Diffusion Mri in Intracranial Hypertension: Quantitative Assesment.

PURPOSE: Intracranial hypertension (IH) is a neurological disease that is characterized by increased intracranial pressure. Idiopathic intracranial hypertension (IIH) is characterized by an increase in intracranial pressure without an underlying neuroradiological cause (1-3). The IH that is associated with a reason such as a mass, hydrocephalus, or drug use, is referred to as secondary intracranial hypertension (SIH). We aimed to detect determine whether the increased intracranial pressure causes a change in the diffusion values of brain in the diffusion MRI images. METHODS: The study includes 24 consecutive patients that were diagnosed with IIH and 18 consecutive patients that were diagnosed with secondary intracranial hypertension (SIH). The control group included 24 patients. Measurement of apparent diffusion coefficient (ADC) was performed using DWI sections obtained from subcortical white matter and the cortex of the frontal lobe in the basal ganglia plane, caudate nucleus head, thalamus, the posterior leg of the internal capsule, corpus callosum splenium; in the centrum semiovale plane, from the central white matter region. with 1.5T MRI using b=500s/mm2 and b=1000s/mm2 values both in patients and control groups. Mean ADC values were compared between IIH, SIH patients and control groups. RESULTS: The ADC values from the head of the caudate nucleus and the cortex were significantly higher in the IIH group, compared to the control group. When the ADC values of the SIH and control groups were compared, it was found that some of the ADC measurements (subcortical white matter, cortex and semioval center) were significantly different. The comparison of the IIH and the SIH groups revealed that the ADC measurements central white matter in the centrum semiovale, the subcortical white matter and the posterior leg of the internal capsule were significantly different. Conclusions: We have found increased diffusion IIH and SIH patients, which supports the development of brain edema. Even though the mechanism of the brain edema in IIH are not entirely clear, it is thought that the mechanism is different from the brain edema caused by a mass or a sinus thrombosis.

A new diagnostic tool for assessment of pelvic dysfunction in MR defecography.

BACKGROUND: Pelvic floor dysfunction is characterized by incomplete fecal defecation, affecting quality of life in a negative way. Magnetic resonance defecography (MRD) is a useful examination that is ionizing radiation-free and easily reproducible, and which provides anatomical and functional details that are obtainable through multiplanar and dynamic examinations. We aimed to detect pathology using MRD in patients with suspected pelvic floor dysfunction and determine its cause. METHODS: MRD was performed in 79 individuals. Dynamic images were obtained at rest, straining, and during defecation. Pelvic hiatus mediolateral diameters were compared between groups. RESULTS: Defecation phase provided significantly more accurate results than the straining phase for determining the existence and severity of pathology. Conclusions: The defecation phase is the most accurate phase for identifying the existence and severity of pathology. As the pelvic hiatus mediolateral diameter is thought to be an important factor in triggering pelvic dysfunction.

The pulmonary findings of Crimean-Congo hemorrhagic fever patients with chest X-ray assessments.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF), characterized by fever and/or hemorrhage, is a zoonotic viral disease with high mortality. The agent causing CCHF is a Nairovirus. The virus is typically transmitted to humans through tick bites. CCHF is a life-threatening disease observed endemically over a wide geographical regions in the world, and there is limited information about pulmonary findings in CCHF patients. PURPOSE: We aimed to investigate the pulmonary findings belonging to a large CCHF patient cohort and to determine if there is any relationship between laboratory findings and disease severity. MATERIALS AND METHODS: A total of 165 patients who were diagnosed with CCHF and examined through chest X-ray (CXR) due to respiratory symptoms at their first examination and/or during their hospitalization were included in this study. In addition to demographical and laboratory findings of the patients, chest X-rays were also examined. RESULTS: Of the 165 patients examined, 96 were male (58.2%) and 69 were female (41.8%). The mean age was 51.64 ± 17.95 years (4-81 years). Single and/or multiple pathological findings were detected in 93 patients (56.4%) as a result of chest X-ray during their first examination. On chest X-ray, consolidation in 74 patients (44.8%), pleural effusion in 64 patients (39.8%), ground glass opacity in 49 patients (29.7%), and atelectasis in 30 patients (18.2%) were detected. CONCLUSION: According to the results of our study, it can be suggested that radiological examination in lungs should be performed primarily with CXR and pulmonary involvement (pleural effusion and consolidation) affects survival in CCHF negatively.

