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Objective:It was investigated whether patients with neurofibromatosis type 1 (NF1) with and without optic glioma (OG) differed from the healthy control group in terms of diffusion tensor imaging (DTI) parameters obtained from optic radiation.Methods:Eighty three patients and 36 healthy controls followed with the diagnosis of NF1 were included in the study. Routine MRI and DTI were applied to all subjects. Fractional anisotropy (FA), mean diffusity (MD), radial diffusity (RD) and axial diffusity (AD) values were calculated by placing ROI on the right and left optic radiation on colored FA maps. Patients with OG detected by conventional magnetic resonance imaging (n=19) were classified as group 1, patients with NF1 without OG (n=64) were classified as group 2 and they were compared with the healthy control group in terms of DTI parameters.Results:The right and left optic radiation FA values of the patients in group 1 and group 2 were significantly different when compared with the healthy control group. Optical radiation FA values were significantly lower than healthy control group. MD values in group 1 patients with OG were significantly higher than healthy control group. Optic radiation RD values were significantly higher in group 1 and group 2 compared with healthy control group.Conclusion:There appears to be microstructural damage in optic radiation in patients with NF1 with or without OG. The idea that changes in FA values detected in optic radiation in visual pathways in patients with NF1 can be predicted in the early period of visual impairment is promising in terms of treatment planning and management.

Chiari malformation type I (CM1) is a common neurosurgical disorder. It often causes debilitation in the affected patients. CM1 is a herniation of the caudal cerebellum into the spinal canal. This study aimed to evaluate the clinical and radiological outcomes of posterior fossa decompression and duraplasty (PFDD) in treated CM1 patients. In retrospective design, we reviewed the medical records of diagnosed patients with CM1 at two neurosurgical centers spanning 8 years from 2010 to 2017. We selected all CM1 patients who underwent PFDD surgery (n = 72) as the core sample for this study. We used the Chicago Chiari Outcome Scale (CCOS) to evaluate clinical outcomes. Pre- and postoperatively, we assessed the syrinx/cord ratio, the syrinx length, and the improvement of aqueductal stroke volume (ASV) on CSF flow MRIs. The mean value of CCOS was 14.1 +/- 2.1. On midsagittal MRIs, the mean regression in ectopia tonsils was 9.4 +/- 1.9 mm (i.e., mean pre- and postoperative tonsil herniation was 13.1 +/- 3.1 mm and 4.0 +/- 1.6 mm, respectively;p < 0.001). On coronal MRIs, the mean regression in ectopia tonsils was 8.4 +/- 1.5 mm (i.e., mean pre- and postoperative tonsil herniation was 13.9 +/- 2.4 mm and 5.8 +/- 1.0 mm, respectively;p < 0.001). A strong positive correlation was observed between clinical improvement and the increase in ASV values. CSF flow MRIs can help in the surgical decision and follow-up of CM1 patients. ASV

Purpose: Histopathological differentiation of primary lung cancer is clinically important. We aimed to investigate whether diffusion tensor imaging (DTI) parameters of metastatic brain lesions could predict the histopathological types of the primary lung cancer. Methods: In total, 53 patients with 98 solid metastatic brain lesions of lung cancer were included. Lung tumors were subgrouped as non-small cell carcinoma (NSCLC) (n = 34) and small cell carcinoma (SCLC) (n = 19). Apparent diffusion coefficient (ADC) and Fractional anisotropy (FA) values were calculated from solid enhanced part of the brain metastases. The association between FA and ADC values and histopathological subtype of the primary tumor was investigated. Results: The mean ADC and FA values obtained from the solid part of the brain metastases of SCLC were significantly lower than the NSCLC metastases (P < 0.001 and P = 0.003, respectively). ROC curve analysis showed diagnostic performance for mean ADC values (AUC=0.889, P = < 0.001) and FA values (AUC = 0.677, P = 0.002). Cut-off value of > 0.909 × 10-3 mm2/s for mean ADC (Sensitivity = 80.3, Specificity = 83.8, PPV = 89.1, NPV = 72.1) and > 0.139 for FA values (Sensitivity = 80.3, Specificity = 54.1, PPV = 74.2, NPV= 62.5) revealed in differentiating NSCLC from NSCLC. Conclusion: DTI parameters of brain metastasis can discriminate SCLC and NSCLC. ADC and FA values of metastatic brain lesions due to the lung cancer may be an important tool to differentiate histopathological subgroups. DTI may guide clinicians for the management of intracranial metastatic lesions of lung cancer.

