Analysis of the volumes of the posterior cranial fossa, cerebellum, and herniated tonsils using the stereological methods in patients with Chiari type I malformation.

OBJECTIVE: The aim of this study was to determine the posterior cranial fossa volume, cerebellar volume, and herniated tonsillar volume in patients with chiari type I malformation and control subjects using stereological methods. MATERIAL AND METHODS: These volumes were estimated retrospectively using the Cavalieri principle as a point-counting technique. We used magnetic resonance images taken from 25 control subjects and 30 patients with chiari type I malformation. RESULTS: The posterior cranial fossa volume in patients with chiari type I malformation was significantly smaller than the volume in the control subjects (P < 0.05). In the chiari type I malformation group, the cerebellar volume was smaller than the control group, but this difference was not statistically significant (P > 0.05). In the chiari type I malformation group, the ratio of cerebellar volume to posterior cranial fossa volume was higher than in the control group. We also found a positive correlation between the posterior cranial fossa volume and cerebellar volume for each of the groups (r = 0.865, P < 0.001). The mean (±SD) herniated tonsillar volume and length were 0.89 ± 0.50 cm(3) and 9.63 ± 3.37 mm in the chiari type I malformation group, respectively. Conclusion. This study has shown that posterior cranial fossa and cerebellum volumes can be measured by stereological methods, and the ratio of these measurements can contribute to the evaluation of chiari type I malformation cases.

Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging.

It may be very difficult to diagnose the pathology in patients with anterior knee pain. Patients with chronic anterior knee pain have been reviewed for the study. Our aim was to delineate the presence of subtle trochlear dysplasia by measuring lateral trochlear inclination (LTI) in axial magnetic resonance imaging (MRI) scans. While there were 109 knees in the study group with anterior knee pain (AKP), control group consisted of 74 knees without AKP. The LTI measurements were performed at the level of proximal cartilaginous area of trochlear groove in axial scans. The condition was termed to be trochlear dysplasia when LTI was below 11 masculine. Parameters in both groups were statistically analyzed and compared for their association with LTI. There was no significant difference between LTI values of male and female subjects in each group. The mean LTI values in anterior knee pain and control groups were 17.32 masculine and 21.5 masculine, respectively, and the difference was statistically significant (P < 0.05). The ratio of knees with trochlear dysplasia was 16.5% in AKP group, which was only 2.7% in control. In the AKP group, the ratio of trochlear dysplasia was significantly high (P < 0.05). Although trochlear dysplasia has been generally detected in cases with patellar instability, this study revealed that the frequency of this finding in patients with other causes of anterior knee pain was also considerably high. Measurement of lateral trochlear inclination in axial MRI scans with radiologic assessment seems to be a valuable diagnostic criterion, especially in patients in whom etiology of anterior knee pain could not be identified.

A reliable surface landmark for localizing supratrochlear artery: medial canthus.

OBJECTIVE: To determine the reliability of medial canthus as a surface landmark to locate supratrochlear vascular pedicle. STUDY DESIGN AND SETTING: The distance from medial canthal line to supratrochlear vascular pedicle was measured in 57 healthy volunteers (Doppler imaging study) and also in 15 fresh cadavers. RESULTS: In the Doppler study, the pedicle was found at most 3 mm lateral or medial to medial canthus (mean +/- SD, 0.8 +/- 0.7 mm). SVP mark tended to be medial to the medial canthus mark in females (males, 6; females, 42), whereas it was lateral to it in males (males, 20; females, 5). In the cadaver study, the pedicle was found 0.7 mm away from medial canthus on average. CONCLUSION: Medial canthus can be used as a reliable landmark for paramedian forehead flaps. When Doppler examination fails, pedicle may be found at most 3 mm away from medial canthus. SVP is more commonly located lateral to medial canthus in males and medial to it in females.

Gastric wall calcification in gastric cancer relapse: case report.

We present the case of a 53-year-old male with subtotal gastrectomy and gastrojejunostomy due to gastric cancer who later developed cancer relapse and diffuse plaque-like calcification in the residual gastric tissue. As far as we know, this is the first case in the English literature in whom gastric tumor calcification developed one year after gastric cancer operation. We also discuss possible mechanisms of gastric wall calcification in such cases.

