Are paraspinal muscle quantity, lumbar indentation value, and subcutaneous fat thickness related to disc degeneration? An MRI-based study.

INTRODUCTION: The aim of the study was to investigate the relationship between lumbar disc herniation and Goutallier classification (GC), lumbar indentation value, and subcutaneous adipose tissue thickness. METHODS: 102 consecutive patients (59 female and 43 male) with lumbar back pain, numbness, tingling, or pain in the lower extremity indicating radiculopathy who had undergone lumbar magnetic resonance imaging (MRI) and had an intervertebral disc herniation in the L4-5 level, were included in the study. 102 patients who have undergone lumbar MRI in the same time period and have no disc herniation were chosen to be the control group and were selected so as to match the herniated group for sex and age. All these patients' scans were re-interpreted regarding paraspinal muscle atrophy (using the GC), lumbar indentation value, and subcutaneous adipose tissue thickness in the L4-5 level. RESULTS: The Goutallier score was higher in the herniated group, compared with the non-herniated group (p < 0.001). There was no statistical difference between herniated and non-herniated groups regarding lumbar indentation value (LIV) and subcutaneous adipose tissue thickness (SATT). A Goutallier score of 1.5 provided the highest sensitivity x specificity value to indicate the disc herniation according to the statistical results. The individuals with a Goutallier score of 2, 3, and 4 have 2.87 times more likely to have disc herniation in their MRIs than the ones with a score of 0 and 1. CONCLUSION: Paraspinal muscle atrophy seems to be related to the presence of disc herniations. The cut-off value of GC to indicate the disc herniation in this study might be useful to predict the risk for disc herniation regarding the Goutallier score. The LIV and SATT measured in magnetic resonance images were randomly distributed between individuals with herniated and non-herniated groups, and statistically, no relationship was observed between these groups regarding these parameters. IMPLICATIONS FOR PRACTICE: The effect of the parameters studied in this research on disc herniations are expected to be an added value to the literature. The awareness of risk factors for intervertebral disc herniations might be used in preventive medicine to predict the risk and understand the tendency of an individual for disc herniations to occur in the future. Further investigations are needed to establish whether there is a causal relationship or correlation between these parameters and disc herniation.

An analysis of lesions associated with developmental venous anomalies.

OBJECTIVE: The aim of this study was to describe different lesions and features associated with developmental venous anomalies (DVAs). METHODS: The records and magnetic resonance imaging (MRI) images of 1,722 patients who underwent cranial MRI between 2010 and 2017 were retrospectively reviewed. It was found that 124 (7.2%) patients had DVAs, and 48 of these patients (38.7%) had additional anomalies accompanying DVAs. Of the patients with DVAs, 25 were female and 23 were male, with a mean age of 39.3 years (range, 3-77 years). MRI was performed in all the patients. RESULTS: In addition to DVAs, cavernomas were present in 30 patients (62.5%), haematomas in 7 (14.5%), gliosis in 6 (12.5%), demyelinating plaques in 4 (8.3%) and a glioblastoma in 1 (2.2%). The mean diameter of the DVAs was 1.1mm and the mean diameter of the lesions was 17.4mm. The susceptibility weighted imaging (SWI) sequence was also applied to 12 patients with cavernomas. The relevant sequence in all of these patients contributed to the diagnosis. CONCLUSION: Our study shows that DVAs can accompany a wide spectrum of lesions, especially cavernomas. Although their pathophysiology has not yet been clearly established, these lesions may have a common aetiology.

Determination of anomalous pulmonary venous return with high-pitch low-dose computed tomography in paediatric patients.