Volume Measurement in the Diagnosis of Mounier Kuhn Syndrome and an Unknown Accompanying Pathology: Pulmonary Artery Enlargement.

BACKGROUND: Mounier Kuhn Syndrome (MKS) is a rare congenital anomaly characterized by abnormal dilatation of the trachea and main bronchi. The aim of this study is to discuss tracheal volume measurement in MKS, and the pathologies accompanying MKS, especially pulmonary artery enlargement. MATERIALS AND METHODS: 38 patients, 18 of whom were diagnosed with MKS and 20 as control group, were included in the study. Trachea volume and pulmonary artery diameter were measured through thorax-computed tomography (CT) images of the patients. Accompanying pathologies were recorded. RESULTS: In the measurements done through the CT scans, the trachea volume was found to be 25.45 cm3 in the control group and 44.17 cm3 in the patient group. The most frequent accompanying pathologies were tracheal diverticulum, bronchiectasis and pulmonary artery enlargement. CONCLUSION: In patients with MKS, there is a significant difference in volume calculation as in trachea diameter. Though bronchiectasis and tracheal diverticulum are known as pathologies most frequently accompanying MKS, to the knowledge of the researchers, pulmonary artery enlargement due to the increase in pulmonary truncus diameter was first emphasized in this article.

Ultrasound measurement of liver longitudinal length in a North Anatolian population: A community-based study.

BACKGROUND: Liver size can be influenced by various factors, including malignant diseases, infective processes, and anthropometric variations among individuals from different geographical locations and races. Therefore, the exact definition of hepatomegaly in the ultrasonographic measurement of liver size is controversial. Moreover, the majority of studies regarding the study of liver size are not community-based. AIMS: The aim of this study is to establish a range of normal liver sizes by ultrasonography with respect to age and sex in healthy individuals and to identify factors affecting liver size. STUDY DESIGN: This was a prospective, community-based study. METHODS: Liver size was measured ultrasonographically from the midclavicular line in 822 individuals, of which 49.3% (n = 405) were male and 51.7% (n = 417) were female. Following physical examination, all participants provided blood samples. Height, weight, and waist circumference were recorded. The mean liver length was calculated for males, females, and for the whole study group. It was also determined whether there was an association between liver size and age, weight, height, body mass index (BMI), body surface area, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) enzyme levels. Results: The mean liver length was significantly different between males (150.04 ± 14.84) and females (147.57 ± 18.32, P = 0.034). Weight and BMI were the most strongly associated with liver size. There was a significant difference between liver size in individuals with normal and elevated levels of AST and ALT enzymes (P < 0.01). CONCLUSION: In a northern Anatolian Turkish population, liver size was greater among males than females. In light of these data, we believe our study may serve as a reference source for the evaluation of liver size.

Magnetic resonance imaging and clinical findings in seminal vesicle pathologies

ABSTRACT Purpose Congenital and acquired pathologies of the seminal vesicles (SV) are rare diseases. The diagnosis of SV anomalies is frequently delayed or wrong due to the rarity of these diseases and the lack of adequate evaluation of SV pathology. For this reason, we aimed to comprehensively evaluate SV pathologies and accompanying genitourinary system abnormalities. Materials and Methods Between March 2012 and December 2015, 1455 male patients with different provisional diagnosis underwent MRI. Congenital and acquired pathology of the SV was identified in 42 of these patients. The patients were categorized according to their SV pathologies. The patients were analyzed in terms of genitourinary system findings associated with SV pathologies. Results SV pathologies were accompanied by other genitourinary system findings. Congenital SV pathologies were bilateral or predominantly in the left SV. Patients with bilateral SV hypoplasia were diagnosed at an earlier age compared to patients with unilateral SV agenesis. There was a significant association between abnormal signal intensity in the SV and benign prostate hypertrophy (BPH) and patient age. Conclusion SV pathologies are rare diseases of the genitourinary system. The association between seminal vesicle pathology and other genitourinary system diseases requires complete genitourinary system evaluation that includes the seminal vesicles.

