Metastases and Primary Brain Tumors Affecting the Fornix of the Brain.

Background The aim of this study is to evaluate the clinical and radiological findings of metastatic tumors and primary brain tumors affecting the fornix. Methods  Between January 2015 and March 2023, we retrospectively evaluated 1087 patients of both sexes who underwent cranial magnetic resonance imaging (MRI) for a preliminary diagnosis of intracranial malignancy in the radiology department of our hospital. Two radiologists with six and 10 years of experience in MRI examination assessed the relationship between primary and metastatic tumors and the fornix. Results  Involvement of the fornix was diagnosed in 29 of the 1087 patients (2.66%), of which fornix was affected by metastatic lesions in 14 patients (48.2%) and primary tumors in 15 patients (51.7%). The majority of metastatic lesions were from lung and breast cancers, with other tumor types including osteosarcoma, renal cell carcinoma, pancreatic adenocarcinoma, pleomorphic sarcoma, and diffuse large B-cell lymphoma. Among all primary tumors, glioblastoma was the most common primary brain tumor invading the fornix, with other diagnoses including diffuse astrocytoma, medulloblastoma, and anaplastic oligodendroglioma. Metastatic and primary brain tumors affecting the fornix were detected over a broad timeline, from the time of diagnosis up to 120 months after diagnosis. A retrospective evaluation of medical records revealed memory deficits in four patients. Conclusion The fornix can be affected by both metastatic and primary brain tumors. It is crucial to understand the relevant neuroanatomical relationships when evaluating lesions that affect the fornix.

The Relationship between Breast Cancer Subtypes, Prognostic Factors, and Apparent Diffusion Coefficient Histogram Analysis.

BACKGROUND: Diffusion Magnetic Resonance Imaging (MRI) is a useful method to evaluate tumor biology and tumor microstructure. The apparent diffusion coefficient (ADC) value correlates negatively with the cellular density of the tumor. OBJECTIVE: This study aimed to investigate the effectiveness of the ADC histogram analysis in showing the relationship between breast cancer prognostic factors and ADC parameters. METHODS: This study is a retrospective observational descriptive study. ADC histogram parameters were evaluated in all tumor volumes of 67 breast cancer patients. Minimum, 5, 10, 25, 50, 75, 90, 95 percentiles, maximum, mean, median ADC values, kurtosis, and skewness were calculated. Breast MRI examinations were performed on a 3T MR scanner. We evaluated the fibroglandular tissue density of bilateral breasts, background enhancement, localization of masses, multifocality-multicentricity, shape, rim, internal contrast enhancement, and kinetic curve on breast MRI. BIRADS scoring was performed according to breast MRI. Pathologically, histologic type, histologic grade, HER 2, Ki 67, ER-, and PR status were evaluated. RESULTS: A significant correlation was found between tumor volume and ADC scores. There is a significant correlation between min ADC values (p< 0.031), max ADC (p< 0.001), and skewness (p< 0.019). A significant correlation was found between tumor kurtosis and lymph nodes (p< 0.029). There was a significant difference in ADC values depending on ER-and PRstatus. (for ER p = 0.004, p = 0.018, p = 0.010, p = 0.008, p = 0.004, p = 0.004, p = 0.02, p = 0.02 and p = 0.038, for PR p < 0.001, p = 0.028, p = 0.011, p = 0.001, p < 0.001, p =<0.001, p < 0.001, and p < 0.001, respectively; p < 0.05). These values were lower in ER-and PR-positive status than in ER-and PR-negative receptor status. According to HER2 status, there was a statistically significant difference in ADC

Preoperative Dynamic Contrast-Enhanced and Diffusion-Weighted Breast Magnetic Resonance Imaging Findings for Prediction of Lymphovascular Invasion of the Lesions in Node-Negative Invasive Breast Cancer.

Purpose: Our single-center retrospective study aimed to investigate the relationship between preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) findings and apparent diffusion coefficient (ADC) values and lymphovascular invasion (LVI) status of the lesions in patients with clinically-radiologically lymph node-negative invasive breast cancer. Methods: A total of 250 breast lesions diagnosed in preoperative magnetic resonance imaging were identified. All patients were divided into 2 subgroups: LVI-negative and LVI-positive according to the pathological findings of surgical specimens. The 2 groups' DCE-MRI findings, ADC values, and histopathological results of lesions were compared. Results: LVI was detected in 100 of 250 lesions. Younger age than 45 years and larger lesion size than 20 mm were found to be associated with the presence of LVI (P < .001). High histological and nuclear grade (P = .001), HER2-enriched molecular subtype (P = .001), and Ki-67 positivity (P = .016) were significantly associated with LVI. The LVI positivity rate was significantly higher in the lesions with medium-rapid initial phase kinetic curve and washout delayed phase kinetic curve (P = .001). The presence of LVI was significantly associated with the presence of peritumoral edema, sentinel lymph node metastasis, adjacent vessel sign, and increased whole breast vascularity (P < .001). When diffusion-weighted imaging findings were evaluated, it was determined that tumoral ADC values lower than 1068 × 10-6 mm2/second (P = .002) and peritumoral-tumoral ADC ratios higher than 1.5 (P = .001) statistically increased the probability of LVI. Conclusion: The patient's age, various histopathological and DCE-MRI findings, tumoral ADC value, and peritumoral-tumoral ADC ratio may be useful in the preoperative prediction of LVI status in breast cancer lesions.