BACKGROUND: In this study, we aimed to image pulmonary venous return anomalies and associated cardiovascular and pulmonary abnormalities by high-pitch low-dose computed tomography (CT) in children. MATERIALS AND METHODS: Forty-one patients with total or partial anomalous pulmonary venous return anomalous between May 2012 and June 2019 were retrospectively reviewed. The anomalies were determined using high-pitch low-dose CT. The patients' mean age was 3 years (6 months to 15 years), and 24 of them were female. RESULTS: There were 10 patients with total pulmonary venous return anomalies (TPVRA) and 31 patients with partial pulmonary venous return anomalies (PPVRA). Six (60%) patients with TPVRA had the supracardiac type, 2 (20%) had the cardiac type, and 2 (20%) had the mixed type. All patients with TPVRA had a large atrial septal defect (ASD), 1 patient also had patent ductus arteriosus, and 1 patient had right cardiac hypertrophy. Forty cases of PPVRA were found in 31 patients. Twenty-seven (67%) of them were right-sided, and 13 were left-sided (33%). Twenty (65%) patients also had an additional cardiovascular anomaly (ASD in 12 patients, persistent superior vena cava in 4 patients, patent ductus arteriosus in 3 patients, and aortic coarctation in 2 patients). Of the 27 patients with right-sided PPVRA, it drained into the superior vena cava in 19 patients, the right atrium in 5 patients, and the inferior vena cava in 3 patients. In left-sided cases, the anomalous pulmonary vein drained into the left innominate vein in 9 patients, and in 4 patients, there were accessory pulmonary veins that drained into the left innominate vein. Many of the patients had additional lung anomalies, including pneumonic infiltration (n = 12), atelectasis (n = 8), and lobar emphysema (n = 5), and some of these findings coexisted. CONCLUSIONS: Anomalous pulmonary venous drains and associated cardiac and extra-cardiac anomalies can be detected reliably and quickly with high-pitch low-dose CT without sedation in paediatric patients.

Tumefactive perivascular space demonstrated with post-contrast time-of-flight MR angiography.

The cerebral perivascular spaces are interstitial fluid-filled anatomic structures surrounding the perforating arteries. They appear as small, round or curvilinear structures on magnetic resonance (MR) imaging. Occasionally, these structures may become very large and cause mass effect. In this case, they may imitate malignant processes and are referred to as tumefactive perivascular spaces. In this study, we present a case of tumefactive perivascular space demonstrated with post-contrast time-of-flight (TOF) MR angiography. To our knowledge, there have been no previous clear demonstrations of the perforating artery in tumefactive perivascular space with contrast-enhanced TOF MR angiography. The purpose of this study was to describe advanced imaging findings in this unusual condition.

A rare cause of congenital portosystemic shunt: type 2 Abernethy malformation.

The Abernethy malformation is characterised by congenital extrahepatic portosystemic shunts and is divided into two groups according to the type of anastomosis. In type 1, all portal venous blood is discharged into the inferior vena cava and there is no intrahepatic portal vein. In type 2, the portal vein is partially discharged to the inferior vena cava via side-by-side anastomoses. Imaging has an important role in the diagnosis and follow-up of this malformation. Magnetic resonance imaging should be preferred to demonstrate both vessel anatomy and associated anomalies. The aim of this study was to present a 17-year-old male patient and to discuss the imaging findings of Abernethy malformation.

Differentiation between hepatic alveolar echinococcosis and primary hepatic malignancy with diffusion-weighted magnetic resonance imaging.

