MRI evaluation of right heart functions in children with mild cystic fibrosis.

BACKGROUND: This study aimed to assess the ventricular anatomy, function of the right ventricle, and the haemodynamic findings of pulmonary artery in children with cystic fibrosis using cardiac MRI. PATIENTS: This prospective study consisted of 32 children with mild cystic fibrosis and 30 age-matched healthy control participants. METHODS: Cardiac MRI was used to assess right ventricular volumes, anatomy, and function and to assessment of haemodynamic findings of pulmonary artery in the control and study groups. Haemodynamic findings of pulmonary arteries were determined using pulmonary arteries peak velocity (cm/s), and pulmonary arteries time-to-peak velocity (ms) and pulmonary artery systolic pressure. All data of children with mild cystic fibrosis were compared with those of 30 age-matched healthy control group participants. RESULTS: Our patients and their age-matched controls were aged from 6 to 17 years and from 7 to 15 years, respectively. We found that ejection fraction (%), cardiac output (L/ml), cardiac output (L/ml/m2), and systolic volume (ml/m2) were significantly lower in children with cystic fibrosis (p < 0.01). Right ventricular anterior wall thickness (mm) was significantly higher in children with cystic fibrosis (p = 0.01). No significant difference was observed between the haemodynamic parameters of pulmonary artery in the patient group. CONCLUSION: In our study, cardiac MRI was used to investigate whether the right ventricle was affected functionally and anatomically in children with mild cystic fibrosis. We detected a significant decrease in right ventricular systolic functions and notable alterations in the right ventricular geometry of children with mild cystic fibrosis. These alterations usually manifest themselves as hypertrophy of the right ventricle. Our study's results demonstrate no relationship between the development of pulmonary hypertension in mild cystic fibrosis children.

Evaluation of the white matter integrity in morbidly obese patients before and after bariatric surgery; a diffusion tensor imaging study.

PURPOSE: To investigate the difference in FA (Fractional anisotropy), ADC (Apparent diffusion coefficient), RD (Radial diffusivity) and AD (axial diffusivity) values of white matter (WM) tracts in morbidly obese subjects before and after bariatric surgery (BS). MATERIALS AND METHODS: A group of thirty-nine morbidly obese subjects are evaluated before and 4-6 months after BS. ADC, FA, RD and AD values of 17 distinct neuroanatomic localizations are measured and DTI parameters are analyzed. RESULTS: Following the BS, the patients' mean BMI decreased from 47.665.21 to 31.723.97. A significant difference is displayed between the pre-surgery and post-surgery FA values of SLF, SFOF, ALIC, fornix, ILF, CST, MCP (p = 0.010, p < 0.001, p = 0.048, p = 0.014, p = 0.012, p = 0.012, p = 0.040 respectively). Following BS, decrease in FA values in the mentioned areas are detected. ADC values obtained from MCP are significantly lower in the post-BS period compared to pre-BS period (p = 0.018). There was a statistically significant difference between the pre-surgery and post-surgery AD values of SLF, SFOF, ILF, ALIC, EC, CST, and MCP (p = 0.001, p = 0.022, p = 0.001, p = 0.011, p = 0.001, p = 0.000, p = 0.000, respectively). Following the BS, AD values of the SLF, SFOF, ILF, ALIC, EC, CST, and MCP are decreased. RD values measured from GCC are significantly lower in the post-BS period compared to pre-BS period (p = 0.008). CONCLUSION: Our study supported the hypothesis of the BS-induced reversibility of the low-grade inflammation in WM tracts in the morbidly obese group following BS. Our DTI results may represent the subacute period findings of the reversal of low-grade inflammation after BS.

Differentiation of lung and breast cancer brain metastases: Comparison of texture analysis and deep convolutional neural networks.

