Spontaneous intracranial hypotension: Exploring the viability of non-contrast FLAIR as a substitute for contrast-enhanced T1WI in assessing pachymeningeal thickening.

PURPOSE: To avoid contrast administration in spontaneous intracranial hypotension (SIH), some studies suggest accepting diffuse pachymeningeal hyperintensity (DPMH) on non-contrast fluid-attenuated inversion recovery (FLAIR) as an equivalent sign to diffuse pachymeningeal enhancement (DPME) on contrast-enhanced T1WI (T1ce), despite lacking thorough performance metrics. This study aimed to comprehensively explore its feasibility. METHODS: In this single-center retrospective study, between April 2021 and November 2023, brain MRI examinations of 43 patients clinically diagnosed with SIH were assessed using 1.5 and 3.0 Tesla MRI scanners. Two radiologists independently assessed the presence or absence of DPMH on FLAIR and DPME on T1ce, with T1ce serving as a gold-standard for pachymeningeal thickening. The contribution of the subdural fluid collections to DPMH was investigated with quantitative measurements. Using Cohen's kappa statistics, interobserver agreement was assessed. RESULTS: In 39 out of 43 patients (90.7%), pachymeningeal thickening was observed on T1ce. FLAIR sequence produced an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 72.1%, 71.8%, 75.0%, 96.6%, and 21.4% respectively, for determining pachymeningeal thickening. FLAIR identified pachymeningeal thickening in 28 cases; however, among these, 21 cases (75%) revealed that the pachymeningeal hyperintense signal was influenced by subdural fluid collections. False-negative rate for FLAIR was 28.2% (11/39). CONCLUSION: The lack of complete correlation between FLAIR and T1ce in identifying pachymeningeal thickening highlights the need for caution in removing contrast agent administration from the MRI protocol of SIH patients, as it reveals a major criterion (i.e., pachymeningeal enhancement) of Bern score.

A Comparative Analysis of Erector Spinae Plane Block Versus Conscious Sedation in Managing Percutaneous Cholecystostomy Pain.

PURPOSE: This study investigates the efficacy of erector spinae plane block (ESPB) for managing perioperative and postoperative pain in patients undergoing percutaneous cholecystostomy (PC) for acute cholecystitis, particularly in high-risk elderly patients with extensive comorbidities and limited functional status. METHODS: In a retrospective single-center study, 58 high-risk patients scheduled for PC were assessed. ESPB was administered to 23 patients, while 22 received conscious sedation. Pain intensity was measured using the numeric rating scale before any analgesic or ESPB administration, during the procedure and at 1 and 12 h post-procedure and secondary outcomes included adverse effects and additional analgesic requirements. RESULTS: The ESPB group experienced significant pain reduction during and post-procedure compared to the conscious sedation group (p = 0.002). Procedure times were shorter (p = 0.015), and postoperative tramadol was less frequently needed in the ESPB group (p = 0.007). The incidence of nausea was also lower in the ESPB group (p = 0.001). No ESPB-related complications were reported. CONCLUSION: ESPB significantly alleviates perioperative and postoperative pain in PC patients, reducing additional analgesic use and side effects. It holds promise as a key component of pain management for high-risk surgical patients. LEVEL OF EVIDENCE: Level 3, Non-randomized controlled cohort/follow-up study.

Percutaneous CT-Guided Microwave Ablation for the Treatment of Osteoid Osteomas: A Single Center Experience.

RATIONALE AND OBJECTIVES: The aim of the current study was to evaluate the feasibility and effectiveness of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OO). MATERIALS AND METHODS: Data from 59 consecutive patients who underwent percutaneous CT-MWA for OO treatment were examined in the current retrospective study. The period of this study spanned from January 2021 to May 2023 at a single institution. The study involved an evaluation of clinical and radiological characteristics, procedural data, Visual Analog Scale (VAS) pain scores, complication incidences, as well as clinical and technical success rates. Statistical analyses were performed by using the Wilcoxon test with Bonferroni correction, Friedman, Spearman, Mann-Whitney U test. RESULTS: 59 patients with an average age of 17.31 ± 8.53 years underwent CT-guided MWA for the treatment of OO. The procedure demonstrated a high success rate, with 96.6% of cases achieving both technical and clinical success. However, recurrence was observed in two patients (3.4%) at the three-month follow-up. These cases were successfully managed with a second MWA procedure. The median VAS pain scores reported by the patients was significantly improved post-procedure: from 8.64 ± 1.14 before treatment to 0.63 ± 0.98 in the first month, 0.41 ± 1.02 in the third month, and 0.15 ± 0.45 in the sixth month. Only one patient (1.7%) experienced a minor complication; no major complications were recorded in this study. CONCLUSION: CT-guided percutaneous MWA is a minimally invasive and a highly effective and safe approach for the treatment of OO.

