Lumbar Opening Pressure and Radiologic Scoring in Idiopathic Intracranial Hypertension: Is There Any Correlation?

BACKGROUND: To investigate correlation between lumbar opening pressure (LOP) and radiological scores based on cranial MRI and contrast-enhanced MR venography in patients with idiopathic intracranial hypertension (IIH). MATERIAL/METHODS: Patients with IIH who underwent brain MRI and contrast-enhanced MR venography before measurement of LOP between 2010-2014 were evaluated retrospectively. Three experienced radiologists (blinded to LOP values) evaluated a total of 51 patients. They reached a consensus on the presence or absence of 6 radiological findings identified in the literature as characteristic for IIH: empty sella, perioptic dilation, optical tortuosity, flattening of the posterior globe, swelling of the optic disc, and bilateral transverse sinus stenosis. The radiological score was obtained by giving 1 point for the presence of each finding, with the highest possible score of 6 points. The correlation between the calculated radiological scores and LOP was evaluated. RESULTS: There was no significant correlation between LOP and radiological scores (r=0.095; p=0.525, Spearman's rank coefficient). Similarly, no significant correlation was detected between LOP and each of the radiological findings (partial empty sella [p=0.137], perioptic dilation [p=0.265], optical tortuosity [p=0.948], flattening of the posterior globe [p=0.491], swelling of the optic disc [p=0.881], and bilateral dural sinus stenosis [p=0.837], Mann-Whitney U test). CONCLUSIONS: There was no significant correlation between LOP and reliable radiological features of IIH.

Successful sleeve lobectomy of pediatric inflammatory myofibroblastic tumor.

Inflammatory myofibroblastic tumor (IMT) is an uncommon solid tumor that was originally described in the lung. A 4-year-old girl was admitted to hospital with urticarial rash. On chest radiographs, an opacity was seen in the inferior zone of the left lung, and computed tomography showed a mass in the left lower lobe. Left lower sleeve lobectomy was performed, and the diagnosis was confirmed as IMT. Sleeve resection is the best option in lesions located in the mainstem bronchus or secondary carina. Herein, we present a rare case of IMT of the lung that was successfully treated with sleeve lobectomy. There have been fewer than 15 childhood cases of IMT reported in the literature, and the present 4-year-old patient is one of the youngest.

Sonography of the chest using linear-array versus sector transducers: Correlation with auscultation, chest radiography, and computed tomography.

PURPOSE: The primary purpose of our study was to compare the efficacies of two sonographic (US) probes, a high-frequency linear-array probe and a lower-frequency phased-array sector probe in the diagnosis of basic thoracic pathologies. The secondary purpose was to compare the diagnostic performance of thoracic US with auscultation and chest radiography (CXR) using thoracic CT as a gold standard. METHODS: In total, 55 consecutive patients scheduled for thoracic CT were enrolled in this prospective study. Four pathologic entities were evaluated: pneumothorax, pleural effusion, consolidation, and interstitial syndrome. A portable US scanner was used with a 5-10-MHz linear-array probe and a 1-5-MHz phased-array sector probe. The first probe used was chosen randomly. US, CXR, and auscultation results were compared with the CT results. RESULTS: The linear-array probe had the highest performance in the identification of pneumothorax (83% sensitivity, 100% specificity, and 99% diagnostic accuracy) and pleural effusion (100% sensitivity, 97% specificity, and 98% diagnostic accuracy); the sector probe had the highest performance in the identification of consolidation (89% sensitivity, 100% specificity, and 95% diagnostic accuracy) and interstitial syndrome (94% sensitivity, 93% specificity, and 94% diagnostic accuracy). For all pathologies, the performance of US was superior to those of CXR and auscultation. CONCLUSIONS: The linear probe is superior to the sector probe for identifying pleural pathologies, whereas the sector probe is superior to the linear probe for identifying parenchymal pathologies. Thoracic US has better diagnostic performance than CXR and auscultation for the diagnosis of common pathologic conditions of the chest. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:383-389, 2016.