PURPOSE: Metastases are the most common neoplasm in the adult brain. In order to initiate the treatment, an extensive diagnostic workup is usually required. Radiomics is a discipline aimed at transforming visual data in radiological images into reliable diagnostic information. We aimed to examine the capability of deep learning methods to classify the origin of metastatic lesions in brain MRIs and compare the deep Convolutional Neural Network (CNN) methods with image texture based features. METHODS: One hundred forty three patients with 157 metastatic brain tumors were included in the study. The statistical and texture based image features were extracted from metastatic tumors after manual segmentation process. Three powerful pre-trained CNN architectures and the texture-based features on both 2D and 3D tumor images were used to differentiate lung and breast metastases. Ten-fold cross-validation was used for evaluation. Accuracy, precision, recall, and area under curve (AUC) metrics were calculated to analyze the diagnostic performance. RESULTS: The texture-based image features on 3D volumes achieved better discrimination results than 2D image features. The overall performance of CNN architectures with 3D inputs was higher than the texture-based features. Xception architecture, with 3D volumes as input, yielded the highest accuracy (0.85) while the AUC value was 0.84. The AUC values of VGG19 and the InceptionV3 architectures were 0.82 and 0.81, respectively. CONCLUSION: CNNs achieved superior diagnostic performance in differentiating brain metastases from lung and breast malignancies than texture-based image features. Differentiation using 3D volumes as input exhibited a higher success rate than 2D sagittal images.

Microstructural alterations in hypoxia-related BRAIN centers after COVID-19 by using DTI: A preliminary study.

PURPOSE: To investigate whether the diffusion tensor imaging (DTI) parameters alterations in the in hypoxia-related neuroanatomical localizations in patients after COVID-19. Additionally, the relationship between DTI findings and the clinical severity of the disease is evaluated. METHODS: The patients with COVID-19 were classified into group 1 (total patients, n = 74), group 2 (outpatient, n = 46), and group 3 (inpatient, n = 28) and control (n = 52). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated from the bulbus, pons, thalamus, caudate nucleus, globus pallidum, putamen, and hippocampus. DTI parameters were compared between groups. Oxygen saturation, D dimer and lactate dehydrogenase (LDH) values associated with hypoxia were analyzed in inpatient group. Laboratory findings were correlated with ADC and FA values. RESULTS: Increased ADC values in the thalamus, bulbus and pons were found in group 1 compared to control. Increased FA values in the thalamus, bulbus, globus pallidum and putamen were detected in group 1 compared to control. The FA and ADC values obtained from putamen were higher in group 3 compared to group 2. There was a negative correlation between basal ganglia and hippocampus FA values and plasma LDH values. The ADC values obtained from caudate nucleus were positively correlated with plasma D Dimer values. CONCLUSION: ADC and FA changes may reveal hypoxia-related microstructural damage after COVID-19 infection. We speculated that the brainstem and basal ganglia can affected during the subacute period.

Importance of Thalamostriatal Pathway Associated With Neurocognitive Dysfunctions in Children With Neurofibromatosis Type 1: Diffusion Tensor Imaging Findings.

OBJECTIVE: To determine whether there is a difference between healthy control group and children with neurofibromatosis type 1 (NF1) in terms of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in different regions of the brain associated with neurocognitive functions and to investigate the correlation between diffusion tensor imaging parameters and neurocognitive dysfunctions. METHODS: The study included 28 children with NF1 and 21 controls. Nine distinct areas related to cognitive functions were selected for the analysis. The ADC and FA values were compared. RESULTS: There was a significant difference between NF1 and healthy control in terms of ADC values obtained from all areas. The ADC values at obtained from thalamus and striatum were positively correlated with the full-scale intelligence quotient (IQ), verbal IQ, and performance IQ. CONCLUSIONS: We are speculated that the development of microstructural damage in the thalamostriatal pathway may lead to neurocognitive dysfunction.

Effect of cerebral microhemorrhages on neurocognitive functions in patients with end-stage renal disease.

