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To assess the usefulness of the visual assessment and to determine diagnostic value of the lesion-to-cerebral cortex signal ratio (LCSR) measurement in the differentiation of demyelinating plaques and non-specific T2 hyperintensities on double inversion recovery (DIR) sequence. DIR and fluid-attenuated inversion recovery (FLAIR) sequences of 25 clinically diagnosed multiple sclerosis (MS) patients and 25 non-MS patients with non-specific T2-hyperintense lesions were evaluated visually and LCSRs were measured by two observers independently. On DIR sequence, the calculated mean LCSR ± SD for demyelinating plaques and non-specific T2-hyperintense lesions were 1.60 ± 0.26 and 0.75 ± 0.19 for observer1, and 1.61 ± 0.27 and 0.74 ± 0.19 for observer2. LCSRs of demyelinating plaques were significantly higher than other non-specific T2-hyperintense lesions on DIR sequence. By using the visual assessment demyelinating plaques were differentiated from non-specific T2-hyperintensities with 92.8 % sensitivity, 97.5 % specificity and 95.1 % accuracy for observer1 and 92.8 % sensitivity, 95 % specificity and 93.9 % accuracy for observer2. Visual assessment and LCSR measurement on DIR sequence seems to be useful for differentiating demyelinating MS plaques from supratentorial non-specific T2 hyperintensities. This feature can be used for diagnosis of MS particularly in patients with only supratentorial T2-hyperintense lesions who are categorized as radiologically possible MS. • Demyelinating plaques and non-specific T2-hyperintensities have different SI on DIR images. • These differences can be assessed by LCSR measurement or visual assessment. • There is an excellent inter-observer agreement for both methods. • This feature can be used in radiologically possible MS cases.

Summary Introduction Whole eye transplantation (WET) holds promise for vision restoration in devastating/disabling visual loss (congenital or traumatic) not amenable to surgical or neuroprosthetic treatment options. The eye includes multiple tissues with distinct embryonic lineage and differential antigenicity. Anatomically and immunologically, the eye is unique due to its avascular (cornea) and highly vascular (retina) components. Our goal was to establish technical feasibility, demonstrate graft viability, and evaluate histologic changes in ocular tissues/adnexae in a novel experimental model of WET that included globe, adnexal, optic nerve (ON), and periorbital soft tissues. Methods Outbred Sprague-Dawley rats (n = 5) received heterotopic vascularized WET from donors. Each WET included the entire globe, adnexa, ON, and periorbital soft tissues supplied by the common carotid artery and external jugular vein. Viability and perfusion were confirmed by clinical examination, angiography and magnetic resonance imaging (MRI). Globe, adnexal, and periorbital tissues were analyzed for histopathologic changes, and the ON was examined for neuro-regeneration at study endpoint (30 days) or Banff Grade 3 rejection in the periorbital skin (whichever was earlier). Results Gross examination confirmed transplant viability and corneal transparency. Average operative duration was 64.0 ± 5.8 min. Average ischemia time was 26.0 ± 4.2 min. MRI revealed loss of globe volume by 36.0 ± 2.8% after transplantation. Histopathology of globe and adnexal tissues showed unique and differential patterns of inflammatory cell infiltration. The ON revealed a neurodegeneration pattern. Conclusion The present study is the first in the literature to establish an experimental model of WET. This model holds significant potential in investigating mechanistic pathways, monitoring strategies or developing management approaches involving ocular viability, immune rejection, and ON regeneration after WET.

We present a case of metastasis of the external auditory canal (EAC) from a primary breast carcinoma in a 53-year-old female with a review of the literature. The patient had been diagnosed with a primary carcinoma 4 years previously. The metastasis had developed recently in her left EAC and presented as a bulky, fleshy, bleeding mass. The mass was causing hearing loss on the left due to complete obstruction in the left EAC. The mass was incompletely removed with a surgical operation and histopathologically metastasis was proven. Although there are few case reports in the literature of various cancers metastasizing to the EAC, metastasis in the EAC from the breast carcinoma is exceedingly rare and only one case has been reported in the literature so far.

To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients’ symptoms and clinical findings were recorded. Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. • Brain herniations into the DVS are more common than previously assumed. • The most frequent locations are the transverse sinus. • These herniations are incidental findings. • The relationship between brain herniation into DVS and headache is uncertain. • High-resolution MR sequences are most useful in detection of brain herniations.

