Synthetic MRI in Neurofibromatosis Type 1.

BACKGROUND AND PURPOSE: Synthetic MRI enables the generation of various contrast-weighted images and quantitative data in a reasonable scanning time. We aimed to use synthetic MRI to assess the detection and underlying tissue characteristics of focal areas of signal intensity and normal-appearing brain parenchyma and morphometric alterations in the brains of patients with neurofibromatosis type 1. MATERIALS AND METHODS: Conventional MR imaging and synthetic MRI were prospectively obtained from 19 patients with neurofibromatosis type 1 and 18 healthy controls. Two neuroradiologists independently evaluated focal areas of signal intensity on both conventional MR imaging and synthetic MRI. Additionally, automatically segmented volume calculations of the brain in both groups and quantitative analysis of myelin, including the focal areas of signal intensity and normal-appearing brain parenchyma, of patients with neurofibromatosis type 1 were performed using synthetic MRI. RESULTS: The comparison of conventional MR imaging and synthetic MRI showed good correlation in the supratentorial region of the brain (κ = 0.82-1). Automatically segmented brain parenchymal volume, intracranial volume, and GM volumes were significantly increased in the patients with neurofibromatosis type 1 (P < .05). The myelin-correlated compound, myelin fraction volume, WM fraction volume, transverse relaxation rate, and longitudinal relaxation rate values were significantly decreased in focal areas of signal intensity on myelin and WM maps (P < .001); however, GM, GM fraction volume, and proton density values were significantly increased on the GM map (P < .001). CONCLUSIONS: Synthetic MRI is a potential tool for the assessment of morphometric and tissue alterations as well as the detection of focal areas of signal intensity in patients with neurofibromatosis type 1 in a reasonable scan time.

Pediatric headache and neuroimaging: experience of two tertiary centers.

INTRODUCTION: Headache is a frequent complaint in children and adolescents. Decision-making for neuroimaging should take into account the cost and the need for sedation in young children. AIM: To evaluate the yield of MRI in pediatric headache patients seen in two large tertiary hospitals. METHODS: Data were retrospectively collected from patient records (n = 613) and neuroimaging reports. Headache was classified according to International Headache Society guidelines. RESULTS: There were 346 children with imaging studies (MRI n = 281, CT n = 65). Of patients who had at least one MRI study, 29% demonstrated an abnormal finding. Findings altering the management were obtained in 21 (7%) patients: the majority (n = 17, 80%) had headache for less than 3 months. On the other hand, four patients with headache longer than 3 months (19%) and 12 patients with normal neurological examination (57%) had significant MRI results affecting management. None of the children in whom the diagnosis of migraine could be made on clinical grounds (n = 40) had a significant MRI finding. CONCLUSION: Neuroimaging should be performed selectively in children with headache seen in pediatric neurology clinics, especially in headache of short duration (< 3 months) and features atypical for migraine. A normal neurological examination should not reassure the clinician.

Milestones of language development in Turkish children.

OBJECTIVES: Language delays are common in childhood, may be associated with delays in other areas of development, and can affect school performance. Various tests designed for general developmental screening or specifically for language are used to assess developmental status in preschool children. Knowledge of the probabilities of normal developmental milestones may simplify detection of problems and delays. The aim of this study was to determine the milestones of language development in Turkish children. PATIENTS AND METHODS: We assessed data from application of the Denver II Developmental Screening Test's Turkish standardization to 1,993 children, 976 (49.0%) boys and 1,017 (51.0%) girls aged 0.6-82.0 months. We used binary logistic regression to analyze the predicted probability of accomplishing the language items on the Denver II Developmental Screening Test. RESULTS: We determined the sequence of assessed language items and the ages associated with accomplishing those items, as well as the ages at which 25, 50, 75, and 100% of children passed the items. Language items followed a sequential route. Graphs had polynomial slopes. CONCLUSION: Curves for normal development allow detection of aberrations in the predicted course of language development, and may facilitate earlier diagnosis of delays in language.

Epipteric bones in the pterion may be a surgical pitfall.

BACKGROUND: The pterion, the most commonly used neurosurgical landmark, is defined as the junction of frontal, parietal, and greater wing of the sphenoid and the squamous part of temporal bones. Our aim was to identify the variations of the pterion which may be a potential surgical pitfall. METHODS: Both sides of 300 adult skulls were examined but 110 sides were eliminated since their pterion could not be identified owing to a damage. The shortest distance between the lateral orbital rim and the most anterior junction of the four bones forming the pterion was measured on all sides. RESULTS: Out of 490 sides the pterion was found to contain epipteric bones in 44 (9 %), and in these skulls the most anterior junction of the bones may be as close as 16 mm to the lateral orbital rim. CONCLUSION: In skulls with an epipteric bone variation, particularly the anterius and proprium types; the pterion can mistakenly be assessed to be at the most anterior junction of bones and a burr hole placed over there may cause inadvertent penetration into the orbit.