Use of 3DFT-CISS sequences and virtual MR endoscopy for the neuroendoscopic treatment of unilateral hydrocephalus: case illustration.

OBJECTIVE: Intraventricular virtual MR endoscopic imaging of the foramen of Monro region by using three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) magnetic resonance imaging in a patient with a unilateral congenital obstruction of the foramen of Monro by a transparent membranous septum was performed to enhance the orientation, achieve a better understanding of the pathology, and plan the surgical intervention in an endoscopic approach to the lateral ventricles. METHODS: 3DFT-CISS sequences and virtual MR endoscopic imaging were performed in a patient before and after endoscopic fenestration procedures, to communicate the lateral ventricle to the third ventricle for the treatment of unilateral ventricular enlargement. RESULTS: Preoperative 3DFT-CISS imaging demonstrated unilateral membranous septa in the localization of the left foramen of Monro which were not observed with routine T2-weighted imaging. 3DFT-CISS imaging and T2-weighted imaging were equally useful for monitoring postoperative changes in the size of the ventricles or cysts and the presence of flow voids after fenestration procedures, but only 3DFT-CISS imaging clearly demonstrated the area of fenestration. CONCLUSION: Virtual MR endoscopy by using 3DFT-CISS sequences is a feasible method in the planning of intraventricular real-time endoscopic surgery, for the enhancement of orientation in a surgical field, and to achieve a better understanding of the pathology.

Using the magnetic resonance three-dimensional volume rendering for tissues technique in the planning of craniotomy flaps with linear scalp incision.

Preoperative three-dimensional images with surface venous anatomy may be used in the planning of a linear scalp incision and the opening site of the dura mater for protection of surface veins during surgical dissection, and to find the splitting site of the brain according to the lesion. In 45 patients who had a brain tumor, linear scalp incision planning was done by regarding the three-dimensional images derived from post-contrast time-of-flight (TOF) sequence raw data. The findings of correspondence and the quality of routine contrast-enhanced magnetic resonance imaging (MRI) and three-dimensional volume rendering for tissues (VRT) images were analyzed separately with the surgical findings according to a visual grading system. Our experience revealed that the surgical findings correlated well with the three-dimensional VRT images. According to a visual surgical grading system, a grade III correlation was found in 20 (45%), grade II in 15 (33%), grade I in 7 (15%), and grade 0 in 3 (7%) patients in our study population. At the end of our research we conclude that this method is useful in terms of the preoperative determination of brain surface anatomy and may be used in the determination of the site of a linear scalp incision according to the localization of an intracranial lesion.

An unusual presentation of familial Mediterranean fever with prolonged hip pain and amyloidosis.

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent self-limiting attacks of joint, chest and abdominal associated with fever. We present an unusual case of FMF with prolonged arthritis and amyloidosis. Familial Mediterranean fever should be considered in the differential diagnosis of prolonged hip pain, even in the absence of symptoms or signs of FMF.

Magnetic resonance imaging in diagnosis of childhood central nervous system tuberculosis.

BACKGROUND: We investigated the role of magnetic resonance imaging (MRI) in diagnosis of central nervous system (CNS) tuberculosis. PATIENTS AND METHODS: The MRI findings (T1, T2 and T1 sequence after contrast) of 11 children with CNS tuberculosis were evaluated and the diagnostic value of contrast enhanced MRI and its correlation with the clinical findings were investigated. RESULTS: The median age of the patients was 6 years; seven were male and four female. MRI findings of the cases were meningeal enhancement (90.9%), hydrocephalus (63.6%), infarction (45.5%), tuberculomas (27.2%), cranial nerve involvement (27.2%) and severe cortical atrophy (9.1%). MRI provided early diagnosis in two cases by demonstrating tuberculomas, and supported the diagnosis in seven cases. However, in two cases MRI findings were inadequate to diagnose CNS tuberculosis, especially at the beginning. CONCLUSION: Contrast enhanced MRI is a very useful technique for diagnosing CNS tuberculosis, particularly by demonstrating the localized lesions, meningeal enhancement and the brain stem. However, a family history of tuberculosis, chest X-ray findings and the clinical picture are still very important for diagnosis.