Objective Primary aim is to compare the diagnostic value of contrast-enhanced 3D GRE T1-weighted sequences with unenhanced MR venography and conventional magnetic resonance imaging (MRI), in detection of dural venous sinus (DVS) and cortical venous thrombosis; secondary aim is to determine the relationship between DVS thrombosis/site and gender, age, infarction or hemorrhage. Methods We retrospectively reviewed conventional MR images, unenhanced MR venography and immediate post-contrast 3D GRE T1-weighted MR images in 30 patients (17 male and 13 female, 21–70 years old, mean age 40.1) with clinically suspected DVS thrombosis. MR examinations had been performed with 1.5T or 3T MR Scanners. DVSs were evaluated in 10 sub-segments, including cortical veins. Each set of MR images were examined separately, blinded to the final diagnosis. Associated findings were also noted and sensitivity, specificity and accuracy of each MRI technique were calculated. Results Final diagnosis of cortical venous and/or dural sinus thrombosis was established in 24 (80%) of 30 cases and 67 (22.3%) out of 300 segments. For detection of the thrombotic segment, sensitivity, specificity, and accuracy were 83.6%, 95.3%, and 92.7% by conventional MR sequences, 89.6%, 91.8%, and 91.3% by unenhanced MR venography, and 92.5%, 100%, and 98.3% by contrast-enhanced 3D GRE T1-weighted sequence, respectively. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis, while gender and age had no significant relation with DVS thrombosis or its site. Conventional MR sequences and unenhanced MR venography were helpful due to additional information they provided in some cases with isolated cortical venous thrombosis, with hyperintense thrombus material and with associated hemorrhage or infarction. Conclusion Contrast-enhanced 3D GRE T1-weighted MRI is the most accurate imaging method for the detection of DVS and/or cortical venous thrombosis. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis.

Introduction: Carotid artery dissection, an infrequent cause of transient ischemic attack and stroke among younger patients, is being increasingly diagnosed. Thromboembolic events occur following carotid artery dissection due to the narrowing of the lumen, which is a potentially life-threatening condition that can cause long-term neurological disabilities. We report a case with internal carotid artery dissection and emphasize the importance of differential diagnoses for headache and neck pain in the young and middle-aged population. Case Report: A 33-year-old female patient was admitted to the emergency department because of headache, neck pain, speech impairment, and weakness on her right side, which persisted for five hours. She had revealed signs of confusion for the last two hours. There was no history of trauma. We received the information from her husband. The neurological examination revealed a weakness on the right upper extremity and non-fluent aphasia. She had normal results from coagulation tests. Occlusion secondary to dissection with a cervical computed tomography angiography was indicated. Low molecular weight heparin and warfarin were administered. Conclusion: It should be kept in mind that carotid artery dissection can be asymptomatic until ischemic symptoms occur. Emergency physicians should consider carotid artery dissection in young patients who present with neck pain and headache

Introduction To discuss the accuracy of the whole-body diffusion-weighted imaging with background body signal suppression (WB-DWIBS) technique performed in the 3.0-T system. Methods We studied 17 patients who underwent positron emission tomography (PET)/CT and WB-DWIBS examinations for staging their diseases. The DWIBS pulse and echo-planar imaging-short T1 inversion recovery single-shot pulse sequences were performed for WB-DWIBS. A PET/CT scan was performed with 18-fluorodeoxyglucose. The lesions were localised and counted in both of the examinations, and WB-DWIBS was evaluated for the neoplastic tissue detection rate, while PET/CT was accepted as the reference standard modality. Results The WB-DWIBS scan had a room occupation time of 32–35 min. All of the metastasis positive patients (n = 12) detected with PET/CT were also detected with WB-DWIBS (100%). In our patient group, there were a total of 109 bone metastases on PET/CT scans, and 93 of them (85.3%) were demonstrated with WB-DWIBS. We detected 128 metastatic lymph nodes on PET/CT, and 123 of them (96.3%) were demonstrated with WB-DWIBS. There were a total of 17 liver metastases on PET/CT, and 15 of them (88.2%) were detected with WB-DWIBS. There was no statistically significant difference between the two imaging modalities in detecting bone, lymph node and liver metastases (P > 0.05). Conclusions WB-DWIBS is a non-invasive technique that may successfully detect the spreading of the tumoural tissue in cancer patients when compared with PET/CT.

