Comprehension of Cochlear Duct Length for Incomplete Partition Types.

OBJECTIVE: Preoperative assessment of the cochlear duct length (CDL) and cochlear dimensions allows the selection of optimized implants. We aimed to evaluate the CDL measurements in incomplete partition (IP) defect patients and to create a reference to the literature. METHODS: Forty-one patients with IP (13 IP I, 23 IP II, and 5 IP III) and 30 controls were included in the study. The standardized cochlear image showing the basal turn in the most expansive plane was reconstructed from temporal high-resolution computed tomography images. Cochlear duct length measured manually (CDL-M) was measured by points placed consecutively on the lateral wall of the cochlea. The defined equations for estimating CDL (CDL measured according to Schurzig et al formula [CDL-Ɵ], CDL measured according to Escudé et al formula [CDL-E], CDL measured according to Alexiades et al formula [CDL-A]) were calculated from the same images. Cochlear duct length mean values obtained by each method were compared for each IP type. RESULTS: The longest CDL value was found in the control group, irrespective of the calculation method. Incomplete partition II cases had the most extended mean CDL among IP types. Incomplete partition III had the shortest CDL among all groups' CDL-M values. However, the mean CDL-M values of IP types I and III showed close results. There was no significant difference between the CDL-E and CDL-M values of the control group. Similarly, no significant difference was found between CDL-Ɵ and CDL-M values in IP type III cases. However, the results of other estimating formulations of all groups differed significantly from CDL-M values. CONCLUSION: Cochlear duct length differences were detected between the control group and IP subtypes. These differences should be considered when choosing the appropriate electrode length. Because the results of formulas estimating CDL may differ from CDL-M in both control and IP cases, it would be more appropriate to use manual measurements in clinical practice.

The Cochlear Size Variations in Incomplete Partitions with Multiplanar Images on Pediatric Temporal Bone CT.

Objectives: The purpose of the study was to evaluate cochlea dimensions by the multiplanar reconstruction of high-resolution computed tomography that could be useful in diagnosing incomplete partition (IP) malformations. Methods: This study included 32 patients with 64 side cochleae diagnosed with IP defect and 38 cochleae as the control without any defect. Basal turn length (BL), cochlear height (CH), Mid-apical length (MAL), Mid-apical height, Cochlear length (A), and Cochlear width (B) were measured on reformat images. Results: Twenty cochleae of these patients have been diagnosed with IP type I, 34 with IP type II, and 10 with IP type III. The MAL values are shorter than the control group in IP types I and III (p<0.001, p<0.001). BL values are shorter in IP type III cases (p<0.001). In IP II cases, BL and MAL values overlapped with the control group. CH did not differ significantly from the control group in any IP type. A and B values were significantly lower than the control group for IP I and III (p<0.01). There is a positive correlation between A and B values for all IP types (p<0.01). Conclusion: Quantitative data about differences in the size and shape of the cochlea in IP cases would help differentiate them from the normal cochlea. Since A and B values showed a positive correlation, it is suggested that A and B values can be used to estimate CDL for IP types.

Diffusion Tensor Imaging of Auditory Pathway: A Comparison of Pediatric Cochlear Implant Candidates and Healthy Cases.

BACKGROUND: We aimed to investigate the changes that may occur in the auditory neural network in pediatric congenital hearing loss cases. METHODS: Fifty-four cochlear implant candidates and 47 normal-hearing controls were included in this retrospective study. Fractional anisotropy, radial diffusivity, and apparent diffusion coefficient maps were generated. We placed region of interest on the cochlear nucleus, superior olivary nucleus, lateral lemniscus, medial geniculate body, auditory radiation, Heschl's gyrus, inferior fronto-occipital fasciculus, superior longitudinal fascicle, and corpus callosum splenium. The area of the cochlear nerve was measured. Diffusion tensor imaging metrics, children's ages, and cochlear nerve area were compared. RESULTS: Apparent diffusion coefficient and radial diffusivity values of patients were higher than the control group in all places except the radial diffusivity values of medial geniculate body. The fractional anisotropy values of the patients in lateral lemniscus, auditory radiation, Heschl's gyrus, inferior fronto-occipital fasciculus, superior longitudinal fascicle, and corpus callosum splenium were lower than the control group. There is a positive correlation between fractional anisotropy and age in both patient and control groups for all locations. The cochlear nerve area is lower in patients (0.88 ± 0.29) than in the control group (1.18 ± 0.14) (P = .000). The cochlear nerve area has a positive correlation with age in the patient group (P = .000) but has not in the control group. The cochlear nerve area positively correlates with fractional anisotropy values of all locations except fractional anisotropy values of medial geniculate body. CONCLUSION: The alterations of diffusion tensor imaging metrics on the auditory pathway reflect the microstructural changes of white matter tracts.