Background Non-small cell lung cancer (NSCLC) is a leading cause of morbidity and mortality. Carboplatin and cisplatin based regimens are used in the treatment of NSCLC. The aim of the study was to find out whether there is a difference in white matter (WM) changes between two platinum-based chemotherapy agents using diffusion tensor imaging (DTI). Patients and methods 25 patients who received chemotherapy for NSCLC and 27 age-matched healthy controls were enrolled in the study. Fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD) and radial diffusivity (RD) values of the study population were measured from 11 regions of interest in pre-chemotherapy and post-chemotherapy MRI data. Results Cisplatin group showed a significant decrease in the FA of the inferior longitudinal fasciculus (P = 0.028). Carboplatin group showed a significant FA decrease and RD increase in the forceps minor (P = 0.022 and P = 0.011, respectively), and a significant reduction in AD and increase in MD in frontal white matter (WM) (P = 0.008 and P = 0.029, respectively). In comparison of post chemotherapy DTI values of the two groups, carboplatin group showed lower FA, and higher MD and RD values than cisplatin group in parieto-occipital WM (P = 0.034, P = 0.034, P = 0.029, respectively). Conclusions The findings of the study suggest that subtle effects of chemotherapy detectable with DTI may emerge after the treatment. In addition, carboplatin regimen may have more impact on WM than cisplatin regimen.

Objective: The aim of this study was to compare virtual bronchoscopy (VB) with multi-slice CT (MSCT) in the diagnosis of centrally located lung cancer and to investigate the effectiveness of VB in the diagnosis of the radiologist. Methods: These patients had central lung mass detected during thorax tomography and were diagnosed as having centrally located lung cancer by histopathological examination. Detection and localization of lesions were determined by MSCT and VB. In addition, the evaluation time was determined in seconds with an electronic stopwatch. Results: The mean age of 32 patients included in the study was 58.14 +/- 15.09. Centrally located squamous cell carcinoma (n=19) and small cell carcinoma (n=13) were included. Eighteen (54.8%) patients were male and 14 (47.6%) were female. All patients diagnosed as having centrally located lung cancer detected by MSCT were also detected by VB (100%). In the evaluation of patients with MSCT and VB; obstruction and/or lesion and their localization completely overlapped. The mean duration of MSCT evaluation of the patients was determined as 58.7 sec, and the mean duration of VB assessment was 549.9 sec. The mean VB evaluation duration was found to be statistically significantly longer than the mean MSCT evaluation duration. Conclusion: Virtual bronchoscopy does not provide a significant additional contribution to MSCT in the diagnosis of centrally located malignant lung tumor. We think that using VB for diagnosis and navigation will be important in terms of efficiency especially in selected patients due to its low specificity and high sensitivity.

