Evaluation of normal-appearing white matter with perfusion and diffusion MRI in patients with treated glioblastoma.

OBJECTIVE: We tried to reveal how the normal appearing white matter (NAWM) was affected in patients with glioblastoma treated with chemo-radiotherapy (CRT) in the period following the treatment, by multiparametric MRI. MATERIALS AND METHODS: 43 multiparametric MRI examinations of 17 patients with glioblastoma treated with CRT were examined. A total of six different series or maps were analyzed in the examinations: Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) maps, Gradient Echo (GRE) sequence, Dynamic susceptibility contrast (DSC) and Arterial spin labeling (ASL) perfusion sequences. Each sequence in each examination was examined in detail with 14 Region of Interest (ROI) measurements. The obtained values were proportioned to the contralateral NAWM values and the results were recorded as normalized values. Time dependent changes of normalized values were statistically analyzed. RESULTS: The most prominent changes in follow-up imaging occurred in the perilesional region. In perilesional NAWM, we found a decrease in normalized FA (nFA), rCBV (nrCBV), rCBF (nrCBF), ASL (nASL)values (p < 0.005) in the first 3 months after treatment, followed by a plateau and an increase approaching pretreatment values, although it did not reach. Similar but milder findings were present in other NAWM areas. In perilesional NAWM, nrCBV values were found to be positively high correlated with nrCBF and nASL, and negatively high correlated with nADC values (r: 0.963, 0.736, - 0.973, respectively). We also found high correlations between the mean values of nrCBV, nrCBF, nASL in other NAWM areas (r: 0.891, 0.864, respectively). DISCUSSION: We showed that both DSC and ASL perfusion values decreased correlatively in the first 3 months and showed a plateau after 1 year in patients with glioblastoma treated with CRT, unlike the literature. Although it was not as evident as perfusion MRI, it was observed that the ADC values also showed a plateau pattern following the increase in the first 3 months. Further studies are needed to explain late pathophysiological changes. Because of the high correlation, our results support ASL perfusion instead of contrast enhanced perfusion methods.

GliMR: Cross-Border Collaborations to Promote Advanced MRI Biomarkers for Glioma.

Purpose: There is an annual incidence of 50,000 glioma cases in Europe. The optimal treatment strategy is highly personalised, depending on tumour type, grade, spatial localization, and the degree of tissue infiltration. In research settings, advanced magnetic resonance imaging (MRI) has shown great promise as a tool to inform personalised treatment decisions. However, the use of advanced MRI in clinical practice remains scarce due to the downstream effects of siloed glioma imaging research with limited representation of MRI specialists in established consortia; and the associated lack of available tools and expertise in clinical settings. These shortcomings delay the translation of scientific breakthroughs into novel treatment strategy. As a response we have developed the network "Glioma MR Imaging 2.0" (GliMR) which we present in this article. Methods: GliMR aims to build a pan-European and multidisciplinary network of experts and accelerate the use of advanced MRI in glioma beyond the current "state-of-the-art" in glioma imaging. The Action Glioma MR Imaging 2.0 (GliMR) was granted funding by the European Cooperation in Science and Technology (COST) in June 2019. Results: GliMR's first grant period ran from September 2019 to April 2020, during which several meetings were held and projects were initiated, such as reviewing the current knowledge on advanced MRI; developing a General Data Protection Regulation (GDPR) compliant consent form; and setting up the website. Conclusion: The Action overcomes the pre-existing limitations of glioma research and is funded until September 2023. New members will be accepted during its entire duration.

Pons ratio as a potential diagnostic biomarker for the detection of growth hormone deficiency in children.

