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The aim of this study was to evaluate the effectiveness of diffusion-weighted imaging (DWI) in the diagnosis of active sacroiliitis. In this prospective study, 66 patients with clinical prediagnosis of active sacroiliitis were evaluated. Four patients who were not suitable for MRI examination were excluded. Twenty subjects with no complaint of low back pain constituted the control group. All of the patients underwent sacroiliac MRI examination performed with a 1.5 Tesla unit using phase array body coil. Before DWI, oblique axial and coronal T1 and T2-weighted TSE followed by STIR sequences were obtained. DWI examinations were obtained on SS-SE EPI sequence through chemical shifting selective fat suppression technique. ‘b’ value was chosen as 50, 400 and 800 mm2/sec and total scanning time was 114 seconds. ADC calculations were made from the ADC maps by placing ROI on the active inflammatory regions in case group and on sacrum and iliac bones in control group. Of the 62 cases, 42 had a radiologic diagnosis of active sacroiliitis, and 20 were regarded as normal. Mean ADC values in 42 patients with active sacroiliitis were significantly higher than control group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of DWI in the diagnosis of active sacroiliitis were found to be 100% for all. The cut-off ADC value was 0.94 x 10-3 mm2/sec for right sacroiliitis and 0.89 x 10-3 mm2/sec for left sacroiliitis. We believe that DWI and ADC quantification can be used successfully for the early diagnosis and follow-up of active sacroiliitis. © 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All Rights Reserved.

The etiology of cerebral hemiatrophy may be congenital or acquired. Trauma, infection, vascular abnormality, ischemic and hemorrhagic conditions may be the etiologic factors in acquired type. There is limited information about its association with other disorders in the literature. We presented three new cases of cerebral hemiatrophy associated with some hematological and developmental disorders. Cerebral hemiatrophy was associated with thalassemia major in a 10-year-old girl, acute myeloblastic leukemia and Marfan syndrome in a 23-year-old man, and craniosynostosis in a 1-year-old boy. To the best of our knowledge, thalassemia major, myeloblastic leukemia, Marfan syndrome and craniosynostosis have not been reported in cerebral hemiatrophy in the literature. (J Pediatr Neurol 2004; 2(3): 171-174).

A 9-year-old male admitted for syncope also had the complains of pain and numbness in his legs and frequent falling down. There was a history of upper respiratory tract infection 10 days before. On neurologic examination, paraparesia and fall a sleep were identified. On magnetic resonance imaging, the symetric signal increases were seen in biparieto-occipital white matter intented to corpus callosum at T2-weighted sequences and cytotoxic edema was seen at diffusion-weighted images. Heterogeneous contrast enhancement was seen on these areas. In addition, at the C7-Th5 vertebrae levels, spinal cord had diffuse increased signal intensity and contrast enhancement. Acute disseminated encephalomyelitis was thought based on clinical and radiological findings. Steroid therapy was started. Significant improvement was shown after treatment. On 2-year follow-up, there was no recurrence. In conclusion, it must be kept in mind that acute disseminated encephalomyelitis can rarely present with biparieto-occipital involvement which extends to corpus callosum and can mimic adrenoleukodystrophy. For the differential diagnosis butterfly glioma, tumefactive demyelinating lesions or multiple sclerosis should be considered.

In this study, cranial computerized tomography (CT) and/or magnetic resonance imaging (MRI) findings were investigated in nine children with acute herpes simplex encephalitis (HSE). HSE was confirmed by polymerase chain reaction. Our purpose was to evaluate the diagnostic value of CT and MRI in the diagnosis of HSE and to determine the widespread of the cranial abnormalities in HSE in childhood. Cranial CT was examined in all children and found to be normal in four children. Cranial MRI was examined in seven children, of whom, three was normal. Temporal involvement was diagnosed in only two children. Our findings revealed that the range of cranial involvement was fairly variable in childhood HSE; aside from typical temporal involvement, cranial images may be normal or widespread involvement including basal ganglia, thalamus, frontal and parietal lobes may be seen in children with HSE.

Patient Female, 58 FINAL DIAGNOSIS: Solitary paraganglioma of the hypoglossal nerve Symptoms: Neck pain Medication: - Clinical Procedure: Surgical resection Specialty: Otolaryngology. Objective Rare disease. Background Paragangliomas are rare neuroendocrine tumors originating in the neural crest. Only a few cases of hypoglossal paraganglioma have been reported in the published literature. The localization of hypoglossal paragangliomas close to the carotid artery precludes determination of tumor origin preoperatively. Case report A 58-year-old female patient was admitted due to neck pain. During physical examination, a significant mass could not be palpated in the upper left part of the neck, despite sensitivity during palpation. Atrophy and left deviation of the left half of the tongue was observed. MRI of the neck revealed a lesion located superior to the carotid bifurcation between the left internal carotid artery and external carotid artery. There was atrophy in the left half of the tongue. The neck mass displaced the left internal carotid artery anteriorly and medially. The operation was performed with left lateral cervical access. This lesion, which derived from the hypoglossal nerve, was excised. Following histopathological evaluation, the lesion was diagnosed as paraganglioma. Conclusions Hypoglossal paraganglioma is quite rare and there are no established criteria for preoperative diagnosis. Hypoglossal paraganglioma must be considered to determine treatment options if a lateral neck mass and ipsilateral tongue atrophy are present at the level of the 12th cranial nerve tract.