Anatomic localization of the popliteal artery at the level of the knee joint: a magnetic resonance imaging study.

PURPOSE: The anatomic localization of the popliteal artery in the mediolateral plane at the level of the joint line was investigated on axial knee magnetic resonance imaging (MRI) scans to study anatomic variations. METHODS: The transverse and central axes were described on axial MRI scans of 334 knees. The distance between the popliteal artery and central axis was measured; the course of the central axis bisected the posterior cruciate ligament in almost all of the cases. The differences in popliteal artery localization according to sex and side were analyzed. RESULTS: Whereas popliteal artery localization was lateral to the central axis in 94.3% of cases, it was on the central axis in 5.7%. The popliteal artery localization was not seen on the medial side of the central axis. There was no significant effect of sex and side. CONCLUSIONS: Arthroscopic surgeons performing posterior cruciate ligament reconstruction or interventions on the posterior horns of the menisci should bear in mind that the risk of arterial complication may be greater for cases having the popliteal artery on the central axis. In conclusion, preoperative evaluation of the popliteal artery with MR axial scans, especially in pericapsular arthroscopic procedures, may prevent popliteal artery injuries. LEVEL OF EVIDENCE: Level III, diagnostic study of nonconsecutive patients.

Radiologic findings of a congenital suprasternal dermoid cyst.

A congenital cystic mass was detected at the suprasternal notch of a seven-month-old male infant. After radiologic examinations including ultrasonography, computed tomography, and magnetic resonance imaging, the cyst was excised and diagnosed as a dermoid cyst. Dermoid cysts of the head and neck are rare lesions, but a midline location is characteristic for these congenital masses. To our knowledge, only two reports have been published, which were similar to our case in localization. Dermoid cysts should be included in the differential diagnosis of midline cysts.

Three-dimensional CT of Eagle's syndrome.

This case report presents three-dimensional computed tomography (3D-CT) findings in the diagnosis of Eagle's syndrome that is characterized with an elongated styloid process or a calcified stylohyoid ligament causing craniofacial or cervical pain. We have performed 3D-CT in three patients suspected to have this condition. Coronal images were taken in two patients and axial images in one patient with a spiral CT scanner. 3D-CT images were then produced. The length of the styloid process in the case suspected of right elongated styloid process was 45.6 mm (left styloid process, 37 mm). In the second case suspected of left elongated styloid process, the length of the left styloid process was 41.1 mm (right styloid process, 40.2 mm). In the last case suspected of right elongated styloid process, the length of the right styloid process was 40.6 mm (left styloid process, 38.9 mm). 3D-CT is a valuable diagnostic tool in the diagnosis of Eagle's syndrome because of its ability to facilitate accurate measurement of the length of the styloid process.

Doppler evaluation of pediatric goiter: effect of mandatory iodination.

PURPOSE: The aim of this study was to evaluate the hemodynamic status of the thyroid in children with goiter after the use of iodinated dietary salt for 3 years in a region of endemic iodine deficiency. METHODS: Sixty-six children between 7 and 12 years of age were included in the study. Three groups were constituted according to sonographically measured thyroid volume and urinary iodine excretion levels. Group 1 included 11 children with thyroid volumes greater than the 97th percentile according to age and sex criteria suggested by the World Health Organization International Council for Control of Iodine Deficiency Disorders and urinary iodine level lower than 100 microg/l. Group 2 included 30 children with thyroid volumes greater than the 97th percentile and urinary iodine level equal to or higher than 100 microg/l. The control group included 25 children who had normal thyroid volume and urinary iodine level. All children were examined by thyroid duplex sonography. Peak systolic velocity (PSV) and resistance index (RI) were measured in the inferior thyroid artery bilaterally. RESULTS: PSV in group 1 was significantly higher than in group 2 and in the control group (P < 0.05 and P < 0.01, respectively). There was no significant difference between the PSV of group 2 and the control group. The RI in groups 1 and 2 was significantly lower than in the control group (P < 0.01 and P < 0.01, respectively). There was no significant difference between the RIs of group 1 and group 2. CONCLUSIONS: These findings suggest an effect of iodination on thyroid hemodynamics before the size of the hyperplastic thyroid returned to normal, in keeping with normalization of the urinary iodine level.