Successful treatment of a rheumatoid arthritis patient with severe synovial hypertrophy and impaired shoulder function with microwave ablation technique.

Rheumatoid arthritis (RA) is a chronic, inflammatory systemic disorder of synovial joints and results in polyarthritis, chronical degeneration, and finally deformities and ankylosis in severe cases. Synovitis and pannus formation are results of inflammatory changes and lead into restriction in joint movement. Shoulders are among the later affected and larger joints and formation of synovitis in early active stages and pannus in later stages might be concluded with frozen shoulder and severe impairment in functionality. These late-term changes cannot be controlled with systemic or local anti-inflammatory agents and synovectomy is chosen in some cases. However, the results are not satisfactory and recurrence is common. In this case report, we presented a case of RA with severe shoulder pain, restricted movement due to synovial hypertrophy, and pannus formation which are resistant to local and systemic interventions and not suitable for surgical or chemical synovectomy. Microwave ablation (MWA) was performed successfully without any complication and she well responded in terms of DAS-28, functional, and pain scores. Range of motion and funcitonal restriction were recovered. This case report describes the use and promising results of MWA in RA with severe synovial hypertrophy and pannus formation even in the absence of active arthritis and effusion. MWA is a safe and minimally invasive technique that can be easily performed in coordinance of rheumatologists and interventional radiologists in proper cases.

Effectiveness of polidocanol sclerotherapy in alleviating symptoms in patients with venous malformations.

OBJECTIVE: The objective of this study was to retrospectively evaluate the effectiveness of polidocanol in managing pain, swelling, functional limiting and cosmetic disorders in patients with venous malformations (VMs). METHODS: This retrospective study included patients who underwent sclerotherapy with polidocanol for VMs between 2020 and 2022. Patient records, imaging findings, and evaluation questionnaires used in the preprocedure and follow-up phases were reviewed. After sclerotherapy, patients were followed up at 1, 2, 3, and 6 months. During these visits, the previously used 11-point verbal numerical rating scale (from 0 [no pain] to 10 [worst pain thinkable]) was used to evaluate the severity of symptoms such as pain, swelling, cosmetic discomfort, and functional limitation, and patients were asked to report the number of days per week they experienced these symptoms owing to the VM. RESULTS: A total of 194 sclerotherapy procedures (mean, 1.6 ± 0.3 procedures) in 84 patients (55 female and 29 male patients; mean age, 22.45 ± 11.83 years) were conducted. The majority of these malformations (81%, or 68 patients) were located in the extremities. We found a significant decrease in pain, swelling, functional limitation, cosmetic appearance, and number of painful days between all time points, except for the comparison between months 3 and 6 (P < .001) CONCLUSIONS: Polidocanol sclerotherapy is a safe and effective treatment for VMs that significantly decreases patient complaints and has a very low complication rate. Particularly, following patients at short intervals and administering additional sclerotherapy sessions when necessary will significantly increase patient satisfaction.

REliability of consensus-based segMentatIoN in raDiomic feature reproducibility (REMIND): A word of caution.

OBJECTIVE: To evaluate the reliability of consensus-based segmentation in terms of reproducibility of radiomic features. METHODS: In this retrospective study, three tumor data sets were investigated: breast cancer (n = 30), renal cell carcinoma (n = 30), and pituitary macroadenoma (n = 30). MRI was utilized for breast and pituitary data sets, while CT was used for renal data set. 12 readers participated in the segmentation process. Consensus segmentation was created by making corrections on a previous region or volume of interest. Four experiments were designed to evaluate the reproducibility of radiomic features. Reliability was assessed with intraclass correlation coefficient (ICC) with two cut-off values: 0.75 and 0.9. RESULTS: Considering the lower bound of the 95% confidence interval and the ICC threshold of 0.90, at least 61% of the radiomic features were not reproducible in the inter-consensus analysis. In the susceptibility experiment, at least half (54%) became non-reproducible when the first reader is replaced with a different reader. In the intra-consensus analysis, at least about one-third (32%) were non-reproducible when the same second reader segmented the image over the same first reader two weeks later. Compared to inter-reader analysis based on independent single readers, the inter-consensus analysis did not statistically significantly improve the rates of reproducible features in all data sets and analyses. CONCLUSIONS: Despite the positive connotation of the word "consensus", it is essential to REMIND that consensus-based segmentation has significant reproducibility issues. Therefore, the usage of consensus-based segmentation alone should be avoided unless a reliability analysis is performed, even if it is not practical in clinical settings.