A 38-year-old female patient experienced a sudden onset of unilateral sensorineural hearing loss due to Moyamoya disease. A detailed summary of audiological and neurological findings indicated that the sudden hearing loss might be due to Moyamoya disease resulting in occlusion of posterior and middle cerebral arteries. Intravenous prednisolone and trimetazidine dihydrochloride may improve hearing thresholds and speech understanding. To our knowledge, this is the first article in the literature reporting a case of sudden hearing loss as the first manifestation of Moyamoya disease in a young adult.

Acute mountain sickness (AMS) is a pathological reaction, occurring as a result of failure to adapt to altitude. The main symptoms reported are headache, nausea, vomiting and fatigue. However, high altitude cerebral and pulmonary edema, occurring in AMS, cause potentially fatal consequences. In our 31-year-old case, who is the group leader and activity organizer among nine mountaineers, who climbed Mt. Aĝri{dotless} for winter climbing, nausea, vomiting, unconsciousness, lack of appetite and severe headache have occurred in connection with high altitude at 4200 m. Brain MRI of the patient revealed wide-spread hyperintense lesions at subcortical white matter, corpus callosum, globus pallidi, and bilateral cerebellar peduncles on T2 and FLAIR series. The patient was referred to anesthesia-intensive care unit of our hospital. Since the appearances are demonstrative, MRI findings are presented. © 2010 Elsevier Ireland Ltd.

The term "Virchow-Robin spaces" (VRS) refers to the extension of the subarachnoid space accompanying a vessel penetrating the cerebral cortex. In case of widening, they can be seen on magnetic resonance imaging as round, oval, or curvilinear well-defined cystic lesions with smooth margins, isointense to cerebrospinal fluid. Although dilated VRS are normal findings that may be seen at all ages, big and atypical forms are rare. Although they have associated mass effect, they should not be mistaken for neoplasm or other disease. We report seven patients whose ages were between 7 and 66 (mean: 35.8) years showing unilateral or bilateral cerebral intraparenchymal extensive cystic dilations corresponding to atypical VRS (two with Type-I and five with Type-II VRS), with clinical and radiological findings.

Introduction We evaluated chest X-ray and clinical findings of patients with lower respiratory tract infection due to influenza H5N1 and presented the radiological findings and clinical course of the infection. Materials and methods Between December 2005 and February 2006, eight hospitalized patients (median age 10, 5–15 years) with avian-flu were evaluated in this study. All patients were evaluated with chest X-ray and four of them with CT scan. Post mortem pathological characterization were also available for three of the patients. Results A rapidly progressive pneumonia with high mortality rate was observed especially for cases with late admission. The major radiologic abnormalities were extensive pneumonic infiltration with segmental and multifocal distribution, mostly located in lower zones of the lung. No pleural effusion and hilar lymphadenopathy was noted. Conclusion Avian flu may be presented as rapidly progressive pneumonia. The chest radiography has an important role in diagnosis and should be obtained daily because of rapid change of the findings that may necessitate prompt action.

Aim: The efficiency of MRI of the flexed knee was studied concerning meniscal lesion staging, existence of tears and meniscocapsulary separation (MCS). Method: In our study with 50 cases, saggital TSE Pd/T2W sequences were acquired in flexion position in addition to routine MRI sequences in neutral position. Subtle or apparent tears and MCSs observed on neutral position acquisitions (NPA) were also evaluated with knee in flexion acquisitions (KFA) in order to evaluate additional diagnostic findings. Statistical evaluation was performed using Chi-square and reliability of medical diagnostic tests. Result: There was no statistically significant difference between NPA and KFA concerning meniscal lesion grading (p>0.05). There was no statistically significant difference between NPA and KFA concerning tears due to signal increase extending to the joint surface. On the other hand, KFA contributed in tears due to MCSs (28,6%). Conclusion: KFA is an applicable method in closed system MR devices, does not disrupt patient comfort and is not time consuming. Using this method, additional information can be acquired with high contrast resolution images. KFA seems to be a superior method to NPA in patients with suspected meniscal tears and especially in cases of MCS. Further studies with extended number of patients will increase the reliability of the results.

Objective: Superficial venous insufficiency is a common problem associated with varicose veins which, if untreated, may progress to venous ulceration. Endovenous laser ablation (EVLA) is a new, minimally invasive method for management of superficial venous insufficiency and varicose veins. The aim of this study was to demonstrate the effectiveness of 980 nm EVLA for treatment of symptomatic saphenous venous insufficiency and to present its early outcomes. Methods: Thirty-eight great saphenous veins and 5 small saphenous veins in 40 patients with saphenofemoral reflux were treated with 980 nm diode endovenous laser equipment. The diameter and length of the vein treated, total laser energy and energy density (Joules/cm) delivered were recorded. To determine the severity of the venous disease Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were used. Patients were followed up for 6 months after the procedure. Complications were recorded prospectively. Results: Forty-three saphenous veins in 40 patients were treated. The mean age of the patients was 39.9 (range 21- 72) years. The mean diameter and length of the veins were 4.9 mm (range, 3.5 to 8.5 mm) and 30.2 cm (range, 16 to 50 cm), respectively. At 6 months follow-up, total occlusion rate was 95.4% (41/43), and recanalization rate was 4.6%. Significant decrease was observed for VCSS and VAS scores after the procedure. No major complication was detected. Conclusion: EVLA treatment for superficial venous insufficiency is safe and can be carried out under local anaesthesia in an outpatient setting with good patient satisfaction and low complication rates.