Stem cell markers: A guide to neoadjuvant therapy in breast carcinomas.

Aim: This study aims to investigate potential associations between the stem cell population and the degree of tumor regression in breast carcinomas treated with neoadjuvant therapy. Settings and Design: The study included 92 patients with breast carcinoma who received neoadjuvant therapy. Tumor regression was defined based on Miller and Payne grading system. Patients with grade 1 or 2 regression on a 5-point scale were included in group 1 (n = 37), grade 3 regression in group 2 (n = 32), and grade 4 or 5 regression in group 3 (n = 23). Materials and Methods: Immunohistochemical staining was performed on paraffin block sections of every case using CD44, CD24, CD29, CD133, ID4, and ALDH1 antibodies to detect stem cells. Statistical Analysis Used: IBM Statistical Package for the Social Sciences (SPSS), version 23.0 (IBM Corp., Armonk, NY, USA) software was used for statistical analyses, and a P value less than 0.05 was considered statistically significant. Results: Histologically high-grade tumors are more common in the near-complete/complete response group (P = 0.004). HER2-positive tumors were more common in the complete/near-complete response group (P = 0.054). Tumor cells positive for stem cell markers CD44 and CD24 were more common in the poor response group (P = 0.027 and P = 0.001, respectively). CD29 expression was reduced in the posttreatment residual tumor tissue in the near-complete/complete response group. Conclusion: High CD44 and CD24 expression may be a predictor of poor response/nonresponse to neoadjuvant therapy in breast carcinomas. Background: In recent years, stem cells have been defined as the main cell population responsible for resistance to anticancer therapies.

Ethmoid roof morphometric measurements of a pediatric population using computed tomography.

OBJECTIVE: To reveal the anatomical relationships of the ethmoid roof on CT in pediatric case group. METHODS: We measured the depth of olfactory fossa (DOF), the width of olfactory fossa (WOF), the angle between lateral lamella and cribriform plate (LLCPA), the width of the olfactory cleft (WOC), the length of lateral lamella (LLL), orbital roof fovea to ethmoidal distance (ORFED) and orbital roof to cribriform plate distance (ORCPD) and we determined Keros and LLCPA types from paranasal sinus CT of subjects under 16 years of age retrospectively. RESULTS: The incidence of Keros type I was higher in females and Keros Type II in males. The ORCPD, DOF and LLL values were found to be higher in 13-16 years age group and WOF and LLCPA in 4-6 years age group. The prevalence of Keros type II was higher in the 13-16 age group, and Keros type I was higher in other age groups. LLCPA type A was the most frequent in all age groups and in both sexes. There was a positive correlation between age and ORCPD, DOF, LLL, and a negative correlation with ORFED, WOF, LLCPA. Olfactory fossa width and depth had a negative correlation. LLCPA had a positive correlation with WOF and a negative correlation with DOF. There was a positive correlation between LLCPA and LLL. DOF and LLL had a positive correlation too. CONCLUSIONS: Paranasal sinus CT provides useful information about frontal skull base anatomic relations before sinus surgery in pediatric cases.

Effect of Quantitative and Semi-quantitative Elastography Methods for the Management of Borderline Lesions on Ultrasonography.

BACKGROUND: Elastography (strain or shear-wave) is a method that estimates tissue stiffness. INTRODUCTION: The aim of this study is to evaluate the quantitative and semi-quantitative ultrasound elastography methods for the diagnosis of BI-RADS 4a and BI-RADS 3 lesions, which are borderline for biopsy and follow-up. MATERIALS AND METHODS: 175 consecutive women with 193 ultrasound-visible breast lesions were classified on Conventional B-mode Ultrasonography (CUS) according to the BI-RADS scoring system. Quantitative and semiquantitative values from ultrasound elastography in the form of strain Elastography Ratio (SER), shear Wave Elastography (SWE) and Shear Wave Elastography Ratio (SWER) were obtained. The lesions categorized as BI-RADS 4a and BI-RADS 3 on ultrasound were subsequently re-categorized according to the elastography values. RESULTS: Except for the 13 BI-RADS 2 lesions, the remaining 180 lesions were biopsied. Pathology showed 83 lesions to be benign and 97 to be malignant. The sensitivity and specificity of the CUS were 96.9% and 75.0%, respectively with an accuracy of 86.0%. Cut-off points calculated based on ROC curves were 56.8 kPa for SWE, 3.53 for SWER and 3.81 for SER. When we downgraded BIRADS 4a lesions based on elastography results, the specificity (CUS+SER 96.9%, CUS+SWE 91.7%, and CUS+SWER 90.6%) and the accuracy (CUS+SER 95.3%, CUS+SWE 92.7%, and CUS+SWER 92.2%) were shown to be better than CUS. When we upgraded BI-RADS 3 lesions based on elastography results, the sensitivity of combined sets of SWE (99,0%) and SWER (100,0%) was better than CUS. CONCLUSION: The rate of false-negative biopsies can be decreased with the combined use of elastography and ultrasonography.

