Pituitary volumes in patients with adjustment disorder.

The pituitary gland plays an important role in the stress response mechanism. Given the direct link between adjustment disorder and stress, we hypothesized that there might be changes in the pituitary gland in these patients. The study comprised a patient group of 19 individuals with adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, and 18 healthy controls. The mean pituitary gland volumes of the patient group were not statistically significantly different from those of the healthy control group (80.81 ± 1.82 mm3 in patients with adjustment disorder vs. 81.10 ± 7.04 mm3 in healthy controls, with a statistically nonsignificant difference of P > 0.05). This finding is contrary to our previous findings in anxiety-related disorders. In this regard, adjustment disorder is not similar to anxiety-related disorders in terms of pituitary gland volumes. We should also clearly state that our study is a pioneering study and that studies with large samples are needed to support our findings. The limitations of our study can be attributed to the small sample size, the utilization of a cross-sectional design, and the inclusion of patients using psychotropic drugs.

Comparison of Computed Tomography-Based Artificial Intelligence Modeling and Magnetic Resonance Imaging in Diagnosis of Cholesteatoma.

BACKGROUND: In this study, we aimed to compare the success rates of computed tomography image-based artificial intelligence models and magnetic resonance imaging in the diagnosis of preoperative cholesteatoma. METHODS: The files of 75 patients who underwent tympanomastoid surgery with the diagnosis of chronic otitis media between January 2010 and January 2021 in our clinic were reviewed retrospectively. The patients were classified into the chronic otitis group without cholesteatoma (n=34) and the chronic otitis group with cholesteatoma (n=41) according to the presence of cholesteatoma at surgery. A dataset was created from the preoperative computed tomography images of the patients. In this dataset, the success rates of artificial intelligence in the diagnosis of cholesteatoma were determined by using the most frequently used artificial intelligence models in the literature. In addition, preoperative MRI were evaluated and the success rates were compared. RESULTS: Among the artificial intelligence architectures used in the paper, the lowest result was obtained in MobileNetV2 with an accuracy of 83.30%, while the highest result was obtained in DenseNet201 with an accuracy of 90.99%. In our paper, the specificity of preoperative magnetic resonance imaging in the diagnosis of cholesteatoma was 88.23% and the sensitivity was 87.80%. CONCLUSION: In this study, we showed that artificial intelligence can be used with similar reliability to magnetic resonance imaging in the diagnosis of cholesteatoma. This is the first study that, to our knowledge, compares magnetic resonance imaging with artificial intelligence models for the purpose of identifying preoperative cholesteatomas.

[A Histopathologically Diagnosed Neurocysticercosis Case from Türkiye]. / Türkiye'de Histopatolojik Olarak Tanisi Konulmus Bir Nörosistiserkoz Olgusu.

Cysticercosis is a parasitic tissue infection caused by larval cysts of Taenia solium. Although the disease affects many tissues, it primarily affects the brain and muscles. The most common form is neurocysticercosis, a term used for human central nervous system involvement with T.solium cysts. Neurocysticercosis is an important public health problem in many parts of the world. Its prevalence is particularly high in places where T.solium tapeworms are common, such as Mexico, Central America, South America, Southeast Asia, Africa, China, India, and Nepal. Its incidence has been increasing rapidly in recent years in non-endemic countries, due to both import and local cases, while in some highly endemic areas, numbers appear to have decreased, possibly due to better sanitation and increased public awareness. It is extremely rare in Türkiye. Cysticercosis is usually caused by drinking water or eating food containing tapeworm eggs. Clinical manifestations can range from completely asymptomatic infection to severe illness or death. Although the infection can involve any part of the central nervous system, symptomatic patients mostly have spinal cord involvement, intracerebral lesion, intraventricular cyst or subarachnoid lesion. An intraparenchymal cerebral cyst typically grows slowly and causes minimal symptoms for years or decades after the onset of infection. The site of involvement and the symptoms experienced determine the diagnosis and treatment method. The current general consensus supports antihelmintic and corticosteroid therapy for viable parenchymal lesions. In this report, a neurocysticercosis case with a single brain lesion that was surgically removed and histologically examined was presented. The patient had complaints of lisp in the tongue, numbness in the lips and left face. The patient had no concomitant chronic disease. The patient did not have a travel history or a history of eating pork but had a history of contact with a dead pig two months ago. Upon detection of a central mass in the brain computed tomography examination, surgical procedure was performed on the patient. Based on the identification of a larval stage of T.solium in biopsy material neurocysticercosis was diagnosed. However, histopathologically demonstration of the parasite is not possible in most cases. The patient received an antiparasitic treatment with albendazole 1000 mg/d in combination with dexamethasone. The patient was successfully treated and is still being followed up by calling for controls.