Isolated inferior thyroidal artery vasculitis: A rare cause of neck pain.

Vasculitis is the inflammatory changes in vessels of any size that usually have a systemic involvement with a quite variable clinical presentation affecting various organs. Although systemic presentation is more common, in some cases localized inflammation of vasculature of a single organ or limited branches of aorta are reported. Here we present, an isolated vasculitis of bilateral inferior thyroidal arteries in a female patient aged 49 years, who presented with neck pain and was diagnosed with ultrasonography and computed tomographic angiography. The clinical and imaging findings were managed successfully with glucocorticoid induction and addition of methotrexate to the treatment. Localized forms of vasculitis are rarer and the limited size of the affected area makes diagnostic investigations and management more complicated. Non-invasive imaging modalities rather than conventional angiography provide useful information in a safer and easier way. Isolated vasculitis of thyroidal arteries is an extremely uncommon site and should be excluded in case of unexplained neck pain, even in the presence of normal laboratory examinations, probably because of the size of the involved vessels.

The Evaluation of Renal Iron Deposition With a 3 Tesla MRI Device in Beta-Thalassemia Major Patients.

Background and objective Beta-thalassemia is the most frequent monogenic disease in the world. In beta-thalassemia major (BTM) patients, blood transfusions for severe anemia usually cause iron overload, leading to increased morbidity and mortality. In this study, we aimed to examine the iron overload in the kidneys of BTM patients with a 3 Tesla (3T) MRI device and assess the relationship between iron overload in the liver and heart as well as serum ferritin levels. Methods This was a retrospective study covering the period between November 2014 and March 2015. MRI was performed on 21 patients with BTM who were receiving blood transfusions and chelation therapy. The control group (n=11) included healthy volunteers. A 3T MRI device (Ingenia, Philips, Best, The Netherlands) using a 16-channel phased array SENSE-compatible torso coil was used. Three-point DIXON (mDIXON) sequence and the relaxometry method were employed to measure iron overload. Both kidneys were analyzed via mDIXON sequence for atrophy or variations. Afterward, the images in which renal parenchyma could be distinguished best were selected. Iron deposition was analyzed via the relaxometry method using a unique software (CMR Tools, London, UK). All data were analyzed using IBM SPSS Statistics v.21 (IBM Corp., Armonk, NY). The Kolmogorov-Smirnov test, independent samples t-test, Mann-Whitney U test, and Pearson's and Spearman's rho correlation coefficient were used. A p-value <0.05 was considered statistically significant. Results There was a statistically significant relationship between beta-thalassemia patients who had cardiac iron deposition and those who did not in terms of T2* time (p=0.02). In contrast, there was no similar relationship for liver iron deposition (p>0.05). Renal T2* values were significantly different between the patient and control groups (p=0.029). T2* times were significantly different between patients who had ferritin levels below 2500 ng/ml and those with ferritin levels above 2500 ng/ml (p=0.042). Conclusion Based on our findings, 3T MRI is a safe and reliable tool for screening iron overload in BTM patients as it makes distinguishing between renal parenchyma and renal sinus much easier and as it is more sensitive to iron deposition.

Inclusion body myositis triggerred with long-term imatinib use.

INTRODUCTION: Imatinib is an orally administered tyrosine kinase inhibitor with wide clinical use in different indications from solid tumors to hematologic malignancies. Inclusion body myositis (IBM) is an acquired myopathy of both inflammatory and degenerative nature. CASE REPORT: We present an 81 years old male with a history of gastrointestinal stromal tumor (GIST) operated 8 years ago and was evaluated for the progressive loss of weight and muscle strength leading to total immobilization in 6 months. He was under imatinib for 8 years despite the remission of GIST. Physical examination disclosed diffuse loss of muscle strength, most prominently involvement of distal upper and proximal lower extremity in an asymmetrical pattern with normal serum creatinine kinase level (CK). Further investigations including bilateral thigh MRI, electromyography (EMG), and PET/CT suggested myositis and degenerative myopathy and ruled out any malignancy. Quadriceps femoris biopsy proved the diagnosis of IBM and no trigger except for imatinib was displayed. MANAGEMENT AND OUTCOME: Clinical improvement in terms of weight loss and muscle weakness was achieved after the discontinuation of imatinib. DISCUSSION: This is the first case of IBM associated with prolonged use of imatinib not reported in the literature so far. Since imatinib is widely used in different conditions, it is important to be aware of even its rare adverse effects. Poor response of IBM to conventional immunosuppressive agents enhances the value of etiology identification to relieve symptoms in addition to supportive care.