BACKGROUND: Death is the most serious complication of intracerebral hemorrhage. Microbleeding can be a precursor of intracerebral hemorrhage. Susceptibility weighted imaging (SWI) should be included in imaging protocols for some specific groups such diabetic hemodialysis patients in terms of prediction of macrohemorrhages. PURPOSE: To investigate intracerebral microbleeding in hemodialysis patients and the correlation between microbleeding and neurocognitive impairment. MATERIAL AND METHODS: Forty-nine hemodialysis cases were involved in the study. Locations of microbleeding, correlation between microbleeding and hypertension, diabetes mellitus (DM), age, and duration of dialysis were analyzed. Standardized mini-mental test was performed. The tested cases were divided into two groups: intracerebral microbleeding (group 1, n = 26) and without intracerebral microbleeding (group 2, n = 17). RESULTS: Incidence of microbleeding and macrohemorrhage was noted as 59% and 14%, respectively, in all cases. All macrohemorrhagic cases also have microbleeding. In group 1, neurocognitive impairment was detected in 10 (38.4%) cases: six and four cases with moderate and mild impairment, respectively. In group 2, neurocognitive impairment was detected in 2 (11.7%) cases, both with mild impairment. A significant positive correlation was detected between microbleeding and neurocognitive impairment (P = 0.031). Although there was no correlation between attention disorder and microbleeding, a positive correlation was detected between close memory impairment and microbleeding (P = 0.027). A positive correlation was detected between DM and microbleeding (P = 0.027). CONCLUSION: In hemodialysis patients, microbleeding can be a cause of neurocognitive impairment which will be important for guide to treatment protocols. SWI should be included in the imaging protocol of diabetic hemodialysis patients with neurocognitive deterioration.

Impaired integrity of commissural and association fibers in essential tremor patients: Evidence from a diffusion tensor imaging study

Background/aim: The evolving understanding of essential tremors (ET) has led to a new definition of neurodegenerative disease, pointing to diffuse brain network involvement with a wide spectrum of associated motor and nonmotor symptoms. Considering the fact that white matter should also be affected by the nature of the disease, our study aimed to evaluate the integrity of white matter and its clinical correlations in ET patients. Materials and methods: Approximately 40 patients diagnosed with ET and 40 age-and sex-matched control subjects (ranging between 18­80 years old) were included in the study. The sociodemographic characteristics and clinical features of the patients were recorded. Tremors were assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Diffusion Tensor Imaging (DTI) was performed to evaluate the integrity of white matter. The selected white matter regions used for DTI assessment were the corpus callosum (CC) (i.e., the largest commissural tract in the human brain), the superior longitudinal fasciculus (SLF), and the inferior longitudinal fasciculus (ILF) (i.e., the largest association fiber bundles). Results: The mean age of the ET patients and control subjects was 44.23 ± 18.91 and 37.45 ± 10.95 years old (P = 0.542). The fractional anisotropy (FA) values of the CC body (P = 0.003), ILF (p = 0.016), average diffusion coefficient (ADC) values of the CC body (p = 0.001), genu (P = 0.049), SLF (V < 0.001), and ILF (P < 0.001) differed between groups. After controlling for age and sex, there was no correlation between tremor severity and DTI parameters, but impaired integrity in the genu of CC FA (P = 0.035, r = 0.442) and the splenium of CC ADC (P = 0.007, r = 0.543) were related with a longer duration of tremor. Finally, positive family history was correlated with the splenium of CC FA and ADC (P = 0.008, r = 0.536; P = 0.027, r = 0.461) and ILF ADC (P = 0.011, r = ­0.519). Conclusion: In our study, major white matter structure changes were found in the ET patients. The results suggest that possible neurodegeneration also affects white matter structures in ET patients and that the duration of the tremor and family history are related with impaired integrity of white matter.

Normal Pressure Hydrocephalus: Clinical Symptoms, Cerebrospinal Fluid Flow Metrics and White Matter Changes.