INTRODUCTION: Pituitary insufficiency (PI) needs further research to optimize treatment. Growth hormone deficiency (GHD) is a subtype of PI. The purpose of the present study is to investigate the possible relationship between GHD and the anatomical position of the pons as revealed by magnetic resonance imaging (MRI) in the pediatric age group. In the current study, we developed a novel and simple index using MRI that could provide an alternative to other indexes in the classical literature. PATIENTS AND METHODS: Brain MRI and clinical data of 48 children with suspected PI (22 females, 26 males; mean age 11.6 ± 2.2 years) were examined retrospectively. To estimate the location of the pons, the ratio of pons height over the axis between the dorsum sellae and the fourth ventricular hill in the sagittal plane (A) to the total height of the pons (B) was calculated (A/B). It was termed the pons ratio (PR). The PRs of children with or without a diagnosis of GHD were then compared statistically. RESULTS: Fifteen children were diagnosed with GHD and treated with growth hormone (GH), whereas the remaining 33 were reported normal. The mean PRs of the children diagnosed with GHD and given GH treatment (0.31 ± 0.07, range: 0.18-0.42) differed significantly from those without PI (0.26 ± 0.06, range: 0.17-0.44; P = 0.018). CONCLUSION: There appears to be an association between GHD and decreased PR in children receiving GH treatment. Spatial measurements of posterior fossa in radiological examinations may provide additional information that is helpful in the diagnosis of suspected cases of GHD.

A ganglion cyst derived from a synovial cyst: A case report.

The synovial and ganglion cysts originating from the facet joint have been named under the name of the Juxtafacet cyst by the several researchers. They put forward that the synovial cyst originated from the synovial joint. But, they failed to clarify the pathophysiology of the formation of the ganglion cyst. In this case report, we reported a 67-year-old male patient was referred to the emergency from another center with the complaint of a left leg pain and weakness in the left foot and patient was treated with microchirurgical technique. His patological examination was evaluated a ganglion cyst. We have discussed and explained the pathophysiology of the formation of a ganglion cyst derivered from a synovial cyst. And separately, we have presented the spinal cysts by grouping them under a new classification called a cystic formation of the soft tissue attachments of the mobile spine as well as dividing them into sub-groups.

Comparative Efficacy of Red Beetroot Extract and Ozonated Olive Oil on Wound Healing in Rats.

OBJECTIVE: To compare and assess the effect of red beetroot extract and ozonated olive oil on wound healing in rats. STUDY DESIGN: Experimental study. Place and Duration of the Study: Department of Experimental Animal Research Laboratory, Faculty of Medicine, Aydin Adnan Menderes University, from June to July 2021. METHODOLOGY: Twenty-one, female Wistar albino rats were divided into 3 groups; red beetroot extract group (RBG, n=7), ozonated olive oil group (OOG, n=7), and physiological saline group (CG). Three round wound areas of similar shapes were produced on the back areas. Skin incisions with a diameter of 15 mm were made in rats with a scalpel under anaesthesia protocol. Beetroot extract was applied to RBG, ozonated olive oil to OOG, and saline to CG, once a day for 21 days. Tissue samples were taken from the wounds on the 3rd, 10th, and 21st day of the study, and a histopathological examination (Hematoxylin eosin staining) was performed for haemorrhage, congestion, necrosis, inflammation and fibrosis levels. Wound healing was also determined macroscopically by photography on same days. Serum oxidant (TOS, µmol H2O2 equivalents/L), antioxidant status (TAS, mmol trolox equivalents/L), serum total thiol (µmol/L), serum native thiol (µmol/L) and paraoxonase (PON, U/L) were determined from blood samples on the 21st day. RESULTS: Lower inflammation and higher blood antioxidant levels were determined in the RGB and OOG groups compared to the CG. A better wound healing on histology was observed in the OOG group compared to RGB. CONCLUSION: Red beetroot extract and ozonated olive oil enhanced wound healing in female rats. Ozonated olive oil had more effective wound-healing effect than beetroot extract. KEY WORDS: Wound healing, Ozonated olive oil, Red beetroot extract, Antioxidant effect.

Giant Virchow- Robin spaces may play a role at headache attributed to hypoxia and/or hypercapnia.

According to International Classification of Headache Disorders (ICHD-III Beta version) headache attributed to hypoxia and/or hypercapnia is classified under the 4 title: 10.1.1 High altitude headache, 10.1.2 Airplane travel associated headache, 10.1.3 Diving headache and 10.1.4 Sleep apnoea headache. Headache associated with airplane travel is encountered infrequently in our clinical practice and firstly reported in 2004 as a case in the literature. The pathophysiology of headache associated with airplane travel is not yet clear. We presented this case in the aspect of the patient having both airplane travel and high altitude headaches and seen giant Virchow-Robin spaces in cranial MRI and disappearence of pain with a preventive treatment.