Maturity evaluation of orthodontically important anatomic structures with computed tomography.

BACKGROUND/OBJECTIVES: The success of the orthopaedic treatment is closely related to the patient's skeletal maturation. This study aimed to evaluate the midpalatal suture (MPS), the zygomaticomaxillary suture (ZMS) maturation, and the closure degree of the spheno-occipital synchondrosis (SOS) in patients of different age groups. The presence of a correlation between these parameters and the palatal dimensions was also verified. SUBJECTS/METHODS: The study was based on computed tomography images of 314 patients between 7 and 30 years of age with no orthodontic treatment history. The images were retrieved from the archive of the Radiology Department of Bezmialem Vakif University Hospital and divided into six groups according to the patient's age: 7-10, 11-13, 14-16, 17-20, 21-25, and 26-30 years. The maturation scores of ZMS, SOS, and MPS were determined, and palatal thickness and length were recorded. The data were analysed by using Statistical Package for Social Sciences for Windows 22.0. RESULTS: A positive relationship was found between SOS closure degree and MPS/ZMS maturation (MPS-ZMS: r = 0.816, MPS-SOS: r = 0.736, ZMS-SOS: r = 0.868, P = 0.000). The degrees of ZMS and MPS maturation were significantly increased as the SOS closure degree increased. The MPS maturation score was significantly lower in patients with a short and thick palate (MPS-palatal thickness: r = 0.405, MPS-palatal length: r = 0.387, P = 0.000). CONCLUSIONS: A positive correlation indicated the simultaneous progress in the maturation of the SOS, MPS, and ZMS. Moreover, the ANS-PNS length increase was found to be correlated with the increase of the MPS, ZMS, and SOS maturation scores. In contrast, a negative correlation was observed between the palatal thickness and the maturation stage of these structures.

Open Versus Arthroscopic Latarjet Procedure for the Treatment of Chronic Anterior Glenohumeral Instability With Glenoid Bone Loss.

PURPOSE: The purpose of this study was to compare the clinical, functional, and radiographic outcomes of open versus arthroscopic Latarjet procedures. METHODS: Between December 2009 to January 2015, all patients older than 18 years of age who were treated with a Latarjet procedure for chronic osseous anterior instability by a single surgeon were included in this retrospective cohort study. Range of motion, strength, Rowe, Western Ontario Shoulder Instability Index (WOSI) scores, and pain level according to the Visual Analog Scale (VAS) were evaluated. In addition, postoperative computed tomography scans were used to evaluate the position of the transferred coracoid, screw orientation, and degree of graft resorption. RESULTS: Forty-eight patients with a mean age of 29.5 years (range 19-59 years) who underwent open (n = 15; group OL) and arthroscopic (n = 33; group AL) Latarjet procedures were included in the study. The mean follow-up was 30.5 months (range 24-50 months). At final follow-up there were significant differences in the mean internal rotation loss (mean of 9° vs 14°, P = .044) favoring open surgery and WOSI (P = .017) scores favoring arthroscopic. No significant differences were detected in mean forward flexion loss (P = .918), external rotation loss (P = .883), Rowe (P = .429), and Visual Analog Scale (P = .208) scores. Mean superoinferior position of the coracoid bone graft was found between the 1:55 and 4:49 o'clock positions (2:05-4:55 for group OL; 1:51-4:47 for group AL) in en-face views. The grafts were placed laterally in 13% (group OL) and 9% (group AL) of patients. The mean α angles of the screws were 11° and 19.2°, respectively (P = .004). The mean graft resorption rates were 21% and 34% (P = .087), respectively. CONCLUSION: Good functional results were obtained after both open and arthroscopic Latarjet procedures for the treatment of chronic osseous anterior shoulder instability. Comparative analysis showed small but statistically significant differences in internal rotation loss favoring open and in WOSI favoring arthroscopic techniques. All measured radiographic parameters were similar with the exception of a significant difference in alpha angle with improved screw position in open surgery. OL and AL techniques provide similar clinical and radiographic outcomes. LEVEL OF EVIDENCE: III; Retrospective cohort study with comparison group.