PURPOSE: The aim of this study was to investigate correlations between clinical symptoms, cerebrospinal fluid flow metrics, hydrocephalus index, small-vessel disease, and white matter (WM) changes in normal pressure hydrocephalus (NPH). METHODS: Aquaductal stroke volumes (ASVs), Z Evans index, Fazekas grading (FG), and diffusion tensor imaging measurements from WM bundles of 37 patients with NPH were retrospectively evaluated. Mann-Whitney U test between clinical symptoms and other variables and Spearman ρ correlations for relationships between variables and Kruskal-Wallis to correlate FG with nonclinical variables were used. RESULTS: Patients with NPH had increased ASV (median 53 µL). No correlation was found between Z Evans index and ASV. Three groups of patients with dementia or ataxia or incontinence had increased ASV values than their counterparts without symptoms (55 vs 48.5 µL, 75 vs 47 µL, 64 vs 49.5 µL, respectively). Patients having 2 common symptoms of dementia and ataxia and patients having all 3 symptoms of dementia, ataxia, and incontinence were compared with ASV values of 63.5 versus 78 µL, respectively. Patients with FG 1 had median ASV values of 45 µL; FG 2, 82.5 µL; and FG 3, 59 µL. Patients with dementia had significantly higher apparent diffusion coefficient (ADC) values of corona radiata (CR) on both sides. There were no significant WM changes in patients with ataxia and incontinence. The Z Evans index was positively correlated with ADC values of CR on both sides and genu of corpus callosum. Fazekas grading was found positively correlated with ADC and negatively correlated with FA values of CR. CONCLUSIONS: Patients with NPH, regardless of stages of the diseases, have increased ASV values and could benefit from shunting. Decreasing ASV values of patients with FG 3 comparing with those with FG 2 support the hypothesis of decreasing compliance of brain with aging and increasing severity of small-vessel disease.

MRI findings and utility of DWI in the evaluation of solid parathyroid lesions.

PURPOSE: To evaluate the MRI findings of solid parathyroid lesions and to elaborate on a possible improvement of MRI detection of parathyroid lesions by the use of additional DWI. MATERIALS AND METHODS: MRI and DWI properties of pathologically proven 20 solid parathyroid lesions were retrospectively reviewed. Mean ADC values (b50 + b400 + b800/3) of parathyroid lesions were compared with that of normal appearing thyroid parenchyma (TP), sternocleidomastoid muscle (SCM) and jugulodigastric lymph nodes (JDLN). RESULTS: Of lesions, 4 were parathyroid hyperplasia, 13 parathyroid adenoma and 3 parathyroid adenocarcinoma. All parathyroid lesions were very bright on fat-saturated T2W images. Parathyroid hyperplasia and adenoma were small sized, homogenous, well-defined and low on T1W, high on T2W and avidly enhancing. Parathyroid carcinoma was large sized, ill-defined and very heterogeneous on MRI including DWI. Means ADC values of parathyroid hyperplasia, adenoma, and adenocarcinoma, TP, SCM and JDLN were measured as 2.3 ± 0.14 × 10-3, 1.7 ± 0.45 × 10-3, 1.5 ± 1.48 × 10-3, 0.87 ± 0.40 × 10-3, 0.55 ± 0.21 × 10-3 and 0.96 ± 0.33 × 10-3 mm2/s, respectively. All parathyroid lesions had high diffusion properties comparing other soft tissue structures of head and neck region. By increasing strength (b value) of diffusion tensor on DWI, solid parathyroid lesions still kept their brightness comparing other soft tissue structures of head and neck region because of their high T2 properties. CONCLUSION: Solid parathyroid lesions had higher diffusion properties comparing other soft tissues structures of head and neck region. This feature makes them easily differentiate from nearby structures on fat-saturated T2W and DWI.

Evaluation of CSF flow metrics in patients with communicating hydrocephalus and idiopathic intracranial hypertension.