Pituitary apoplexy: an overview of 186 cases published during the last century.

BACKGROUND: Pituitary apoplexy is a rare and life-threatening complication occurring in 0.6-10.5% of all cases of pituitary adenomas. Although the association between pituitary apoplexy and visual dysfunction has been recognized for a long time, the optimal management of this problem still remains controversial. The purpose of this overview was to present the surgical experience by analyzing the literature on the management of pituitary apoplexy for better treatment of these cases. MATERIALS AND METHOD: To establish a new guideline for the surgical treatment of this entity, publications reported during the last century and databases containing medical literature were analyzed. In addition, an illustrative case with pituitary apoplexy presenting with complaints of sudden onset severe headache associated with nausea, vomiting, and a sudden loss of vision was described. In fact, the experience in our complicated patient prompted us to review the available literature on the management of pituitary apoplexy to date. CONCLUSIONS: Based on an overview of 186 cases of apoplectic pituitary adenoma presenting with monocular or binocular blindness, we highlight the importance of correct diagnosis and an early, but not necessarily emergency, surgery within the first week of admission to optimize visual outcome of such patients. The illustrative case further exemplifies the value of close interaction between members of the management team for optimal outcome.

Recurrent and atypical posterior reversible encephalopathy syndrome in a child with peritoneal dialysis.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiologic entity characterized by headache, seizures, visual changes, altered mental status, and focal neurologic signs. Typically, PRES involves the parietooccipital lobes; however, it can involve atypical localizations such as frontal lobe, basal ganglia, thalamus, brainstem, and gray matter. Sudden increases in blood pressure and associated renal failure are probably the most frequently encountered etiologies in the literature. Recurrence of PRES is not common. In this article, we present recurrent atypical PRES in a hypertensive child with end-stage renal disease on a peritoneal dialysis program as a rare case and we discuss recurrence. Infections and sudden increase in blood pressure were observed as the causes of recurrent PRES in our patient. The reversibility of PRES depends on immediate diagnosis and therapy; therefore, it should be kept in mind in the differential diagnosis of seizures or coma in chronic kidney disease patients.

Ultrasonographic examination of the carpal canal in dogs.

The aim of this study was to determine the course of the median nerve and its adjacent structures in the carpal canals of 8 healthy dogs by using high-frequency transducers. Before performing ultrasonography, the transverse and posteroanterior diameters as well as the perimeter of the carpus were measured at just proximal to the side of the carpal pad. The anatomical structures were then determined at two levels of the carpal canal, which were named the proximal and distal levels, on the transverse sonograms. The cross-sectional areas, perimeters and the transverse and posteroanterior diameters of the median nerve were measured at these levels. Although all the measurements were larger at the proximal level, significant differences between the proximal and distal levels were determined for the cross-sectional area, the perimeter and the transverse diameter of the median nerve. On the transverse sonogram, the deep digital flexor tendon was seen in almost the center of the carpal canal like a comma shape and also it had a small concavity on the caudal side. The superficial digital flexor tendon was seen as an ovoid shape on the transverse sonograms and it was located nearly at the posterior side of the carpal canal. Both tendons were seen as intermediate-grade echogenic structures. The median artery was located inside of the concavity of the deep digital flexor tendon. Also, the median nerve was seen at the posteromedial side of the median artery. As a result of this study, the cross-sectional areas of the median nerve ranged between 1.01-2.68 mm(2) at the proximal level and between 0.93-1.91 mm(2) at the distal level.

Orbital blood flow parameters in unilateral pseudoexfoliation syndrome.