Background: Neurosarcoidosis manifests symptomatically in 5% of patients with sarcoidosis and diagnosis can be challenging if not clinically suspected. Cerebral mass-like presentation of neurosarcoidosis rarely reported in the literature. We presented a woman with neurosarcoidosis who had a cerebral mass-like lesion which completely disappeared after medical treatment. Discussion: A 37-year-old woman with history of pulmonary sarcoidosis referred to the emergency service of our hospital with a one-month history of progressive dizziness, nausea and seeing flashing lights. At neurologic examination, numbness and weakness on the left side of the body, deviation of uvula toward the right side was seen. Cranial MRI demonstrated a 2.5x2 cm in size mass lesion which hypointense on T1 WI, heterogeneous hyperintense on T2 and FLAIR sequence with peripheral vasogenic edema and heterogeneous, irregular contrast enhancement simulating brain tumor. Also, leptomeningeal and nodular contrast enhancement was seen on brainstem, cerebellar vermis, perimesencephalic cistern and left frontal, bilateral parietooccipital sulcus. In laboratory tests; The level of serum angiotensin-converting enzyme (ACE) was 53 IU/mL (N:8-52 IU/mL) and cerebrospinal fluid (CSF) ACE was 23 IU/mL (N:0-2.6 IU/mL). CSF cytology analysis was normal. Pattern 2 oligoclonal bands were present. With these clinical, laboratory and radiological findings, cerebral involvement of sarcoidosis was suspected. Biopsy was not performed due to the high risk of morbidity caused by the deep location of the lesion.Patient was treated with methylprednisolone and Azathioprine for a month.On post-treatment control imaging; lesion disappeared completely without residual leptomeningeal and nodular contrast enhancement.Also, neurologic symptoms were decreased remarkably. Conclusion: Multi-system inflammatory disorders like sarcoidosis, can present with mass-like lesion in the brain parenchyma. While early diagnosis is important to prevent unnecessary interventions like biopsy and surgery, it is crucial to initiate the necessary treatment with the aim of recovery without sequelae. Radiological and clinical follow-up are fundamental in differential diagnosis.

Background: The importance of pre-treatment Diffusion Tensor Imaging (DTI) parameters in determining the response to treatment after radiosurgery in patients with meningioma has not yet been clearly revealed. Objective: This study was conducted to determine tumor volume changes in terms of radiological response in patients with meningioma treated with Gamma Knife Radiosurgery (GKR) and to analyze the relationship between Total Tumor Volume (TTV) and Diffusion Tensor Imaging (DTI) parameters. In addition, we investigated whether the response to treatment can be predicted by pre-radiosurgery DTI findings. Methods: Fifty-four patients were assessed using MRI and DTI before and after GKR. Mean Diffusivity (MD), Fractional Anisotropy (FA), Radial Diffusivity (RD), and TTV of tumour were determined. Patients with 10% or more decrease in TTV after GKR were classified as group 1 and those with less than 10% decrease in volume or increase in volume were considered group 2. The relationships between MD, RD, and FA values and TTV were investigated. Results: A decrease of 46.34% in TTV was detected in group 1 after GKR, while TTV increased by 42.91% in group 2. The lowest pre-treatment FA value was detected in group 1. In addition, after GKR, FA values showed a significant increase in group 1. MD and RD values increased in both groups after radiosurgery. There was a negative correlation between pre-treatment FA, RD, and MD values after radiosurgery. Conclusions: Detection of low FA values due to the poor fiber content in meningioma before radiosurgery may be a guide in predicting the response to treatment. Further studies are required to have a better understanding of the relationship between pre- and post-treatment follow-up FA values and tumor volume in determining the efficacy of GKR in patients with meningioma.

Objective The aim of this study was to evaluate the capability and the reliability of diffusion-weighted imaging (DWI) in the changes of kidneys occurring after extracorporeal shock wave lithotripsy (ESWL) treatment for renal stones. Materials and Methods A total of 32 patients who underwent ESWL treatment for renal stone disease between June and December 2011 were enrolled in this prospective study. Color Doppler ultrasonography (CDUS) and DWI were performed before and within 24 hours after ESWL. DWI was obtained with b factors of 0, 500 and 1000 s/mm2 at 1.5 T MRI. Each of Resistive index (RI) and ADC values were calculated from the three regions of renal upper, middle and lower zones for both of the affected and contralateral kidneys. Paired sample t test was used for statistical analyses. Results After ESWL, the treated kidneys had statistically significant lower ADC values in all different regions compared with previous renal images. The best discriminative parameter was signal intensity with a b value of 1000 s/mm2. The changes of DWI after ESWL were noteworthy in the middle of the treated kidney (p0.05). Conclusion DWI is a valuable technique enables the detection of changes in DWI after ESWL treatment that may provide useful information in prediction of renal damage by shock waves, even CDUS is normal.