PURPOSE: To search for CSF dynamics of idiopathic intracranial hypertension (IIH) and communicating hydrocephalus and any correlation between MRI findings, CSF metrics and CSF opening pressure in IIH. MATERIALS AND METHODS: Healthy subjects (30) and subjects with IIH (29) and high-pressure communicating hydrocephalus (43) were enrolled. Nonparametric Kruskal-Wallis test (p = 0.05) was used to compare three groups, Mann-Whitney U test with Bonferroni correction to compare two groups (p = 0.016). Correlation of MRI findings of IIH with CSF metrics and CSF opening pressure was analyzed by Spearman's Rank correlation coefficient (p = 0.05). RESULTS: In IIH, no correlation between MRI findings and aqueductal stroke volume (ASV) but statistically significantly CSF opening pressure in the presence of transverse sinus compression was noted. Comparing with healthy subjects, ASV was nonsignificantly lower and standardized diastolic and sum and difference of systolic and diastolic flow durations were statistically significantly lower. Comparing with hydrocephalus, the width of prepontine cistern (PPC)/the width of aqueductus sylvii (AS) was significantly higher and other CSF metrics with standardized systolic and sum of systolic and diastolic flow durations were significantly lower. In hydrocephalus, ASV and peak velocities were significantly higher. Compared with normal group, PPC/AS and reverse/forward flow duration were significantly lower and other CSF metrics were significantly higher. CONCLUSION: In hydrocephalus, significant increase in ASV and peak velocities were noted. In IIH, CSF opening pressure was statistically significantly high in the presence of transverse sinus compression and standardized diastolic flow durations were statistically significantly short that are probably effects of increased impedance of CSF flow against increased intracranial pressure and unchanged or even decreased intraventricular CSF volume.

Comparison of Delay-Sensitive and Delay-Insensitive Computed Tomography Perfusion Methods in Acute Ischemic Stroke and Their Variability According to Location of Critical Vascular Stenosis.

OBJECTIVE: The aim of this study was to evaluate visual and quantitative differences of delay-sensitive (singular value deconvolution [SVD]) and delay-insensitive (SVD+) computed tomography perfusion (CTP) postprocessing methods in acute ischemic stroke patients and their variability according to location of critical stenosis. METHODS: The CTPs of 45 patients were retrospectively processed with 2 different methods. Comparing with the contralateral normal hemisphere, relative and difference of metrics were calculated (relative cerebral blood volume, relative cerebral blood flow [rCBF], relative mean transite time [rMTT], and difference mean transite time [dMTT]). Patients were categorized into 5 groups according to superiority in visual assessment of penumbra between postprocessing methods. Locations of critical stenosis and their percentages in each group were identified and compared. RESULTS: Differences were formulated as (rCBF/1.4, rMTT × 1.4, dMTT/3.8) SVD = (rCBF, rMTT, dMTT) SVD+. In group 1, penumbra was noted in SVD, whereas pseudohyperperfusion was noted in SVD+. In groups 2 and 3, penumbra was better distinguished in SVD than in SVD+ in decreasing easiness, respectively. In group 4, penumbra assessment was similar in both. In group 5, penumbra was better distinguished in SVD+. Groups 1 and 5 were the groups in which the frequency of critical distal stenosis was 100%. Groups 2, 3, and 4 were the groups having high rates of proximal critical stenosis in decreasing proportions, respectively (90%, 87%, and 77%). CONCLUSIONS: In both CTP methods, the most prominent difference was found in dMTT. Visually, penumbra was better distinguished by SVD in proximal critical stenosis, whereas was better distinguished by SVD+ in distal critical stenosis. In cases having both ipsilateral critical proximal and distal stenoses, penumbra was noted in SVD but pseudohyperperfusion in SVD+. This finding showed that extraction of contrast delay in the SVD+ method might cause false results in cases of ipsilateral critical proximal and distal stenoses.

Volumetric differences suggest involvement of cerebellum and brainstem in chronic migraine.

BACKGROUND: Chronic migraine (CM) is a disabling neurologic condition that often evolves from episodic migraine. There has been mounting evidence on the volumetric changes detected by magnetic resonance imaging (MRI) technique in migraineurs. These studies mainly focused on episodic migraine patients and less is known about the differences in CM patients. METHOD: A total of 24 CM patients and 24 healthy control individuals (all females) were included in this study. All participants underwent neurological examination and MRI. High-resolution anatomical MRI images were processed with an automated segmentation method (FreeSurfer). White-matter abnormalities of the brain were also evaluated with the Age-Related White-Matter-Changes Scale. RESULTS: The volumes of the cerebellum and brainstem were found to be smaller in CM patients compared to healthy controls. White-matter abnormalities were also found in CM patients, specifically in the bilateral parieto-occipital areas. There was no correlation between the clinical variables and volume decrease in these regions. CONCLUSION: CM patients showed significant volume differences in infratentorial areas and white-matter abnormalities in the posterior part of the brain. It is currently unclear whether the structural brain changes seen in migraine patients are the cause or the result of headaches. Longitudinal volumetric neuroimaging studies with larger groups, especially on the chronification of migraine, are needed to shed light on this topic.