Neurometabolic Diseases in Children: Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy Features.

BACKGROUND: Neurometabolic diseases are a group of diseases secondary to disorders in different metabolic pathways, which lead to white and/or gray matter of the brain involvement. DISCUSSION: Neurometabolic disorders are divided in two groups as dysmyelinating and demyelinating diseases. Because of wide spectrum of these disorders, there are many different classifications of neurometabolic diseases. We used the classification according to brain involvement areas. In radiological evaluation, MRI provides useful information for these disseases. CONCLUSION: Magnetic Resonance Spectroscopy (MRS) provides additional metabolic information for diagnosis and follow ups in childhood with neurometabolic diseases.

Is femoral trochlear dysplasia related to global joint hypermobility?

BACKGROUND: Hypermobility is a known risk factor for patellar instability. In this study, we hypothesized that a significant relationship exists between global joint hypermobility and trochlear dysplasia. METHODS: Follow-up patients from the shoulder department of our institution with global joint hypermobility (Group 1, n = 42) and healthy volunteers (Group 2, n = 42) without known knee complaints were included in our study. All participants underwent knee magnetic resonance imaging (MRI) for the evaluation of possible trochlear dysplasia, and the measurements included lateral trochlear inclination; trochlear facet asymmetry; the depth of the trochlear groove; condylar asymmetry; lateralization of the patella; sulcus angle; and the lateral, medial and central trochlear height. The Dejour classification was also assessed. RESULTS: The age and gender distributions of the groups were similar (p > 0.05). The radiological evaluations revealed that the lateral trochlear inclination (p < 0.001), trochlear facet asymmetry (p < 0.001), depth of the trochlear groove (p < 0.001), lateralization of the patella (p < 0.001), sulcus angle (p < 0.001), and central trochlear height (p < 0.001) were significantly different between the two groups. The condylar asymmetry and lateral and femoral condylar height parameters were similar between the groups (p = 0.297, p = 0.890 and p = 0.521, respectively). According to the Dejour classification, 39 patients had dysplasia in Group 1, whereas dysplasia was detected in only 4 of the participants in Group 2. CONCLUSIONS: Our study revealed that most of the trochlear dysplasia criteria were met in patients with global joint hypermobility. In addition to a clinical patellofemoral examination, the precise radiological evaluation of the joint is beneficial in patellofemoral instability patients with concomitant hypermobility. Patient cohort of this study was consist of patients underwent shoulder surgery.

Magnetic Resonance Spectroscopy Features of the Visual Pathways in Patients with Glaucoma.

PURPOSE: The aim of the study was to investigate any metabolic changes on magnetic resonance spectroscopy (MRS) throughout the visual pathway of the brain in patients with glaucoma and a control group and correlate the results with clinical findings. MATERIAL AND METHODS: A total of 87 patients were enrolled in the study, 30 healthy controls, 25 glaucoma, 16 suspected glaucoma (GS) and 16 ocular hypertension (OHT) patients. A single voxel MRS on TE 30 ms was performed by placing the volume of interest (VOI) on the corpus geniculatum laterale (CGL) and primary visual cortex (VC). Peak values of metabolites, such as N­acetyl aspartate (NAA), creatine (Cr), choline (Cho) and Myo-inositol (Ins) were investigated on MRS. The MRS results were correlated with age, intraocular pressure (IOP), retinal nerve fiber length (RNFL), mean deviation (MD) and cup disk ratio (CD). RESULTS: The NAA values obtained from the CGL in glaucoma and GS cases were lower than the healthy control group. The Cho values at CGL in glaucoma were lower than GS and controls. There was a negative correlation between NAA values of the VC and CD in glaucoma cases. Additionally, there was a negative correlation between age and RNFL in both glaucoma and GS cases. CONCLUSION: The use of MRS can reveal neurodegeneration in CGL and VC in patients with glaucoma. Depiction of metabolic changes throughout the visual pathways via MRS will guide the treatment planning and follow-up in glaucoma and GS cases.