PURPOSE: The evaluation of orbital blood flow parameters in patients with unilateral pseudoexfoliation syndrome (XFS) and in age-sex-matched control subjects using color Doppler imaging. METHODS: This prospective, comparative case series included 33 unilateral XFS patients and 33 age-sex-matched control subjects. Color Doppler imaging was used to evaluate the XFS-affected (Group 1) and -unaffected (Group 2) eyes that were matched with the corresponding side (Groups 3 and 4) of control subjects. All subjects were given a complete ophthalmological examination. A masked radiologist obtained the peak systolic velocity (PSV) and end diastolic velocity (EDV) of ophthalmic (OA), central retinal (CRA), nasal posterior ciliary (NPCA) and temporal posterior ciliary arteries (TPCA) as well as mean velocity of central retinal vein (CRV). Resistivity indices (RI) were calculated. RESULTS: Analysis of peak systolic and end diastolic velocity (PSV, EDV) and RI between Groups 1-2 and 3-4 did not show any significant difference. Comparing Groups 1-3 (corresponding eyes of pseudoexfoliation-affected and control subjects) and Groups 2-4 (corresponding eyes of pseudoexfoliation-unaffected and control subjects) revealed significantly low values for OA, PSV and EDV in both eyes of the XFS patients. The OA RI value in Group 1 was found to be significantly higher than that in Group 3 with the cut-off value of 0.72. CONCLUSION: These findings suggest that ophthalmic artery hemodynamic parameters change in both eyes of unilateral XFS patients, illustrating out the systemic nature of the disease. We conclude that XFS decreases OA blood flow velocities and increases vascular resistance through progressive build-up.

Invasive fungal granuloma of the brain caused by Aspergillus fumigatus: a case report and review of the literature.

BACKGROUND: Involvement of the brain by Aspergillus fumigatus, named as invasive aspergillosis, is extremely rare. Definitive diagnosis needs isolation of the fungus from the tissue specimens and its culture. The disease is very resistant to treatment and quickly becomes fatal despite antifungal chemotherapy with AmB preparations, the drugs of choice for the infection. CASE DESCRIPTION: We hereby present a unique case of fungal granuloma of the brain due to A fumigatus, which was cured successfully by intensive antifungal treatment, along with a brief literature review. CONCLUSIONS: Although it is rare, we draw the attention to the fact that early diagnostic procedures with rapid confirmation of Aspergillus infection and an early initiation of therapy are pivotal for a benign clinical course in such cases. A complete regression of the disease could be achieved with medical therapy alone with conventional AmB or liposomal AmB combined with oral itraconazole even if a total surgical excision of the lesions could not be performed in complicated cases, as in our patient.

Age-related changes in the incidence of pineal gland calcification in Turkey: A prospective multicenter CT study.

The goal of this cross-sectional observational study was to determine the incidence of pineal gland calcification (PGC), to investigate the interaction of PGC and aging, and to compare the incidence of PGC among the populations living in Turkey. In a prospective study the rate of PGC on CT scans of 1376 individuals in six referral centers from different regions of Turkey was investigated, with emphasis on effects of climatological parameters and aging on PGC. It was found that the incidence of PGC increased rapidly after first decade and the increase remains gradual thereafter, higher in males than in females for all age groups. There was a significant difference for incidence and degree of PGC between different clinics and between both sexes (p<0.001). In addition, there was a significant difference for the degree of PGC between the clinics in low altitude group and those in high altitude group (p<0.001 for each). Logistic regression analysis revealed that age, sex, altitude and intensity of sunlight exposure significantly affected the risk of PGC (odds ratios (OR) 1.335, 95% confidence intervals (CI) 1.261-1.414, p<0.001; OR 1.900, 95% CI 1.486-2.428, p<0.001; OR 0.715, 95% CI 0.517-0.990, p<0.05; OR 0.997, 95% CI 0.994-0.999, p<0.01, respectively). Furthermore, by multiple linear regression analysis, high altitude and increased intensity of sunlight exposure were found to affect the degree of PGC (beta=0.003, p<0.001). It is concluded that there is a close relationship between PGC and the aforementioned parameters, supporting a link between the development of PGC and these. This study provides some reference data for new clinical studies on the putative role of pineal gland in future.

Spontaneously ruptured uterine angioleiomyoma.

