Is the brain spared in Crimean-Congo haemorrhagic fever? An MR-SWI study to reveal CNS involvement.

OBJECTIVES: The aim of this prospective study is to investigate the central nervous system involvement in Crimean-Congo haemorrhagic fever (CCHF) with magnetic resonance imaging (MRI) in conjunction with clinical and laboratory findings. METHODS: Between July 2015 and August 2016, 36 patients with CCHF were undergone brain MRI including SWI. Two MRIs, one at the time of admission and the second in the convalescent period, were performed for each patient in order to see if there is any sign of central nervous system (CNS) involvement, especially in terms of intracranial haemorrhage or viral encephalitis. Clinical severity scoring was also done and laboratory findings were noted in order to correlate with clinical and imaging findings. RESULTS: None of the 36 patients showed any MRI findings of an acute intracranial event during the course of the disease. There was a significant difference between mild cases and moderate cases in terms of some laboratory parameters (p < 0.05). CONCLUSIONS: Although CCHF is a highly lethal disease which involves multiple organs and systems, CNS involvement seems to be extremely rare in mild and moderate cases. KEY POINTS: • MRI is the imaging method of choice to diagnose microbleeds and encephalitis • Although CCHF causes multisystem bleeding, intracranial haemorrhage seems to be very rare • CNS complications are uncommon, even in the setting of suggestive symptoms • Death usually results from extracranial bleeding and multiorgan failure • Severity scoring is associated with some laboratory abnormalities in CCHF.

The Role of Triangular Vertebral Canal Shape in Surgical Management of Patients with Lumbar Spinal Stenosis: A Cross-Sectional Study.

AIM: We assessed the role of triangular vertebral canal shape (VCS) in pain severity, pain-related findings, and postoperative satisfaction in patients with lumbar spinal stenosis (LSS) who had undergone decompressive surgery. MATERIAL AND METHODS: This cross-sectional study conducted at a single center included 61 consecutive patients who had undergone surgical treatment for LSS. By comparing pre- and postoperative data, the role of triangular VCS in pain severity [assessed using a visual analog scale (VAS)], pain-related findings, and postoperative satisfaction of patients was examined. VCS was determined to be triangular, oval, or circular based on magnetic resonance imaging (MRI) and magnetic resonance myelography (MRM) findings. RESULTS: Preoperative VAS scores of patients with triangular VCS were significantly higher than those of patients with oval and circular VCSs (P 0.05). No significant difference was found in postoperative VAS scores among patients with triangular, oval, and circular VCSs. In all subgroups, postoperative VAS scores were significantly lower than preoperative scores (P 0.05). This postoperative decrease in VAS scores was significantly higher among patients with triangular VCS than in those with oval or circular VCS (P 0.05). CONCLUSION: Combined use of MRI and MRM can be recommended for symptomatic patients when planning surgery. Although pain severity decreased postoperatively in all patients, this decrease was more pronounced in patients with triangular VCS than in those with oval or circular VCS. During preoperative counseling of patients with LSS, the presence of triangular VCS should be considered. This may improve surgical outcome and patient satisfaction.

Prominent cerebral veins on susceptibility-weighted imaging (SWI) in pulmonary embolism.

OBJECTIVES: Clinical applications of susceptibility-weighted imaging (SWI) are increasing steadily. The aim of this study is to investigate the appearance of cerebral veins on SWI, which is very sensitive to the deoxyhaemoglobin level in vessels, in pulmonary embolism (PE). METHODS: The cranial SWI images of 19 patients with PE and 22 controls from September 2013 through March 2016 were retrospectively examined for the presence of prominent cerebral veins. MRI findings were correlated with blood oxygen levels. RESULTS: 12 of 19 patients with PE had hypoxemia and SWI images of 11 of these hypoxemic patients depicted prominent cerebral veins in the form of increased number, diameter, and elongation. The mean PaO2 and SaO2 in these patients were 48.5 ± 9.1 mmHg and 75.2 ± 8.0 %, respectively. There was a significant correlation between the presence of prominent veins on SWI and hypoxemia (p < 0.05). Of the 7 patients with normal blood oxygen pressure and saturation, 1 also showed an augmented appearance of cerebral veins on SWI. CONCLUSIONS: In the presence of neurological symptoms suggestive of an intracranial pathology in patients with PE, a SWI added to the conventional MRI sequences may predict hypoxemia and exclude other intracranial pathologies. KEY POINTS: • Patients with PE may exhibit nonspecific symptoms suggestive of an intracranial pathology. • A cerebral venous prominence on SWI should raise the suspicion of hypoxia. • SWI-mIP images intensify the appearance of veins and help distinguish other hypointensities.