BACKGROUND: To investigate the efficacy of 1 molar (containing 1 mol/mL gadobutrol) contrast material in the differentiation of malignant and benign breast lesions with MRI. MATERIAL AND METHODS: Thirty-seven women (age range: 22-77 years, mean: 43.7 years) with 76 breast lesions were included in this study. Dynamic post-contrast images with 0.2 mL/kg gadobutrol (Gadovist) injection were obtained in all patients. Contrast-to-noise-ratio (CNR) of the lesions, as well as their contrast enhancement patterns (ring, heterogeneous, homogenous), and perilesional increased vascularity were studied. RESULTS: Fifty-six benign and 20 malignant lesions were examined histopathologically. In malignant cases, heterogeneous and peripheral enhancements were most commonly determined, whereas homogeneous enhancement was most commonly determined in benign cases. CNR was 450% in malignant lesions, and 60% in benign lesions. CONCLUSIONS: Type II/III contrast-time curves, ring/heterogeneous enhancement, prominent increase in CNR, and perilesional vascularity increase are important findings determining malignancy, whereas Type I curves, homogenous enhancement, a slight increase in CNR, and absence of perilesional vascularity increase support findings of benign breast lesions. By increasing CNR and providing increased perilesional vascularity, Gadovist can help in the determination of malignant breast lesions.

Purpose: To evaluate the effectiveness of percutaneous treatment under sonographic guidance in abdominal hydatid cysts. Material and Methods: Fifty‐two hydatid cysts in 33 patients were treated using a percutaneous approach under sonographic guidance. Forty‐five cysts were located in the liver, 6 in the spleen, and 1 in the pancreas. Forty‐nine cysts were type I, and 3 were type II. Thirty‐one cysts in 15 patients were treated with puncture and aspiration of the contents, injection of hypertonic saline solution, and respiration (PAIR); 15 cysts in 14 patients were treated with puncture, aspiration of cyst contents, injection of hypertonic saline solution, drainage, and injection of sclerosing agent (PAIDS); and 6 cysts in 4 patients were treated with puncture, aspiration of cyst contents, injection of sclerosing agent, and re‐aspiration (mPAIDS). Hypertonic saline or alcohol was used as a scolicidal agent. The follow‐up period was between 17 and 53 months. Results: A decrease in the dimensions of the cysts, solidification of the contents, and irregularity in the walls of cysts, all of which were considered signs of cure, were found in all patients. Recurrence was observed in one case and anaphylaxis in one. Conclusion: Percutaneous treatment of abdominal hydatid cysts is a safe, easily applicable, well‐tolerated, and effective method.

Aneurysmal bone cyst (ABC), especially in the ribs, is a rare disease, considering to be a benign lesion which occurs mostly in children and young adults. This case, however, concerns a 46-year-old female patient, with complaints of pain and palpable mass in the right thoracic wall, who was diagnosed to have ABC originating from the rib demonstrated by radiological examinations, aspiration biopsy, and histopathological verification. Surgical resection was performed to the lesion.

Purpose: The purpose of this study was to assess the patterns of contrast enhancement of hepatic hemangiomas on gadolinium-enhanced MR fluoroscopy imaging prospectively. Method: Investigation was performed on a 0.3-T open MR unit. Gadolinium-enhanced MR fluoroscopy images were obtained in 24 patients with 28 hepatic hemangiomas. Each MR fluoroscopy image was obtained in 2 s and MR fluoroscopy lasted for 10–25 min for each investigation. Results: Three patterns of contrast enhancement were observed in 24 patients on MR fluoroscopy images. Four small lesions were not detected on MR fluoroscopy images. Uniform enhancement was seen in nine lesions (29%), peripheral nodular enhancement progressing centripetally to uniform enhancement was seen in nine lesions (29%), and peripheral nodular enhancement with persistent central hypointensity was seen in six lesions (22%). Conclusion: Enhanced MR fluoroscopy technique could obtain dynamic images of hepatic hemangiomas. It can be suggested as a useful technique for the showing of enhancement of hepatic hemangiomas, keeping in mind its low sensitivity in the diagnosis of small hemangiomas.

Early diagnosis of brucellar spondylodiscitis is often difficult because of the long latent period. Radiographs of the spine, bone scan, and computed tomography (CT) scan provide insufficient data. Among 25 patients with brucellar spondylodiscitis studied by magnetic resonance imaging (MRI), 9 were in the acute stage and 16 were in the chronic stage. MRI is the investigation method of choice in diagnosing brucellar spondylodiscitis.

We report on a 5-year-old boy presenting with tethered cord, diastometamyelia, spinal dysraphism, terminal lipoma, spinal epidermoid, and dermal sinus tract with CT, conventional MRI, and diffusion-weighted MRI findings. To the best of our knowledge, our case has the property to be the first case in the literature showing the association of these pathologies all together.