Is it useful to use computerized tomography image-based artificial intelligence modelling in the differential diagnosis of chronic otitis media with and without cholesteatoma?

OBJECTIVE: Cholesteatoma is an aggressive form of chronic otitis media (COM). For this reason, it is important to distinguish between COM with and without cholesteatoma. In this study, the role of artificial intelligence modelling in differentiating COM with and without cholesteatoma on computed tomography images was evaluated. METHODS: The files of 200 patients who underwent mastoidectomy and/or tympanoplasty for COM in our clinic between January 2016 and January 2021 were retrospectively reviewed. According to the presence of cholesteatoma, the patients were divided into two groups as chronic otitis with cholesteatoma (n = 100) and chronic otitis without cholesteatoma (n = 100). The control group (n = 100) consisted of patients who did not have any previous ear disease and did not have any active complaints about the ear. Temporal bone computed tomography (CT) images of all patients were analyzed. The distinction between cholesteatoma and COM was evaluated by using 80% of the CT images obtained for the training of artificial intelligence modelling and the remaining 20% for testing purposes. RESULTS: The accuracy rate obtained in the hybrid model we used in our study was 95.4%. The proposed model correctly predicted 2952 out of 3093 CT images, while it predicted 141 incorrectly. It correctly predicted 936 (93.78%) of 998 images in the COM group with cholesteatoma, 835 (92.77%) of 900 images in the COM group without cholesteatoma, and 1181 (98.82%) of 1195 images in the normal group. CONCLUSION: In our study, it has been shown that the differentiation of COM with and without cholesteatoma with artificial intelligence modelling can be made with highly accurate diagnosis rates by using CT images. With the deep learning modelling we proposed, the highest correct diagnosis rate in the literature was obtained. According to the results of our study, we think that with the use of artificial intelligence in practice, the diagnosis of cholesteatoma can be made earlier, it will help in the selection of the most appropriate treatment approach, and the complications can be reduced.

Insula volumes in patients with schizoaffective disorder.

We aimed to investigate insula volumes in patients with schizoaffective disorder with the motivation that schizoaffective disorder has strong resemblance of clinical presentaion with schizophrenia and bipolar disorder and that there have been studies on insula volumes in patients with schizophrenia and bipolar disorder but not in patients with schizoaffective disorder.

Volúmenes de la ínsula en pacientescon trastorno esquizoafectivo / Insula volumes in patients with schizoaffective disorder

Nuestro objetivo era investigar los volúmenes de la ínsula en pacientes con trastorno esquizoafectivo con la motivación de que el trastorno esquizoafectivo presenta una gran similitud de manifestación clínica con la esquizofrenia y el trastorno bipolar, además de que ha habido estudios sobre los volúmenes de la ínsula en pacientes con esquizofrenia y trastorno bipolar, pero no en pacientes con trastorno esquizoafectivo. Nuestra hipótesis era que los pacientes con trastorno esquizoafectivo tendrían alteraciones similares en cuanto a los volúmenes de la ínsula. Se incluyó en el estudio a dieciocho pacientes con trastorno esquizoafectivo y a diecinueve sujetos de control sanos. Los volúmenes medios de la región de la ínsula para ambos lados fueron estadísticamente significativos en los pacientes con trastorno esquizoafectivo en comparación con los sujetos de control sanos (P<0,001). En conclusión, nuestros hallazgos sugieren que los pacientes con trastorno esquizoafectivo tenían volúmenes reducidos de la región de la ínsula. Debido a algunas limitaciones, se requiere replicar nuestros resultados actuales en este grupo de pacientes.(AU)