Efficacy of diffusion-weighted MRI in the differentiation of all liver hydatid cyst types.

INTRODUCTION: The aim of this study was to evaluate the efficacy of diffusion-weighted images (DWIs) in the differentiation of hydatid cysts (HCs) of the liver. METHODS: In this prospective study, 54 patients with 92 HC lesions were evaluated. The mean apparent diffusion coefficient (ADC) values of each lesion were calculated using the ADC maps derived from the DWIs at b-values of 50, 500 and 1000 s/mm(2). We compared the mean ADC values of the different HC types, which had already been classified using the sonographic criteria. A receiver operator curve (ROC) analysis was used for determining the diagnostic performance of the ADC values of the HC types. RESULTS: When the mean ADC values of each type of HC were compared using each of the b-values, no statistically significant differences were obtained between (cystic echinococcosis) CE1 and CE2 or CE3, CE2 and CE3, CE3 and CE4, or CE4 and CE5. In addition, the mean ADC values of CE1 and CE2 were significantly higher than those of CE4 and CE5. For discrimination between types CE1, CE2 and CE3, and types CE4 and CE5, the sensitivity and specificity values were, respectively, 75.9 and 89.5 for the b50 DWI, 87.0 and 86.8 for the b500 DWI, and 75.9 and 89.5 for the b1000 DWI in the ROC analysis. CONCLUSION: Diffusion-weighted imaging may be useful for providing additional data to determine the type of HC, and for differentiating types CE1, CE2 and CE3 from types CE4 and CE5.

Vitreous humor diffusion measurements from diffusionweighted imaging in idiopathic intracranial hypertension.

BACKGROUND AND PURPOSE: Idiopathic intracranial hypertension is a disease with uncertain etiology. It is not caused by an intracranial mass lesion or hydrocephalus and is characterized by abnormal elevation of intracranial pressure and normal composition of the cerebrospinal fluid. The orbita and intracranial area are closely related anatomically. Elevated intracranial pressure can be transmitted to the orbita through the cerebrospinal fluid around the optic nerve sheath changes at the vitreous humor on diffusion-weighted imaging have not been systemically studied in idiopathic intracranial hypertension. Purpose - The purpose of this study was to investigate diffusion changes in the vitreous humor in patients with intracranial hypertension. METHODS: In this retrospective study, 25 patients with papilledema and who had been definitively diagnosed with idiopathic intracranial hypertension and 20 control participants were evaluated. Control subjects and patients were scanned with a 1.5 Tesla magnetic resonance imaging. Apparent diffusion coefficient maps were obtained from diffusion-weighted imaging with a b value of 1000 s/mm2 and apparent diffusion coefficient values were automatically calculated. These images were obtained by a radiologist who was blinded to the details of the study for center of each vitreous humor and the body of lateral ventricle. The mean apparent diffusion coefficient values of each vitreous humor and the body of the lateral ventricle were calculated for each group (control group and patients) and quantitative comparisons were performed. RESULTS: There were no statistically significant differences in mean apparent diffusion coefficient values of the right vitreous humor, left vitreous humor and the body of the lateral ventricle between the patients with idiopathic intracranial hypertension and the control group (p=0.766, p=0.864, p=0.576, respectively). CONCLUSION: Vitreous humor is a closed system and has no direct relationship with the cerebrospinal fluid or cerebral tissue and although morphological changes occur in the orbital structures, including the optic disk and optic nerve in idiopathic intracranial hypertension, the indirect effects of these changes on the vitreous humor may be too subtle to measure. Conclusion - We did not find a significant difference in the mean apparent diffusion coefficient value of the vitreous humor between the patients with idiopathic intracranial hypertension and the control group. However, future studies will be necessary to determine if changes in the vitreous humor can be used to diagnose intracranial hypertension.

Efficacy of diffusion-weighted magnetic resonance imaging in the evaluation of extrahepatic cholestasis-related hepatic fibrosis.