The posterior lumbar dural depth: an ultrasonographic study in children.

Lumbar puncture or identification of the epidural space is technically more difficult in children. Prior obtained information regarding the distance from skin to the dura mater may be useful as leading to an increase in success. We studied the anatomy of the posterior lumbar spine at the L4-5 intervertebral space in 137 children, using ultrasonography. Children aged between 7 and 12 years in whom weight and height are in 3-97 percentiles (recommended for healthy Turkish boys and girls) were investigated. The measured distance from skin to dura mater was found significantly higher in girls (2.59+/-0.44 cm) than boys (2.43+/-0.46 cm) (p<0.05). Prediction of the posterior dural depth at L4-5 level was obtained using single linear regression equation. All demographic variables correlated significantly with the dural depth in both sexes. In girls the skin-duramater distance achieved highest correlation ranks with weight and body surface area (BSA): 'dural depth' (cm)=1.094+[0.048 x weight (kg)], r=0.79, p<0.01 and 'dural depth' (cm)=0.337+[2.119xBSA m2], r=0.76, p<0.01). We concluded that the distance between the skin and the dura mater at the level of L4-5 interspace could be predicted using a statistical model based on the age, weight, height or BSA of children aged between 7-12 years old.

Comparison of early and late pleuropulmonary findings of ankylosing spondylitis by high-resolution computed tomography and effects on patients' daily life.

Ankylosing spondylitis (AS) is a multisystemic disease and extra-articular features may develop as pleuropulmonary involvement. We aimed to show and compare the early and late pleuropulmonary findings of AS and its effects on patients' daily life by causing dyspnea. The study consisted of 38 patients (33 male, 5 female). All patients met the New York criteria for AS. Patients were divided into two groups for comparison of early (disease duration <10 years and normal chest X-ray, 18 patients) and late (disease duration >/=10 years and normal or abnormal chest X-ray, 20 patients) manifestations. All patients underwent high-resolution computed tomography (HRCT) and pulmonary function tests. A questionnaire was completed to measure perceived shortness of breath (dyspnea score) with activities of daily living such as dressing, shaving or walking. HRCT findings were abnormal in 27 of the 38 patients (73%). Pulmonary involvement was high in early AS (61.1%). The number of findings in early and late AS found were as follows: mosaic pattern (9/10), parenchymal micronodules (2/3), parenchymal bands (5/9), bronchial wall thickening (2/10), ground-glass opacity (7/7), and interlobular septal thickening (6/10). A moderate correlation was obtained between presence of mosaic pattern and forced midexpiratory flow rate (FEF(25-75)) values indicating small airway obstruction (r=0.346, p=0.019). The dyspnea score was statistically higher in patients with AS having pulmonary involvement than those without involvement. Pulmonary involvement is common in early AS compared to late AS. The involvement of small airways was found frequently as interstitial lung disease in early and late AS. This study also suggests that AS with pulmonary involvement may affect patients' daily life by causing dyspnea, which is why early detection of pulmonary lesions may have clinical importance and should be studied in a large cohort.

Evaluation of carotid artery wall thickness with high-resolution sonography in obstructive sleep apnea syndrome.