We aimed to investigate insula volumes in patients with schizoaffective disorder with the motivation that schizoaffective disorder has strong resemblance of clinical presentaion with schizophrenia and bipolar disorder and that there have been studies on insula volumes in patients with schizophrenia and bipolar disorder but not in patients with schizoaffective disorder. We hypothesized that patients with schizoaffective disorder would have similar alterations in regard to insula volumes. Eighteen patients with schizoaffective disorder and nineteen healthy controls were included into the study. Insula volumes were measured by using the MRI. the mean volumes of the insula region for both sides were statistically significant smaller in patients with schizoaffective disorder compared to those of healthy ones (P<0.001). In conclusion, our findings suggest that patients with schizoaffective disorder had reduced volumes of the insula region. Beacuse of some limitations, it is required to replicate our present results in this patient group.(AU)

Superior Temporal Gyrus Volumes in Patients With Social Anxiety Disorder.

Objective: To determine if superior temporal gyrus volumes are altered in patients with a social anxiety disorder.Methods: Magnetic resonance imaging (MRI) was utilized to determine the superior temporal gyrus volume in 21 patients with a social anxiety disorder and 20 control subjects without a social anxiety disorder. The superior temporal gyrus volumes were measured by manual tracing method. The study was conducted between September 2019 and April 2020.Results: The mean superior temporal gyrus volume for both sides was statistically significantly smaller than that of control subjects (left side: 11.38 ± 0.85 cm3 for patients and 12.73 ± 0.86 cm3 for controls, t=-5.064, P < .001; right side: 11.42 ± 0.84 mm3 for patients and 12.92 ± 0.85 cm3 for controls, t=-5.574, P < .001). Moreover, when comparing volumetric measurements for subregions, we detected that volumes of all subregions were also statistically significantly smaller than those of healthy comparisons (for both sides of the Heschl's gyrus and planum temporale).Conclusions: The study findings suggest that patients with social anxiety disorder seem to have smaller superior temporal gyrus volumes compared to healthy control subjects, although we do not know whether these results were in accordance with functional changes of the same region.

1HMRS in the Hippocampus of the Female Patients with Conversion Disorder.

INTRODUCTION: Previously, we found a lower NAA (N-acetyl aspartate)/CRE (creatine) ratio in conversion disorder patients, when compared to healthy controls. In this context, the present study was designed to determine the changes in hippocampal NAA, CHO (choline), and CRE values in conversion disorder female patients, which has similar symptom basement and hypothesize that the patients with conversion disorder would have also changed neurochemicals in their hippocampal regions. METHOD: Twenty female patients and healthy controls were included in the study. Proton magnetic resonance spectroscopy (1HMRS) method was used to determine the NAA/CHO, NAA/CRE, and CHO/CRE ratios. RESULTS: The data were analyzed via age-controlled General Linear Model and it was found that the ratio of NAA/CHO was significantly lower in conversion disorder female patients when compared to healthy controls. However, NAA/CRE or CHO/CRE ratios were similar for conversion disorder patients and healthy controls. CONCLUSION: It was concluded that conversion disorder female patients might have reduced NAA/CHO ratio which implicates reduced neuronal viability, possibly related to anxiety and indirectly to somatoform symptoms.