The aim of this work was to show contribution of power Doppler imaging in the diagnosis of the carotid body tumors. Six patients with a nontender mass beneath the mandibular angle were evaluated with gray scale and power Doppler sonography. Well-defined, solid, weakly hyperechoic masses were noted on gray scale sonography in the carotid bifurcation. Power Doppler sonography showed abundant flow, characterized as an intense blush, throughout the entire tumor in all patients. We believe that invasive and expensive diagnostic modalities are not necessary to evaluate carotid body tumors. Gray scale sonography and power Doppler imaging are sufficient for primary diagnosis of carotid body tumors.

In addition to color and pulsed Doppler sonography findings, we aimed to describe power Doppler sonography findings in Graves’ disease in this study. Twenty-three patients with Graves’ disease were imaged with gray-scale, color and power Doppler sonography. Twenty normal volunteers were examined by the same equipment and the same technique as a control group. A subjective grading system was used to categorize the vascularization in pulsed Doppler sonography images from normal to markedly increased vascularization. Power Doppler sonography exhibited diffuse hypervascularity in the thyroid gland in all patients. The flow was covering about all the parenchyma. Four patients showed mild, 12 patients moderate and seven patients marked vascularity. The intensity of power Doppler flow pattern was not correlated with the severity of the disease. This study demonstrated that power Doppler sonography is a convenient, time saving, inexpensive and noninvasive method as compared with isotope scan and some other laboratory tests for confirmation of Graves’ disease.

Intradiploic meningioma, which may be classified as a subgroup of intraosseous meningioma, is a rarely encountered disorder. To date, less than 10 cases have been reported. Here, we report a case of fronto-orbito-nasal intradiploic meningioma, A 12-year-old female with exophthalmos and diplopia was operated on for a cranial intradiploic mass lesion. Histopathological evaluation of the specimen confirmed the diagnosis of intradiploic psammomatous meningioma. Her exophthalmos did not change, but the diplopia disappeared. This case is unique in that it is an extensive case of intradiploic meningioma of the orbital roof and frontal base in a child. Intradiploic meningiomas generally are of psammomatous type. Especially tumors adjacent to the orbita cause exophthalmos; cases located on the other side of the calvarium may not cause any symptom or sign other than headache or sometimes a mass on the scalp. Treat ment, as with meningiomas located in the intracranial cavity, is total resection of the lesion. Copyright (C) 2000 S. Karger AG. Basel.

The aim of this study was to investigate the flow volumes of the internal jugular veins (IJVs) in patients with cerebral venous sinus thrombosis (CVST) using Doppler ultrasonography (DUS) and to compare the findings with the control group. Forty patients diagnosed with CVST between 2008 and 2010 were included in the study. The patients diagnosed with a thrombosis via MRV and MRI underwent a bilateral examination of the IJVs by DUS. The patients were divided into three groups: Group I (n=29) unilateral total thrombosis; Group II (n= 6) bilateral diffuse thrombosis; and Group III (n=5) unilateral partial thrombosis. The IJV flow volumes of each group were compared to that of the control group (n=20). In Group I, the average flow volume was 53 ml/min on the side of the thrombosis. In Group II, the mean volume of the right and left IJV was 265 ml/min, and in Group III, the mean volume on the side of the partial thrombosis was 160 ml/min. The flow volume on the thrombosed side in Group I and Group III and the mean of the total bilateral flow volume in Group II were significantly lower than that of the control group. IJV flow volumes in the CVST group were significantly lower compared to the control group. Reduced flow volumes of the IJV may be diagnostic for CVST or an additional parameter to be considered with the use of MRI.

An 11-year-old girl was admitted with back pain for 2 months, inability to walk for 15 days, and enuresis and encopresis for 2 days. She had been hospitalized with the diagnosis of brucellosis in another hospital. At presentation, she had paraplegia, sphincter dysfunction, and bilateral sensory loss below the T6 level, and was initially diagnosed with transverse myelitis caused by brucellosis. On the third day of hospitalization, however, agglutination test for brucella was negative, but it was positive for Salmonella. Therefore, transverse myelitis was considered to be due to salmonellosis. Thoracic spine magnetic resonance imaging showed an extradural, paraspinal mass at the level of T6-T7. The mass was totally extracted, and histopathological examination revealed Ewing's sarcoma. During follow-up, no improvement in paraplegia was noted and an enlarged presacral decubital ulcer developed. Aside from supportive care, local radiotherapy was applied. Unfortunately, the patient died from probable infection 9 months after the diagnosis. We emphasize that metastatic spinal Ewing's sarcoma may mimic brucellosis and transverse myelitis in childhood.

Laryngocele may be defined as an abnormal dilatation of the saccule of the ventricle and its pathogenesis is uncertain. We report a laryngocele caused by amyloidosis localized to larynx in a 60-year-old male patient. We would like to mention that amyloidosis should be evaluated in the etiology of patients diagnosed as having a laryngocele.

