Unilateral isolated alar ligament rupture in an adult female patient.

Only seven cases of isolated unilateral rupture of the alar ligament had been previously reported. The authors report the first adult female case of this rare injury. The patient in their case, a 36-year-old female presented after a trauma due to falling, and at that moment, she had fainted due to a sudden pain between the neck and head. The radiological examinations [magnetic resonance imaging (MRI) and X-rays] had been interpreted as normal. She had a positive Alar ligament test at the right side, and a thin section craniovertebral junction computed tomography was obtained which revealed an asymmetrically left-sided odontoid process and a new MRI revealed a right-sided alar ligament rupture. Thus she underwent a bilateral greater occipital nerve block together with pulse radiofrequency and trigger point injection at splenius capitis, levator scapula, and trapezius followed by the application of a halo orthosis to be worn for 3 months. The patient was found to be pain-free in the follow-up examinations. With pure unilateral alar ligament rupture, the atlantooccipital joint is not disrupted and the craniovertebral junction is not destabilized. To date, only eight cases of isolated unilateral alar ligament rupture have been reported one of which was a 25 years old male; all of whom presented with marked neck pain and treated by external immobilization for 4 weeks to 4 months and our case is the first adult female patient.

The diagnostic value of neurogranin in patients with carbon monoxide poisoning: Can it show early neurological damage?

BACKGROUND AND AIM: Carbon monoxide poisoning is a toxicological emergency that causes neurological complications. High serum neurogranin can be detected in acute or chronic conditions where brain tissue is damaged. This study aimed to investigate the diagnostic value of serum neurogranin level and its role in demonstrating neurological damage in patients admitted to the emergency department with carbon monoxide poisoning. MATERIALS AND METHODS: The study was conducted prospectively on patients with carbon monoxide poisoning (patient group) and healthy volunteers (control group). Demographic characteristics and serum neurogranin level of all participants and symptoms at admission, neurological examination findings, laboratory results, and Diffusion-Weighted Magnetic Resonance Imaging results of the patient group were recorded. We used an independent sample t-test to compare neurogranin levels and bivariate correlation analysis to compare the relationship between serum neurogranin levels and data belonging to the patient group. RESULTS: Sixty eight participants (patient group, n = 36; control group, n = 32) were included in the study. Serum neurogranin level was significantly higher in patients with carbon monoxide poisoning (0.31 ± 0.16 ng/ml) compared to control group (0.22 ± 0.10 ng/ml) (p = 0.015). The mean Glasgow Coma Scale of the patients with carbon monoxide poisoning was 14.59 ± 0.23, and of Diffusion Weighted Magnetic Resonance Imaging results were completely normal in 94.4% (n = 34). There was no correlation between serum neurogranin level and Diffusion Weighted Magnetic Resonance Imaging results (r = -0.011; p = 0.953). CONCLUSION: Serum neurogranin level may be a new diagnostic biomarker in patients admitted to the emergency department with carbon monoxide poisoning. The high serum neurogranin levels detected in patients with normal diffusion-weighted imaging after carbon monoxide poisoning suggest that there is neurological damage in these patients, even if imaging methods cannot detect it.

A Case Report of a Prenatally Missed Mowat-Wilson Syndrome With Isolated Corpus Callosum Agenesis.

Mowat-Wilson syndrome (MWS) is an autosomal dominant genetic disorder caused by ZEB2 gene mutations, manifesting with unique facial characteristics, moderate to severe intellectual problems, and congenital malformations as Hirschsprung disease, genital and ophthalmological anomalies, and congenital cardiac anomalies. Herein, a case of 1-year-old boy with isolated agenesis of corpus callosum (IACC) in the prenatal period is presented. He was admitted postnatally with Hirschsprung disease (HSCR), hypertelorism, uplifted earlobes, deeply set eyes, frontal bossing, oval-shaped nasal tip, ''M'' shaped upper lip, opened mouth and prominent chin, and developmental delay. Hence, MWS was primarily considered and confirmed by the ZEB2 gene mutation analysis. His karyotype was normal. He had a history of having a prenatally terminated brother with similar features. Antenatally detected IACC should prompt a detailed investigation including karyotype and microarray; even if they are normal then whole exome sequencing (WES) should be done.

