Use of sonography in carpal tunnel syndrome surgery. A prospective study.

The diagnosis of carpal tunnel syndrome (CTS) is mainly based on the characteristic symptoms and confirmed with nerve conduction studies. Sonography can provide measurements of the increased cross-sectional area of median nerve. The use of sonography was evaluated for the diagnosis and postoperative follow up of 48 wrists in 26 consecutive patients with CTS. Clinical evaluation and sonography were effective for the diagnosis in 40 wrists. Nerve conduction studies were needed in eight wrists, because of the decrease in cross-sectional area of the nerve as a result of degenerative changes. After 3 months, sonography detected statistically significant decreases in the cross-sectional areas of the median nerves. The sonographic studies were well tolerated by all patients. Sonography was both time-saving and cost-effective.

Gadolinium-enhanced 3D MR angiography of pulmonary hypoplasia and aplasia.

OBJECTIVE: The goal of this study was to determine the role of gadolinium-enhanced 3D MR angiography (MRA) in patients with suspected pulmonary hypoplasia and aplasia in a retrospective analysis of MRA and digital subtraction angiography in 11 patients with clinical and/or radiologic suspicion of pulmonary hypoplasia and aplasia. CONCLUSION: Gadolinium-enhanced 3D MRA is capable of diagnosing pulmonary hypoplasia and aplasia rapidly and accurately. Both pulmonary hypoplasia and aplasia can be shown morphologically in a noninvasive manner, obviating digital subtraction angiography.

MRI appearance of retrocalcaneal bursitis and rheumatoid nodule in a patient with rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and sometimes multisystem involvement. Rheumatoid nodules have been reported in as many as 20-30% of patients with rheumatoid arthritis; however, they are not commonly seen in the feet. We present magnetic resonance (MR) findings of a rarely seen case of rheumatoid bursitis in the retrocalcaneal bursa associated with a subcutaneous rheumatoid nodule inferior to the calcaneus which histologically confirmed the rheumatoid arthritis. To the best of our knowledge, this is the first case that rheumatoid bursitis in the retrocalcaneal bursa associated with the rheumatoid nodule in the foot was revealed by MR imaging.

Soft-tissue masses: use of a scoring system in differentiation of benign and malignant lesions.

The purpose of this study was to show the qualitative and quantitative MRI characteristics of soft-tissue masses in differentiation of benign and malignant lesions. A total of 90 soft-tissue lesions were reviewed in this study. The scoring system presents a more objective diagnostic performance in the prediction of benign or malignant masses. With the use of this scoring system, unnecessary biopsy can be precluded in benign lesions.

Value of contrast-enhanced magnetic resonance cholangiography in patients undergoing laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is the preferred treatment for symptomatic gallstone disease. Biliary injury during LC is still a serious problem. Knowledge of anatomic detail is important for not encountering the injury. Magnetic resonance cholangiography (MRC) is a noninvasive method for imaging the biliary ducts. However, MRC has many drawbacks such as not showing anatomic structures in detail and respiratory motion. In this study, contrast-enhanced MRC was used to show cystic ducts that are not seen on MRC. Reasons for patient referral for MRC and contrast-enhanced MRC included suspicion of cholecystolithiasis, adenomyomatosis, and gallbladder polyp. Our results show that routine MRC revealed cystic ducts in 38 patients (77.5%) and contrast-enhanced MRC in 46 patients (93.8%). Intraoperative cholangiography (IOC) was taken as gold standard for all patients. We found that contrast-enhanced MRC can provide a useful supplement to MRC in patients with cystic ducts not seen on MRC. To our knowledge, this is the first study of visualization of a cystic duct in patients undergoing LC depicted by both MRC and contrast-enhanced MRC.

Value of contrast-enhanced magnetic resonance cholangiography in patients undergoing laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is the preferred treatment of symptomatic gallstone disease. Biliary injury during LC is still a serious problem. Knowledge of anatomic detail is important for not encountering the injury. Magnetic resonance cholangiography (MRC) is a noninvasive method for imaging the biliary ducts. However, MRC has many drawbacks such as not showing anatomic structures in detail and respiratory motion. In this study, contrast-enhanced MRC is used to show cystic ducts that are not seen by MRC. Reasons for patient referral for MRC and contrast-enhanced MRC included suspicion of cholecystolithiasis, adenomyomatosis, and gallbladder polyp. Our results show that routine MRC revealed cystic ducts in 38 patients (77.5%) and contrast-enhanced MRC in 46 patients (93.8%). Intraoperative cholangiography (IOC) was taken as gold standard for all patients. We found that contrast-enhanced MRC can provide a useful supplement to MRC in patients with nonvisualized cystic ducts by MRC. To our knowledge, this is the first study of visualization of cystic duct in patients undergoing LC depicted by both MRC and contrast-enhanced MRC.

'Ecstasy'(MDMA)-induced pneumomediastinum and epidural pneumatosis.

Epidural pneumatosis and pneumomediastinum may occur after the inhalation of "Ecstasy" (methylenedioxymetamphetamine), but only one case has been reported in the literature. We report the case of a 21- year-old male patient who presented with epidural pneumatosis and pneumomediastinum. Chest CT demonstrated the pneumomediastinum and multiple air bubbles within the spinal canal.