Sonographic evaluation of jugulodigastric and juguloomohyoid lymph nodes.

The jugulodigastric (JD) and juguloomohyoid (JO) lymph nodes are levels II and III cervical lymph nodes corresponding to the upper and middle internal jugular chains, respectively. The aim of this study is to delineate the sonographic properties of these two nodes, which are commonly encountered in routine neck sonography, in subjects with normal neck ultrasound findings. Atypical findings can make it difficult to differentiate benign from malignant lymph nodes. The JD and JO lymph nodes of 126 subjects were examined by ultrasonography, and size, shape, presence of echogenic hilus and Doppler activity were recorded. Among the lymph nodes examined, 31.6% were not elliptical. Proportionally more of the JO than the JD nodes were round; there was a significant difference in roundness index between them (P < 0.05). An echogenic hilus was demonstrated in 223 of the 252 JD nodes and in 161 of the 252 JO nodes. Significantly more of the lymph nodes with roundness index <2 lacked a visible echogenic hilus. There was a positive correlation between the visibility of an echogenic hilus and Doppler activity. Normal jugulodigastric and juguloomohyoid lymph nodes are relatively prominent in the upper and middle jugular chains, respectively. Awareness of variations in the sonographic appearance of these nodes could preclude unnecessary procedures. Clin. Anat. 29:943-948, 2016. © 2016 Wiley Periodicals, Inc.

The relationship of patent foramen ovale location with severity of stroke: A new risk factor for paradoxical embolism.

OBJECTIVE: Patent foramen ovale (PFO) is a common developmental anomaly and is well associated with paradoxical embolism and cryptogenic stroke. The aim of this study was to investigate the relationship of PFO location with severity of cryptogenic stroke. MATERIALS AND METHODS: Fifty patients with cryptogenic stroke and echocardiographically proven PFO were classified according to the severity of stroke. In order to define the location of PFOs, an imaginary line dividing the length of interatrial septum vertically into two equal parts was drawn manually at axial plane on cardiac multidetector computed tomography. PFOs located at superior part of this imaginary line was defined as superiorly located PFO, while PFOs located at inferior part of this imaginary line was defined as inferiorly located PFO. RESULTS: Fourteen patients (28%) revealed mild, 20 patients (40%) revealed moderate and 16 patients (32%) had severe stroke. Based on PFO location, there were 34 patients (68%) with superiorly (group 1), and 16 patients (32%) with inferiorly (group 2) located PFO. It was found that patients of group 1 had significantly higher frequency of moderate or severe stroke compared to those of group 2 (p < 0.005) CONCLUSION: In conclusion, the patients with superiorly located PFO had higher frequency of severe stroke compared to the patients with inferiorly located PFO. Since this is a preliminary study, clinical application and importance of this finding necessitates further large-scale interventional studies.

A DWI study of the contralateral hemisphere in cerebral hemiatrophy.

BACKGROUND AND AIM: Cerebral hemiatrophy (CHA) is a congenital or acquired loss of volume in one hemisphere of the brain. The MR findings of the affected hemisphere have been a subject of many studies, however, the contralateral hemisphere has not been investigated. There is, in fact, an integrity between two hemispheres of the brain through transverse connection fibers. The aim of this study is to investigate the changes in the contralateral hemisphere in CHA. MATERIALS AND METHODS: Apparent diffusion coefficient (ADC) values were measured in deep gray and white matter areas in the normal-appearing contralateral hemisphere in 23 patients with CHA, in order to get in vivo information about a possible Wallerian degeneration or microstructural changes. Results were compared with the control group. RESULTS: Normal ADC values were encountered in the contralateral hemisphere in all (100%) CHA patients. The difference between the ADC values of gray and white matter in CHA patients and the control group was not statistically significant. CONCLUSION: Normal ADC values in the contralateral hemisphere in CHA patients suggests a compensatory mechanism restricting Wallerian degeneration or diffusion alteration.