Angioleiomyoma is an uncommon type of leiomyoma of the uterus that originates from smooth muscle cells and contains thick-walled vessels. A 45-year-old woman with the complaint of lower abdominal pain was admitted to the hospital. In the operation a ruptured, bleeding uterine tumor was seen. She underwent total hysterectomy and bilateral salpingo-oophorectomy. On pathologic examination of the specimen, the tumor was diagnosed as angioleiomyoma. Here, an unusual clinical presentation of uterine angioleiomyoma was reported.

Correlation of serum trace elements and melatonin levels to radiological, biochemical, and histological assessment of degeneration in patients with intervertebral disc herniation.

The aim of our study was to assess the blood concentrations of some trace elements and melatonin (MLT) in patients with intervertebral disc herniation (IDH) and to investigate the interaction of histological and biochemical degeneration findings with aging. The present study was carried out on 13 subjects (8 women and 5 men) diagnosed with IDH. They were divided into three groups according to their ages. Nighttime serum MLT, zinc (Zn), and magnesium (Mg) levels were determined in all patients. In addition, computed tomography (CT) scan of the brain and magnetic resonance imaging examination of the lumbar spine were obtained in this study. The Zn level and Zn/Mg ratio showed a decline in patients with IDH with aging, whereas the serum Mg level and tissue hydroxyproline content increased. A positive correlation between serum Zn and MLT concentrations was found (r=0.104, p=0.734). In addition, there was a positive correlation between serum Zn level and Zn/Mg ratio (r=0.835 and p<0.01), and a negative correlation between serum Mg level and Zn/Mg ratio (r=-0.571, p<0.05). On CT study, both volume percentage of calcified pineal gland and density of calcification were found to increase progressively with advancing age. The results of semiquantitative evaluation of disc tissues of patients with IDH for histological degeneration findings showed that 66.7% of discs treated had slight degeneration in younger age group, but 75.0% and 100% of discs had moderate or marked degeneration in older age groups. Our data indicated that there is a close relationship between MLT and Zn or Mg levels in the serum samples of patients with IDH, and the levels of these elements might be affected by the presence of degeneration process and serum MLT level, or vice versa.

The level of quality of radiology services in Turkey: a sampling analysis.

PURPOSE: To determine the quality of radiographs, which have been referred from 40 different institutions for consultation, to discuss the causes of wasted resources, and to present possible solutions. MATERIALS AND METHODS: Five experienced radiology instructors determined the types of radiological examinations referred for consultation (conventional radiography, mammography, computed tomography and magnetic resonance imaging), the institutions at which they were performed (university or state hospital, private health center), and assessed the coverage area, field of vision (FOV), and dosage of x-ray. They also investigated problems in film processing, defects in sequence-printing windows, checked window levels, and checked the amount and timing of contrast material used. According to these criteria, the reviewers subjectively classified each radiograph as: 1. Poor, examination should be completely repeated, 2. Fair, examination should be partially repeated, 3. Good, accepted as adequate, no need for an additional examination, 4. Excellent, examination was as it should be. RESULTS: We reviewed 120 radiological examinations from 40 different institutions in 4 reference centers. Frequency of problems determined for each category was as follows: coverage area 32.5% (39/120), FOV 16% (14/86), X-ray dosage 16% (15/94), film processing 31% (37/120), sequence or window 65% (53/81), window level 44% (36/81); contrast material 51% (25/49), timing of contrast material 61% (30/49). Only 22% of the examinations were classified as excellent, whereas 47% required complete or partial repetition. CONCLUSION: Approximately half of the radiological examinations in our sampling required partial or complete repetition. Health, ethical, and economic aspects of the problem necessitates the prompt application of measures to establish radiological quality control and standardization procedures.

Pathological rupture of the normal spleen: Review with the literature.

