Evaluation of olfactory bulbus volume and olfactory sulcus depth development with 3 Tesla magnetic resonance imaging in childhood.

BACKGROUND: This study aimed to reveal the change in olfactory bulbus volume (OBV) and olfactory sulcus depth (OSD) in healthy Turkish paediatric individuals between 1 month and 18 years of age with 3 Tesla magnetic resonance imaging (MRI), taking into account different age groups and gender factors. MATERIALS AND METHODS: In this retrospective study, 190 paediatric individuals who underwent cranial MRI were evaluated. Healthy paediatric cases were divided into four groups as infantile period (first 24 months when cerebral myelinisation was completed), early childhood (2-6 years), childhood (6-12 years) and adolescence (12-18 years). OBV and OSD measurements were performed on coronal T2-weighted brain MRI by 3 Tesla magnetic resonance scan. The mean, right and left OBVs and OSDs were used for evaluation. RESULTS: The mean age was 9.9 ± 7.5 months for the infantile period, 4.5 ± 1.3 years for early childhood, 9.3 ± 1.7 years for childhood and 15.2 ± 1.7 years for adolescence. Mean, right and left OBV was found to be slightly larger in male children than in female children (p = 0.015, p = 0.033 and p = 0.010, respectively). There was no statistical difference between the genders for mean, right and left OSD (p = 0.559, p = 0.536 and p = 0.598, respectively). Among the age groups, the values of the 3rd and 4th groups in terms of mean, right and left OBV were higher than in the other two groups (p < 0.001). In terms of OSD, mean, right and left values were higher in group 2, 3 and 4 than in group 1 (p < 0.001). CONCLUSIONS: These data differ by paediatric age group and gender for the development of OBV and OSD. Normal values for the paediatric age group and gender should be calculated to detect olfactory dysfunction.

The incidence of pneumatised inferior turbinate and relation to close anatomic structures.

BACKGROUND: Pneumatisation of the inferior turbinate (PIT) is a rare abnormality of the paranasal sinus. It is very difficult to differentiate from the hypertrophia of the inferior turbinate clinically. Thus, it is important to be considered, especially in cases with no response to medical treatments. We aimed to investigate the presence and the frequency of PIT by computed tomography (CT). MATERIALS AND METHODS: A total of 2905 cases (1381 female, 1524 male) with an age range between 16 and 84 were included. RESULTS: The pneumatisation of the inferior turbinate was observed in 1.72% of the cases with a percentage of 1.88% in women and 1.57% in men. In PIT (+) cases the bilaterality was found in 54% of them. According to the subtypes, 70% was lamellar, 28% was bullous and 2% was extensive. No statistically significant difference was found for age distribution. The most commonly associated variations were the pneumatisation of the middle and upper turbinate and the septal deviation. CONCLUSIONS: The pneumatisation of the inferior turbinate is a rare variation with a similar frequency among men and women. It is diagnosed by CT and when symptomatic, the optimal treatment is surgery.

Circle of Willis variations and artery diameter measurements in the Turkish population.

BACKGROUND: The aim of this study was to evaluate the frequency of circle of Willis (COW) variations and the measurements of the COW vessel diameters in the Turkish population. MATERIALS AND METHODS: The patient population for this single-centre, retrospective study was formed of patients who had brain magnetic resonance angiography (MRA). A total of 384 subjects were included in the study. The three-dimensional time-of-flight (TOF) technique was used for MRA imaging to evaluate the anatomy of the COW. Variations in the COW were recorded. The diameters of the critical arteries of the COW were measured. RESULTS: Adult configuration of the COW was determined in 326 (85%) cases, foetal configuration in 50 (13%) cases and transitional configuration in 8 (2%) cases. The COW was normal in 328 (85.4%). In the remaining 56 (14.6%) cases, agenesis was determined in 62 vessels. The mean calibrations of the vessels were measured as 2.85 mm in the basilar artery, 4.24 mm in the right internal carotid artery (ICA), 4.32 mm in the left ICA, 1.58 mm in the right A1, 1.64 mm in the left A1, 2.13 mm in the right M1, 2.10 mm in the left M1, 1.80 mm in the right P1, 1.88 mm in the left P1, 1.12 mm in the right posterior communicating artery, and 1.12 mm in the left posterior communicating artery. CONCLUSIONS: Circle of Willis variations may show geographic and ethnic differences. Knowledge of the frequency and types of variation in the population is important for neurosurgeons and in radiological interventional procedures as a guide for entry and in respect of collateral which could develop later.