The negative prognostic impact of bone metastasis with a tumor mass.

OBJECTIVE: Typically, bone metastasis causes osteolytic and osteoblastic lesions resulting from the interactions of tumor cells with osteoclasts and osteoblasts. In addition to these interactions, tumor tissues may grow inside bones and cause mass lesions. In the present study, we aimed to demonstrate the negative impact of a tumor mass in a large cohort of patients with bone metastatic cancer. METHODS: Data from 335 patients with bone metastases were retrospectively reviewed. For the analysis, all patients were divided into three subgroups with respect to the type of bone metastasis: osteolytic, osteoblastic, or mixed. The patients were subsequently categorized as having bone metastasis with or without a tumor mass, and statistically significant differences in median survival and 2-year overall survival were observed between these patients (the median survival and 2-year overall survival were respectively 3 months and 16% in patients with a tumor mass and 11 months and 26% in patients without a tumor mass; p<0.001). RESULTS: According to multivariate analysis, the presence of bone metastasis with a tumor mass was found to be an independent prognostic factor (p=0.011, hazard ratio: 1.62, 95% confidence interval: 1.11-1.76). Bone metastasis with a tumor mass was more strongly associated with osteolytic lesions, other primary diseases (except for primary breast and prostate cancers), and spinal cord compression. CONCLUSION: Bone metastasis with a tumor mass is a strong and independent negative prognostic factor for survival in cancer patients.

The negative prognostic impact of bone metastasis with a tumor mass

OBJECTIVE: Typically, bone metastasis causes osteolytic and osteoblastic lesions resulting from the interactions of tumor cells with osteoclasts and osteoblasts. In addition to these interactions, tumor tissues may grow inside bones and cause mass lesions. In the present study, we aimed to demonstrate the negative impact of a tumor mass in a large cohort of patients with bone metastatic cancer. METHODS: Data from 335 patients with bone metastases were retrospectively reviewed. For the analysis, all patients were divided into three subgroups with respect to the type of bone metastasis: osteolytic, osteoblastic, or mixed. The patients were subsequently categorized as having bone metastasis with or without a tumor mass, and statistically significant differences in median survival and 2-year overall survival were observed between these patients (the median survival and 2-year overall survival were respectively 3 months and 16% in patients with a tumor mass and 11 months and 26% in patients without a tumor mass; p<0.001). RESULTS: According to multivariate analysis, the presence of bone metastasis with a tumor mass was found to be an independent prognostic factor (p=0.011, hazard ratio: 1.62, 95% confidence interval: 1.11–1.76). Bone metastasis with a tumor mass was more strongly associated with osteolytic lesions, other primary diseases (except for primary breast and prostate cancers), and spinal cord compression. CONCLUSION: Bone metastasis with a tumor mass is a strong and independent negative prognostic factor for survival in cancer patients. .

Exploration of orbital and orbital soft-tissue volume changes with gender and body parameters using magnetic resonance imaging.

The aim of the present study was to examine the total orbital volume (TOV) and total orbital fat volume (TOFV) in normal orbits in different age groups and to investigate the correlation of these measurements with age, gender and body parameters by magnetic resonance imaging (MRI). MRI data were acquired retrospectively from a total of 1,453 subjects divided into five age groups with 10-year intervals. The TOV and TOFV were measured using T1-weighted MRI for each subject and body parameters were also obtained. The measurements demonstrated that TOV increased with age and that the volume was larger in men than in women. While weight and height exhibited positive correlations with TOV in male and female subjects in the 20-29, 30-39 and 40-49-year-old age groups, only weight showed a positive correlation with TOV in female subjects in the 50-59 and 60-69-year-old age groups. However, TOFV increased by age in all groups and the increments were larger in women than in men. These results provide basic information about the effect of age, gender and body parameters on TOV and TOFV. The variations in TOV are associated with orbital soft-tissues changes rather than with TOFV.