Transarterial chemoembolization (TACE) is a widely used treatment choice for hepatocellular cancer. DC Bead microspheres are a new embolic material for TACE that doxorubicin can be loaded to. The tumor response rate of this well-tolerated treatment was changed between 60% and 81.8%. We report a case of ischemic cholecystitis after TACE with drug-eluting beads (DEB) that required cholecystectomy. The possibility of cholecystitis is always remembered during TACE-DEB for tumors in segment IV and/or V. Although selective catheterization is related with a lower risk for ischemic cholecystitis, the anatomic and vascular variability in patients with malignancy may lead to some unexpected conditions.

Popliteal artery entrapment syndrome (PAES) is a rare congenital vascular pathology caused by the compression of the popliteal artery by adjacent muscle and tendinous structures. Popliteal artery aneurysm associated with this syndrome is extremely rare. A 45-year-old male suffering from pain at the right lower extremity during exercise was admitted to our hospital. Physical examination and Doppler imaging revealed a weak pulse at the posterior tibial artery and no pulse at dorsalis pedis and anterior tibial arteries. The patient was further evaluated with multidetector computed tomography angiography (MDCTA). MDCTA revealed PAES due to compression of the accessory fibers of the gastrocnemius muscle and related thrombosed popliteal aneurysm.

OBJECTIVES The purposes of this study were to prospectively identify diuretic-induced renal length changes and to determine whether the percentages of the renal length changes allow estimation of the differential renal function. METHODS Twenty-three children (14 boys and 9 girls; mean age, 7.83 years) who were undergoing technetium Tc 99m diethylenetriamine pentaacetic acid or technetium Tc 99m mercaptoacetyltriglycine diuretic renography were included in this study. Renal lengths were measured by sonography just before and 15 to 20 minutes after diuretic injection. The Spearman test was used to assess the correlation between renal length increases due to diuretic injection and the differential renal function. RESULTS The mean renal lengths ± SD measured before and after diuretic administration were 91.52 ± 20.87 and 95.38 ± 21.46 mm, respectively. The increase in renal length after diuretic administration was statistically significant (P < .001). There was a positive correlation between the renal length change and functional status (P = .006). CONCLUSIONS Renal length may change after diuretic injection according to the functional status, and the sonographic measurements of these changes may be used as an alternative to other imaging methods in estimation of renal function.

In this paper, we report a case of a 23-year-old male patient with bilateral absence of the flexor pollicis brevis and abductor pollicis brevis muscles with an intact functioning opponens pollicis and flexor pollicis longus muscles with bilateral thenar atrophy due to its rarity. All physical, neurological, ultrasonographic, direct radiographic, electromyographic and MRI studies were used to confirm and document this congenital anomaly.

The aim of this study was to evaluate the number, course, width and location of nutrient artery canals of the femur by using multidetector computed tomography (MDCT). Sixty-six adult (35 right and 31 left) dry femurs were included in this study and scanned by MDCT. Nutrient artery canals were evaluated on the multi-planar reformatted and volume rendered images which were reproduced on the basis of axial images. The median value of nutrient artery canals was two (minimum 1 and maximum 6). We determined that there was a negative correlation between the number of nutrient canals and the canal diameters. The outer ostia of the nutrient artery canals were most frequently located at the middle third segment of femoral diaphysis (65%). While the vast majority of the canals were showing upward courses (95%), only a few canals were having transverse (3%) or downward (2%) courses. Most encountered location of outer ostia of the canals according to linea aspera was the medial lip of the linea aspera (44%). Various variations were demonstrated in the number, course, and location of nutrient artery canals using MDCT. In conclusion, the knowledge of the topographic features of the nutrient artery canals may be useful in various clinical implications such as bone grafting or radiologic evaluation for the fracture lines.