Magnetic resonance imaging histogram analysis of corpus callosum in a functional neurological disorder

Background/aim: The aim of the present study was to examine and compare the corpus callosum (CC) via histogram analysis (HA) on T1-weighted MR images of patients diagnosed with Functional Neurological Disorder (FND) and healthy controls. Materials and methods: The study group included 19 female patients diagnosed with FND, and the control group included 20 healthy subjects. All participants were scanned with a 1.5 T MR scanner. A high-resolution structural image of the entire brain was obtained with sagittal 3D spiral fast spin echo T1-weighted images. Gray level intensity, standard deviation of the histogram, entropy, uniformity, skewness, and kurtosis values were determined with texture analysis. A student's t-test was used to compare the group data. P < 0.05 was accepted as statistically significant. Results: It was determined that the mean gray level intensity, standard deviation of the histogram, entropy calculated by the maximum, median and variance and size M percentage values were higher in patients with FND. Kurtosis and size U percentages values were lower in patients with FND. Conclusion: In the present study, analysis of CC with T1-weighted MR image HA demonstrated significant differences between FND patients and healthy controls. The study findings indicated that HA is a beneficial technique for demonstrating textural variations between the CCs of patients with FND and healthy controls using MR images.

Insula volumes are altered in patients with social anxiety disorder.

OBJECTIVE: In the present study, we aimed at examining the volumes of the insula in more pure patients with a social anxiety disorder. METHODS: We examined twenty-one patients with social anxiety disorder according to DSM-IV and twenty healthy controls. All patients and controls were applied to magnetic resonance imaging (MRI). Insula volumes were measured by using the manual tracing method in accordance with the standard anatomical atlases and related previous studies on insula volumes. RESULTS: We found that the mean posterior and anterior insula volumes for both sides of patients were statistically significantly reduced compared to those of healthy control subjects. CONCLUSION: Consequently, in the present study, we found that patients with a social anxiety disorder had reduced insula volumes compared to those of healthy control subjects. However, to get strong this finding, novel studies with a larger sample size are required.

Reduced hippocampus and amygdala volumes in antisocial personality disorder.

In the present paper, we aimed to investigate hippocampus and amygdala volumes in a group of patients with antisocial personality disorder and hypothesized that hippocampus and amygdala volume alterations would be observed. It was measured hippocampus and amygdala volumes of twenty patients with antisocial personality disorder and those of healthy control subjects. We found that both sides of hippocampus and amygdala volumes of patients with antisocial personality disorder were statistically significantly reduced compared to those healthy control subjects, and observed statistically important correlations between the left and right and left hippocampus and left amygdala volumes, and age, some results on scale scores. Consequently, the present study suggest that hippocampus and amygdala volumes of patients with antisocial personality disorder had abnormally smaller than those of healthy control subjects, considering that these abnormalities might be associated with at least some clinical features of antisocial personality disorder. However, longitudinal studies are needed to assess causality of this relationship.

Smaller Pituitary Volumes in Patients with Delusional Disorder.

INTRODUCTION: Delusional disorder shares some clinical characteristics of OCD and hypochondriasis. Delusions compared to obsessions in the OCD and compared to bodily preoccupations in the hypochondriasis are more established beliefs. AIM: To measure pituitary volumes in patients with delusional disorder and hypothesized that volumes would be reduced in those patients by a mechanism that we could not account for before for patients with OCD and hypochondriasis. METHODS: Eighteen patients with delusional disorder and healthy controls were included into the study. Pituitary gland volumes were measured. RESULTS: When using independent t test, the mean total pituitary volume was 777.22±241.28 mm3 in healthy controls, while it was 532.11±125.65 mm3 in patients with delusional disorder. The differences in regard to pituitary gland volumes between patients with delusional disorder and healthy control subjects were statistically meaningful (p<0.01), as supported by ANCOVA, with the covariates of age, gender and total brain volumes as covariates. CONCLUSION: We determined that patients with delusional disorder had smaller pituitary volumes compared to those of healthy control subjects.

Pineal gland volumes are changed in patients with obsessive-compulsive personality disorder.