BACKGROUND/AIM: To investigate the efficacy of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis and staging of fibrosis induced by experimental bile duct ligation (BDL). MATERIALS AND METHODS: Twenty-four rats were divided randomly into four groups: control, BDL--3 days, BDL--2 weeks, and BDL--4 weeks. DWI was performed with b-values of 100 and 500 on the rats from control group at day zero, on the rats from the BDL--3 days group at the end of day 3, on the rats from the BDL--2 weeks group at the end of day 14, and on the rats from the BDL--4 weeks at the end of day 28. RESULTS: When fibrosis scores generated in all groups were evaluated together, a strong negative correlation was detected between fibrosis scores and apparent diffusion coefficient (ADC) values measured using b 100 and b 500. ADC values obtained using b 100 were found to be significantly higher compared to the fibrosis observed in both the BDL--2 weeks and BDL--4 weeks groups (P < 0.003 and P < 0.001, respectively). CONCLUSION: We think that DWI may be an alternative to liver biopsy for the diagnosis and staging of hepatic fibrosis with underlying extrahepatic cholestasis.

Extraspinal Incidental Findings on Routine MRI of Lumbar Spine: Prevalence and Reporting Rates in 1278 Patients.

OBJECTIVE: The aim of the present study was to determine the prevalence and reporting rate of incidental findings (IF) in adult outpatients undergoing lumbar magnetic resonance imaging (MRI). MATERIALS AND METHODS: Re-evaluation of a total of 1278 lumbar MRI images (collected from patients with a mean age of 50.5 years, range 16-91 years) captured between August 2010-August 2011 was done by a neuroradiologist and a musculoskeletal radiologist. IFs were classified according to organ or system (liver, gallbladder, kidney, bladder, uterus, ovary, lymph node, intestine and aorta). The rate of reporting of a range of IF was examined. The outcome of each patient's treatment was evaluated based on review of hospital records and by telephone interviews. RESULTS: A total of 253 IFs were found in 241 patients (18.8% of 1278). Among these, clinically significant IFs (n = 34) included: 2 renal masses (0.15%), 2 aortic aneurysms (0.15%), 2 cases of hydronephrosis (0.15%), 11 adrenal masses (0.86%), 7 lymphadenopathies (0.55%), 6 cases of endometrial or cervical thickening (0.47%), 1 liver hemangioma (0.08%), 1 pelvic fluid (0.08%) and 2 ovarian dermoid cysts (0.15%). Overall, 28% (71/253) of IFs were included in the clinical reports, while clinically significant findings were reported in 41% (14/34) of cases. CONCLUSION: Extraspinal IFs are commonly detected during a routine lumbar MRI, and many of these findings are not clinically significant. However, IFs including clinically important findings are occasionally omitted from formal radiological reports.

Two-detector Computed Tomography Map of the Inferior Epigastric Vessels for Percutaneous Transabdominal Intervention Procedures.

BACKGROUND: It is crucial to know anatomic variations and the exact course of an inferior epigastric artery (IEA) to prevent any complications during percutaneous abdominal interventions. AIMS: The aim of this study was to map the inferior epigastric vessels using reconstructed two-detector computed tomography images and measure the distance from the inferior epigastric artery (IEA) to the midline to determine a safe route for percutaneous abdominal interventions. STUDY DESIGN: Retrospective comparative study. METHODS: Coronal reconstructed two-detector computed tomography images of 200 patients were evaluated to measure the distances between the IEA and midline at three levels (origin, middle, and distal). Vein and artery arrangements were documented. RESULTS: The most frequently encountered arrangement (41.5%) was a single vein and artery on both sides. Mean distances on the right and left sides were 4.01 and 4.47 cm at the umbilical level, 3.81 and 4.26 cm at the midlevel, and 5.62 and 5.51 cm at the origin level. On both sides, measurement differences between the three levels were highly significant (p<0.05). In addition, a total of 56 IEA bifurcations were depicted in all 200 patients. Thirteen of the 56 bifurcations occurred only on the right side, 11 only on the left side, and 32 on both sides. CONCLUSION: It is important to be attentive to the IEA's course, at different midline levels, when attempting percutaneous interventions via an abdominal approach.