Role of thalamic diffusion for disease differentiation between multiple sclerosis and ischemic cerebral small vessel disease.

INTRODUCTION: Cerebral small vessel disease (CSVD) and multiple sclerosis (MS) both harbor multiple, T2-hyperintense white matter lesions on conventional magnetic resonance imaging (MRI).We aimed to determine the microstructural changes via diffusion-weighted imaging (DWI) in normal appearing thalami. We hypothesized that the apparent diffusion coefficient (ADC) values would be different in CSVD and MS, since the extent of arterial involvement is different in these two diseases. METHODS: DWI was performed for 50 patients with CSVD and 35 patients with MS along with gender- and age-matched controls whose conventional MRI revealed normal findings. DWI was done with 1.5 Tesla MR devices using echo planar imaging (EPI) for b = 0, 1000 s/mm(2). ADC values were obtained from the thalami which appeared normal on T2-weighted and FLAIR images. Standard oval regions of interest (ROIs) of 0.5 cm(2) which were oriented parallel to the long axis of the thalamus were used for this purpose. RESULTS: The mean ADC value of the thalamus was (0.99 ± 0.16) × 10(-3) mm(2)/s in patients with CSVD, whereas the mean ADC value was (0.78 ± 0.06) × 10(-3) mm(2)/s in the control group. The mean ADC value was significantly higher in patients with CSVD compared to the controls (p < 0.001). The mean ADC values of the thalamus were (0.78 ± 0.08) × 10(-3) mm(2)/s in MS patients, and (0.75 ± 0.08) × 10(-3) mm(2)/s in the control group, which are not significantly different (p > 0.05). CONCLUSION: Our study revealed a difference in the diffusion of the thalami between CSVD and MS. DWI may aid in the radiological disease differentiation.

A rare cause of pleural effusion: ruptured primary pleural hydatid cyst.

Hydatidosis is an endemic parasitic disease in Mediterranean countries, often caused by the dog tapeworm Echinococcus granulosus. The disease predominantly affects the liver (60-70%) and lungs (30%), and the surgical management is considered as the gold standard for treatment. Besides anaphylactic reactions, the most frequent complication of the hydatid disease is rupture into neighbouring structures, often affecting the bronchi, gastrointestinal tract and peritoneal/pleural cavities, according to its location. Primary pleural hydatidosis is an extremely rare entity and we present a ruptured pleural hydatid cyst with unusual location.

Multidetector computed tomographic angiography findings in a rare case of popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome (PAES) is a disorder of the young age group characterized by ischemia of the lower extremities due to an abnormal association between the popliteal artery and adjacent musculotendinous structures. Several underlying anatomical abnormalities causing this syndrome are described and classified. In this study, we present an unusual case of PAES along with multidetector computed tomographic angiography findings.

[Diffuse cerebrovascular air embolism on CT secondary to cardiopulmonary resuscitation]. / Kardiyopulmoner resüsitasyon sonrasi BT'de saptanan difüz serebrovasküler hava embolizmi.

Air embolism is known to be a complicating factor in several clinical settings, including thoracic, cardiovascular and neurosurgical operations, central line placement, penetrating thoracic and cranial trauma and haemodialysis. Computed tomography (CT) is useful for showing cerebral air embolism. However, CT demonstration of massive air in all of the major cerebral arteries is extremely rare. In this report, we present a 45-year-old woman with cerebrovascular pneumoangiogram on postmortem CT examination after an unsuccessful posttraumatic cardiopulmonary resuscitation and discuss the possible mechanisms of pneumoangiogram.

Complicated giant polycystic ovary mimicking tumor: MR imaging findings.

A previously healthy 14-year-old girl presented with a 1-year history of abdominal pain that had worsened during the past 4 days. She had a right lower abdominal mass that was initially diagnosed as an ovarian tumor. MR imaging revealed a unilaterally enlarged and partially torted left polycystic ovary. Polycystic ovary is a common cause of increased ovarian volume in women of reproductive age. It is characterized by numerous small peripherally located follicles and increased stroma. It may mimic a neoplasm and lead to difficulties in diagnosis. In this case report, we discuss the unusual MR imaging findings and the pitfalls in diagnosis.