PURPOSE: To determine the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in discriminating between hepatic alveolar echinococcosis (AE) and hepatocellular carcinoma and intrahepatic cholangiocarcinoma. METHODS: We included 49 patients (27 men, 22 women; mean age: 52.02±9.76 [SD] years; range: 25-72years) with 57 histopathologically confirmed hepatic AE lesions. Fifty patients (18 men, 32 women; mean age: 58.93±8.42 [SD] years; range: 42-71years) with 61 histopathologically confirmed hepatocellular carcinoma and 50 patients (24 men, 26 women; mean age: 50.11±7.70 [SD] years; range: 38-69years) with 54 histopathologically confirmed intrahepatic cholangiocarcinoma lesions were used as control groups. All patients had MRI examination of the liver that included conventional MRI sequences and DW-MRI using b values of 50, 400 and 800s/mm2. Two radiologists evaluated conventional MRI and DW-MRI images and calculated ADC values of hepatic lesions. RESULTS: The mean ADC value of solid components of hepatic AE lesions was 1.34±0.41×10-3 mm2/s (range: 0.9-1.59×10-3 mm2/s) and was significantly higher than that of the solid components of hepatocellular carcinoma lesions (mean ADC value, 0.99±0.29×10-3 mm2/s; range: 0.7-1.15×10-3 mm2/s) and of intrahepatic cholangiocarcinoma lesions (mean ADC value, 1.05±0.22×10-3 mm2/s; range: 0.86-1.18×10-3 mm2/s) (P<0.001). CONCLUSION: In general ADC values can help discriminate between AE and hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, the use of ADC values cannot help differentiating Type 4 AE from hepatocellular carcinoma or intrahepatic cholangiocarcinoma.

Comparison of the superb microvascular imaging technique and the color Doppler techniques for evaluating children's testicular blood flow.

OBJECTIVE: We have compared conventional Color Doppler (CD) and Power Doppler (PD) techniques, which are used for evaluating the testicular blood flow in small children, and the Superb Microvascular Imaging (SMI), which is a new technique. We have also investigated their contributions to testicular evaluations. PATIENTS AND METHODS: We evaluated blood flow in testicles using a grading system with CD, PD and SMI techniques. We determined the average duration of the three techniques. RESULTS: There was a statistically significant difference between the SMI and CD techniques for all patients (p < 0.001, p = 0.001). When we compared the PD and SMI, either as much or more vascular information was obtained (p = 0.106). There was a statistically significant difference between the application durations of the tests (p < 0.05). CONCLUSIONS: Superb Microvascular Imaging yields more detailed vascular information in blood flow in testicles in small children, than either CD or PD. Furthermore, this technique decreases the duration of the examination at a significant level. Superb Microvascular Imaging may represent an alternative method that can be used safely for evaluating blood flow in the testicles of small children. Additional studies may increase the reliability of SMI.

Non-contrast-enhanced imaging of haemodialysis fistulas using quiescent-interval single-shot (QISS) MRA: a feasibility study.

AIM: To assess the efficiency of a novel quiescent-interval single-shot (QISS) technique for non-contrast-enhanced magnetic resonance angiography (MRA) of haemodialysis fistulas. MATERIALS AND METHODS: QISS MRA and colour Doppler ultrasound (CDU) images were obtained from 22 haemodialysis patients with end-stage renal disease (ESRD). A radiologist with extensive experience in vascular imaging initially assessed the fistulas using CDU. Two observers analysed each QISS MRA data set in terms of image quality, using a five-point scale ranging from 0 (non-diagnostic) to 4 (excellent), and lumen diameters of all segments were measured. RESULTS: One hundred vascular segments were analysed for QISS MRA. Two anastomosis segments were considered non-diagnostic. None of the arterial or venous segments were evaluated as non-diagnostic. The image quality was poorer for the anastomosis level compared to the other segments (p<0.001 for arterial segments, and p<0.05 for venous segments), while no significant difference was determined for other vascular segments. CONCLUSION: QISS MRA has the potential to provide valuable complementary information to CDU regarding the imaging of haemodialysis fistulas. In addition, QISS non-enhanced MRA represents an alternative for assessment of haemodialysis fistulas, in which the administration of iodinated or gadolinium-based contrast agents is contraindicated.

Clinical utility of hepatic-perfusion computerized tomography in living-donor liver transplantation: a preliminary study.