Magnetic resonance imaging and clinical findings in seminal vesicle pathologies.

PURPOSE: Congenital and acquired pathologies of the seminal vesicles (SV) are rare diseases. The diagnosis of SV anomalies is frequently delayed or wrong due to the rarity of these diseases and the lack of adequate evaluation of SV pathology. For this reason, we aimed to comprehensively evaluate SV pathologies and accompanying genitourinary system abnormalities. MATERIALS AND METHODS: Between March 2012 and December 2015, 1455 male patients with different provisional diagnosis underwent MRI. Congenital and acquired pathology of the SV was identified in 42 of these patients. The patients were categorized according to their SV pathologies. The patients were analyzed in terms of genitourinary system findings associated with SV pathologies. RESULTS: SV pathologies were accompanied by other genitourinary system findings. Congenital SV pathologies were bilateral or predominantly in the left SV. Patients with bilateral SV hypoplasia were diagnosed at an earlier age compared to patients with unilateral SV agenesis. There was a significant association between abnormal signal intensity in the SV and benign prostate hypertrophy (BPH) and patient age. CONCLUSION: SV pathologies are rare diseases of the genitourinary system. The association between seminal vesicle pathology and other genitourinary system diseases requires complete genitourinary system evaluation that includes the seminal vesicles.

Is hemorrhage the reason in crimean-congo hemorrhagic fever patients with neurological signs and symptomsa.

PURPOSE: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease can result in mortality varying from 3.0% to 50.0%. In this study, we wished to discuss computed tomography (CT) findings together with clinical and laboratory findings in patients who had disease-related neurological signs. MATERIALS AND METHODS: The study included patients who were diagnosed with CCHF. Seventeen patients that had neurological signs were enrolled as the patient group. As a control group, 40 patients diagnosed with CCHF and did not have neurological signs were enrolled. Patients who had neurological signs were examined with brain CT. Radiological and clinical findings of both groups were compared. RESULTS: There were pathological findings in three patients while brain CT's of 14 patients were evaluated as normal. Blood urea nitrogen, lactate dehydrogenase, creatine kinase, total bilirubin, neutrophil, activated partial thromboplastin time, and C-reactive protein levels were significantly higher in the group with neurological signs whereas platelet count and calcium levels were significantly lower in this group. Six of 57 patients died during the follow-up period. Six patients who died were in the group, in which central nervous system (CNS) imaging study was performed. CONCLUSION: As the presence of CNS signs is a bad prognostic indicator in CCHF, they should be investigated carefully.

A Comparison of Ultrasonography, Computerised Tomography, and Conventional MRI Findings for Splenic Nodules Associated with Type 1 Gaucher's Disease with Diffusion-Weighted MRI Findings.

A 26-year-old female patient with Type 1 Gaucher's disease (GD) was admitted to our clinic with complaints of stomachache and signs of anemia. The patient underwent ultrasonography (US), computerised tomography (CT), and magnetic resonance imaging (MRI) scan. Imaging studies revealed massive hepatosplenomegaly, choledocolithiasis, and six nodules in the spleen with a mean size of 14 mm. The nodules appeared hyperechoic, hypoechoic, and of mixed echogenicity on the US and hypodense on the CT. While the nodules were observed to be iso-hypointense in T1-weighted (T1WI) images, they appeared to be hyperintense in the T2-weighted (T2WI) images. There were no diffusion restrictions in these nodules that appeared on the diffusion-weighted magnetic resonance imaging (DWI). A nodule located at the lower pole was observed to be hypointense in the T2WI images. The nodule located at the lower pole, which appeared hypointense in T2WI series, had restricted diffusion upon DWI. In this study, we aimed to present the properties of splenic GD nodules using US, CT, and conventional MRI, together with DWI. This case report is the first to apply US, CT, and conventional MRI, together with DWI, to the splenic nodules associated with Gaucher's disease.

Thorax CT findings in patients with Crimean-Congo hemorrhagic fever (CCHF).