Objective: While developed countries do age estimation for the purpose of identifica - tion, in countries such as Turkey, it is used to determine the real age of a person with an already known identity because of inaccurate birth records. The aim of this article was to investigate whether the calcification degree of the first costal cartilage could be a marker for age determina - tion. Material and Methods: We retrospectively analyzed the postero-anterior chest x-rays of 471 patients (270 males, 201 females; mean age ± standard deviation 42.38±20.69 years) who presented to the radiology department for various reasons. The calcification degree of the right first costal cartilage was classified in four stages based on criteria used by Barchilon and Garamendi, and the patients were classified in seven groups regarding their ages. The correlation between the calcifi - cation stage of the right first costal cartilages and age group was analyzed by Spearman's rho. Re- sults: According to the first costal cartilage calcification stage, the mean ages were 5.56, 25.49, 45.39 and 66.02 at stage 0, 1, 2 and 3, respectively. The calcification degree of the right first costal carti - lage and age correlated significantly in males and females (Spearman's rho=0.904, p

Poster: "ECR 2011 / C-0036 / Feasibility of MR urography in patients with urinary diversion " by: " B. Battal , M. Kocaoglu, E. Aydur, M. Dayanc, A. T. Ilica; Ankara/TR"

Cerebrospinal fluid (CSF) spaces include ventricles and cerebral and spinal subarachnoid spaces. CSF motion is a combined effect of CSF production rate and superimposed cardiac pulsations. Knowledge of CSF dynamics has benefited considerably from the development of phase-contrast (PC) MRI. There are several disorders such as communicating and non-communicating hydrocephalus, Chiari malformation, syringomyelic cyst and arachnoid cyst that can change the CSF dynamics. The aims of this pictorial review are to outline the PC MRI technique, CSF physiology and cerebrospinal space anatomy, to describe a group of congenital and acquired disorders that can alter the CSF dynamics, and to assess the use of PC MRI in the assessment of various central nervous system abnormalities.

The purpose of this study was to reveal the association whether the distal morphometry of femur had a relation with femur height or width. Sixty-six adult (35 right and 31 left) dry femurs from Caucasians were used in this study. Computed tomography (CT) imaging was applied to obtain measurement values of the femur. Femur height (413.29 ± 28.40 mm) and width (29.86 ± 2.72 mm) were all checked one by one to determine the correlation with the parameters obtained. Both values exposed high rates of correlation with height (26 ± 2.34 mm) and width (20.85 ± 2.76 mm) of femur notch; also, measures of epicondylar, bicondylar and condylar diameters of femur were obtained. Measures were checked if there was a correlation with femur height and width. Differences displayed in distal morphometry of femur according to race and sex are due to other morphometric measures of femur rather than race and sex. We believe that displaying the high rates of correlation of distal morphometry of femur with femur height and width will be the factor which determines the selection and production of prosthesis among the long or short individuals of folks.

Objectives The objective of the study was to assess the value of visual assessment of signal intensities on b800 diffusion-weighted images and apparent diffusion coefficient (ADC) maps in differentiation of benign and malignant focal liver lesions (FLLs). Methods Approval for this retrospective study was obtained from the institutional review board. One hundred forty-three FLLs in 65 patients (38 women, 27 men; mean age, 50.8 years) underwent magnetic resonance (MR) imaging and diffusion-weighted imaging (DWI) with a respiratory-triggered single-shot echo-planar imaging sequence. Focal liver lesions were evaluated visually according to the signal intensities on b800 and ADC map images, and ADC values were also calculated. The conventional MR imaging, follow-up imaging findings, and histopathologic data were regarded as gold standard. Normal distribution was assessed with Kolmogorov-Smirnov test. The accuracies of visual assessment and ADC values in differentiating benign and malignant FLLs were assessed with the Student t test, and threshold values were determined with receiver operating characteristic curve analysis. Results By using a cutoff value of 1.21 × 10⁻³ mm²/s, ADC had a sensitivity of 100%, a specificity of 89.3%, and an accuracy of 92.3% in the discrimination of malignant FLLs. With the visual assessment of the DWIs and ADC maps, malignant lesions were differentiated from benign ones, with 100% sensitivity, 92.2% specificity, and 94.4% accuracy. Although some benign lesions were interpreted as malignant, no malignant lesion was determined as benign in visual assessment. Conclusions Most FLLs are benign ones such as hemangiomas and cysts, which can be readily and practically characterized only by using visual assessment of DWIs without requiring time-consuming conventional and dynamic contrast-enhanced imaging sequences. Some benign lesions that are falsely interpreted as malignant can be further characterized by using conventional and contrast-enhanced MR studies.

