Effect of carotid artery stenting on ophthalmic artery flow patterns.

OBJECTIVES: The purpose of this study was to assess the effect of carotid artery stenting on ophthalmic artery blood flow using transorbital color and spectral Doppler sonography and review the changes in relation to cerebral hemodynamics. METHODS: Twenty-eight consecutive patients with severe internal carotid artery stenosis (≥ 70%) who were scheduled for carotid stenting were included. Ophthalmic artery Doppler sonography was performed bilaterally before and after stenting. The flow direction, peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index in the ophthalmic artery were recorded. RESULTS: Twenty male and 8 female patients with 10 right-sided and 18 left-sided stenoses were studied. The mean overall carotid stenosis ratio ± SD was 87.3% ± 9.9%. After stenting in the ophthalmic artery ipsilateral to the stenosis, significant increases in the PSV (-3.87 ± 48.81 to 46.70 ± 25.33 cm/s; P < .001), and EDV (-3.02 ± 16.31 to 11.24 ± 7.37 cm/s; P < .001) were detected, and the increase in the PI approached significance (1.40 ± 0.59 to 1.62 ± 0.52; P = .055). A change in the flow direction from retrograde to antegrade was noted in 11 patients (39%) after stenting, and in 1 patient with no detectable flow, reconstitution of flow was observed. Increases in the PSV and EDV (P= .03 for ΔEDV) were more pronounced in symptomatic patients than asymptomatic patients after stenting. CONCLUSIONS: Substantially decreased ophthalmic artery velocity and retrograde flow are suggestive of high-grade carotid artery stenosis (≳90%). Stenting improves ophthalmic artery perfusion and positively changes cerebral hemodynamics in high-grade carotid artery stenosis, especially in symptomatic patients, which can be monitored with ophthalmic artery Doppler sonography.

High frequency of kidney and urinary tract anomalies in asymptomatic first-degree relatives of patients with CAKUT.

BACKGROUND: Congenital anomalies of the kidney and urinary tract (CAKUT) commonly cause chronic kidney disease in children. While most CAKUT cases are sporadic, observed familial clustering suggests that the pathogenesis is influenced by genetic factors. METHODS: The purpose of the present study is to determine the frequency of the kidney and urinary tract anomalies in asymptomatic first-degree relatives of patients with CAKUT. A total of 218 index patients and their families followed at an academic hospital in Ankara, Turkey, were enrolled in the study. RESULTS: Family histories revealed at least one other member with a known kidney or urinary tract disease in 50% and CAKUT in 22.9% of the families. All asymptomatic first-degree relatives of 180 index patients were screened for kidney and urinary tract anomalies using ultrasound. New anomalies were diagnosed in 116 asymptomatic first-degree relatives (23%) in 87 families (48.3%). When family histories and ultrasound findings of 180 index patients were evaluated together, 129 first-degree relatives in 92 families (51.1%) had CAKUT. CONCLUSIONS: This study suggests that genetic mechanisms might be very important in the pathogenesis of apparently sporadic CAKUT. Identification of the underlying gene mutations will provide further insights into the knowledge of the kidney and urinary tract development and pathogenesis of CAKUT.

Is there an association between mastalgia and fibromyalgia? Comparing prevalence and symptom severity.

To determine the prevalence of mastalgia in patients with fibromyalgia (FM) and the prevalence of FM in patients with mastalgia in order to investigate coexistence, and to compare the pain patterns in the case of mastalgia or FM alone versus the two in combination. Fifty consecutive patients with mastalgia and 50 consecutive patients with FM were assessed and examined both for the existence and severity of mastalgia and FM. A high proportion of patients with mastalgia (36%) fulfilled the criteria for FM and 42% had mastalgia in the FM group. Two distinctive entities mastalgia and FM, being both unexplained pain syndromes, seem to frequently coexist. Patients with mastalgia or FM should be thoroughly questioned considering each of the diseases so that in case of coexistence an appropriate therapy might be implemented for a successful pain management.

Clinically Positive Axillary Lymphadenopathy May Lead to False Diagnosis of Overstaged Breast Cancer in Patients with Sjögren's Syndrome: A Case Report.

Sjögren's syndrome (SS) is an autoimmune disease that chronic inflammation and lymph node proliferation. Patients with SS carry a greater risk of developing lymphoproliferative malignancy. In addition to other organ cancers, breast cancer may also occur in these patients. Considering these, breast cancer in patients with SS can be misdiagnosed as being in an advanced stage particularly in the presence of axillary lymphadenopathy. Here, we report a rare case of a 45-year-old woman with SS who presented with a breast mass. Radiology showed a 4 cm solid lesion and conglomerates of axillary lymphadonepathy. A breast biopsy revealed ductal carcinoma in situ. A modified radical mastectomy was performed; however, no axillary metastases were detected. Clinicians should remain vigilant to the possibility that a false clinical impression of axillary metastasis may occur in such patients with breast cancer. Therefore, axillary node status should be verified first.