BACKGROUND: Vascular complications are a primary diagnostic consideration in liver transplant recipients, with an overall incidence of 9%. Cross-sectional imaging techniques provide information regarding vascular structure and luminal patency but can not quantitatively assess hepatocyte damage in the liver graft parenchyma. Perfusion computerized tomography (CT) is a recently developed method that allows for quantitative evaluation of hemodynamic changes in tissue. Our objective was to evaluate the clinical utility of perfusion CT in assessing vascular complications during living-donor liver transplantation (LDLT). METHODS: The 33 recipients were divided into 3 groups according to Doppler ultrasonographic findings: hepatic arterial complication group, portal venous complication group, and hepatic venous complication group. Blood volume (BV), blood flow (BF), arterial liver perfusion (ALP), portal venous perfusion (PVP), and hepatic perfusion index (HPI) were calculated for the affected vascular territory regions. RESULTS: Compared with normal liver parenchyma, BV, BF, ALP, and HPI were significantly lower in the hepatic arterial complication group. Although PVP and BV were significantly lower, ALP, HPI, and BF were higher in the affected vascular territory region than in normal liver parenchyma for the portal venous complication group. In the hepatic venous complication group, PVP was significantly higher and BF, ALP, and HPI significantly lower in the affected vascular territory regions than in normal liver parenchyma. CONCLUSIONS: Perfusion CT imaging is a noninvasive technique that enables the quantitative evaluation of vascular complications in the graft parenchyma after LDLT and permits a quantitative evaluation of the treatment response.

A rare reason for liver transplantation: hepatic alveoloar echinococcosis.

One of the rare indications for liver transplantation is hepatic alveolar echinococcosis (AE). We present a case of hepatic AE with portal vein involvement.

Can biliary-cyst communication be predicted by Gd-EOB-DTPA-enhanced MR cholangiography before treatment for hepatic hydatid disease?

AIM: To evaluate the role of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) in the evaluation of biliary-cyst communication (BCC) before treatment for hepatic hydatid disease (HHD). MATERIAL AND METHODS: Thirty-one patients with clinical and laboratory follow-up for HHD with suspected diagnosis of BCC underwent three-dimensional (3D) T2-weighted MRC and T1-weighted contrast-enhanced MRC, dynamic 3D gradient echo (GRE) sequences, using Gd-EOB-DTPA to identify the presence or absence of BCC. A total of 45 hepatic hydatid cysts in the 31 patients were evaluated for cyst diameter, BCC, and the time to contrast-enhancement of the hydatid cyst after Gd-EOB-DTPA injection. The surgical and interventional radiological procedures and imaging findings were compared. The sensitivity, specificity, and accuracy of both techniques in identification of BCC were calculated. RESULTS: The accuracy of contrast-enhanced MRC for identifying BCC was superior with a sensitivity of 87.4% and accuracy of 90.5% (p < 0.05). A diameter of ≥10 cm was associated with significantly increased risk of BCC on contrast-enhanced MRC images (p < 0.05). CONCLUSION: The use of Gd-EOB-DTPA-enhanced MRC yields information that complements T2-weighted MRC findings and improves identification of BCC. The use of T2-weighted MRC, in addition to contrast-enhanced MRC, is recommended to increase preoperative accuracy of identifying BCC.

Diffusion-weighted imaging in the evaluation of hormonal cyclic changes in abdominal wall endometriomas.

AIM: To investigate the utility of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the diagnosis of abdominal wall endometrioma (AWE) and to compare the ADC (apparent diffusion coefficient) values of AWE with those of the uterine endometrium during two different phases of the menstrual cycle. MATERIALS AND METHODS: A total of 22 women aged between 27 and 42 years (mean 32.8 years) and who had regular menstrual cycles were included in the study. These patients had a total of 25 AWE lesions. The mean and standard deviation of the ADC values of the normal endometrium/AWE were calculated for the menstrual and luteal phases. All examinations were performed using a 1.5 T magnet (b-values of 50, 400, and 800 mm/s(2)). The results were analysed using the Shapiro-Wilk test, the Pearson correlation test, the analysis of variance (ANOVA) test, and the paired sample t-test. RESULTS: The ADC values of the endometrium were different in the two phases of the menstrual cycle (menstrual phase: 0.924 ± 0.171; luteal phase: 1.171 ± 0.135). Similarly, the ADC values of the AWE were different in these phases (menstrual phase: 0.937 ± 0.256, luteal phase: 1.256 ± 0.215). In both AWE and the uterine endometrium, the ADC measurements were significantly lower in the menstrual phase than during the luteal phase. This difference was statistically significant (p < 0.05). There was no significant difference in the ADC values between the endometrial layer and AWE during the same phase (p = 0.216 for menstrual phase, p = 0.104 for luteal phase, paired sample t-test). CONCLUSION: The present study demonstrated that in all patients, the DWI features of AWEs were significantly similar to those of the uterine endometrial tissue. Additionally, the ADC measurements of the patients showed similar cyclical changes. These results suggest that the ADC values of a lesion close to the uterine endometrium may be used to differentiate AWE from the other disease entities of the abdominal wall.