OBJECTIVE To determine the normal anatomical features and variations of the bronchial arterial system and to determine the relationship among ectopic bronchial arteries, location (right-left) of the bronchial arteries, and variations of the aortic arch in patients as well as the sex of the patients who underwent multidetector computed tomographic angiography of the thorax for various reasons. METHODS A total of 163 patients who underwent multidetector computed tomographic angiography of the thoracic vascular structures for various reasons were analyzed retrospectively. The right and left bronchial arteries were analyzed individually, and normal anatomic features and variations were recorded. The χ and Mann-Whitney U tests were used to evaluate relationships among the patients' sex, side and number of the bronchial arteries, aortic arch variations, and bronchial artery variations. RESULTS There were 432 bronchial arteries (right, 229; left, 203) in 163 patients (117 men, 46 women; mean age, 51.7 years). All of the patients have at least one bronchial artery (mean, 2.65; maximum, 5). The number and diameters of the bronchial arteries were statistically higher on the right side. The number of the bronchial arteries was significantly higher in the men (P < 0.05). Ectopic bronchial arteries were present in 43 (26.4%) of the 163 patients. Aortic arch variations were present in 27 (22.5%) of 120 patients with normal bronchial arteries and in 11 (25.6%) of the 43 patients with ectopic bronchial arteries. There was no statistically significant correlation between aortic arch variations and ectopic bronchial arteries (P = 0.861). CONCLUSIONS The anatomic features of the bronchial arteries show differences between individuals and the sexes. Multidetector computed tomographic angiography allows a precise and detailed evaluation of bronchial arterial system.

Various types of lesions can occur within the corpus callosum (CC) which is a white matter tract communicating corresponding regions of the cerebral hemispheres. Magnetic resonance imaging is the modality of choice for the evaluation of the CC. In addition, diffusion weighted imaging and diffusion tensor imaging can provide additional information about the CC. The aim of this study is to illustrate the imaging features of the corpus callosum and its pathologies.

Aberrant bronchial arteries are rarely seen and may originate from various vascular structures. In our case, a 48-year-old man with recurrent chest pain underwent multidetector CT (MDCT) coronary angiography. MDCT images demonstrated an aberrant right bronchial artery originating from the right coronary artery. To our knowledge, this is the first case report of an aberrant right bronchial artery originating from the right coronary artery.

Peliosis is a rare benign disorder that is characterized by the presence of diffuse blood-filled cystic spaces and can occur in the liver, spleen, bone-marrow, and lungs. We present a 10-year-old boy with Fanconi anemia who presented with peliosis hepatis due to androgen treatment. Magnetic resonance (MR) imaging revealed multiple non-enhancing masses. Some of the lesions revealed fluid-fluid levels and extrahepatic extension on MR images. Diffusion-weighted (DW) imaging showed restricted diffusion. Fluid-fluid levels and extrahepatic extensions are unusual findings for hepatic peliotic lesions. In addition, DW imaging findings of peliosis hepatis have not been reported previously.

The purpose of this study was to investigate the effect of hyperbaric oxygen (HBO) treatment on flow-mediated vasodilation (FMD) by ultrasound examination.We studied 14 young patients without cardiovascular problems who underwent HBO treatment. The indications for HBO treatment were osteomyelitis (n = 8), Crohn disease (n = 2), perianal abscesses (n = 2), lingual artery embolization (n = 1), and aseptic necrosis (n = 1). The ultrasound evaluation for FMD was performed before HBO treatment, after 1 session of HBO treatment, and after 10 sessions of HBO treatment. The right brachial artery FMD response was evaluated by the mean of the baseline right brachial artery diameter, absolute change in the diameter before and after cuff inflation/deflation, and percent change in the diameter.Statistical analysis showed a significant change in the preinflation right brachial artery diameter before (mean +/- SD, 3.6 +/- 0.54 mm) and after (3.76 +/- 0.56 mm) 10 sessions of HBO treatment (P.05). The absolute changes in the right brachial artery diameter before and after cuff inflation/deflation (0.36 +/- 0.2 mm before HBO treatment, 0.37 +/- 0.22 mm after 1 session of HBO treatment, and 0.38 +/- 0.21 mm after 10 sessions) and percent change in FMD (10% +/- 5.8% before HBO treatment, 10.6% +/- 7.5% after 1 session of HBO treatment, and 10.6% +/- 7.7% after 10 sessions) after induction of a hyperemic response by cuff inflation were not statistically significant (P.05).Hyperbaric oxygen treatment did not have an immediate effect on FMD (absolute change in the right brachial artery diameter after cuff inflation/deflation); however, the right brachial artery diameter increased after 10 sessions of HBO treatment. This may suggest chronic stress on the vascular endothelium after HBO.