The significance of the right hepatic artery originating from the superior mesenteric artery in patients with cavernous transformation of the portal vein.

PURPOSE: Dilatation of the hepatic artery in response to decrease in portal vein flow is known as hepatic arterial buffer response (HABR). In this study, the effect of HABR on variant hepatic arterial anatomy is investigated by analyzing the frequency of the right hepatic artery originating from the superior mesenteric artery (variant artery) and by determining the diameters of variant artery and common hepatic artery (CHA) in patients with cavernous transformation of the portal vein. MATERIALS AND METHODS: Forty-one patients who were referred for contrast-enhanced abdominal magnetic resonance angiography were retrospectively evaluated in two groups: group 1 (n = 15), cirrhotic patients with cavernous transformation of the portal vein; and group 2 (n = 26), cirrhotic patients without cavernous transformation of the portal vein. RESULTS: The frequency of the variant artery was significantly higher (53%) in patients with cavernous transformation of the portal vein (P < 0.01) than those without cavernous transformation (11.5%). The mean diameters of the CHA and the variant artery in 2 groups were not significantly different. CONCLUSION: Vasodilatation at the level of intrahepatic arterioles (HABR) in response to diminished portal flow may be a factor that increases the frequency of the variant hepatic artery.

Lupus mastitis is not a surgical disease.

A 23-year-old woman with a 2-year history of discoid lupus (SLE) presented with a right lateral upper quadrant breast mass. Physical examination revealed a 5 cm irregular, hard lesion suggestive of a breast malignancy. Ultrasound-guided fine needle aspiration biopsy of the mass confirmed the diagnosis as lupus mastitis. Differential diagnosis of a breast mass in a patient with SLE must include the possibility of lupus mastitis. Surgical resection is usually not necessary, and medical treatment can be implemented successfully.

Synovial cyst: an uncommon cause of back pain.

Synovial cyst is an uncommon cause of back pain and radiculopathy. This case report describes the magnetic resonance imaging findings of two lumbar synovial cysts with special emphasis on the differential diagnoses of other extradural cystic lesions.

Direct contrast-enhanced 3D MR venography evaluation of upper extremity deep venous system.

PURPOSE: To investigate the diagnostic value of direct contrast-enhanced three dimensional magnetic resonance (3D MR) venography in mapping the deep venous system of the upper extremities and to plan potential interventional procedures. MATERIALS AND METHODS: Nineteen cases with the diagnoses of end-stage renal disease with multiple hemodialysis catheter access were examined. Direct contrast-enhanced 3D MR venograms were obtained with 1.5 Tesla device with 3D-FSPGR pulse sequence and using body coil following the manual injection of gadolinium solution prepared by diluting 20 ml of contrast substance in 200 ml saline with a proportion of 1:10 through intravenous access opened symmetrically in antecubital fossa. In the workstation, evaluation was performed on three-dimensional images, two-dimensional multiplanar reformats and maximum-intensity projection method obtained from the source images. Intravenous DSA was performed on all the patients, and two radiologists evaluated MR venograms and conventional angiograms independently from each other. Results of MR venography and conventional angiography were then compared. RESULTS: In all cases, the MR venograms obtained were capable of supporting the diagnoses. Venous pathologies were found in 16 cases. In three cases central veins were evaluated to be patent. Results of MR venography and conventional angiography were consistent with each other (100% sensitivity and 100% specificity). CONCLUSION: Direct contrast-enhanced 3D MR venography is a well-tolerated sensitive technique in explaining the cause of the malfunctioning arterio-venous fistulas and in pre-surgical planning before placing new catheters or creating fistulas. It is possible to obtain high-quality images with this technique as an alternative to invasive angiography.

Primary sclerosing cholangitis: MR cholangiopancreatography and T2-weighted MR imaging findings.

PURPOSE: To present MR cholangiopancreatography (MRCP) findings and to determine the hepatic morphological changes of primary sclerosing cholangitis (PSC) seen on T2-weighted fast spin echo (FSE) images. MATERIALS AND METHODS: Twenty-three patients (15 women, 8 men) with ages ranging from 17 to 80 years (median, 45.1 years) were included in the study. MR imaging was performed on a 1 Tesla MR unit using a phased-array coil. Heavily T2-weighted images were obtained with single-shot fast spin echo technique for MRCP. Morphological changes encountered in livers were evaluated with coronal and axial T2-weighted fast spin echo images. RESULTS: Irregularities, multifocal strictures, and dilatations in different levels of the biliary channels were seen in all patients. T2-weighted images showed lobulated hepatic contours in 21.73%, atrophy in both anterior and posterior segments of the right lobe in 21.73%, atrophy in the anterior segment in 13.04%, atrophy in both medial and lateral segments of the left lobe in 17.39%, atrophy in the medial segment in 8.69%, atrophy in the lateral segment in 4.34%, hypertrophy in the posterior segment of the right lobe in 4.34%, global hypertrophy in the left lobe in 4.34%, hypertrophy in the lateral segment of the left lobe in 4.34%, and caudate lobe hypertrophy in 21.73% of the patients. In addition, periportal edema was noted in 39.13%, increased parenchymal signal on T2-weighted images in 26.08%, periportal and/or portocaval lymphadenopathy in 34.78%, and portal hypertension in 34.78% of our patients. In one patient (4.34%), the liver had a round shape characteristic of PSC. CONCLUSION: MR imaging is a useful method for establishing the changes in biliary ducts specific to PSC, and for identifying long-standing cases complicated with cirrhosis.

