An evaluation of diaphragmatic movements in hemiplegic patients.

OBJECTIVE: The aim of this study was to evaluate the effect of hemiplegia on diaphragmatic movements using motion-mode ultrasonography. METHODS: 23 hemiplegic patients who were diagnosed with a single-hemisphere lesion (mean age 60.5 years; 13 males and 10 females) and a control group of 20 patients (13 males and 7 females) were all evaluated by ultrasonography. Ultrasonography recordings were made of the amplitude of diaphragmatic movement during spontaneous and deep breathing. The patients underwent lung function tests. RESULTS: When the hemiplegic and control groups were compared, the forced vital capacity, forced expired volume in 1 s, maximum inspiratory pressure and maximum expiratory pressure values were significantly lower in the groups with right and left hemiplegia (p<0.05). When a comparison was made between the right hemiplegic group and the control group and between the left hemiplegic group and the control group in terms of diaphragmatic excursions, for both groups, no significant difference was determined between the movements of the right hemidiaphragm during spontaneous and deep breathing and those of the left hemidiaphragm in spontaneous respiration. In contrast, for both hemiplegic groups, a significant decrease was noted in the movements of the left hemidiaphragm in deep respiration. CONCLUSION: The diaphragm is both contralaterally innervated and ipsilaterally innervated, and innervation exhibits marked variations from person to person. This provides an explanation for varying diaphragmatic movements in hemiplegic cases during deep respiration.

Is there a role for apparent diffusion coefficients in the differential diagnosis of brain tumors?

We determined the potential benefits of apparent diffusion coefficient (ADC) values of enhancing-nonenhancing solid portions, cystic-necrotic areas and surrounding edema in the differential diagnosis of brain tumors. Eighty-eight patients with brain tumors: 16 low-grade gliomas, 21 high-grade gliomas, 26 metastases and 25 meningiomas were imaged prospectively in a 1.5 Tesla magnetic resonance (MR) unit. Routine MR imaging and echo-planar diffusion-weighted imaging (DWI) with b values of 0 and 1000 mm(2)/s were performed. ADC values were obtained in different tumor parts and peritumoral edema. The ADCs of contrast-enhancing tumor regions were higher in high-grade gliomas than meningiomas (p<0.05). No significant differences were found in ADCs of contrast-enhancing regions comparing other tumor groups (p≥0.05). The ADCs in non-enhancing tumor regions did not differ between low-grade and high-grade gliomas (p≥0.05). The ADCs in cystic-necrotic regions of tumors and surrounding edema were not significantly different comparing all tumor groups (p≥0.05). There were no significant differences between ADCs of contrast-enhancing and non-enhancing regions of high-grade and low-grade gliomas (p≥0.05). No significant differences were found in ADCs of contrast-enhancing and non-enhancing areas of tumors comparing to surrounding edema (p≥0.05). ADC was not found to be useful in distinguishing different tumor types and its value in the diagnosis of brain tumors is limited due to considerable overlaps.