MRI-based detailed evaluation of the anatomy of the human coccyx among Turkish adults.

AIM: The human coccyx varies considerably in shape and size. The objective of this study was to investigate the morphology and morphometry of the coccyx on pelvic magnetic resonance imaging in asymptomatic individuals among Turkish adults. MATERIALS AND METHODS: This study was conducted retrospectively on the pelvic magnetic resonance images of 456 adult patients without a history of trauma in the coccyx region. The coccygeal vertebrae count, number of bone segments, and intercoccygeal and sacrococcygeal joint fusions were determined from the sagittal plane images. In addition, the length and angles (the sacrococcygeal angle, intercoccygeal joint angle, and sacrococcygeal joint angle) were measured. STATISTICAL ANALYSIS USED: Data were analyzed using the T-test or Mann-Whitney U-test, the ANOVA, or Kruskal-Wallis tests, and the chi-square test was used for the categorical variables. RESULTS: The coccyx is formed by four, five, or three vertebrae in a decreasing ratio. The coccyx is composed of one to five bone segments; one bone segment was found in 2.8% of the cases. Intercoccygeal joint fusions been observed predominantly in the last intercoccygeal joint, with or without sacrococcygeal joint fusion. The coccyx was found to be longer in adult males than in adult females. The sacrococcygeal angle might be anteverted or retroverted. CONCLUSION: The findings are contrary to the conventional knowledge in that the vertebrae shaping the coccyx were completely fused and consisting of a single bone in very few cases. Better understanding of the anatomical variation of the coccyx may be useful for clinicians evaluating patients presenting with conditions in the coccygeal region.

Intracranial lipomas: clinical and imaging findings.

PURPOSE: Intracranial lipomas are rare congenital malformations. The most common location of intracranial lipoma is the midline cerebral structures. The most frequently seen symptoms are headaches, seizures, psychomotor retardation and cranial nerve deficits. This study aimed to evaluate the clinical and radiological findings of 14 patients with intracranial lipoma. MATERIALS AND METHODS: The study comprised 14 patients diagnosed with intracranial lipoma from computed tomography and magnetic resonance imaging taken after presentation at our hospital with headaches or seizures between January 2008 and April 2012. The cranial CT and MR images were evaluated by two experienced specialist radiologists. The lipoma localisation, size, morphology, any concomitant anomalies and findings of compression were recorded. RESULTS: The study comprised 14 patients diagnosed with intracranial lipoma. The lipoma was observed to be located pericallosal, adjacent to the mamillary body and the optic chiasm, interhemispheric, in the quadrigeminal cistern and sylvian fissure. 3 patients had a history of seizures. The others had headaches. CONCLUSIONS: If there are no concomitant central nervous system (CNS) anomalies, there are no significant clinical or neurological findings apart from headaches.

Inferior vena cava hypoplasia with right hepatic vein and accessory inferior hepatic vein shunt.

Inferior vena cava (IVC) hypoplasia is a rare condition. Venous blood flow is usually provided through collaterals in the azygos or hemiazygos venous systems. However, portosystemic shunts with intrahepatic venous collateral are extremely rare. The case is presented here of a large shunt between the right hepatic vein, accessory inferior hepatic vein, and inferior vena cava in a 37-year-old female patient with IVC hypoplasia.

Is nasal packing required in epistaxis?

OBJECTIVE: To demonstrate the efficacy of identification of bleeding source with nasal endoscopy and cauterization (bipolar or radiofrequency) without nasal packing in adults with posterior epistaxis unable to be treated with nasal packing. MATERIALS AND METHODS: The average age of patients was 56.16 ± 12.6 (38-72) years, and female-male ratio was 1/5. The average systolic blood pressure was found to be 150 ± 30, while diastolic blood pressure was 90 ± 20 mmHg. Average hemoglobin concentration was 11.2 ± 3.1 (7-15). The bleeding was on the left side in 8 patients and on the right in 4 patients. Probable etiology was considered hypertension crisis (33.3%), use of nasal steroids (8.3%), nasal surgery (8.3%), however in half (50%) of the cases the cause was unidentified. Of the cases, 6 had hypertension, 4 COPD, 10 tobacco use and 5 alcohol use. The source of epistaxis was anterior ethmoidal artery in 2 cases and spheopalatine artery in 10 cases. Two of the cases were treated with radiofrequency coagulation, and ten with bipolar cauterization. Only one of the cases was administered 2 units of packed red blood cells, and one of the cases had postoperative recurrent bleeding. The patients were hospitalized in average 3.2 (2-5) days and no reccurence of hemorrhage was seen in 3 month follow up. CONCLUSIONS: Dundee epistaxis menagement protocol described by Barnes and Spielman may be applied in adults. Endoscopical detection of the bleeding site and cauterizing the arterial feed source is highly successful in the treatment. Nasal packing may more commonly lead to complication especially in the elderly and in patients with heart and respiratory problems.