The role of classic spin echo and FLAIR sequences for the evaluation of myelination in MR imaging.

PURPOSE: The aim of this study was to assess the features of the normal brain development in terms of myelination in infants and young children on fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging, and to determine if FLAIR imaging is superior to spin echo MR sequences. MATERIALS AND METHODS: T1-weighted (T1W) fast spin echo T2-weighted (FSE T2W), and FLAIR images were obtained in 76 pediatric patients between the ages of 0 and 48 months, on a 1 Tesla MR unit. On these images, the signal intensities of 16 different white matter regions were compared to those of adjacent gray matter, and for each brain region. Comparisons between the gray and white matter signal intensities were scored by the consensus of two radiologists on a scale of -1 to +1 for each patient. RESULTS: In the first 6 months, hypointense white matter signal intensity changed to hyperintensity on T1W images. After the first 6 months, white matter progressed from hyperintense to hypointense on T2W images. Except for the cerebral white matter, FLAIR images showed the same signal transition, though slightly later than what was seen on T2W images. The deep cerebral white matter, which was hypointense on birth, became hyperintense early in the first several months of life, and finally, reconverted to hypointense during the second year of life on FLAIR images. CONCLUSION: Myelination, which is an indicator of brain maturation, was successfully demonstrated both in classic spin echo sequences and on FLAIR images. These imaging techniques are an essential component of routine MR imaging of the dating of and differentiation between normal and pathological brain development.

[Late presentation of an extrarenal pseudoaneurysm in a renal transplant patient: CT and color Doppler US findings (case report)]. / Renal transplantasyon sonrasi gelisen ekstrarenal psödoanevrizma: BT ve renkli Doppler US bulgulari.

Vascular complications associated with renal transplants are a significant cause of graft dysfunction or failure. The most common complications are arterial and venous stenoses/thromboses, intrarenal and extrarenal arteriovenous fistulas, and pseudoaneurysms. In this case report, an extremely rare complication following renal transplantation, an extrarenal pseudoaneurysm, is presented with CT, gray scale, and color Doppler US findings.

[Anatomic variations of the bile ducts: MRCP findings]. / Biliyer sistemin anatomik varyasyonlari: MRKP bulgulari.

PURPOSE: Anatomic variations of intra or extrahepatic bile ducts may be problematic during surgical procedures. Besides iatrogenic trauma of the bile ducts during cholecystectomy, formation of bile duct stones, recurrent pancreatitis, cholangitis and biliary malignancies can be seen. The aim of this study was to evaluate the frequency of anatomic variations of the biliary tree and to present the magnetic resonance cholangiopancreatography (MRCP) findings. MATERIALS AND METHODS: Between July 2000 and April 2004, 581 patients suspected to have pancreatobiliary disease, were referred to our MR unit. Four hundred and seventy-five patients with ages ranging from 22 to 88 (median: 56) were included in the study retrospectively. MRCP was performed on a 1 Tesla MR unit, using phased-array coil for signal detection. Heavily T2 weighted images were obtained with SSFSE technique. Axial and coronal source images and reformatted images were all evaluated together for the possibility of any anatomic variation. RESULTS: Anatomic variations at different levels of biliary tree were found in 115 patients (24.2%). MRCP showed an aberrant right hepatic duct in 23 patients (4.8%), a right posterior hepatic duct in 27 patients (5.7%), trifurcation in 4 patients (0.8%), a long cystic duct in 8 patients (1.7%), a medial cystic duct insertion in 3 patients (0.63%), a low medial cystic duct insertion in 18 patients (3.8%), a short cystic duct in 1 patient (0.2%), a high localized gallbladder in 5 patients (1%), a vascular compression of common hepatic duct in 12 patients (2.5%), a pancreatobiliary junction anomaly in 3 patients (0.63%). Eleven patients had more than one anatomic variation (2.3%). CONCLUSION: MRCP is a useful, rapid, and non-invasive method for demonstrating the anatomy and the variations of the biliary tree. Diagnosis of these anatomic variations prior to surgical procedures may prevent iatrogenic injury to bile ducts.