PURPOSE: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with high mortality. The agent causing CCHF is a Nairovirus. The virus is typically transmitted to humans through tick bites. CCHF is a life-threatening disease observed endemically over a wide geographical regions in the world and a little known about pulmonary findings in CCHF patients. METHODS: The patients that were admitted and diagnosed with CCHF between April 2010 and September 2015 were examined. Patients' medical records were then evaluated retrospectively. Patients who underwent thorax CT evaluation based on the clinical findings at the time of admission and/or during the hospital stay were included in the study. Patients' laboratory test results and thorax CT findings for respiratory assessment along with demographic characteristics. RESULTS: Forty patients diagnosed with CCHF that underwent thorax CT based on their indications were included in the study. Twenty-seven patients (62.5 %) were male with a mean age of 55.22 ± 19.84 years. According to these results, the three most common thorax CT findings were parenchymal infiltration [32 patients (80 %)], pleural effusion [31 patients (77.5 %)], and alveolar infiltration [28 patients (70 %)]. Moreover, we determined that the most frequently seen radiological findings often occurred bilaterally. CONCLUSIONS: There is still not enough information regarding this life-threatening disease. We also would like to emphasize that both direct radiography and thorax CT are highly successful in detecting frequently encountered radiological findings such as pleural effusion, alveolar hemorrhage, and parenchymal infiltration that indicate pulmonary involvement.

Does Crimean-Congo Hemorrhagic Fever Cause a Vasculitic Reaction with Pulmonary Artery Enlargement and Acute Pulmonary Hypertension?

PURPOSE: Crimean-Congo hemorrhagic fever (CCHF) is a viral tick-borne illness. Although its etiopathogenesis is not clearly understood, it is known to be a Nairovirus. We aimed to examine the viral effects of intense systemic inflammation and vascular damage on the pulmonary vascular beds and lung tissues. METHODS: A total of 45 patients who were diagnosed with CCHF were considered for this retrospective study. In this patient group, those whose lungs had been visualized via thoracic computer tomography (CT) were entered into the study. Diameters of the pulmonary trunk, main pulmonary arteries, atria, and ventricles were measured. Study group measurements were compared with the control group, which included patients with normal thoracic CT. RESULTS: Overall, 90 patients were enrolled in the study, with 45 patients in the study group and 45 in the control group. In the study group, the man-to-woman balance was 3/2. The average age in the study group was 54.07 ± 17.91 years. In comparing the average diameters of pulmonary arteries in the study and control groups, the study group's average pulmonary artery diameter was significantly larger than the control group (p < 0.001). CONCLUSIONS: The increase in diameters of the pulmonary trunks and main pulmonary arteries due to CCHF was first shown in this current study. Moreover, due to our findings, it should be noted that with the rise in pulmonary artery diameter in CCHF, pulmonary hypertension can appear acutely, and this condition can be significantly alter clinical course and follow-up of the viral illness.

Is evaluation of placenta with real-time sonoelastography during the second trimester of pregnancy an effective method for the assessment of spontaneous preterm birth risk?

PURPOSE: The aim of this study is to investigate the effectiveness of placental strain ratio (SR) values measured by real-time sonoelastography (SE) in the second trimester in the prediction of spontaneous preterm birth (sPTB). METHODS: This study included 70 pregnant women who applied to our clinic for routine second-trimester screening. Placental SR measurements were performed with the SE method. Two different SR measurements were performed by taking two different tissues as references. The SR value measured when taking the rectus abdominis muscle as a reference was termed the muscle-to-placenta strain ratio (MPSR), while the SR value measured when taking subcutaneous tissue as a reference was termed the fat-to-placenta strain ratio (FPSR). Women whose gestational age at birth was less than 37 weeks 0 days were accepted as sPTB. The association between gestational age at birth and MPSR and FPSR was investigated. Receiver operating characteristics analysis was used to calculate the sensitivity and specificity of the elastographic outcomes. RESULTS: There was a low-level negative correlation between MPSR and gestational age at birth (r=-0.300, P=.012) and there was a moderate-level negative correlation between FPSR and gestational age at birth (r=-0.513, P<.001). The multivariate linear regression analysis showed that the FPSR (ß=0.609, P=.002) was the significant predictor for the sPTB. CONCLUSIONS: Our data indicate that the FPSR value measured with real-time SE in the second trimester of pregnancy may be effective in the prediction of sPTB.