Pancreas and kidney changes in type 2 diabetes patients: the role of diffusion-weighted imaging

Background/aim: The aim of this study was to compare renal and pancreatic apparent diffusion-coefficient (ADC) values of diabetic patients and control subjects and to examine their potential association with several diabetes-related clinical parameters. Materials and methods: A total of 80 sex- and age-matched patients were included in the study. Of them, 40 were patients with type 2 diabetes and 40 were nondiabetic participants. Abdominal diffusion-weighted MRIs of both groups were retrospectively reviewed. Diabetes-related clinical parameters were recorded. Results: The difference between the mean ADC values of the patient group and the control group was significant (p = 0.012). It was also found that the mean pancreatic ADC values of diabetic patients and the control group significantly differed (p = 0.02). Besides, there were positive correlations between the mean pancreatic ADC values and age, Hb1Ac level, treatment type, and disease duration (p < 0.05). While eGFR values positively correlated with the mean renal ADC values (p < 0.05), there were negative correlations between such values and age, serum creatinine level, and disease duration (p < 0.05). Conclusion: Renal and pancreatic ADC values of diabetic patients could potentially play a role, as markers of renal and pancreatic functions, in clinical decisions in the follow-up of such patients.

The Diagnostic Value of sTWEAK in Acute Ischemic Stroke

Background: Considering the critical role of early diagnosis and management of acute ischemic stroke, biomarkers that can reliable assist in the diagnosis are still needed. These biomarkers should rapidly analyze, have high specificity for brain damage, and be available in the emergency settings for early diagnosis and exclusion of other conditions that mimic acute ischemic stroke. Soluble tumor necrosis factor-like weak inducer of apoptosis, a protein involved in the regulation of several biological functions, could be a potential acute ischemic stroke biomarker. Aims: To investigate the diagnostic value of soluble tumor necrosis factor-like weak inducer of apoptosis in patients with acute ischemic stroke and examine the relationship between ischemic area volume determined at diffusion-weighted magnetic resonance imaging and soluble tumor necrosis factor-like weak inducer of apoptosis. Study Design: A prospective, case-control study. Methods: This case-control prospective study included 36 patients with acute ischemic stroke and 36 healthy volunteers. Information on age, sex, presence of chronic disease, neurological examination findings, times of presentation to the emergency department after acute ischemic stroke, soluble tumor necrosis factor-like weak inducer of apoptosis levels, ischemic area volumes at diffusion-weighted magnetic resonance imaging, and 6-month mortality rates after stroke were recorded. The results were analyzed on SPSS 22.0 software (SPSS Inc., Chicago, IL, USA), and p<0.05 was considered statistically significant. Results: A soluble tumor necrosis factor-like weak inducer of apoptosis cut-off value of 995.5 pg/mL exhibited a sensitivity of 80.5% and a positive predictive value of 82.5% with an area under the curve of 0.84 (95% confidence interval: 0.74-0.94; p<0.001). The mean soluble tumor necrosis factor-like weak inducer of apoptosis levels in the acute ischemic stroke group (1968.08±1441.99 µg/L) were significantly higher than those in the control group (704.81±291.72 µg/L) (p<0.001). No correlation was observed between soluble tumor necrosis factor-like weak inducer of apoptosis levels and ischemic area volume measured at diffusion-weighted magnetic resonance imaging (r=-0.008; p=0.07). The mean ischemic area volume was 505.68±381.10 and 60.96±80.89 mm3 in the nonsurviving and surviving patients, respectively (p=0.002). Conclusion: Soluble tumor necrosis factor-like weak inducer of apoptosis can be used in the diagnosis of acute ischemic stroke. However, it is inconclusive in estimating ischemic area volume and early mortality following acute ischemic stroke. Ischemic area volume measured at diffusion-weighted magnetic resonance imaging is a marker of poor prognosis and can be used in predicting early mortality.

Detection of hip osteoarthritis by using plain pelvic radiographs with deep learning methods.

OBJECTIVE: The incidence of osteoarthritis is gradually increasing in public due to aging and increase in obesity. Various imaging methods are used in the diagnosis of hip osteoarthritis, and plain pelvic radiography is the first preferred imaging method in the diagnosis of hip osteoarthritis. In this study, we aimed to develop a computer-aided diagnosis method that will help physicians for the diagnosis of hip osteoarthritis by interpreting plain pelvic radiographs. MATERIALS AND METHODS: In this retrospective study, convolutional neural networks were used and transfer learning was applied with the pre-trained VGG-16 network. Our dataset consisted of 221 normal hip radiographs and 213 hip radiographs with osteoarthritis. In this study, the training of the network was performed using a total of 426 hip osteoarthritis images and a total of 442 normal pelvic images obtained by flipping the raw data set. RESULTS: Training results were evaluated with performance metrics such as accuracy, sensitivity, specificity, and precision calculated by using the confusion matrix. We achieved accuracy, sensitivity, specificity and precision results at 90.2%, 97.6%, 83.0%, and 84.7% respectively. CONCLUSION: We achieved promising results with this computer-aided diagnosis method that we tried to develop using convolutional neural networks based on transfer learning. This method can help clinicians for the diagnosis of hip osteoarthritis while interpreting plain pelvic radiographs, also provides assistance for a second objective interpretation. It may also reduce the need for advanced imaging methods in the diagnosis of hip osteoarthritis.