Cranial MR imaging findings of potassium chlorate intoxication.

We present the case of a patient who attempted suicide by ingesting matchstick heads (55% potassium chlorate). The patient presented to the emergency room with loss of consciousness, and MR imaging revealed symmetric hyperintense signal within the deep gray matter and medial temporal lobes. The patient improved after undergoing conventional treatment and hyperbaric oxygen.

CT fluoroscopy-guided percutaneous needle biopsies in thoracic mass lesions.

OBJECTIVE: We aimed to evaluate the usefulness of computed tomographic (CT) fluoroscopy guidance for transthoracic needle biopsies. METHODS AND MATERIAL: CT fluoroscopy-guided biopsies were performed in 81 patients with thoracic mass lesions. Interrupted CT fluoroscopy technique was used with 50-130 mA at 120 kV exposure parameters and slice thickness of 10 mm. We used aspirating needle in 41 patients, cutting needle in 28 patients, and both in 12 patients. We obtained adequate biopsy material in 69 patients at first attempt. Mean fluoroscopy time was 15.17 s and maximum procedure time was 18 min. RESULTS: Adequate samples for pathological diagnosis were obtained in all lesions. Pathological diagnoses were malignant in 41 patients, benign in 27 patients, and suspiciously malignant in 13 patients. There was no significant difference between diagnostic accuracy of the needles in malignant and benign lesions. Complications were observed in 11 patients (13.5%). DISCUSSION AND CONCLUSION: CT fluoroscopy-guided technique provides effective real-time needle biopsy in patients with small tumor size and with tumor located near blood vessels, and in non-compliant patients for diagnosing thoracic lesions.

Evaluation of styloid process by three-dimensional computed tomography.

The purpose of this paper was to investigate the length, medial angulations and other structural variants of the styloid process (SP) by three-dimensional computed tomography (3D CT) in patients without any complaints related to elongated SP. We performed temporal computed tomography (CT) scans in 138 cases (87 males, 51 females) with a mean age of 34.5 (17-86). The structure, length and medial angulation of SPs were evaluated on 3D reconstructed images. SP lengths varied between 1.58 and 5.48 cm (average length 2.83 cm), and the angles varied between 60.6 and 84.1 degrees (average angle 69.4 degrees). Other morphological findings were absence of SP (3 unilateral and 1 bilateral), ossification of stylohyoid ligament (9 unilateral and 27 bilateral), irregular SP (5 unilateral and 5 bilateral), fragmentation of SP (12 unilateral and 9 bilateral), absence of the proximal part (5 unilateral and 9 bilateral) and double proximal part (1 unilateral). According to our results, we propose a new classification. Absence of SP, absence of the proximal part of SP, duplication of the proximal part of SP and angle values of SP have never been reported before according to the available medical literature. 3D CT is an effective method in the evaluation of the SP length, angulations and other morphological characteristics.

[A comparison of planar scintigraphy and MRI in the screening of skeletal metastases]. / Kemik metastazi taramasinda Tc-99m-MDP kemik sintigrafisi ile MRG'nin karsilastirilmasi.

PURPOSE: In this study, we aimed to compare magnetic resonance imaging (MRI) and planar scintigraphy findings of patients with known or suspected skeletal metastases. MATERIALS AND METHODS: Twenty eight patients (13 women, 15 men) ranging from 35 to 63 years old, underwent whole body MRI with coronal plane turboSTIR sequence and Tc 99m methylene diphosphonate planar scintigraphy for detecting skeletal metastases. RESULTS: MRI showed metastases in 20 cases, whereas scintigraphy was positive in 23 cases. In 2 patients where scintigraphy showed 4 lesions, MRI showed them to be degenerative changes. In 3 patients scintigraphy showed 4 metastases that were not seen on MRI. In 7 patients extraskeletal metastases were identified by MRI alone. Statistical analysis showed exact correlation between both techniques (Mc Nemar p = 0.25). CONCLUSION: Our results suggest that whole-body MRI is as effective as scintigraphy in skeletal metastases. In the future, developments in MRI technology, increases in the number of MRI units and new studies may make MRI an alternative screening technique to scintigraphy.

Intrahepatic splenosis: a case report.

Splenosis is heterotopic autotransplantation and seeding of splenic tissue. In the literature, only a few cases of splenosis involving the liver and the radiologic characteristics of these lesions have been reported. We report a case of intrahepatic splenosis diagnosed by ultrasound, computed tomography, magnetic resonance imaging and scintigraphic features. To our knowledge, our patient is the first case diagnosed only by radiologic and radionuclide examination without any intervention.

Multiple rice body formation in the subacromial-subdeltoid bursa and knee joint.

Multiple rice body formation is an uncommon disorder which resembles synovial chondromatosis both radiologically and clinically. The clinical symptoms are usually non-specific. We report on a pathologically proven multiple rice body formation in both the left subacromial-subdeltoid bursa and knee joint in a 4-year-old girl.