Hyperperfusion in carotid stenting patients.

PURPOSE: This study aimed to define hyperperfusion in carotid stenting patients without excluding patients with stenosis on the contralateral side. MATERIALS AND METHODS: A total of 32 patients were enrolled. Prestent computed tomography perfusions were performed within 1 week before stenting, poststent perfusions 3 days after stenting. Prestent relative cerebral blood volume, relative cerebral blood flow, and relative mean transient time (rMTT) were calculated by dividing measurements from ipsilateral stent sides to contralateral sides and prestent difference mean transit time (dMTT) by subtracting contralateral mean transient time (MTT) from ipsilateral MTT. Poststent values were calculated similarly. For differences between prestent and poststent values, independent t test was used between groups and paired sample t test within the groups. RESULTS: Of the 31 patients, 4 showed poststent clinical hyperperfusion syndrome. Six showed poststent radiologic hyperperfusion with increased cerebral blood flow, increased or spared cerebral blood volume, and shortened MTT values, but only 1 demonstrated clinical hyperperfusion. Between normal and hyperperfused groups, only appreciable difference was noted in prestent and poststent dMTT without statistical significance. Within the groups, only statistical difference (P < 0.001) was noted in rMTT and dMTT in normal groups and no significant difference in the hyperperfused group. CONCLUSIONS: Radiologic hyperperfusion does not match clinical hyperperfusion. Normal group responded to stenting with statistically significant changes of rMTT and dMTT. Hyperperfusion mostly occurred in the contralateral critically stenosed patients. The hyperperfused group, due to similar MTT of both hemispheres and ipsilateral internal carotid artery being the main feeder of both hemispheres, did not show significant changes in their rMTT and dMTT values after stenting. This shows that reduced hemodynamic reserve is the main reason behind the hyperperfusion after carotid stenting.

The effect of local simvastatin application on critical size defects in the diabetic rats.

OBJECTIVES: To evaluate bone-healing effects of local simvastatin application to critical size defects (CSDs) in the experimental diabetes mellitus (DM) rat model. MATERIALS AND METHODS: A total of 35 male Sprague-Dawley rats with an average weight of 350 g and aged 3 months were used in this study. The rats were divided into five groups of seven animals each: passive control (group A), active control (group B), 0.5 mg simvastatin (group C), 1.0 mg simvastatin (group D), and 1.5 mg simvastatin (group E). Streptozotocin was used to induce Type 1 diabetes in all rats. Eight mm CSDs were created under anesthesia in each rat calvarium. CSDs were left empty in group A. Defects in group B were grafted alone with a gelatin sponge mixed with normal saline. Defects in the experimental groups (groups A, B, and C) were grafted with gelatin sponge mixed saline solutions contain 0.5, 1.0, 1.5 mg simvastatin. Rats were sacrificed after 1 month, and the defects were prepared for radiologic and histomorphometric assessment of regenerated bone. RESULTS: None of the specimens exhibited complete closure of new bone across the 8-mm defect. A correlation between computed tomography and histomorphometric analysis was not determined. Both amount of volume and area of regenerated bone were found higher in the experimental groups than in the control groups. However, these values were not found statistically significant degree (P < 0.05) for each groups. The density of regenerated bone in the region of interest was higher in the control groups in contrast to in the experimental groups. However, statistical significance was just found between groups C and A and between groups C and B (P < 0.05). CONCLUSION: The local simvastatin application enhanced healing of the bone defects in the diabetic rat model CSDs.

The effect of obesity on brain diffusion alteration in patients with obstructive sleep apnea.