ADC evaluation of the corticospinal tract in multiple sclerosis.

Apparent diffusion coefficient (ADC) values derived from diffusion-weighted MR imaging (DWI) provide important information about tissues. The goal of this study was to evaluate the ADC values in the corticospinal tract regions in multiple sclerosis (MS). The ADC values of 42 patients with multiple sclerosis and 46 healthy people were measured. The ADC values in the corticospinal tract at the capsula interna posterior crus from six points and mesencephalon from three points bilaterally in MS patients were compared with those of controls. An ANOVA post hoc test was used to analyse the differences in mean ADC values between the MS and control groups. The mean ADC values of the right (p = 0.008) and left internal capsules (p = 0.000) and right (p = 0.002) and left mesencephalons (p = 0.044) in MS patients were significantly lower than in the control group. There was no significant difference between the right and left side ADC values in MS (p = 0.313 vs. p = 0.223) and control groups (p = 0.756 vs. p = 0.105), respectively. The mean ADC values of the corticospinal tract in MS patients were significantly lower than in the control group. This decreased diffusion may be the result of cellular infiltration due to inflammation, cytotoxic oedema, demyelination or remyelination processes.

Better visualization of vermiform appendix with tissue harmonic imaging compared to conventional sonography.

BACKGROUND: Surgery of appendicitis carries 7-11% negative appendectomy rates. Sonographically visualized normal appendix precludes unnecessary computed tomography (CT) examination and may reduce negative appendectomy rates. Tissue harmonic imaging (THI) has been reported to improve the overall image quality. OBJECTIVE: We aimed to assess whether THI is more successful than conventional ultrasonography (US) in detecting normal and pathologic appendices. PATIENTS AND METHODS: The study was performed on 185 patients who applied for routine US examinations in whom clinical findings of appendicitis were detected in 25. We searched for the appendix; applying both THI and conventional US to each patient, one before and the other after the routine US examinations. Patients were divided into two groups; one was evaluated first with conventional US and the other first with THI. When the appendix was found, localization, diameter and time spent for visualization were recorded. Twelve patients were operated; all of whom had appendicitis pathologically. Two methods were compared for: 1. Success rates in all patients; female, male and child groups separately; 2. Visualization of pathologic and normal appendices; 3. Time for visualization of appendix; 4. Comparison of success rates in the adult and child population. The relationship between the rate of visualization and body mass index was evaluated. RESULTS: The appendix was visualized better by THI in all patients, and in the female and male groups (P < 0.001). In children, both methods were more successful compared to adults (P < 0.001, compared to male group, P < 0.001, compared to female group), with no difference between the methods (P = 0.22). When only the normal appendices were concerned, there was significant difference between both methods (P < 0.000). Both methods detected pathologic appendices better than normal ones, with a higher ratio for THI (P = 0.022 for the THI group, and χ(2) = 7.22, P = 0.07 for the conventional US group). THI visualized the appendix faster. Both methods were more successful in lean patients (P = 0.004 for THI, P = 0.001 for conventional US imaging). CONCLUSIONS: THI visualizes appendix better than conventional US. It is a simple and time saving method that may eliminate further diagnostic imaging, and it may decrease negative appendectomy rates and related complications.

Focal liver lesions evaluated by MR imaging.

Magnetic resonance signal intensity of focal liver lesions is the result of their histological and cytological features. Therefore, analysis of lesion signal intensity and enhancement patterns obtained with magnetic resonance imaging is essential for the differential diagnosis of focal liver lesions. In this article, we review the magnetic resonance imaging features of the most common focal liver lesions.

Risky anatomic variations of sphenoid sinus for surgery.

