Neuroanatomical comparison of treatment-resistant and treatment-responsive schizophrenia patients using the cloud-based brain magnetic resonance image segmentation and parcellation system: An MRIcloud study.

Recent developments in neuroimaging have improved our understanding of the biological mechanisms underlying schizophrenia. However, neuroimaging findings in treatment-resistant schizophrenia (TRS) remain unclear. In the present study, we aimed to explore potential neuroanatomical regions that may be associated with treatment resistance in schizophrenia patients by comparing neuroanatomical regions of TRS and non-TRS patients using the MRICloud method. A total of 33 schizophrenia patients (meeting DSM 5 diagnostic criteria for schizophrenia) were included in the study. Patients were dichotomized into TRS (n = 18) and non-TRS (n = 15) groups, and all patients underwent MRI. Neuroanatomical regions of TRS and non-TRS patients were compared using the MRICloud method. Disease severity was measured using the Positive and Negative Syndrome Scale (PANSS). Interestingly, a statistically significant greater left Corpus Collosum (CC) thickness was found in TRS patients compared to non-TRS patients. It is clear that further studies comparing TRS patients with non-TRS patients are needed, and these studies should focus on the circuits in the corpus callosum that are thought to play a role in treatment resistance. Further longitudinal studies are also needed to complement the cross-sectional studies, using a multimodal imaging approach in the patients with clearly defined TRS criteria.

Use of dual energy CT urography in evaluation of urinary stone and complex cyst.

BACKGROUND: Dual-energy computed tomography scans can provide significant benefits to the urinary system. The aim of this study is to determine the limitations and benefits of using dual energy CT urography in patients with urinary system stones and cysts. METHODS: In the analysis of the images, the virtual noncontrasted images obtained from the combined nephrogenicexcretory phase and the true noncontrasted images were evaluated. The true noncontrast images were accepted as the gold standard for stone detection. RESULTS: Eighty-three different stones were detected in 26 of the 115 patients included in the study. Sensibilities of virtual noncontrast images in detecting urinary system stones were 66.7% and 65.4% according to the first and second radiologists, respectively. In this study, 32 hyperdense cysts were detected. According to iodine map images, there was no enhancement in 26 of 32 cysts; only 5 cysts showed minimal contrast enhancement. One patient could not decide on contrast enhancement. DISCUSSION: As a result, if CT urography is performed with dual energy, it can provide additional information in patients with urinary system disorder.

Analysis of changes in brain morphological structure of taekwondo athletes by diffusion tensor imaging.

OBJECTIVE: Taekwondo, which is the most preferred sport among the martial arts, is known to improve individuals physically, spiritually and mentally. The aim of this study is to reveal the effect of teakwondo sport on the brain and brain structures. DESIGN;: 30 taekwondo athletes and 15 control groups were included in this study. Diffusion tensor MR images of each participant were taken. The information was obtained by the self-declaration of the athletes, whether they were sports years, amateur or elite. METHOD: Total brain volume and volumes of white matter, gray matter, frontal lobe, precentral gyrus, corticospinal tract, basal nuclei, postcentral gyrus, hippocampus and amigdala and the ratio of these volumes to total brain volume were evaluated statistically between the groups using MriCloud software and ROIEditor program. RESULTS: An increase in total brain volume, gray matter, frontal lobe and precentral gyrus volume in athletes was associated with taekwondo training. When the ratio of brain parts to total brain volume was examined, it was determined that there was a difference in the ratio of gray matter, white matter volumes in amateur athletes, right frontal lobe, left corticospinal tract, right postcentral gyrus volumes in elite athletes, and left postcentral gyrus volumes of both athletes compared to sedentary individuals. CONCLUSIONS: The increase in the volume of gray matter, frontal lobe, postcentral gyrus and corticospinal tract together with the brain volume shows that taekwondo exercise contributes to physical, spiritual and mental development.

Refractory obsessive-compulsive disorder with symptoms regressing after thalamic infarction: A case report.