OBJECTIVE: In the present study, taking into consideration our previous studies showing an association on the neuroanatomy of OCD and obsessive-compulsive personality disorders (OCPD), we also decided to examine pineal gland volumes in patients with obsessive-compulsive personality disorder and hypothesized that gland volumes would be found as altered in comparison with those of healthy subjects. METHODS: Sixteen patients with OCPD and eighteen healthy control subjects underwent magnetic resonance imaging (MRI). We compared the volumes of pineal gland by using MRI between groups. RESULTS: As compared to healthy control subjects, patients with OCPD had statistically significant smaller pineal gland volumes by using independent sample t test (87.34 ±â€¯19.72 mm3 for patients with OCPD vs. 108.62 ±â€¯22.56 mm3, with a statistically significantly difference of p < 0.01.When controlling for gender distribution, age and whole brain volumes in the General Linear Model, we saw that patients with OCPD had still statistically significant smaller pineal volumes compared to those of healthy control subjects. CONCLUSION: Finally, the findings of the present study revealed that patients with OCPD had reduced pineal gland volumes compared to those of healthy control subjects, supporting the fact that OCPD might be included in the OCD spectrum disorders, since we have previously found same result in patients with OCPD.

Volumetric MRI study of orbito-frontal cortex and thalamus in obsessive-compulsive personality disorder.

OBJECTIVES: Obsessive compulsive personality disorder (OCPD) is currently thought to bear a close relationship with obsessive-compulsive disorder (OCD), and other compulsive disorders such as eating disorder and autistic spectrum disorder, as well as with the personality disorders, focusing on some important dimensions like phenomenology, heritability, environmental risk factors, comorbidity, course of illness, neurocognitive endophenotypes, and treatment response. In the present study, when we have taken into consideration the knowledge aforementioned, we aimed to examine OFC and thalamus volumes in patients with OCPD. METHODS: We comparatively measured orbito-frontal cortex (OFC) and thalamus volumes of patients with OCPD and healthy control subjects. RESULTS: Patients with OCPD had considerably smaller left and right OFC volumes compared to those of healthy control subjects. We also found that thalamus volumes of patients were statistically significantly greater than those of healthy comparisons for both sides of region of interest. CONCLUSIONS: We consider that volumetric alterations determined in the present study may be involved in the pathophysiology of the OCPD, considering that OCPD might be related to OCD spectrum disorders neuroanatomically.

Hippocampus and amygdalar volumes in patients with obsessive-compulsive personality disorder.

OBJECTIVES: Moving from the point that there might be an association between the neuroanatomy of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder, we decided to examine the volumes of hippocampus and amygdala of patients with obsessive-compulsive personality disorder, which was previously evaluated in OCD patients by us. METHODS: Volumes of the hippocampus, and amygdala were measured by magnetic resonance imaging (MRI) in patients with obsessive-compulsive personality disorder and healthy control subjects. Manual tracing was used. RESULTS: We detected that the mean left and right sides of hippocampus and amygdala volumes of the patients with obsessive-compulsive personality disorder were smaller than those of the healthy controls. CONCLUSION: Consequently, our present results suggest that hippocampal and amygdalar structural abnormalities may be related to the neuroanatomy of obsessive-compulsive personality disorder. However, it is required novel studies with larger sample.

Pituitary gland volumes in patients with obsessive-compulsive disorder before and after cognitive-behavioral therapy

Objective: The beneficial effects of psychopharmacological and cognitive behavioral therapy (CBT) on the brain are not well understood. In a previous study, we found smaller pituitary volumes in patients with obsessive-compulsive disorder (OCD). The purpose of this study was to examine the effect of CBT on pituitary gland volume. Methods: A total of 81 patients with various anxiety disorders and the same number of healthy controls underwent magnetic resonance imaging, and their pituitary gland volumes were compared at baseline. Pituitary gland volumes were also measured before and after CBT in the patient group. Results: OCD patients had smaller pituitary gland volumes at baseline than healthy controls (0.54±0.29 cm3 for OCD patients vs. 0.82±0.30 cm3 for healthy controls; p < 0.001). We found no significant changes in OCD patient pituitary gland volume after the 16-week treatment period, with mean pre- and post-treatment values of 0.54±0.29 cm3 and 0.56±0.32 cm3, respectively (p > 0.05). Conclusion: Our results indicate an absence of post-CBT volumetric changes in the pituitary gland of OCD patients.