PURPOSE: An increased intima-media thickness (IMT) in the carotid arteries is a marker of generalized atherosclerosis, and it has been associated with a high risk of stroke. The aim of this study was to investigate whether patients with obstructive sleep apnea syndrome (OSAS) have an increase in atherosclerotic indicators in the carotid arteries. METHODS: We studied 30 men with severe OSAS who had an apnea-hypopnea index (AHI) of at least 20. IMT measurement and the presence of stenotic occlusive lesions in the carotid arteries (right common carotid artery [RCCA], right bulb [Rbulb], right internal carotid artery [RICA], left common carotid artery [LCCA], left bulb [Lbulb], and left internal carotid artery [LICA]) were investigated by high-resolution sonography. Results of the sonographic examinations were compared with those for a group of 20 subjects with mild OSAS (AHI <20) and 20 healthy subjects. RESULTS: The mean IMT of the carotid arteries of patients with severe OSAS was significantly higher than those of patients with mild OSAS and control subjects (RCCA 0.81 versus 0.63 versus 0.58, p <0.01; Rbulb 0.96 versus 0.87 versus 0.65, p <0.001; RICA 0.77 versus 0.69 versus 0.61, p <0.05; LCCA 0.97 versus 0.78 versus 0.67, p <0.01; Lbulb 1.01 versus 0.89 versus 0.72, p <0.01; LICA 0.91 versus 0.75 versus 0.65, p <0.001). CONCLUSIONS: This study shows that the carotid arteries' IMT is increased in patients with severe OSAS. This increase may predispose the patients to cerebrovascular disease. Additionally, the findings support the hypothesis that patients with OSAS are at risk of developing cerebrovascular disease regardless of the presence or absence of other vascular risk factors (eg, hypercholesterolemia, diabetus mellitus, and hypertension).

How does nose blowing effect the computed tomography of paranasal sinuses in chronic sinusitis?

OBJECTIVE: Our aim was to determine whether inward or outward movement of the secretions in the paranasal sinuses due to nose blowing after nasal decongestion has any effect on the paranasal sinus computed tomography (CT) images in patients with sinusitis and to asses whether nose blowing may result in misdiagnosis or overdiagnosis in radiological evaluation of sinusitis. MATERIALS AND METHODS: Twenty-four patients with chronic sinusitis were evaluated in an academic tertiary care hospital and data were collected prospectively. After coronal sinus computed tomography scans were performed at 100 mA setting which was half the value of the standard radiation dose suggested by the manufacturer, topical decongestion was applied to each nostril followed by nose blowing 10 min later. Sinus CT scans were then repeated at the same setting. We evaluated the mucosal thickness of medial, lateral, superior and inferior maxillary and frontal sinus walls and the maximal thickness in anterior ethmoidal cells. The measurements prior to and following nose blowing were compared with Wilcoxon signed ranks test. The obtained images were also staged using Lund-McKay staging system separately and the scores were compared with Student's t-test. RESULTS: We observed a tendency towards reduction in mucosal thickness after nose blowing. There were statistically significant differences between maxillary sinus inferior wall and frontal sinus inferior wall mucosal thickness values prior to and after nose blowing. The difference however was very small, about 0.5 mm in magnitude and Lund-McKay score did not change in any of the patients after nose blowing. CONCLUSION: Nose blowing and topical nasal decongestion does not have any effect on the diagnostic accuracy of sinus CT in chronic sinusitis patients.

Assessment of image quality of a standard and three dose-reducing protocols in adult cranial CT.

The purpose of this study was to analyze the effect of various tube current settings (mAs) and optimize the image quality and dose for adult cranial CT protocol. Sixty adult patients who underwent a cranial CT scanning for different indications were subdivided into three subgroups. Subjective image and noise quality scores and quantitative noise measurements were selectively studied on three reference levels (cerebellar, basal ganglia and centrum semiovale levels). For each subgroup, only one level was studied. Head circumference (HC) and the maximum anteroposterior diameter (MAPD) of each patient were measured. At 50% decreased dose protocol, there was no poor quality score at any level. At nearly 60% decreased dose protocol, the incidence of poor quality scores was much higher at the cerebellar level than at the other two levels. For the same protocol number, quantitative noise measurements were higher at the cerebellar level than the other two supratentorial levels. The correlation was found to be significant between HC, MAPD and quantitative noise measurements, and there was a non-significant correlation between HC and subjective noise scores. In adult cranial CT, depending on the level, a dose reduction of up to 60% may be possible while maintaining image quality.

[3D-CT investigation of craniofacial and cervical spine anomalies in congenital muscular torticollis]. / Konjenital müsküler tortikolliste kranyofasiyal ve servikal vertebra anomalilerinin 3B-BT ile incelenmesi.