Functional magnetic resonance imaging in children with Asperger's syndrome.

Asperger's syndrome is a pervasive developmental disorder of unknown etiology. We evaluated children with this syndrome (n = 9) and control (n = 8) children by functional magnetic resonance imaging (MRI) during a task involving social judgment. All control and 5 of 9 subjects with Asperger's syndrome showed signal intensity changes in frontal regions. Four patients with Asperger's syndrome, including one case with right frontal dysplasia, had no signal intensity change during the task. In this first functional MRI study of childhood Asperger's syndrome, frontal activation patterns demonstrated some differences between patients and normal subjects. Further studies using other functions frequently impaired in Asperger's syndrome are warranted.

"Air bubble": a new diagnostic CT sign of perforated pulmonary hydatid cyst.

The greatest difficulty in the CT diagnosis of perforated pulmonary hydatid cyst (PPHC) is the increase in the attenuation numbers following infection. Because of the solid density of infected hydatid cysts, the differentiation from an abscess or neoplasm is usually impossible. The aim of this study was to evaluate the value of "air bubble" as a new CT sign in the diagnosis of PPHC. Sixty-five patients (28 men and 37 women) with PPHC were included in the study. As a control group, 55 patients who had malignant (n = 36) or non-malignant (n = 19) pulmonary diseases were also examined. Radiological diagnosis with classical CT findings was made in only 38 of 65 patients (58.5 %) with PPHC. Air bubble sign was positive in 54 of the patients with PPHC (sensitivity 83.1 %) but only 3 of 55 patients in control group (specificity 94.5 %). When we analyzed the CT scans with classical CT findings including air bubble, the diagnosis of PPHC was made in 61 of patients (93.8 %). It is concluded that "air bubble sign" is a valuable CT finding in the diagnosis of PPHC.

Multiple sclerosis in a six-year-old boy (case report).

A 6-year-old boy with multiple sclerosis, youngest diagnosed in our hospital, is presented. In addition to the clinical findings, the diagnosis was supported by increased immunoglobulin levels, positive IgG index and oligoclonal bands in the cerebrospinal fluid, normal cranial angiography, typical lesions on the cranial computed tomography and magnetic resonance imaging.

Periureteric effects of electromagnetic shock waves.

The effect of electromagnetic shock waves on the ureter and periureteric soft tissue was investigated in 10 patients who underwent extracorporeal shock wave lithotripsy (ESWL) for lower ureteric stones. Seven patients were males and 3 females, their ages ranged between 15 and 52. The number of shock waves applied varied between 3000 and 6000, at a mean of 19 kV. The patients were examined after their first ESWL. Magnetic resonance imaging (MRI) was performed within 6 hours of treatment by a Magnetom 1 Tesla Unit. No haematoma, fluid collection or abnormality was detected in the periureteric space, muscle or surrounding structures by MRI. Although subcapsular, intra- or perirenal haematomas can be observed in patients with kidney stones treated with ESWL, it appears to be safe for lower ureteric stones.

Cysts of the prostate, seminal vesicles and diverticulum of the ejaculatory ducts.

The close proximity of the prostate, vas deferens, seminal vesicles and ejaculatory ducts are a diagnostic challenge to the cysts located in that region. Three patients with diverticulum of the ejaculatory ducts, 2 with prostate cysts and 1 patient with seminal vesicle cyst are presented. Transrectal ultrasound, computed tomography and magnetic resonance imaging together with aspiration of the cyst establish diagnosis and probably prevent unnecessary exploration.

Intrathoracic goiter with hyperthyroidism, tracheal compression, superior vena cava syndrome, and Horner's syndrome.

Intrathoracic goiter is an important cause of mediastinal masses. We present a patient with hyperthyroidism, tracheal compression, superior vena cava syndrome (SVCS) and Horner's syndrome due to intrathoracic goiter. To our knowledge, this is the first case in the literature with all of these combined findings.