Fatty degeneration of multifidus muscle in patients with chronic low back pain and in asymptomatic volunteers: quantification with chemical shift magnetic resonance imaging.

OBJECTIVE: To evaluate and compare the fatty degeneration of multifidus muscles by chemical shift magnetic resonance imaging (MRI) in patients with chronic low back pain and in asymptomatic volunteers. MATERIALS AND METHODS: Sixty-five patients with lumbar disc pathology were selected prospectively for this study. The control group consisted of 25 asymptomatic volunteers. The patients were grouped according to the fatty degeneration of multifidus muscles by a semiquantitative method (grade 0-4) on axial T2 weighted imaging. Chemical shift MRI was performed in the axial plane using a double-echo fast low-angle shot (FLASH) sequence. Fatty degeneration was calculated through signal intensity suppression rate (SISR) and signal intensity index (SII). RESULTS: The semiquantitative grading of fatty degeneration of the multifidus muscle was 0 in 25 of 65 patients (patient group 0), 1 in 20 patients (patient group 1), 2 in 20 patients (patient group 2). Neither grade 3 nor grade 4 were detected in patient groups. For the control group, patient group 0, patient group 1, and patient group 2, median SISR values were 5.00, -9.00, -17.50, and -22.50 %, respectively. SII median values were -4.20 % for the control group, 7.00 % for patient group 0, 12.50 % for patient group 1, and 19.50 % for patient group 2. SISR values in the multifidus muscle calculated for the patient groups were significantly lower than those calculated for the control group. SII values in patients groups were significantly higher than in the control group. CONCLUSIONS: Chemical shift MRI may be a useful method to quantitatively evaluate the fatty degeneration in multifidus muscle in patients with low back pain.

The role of MR imaging with half Fourier acquired single shot turbo spin echo sequence in the diagnosis of lung lesions in comparison with multislice CT.

OBJECTIVE: To compare the diagnostic values of magnetic resonance imaging using Half Fourier Acquired Single Shot Turbo Spin Echo sequence and multidetector computed tomography in patients with pathologically examined pulmonary lesions. METHODS: The retrospective, descriptive study was conducted at Radiology Department, Diskapi Research Hospital, Ankara, Turkey, and comprised records of patients with pathologically examined pulmonary lesions between May 2009 and March 2012. Patients were divided into three groups and examined by both multidedector computed tomography and magnetic resonance imaging. During the imaging, patients were not administered any intravenous contrast medium. Electrocardiogram gating and breath holding were not performed in echo sequence. Pulmonary lesions were evaluated on the basis of their dimensions, numbers, differentiation from atelectasis and consolidation, invasion to the thoracic wall-mediastinal structures and presence of lymphadenopathies. RESULTS: Sensitivity of all patients was 50% (p = 0.214) and specificity of CT and MRI were 82.5% (p = 0.134) for the detectability of submilimetric nodules. For differentiation of the mass from atelectasis and consolidation, the sensitivity of computed tomography was statistically more significant compared to magnetic resonance imaging (86.6%; p = 0.035). For the invasion of the mass to the mediastinal structures and the thoracic wall, the sensitivity of magnetic resonance imaging was statistically more significant compared to tomography (86.6%; p = 0.035). CONCLUSION: HASTE sequence can be used to determine the invasion of the pulmonary mass to the mediastinal structures and the thoracic wall since it is more sensitive than computed tomography. It can also be used to detect submilimetric nodules. It has equal sensitivity and specificity compared to computed tomography. But computed tomography is superior for the differentiation of the mass from atelectasis and consolidation.

Sonographic findings in a case of polyneuropathy associated with POEMS syndrome.

Polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes (POEMS) syndrome is a rare multi-system disease. We describe the ultrasonography (US) and color Doppler ultrasonography (CDUS) findings of peripheral neuropathy in a patient with POEMS syndrome. In US examination, peripheral nerves were found to be diffusely thickned in both upper limbs. CDUS imaging showed arterial blood flow with low systolic peaks on the nerves.

Carotid blowout syndrome with oronasal hemorrhage: magnetic resonance imaging findings.

Carotid blowout syndrome (CBS) is a rare but well-known complication of aggressive radiotherapy management of head and neck cancer. Reports on magnetic resonance imaging (MRI) findings of CBS are limited in the relevant literature, probably because of the angiography priority of this complication. We describe MRI findings in a patient with nasopharyngeal carcinoma complicated with CBS.

Trumpet maneuver in the sonographic diagnosis of an external laryngocele.

Laryngocele is an uncommon disease defined as an abnormal dilatation or herniation of the laryngeal saccule, forming an air-filled cavity. Radiologic evaluation of a suspected laryngocele generally includes plain radiographs, CT, and MRI. There are very few reports in the literature on sonographic findings of laryngocele. Trumpet maneuver has been reported in CT examination for the diagnosis of laryngocele. However, to the best of our knowledge, the use of trumpet maneuver in the sonographic diagnosis of laryngocele has not been previously described. This report presents the sonographic findings of an external laryngocele while performing the trumpet maneuver.

Continuous-type splenogonadal fusion associated with an ipsilateral testicular atrophy: sonographic findings.