Congenital abnormalities of the internal carotid artery (ICA) are extremely rare and aplasia/hypoplasia of the ICA associated with other congenital malformations is uncommon. An 8-year-old male patient was admitted to our hospital for extreme nervousness, attention problems and hyperactivity. On MR examination, left phytisis bulbi, left frontal lobe atrophy, assymmetric dilataion in the left lateral ventricle and hamartomas in both globus pallidi, right thalamus, and bilateral cerebellar hemispheres posterior to the fourth ventricle were observed. Left ICA was observed as hypoplastic in the cervical and cranial MR-angiography. Left MCA and ACA could not be visualised. Left carotid canal hypoplasia and left sphenoidal bone dysplasia were detected on CT. As far as we know, only 4 cases with concomitancy of ICA hypoplasia-NF Type-1 have been reported up to the present. In our case, in addition, phytisis bulbi is accompanying this coexistence. Turkish Başlık: Nörofibromatozis Tip-I, Sol İnternal Karotid Arter Hipoplazisi ve Sol Fitizis Bulbi Birlikteliği Anahtar Kelimeler: Nörofibromatozis tip-1, internal karotid arter hipoplazisi, fitizis bulbi Konjenital İCA anomalileri oldukça nadir olup İCA aplazi/hipoplazisinin diğer konjenital malformasyonlarla birlikteliği çok ender görülür. Sekiz yaşında erkek hasta aşırı sinirlilik, dikkat eksiliği ve hiperaktivite şikayetleri ile hastanemize başvurdu. MR incelemesinde; sol gözde fitizis bulbi, sol frontal lob atrofisi, sol lateral ventrikülde asimetrik dilatasyon, her iki globus pallidusta, sağ talamusta ve her iki serebellar hemisferde 4. ventrikül posterior komşuluğunda hamartomlar mevcuttu. Boyun ve beyin MR-anjiografide sol İCA'nın hipoplazik olduğu izlendi. Sol MCA ve ACA izlenmedi. BT'de sol karotid kanal hipoplazisi ve sol sfenoid kemik displazisi saptandı. Bildiğimiz kadarı ile şu ana kadar İCA hipoplazisi-NF Tip 1 birlikteliği bulunan 4 vaka bildirilmiştir. Vakamızda ek olarak bu birlikteliğe fitizis bulbi eşlik etmektedir., Konjenital İCA anomalileri oldukça nadir olup İCA aplazi/hipoplazisinin diğer konjenital malformasyonlarla birlikteliği çok ender görülür. Sekiz yaşında erkek hasta aşırı sinirlilik, dikkat eksiliği ve hiperaktivite şikayetleri ile hastanemize başvurdu. MR incelemesinde; sol gözde fitizis bulbi, sol frontal lob atrofisi, sol lateral ventrikülde asimetrik dilatasyon, her iki globus pallidusta, sağ talamusta ve her iki serebellar hemisferde 4. ventrikül posterior komşuluğunda hamartomlar mevcuttu. Boyun ve beyin MR-anjiografide sol İCA'nın hipoplazik olduğu izlendi. Sol MCA ve ACA izlenmedi. BT'de sol karotid kanal hipoplazisi ve sol sfenoid kemik displazisi saptandı. Bildiğimiz kadarı ile şu ana kadar İCA hipoplazisi-NF Tip 1 birlikteliği bulunan 4 vaka bildirilmiştir. Vakamızda ek olarak bu birlikteliğe fitizis bulbi eşlik etmektedir.

Primary germ cell tumors may spread to the lung, liver, brain, and bone hematogenously. However, spinal metastasis is extremely rare. A case with yolk sac tumor (YST) and cauda equina metastasis was presented in a 2-year-old boy. Two months prior to admisssion, he underwent left radical orchiectomy for testicular YST. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed spinal and cauda equina involvement. This is the first report of metastasis of testicular YST to cauda equina in a child.

Purpose To study the diagnostic value of diffusion-weighted imaging (DWI) in soft tissue abscesses. Materials and methods Fifty patients were included in this study who were thought to have soft tissue abscess or cystic lesion as a result of clinical and radiological examinations. Localisations of the lesions were: 1 periorbital, 3 breast, 14 intraabdominal, and 32 intramuscular lesions. After other radiological examinations, DWI was performed. The signal intensity values of the lesions were evaluated qualitatively according to the hyperintensity on b-1000 DWI, using 1.5 T MR system. All of the lesions were aspirated after DWI, and detection of pus in the aspiration material was accepted as gold standard for the diagnosis of abscess. Results In 38 of the 50 patients, hyperintensity was obtained on diffusion-weighted images. False-positive results were maintained in 2 of these patients, and true-positive results were maintained in 36 of them. In 11 of the 50 patients, hypointensity was visualised on diffusion-weighted images. False-negative results were maintained in 3 of these patients, and true-negative results were maintained in 8 of them. An abscess which was seen on post-contrast conventional MRI could not be seen on DWI, and this was regarded as false-negative. Conclusion The sensitivity and specificity of diffusion-weighted images for detecting soft tissue abscesses were found to be 92% and 80%, respectively. DWI has a high diagnostic value in soft tissue abscesses, and is an important imaging modality that may be used for the differentiation of cysts and abscesses.

Enchondromatosis is a congenital nonhereditary condition characterized by multiple symmetrically distributed intraosseous cartillaginous masses in the metaphyses and diaphyses of bones. We report a case of bilateral multiple enchondromas and cerebral hamartomas in an 11-year-old boy in whom x-rays displayed distortion and expansion of bilateral long tubuler bones, hands and feet, scapulas, pelvis, and occipital regions of the calvarium. In addition to osseous abnormalities, bilateral cerebral hamartomas were observed on cranial magnetic resonance imaging (MRI). To the best of our knowledge, this is the first case in the literature with enchondromatosis and cerebral hamartomas.