Obsessive compulsive disorder (OCD) is a common neuropsychiatric disorder involving predominantly the cortico-striato-thalamo-cortical loop. Although it is usually associated with various disorders of basal ganglia and thalamus, it is difficult to say what kind of impairment causes this situation exactly. Structural brain lesions may be one of the rare causes of refractory psychiatric symptoms. Analysis of such type of cases gives an idea about the neurobiology of psychiatric diseases. In this manuscript, we presented a case of refractory OCD with symptoms regressing after thalamic infarction and discussed with relevant literature.

Evaluation of CSF flow dynamics in patients with schizophrenia using phase-contrast cine MRI.

Patients with schizophrenia show progressive clinical deterioration. Brain abnormalities have been suggested in these patients, including enlargement of the lateral ventricles, increased cerebrospinal fluid (CSF) volume and reductions in the frontal and temporal lobes. CSF flow pathology is a central factor in the development of many neurological disorders, but much less is known about the role of CSF flow dynamics in schizophrenia. In this study, parameters of CSF flow dynamics at the aqueduct level of 50 schizophrenic patients were compared to those of 50 controls using phase-contrast cine magnetic resonance imaging. Patients had lower peak velocity, lower net forward volume, and lower average flow over the range studied than controls. The average velocity was significantly lower in patients exhibiting violent behavior compared to non-violent patients. The aqueduct tendedto be larger in schizophrenic patients with earlier age of onset of the disorder. Furthermore, as the number of hospitalizations increased, the average velocity and flow over the range studied decreased commensurately. This study demonstrated that CSF flow dynamics are altered in patients with schizophrenia. The results indicated that additional studies of CSF flow dynamics in schizophrenia are needed, along with volumetric examinations of the brain, to elucidate the pathophysiology of the disease.

The effects of residual parotid volume on symptom-specific quality of life and complications in patients undergoing parotid surgery.

PURPOSE: To measure postoperative residual parotid volumes in parotidectomy patients and to measure the effect of residual parotid volumes on the symptom-specific quality of life (SSQOL) and complications. METHODS: Between January 2010 and December 2016, 148 parotid gland surgeries were performed, and 74 patients were included in the study. Bilateral parotid gland volumes were measured by Magnetic Resonance Imaging (MRI). Parotidectomy Outcome Inventory-8 and aesthetic scale questionnaire were applied to the patients. The volumetric averages obtained were compared with the questions in the SSQOL scale, the aesthetic scale data, and complications. RESULTS: In the volumetric examination performed with MRI, the mean residual volumes of the operated parotid glands were 9.5 cm3, while the non-operated side was 28.8 cm3. The width of the surgery and the residual parotid tissue volume was inversely correlated. There was a statistically significant difference between the residual parotid gland volume and the pain related to the surgical area, depression in the surgical site, Frey's syndrome, incision scar, and numbness. As the residual parotid gland volumes decreased, the patients' cosmetic problems related to the surgical field increased significantly, and their SSQOL decreased. CONCLUSION: Postoperative residual parotid tissue volume could be an objective parameter to measure patients' SSQOL and complications. After parotidectomy, the maximum amount of disease-free tissue of the parotid gland should be left in place to increase patients' quality of life and minimize complications.

Can T2 blackout effect be a marker of iron accumulation in brains of multiple sclerosis patients?