Large-cell lung cancer originating from tracheal bronchus - A rare case.

Tracheal bronchus is a rarely seen congenital anomaly generally originating from the right lateral wall of the trachea and approximately 2 cm above the carina. It was firstly defined by Sandifort in 1785 and its frequency of incidence in normal population changes between 0.1% and 2%. There are two types called ''Supernumerary'' and ''Displaced''. It is a rarely seen kind of tracheal anomaly although fairly well defined. The cases accompanied by lung cancer are seen more rarely. Nine cases of this association were reported in literature and tracheal bronchus-lung cancer association whose pathological result is undifferentiated large-cell carcinoma has not been stated so far. We present a 75 years old male patient as possibly the first case having tracheal bronchus and large-cell carcinoma association in literature.

Sub-branch and mixed-type intraductal papillary mucinous neoplasms of the pancreas: 2 case reports.

Intraductal papillary mucinous neoplasia (IPMN) is one of the cystic neoplasias of the pancreas. The imaging findings provide that these tumors are differentiated from the other cystic lesions of the pancreas, especially from the chronic pancreatitis, where the treatment protocol is completely different. Therefore, the correct diagnosis and classification of the IPMN ensures that the patient receives the correct approach and the appropriate surgery, if necessary. The purpose of this study is to emphasize the imaging findings of the different types of the IPMN and the changes in the management protocol of the patients according to these radiological findings.

The evaluation of abdominal findings in Crimean-Congo hemorrhagic fever.

OBJECTIVE: Crimean-Congo hemorrhagic fever (CCHF) is a widely seen, fatal disease and is endemic to some countries. It affects many organs in the abdomen. Comprehensive radiological study of CCHF is quite rare. This study will use multiple detector computed tomography (MDCT) to investigate if there is a relationship between clinical laboratory measurements and abdominal findings in CCHF and discuss our findings in the light of the literature. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 443 patients diagnosed with CCHF in our hospital between April 1, 2008 and September 30, 2014. Fifty-one patients had undergone abdominal MDCT examination. RESULTS: The most common findings seen in abdominal MDCT were intra-abdominal free fluid and hepatomegaly. Gallbladder wall thickening, heterogeneity in mesenteric, omental fatty tissue, and splenomegaly were other common findings. Subcutaneous fat tissue edema, intramuscular hemorrhage, duodenal wall thickening, colon wall thickening, pancreatitis, and acute renal failure were among the rare findings seen in abdominal MDCT. Comparison of these findings to the clinical laboratory parameters showed a strong relationship between intra-abdominal free fluid and platelet count. CONCLUSION: Our study is the first comprehensive study on abdominal MDCT findings of CCHF. We detected a strong relationship between patients' platelet count and abdominal free liquid. Therefore, it should be kept in mind that abdominal free fluid can be among clinical manifestations in patients with platelet counts ≤50000 and that this manifestation can become aggravated.

Evaluation of morphological changes in pharynx with dynamic CT and MRI in snoring patients.

BACKGROUND: Identifying the craniofacial abnormalities that cause snoring and the narrowest area of the upper airway creating obstructions can help to determine the proper method of treatment. AIM: To identify the factors that can cause snoring and the areas of the airway that are the most likely to collapse with upper airway imaging. MATERIAL AND METHODS: Axial pharynx examinations with CT (computerized tomography) and magnetic resonance imaging (MRI) were performed to 38 patients complaining of snoring and 12 patients who did not complain of snoring. The narrowest areas of nasopharynx, hypophraynx, oropharynx, bilateral para-pharyngeal fat pad and para-pharyngeal muscle thickness were measured. RESULTS: In snoring patients, the narrowest part of the upper airway was the retro-palatal region in the oropharynx, as measured with both imaging methods. When patients with and without snoring were compared, the former that a higher body mass index and neck diameter and a narrower oropharynx area. In dynamic examinations, we determined that as para-pharyngeal muscle thickness increased, medial-lateral airway diameter and the oropharynx area decreased. CONCLUSIONS: The narrowest section of the airway is the retro-palatal region of the oropharynx, measured both with CT and MRI.