Infected primary hydatid cyst located in the Sartorius muscle.

Primary intramuscular hydatid cyst should be considered for the differential diagnosis of cystic soft tissue masses especially in the endemic areas though primary muscular hydatidosis is a rare clinical entity. We aimed to report the case of a 30-year-old female patient with infected primary intramuscular hydatid cyst located in the sartorius muscle.

Examining cerebral metabolic abnormalities in chronic obstructive pulmonary disease (COPD) patients by localized proton magnetic resonance spectroscopy (MRS).

PURPOSE: The study was planned based on the hypothesis that cerebral metabolism is impaired in chronic obstructive pulmonary disease (COPD) by using localized in vivo proton magnetic resonance spectroscopy. MATERIALS AND METHODS: The study comprised 30 male patients, aged 45-70 years, with moderate level COPD and an aged matched group of 30 healthy males as the control group. Cerebral metabolism was investigated with proton magnetic resonance spectroscopy (MRS) using multivoxel technique. Data normal distribution conformity was evaluated by the One Sample Kolmogorov Smirnov Test and homogeneity by the One-Way ANOVA test. For both the COPD and control group, data were obtained as mean, standard deviations, minimum and maximum values. Independent sample t-test was used for the comparison of means between the two groups. RESULTS: The frontal and parietal white matter in patients with COPD showed an overall reduction in cerebral metabolites. The NAA (N-acetylaspartate)/Cr (Creatinine), Cho (Choline)/Cr ratios of the cerebral frontal and parietal white matter regions in the COPD group were significantly lower than the control group. CONCLUSIONS: The findings of this study through the use of MRS confirmed that most patients with symptomatic COPD have cerebral metabolic abnormalities.

Primary retroperitoneal hydatid cyst.

Hydatid cyst is formed from parasitic infestation by Echinococcus granulosus, and may involve several bodily organs, primarily the liver and lungs. In endemic regions, hydatid cyst should be borne in mind in cases of retroperitoneal cystic masses. Diagnosis of hydatid cyst is made from radiological findings and serological test positivity. Hydatid cyst diagnosis can be made from typical radiological imaging findings. This paper presents the imaging findings of a 56-year old male with retroperitoneal hydatid cyst.

Radiological evaluation of the styloid process length in the normal population.

BACKGROUND: The aim of this study was to evaluate the styloid process (SP) length in the normal population using multidetector computed tomography (MDCT). MATERIALS AND METHODS: In this study, 160 patients who underwent paranasal MDCT between January 2012 and December 2012 were retrospectively evaluated. The patients were divided into groups according to their age and gender: Group 1 age 31-40 years old, 111 subjects; Group 2 age 41-50 years old, 49 subjects; Group A 98 males; Group B 62 females. The mean SP length was calculated from the mean of 2 measurements. SPs were assessed for their average lengths in different gender and age groups. Student's t-test was used for the comparison of the mean SP lengths between the groups. Differences were considered to be statistically significant at p<0.05. RESULTS: The mean SP length on both sides varied from 18 to 51 mm (28.4±5.5) in all the patients. The mean SP length was 27.2±5.2 mm in females and 29.2±5.6 mm in males. There was a statistically significant difference between the mean SP lengths in terms of gender (p<0.028). The mean SP length was 28.5±5.7 mm in Group 1 and 28.2±5.1 mm in Group 2. There was no statistically significant difference between the mean SP lengths in terms of age (p>0.718). CONCLUSIONS: In conclusion, there is still no consensus on the normal values of SP length. Normal values should be determined according to the geographical regions and ethnic groups for the diagnosis of Eagle's syndrome.