OBJECTIVE: T2 blackout (TBO) effect, which is a common finding in the brains of multiple sclerosis (MS) patients and older population that are imaged for other reasons on diffusion weighted imagings (DWI) and apparent diffusion coefficient (ADC) map show the existence of paramagnetic materials in the tissue. Because iron is known to accumulate in especially deep gray matter (DGM) structures in MS brains, we aimed to investigate the relationship between TBO and clinico-radiological parameters that may be iron-related in MS. METHODS: We retrospectively reviewed the latest MR images of MS patients on 3 Tesla MR scanner between 2018 and 2019. TBO existence and severity on DWI-ADC was assessed by two radiologists and its correlation with several outcomes of MS was investigated. RESULTS: No significant relationship was found between TBO and gender, subtype of MS whereas TBO was positively correlated with parameters such as black-hole lesions, cortical atrophy, duration of disease, age and extended disability status scale (EDSS) score. CONCLUSIONS: TBO shows correlation with the conditions which were revealed to be associated with iron accumulation in the brain of MS patients in the literature. Therefore, we concluded that TBO and its severity in DGM may represent iron accumulation in MS brains. ADVANCES IN KNOWLEDGE: TBO effect as a frequent imaging finding in daily practice may be used as predictor of the disease course of MS due to possible effects of iron accumulation in brain and thereby may be useful in modifying treatment strategies.

Two New Cases and Literature Review of CLIPPERS Syndrome with Long-Term Follow-up.

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory disorder of the central nervous system. The pathophysiology of CLIPPERS is unknown. The disease has characteristic radiological lesions located in the pons, bulbus, and cerebellum. Here we report two new cases and review the literature on CLIPPERS syndrome. A 35-year-old woman presented with a 2-month history of progressive double vision, vertigo, gait ataxia, nausea, and vomiting. The second case was that of a 40-year-old Iraqi man who presented with a 3-month history of vertigo, headache, and gait ataxia. Diagnosis of CLIPPERS was established based on findings of punctate, nodular enhancing lesions in the pons and bulbus in the first case and in the cerebellum in the second. Our patients responded well to steroid therapy and remained relapse-free for 2 years. CLIPPERS is a rare autoimmune disorder with characteristic radiological findings. Long-term immunosuppressive therapy is necessary for treatment.

The Role of Insular Cortex in Response to Group Therapy in Vaginismus Patients: Magnetic Resonance Spectroscopy Study.

OBJECTIVE: Disgust has been propounded as a potential etiological factor in certain sexual dysfunctions such as vaginismus. Studies reports that insular cortex is activated as a response to disgust. The present study aimed to investigate the predictive role of metabolites in insular cortex in response to group therapy among vaginismus patients. METHODS: Study sample consisted of 51 vaginismus patients attended an ambulatory group therapy, of whom 26 benefited from 8-week group therapy and 25 were unresponsive to group therapy. All of the patients underwent H magnetic resonance spectroscopy (H-MRS), and insular cortex N-acetyl aspartate (NAA), Creatinine (Cr), Glutamine (Gln), Glutathione (GSH), Choline (Cho), Myo-inositol (mIns), Glutamate (Glu) and Lactate (Lac) concentrations were compared between the groups. RESULTS: Comparing insular cortex metabolite concentrations between the groups, Cho was statistically significantly higher (p=0.005) but mIns was significantly lower (p=0.001) in the unresponsive to group therapy group. CONCLUSION: MR spectroscopy findings of the present study indicated significant metabolic changes such as increased Cho/Cr ratio and decreased mIns/Cr ratio in the insular cortex of vaginismus patients who were unresponsive to group therapy. Our results support the studies suggesting that disgust is an important emotion in vaginismus patients and also that insula plays a role in the neurobiology of disgust.

A case of high grade glioma following treatment of relapsing-remitting multiple sclerosis with fingolimod.

Multiple sclerosis is a major cause of neurological disability, especially in young adults. There have been several case reports of an increased risk of cancer after long-term treatment for multiple sclerosis. Fingolimod is an immunomodulating agent used in the treatment of relapsing-remitting multiple sclerosis. The side effects commonly associated with fingolimod are cardiac side effects, macular edema, and elevated liver enzyme levels. Increased risks of infection and cancer have also been reported. High grade glioma is an aggressive primary brain tumor. There has been one case report of high grade glioma during fingolimod treatment. Here, we report the case of a 58-year-old woman diagnosed with glioblastoma multiforme after one year of fingolimod treatment for multiple sclerosis.