Polyorchidism and adenomatous hyperplasia of the rete testis: a case report with sonographic and magnetic resonance imaging findings and review of literature.

Supernumerary testis or polyorchidism is a rare congenital anomaly with about 200 reported cases in the literature. It may be associated with cryptorchidism, testicular torsion and neoplasms. Ultrasonography and magnetic resonance imaging are effective noninvasive methods of accurately detecting polyorchidism. In most cases, ultrasonography is diagnostic and magnetic resonance imaging plays confirmatory role by providing additional information if complicated with neoplasia. We report a case of 16-year-old man with right supernumerary testis associated with adenomatous hyperplasia of the rete testis, its sonographic and magnetic resonance imaging findings and management.

"Mustache sign" due to Stensen duct dilation.

An 80-year-old woman presented with a 5-year history of painless swellings of the left and right cheeks. The degree of swelling did not change with mastication. On palpation, the cheeks were soft, well defined, and movable. Compression and massage of the swollen areas caused increased salivary discharge from the orifices of the Stensen ducts. Three-dimensional computed tomography showed well-bordered, 15- to 20-mm wide, bilateral, tube-like dilatations of the ducts. The ductal origin of the swellings was explained to the patient, but she refused invasive procedures, thus no sialogram or surgical procedure was performed. We describe the clinical and radiographic features of a case of bilateral, congenital Stensen duct dilatation with bilateral swelling of the cheeks.

The utility of multidetector computed tomography for evaluation of congenital heart disease.

BACKGROUND: Congenital heart diseases (CHD) are the leading cause of birth defect-related deaths. Multi detector computed tomography (MDCT) plays an important role for imaging CHD in addition to echocardiography and provides a comprehensive evaluation of complex heart malformations for the referring cardiologist. The aim of the study was to evaluate the utility of MDCT in the assessment of CHD. MATERIALS AND METHODS: A 102 patients with CHD were investigated after initial assessment by echocardiography. The information obtained by MDCT and findings of echocardiography were reviewed together by paediatric cardiologists and cardiac radiologists. Perioperative anatomic descriptions, wherever available(n = 34) formed the gold standard for the comparison. RESULTS: The clinical consensus diagnosis defined 154 cardiovascular lesions in the patients. The results were classified in groups. We present the appearance of various congenital cardiac lesions seen in clinical practice. CONCLUSIONS: MDCT provides important information about anatomic details of CHD for the referring cardiologist. The evaluation of different anatomic structures such as heart, great vessels, lungs and abdomen is possible in one acquisition with this technique.

MDCT angiography assessment of tetralogy of Fallot with atresic left pulmonary artery.

A 24-year-old female patient was admitted to clinic with a 10-year history of dyspnoea. A chest radiograph showed mild cardiomegaly and echocardiography revealed classic findings of Fallot's tetralogy (TOF). Multidetector-computed tomography (MDCT) angiography was performed to evaluate the additional vascular anomalies. MDCT undoubtedly revealed left pulmonary arterial atresia as well as complex intracardiac and vascular anatomic features of TOF. We described both image findings of MDCT angiography for TOF and additional vascular anomalies in this patient (Fig. 3, Ref. 8).