Computerized Tomography Texture Analysis in the Differential Diagnosis of Intracranial Epidermoid and Arachnoid Cysts.

PURPOSE: This study evaluated the differences between arachnoid and epidermoid cysts in computerized tomography (CT) texture analysis (TA). MATERIAL AND METHODS: The study included 12 patients with intracranial epidermoid cysts and 26 patients with intracranial arachnoid cysts who were diagnosed with diffusion-weighted magnetic resonance imaging (DW-MRI) and who had undergone an unenhanced CT examination before treatment. The LIFEx application software was used to obtain texture features. Eighty-two texture features from 38 lesions were automatically calculated for each lesion. The Shapiro-Wilk test was used to test the normality of the scores, and the Mann-Whitney U Test was used to test the difference between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic regression modeling examined the parameters' diagnostic performances. RESULTS: The median age of the patients was 53 years (range: 19-88 years). Eighty-two texture parameters were evaluated in the first order: gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), neighbor gray-tone difference matrix (NGTDM), and gray-level size zone matrix (GLSZM) groups. There was a statistically significant difference between the arachnoid cyst and the epidermoid cyst in the variables of compacity, compactness 1, compactness 2, sphericity, asphericity, sum average, coarseness, and low gray-level zone (p<0.05). According to the multiple logistic regression model, it was determined that the sum average in the GLCM group (B=-0.11; p=0.015), coarseness (B= 869.5; p=0.044) in the NGTDM group, and morphological sphericity (B=24.18; p=0.047) were the radiomics variables that increased the probability of epidermoid diagnosis. According to the classification table of the model, the sensitivity rate was found to be 83%, and the specificity rate was found to be 96%. Therefore, the probability of accurate model classification was 92%. CONCLUSION: CT TA is a method that can be applied with high diagnostic accuracy in the differential diagnosis of intracranial epidermoid and arachnoid cysts, especially in patients who cannot undergo an MRI examination.

The relationship of T2 hypointensity and diffusion restriction of brain metastases with the presence and amount of vasogenic edema in MRI.

AIM: Brain metastases are seen in 15-40% of patients diagnosed with cancer. We aimed to search the relationship between the T2 hypointensity, diffusion-weighted imaging characteristics, and the presence and amount of vasogenic edema of brain metastasis in magnetic resonance imaging (MRI). METHODS: A total of 292 patients with brain metastasis were included in the study. T2 signals of metastatic lesions, accompanying diffusion restriction and perilesional vasogenic edema findings, were investigated. In metastases accompanied by vasogenic edema, the largest dimension of the vasogenic edema-mass complex on T2-weighted sequences and the largest dimension of the mass in contrast-enhanced T1-weighted series were measured and the edema-mass ratio (EMR) was calculated by comparing these two values. RESULTS: The frequency of vasogenic edema was statistically significantly higher in T2 hypointense metastases (89.1% vs 58.8%, χ2 = 18.949, p = <.001) and metastases accompanied by diffusion restriction(81% vs 61.5%, χ2 = 6.971, p = .008). EMR values were found to be statistically significantly higher in T2 hypointense metastases (EMR→ Z = -4.507, p = <.001) and metastases with diffusion restriction(EMR→ Z = -3.819, p = .001). CONCLUSIONS: The frequency of vasogenic edema and EMR rates were higher in patients in T2 hypointense metastases and metastases accompanied by diffusion restriction in MRI.

Correlation of Clinical Course with Computed Tomography Findings and Biochemical Parameters at the Time of Admission in COVID-19 Patients.

OBJECTIVE: The primary objective of our study was to evaluate the predictive performance of serum inflammatory markers and the semiquantitative computed tomography severity scoring system on diagnosing the Covid 2019 disease and its course. METHODS: Our study is a single-center retrospective cohort study. The data of 213 adults who were confirmed to have coronavirus disease 2019 by polymerase chain reaction tests in the period between April 2020 and August 2020 were evaluated. One hundred eighty four of these patients whose C-reactive protein, d-dimer, and ferritin levels, lymphocyte counts, and thoracic computed tomography images were obtained at the time of admission were included in the study. The semi-quantitative computed tomography severity score was calculated for all patients. RESULTS: The median age of the 184 patients included in the study was 51.5 (19-91) years. The incidence of intensive care need and mortality was 10.3% (n=19) and 5.4% (n=10), respectively. The intensive care need and mortality rate was significantly correlated with higher thoracic computed tomography involvement scores at admission. There was a statistically significant and positive correlation between the computed tomography scores and the C-reactive protein, d-dimer, and ferritin levels. Older age (>65 years-old) and thoracic computed tomography scores of 11 and higher were independent factors correlated with need for intensive care. CONCLUSION: Serum inflammatory markers and semi-quantitative computed tomography severity scoring system were predictive in diagnosing the Covid 2019 disease and its course.