The authors examined clinical outcome and cranial magnetic resonance imaging (MRI) findings in infants with hypoglycemia to determine the effects of hypoglycemia on the developing brain. A total of 110 infants with hypoglycemia were included in the study. Of the patients, 36 were females and 74 were males. The age of the infants was between 1 day and 22 months. Of the 110 infants, 47 were preterm neonates, 40 were term neonates, and 23 were older than 28 days. No difference in serum glucose level was noted between symptomatic and asymptomatic infants. The most common observed abnormal findings were hyperintense lesions, encephalomalacia, and cerebral atrophy. Abnormal MRI findings were found in 4% of preterm infants, in 32.5% of term infants, and in 43.5% of older infants. Abnormal MRI findings were statistically significantly more common in symptomatic infants than in asymptomatic infants. Of the infants, 45.5% of hypoglycemic infants had cerebral palsy and/or cerebral palsy plus epilepsy.

A 48-year-old man who had a complaint of swelling in the left submandibular region and right side of the neck was referred to our radiology clinic for sonographic examination that revealed a type 1 hydatid cyst with a diameter of 32 mm in the left submandibular gland, and a type 3 hydatid cyst with a diameter of 33 mm in the right thyroid gland. The diagnosis was verified by computed tomography, magnetic resonance imaging, and hemagglutination tests. To the best of our knowledge, this is the second case in the literature of hydatid cysts involving both submandibular and thyroid glands. There was no abdominal, thoracic or brain involvement. The patient was a singer and did not accept surgical treatment, and percutaneous drainage with the PAIR (Puncture-Aspiration of cyst contents-Injection of hypertonic saline solution-Reaspiration) technique was performed for both cysts. There were no complications during or after the intervention. During 4 months of follow up the sizes of both cysts were decreased and the germinative membranes were shrunken, having a pseudotumor appearance. To the best of our knowledge, this is the first case in the literature that the PAIR method was applied for thyroid and submandibular gland hydatid cysts. Percutaneous treatment of thyroid and submandibular gland hydatid cysts seems to be a safe and effective procedure as a possible alternative to surgery.

We present a case of the Goldston syndrome which is the association of polycystic kidneys with Dandy-Walker malformation. The diagnosis was made by ultrasound in twenty second week of gestation. Obstetric ultrasound and fetal MRI studies showed hydrocephalus, agenesis of the cerebellar hemispheres, vermian hypoplasia, cystic dilatation of the 4th ventricle, enlargement of the posterior fossa, abdominal distension, and oligohydramnios.. The kidneys were symmetrically enlarged and multicystic. To our knowledge this is the third reported case of Goldston syndrome which was diagnosed during intrauterine life.&nbsp

We report the ultrasonography (US) and computed tomography (CT) findings of a rare case of extraskeletal Ewing sarcoma involving the left chest wall with a diameter of 4cm in a 5 years old girl. The lesion was heterogenously hypoechoic on sonography with a lobulated smooth contour. On CT, the lesion had central necrotic areas and was enhancing heterogeneously. With these US and CT findings surgical excision of the tumor was performed. Histopathologically the mass was evaluated as round cell malignant neoplasm (Ewing tumor/ “Askin tumor”/ primitive neuroectodermal tumor (PNET)). Chemotherapy and radiotherapy were planned to the patient.

Herein, we report a 66 year old woman who was diagnosed to have intrabiliary rupture of liver hydatid cyst with demonstrative computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography findings, with a review of the literature. © 2009 Avcu et al; licensee Cases Network Ltd.

PURPOSE The aim of this study was cerebrospinal flow quantification in the cerebral aqueduct using cine phase-contrast magnetic resonance imaging (MRI) technique in both sexes and five different age groups to provide normative data. MATERIALS AND METHODS Sixty subjects with no cerebral pathology were included in this study. Subjects were divided into five age groups: or =45 years. Phase, rephase, and magnitude images were acquired by 1.5 T MR unit at the level of cerebral aqueduct with spoiled gradient echo through-plane, which is a cine phase-contrast sequence. At this level, peak flow velocity (cm/s), average flow rate (cm/ s), average flow (L/min), volumes in cranial and caudal directions (mL), and net volumes (mL) were studied. RESULTS There was a statistically significant difference in peak flow between the age group of < or =14 years and the older age groups. There were no statistically significant differences in average velocity, cranial and caudal volume, net volume, and average flow parameters among different age groups. Statistically significant differences were not detected in flow parameters between sexes. CONCLUSION When using cine-phase contrast MRI in the cerebral aqueduct, only the peak velocity showed a statistically significant difference between age groups; it was higher in subjects aged < or =14 years than those in older age groups. When performing age-dependent clinical studies including adolescents, this should be taken into consideration.

Conjoined twins are an extremely rare congenital malforma- tion without any known genetic predisposition. Omphalopa- gus twins are the second most common variety of conjoined twins and usually are joined at the umbilicus. We present omphalopagus conjoined twins demonstrated with true FISP (fast imaging with steady-state procession) and HASTE (half- Fourier acquisition single-shot turbo spin-echo) magnetic resonance imaging (MRI) sequences, which showed Dandy- Walker malformation in one of the pair. To our knowledge, this is the first case of conjoined twins with this malformation, which was diagnosed with ultrafast MRI.