Frequency, distribution and severity of prevalent osteoporotic vertebral fractures in postmenopausal women.

AIM: Assessment of previous vertebral fractures provides useful information to predict future fracture risk. This study aimed to determine the frequency, distribution and severity of prevalent osteoporotic vertebral fractures in postmenopausal women. MATERIAL AND METHODS: Data on patient characteristics, bone densitometry values, and spine radiographs (T2-L5) were reviewed in 232 postmenopausal women admitted to our osteoporosis clinic. RESULTS: Prevalent vertebral fractures were detected in 28 (12.1%) women (95%CI: 7.8 16.3). Fifteen women (6.5%) had mild fractures and 13 (5.6%) had moderate or severe fractures according to Genant's semi-quantitative technique. The T-score was associated with the presence of prevalent vertebral fractures (OR= 0.61; 95%CI: 0.38-0.96, P= 0.034). The most frequently fractured vertebrae were T11 and T12, followed by T7 and T9. Sixty percent of fractures were wedge-type while 40% were biconcave. The frequency of wedge-type fractures at the T11-T12 levels (93.8%) was higher compared to that at all other levels (44.1%) (P= 0.001). CONCLUSION: We determined the frequency, distribution, and severity of prevalent fractures and identified certain distribution patterns of fracture locations and types. To verify our results and detect possible predictive factors for fracture risk, population-based larger trials are needed.

Intracranial hypotension is a rare cause of orthostatic headache: a review of the etiology, treatment and prognosis of 13 cases.

OBJECTIVES: The aim of this investigation is to examine the causes, clinical picture, treatment, and prognosis of spontaneous intracranial hypotension, a rare cause of orthostatic headache, among the cases presenting in our clinic. METHODS: Thirteen cases (5 males and 8 females), diagnosed with spontaneous intracranial hypotension in our clinic between January 1st, 2009 and October 30th, 2011, were included in this study. The presenting symptoms, treatment, findings on cranial magnetic resonance imaging, cerebrospinal fluid pressure measured at lumbar puncture (in available patients), and the healing period of the patients were recorded. RESULTS: Five patients with orthostatic headache and accompanying symptoms were treated with bed rest, increase in oral fluid intake, intravenous hydration and caffeine, and experienced a complete recovery. Complete recovery was observed in two patients (15.3%) within 10 days, in another two (15.3%) within 15 days and in one patient (7.6%) within 21 days. Headache and other clinical symptoms significantly regressed within 30 days in four patients (37.6%) who received similar treatment, but a mild headache persisted intermittently during follow-up in these individuals. As the headache had not resolved after 30 days, an epidural blood patch was applied in these four cases (37.6%) and the clinical picture completely improved within 10 to 15 days. CONCLUSION: Spontaneous intracranial hypotension should primarily be suspected in cases complaining about postural headache and contrast-enhanced cranial imaging should be performed. The presence of cranial nerve paralysis and pyramidal tract signs should b considered. Conservative treatments should be considered initially, however if conservative treatments fail, epidural blood patches must be applied.

Combined antithrombotic treatment with aspirin and clopidogrel for patients with capsular warning syndrome: a case report.

Capsular warning syndrome is characterized by recurrent transient ischemic attacks and is caused by microthrombosis or hypoperfusion of small-sized vessels. The pathophysiological basis of this syndrome is not well understood and currently a consensus has not been reached on its optimal treatment. In this study, we present 2 cases with favorable clinical outcomes after combined antithrombotic treatment with loading doses of clopidogrel and aspirin.

Digital subtraction angiography of a persistent trigeminal artery variant.

Persistent trigeminal artery variants are described as cerebellar arteries that directly originate from the precavernous segment of the internal carotid artery. This has been observed in 0.18% of cerebral catheter angiograms. On the other hand, a persistent trigeminal artery variant feeding both the anterior inferior cerebellar artery and the posterior inferior cerebellar artery territory is very rare. We present this uncommon anomalous artery along with digital subtraction angiography findings and discuss its clinical significance in light of the literature.