PURPOSE: We investigated diffusion alterations in specific regions of the brain in morbid obese, obese, and nonobese OSA patients and searched whether there is a correlation between BMI and ADC values. MATERIALS AND METHODS: DWIs of 65 patients with OSA were evaluated. The patients were classified according to BMI as morbid obese (n = 16), obese (n = 27), and nonobese (control, n = 22) groups. ADC measurements were performed from 24 different regions of the brain in each patient. The relationship of BMI with ADC values was searched. RESULTS: The ADC values in hypothalamus, insular cortex, parietal cortex, caudate nucleus, frontal white matter, and posterior limb of internal capsule were all increased in obese patients (n = 43) compared to control group. The ADC values of midbrain, hypothalamus, orbitofrontal cortex, and parietal cortex were significantly increased in morbid obese compared to obese patients. In obese patients, the degree of BMI was positively correlated with ADC values of orbitofrontal cortex, parietal cortex, and hypothalamus. CONCLUSION: We observed increasing brain vasogenic edema with increasing BMI, suggesting that the main reason of brain diffusion alteration in patients with OSA could be obesity related.

MRI findings in crural compartment syndrome: a case series.

Compartment syndrome occurs when the pressure inside a closed fascial compartment increases to a level that compromises the blood supply to the structures. Untreated compartment syndrome commonly leads to muscle necrosis, limb amputation, and, if it is severe, which is seen in large compartments, renal failure and death may occur. We discussed MRI findings of crural compartment syndrome based on the case series.

Diffusion-Weighted Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy Features of Abdominal Viscera in a Patient with Gaucher's Disease.

A 46-year-old woman with Gaucher's disease (GD) consulted our clinic for abdominopelvic magnetic resonance imaging (MRI), as physical examination had revealed hepatosplenomegaly. Upper abdominal MRI showed massive hepatosplenomegaly and innumerable hypointense splenic nodules on T1-weighted images. Diffusion-weighted MRI (DW-MRI) and magnetic resonance spectroscopy (MRS) were performed to liver parenchyma and splenic nodules. MRS revealed lactate, lipid, acetate, and alanine peaks in splenic nodules, and choline, creatine, lipid, myo-inositol-glycine, and lactate peaks in the liver parenchyma. The DW-MRI showed diffusion restriction in splenic nodules. It was concluded that MRI is a reliable method for the diagnosis and follow up of GD. Coupling DW-MRI and MRS allows quantitative evaluation, thereby increasing the efficacy of the method. This is the first report in the literature presenting advanced abdominal MRI findings in GD.

Long-Term Disease Course of Pontocerebellar Hypoplasia Type 10.

BACKGROUND: Pontocerebellar hypoplasia type 10 (PCH10) due to CLP1 gene mutations is characterized by structural brain anomalies, progressive microcephaly, severe intellectual and physical disabilities, and spasticity. In this follow-up study, evolution of phenotypic and neurological characteristics of patients with PCH10 is discussed. METHODS: Phenotype, growth parameters, motor functions, developmental tests, spasticity assessments, functional independence assessments, electroencephalography (EEG), and brain magnetic resonance imaging (MRI) of 10 patients with PCH10 were monitored on separate examinations. Alterations were recorded. RESULTS: Patients were followed-up for an average of 2.83 years. The tone of the upper extremities was significantly higher than that of the lower extremities, according to Modified Ashworth Scale (MAS) values. Sixty percent of patients could sit unsupported; 20% achieved supported sitting initially but lost the ability during follow-up. Absence of grabbing or sitting was observed in 20% of patients. During follow-up, one person achieved supported sitting and one person achieved head holding. Only one patient was able to speak a few words. Cerebellar atrophy (two of 10), pons hypoplasia (four of 10), cortical atrophy (seven of 10), enlarged ventricles (10 of 10), thinning of the corpus callosum (10 of 10), hypomyelination (six of 10), and increased white matter signal intensity (six of 10) were the observed MRI findings. CONCLUSIONS: Progressive cerebral and cerebellar atrophy was demonstrated radiologically for the first time in a PCH10 cohort. It is of crucial importance to identify these patients promptly with the help of dysmorphic findings and spasticity being pronounced in the upper extremities. Furthermore, we note that phenotypic and neurological examination findings tend to change slightly over time.