In this study, cranial magnetic resonance imaging (MRI) findings were investigated in children with moderate and severe protein energy malnutrition (PEM) to determine cerebral abnormalities in malnutrition in childhood. A total of 20 children aged 3 months to 36 months were included in the study. Thirteen (65%) children had severe malnutrition and seven (35%) children had moderate malnutrition. Fifteen (75%) children had abnormal MRI findings: all of them had cerebral atrophy, and 10 (75%) children had cerebral atrophy plus ventricular dilatation. None of the children had abnormality in the brain stem or cerebellum. The authors did not find statistically significant differences between the groups when comparing the MRI findings for degree of malnutrition, head circumference, iron deficiency anemia, and serum albumin levels. In conclusion, the findings showed that most (75%) children with moderate/severe PEM had abnormal MRI findings. Therefore, it is suggested that children with PEM should be evaluated for cerebral atrophy.

Objective This study aimed to investigate the localization of the lipoma, as well as associated intracranial and extracranial lesions in 14 patients immediately following hospital admission. The pathological findings from the neurological examinations of these patients are also investigated. Methods Fourteen patients who were admitted to our clinic with a variety of symptoms and diagnosed with intracranial lipoma were included in the study. Problems presented upon admission, neurological findings, and other existing system abnormalities were evaluated. Localization of the lipomas and accompanying pathologies were determined by using computerised tomography and magnetic resonance imaging. Results The most frequent reasons for admission of patients with intracranial lipomas were: headache 7 (50%), trauma 3 (21.5%), epilepsy 3 (21.5%) and one with symptoms due to the local mass effect of tumor (7%). Although the pericallosal region is accepted as the region where lipomas commonly occur, this study found the most frequent occurrence in the quadrigeminal cistern. Intracranial lipoma calcification was only evident in 1 of the 14 patients. In addition, contrary to the expectations, intracranial and extracranial lesions accompanying lipomas were rare. All patients received systematic treatment. Conclusion This study showed that intracranial lipomas are more frequent in the quadrigeminal region of the brain; most are asymptomatic, generally caught incidentally; and accompanying intracranial and extracranial pathologies are less common than expected.

OBJECTIVE The purpose of this study was to review the clinical manifestations, radiologic findings, and treatment modalities of our cases with lateral sinus thrombosis (LST). METHOD Documents of patients with LST, diagnosed and treated from 1995 to 2001 in our clinic, were examined retrospectively. RESULTS Four patients with the diagnosis of LST were treated during this period. Among the clinical manifestations of these patients, the most frequently encountered symptoms were earache and headache, in addition to otorrhea and hearing loss. Four cases had chronic otitis media, three with cholesteatoma and one with polyps. Delta sign was detected in three cases on computed tomography, whereas a suspicious image was noted in one case. This case underwent magnetic resonance angiography, and the diagnosis of LST was established conclusively. In two cases, because pus was aspirated via lateral sinus punctures performed intraoperatively, these sinuses were explored and obliterated following radical mastoidectomy. Because pus was not aspirated via punctures of the other two cases, their sinuses were not explored. Only radical mastoidectomy was performed surgically for these cases. Dual antibiotics and low-dose anticoagulant therapy were given concomitantly to all cases in the postoperative period. Recanalizations of the nonobliterated lateral sinuses were detected with Doppler ultrasonography of internal jugular vena at 15 days and 3 months after the termination of postoperative treatment. CONCLUSION Clinical findings and radiologic techniques play an important role in the diagnosis of LST. In the treatment, if pus is found in the lateral sinuses, it is necessary to explore, clean, and obliterate them, whereas in cases in which the aspirates do not contain pus, mastoidectomy is sufficient. On the other hand, a low dose of anticoagulant can be used together with antibiotics in the nonobliterated lateral sinuses.

We report ultrasound‐guided direct percutaneous injection of n‐butyl cyanoacrylate for preoperative embolization of carotid body tumor in a 50‐year‐old patient. Angiographic road map assistance was used for protection of parent arteries during the injection. After embolization, complete devascularization of the tumor was achieved without complications. The tumor was removed surgically with minimal blood loss. This procedure is effective and promising for preoperative embolization of carotid body tumors.

Objective: Cold abscesses, although common in spinal tuberculosis, are usually localized to the level of infection, follow tissue planes, and may extend into the spinal canal at any level. They may cause symptoms resulting from neurovascular compression, hemorrhage, and direct mass effect. Design and patients: We present an unusual case of cervical tuberculous spondylodiscitis in a 25-year old man with a cold abscesses involving the retropharyngeal, mediastinal, and retroperitoneal areas bilaterally. The abscess tracked from the neck to the psoas muscles bilaterally. Following the diagnosis the patient received 9 months of antituberculous therapy. Results: MRI showed resolution on medical treatment alone. Conclusions: Even in the presence of massive paravertebral cold abscesses medical treatment alone may well suffice for this common worldwide disorder. MRI is ideal for monitoring regression of massive abscesses in deep anatomical locations.

WOS: 000221975800002 PubMed: 15158218 Although radiological findings of cerebral hemiatrophy (Dyke-Davidoff-Masson Syndrome) are well known, there is no systematic study about the gender and the affected side in this syndrome. Brain images in 26 patients (mean aged 11) with cerebral hemiatrophy were retrospectively reviewed. Nineteen patients (73.5%) were male and seven patients (26.5%) were female. Left hemisphere involvement was seen in 18 patients (69.2%) and right hemisphere involvement was seen in eight patients (30.8%). We conclude that male gender and left side involvement are frequent in cerebral hemiatrophy disease. (C) 2004 Elsevier Inc. All rights reserved.