We searched for the surgically risky anatomic variations of sphenoid sinus and aimed to compare axial and coronal tomography in detection of these variations. Fifty-six paranasal tomography images (112 sides) were evaluated for coronal, axial and both coronal and axial images. Tomographic findings including bony septum extending to optic canal or internal carotid artery; protrusions and dehiscences of the walls of internal carotid artery, optic nerve, maxillary nerve and vidian nerve; extreme medial course of internal carotid artery; patterns of aeration of the anterior clinoid process; and Onodi cells were evaluated. The results were classified as "present, absent, suspicious-thin (only for dehiscence) or no-consensus". The results of each plane were compared with that of the result of the both planes together. Kappa coefficient and Chi-square tests were used to compare both planes. Twelve cadaveric dissections were performed to reveal the proximity of sphenoid sinus to surgically risky anatomic structures. Endoscopy was applied to five cadavers. 18 evaluations were classified as 'no-consensus'. We detected 34, 35, 34 and 40 protrusions of internal carotid artery, optic nerve, maxillary nerve, vidian nerve, respectively. Dehiscences were present in 6, 9, 4 and 8, and suspicious-thin in 8, 10, 16 and 25 in canals of internal carotid artery, optic nerve, maxillary nerve and vidian nerve, respectively. Bony septum to internal carotid artery and optic nerve was observed in 30 and 22 cases. We observed 9 extreme medial courses of internal carotid artery, 27 aerated clinoid process and 9 Onodi cells. Axial images were superior in detection of bony septum to internal carotid artery and Onodi cells; while the coronal images were more successful in detection of protrusion of optic nerve and vidian nerve, and dehiscense of maxillary nerve and vidian nerve (P<0.05). In cadaveric dissections, the septa were inserted into the bony covering of the carotid arteries in two sinuses (8.3%). Detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and reducing intraoperative complications. Coronal tomography more successfully detects the sphenoid sinus anatomic variations.

Transient arterial enhancement in a hepatic peritumoral fat-spared area.

Early-enhancing areas that are perfusion abnormalities rather than tumor deposit are sometimes encountered on arterial dominant-phase images in multisection dynamic magnetic resonance imaging. Focal sparing in diffusely fatty liver is also a well recognized entity. However, both conditions occasionally create problems in the diagnosis of hepatic mass lesions. Familiarity with these abnormalities on ultrasonography and multisection dynamic magnetic resonance images is important to prevent misinterpretation of these pseudolesions as real masses. In addition, focal sparing can be the only clue for a space occupying lesion in the liver. We present here the ultrasonography and magnetic resonance imaging findings of a case with liver metastasis from pancreas cancer which caused a wedge-shaped fat-spared enhancing area on dynamic magnetic resonance imaging.

Superior mesenteric artery syndrome: CT and ultrasonography findings.

PURPOSE: The purpose of the study was to describe computed tomography (CT) and ultrasonography findings in superior mesenteric artery syndrome (SMAS). MATERIALS AND METHODS: The study was performed on 89 CT examinations. Ultrasonography was performed on 32 and barium study was performed on four of these subjects. Group A consisted of cases with one or more of the following complaints: postprandial epigastric pain, weight loss and vomiting. Group B consisted of the remaining cases. Cases who had all of the above-mentioned clinical findings and duodenal dilatation, to-and-fro barium movement and SMA indentation in barium study were diagnosed as having SMAS. Body mass index (BMI, kg/m2) was calculated. The distance between SMA and aorta, at the location where the duodenum passes from, was measured on CT and ultrasonography. The angle between SMA and aorta was measured on ultrasonography images. Group and gender differences were analyzed with t-test, the relationship between clinical and CT findings was analyzed with Mann Whitney U test and the relations between BMI-CT and CT-ultrasonography measurements were analyzed with Pearson coefficients. RESULTS: Of 13 cases in Group A, 3 were diagnosed as SMAS. Eight of the cases showed gastric and/or duodenal dilatation. In 6 cases, antrum had an abnormally high location at portal hilus. In Group A, the SMA-aorta distance was 6.6 +/- 1.5 mm and the SMA-aorta angle was 18.7 +/- 10.7 degrees . In Group B, these values were 16.0 +/- 5.6 mm and 50.9 +/- 25.4 degrees , respectively (p < 0.001). Cut-off values between SMAS and Group B were 8 mm (100% sensitivity and specificity), and 22 degrees (42.8% sensitivity, 100 % specificity). CT and ultrasonography measurements (p < 0.001) and SMA-aorta distance and BMI (p=0.004) were significantly correlated. The SMA-aorta distance was significantly shorter in females (p=0.036). CONCLUSION: Gastric and/or duodenal dilatation and a diminished SMA-aorta distance have a significant correlation with clinical symptoms of SMAS that include postprandial pain, vomiting and weight loss.

Cerebral hemodynamics in ocular hypertension.