Pituitary gland volumes in patients with obsessive-compulsive disorder before and after cognitive-behavioral therapy.

OBJECTIVE: The beneficial effects of psychopharmacological and cognitive behavioral therapy (CBT) on the brain are not well understood. In a previous study, we found smaller pituitary volumes in patients with obsessive-compulsive disorder (OCD). The purpose of this study was to examine the effect of CBT on pituitary gland volume. METHODS: A total of 81 patients with various anxiety disorders and the same number of healthy controls underwent magnetic resonance imaging, and their pituitary gland volumes were compared at baseline. Pituitary gland volumes were also measured before and after CBT in the patient group. RESULTS: OCD patients had smaller pituitary gland volumes at baseline than healthy controls (0.54±0.29 cm3 for OCD patients vs. 0.82±0.30 cm3 for healthy controls; p < 0.001). We found no significant changes in OCD patient pituitary gland volume after the 16-week treatment period, with mean pre- and post-treatment values of 0.54±0.29 cm3 and 0.56±0.32 cm3, respectively (p > 0.05). CONCLUSION: Our results indicate an absence of post-CBT volumetric changes in the pituitary gland of OCD patients.

Orbito-frontal cortex and thalamus volumes in the patients with obsessive-compulsive disorder before and after cognitive behavioral therapy.

Background The effect of a variety of treatment modalities including psychopharmacological and cognitive behavioral therapy on the brain volumes and neurochemicals have not been investigated enough in the patients with obsessive-compulsive disorder. Therefore, in the present study, we aimed to investigate the effect of cognitive behavioral therapy on the volumes of the orbito-frontal cortex and thalamus regions which seem to be abnormal in the patients with obsessive-compulsive disorder. We hypothesized that there would be change in the volumes of the orbito-frontal cortex and thalamus. Methods Twelve patients with obsessive-compulsive disorder and same number of healthy controls were included into the study. At the beginning of the study, the volumes of the orbito-frontal cortex and thalamus were compared by using magnetic resonance imaging. In addition, volumes of these regions were measured before and after the cognitive behavioral therapy treatment in the patient group. Results The patients with obsessive-compulsive disorder had greater left and right thalamus volumes and smaller left and right orbito-frontal cortex volumes compared to those of healthy control subjects at the beginning of the study. When we compared baseline volumes of the patients with posttreatment ones, we detected that thalamus volumes significantly decreased throughout the period for both sides and that the orbito-frontal cortex volumes significantly increased throughout the period for only left side. Conclusions In summary, we found that cognitive behavioral therapy might volumetrically affect the key brain regions involved in the neuroanatomy of obsessive-compulsive disorder. However, future studies with larger sample are required.

Evaluation of Cortical Brain Parenchyma by Diffusion and Perfusion MRI Before and After Chronic Subdural Hematoma Surgery.

AIM: To evaluate microcirculatory changes in neighboring parenchyma as a result of pressure due to chronic subdural hematoma (CSDH) in early and late periods after hematoma drainage. MATERIAL AND METHODS: The subject group consisted of 25 patients who underwent CSDH drainage. Brain diffusion and perfusion magnetic resonance images (MRIs) were obtained preoperatively, and at 48 hours (early period) and 2 months (late period) postoperatively. Measurements were performed on 1 cm2 regions of interest (ROI) in the neighboring parenchymal tissue. RESULTS: The early postoperative diffusion values showed improvement compared to the preoperative values. The late postoperative values showed improvement compared to the preoperative and early postoperative values. The early postoperative perfusion values showed slight decline compared to the preoperative values. However, the late postoperative values showed improvement compared to the preoperative and early postoperative values. CONCLUSION: The fact that there was an increase in diffusion values from early to late postoperative periods, compared with the preoperative period, indicates that the beneficial effects of surgery increase over time. Brain perfusion was found to be slightly decreased in early postoperative period. Following CSDH drainage, neurological deteriorations are observed in some patients in the early postoperative periods; a slight impairment in perfusion may account for this. However, during the late postoperative period, perfusion was seen to recover prominently.