Extraskeletal Ewing's sarcoma is often described as a tumour involving the soft tissues of the lower extremities and the paravertebral region. Involvement of the paranasal sinus is a very rare entity. We present a case of primary Ewing's sarcoma of the paranasal sinus extending into the middle cranial fossa in a 40-year-old female. CT and MRI findings of this unusual case are discussed. To our knowledge, this case is the first to be reported with CT and MRI documentation.

The purpose of this study was to evaluate the feasibility of using an open-configuration magnetic resonance (MR) imaging system with MR fluoroscopic guidance to perform percutaneous transthoracic fine-needle aspiration biopsy in patients with lung masses. Percutaneous transthoracic aspiration biopsy in patients with lung masses. Percutaneous transthoracic aspiration biopsies were performed with MR fluoroscopic guidance in 14 patients. The masses were 2-7 cm in diameter (mean, 4.1 cm). The needle was positioned by using a free-hand technique with MR fluoroscopic guidance. The needle tip reached the target lesion, and biopsy was performed. Analysis of the biopsy specimens facilitated a specific diagnosis in all patients. Pneumothorax was noted in two patients (14%) with chronic obstructive pulmonary disease. Study results showed that the described MR fluoroscopy-guided transthoracic biopsy technique can be used safely and successfully for lung masses. MR fluoroscopy can be used to reach the target lesion easily and accurately. (C) RSNA, 2003.

Hemangiomas are the most common lesions of the major salivary glands during infancy and early childhood. Changes in blood flow dynamic within hemangioma results in thrombus and phleboliths. There have been a number of reports of hemangiomas with phleboliths in parotid and submandibular glands. We present the first case of a hemangioma with multiple phleboliths in the subligual gland as a cause of submental opacity, and discussed the diagnosis of radiopaque masses in the sublingual and submental regions. (C) 2003 Tohoku University Medical Press.

In recent years, the popularity of intramedullary humeral nailing is on the rise in spite of its handicaps. There are many problems in intramedullary humeral stabilization because of the anatomic structure of the bone. We performed various methods and measurements to determine shape, length and diameter and curvature of the medullary canal of the humerus in 57 human dry cadaver bones. Anterior angulation with an average of 21 cm apart from greater tubercle was found at 1/3 distal part. Mean degree of angulation was 9 degrees (max: 15, minutes: 5, S.D.: 2.84). Humerus bones with septal aperture (supratrochlear foramen) at the fossa coronoidea were observed to have very narrow medullary canal. The best point for nail insertion was found to be an area on the line from greater tubercle anteromedially to caput humeri. This study revealed that carefully evaluated structure of humeral medullary canal and various congenital constructions such as septal aperture, and correct selection of a nail with proper length and diameter are essential for successful nailing.

Seasonal and weather influence on the incidence of cerebrovascular disease has been reported previously. The aim of this retrospective study was to determine whether the time of onset of ischemic strokes (IS) and intracerebral hemorrhages (ICH) were associated with the environmental temperature or the time, as a month or season, in our region. We analyzed the monthly and seasonal incidence of stroke between 1997 and 2001. Four hundred and fifty-one cases were admitted to our clinic (IS; n = 288 and ICH; n = 163), and aged from 16 to 94 years. The study was carried out in province of Van in eastern Turkey. The present study demonstrated a peak occurrence of IS in August (n = 41). For ICH, we observed a peak occurrence in July (n = 23). The highest number of IS occurred in summer (n = 108), the most moderate amount in autumn (n = 81), and the least in spring (n = 38). The hemorrhagic events were highest in summer (n = 58), most moderate in winter (n = 61), and lowest in spring (n = 31) and autumn (n = 32). There was a significantly greater incidence of IS and ICH during the summer than any other season in the province of Van, Turkey. This may reflect the role of weather temperature in the development of stroke and allow us to take preventive measures.

The aim of this study was to show reduction of the diaphragmatic excursion with MR fluoroscopy in patients with chronic obstructive pulmonary disease (COPD) and to compare the results with pulmonary function test (PFT). The study included 13 men and 10 women (average age 56.2) with COPD, and 9 men and 6 women (average age 55.8) as a control group. MR fluoroscopy images with Spoiled Gradient-echo pulse sequence was obtained during deep inspiration and expiration. After examination, over cine-loop display, the highest and lowest positions of the diaphragm were identified and the distance of excursion was measured. Differences in the diaphragmatic excursion between patient and healthy subjects were compared. We have also compared MR fluoroscopy results with PFT. In each person of both groups, excursion of the diaphragm was demonstrated clearly in cine-loop display. Differences of excursion between deepest and highest point of diaphragm were on average 26 and 20 mm, respectively, in the right and left side in patients and 69 and 56 mm in healthy group. Significant correlation was found between expiratory volume in 1 s and MR fluoroscopy results. MR fluoroscopy study showed that there were significant statistical differences in diaphragmatic excursion between patients with COPD and healthy subjects. Expiratory volume in 1 s is closely associated with the diaphragmatic excursion. MR fluoroscopy would seem to be a useful method for showing diaphragmatic excursion. (C) 2001 Elsevier Science Inc. All rights reserved.