Vasogenic Edema Pattern in Brain Metastasis.

OBJECTIVE: To determine the relationship of the presence and amount of vasogenic edema with origin, type, and grade of primary cancer. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Radiology Clinic, Ankara, Turkey, from July 2017 to October 2021. METHODOLOGY: Brain MRI scans of 292 patients were retrospectively evaluated. Age, gender, origin, type, and grade of primary cancer were determined. Metastasis type, and presence of vasogenic edema accompanying metastatic lesion were questioned. In cases of vasogenic edema accompanying metastatic lesions, the largest diameter of the vasogenic edema mass complex was measured in T2 sequences. In the contrast-enhanced series, the largest diameter of the metastatic lesion was measured, and the edema-mass ratio (EMR) was calculated by proportioning the diameter of the edema mass complex to the diameter of the mass. RESULTS: The frequency of vasogenic edema was found higher in patients with lung cancer compared to other primaries. The EMR was found statistically significantly higher in patients with primary lung cancer (p=0.001). This was particularly evident in the adenocarcinoma group. In the patient group with primary breast cancer, EMR was found significantly lower in patients with invasive ductal carcinoma. (IDC→1.95±0.66 vs. Other→2.48±0.52, Z=-2.301, p=0.021). CONCLUSION: The amount and presence of vasogenic edema in patients with brain metastases may differ according to the origin and type of primary tumour. KEY WORDS: Brain edema, Metastatic disease, Magnetic resonance imaging.

Measuring the shape and dimensions of normal the bony structures in the craniovertebral junction from computed tomography images of the pediatric age group.

BACKGROUND: The aim of this study is to contribute to the literature by determining the morphometric reference values of the bony structures in the craniovertebral junction (CVJ) from computer tomography (CT) images of the pediatric age group. METHODS: In this study, CT's of 151 simple trauma patients aged between 3 and 15 years between 2016 and 2020 were evaluated. All CT examinations were performed using a 32-slice CT and included images of the skull base and C1-C2 junction. A total of 10 measurements were obtained from these images, including Wachenheim clivus canal angle (WCA), Welcher basal angle (WBA), Cran-iocervical tilt angle (CCT), power ratio (PR), Atlantodens interval, McRae Line (MRL), McRae - Dens distance, basion-dens interval (BDI), basion-axis interval (BAI), and atlantooccipital measurement (AOM). RESULTS: In comparison between gender groups, MRL (p=0.011) and AOM (p<0.001) measurements were found to be significantly higher in males. McRae-Dens distance, BDI, and AOM were significantly higher in patients aged 3-9 years (respectively, p=0005, p=0.003, p<0.001), and BAI (p=0.001) was significantly higher in patients aged 10-15 years. The McRae - Dens distance (p=0.119) was similar between patients with and without terminal ossicle in odontoid apex. But BDI of patients without terminal ossicle was significantly higher (p=0.048). All parameters, except the WCA, WBA, CCT, and PR, were statistically significantly correlated with the patient age (respectively, p=0.21, p=0.13, p=0.70, p=0.99). CONCLUSION: In this study, the morphometric reference values of the bone structures at the CVJ were determined from the CT images of the pediatric age group.

Endovascular Treatment of Intracranial Anterior Circulation Aneurysms with Flow Diverters: A Single Centre Experience with mid and long-term results.

AIM: We report our experience with flow diverter devices in the treatment of intracranial aneurysms arising from anterior circulation with mid and long-term follow-up. MATERIAL AND METHODS: 78 aneurysms in 61 patients (range 25-81 years, 13 male, 48 female) were treated with flow diverter devices. 40 (51,3%) aneurysms were treated with pipeline embolization device (PED), 24 (30,8%) aneurysms were treated with SILK stent, 12(15,4%) aneurysms were treated with flow redirection endoluminal device (FRED) and two aneurysms were treated with P64 Flow Modulation Device (P64). Angiographic follow-up data at six month and one yea were recorded and the occlusion degrees of aneurysms were evaluated according to the scale which was formed by Kamran et al. RESULTS: At six month follow-up, complete occlusion (grade 4) rate was 60,8% and at one year increased to 74,3%. Statistical analysis revealed significant difference (p=0,002) between six month and one year follow-up results but there was no significant association (p=0,531, p=1,000) between aneurysm occlusion rate and aneurysm diameter. Two patient (3,2%) died due to hemorrhagic complication. CONCLUSION: Endovascular treatment of intracranial anterior circulation aneurysms with flow diverters is a safe and effective treatment option. A high rate of stable occlusion is achieved at long term follow-up.