Several vascular abnormalities related with urinary system such as crossing accessory renal vessels, retroiliac ureters, retrocaval ureters, posterior nutcracker syndrome, and ovarian vein syndrome may be responsible for urinary collecting system obstruction. Split-bolus magnetic resonance urography (MRU) using contrast material as two separate bolus injections provides superior demonstration of the collecting system and obstructing vascular anomalies simultaneously and enables accurate preoperative radiologic diagnosis. In this pictorial review we aimed to outline the split-bolus MRU technique in children, list the coexisting congenital collecting system and vascular abnormalities, and exhibit the split-bolus MRU appearances of concurrent urinary collecting system and vascular abnormalities.

Pneumothorax (PTX) is rarely reported in patients receiving hyperbaric oxygen (HBO2) therapy. Patients with air-trapping lesions in the lungs and those with a history of spontaneous PTX, lung disease, mechanical ventilation or chest trauma are at an increased risk for PTX during HBO2 therapy. A 28-year-old male earthquake survivor was referred to our center for multiple wounds 21 days after being rescued from the debris. He had been intubated and put on mechanical ventilation for three days because of adult respiratory distress syndrome (ARDS). At initial presentation, he was conscious, well-oriented and hemodynamically stable. The initial six HBO2 treatments were uneventful. On the seventh HBO2 treatment, the patient lost consciousness and developed cardiopulmonary arrest near the end of decompression. The HBO2 specialist accompanying the patient inside the chamber immediately initiated CPR. A diagnosis of tension PTX was made. After the patient was removed from the chamber, a chest tube was inserted, which improved the symptoms. Although rare, tension PTX can occur during HBO2 therapy. Early diagnosis and intervention are crucial for saving a patient's life. Increased vigilance is required during treatment of patients with risk factors for PTX.

We describe a patient with Burkitt lymphoma who developed carotidynia. MRI showed thickening of the walls of both common carotid arteries and PET CT showed increased radiotracer uptake in the same regions. MRI was essential in establishing the diagnosis of this rare clinical presentation.

The anterior inferior cerebellar artery (AICA) arises from the lower side of the basilar artery and supplies blood to the rostral olfactory bulb, rostral pontine base, and cerebellar regions. The AICA syndrome was first defined by Adams in 1943. Here, we present a case of a patient with a left AICA occlusion who suddenly started experiencing dizziness and had abnormal gait; he was subsequently diagnosed with ischemia in the left cerebellar hemisphere. A 55-year-old man was admitted to the hospital with complaints of sudden onset of vertigo, speech disorder, and imbalance. The neurological examination revealed gait disturbance, and left-sided ataxia. In addition, dysarthric speech left peripheral facial paralysis, loss of pain and heat sensations in the left half of the face and right half of the body. Bilateral horizontal nystagmus was observed. Babinski and Hoffman signs were also observed on the left side. The patient was evaluated with diffusion weighted (DW) magnetic resonance (MR) imaging. On DW image and apparent diffusion coefficient (ADC) maps precisely determined diffusion restrictions in the antero-inferior part of the left cerebellar hemisphere and the left part of the inferior vermis. MR angiography revealed occlusions in the right internal carotid artery and left AICA; hence, he was administered antiagregan treatment. We have presented this case because infarctions in the AICA have different clinical features from those observed in other cerebellar arteries, and such cases are rarely observed in neurological practice.

WOS: 000351966100008 PubMed ID: 25475850 The aims of this study were to evaluate volumetric changes in the nasal cavity (NC) and pharyngeal airway space (PAS) after Le Fort I maxillary distraction osteogenesis (MDO) using a three-dimensional (3D) simulation program, and to determine the effects of MDO on respiratory function during sleep with polysomnography (PSG). 3D computed tomography images were obtained and analyzed before surgery (T0) and at a mean 8.2 +/- 1.2 months postsurgery (T1) (SimPlant-OMS software) for 11 male patients (mean age 25.3 +/- 5.9 years) with severe skeletal class III anomalies related to maxillary retrognathia. The simulation of osteotomies and placement of distractors were performed on stereolithographic 3D models. NC and PAS were segmented separately on these models for comparison of changes between TO and T1. PSG including the apnoea hypopnoea index (AHI), sleep efficiency, sleep stages (weakness, stages 1-4, and rapid eye movement (REM)), and mean lowest arterial O-2 saturation were obtained at TO and T1 to investigate changes in respiratory function during sleep. MDO was successful in all cases as planned on the models; the average forward movement at A point was 10.2 mm. Increases in NC and PAS volume after MDO were statistically significant. These increases resulted in significant improvement in sleep quality. PSG parameters changed after MDO; AHI and sleep stages weakness, 1, and 2 decreased, whereas REM, stages 3 and 4, sleep efficiency, and mean O-2 saturation increased.

