Unusual vascular cause of syncope in an adult patient: type 2 proatlantal intersegmental artery.

A proatlantal intersegmental artery anomaly may present with symptoms such as dizziness and syncope. Because it has the risk of damage in surgical and interventional radiological procedures, to know the presence of this unusual vascular anomaly is very important.

Pulmonary diffuse calcified multiple nodules in alveolar echinococcosis.

Alveolar echinococcosis is a potentially life-threatening parasitic disease primarily involving the liver caused by echinococcus multilocularis. Alveolar echinococcosis shows tumor-like growth that can lead to infiltration of neighboring organs. It is a slowly progressive disease and most commonly metastasizes to the lung. In this study, a 45-year-old female case of alveolar echinococcosis with bilateral pulmonary diffuse calcified multiple nodules metastases is presented.

Investigation of incidental findings of temporomandibular joint disorders on brain magnetic resonance imaging in three-dimensional T2-weighted SPACE sequence performed for brain imaging.

Objectives: The study aimed to determine the temporomandibular joint (TMJ) findings, to investigate the prevalence contribution of this sequence on cases in which cranial magnetic resonance examination was performed and three-dimensional (3D) T2-SPACE (T2-weighted sampling perfection with application-optimized contrasts using different flip-angle evolutions) sequence was used by retrospectively scanning the magnetic resonance imaging (MRI) archive of our hospital, and to reveal the advantages of the 3D-T2 SPACE sequence in patients with TMJ disorders. Patients and methods: The cross-sectional retrospective study was conducted with 499 patients (289 females, 210 males; mean age: 50.1±17.7 years; range, 8 to 92 years) who underwent brain MRI and had 3D-T2 SPACE between March 1, 2021 and March 1, 2022. Two radiologists analyzed the TMJs of the subjects included in the study in 3D-T2 SPACE sequences. Results: At least one incidental finding was detected in the TMJ in 37.1% (n=185) of the patients included in our study. In our study, the most common (13.6%) MRI findings were osteoarthritic changes and synovial cysts. Joint effusion (13.2%) and disc displacement (9%) were less frequent. When the relationship between the age of the patients and the presence of incidental findings, degeneration, effusion, disc displacement, and cyst was examined, the age of the patients with incidental findings (p=0.001) and osteoarthritic changes (p<0.001) was statistically significantly higher. Conclusion: Incidental findings, particularly osteoarthritic changes and synovial cysts, can be seen quite commonly in the TMJ in brain MRI using 3D T2-SPACE sequences in the general population. The 3D T2-SPACE sequence provides valuable information in the recognition of TMJ disorders.

The 2D and 3D MR arthrographic description of aponeurotic expansion of supraspinatus tendon and biceps tendon anomaly in a large patient cohort.

OBJECTIVE: To describe the aponeurotic expansion of supraspinatus tendon (AEST) and biceps tendon abnormalities with magnetic resonance (MR) arthrographic examinations and determine their prevalence in patients, we performed a high-resolution 3D direct MR arthrography. MATERIALS AND METHODS: This was a retrospective study of 700 shoulder MR arthrograms performed between May 2010 and January 2022. Extension in the coronal plane of an AEST on 3D fat-suppressed T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography was identified. Based on its morphology, the AEST on MR arthrography was divided into four subtypes: absence of tendinous thickness in the bicipital synovial surface or intra-synovial tendon-like structure in the bicipital groove, thin and flat tendinous thickness ≥1 mm of bicipital synovium, oval tendinous structure less than half the size of the adjacent biceps tendon, oval tendinous structure more than half the size of the adjacent biceps tendon, and oval tendinous structure larger than the adjacent biceps tendon. Based on its origin and termination, aponeurotic expansions can be divided into three subtypes: proximal pulley zone, middle humeral neck zone, and distal myotendinous junction zone. Association with the biceps synovium of the AEST was categorized into three types: intra-synovial, extra-synovial, and trans-synovial. RESULTS: An AEST in the anterior shoulder joint in 3D VIBE MR arthrography images was identified in 63 (9%) of 700 arthrograms. The most common arthrographic type of AEST was type 1-this was detected in 39 of 63 patients. The most common course type of the AEST was anteriorly midline. The most common distal insertion type was at the tenosynovial sheath of the long head of the biceps tendon (LHBT) in the middle humeral neck zone-this was detected in 31 of 63 patients. There were only 10 MR arthrograms biceps tendon abnormality, including 4 biceps agenesis and 6 split ruptures. CONCLUSION: A 2D and high-resolution 3D MR arthrography can demonstrate the anatomical detail around the bicipital groove and facilitate the differentiation between a biceps tendon anomaly and an AEST. On high-resolution 3D MR arthrographic images, the AEST tends to be in the anterior midline and anteromedial portions of the biceps synovium with intra-synovial, extra-synovial, and trans-synovial courses and its three different insertion types.

Comparison of conventional MR arthrography and 3D volumetric MR arthrography in detection of cartilage defects accompanying glenoid labrum pathologies.

OBJECTIVES: In this study, we aimed to compare conventional and T1-weighted volumetric magnetic resonance arthrography (MRA) in the diagnosis and grading of glenoid cartilage defects that accompany labral pathologies. MATERIALS AND METHODS: A total of 79 patients who were prediagnosed with labrum pathologies based on shoulder magnetic resonance imaging (MRI) had MRA and CTA between December 2021 and May 2022. CTA was regarded as reference standard. CTA images were examined by a radiologist experienced in musculoskeletal radiology, and MRA images were examined by two radiologists independently to determine presence, grade, and localization of any glenoid cartilage defect, if present. Sensitivity, specificity, and accuracy were calculated separately for conventional and T1-weighted volumetric MRA. In addition, at the last stage, two observers examined all MRAs together, and the presence of a cartilage defect was decided by consensus, and the overall sensitivity, specificity, and accuracy were calculated. RESULTS: Cartilage defect was detected on CTAs of 48 (60.75%) cases of among 79 patients with labrum pathology. The sensitivity, specificity, and accuracy of conventional MRA for two examiners were 17-19%, 100-100%, and 49-51%, respectively, while those values were 67-65%, 92-97%, and 84-77%, respectively, for T1-weighted volumetric MRA. Inter-examiner agreement was excellent for diagnosis of cartilage defects on all MRAs. The overall sensitivity, specificity, and accuracy for detection of glenoid cartilage lesions by MRA were 69%, 97%, and 80%, respectively. CONCLUSION: T1-weighted volumetric MRA seems to demonstrate cartilage defects accompanied with labrum pathologies accurately with high sensitivity, specificity, and excellent inter-examiner agreement.

Unusual Anatomic Variation: Intradural Conjugation of the Hypoplastic Left ICA and the Enlarged Accessory Meningeal Artery.

The precise definition of the accessory meningeal artery was not available until 1961. It can originate from the maxillary artery or middle meningeal artery and supplies the meatus and membranous portion of the auditory tube, the lateral pharyngeal muscle, and the medial pterygoid muscle; Laterally, it supplies the lateral pterygoid muscle, the extracranial part of the mandibular nerve, the pterygoid venous plexus, and the sphenoid periosteum. Here, we present a 70-year-old male patient who applied to the neurosurgery clinic with complaints of chronic headaches and dizziness. Magnetic resonance angiography and computed tomography angiography showed hypoplasic appearance of the left internal carotid artery and an enlarged accessory meningeal artery variant merging with its ophthalmic segment.