Comparison of functional patency rates between paclitaxel-eluting versus plain balloon angioplasty in hemodialysis patients with central venous stenosis: An intra-individual comparison study.

Central venous stenosis (CVS) is usually a late-diagnosed clinical entity that is common in hemodialysis patients. It causes various problems ranging from hemodialysis difficulty to loss of the arterio-venous (A-V) fistula. In the present study, we aimed to determine the effect of drug eluting balloon while excluding the influence of other variable factors by evaluating the same individuals with plain and paclitaxel-eluting balloons. This research was a prospective study of 18 symptomatic hemodialysis patients (age 50.9 ± 14.0 years, range 32-72 years; 11 male, 7 female) with CVS who underwent treatment by plain balloon angioplasty (PBA) and paclitaxel-eluting balloon angioplasty (PEBA) in our hospital from January 2016 to June 2017. First, third and sixth month central vein patency rates were compared. The median patency rates of central veins were 109.0 (range: 10-324) days after PBA and 238.5 (range: 157-501) days after PEBA (p < 0.001). There was no statistically significant difference between PBA and PEBA angioplasty in one-month patency (p Ëƒ 0.05). By contrast, a statistically significant difference was found between 3- and 6-month patency rates (p = 0.031 and p Ë‚ 0.001, respectively). Kaplan-Meier analysis revealed that the primary cumulative patency rate of PEBA was significantly longer than that of PBA (p ˂ 0.001). In this prospective study, PEBA patency is superior to PBA patency in the treatment of CVS in dialysis patients.

Isolated Asymptomatic Pulmonary Artery Sling in a Preterm Neonate.

Pulmonary artery sling is an uncommon entity in the neonatal period. It is defined as an abnormally originated left pulmonary artery arising from the posterior aspect of right pulmonary artery. Because of the associated structures in this region, mostly originating from sixth aortic arch, tracheobronchial anomalies and congenital heart defects, it frequently accompanies the pulmonary artery sling. Etiology of pulmonary artery sling has not been determined to date. Surgical correction is necessary even for asymptomatic cases because of the high mortality. Postoperative mortality is commonly associated with airway defects. Therefore, prompt diagnosis and timely intervention decrease the morbidity and mortality. We, herein, present a case of a neonate with isolated pulmonary artery sling un-associated with their developmental anomalies. Antenatal history was positive for maternal hypothyroidism, for which she was taking L-thyroxine. To the best of our knowledge, this is the first pulmonary artery sling case accompanied by maternal hypothyroidism. Key Words: Pulmonary artery sling, Neonate, Hypothyroidism.

The nutcracker syndrome: The usefulness of different MRI sequences for diagnosis and follow-up.

OBJECTIVE: Nutcracker Syndrome (NCS) is the extrinsic compression of the left renal vein by neighboring arterial, ligamentous, muscular, or osseous structures. Diagnosis is made by Doppler ultrasonography (US), multidetector computerized tomography (MDCT), magnetic resonance imaging (MRI), phlebography. The aim of the current study is to assess the value of MRI and compare the efficiency of different sequences in diagnosis and follow up of children with NCS. MATERIAL AND METHODS: A total of 40 children (female/male ratio 3:1) with NCS were included in this prospective study. A standardized abdominal MRI protocol was used and T2-TRUFI (True Fast Imaging with Steady-State Free Precession), T2-HASTE (Half Fourier Acquisition with Single Shot Turbo Spin Echo), T1-VIBE (Volumetric Interpolated Breath Hold Examination), and out-of-phase (opposed-phase) T1 sequences were obtained. The sequences were compared according to anatomical depiction, measurability, and pulsation artifact. RESULTS: A four point-scale was used to assess subjective image quality and the results were listed as: 1 = poor, 2 = fair, 3 = good, and 4 = excellent. Both in total and for each individual criterion, the highest scores were obtained with T2-TRUFI (total mean 3.74 ±â€¯0.45, anatomical depiction 3.9 ±â€¯0.3, measurability 3.8 ±â€¯0.4, aortic pulsation artifact 3.52 ±â€¯0.55). CONCLUSION: Although Doppler US is the gold standard technique in the diagnosis of NCS, MR imaging may be used as an additional modality, as it is superior to Doppler US in terms of anatomic depiction and a lower rate of imaging artifacts. Non-contrast MR imaging, particularly TRUFI sequence, may have an incremental value in the accurate diagnosis and follow-up of these patients.