Aort koarktasyonu, yasam beklentisini dusuren, ciddi klinik sonuclar dogurabilen, tedavi edilmediginde yuksek mortalite ve morbiditeye neden olan konjenital bir hastaliktir. Gunumuzde bu patolojinin tedavisinde cerrahi duzeltme, perkutan yaklasim ile balon dilatasyonu ve stent yerlestirme uygulamalari etkin olarak kullanilmaktadir. Perkutan girisim ile stent yerlestirilmesi koarktasyonun tedavisinde en az invaziv yontem olsa da, hem cerrahi duzeltme islemlerinin hem de perkutan tedavinin cesitli komplikasyonlari raporlanmistir. Cok kesitli bilgisayarli tomografi (CKBT) anjiyografi bu hastalarda islem sonrasi koarktasyon alaninin kontrolu ve olasi komplikasyonlarin degerlendirilmesinde guvenle kullanilabilecek etkin bir radyolojik goruntuleme yontemidir. Bu yazida, femoral ve sol brakiyal arter yoluyla girisim yapilarak basarili sekilde perkutan stent tedavisi uygulanan aort koarktasyonlu bir olguda endotel hasari ve/veya lokal vazokonstruksiyona ikincil olustugu degerlendirilen trombotik sol brakiyal arter okluzyonunun CKBT anjiyografi bulgularini sunmayi amacladik. CKBT anjiyografi ayni anda hem stent alaninin hem de brakiyal arter okluzyonunun degerlendirilmesine olanak saglayarak taniya ve tedavi planlamasina onemli katkida bulunmustur

To present postoperative cardiac magnetic resonance (CMR) imaging features of cases of surgically repaired tetralogy of Fallot (TOF) and to evaluate the relationship among data used in follow-up procedures, such as right ventricular ejection fraction (RV-EF), pulmonary regurgitation fraction (PRF), and the degree of right ventricular (RV) dysfunction. Materials and methods: Fourteen patients (9 males and 5 females; mean age 11.9 ± 3.6 years) with surgically repaired TOF who were admitted to our clinic for follow-up CMR imaging between July 2008 and September 2011 were included in the study. A protocol that consisted of cine steady-state free precession (SSFP) and velocity-encoding phase-contrast and contrast-enhanced MR angiography techniques was performed for every patient with 1.5-T equipment. PRF, RV function, and vascular pathologies were evaluated with phase-contrast velocity-encoding MR technique, cine SSFP sequence, and contrast-enhanced MR angiography, respectively. The relationship among RV-EF, PRF, and the degree of RV dysfunction were evaluated by using chi-square and Mann–Whitney U tests. Results: Various findings such as pulmonary regurgitation, decreased RV-EF, RV enlargement, increased trabeculation of RV wall, deterioration of the RV function, RV outflow tract dilatation, dyskinesia of the interventricular septum, and tricuspid regurgitation were observed. Mean PRF was 41.4 ± 5.4% (range: 29% to 48%), while mean RV-EF was 42.3 ± 9.2% (range: 29.3% to 58.5%). There was no statistically significant relationship between the degree of PRF and the degree of RV dysfunction (P = 0.147, chi-square test, Spearman's rho= -0.158). Conclusion: CMR imaging is an adequate method in follow-up of quantitative measurements of parameters such as PRF and RV dysfunction in addition to morphological features, and in determination of the possible complications in patients with surgically repaired TOF. In these patients, the degree of PRF does not correlate with the degree of RV dysfunction.

