A variant of the median arcuate ligament syndrome: are sagittal images enough for diagnosis?

Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is a rare cause of abdominal discomfort, postprandial pain and weight loss. Doppler ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), and selective catheter angiography can be used to identify this abnormality. Classically, the "fish hook" appearance is seen on sagittal images. In our case, mild stenosis (20 %) was seen at the origin of the celiac artery without typical "fish hook" appearance. Higher degree stenosis (55 %) was demonstrated on axial images. We are presenting a rare case of a MALS caused by prominent crura.

Role of apparent diffusion coefficient values and diffusion-weighted magnetic resonance imaging in differentiation between benign and malignant thyroid nodules.

OBJECTIVE: The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI). MATERIALS AND METHODS: Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm(2)b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed. RESULTS: The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively. CONCLUSION: We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules.

Arterial supply of the posterior interventricular sulcus: a CT coronary angiographic study.

OBJECTIVE: The objective of this study was to determine the different vascularization patterns of the posterior interventricular sulcus (PIS) with coronary CT angiography. MATERIALS AND METHODS: Three hundred and fifty-six coronary CT angiograms (CCTA) were retrospectively analyzed in 248 men and 108 women (mean age, 54.9 years ± 13.6 [standard deviation]). The PIS was divided into three segments from the crux cordis to the notch of the cardiac apex according to the American Heart Association classification (basal, mid ventricular and apical), and the artery or arteries supplying each segment were recorded. The relative frequency of the different vascularization patterns was calculated and the distribution of dominance types was recorded. RESULTS: Blood was supplied to the PIS by one or more branches of the right coronary artery (RCA), the left circumflex artery (LCX), or the left anterior descending artery (LAD). We observed 25 different irrigation patterns. In the most frequent pattern (31.3%), the basal and mid-ventricular segments were perfused by a single arterial branch originating from the RCA at the crux, and the apical segment was perfused by the LAD traveling beyond the notch of the cardiac apex and entering the posterior interventricular sulcus. Of the 356 cases, the circulation was right dominant in 310 (87.1%), left dominant in 34 (9.5%), and balanced in 12 (3.4%) cases. Individual segments were perfused by a single artery in 288 (80.9%) cases, and by more than one in the remainder. CONCLUSION: CCTA allows detailed assessment of the arterial supply of the PIS, and allowed to describe 25 subtypes. This information is of potential value to both cardiac surgeons and interventional cardiologists who plan bypass surgery or angioplasty aiming at the posterior interventricular artery.

Primary angiosarcoma of the spleen.

Primary angiosarcoma of the spleen is a rare neoplasm with a very poor prognosis. We present computed tomography and magnetic resonance imaging of a 49-year-old man with primary splenic angiosarcoma and liver metastasis. The literature on primary splenic angiosarcoma is reviewed and imaging variability of this rare tumor is discussed.

Multicentric malignant peripheral nerve sheath tumor.

We present a case of malignant peripheral nerve sheath tumor of multicentric origin, an extremely rare condition. A 25-year-old man was admitted to hospital with presenting symptoms of cough, dyspnea and left lateral back pain. Computed tomography and magnetic resonance imaging revealed extrapleural masses in the left hemithorax in addition to synchronous left inguinal mass. After surgical resection of the masses from the thoracic and inguinal regions, histological examination confirmed the preoperative diagnosis of malignant peripheral nerve sheath tumor.