INTRODUCTION: Atraumatic spontaneous rupture of the spleen is an uncommon but fatal condition that may coexist with other disease. Our case was presented with obvious CT findings of a spontaneous rupture of the spleen. PRESENTATION OF THE CASE: A 75-year-old woman admitted to the emergency service with abdominal pain. Although there was no evident splenomegaly in the abdominal CT examination, the patient was diagnosed with diffuse large B-cell lymphoma, and densities in harmony with the free air were detected in the spleen and the abdomen. DISCUSSION: It is clear that a healthy spleen does not rupture without marked trauma; hence, a doctor must carefully investigate the underlying pathology. Splenomegaly, the infiltration of the spleen and the capsule and consequently a splenic infarct and hemorrhage were set forth as the causes of the rupture of the spleen in lymphomas. However, our case had no splenomegaly or splenic involvement of lymphoma in the pathological examination. Even in the absence of splenomegaly, rupture may develop for such reasons as inflammation and embolism. Splenic infarcts are also in the developmental mechanism. CONCLUSION: Although atraumatic rupture of the spleen is not prevalent, it is a case which must be considered in an acute abdominal pain as it has highly fatal outcomes without CT exam.

Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings.

OBJECTIVE: Localized low attenuated areas (pseudolesions) in the medial segment of left liver lobe are not rarely seen in the screening of abdomen using helical CT. The purpose of this study was to determine the prevalence of pseudolesions in the routine helical CT of abdomen and to evaluate the morphologic and enhancement features of pseudolesions in the unenhanced and enhanced CT examinations. MATERIALS AND METHODS: We retrospectively evaluated 333 contrast enhanced abdominal CT examination of 328 patients with no known liver disease, to detect the presence of pseudolesion of liver. In the presence of unenhanced and arterial phase examinations, these images were also analyzed. The imaging criteria for pseudolesion of liver was localized low attenuated area with geometric, ovoid or nodular shaped and with no mass effect adjacent to the falciform ligament, gallbladder, or porta hepatis. Previous CT, CTAP and MR examinations were also reviewed to understand the evolution of pseudolesion in patients in whom a pseudolesion was detected in the portal phase of helical CT examination. RESULTS: We identified a pseudolesion in the 65 (19.8%) of 328 patients in portal phase of helical CT examinations. Pseudolesions were identified in the medial segment of left liver lobe adjacent to falciform ligament in the 92.8% of patients, both sides of falciform ligament in the 1.5% of patients, adjacent to porta hepatis in the 3% of patients and adjacent to gallbladder 3% of patients. These lesions had triangular shape in the 66.1% of patients, ovoid shape in the 18.6% of patients, and nodular shape in the 15.3% of patients. Unenhanced, arterial and portal phase images were exist in the 50.7% of 65 patients. The pseudolesions were not identified on the unenhanced images in the 75.7% of patients and on the arterial phase images in the 55.6% of patients. CONCLUSION: Pseudolesions around the falciform ligament are not rarely seen in the routine helical CT examination of liver and abdomen. The pseudolesions are more encountered in the portal phase of helical CT examination. These lesions seem to be likely focal fatty infiltration or perfusion defect due to venous supply variation or both. Nodular shaped pseudolesions may be interpreted as true tumors and further study may require for differential diagnosis.

Transient hepatic attenuation differences at biphasic spiral CT examinations.

Transient hepatic attenuation difference (THAD) is a perfusion disorder that can sometimes be observed in hepatic arterial phase of a biphasic spiral CT examination. The involved site of liver by THAD appears as an area of high attenuation on the hepatic arterial phase image and returns to normal attenuation on portal venous phase image. The knowledge of the shape, distribution and causes of THAD is essential to differentiate the THAD from other pathologies such as neoplasm.

Sponge-induced granuloma ("gauzoma") as a complication of posterior lumbar surgery.

A 45-year-old woman presented with complaints of low back pain and sciatica on the left persisting for 2 years. She had undergone left hemilaminectomy and discectomy for L4-5 intervertebral disc herniation at another medical center. Spinal computed tomography and magnetic resonance (MR) imaging revealed a mass lesion in the posterior paravertebral region. The mass was hypointense with ring enhancement on the T(1)-weighted images and hyperintense on the T(2)-weighted images. Surgery found a retained sponge within the paraspinal mass cavity which was removed totally. Foreign-body granuloma ("gauzoma") induced by forgotten sponge material is not an unusual complication of posterior lumbar surgery and should be considered as a potential cause in cases of surgical wound infections. MR imaging is essential to achieve the correct differential diagnosis.