PURPOSE: To investigate the accompanied craniofacial and cervical spine anomalies in congenital muscular torticollis (CMT) with three-dimensional computerized tomography (3D-CT). MATERIALS AND METHODS: We examined six cases of CMT. Cranial and cervical 3D CT was performed in all cases. Facial midline deviation angle (FDA), upper hemifacial width, lower hemifacial width (LHFW), length of hemimandible and zygomatic arcus, posterior hemicranial width (PHCW), anterior hemicranial width and cranial base midline deviation angle (CBDA) were measured on cranial 3D-CT images. Value of orbital index was calculated. Data achieved both ipsilaterally and contralaterally were compared with paired t-test. Atlanto-axial rotation angle (AARA) and atlantodental interval (ADI) values were measured on cervical 3D-CT images. RESULTS: Ages ranged between 2-26 years with a M/F ratio of 1/5. Facial asymmetry was diagnosed in all cases and LHFW was significantly undersized when compared to contralateral side (p < 0.05). FDA was measured 5.4+/-2.0 degrees on the average. Zygomatic arcus and hemimandible were significantly undersized on the side of torticollis (p < 0.05). Occipital plagiocephaly existed in all cases and PHCW was significantly extensive on torticollis side (p < 0.05). CBDA was measured 4.5+/-1.7 degrees on the average. Rotational movement of atlas over axis was observed in all cases where the AARA was 15.0+/-7.4 degrees. ADI was lesser than 3 mm in all cases. CONCLUSION: Even occipital plagiocephaly, maxillary and orbital deformity were commonly found in cases of CMT, most dominant asymmetry was observed in lower hemifacial region, zygomatic arcus and mandible by 3D-CT imaging. Rotational movement of first cervical vertebra over the second one was determined in all cases.

Antioxidant response at early stages and low grades of simple coal worker's pneumoconiosis diagnosed by high resolution computed tomography.

In miners exposed to coal dusts, coal worker's pneumoconiosis (CWP) can occur. The purpose of the present study is to better understand the relations between coal dust exposure and activities of blood plasma antioxidant enzymes, namely, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and lipid peroxidation end product malondialdehyde (MDA) concentration in coal workers with early and low grade simple CWP diagnosed by high resolution computed tomography (HRCT). Forty-three coal workers who had profusions of 0/1-2/2 according to ILO 1980 chest X-ray (CXR) classification, 43 coal workers without CWP (control group 1) and 44 healthy subjects (control group 2) who were randomly selected from the population register or recruited from the hospital staff were enrolled. Coal workers were reevaluated by HRCT (Hosoda-Shida classification) due to its higher sensitivity than standard CXR. Then, blood plasma SOD and GSH-Px activities and MDA plasma levels were measured. CWP was found positive in 46 of 89 coal workers by HRCT evaluation. Profusion 0 (P0, CWP not present), profusion 1 (P1, early CWP) and profusion 2 (P2, low grade CWP) were found in 43, 23 and 19 of patients found to have CWP by HRCT, respectively. We had no worker with profusion 3 (P3). Complicated CWP was shown in four of 46 patients and thesecases were excluded as the study was restricted to early and low-grade pneumoconiosis. In respect to the plasma levels of MDA and plasma activities of SOD and GSH-Px, statistically significant differences were found between CWP cases and control groups (p < 0.01, p < 0.01, p < 0.001 respectively). Statistical differences were also obtained for the plasma activities of SOD and GSH-Px and levels of MDA in relation to HRCT profusions (p < 0.05). In conclusion, these findings suggest an oxidative stress due to increased free radicals and reactive oxygen metabolite production in early stages and low grades of simple CWP diagnosed by HRCT.

[Double inversion recovery sequence in temporal lobe epilepsy: preliminary results]. / Temporal lob epilepsisinde "double inversion recovery" sekansi: ön sonuçlar.