Sir d We read the recent article by Schmid-Tannwald et al., 1 published in the Journal with a great interest. In this article, the authors discussed the role of quantitative and qualitative assessment of diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) maps in infected and non-infected collections in the liver. As we have a special interest in DW imaging in the characterization of liver lesions, 2e6 we would like to contribute regarding the efficacy of DW imaging and ADC measurement in the evaluation of the hepatic abscess and noninfected fluid collection. As the authors mentioned in the article, ADC values of each lesion were measured by drawing a circular region of interest (ROI), encompassing the entire lesion, on the image in which the lesion was largest. We think that ADC measurement must be performed several times with using small ROIs in different regions and the lowest ADC value must be take into consideration. 2e6 In our clinical practice, we noticed that ROIs encompassing the entire lesion can lead to misinterpretation of the ADC value of the lesion, particularly in those with different components such as necrotic, cystic, infected, or neoplastic tissue. Those areas with high ADC values can increase the mean ADC value of the lesion and can lead to misinterpretation. Another issue is the visual assessment of the DW images and ADC maps, which provides easy and confident evaluation of the solidecystic and simpleecomplicated focal liver lesions. Particularly, in hepatic abscess, central diffusion restriction and peripherally relative increased diffusion in DW images and ADC maps are unique findings and these features can be easily evaluated by visual assessment without time-consuming ADC measurements. Visual assessment is also useful for overcoming the reproducibility problems associated with DW imaging in the liver due different magnetic resonance imaging (MRI) machines, sequence parameters, and differences in ADC values in different parts of the liver.2,4e6

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) is a rare but very serious congenital coronary artery anomaly. Multidetector computed tomography (MDCT) coronary angiography has recently become the gold standard for depicting anatomical variations and anomalies of the coronary arteries because the origin and course of anomalous arteries can be demonstrated very accurately by this technique. In this report, we present a case of 22-year-old female who was admitted to our emergency department with cardiac arrest. In the course of diagnosis, MDCT coronary angiography revealed a left coronary artery arising from the pulmonary artery as well as marked dilatation of the coronary arteries.

This study aimed to investigate the clinical outcome of nasal septal surgery at altitude of 2,200 m. The study is a retrospective medical record review. Medical records of 137 patients were investigated in this study; 105 of these patients received septoplasty procedure and 32 received septorhinoplasty procedure at altitude of 2,200 m. Improvement of nasal obstruction was found in 79.6% and no change was seen in 20.4% of the patients. Complications were seen in 30.7%. The most frequent complication was persistent nasal obstruction. Outcomes of nasal septal surgery at high altitude were similar with previous studies done at low altitudes. Although high-altitude environmental factors may result in a number of clinical conditions, high-altitude conditions does not make a significant difference in the outcome of nasal septal surgery.

Brain herniations into dural venous sinuses (DVS) are rare findings recently described and their etiology and clinical significance are controversial. We describe five patients with brain herniations into the DVS or calvarium identified on MRI, and discuss their imaging findings, possible causes, and relationship to the patient's symptoms. All patients were examined with MRI including high resolution pre- and post-contrast T1- and T2-weighted sequences. With respect to brain herniations we documented their locations, signal intensities in different sequences, and size. We then reviewed clinical records in an attempt to establish if any symptoms were related to the presence of these herniations. Three males and two females were examined (age range, 11–68 years). Three patients had unilateral temporal lobe herniations into transverse sinuses, one had a cerebellar herniation into the skull, and one had bilateral temporal lobe herniations into the transverse sinuses as well as a cerebellar herniation into the sigmoid sinus. In all, the herniated brain and surrounding cerebrospinal fluid (CSF) had normal signal intensity on all MRI sequences. When correlated with clinical symptoms, brain herniations were thought to be incidental and asymptomatic in three patients and two patients had histories of headaches. Brain herniations with surrounding CSF into the DVS/skull should be considered potential sources of filling defects in the DVS. We believe that they are probably incidental findings that may be more common than previously recognized and should be not confused with the more common arachnoid granulations, clots, or tumors. Two patients had headaches, but their relation to the presence of herniated brain was uncertain.

Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. Multiple treatment options are available for HCC including curative resection, liver transplantation, radiofrequency ablation, trans-arterial chemoembolization, radioembolization and systemic targeted agent like sorafenib. The treatment of HCC depends on the tumor stage, patient performance status and liver function reserve and requires a multidisciplinary approach. In the past few years with significant advances in surgical treatments and locoregional therapies, the short-term survival of HCC has improved but the recurrent disease remains a big problem. The pathogenesis of HCC is a multistep and complex process, wherein angiogenesis plays an important role. For patients with advanced disease, sorafenib is the only approved therapy, but novel systemic molecular targeted agents and their combinations are emerging. This article provides an overview of treatment of early and advanced stage HCC based on our extensive review of relevant literature.