Delayed bilhemia complicating percutaneous transhepatic biliary drainage: Successful treatment with primary coil embolization.

Bilhemia is very rare and serious complication of percutaneous transhepatic biliary drainage (PBD). Bile leakage occurs into the bloodstream through a fistula between the biliary tree and the hepatic venous system. We report a case of a 45-year-old woman with bilhemia complicated by PBD. She was successfully treated with primary coil embolization of biliovenous fistula tract. In the follow-up, bilirubin values dramatically regressed and returned to its normal limits. Rapid increase in total and direct bilirubin values after PBD without biliary tree dilatation almost always suggest biliovenous fistula. It is more likely that biliovenous fistulas will develop in catheters that are removed before the time of the tract maturation. Symptomatic bilhemia should be treated as soon as possible to prevent major complications like bile pulmonary embolism and biliary sepsis.

A rare case of cephalothoracopagus janiceps conjoined twins.

Yilmaz-Semerci S, Güzelbey T, Kurnaz D, Kalkan S, Çetinkaya M. A rare case of cephalothoracopagus janiceps conjoined twins. Turk J Pediatr 2018; 60: 751-754. Conjoined twins represent a rare phenomenon of a monochorionic monoamniotic twin. Five types of conjoined twins have been described and thoracocephalopagus was reported to be seen with an incidence of 1 in 3 million. The etiology has not been elucidated yet. Therefore, more data is required to understand this entity better. Herein, we report a case of thoracocephalopagus.

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

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

Diffusion Tensor Imaging of the Uterine Zones Related to the Menstrual Cycle and Menopausal Status at 3 Tesla MRI.

BACKGROUND: Diffusion and diffusion tensor imaging techniques (DTI) are widely available and used both in central nervous system and body imaging, including gynecological diseases. AIMS: The aims of this study were to assess the capability of DTI of uterine zones in relation to the menstrual cycle and ascertain the normal apparent diffusion coefficient and fractional anisotropy values at 3T magnetic resonance imaging (MRI). STUDY DESIGN: Prospective clinical study. METHODS: A total of 13 young reproductive and 12 postmenopausal healthy volunteers were included in the study. MRI examination included sagittal T2-weighted and single-shot echo planar imaging DTI obtained under free breathing. Fractional anisotropy (FA) values of the endometrium, junctional zone, and myometrium were determined. RESULTS: The median (minimum-maximum) FA of the endometrium, myometrium, and junctional zone of the reproductive group were 0.31 (0.260-0.465), 0.42 (0.302-0.664), and 0.58 (0.420-0.745), respectively, in the proliferative phase and 0.26 (0.180-0.413), 0.48 (0.357-0.656), and 0.59 (0.490-0.675)], respectively, in the secretory phase. In the postmenopausal group, the FA values of the endometrium, myometrium, and junctional zone were 0.275 (0.136-0.425), 0.255 (0.191-0.553), and 0.27 (0.129-0.397), respectively. Apparent diffusion coefficient (ADC) values of the endometrium, myometrium, and junctional zone of the reproductive group were 1.25±0.254 (0.970-1.463), 1.67 (1.213-1.854), and 1.23 (0.853-1.301), respectively, in the proliferative phase and 1.32±0.283 (1.165-1.706), 1.55 (1.360-1.791), and 1.17 (1.163-1.705), respectively, in the secretory phase. In the postmenopausal group, the ADC values of the endometrium, myometrium, and junctional zone were measured as 1.100±0.192 (0.850-1.302), 1.14 (0.864-1.283), and 1.09 (0.912-1.291). The FA values of the endometrium and myometrium were lower in the secretory phase of the reproductive group, while ADC values were higher. However, both the FA and ADC values were lower in the postmenopausal group. CONCLUSION: The present study showed that uterine DTI is feasible when used quantitatively. While FA values tend to decrease, ADC values increase significantly in all zones in the secretory phase except the junctional zone. Zonal FA and ADC values of postmenopausal women are lower in comparison to those in young women.

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

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