PURPOSE: DIR (double inversion recovery) is a sequence with the hybrid contrast of both FLAIR and STIR sequences, produced by the application of double inversion recovery pulse. It has been suggested that DIR provides high sensitivity to lesions with low T2 contrast. The purpose of this study was to test the hypothesis that DIR sequence is superior to conventional sequences in the identification of mesial temporal sclerosis and other temporal lobe lesions in patients with temporal lobe epilepsy. MATERIALS AND METHODS: Thirty-three subjects with a prediagnosis of temporal lobe epilepsy and ten healthy control subjects with no abnormality on magnetic resonance imaging studies have been studied with DIR, FLAIR and T2W sequences. Coronal images through temporal lobes and hippocampus were acquired. Qualitatively, overall sensitivity to the presence of lesions, hippocampal lesion detectability, temporal horn dilatation and artifacts were evaluated in temporal lobe epilepsy cases and quantitatively, hippocampal and white matter signal-to-noise ratio as well as hippocampus-white matter contrast-to-noise ratio were calculated in the healthy subjects. Subjective scores were graded on a scale of 3 or 4 points. RESULTS: Signal-to-noise ratio scores were higher on T2W sequence, however contrast-to-noise ratio scores were higher on DIR sequence compared to the other two sequences. Imaging findings were compatible with mesial temporal sclerosis in seven patients, tumoral mass in two, and chronic infarct in four. DIR sequence was less sensitive to hippocampal atrophy than the other two sequences because of cerebrospinal fluid artifacts. Overall sensitivity to the presence of lesions and hippocampal lesion detectability scores, although similar among three sequences, were highest with DIR sequence. However, lesion sensitivity scores were highest for lesions compatible with mesial temporal sclerosis and for solid masses and lowest for cystic lesions on DIR sequence. CONCLUSION: Despite the presence of artifacts, DIR is a sequence providing high sensitivity to mesial temporal sclerosis like lesions at hippocampus. DIR might be useful as an additional sequence when the other conventional sequences reveal a suspicious lesion with no accompanying hippocampal atrophy.

Presence and HRCT quantification of bronchiectasis in coal workers.

PURPOSE: The purpose of this study was to evaluate the presence of bronchiectasis in coal workers with or without coal worker pneumoconiosis (CWP) and to assess the extent of bronchiectasis, severity of bronchial wall dilatation and thickening by high resolution computed tomography (HRCT). MATERIALS AND METHODS: The retrospective study consisted of HRCT archieves of 93 coal workers. The coal workers with previous diagnosis of COPD (six), asthma (one) and tuberculosis (three) were excluded. Five coal workers with progressive massive fibrosis were not included into the study. The resulting patient group consisted of 78 patients (43 CWP; 35 non-CWP). Pneumoconiosis profusions of CWP workers were between p0/1 and p2/2 according to ILO 1980 chest X-ray classification. HRCT examinations of all subjects were evaluated for the presence, extent, dilatation and thickness of bronchiectasis. Analysis of extent, dilatation and thickness were performed according to established criteria. RESULTS: The diagnosis of bronchiectasis was put on 19 of 43 CWP (44.1%) and 7 of 35 non-CWP workers (20.0%). There were statistically significant differences between bronchiectasis positive and negative coal workers with CWP concerning age and exposure duration (P = 0.012 and 0.009, respectively). Then, multiple logistic regression analysis was performed to define exact risk factors. Exposure duration was only found to be related with presence of bronchiectasis [(odds ratio) OR = 1.494, 95% confidence interval 1.168-1.912]. CONCLUSIONS: The data from the present study shows that bronchiectasis is frequent and severe in CWP workers than without. Bronchiectasis is influenced by coal dust exposure. Thus, coal dust protection measures must be controlled efficiently to prevent bronchiectasis in coal workers.

Echinococcosis involving the liver, retrovesical and seminal vesicle presented with syncope.

Hydatid disease of the urogenital system, especially of the retroperitoneum and seminal vesicles, is a very rare condition. We report a case of hydatid disease located in the liver, retrovesical region and seminal vesicle that was diagnosed incidentally while investigating the etiology of syncope. Transabdominal and transrectal ultrasonography revealed hypoecoic multicystic masses which had thin septations and walls in the liver, retrovesical region and seminal vesicle. Abdominal computed tomography examination showed multicystic low attenuation masses in the same region. Pelvic magnetic resonance image findings revealed multiple cystic masses in the retrovesical region and the right seminal vesicle. In conclusion, the diagnosis of hydatid disease should be kept in mind with patients who have cystic lesions in seminal vesicle and retrovesical region.