 6 months) periods. Nidus size, calcification, cortical thickening, maximum signal intensity (SImax), time of SImax (Tmax), slope of signal intensity-time (SIT) curves were noted. CT and dynamic MR imaging findings were compared between follow-up periods. RESULTS: Clinical success rate was 100%. The mean of OO nidi size was 5.85 ± 1.98 mm before treatment. There was a significant difference for OO nidi sizes between pretreatment and second follow-up period examinations (p = 0.002). SImax and slope of SIT curves of all patients (100%) showed decrease on follow-up MRIs. There was a significant decrease for SImax values between pretreatment and second follow-up period. There was a significant decrease for slope of SIT curves between pretreatment and both follow-up periods. CONCLUSIONS: RFA is an effective and safe treatment choice for osteoid osteomas. On follow-up imaging, slope of SIT curve and Tmax have the most important positive predictive value for long-term outcomes and single dynamic contrast-enhanced MRI within first 3 months after treatment may be sufficient for symptom-free patients.

Anatomical variations related to pathological conditions of the peroneal tendon: evaluation of ankle MRI with a 3D SPACE sequence in symptomatic patients.

OBJECTIVE: To evaluate anatomical variations in the lateral ankle and their relationships with pathological conditions of the peroneal tendon on magnetic resonance imaging (MRI) in symptomatic patients. MATERIALS AND METHODS: Sixty-nine ankles MRIs of 60 adult patients with symptomatic ankles were included. The presence and sizes of peroneal tubercle and retrotrochlear eminence (RTE), the prevalence of peroneus quartus (PQ), os peroneum, and boomerang-shaped peroneus brevis (PB) tendon, the shape of the retromalleolar fibular groove (RMFG), and the location of the PB muscle-tendon junction were evaluated. The relationships of these variations with peroneal tendinopathies were assessed. The correlations between pathological peroneal conditions on MRI and clinical findings were evaluated. RESULTS: Peroneal tubercle (mean size, 3.2 mm) and RTE (mean size, 4.5 mm) were identified in 58 (84%) and 69 (100%) ankles respectively. PQ muscle, os peroneum, and boomerang-shaped PB tendon were found in 9 (13%), 7 (10%), and 24 (34.8%) ankles respectively. The RMFG was concave, flat, convex, and irregular in 14 (20.3%), 40 (58%), 13 (18.8%), and 2 (2.9%) ankles respectively. Sixteen (23.2%) patients had low-lying PB muscle belly. Only boomerang-shaped PB tendons showed a significant relationship with peroneal tendinopathies. MRI and clinical findings had a poor correlation in pathological peroneal conditions and both had low sensitivity in diagnosis. CONCLUSION: Lateral ankle anatomical variations are common and cannot be attributed to pathological conditions of the peroneal tendon, except for boomerang-shaped PB tendons. Both clinical and MRI findings have low sensitivity in the diagnosis of peroneal tendinopathies, which are often incidental findings on MRI.

Effects of isokinetic, isometric, and aerobic exercises on clinical variables and knee cartilage volume using magnetic resonance imaging in patients with osteoarthritis.

OBJECTIVES: This study aims to evaluate the effect of isokinetic, isometric, and aerobic exercise protocols on pain, disability, physical function, and articular cartilage in osteoarthritis. PATIENTS AND METHODS: A total of 45 women (mean age 52.1 years; range 45 to 65 years) who were admitted to the Physical Medicine and Rehabilitation outpatient clinic and were diagnosed with primary bilateral knee osteoarthritis between May 2008 and January 2010 were included. The patients were randomly divided into three groups as isokinetic (n=15), aerobic (n=15), and isometric exercise groups (n=15). Exercise protocols were applied five days a week for four weeks. Pain was evaluated using a 10 cm Visual Analog Scale for Pain (VAS-pain), pain, joint stiffness and physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and disability was assessed using the Lequesne Index before and after the interventions. Isokinetic knee muscle strength measurements were also obtained. Patellar and femoral cartilage volumes were analyzed using magnetic resonance imaging. RESULTS: The VAS-pain, WOMAC, and Lequesne scores and peak torque values of knee extension improved in all groups with the highest improvement in the isokinetic group. For the knee flexion peak torque values, improvements were significant only in the isokinetic group at both velocities. There was no significant change in the femoral cartilage volume in any group after the interventions. However, patellar cartilage volume significantly increased in the isometric group (p=0.036). CONCLUSION: A four-week isokinetic, aerobic, and isometric exercise programs improved pain and functional capacity in patients with knee osteoarthritis. Isokinetic exercise also increased the muscle strength with improved maintenance of the quadriceps/hamstring ratio. Only isometric exercise increased the patellar cartilage volume.

Epidural patch with autologous platelet rich plasma: a novel approach.

We aimed to perform an epidural patch using platelet rich plasma (PRP), which has the potential to regenerate and heal tissues via degranulation of platelets, in a 34-year-old parturient suffering from persistent post-dural puncture headache (PDPH) after failed epidural blood patch (EBP). After her admission to our unit, we reconfirmed the clinical and radiologic diagnosis of PDPH. Cranial MRI with contrast showed diffuse pachymeningeal thickening and contrast enhancement with enlarged pituitary consistent with intracranial hypotension. Clinical and radiological improvements were observed 1 week after the epidural patch using autologous PRP. Therefore, we recommend using autologous PRP for epidural patching in patients with incomplete recovery after standard EBP as a novel successful approach.