PURPOSE: To evaluate the cerebral blood flow velocity in patients with ocular hypertension. MATERIAL AND METHODS: Twenty-four ocular hypertensive patients and 24 age- and sex-matched healthy volunteers were recruited in a prospective comparative study. All subjects had normal findings on full-threshold visual field tests and clinically normal optic nerves. All patients with ocular hypertension had an intraocular pressure (IOP) of >21 mmHg on three separate occasions without treatment. Systolic and diastolic blood pressure by cuff, heart rate by palpation, IOP by Goldmann applanation tonometry, central corneal thickness by ultrasound pachymetry, blood flow velocities, and pulsatility index of the ipsilateral middle cerebral artery by transcranial color Doppler were measured. RESULTS: Systolic and diastolic blood pressures (P=0.40 and P=0.45, respectively), heart rate (P=0.30), and central corneal thickness (P=0.23) were similar in each group. Peak and end-diastolic blood flow velocities in the middle cerebral artery did not differ between ocular hypertensives and controls (P=0.37 and P=0.87, respectively). In addition, pulsatility index did not significantly differ between ocular hypertensives and controls (P=0.61). CONCLUSIONS: The results of this study suggest that ocular hypertension is not associated with reduction in blood flow velocity and elevation of resistance in the middle cerebral artery.

Doppler sonography of the normal lacrimal gland.

PURPOSE: We used Doppler sonography to determine the resistance index (RI) and pulsatility index (PI) of the normal lacrimal artery (LA) in both females and males. We also compared the values obtained at various periods of reproductive life. METHODS: The study was performed in 25 prepubertal girls, 28 females of reproductive age, and 27 postmenopausal women, 23 pregnant women, and 104 healthy males. Doppler sonography was used to determine the RI and PI of the LA. RESULTS: The mean PI for the entire patient population was 1.48 +/- 0.60 and the RI was 0.72 +/- 0.09. The RI and PI values of the LA did not differ between males and females. Similarly, the mean RI and PI values of the LA did not change significantly between the various reproductive phases. CONCLUSION: The PI and RI of the lacrimal gland are similar in both sexes. Moreover, they are not altered by changes in levels of sex steroids.

Giant abdominal wall abscess dissecting into thorax as a complication of ESWL.

Abscess as a complication of extracorporeal shock wave lithotripsy is a rare condition. We present the computed tomography findings of an abdominal wall abscess that occurred after extracorporeal shock wave lithotripsy for which prophylactic antibiotics had not been given. The abscess destroyed the posterior abdominal wall muscles and dissected into the thorax. The muscles were thickened and showed enhancement. A parenchymal defect in the right kidney adjacent to a caliceal stone, with strands extending from this defective region to the abscess, was observed, and was thought to be the result of parenchymal destruction caused by the shock waves. Other parts of the kidney and psoas muscle were normal. Microbiologic examination revealed Escherichia coli.

Contrast media induces hypoperfusion in kidneys with ureteral stone: Doppler US study.

We aimed to assess the hemodynamic effects of nonionic low-osmolarity contrast media (CM) on kidneys with ureteral stone (KUS). A total of 16 patients with KUS (group A) and 25 control patients (group B) were evaluated with Doppler ultrasound (US) bilaterally for main (MRA), interlobar (ILA) and arcuate renal arteries (ARA), before and 15 min after CM for IV pyelography. Peak systolic (PSV) and end diastolic velocities (EDV) and resistance index (RI) were measured. Data were analyzed by ANOVA and t-test. In group A, CM induced increase in PSV of MRA of contralateral kidney (p = 0.021) and decrease in PSV of ILA (p = 0.024), decrease in PSV and EDV and increase in RI of ARA of KUS (p = 0.010, 0.005, 0.027, respectively). CM induced hypoperfusion in KUS and compensatory changes in contralateral kidneys, similar to the effects of diuresis or mannitol. We conclude that the effect of CM on KUS is related to its osmolar load.

Quantitative analysis of liposuction with B mode ultrasound.

BACKGROUND: The objective of this study was to determine whether ultrasonography is a reliable method for monitoring subcutaneous fat thickness in the quantitative analysis of liposuction results. METHODS: Subcutaneous fat thicknesses before and 2 months after liposuction in prespecified areas were measured in 14 patients using a 7.5-MHz ultrasound scanner. Pre- and postoperative subcutaneous fat thicknesses were compared statistically. RESULTS: The thicknesses of pre- and postoperative subcutaneous fat layers were statistically different. CONCLUSION: Ultrasound is a valuable tool for perioperative guidance, preoperative planning, and quantitative analysis of the procedure results.