Splenogonadal fusion is a rare congenital anomaly in which the spleen is abnormally connected to the gonad. Two types of splenogonadal fusion have been described: continuous and discontinuous. Splenogonadal fusion is frequently associated with cryptorchidism and/or congenital orofacial/limb anomalies. We describe the ultrasound findings in a case of continuous-type splenogonadal fusion associated with ipsilateral testicular atrophy with correlation with MRI.

Significance of fibrosis around and/or at external urinary sphincter on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence.

OBJECTIVES: To determine the clinical importance of fibrosis on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence (PPI) due to sphincteric incompetence. METHODS: Urethral and periurethral fibrosis was determined by pelvic magnetic resonance imaging in patients who did (n = 22) or did not (n = 14) have urinary incontinence after transurethral resection, transvesical prostatectomy, or radical retropubic prostatectomy. The relation between fibrosis and the duration of incontinence, pad weight, symptom score, cystoscopy findings, and urodynamic findings was examined. RESULTS: Fibrosis was seen in all patients (22 of 22) in the study group and in 4 of 14 patients in the control group (P <0.001). All the patients with severe fibrosis had undergone radical retropubic prostatectomy (P <0.001). Similar to the etiology for incontinence, no relation was found between the severity of fibrosis and the duration of incontinence, pad weight, symptom score, cystoscopy findings, or urodynamic findings. However, the duration of incontinence was shorter in patients with mild fibrosis, clinically. CONCLUSIONS: The results of our study have shown that the incidence of fibrosis is much greater in patients with PPI than in patients without PPI. Consequently, we believe that fibrosis plays an important role in the development of PPI because it may have a negative effect on external urethral sphincter function.

Is every chronic low back pain benign? Case report.

BACKGROUND: There is a well-recognized association between chronic back pain and the existence of an AAA. In literature, there are few reported AAA cases that describe patients with extensive pressure erosion of the vertebral body. CASE DESCRIPTION: The authors present the case of a 38-year-old woman with chronic low back pain for the last 2 years in whom an AAA was formed during the follow-up period. The patient presented with an episode of low back pain following hard work 2 years ago. MR imaging of the lumbar spine was reported as disc degeneration at the L4-5 and L5-S1 levels. She was given medical treatment and was doing well with occasional back pain for a year. One year later, she suffered another disabling pain attack, and MR imaging revealed an additional focal disc protrusion at the L4-5 level. She was again medically treated. In August 2004, she presented with severe low back pain, and this time, MR imaging showed edema and erosion at the anterior part of L3 vertebra body. MR imaging studies (2- and 3-dimensional) depicted AAA as the cause. She was operated on, and the aneurysm was resected with graft repair of the site. She was pain-free in the postoperative period. CONCLUSIONS: The evaluation of a patient with chronic back pain needs a thorough clinical and radiological workup. Limited evaluation of the bony and nervous structures of the spinal canal radiologically is insufficient. Pre- and paravertebral structures as well as vertebral body should carefully be evaluated to diagnose other causes of pain.

Doppler ultrasonography findings in ocular Behçet's disease.

The aim of this prospective study was to determine and compare the orbital Doppler ultrasonography parameters of patients with Behçet's disease (with or without ocular involvement) with those of healthy subjects. We evaluated ophthalmic artery (OA), central retinal artery, posterior ciliary artery (PCA), central retinal vein, and superior ophthalmic vein (SOV) flow velocities and resistance indices (RIs). Detection of the decreased flow velocities in the OA and SOV and the increased RI in the OA and PCA might allow the identification of active period of patients with Behçet's disease.

Conventional and diffusion-weighted MR imaging of cerebral aspergillosis.

Central nervous system aspergillosis has increased dramatically in recent years. Most of the cases are immunocompromised patients infected from a primary site, usually the lungs or paranasal sinuses, and the organism may spread to the central nervous system. Different neuroimaging patterns that have been reported vary depending on the immunological status of the patients and on the age of the lesions. Description of typical radiological patterns in cerebral aspergillosis patients may be helpful in establishing early diagnosis and treatment. In this case report, we present magnetic resonance images of cerebral aspergillosis and the contribution of diffusion-weighted magnetic resonance imaging to the diagnosis.

A rare anomalous origin of right vertebral artery: findings on Doppler sonography.

Anomalous origin of the right vertebral artery from the right common carotid artery occurs rarely. To the best of our knowledge, the medical literature contains no information about gray-scale and Doppler sonography findings in this anomaly, despite the extensive information available from angiographic studies and postmortem examinations. We present the case of a 32-year-old man who suffered from a sudden onset of hemiparesis on the left side. Doppler sonography revealed a partial thrombosis in the proximal part of right common carotid artery. The right vertebral artery was shown to originate from the proximal part of the right common carotid artery. The right vertebral artery was patent. Thus, the use of color Doppler sonography can aid in the diagnosis of some vascular anomalies.

[A comparison between findings of high resolution computed tomography and magnetic resonance imaging in the preoperative assessment of cochlear implant patients]. / Koklear implantasyon öncesinde yüksek çözünürlüklü bilgisayarli tomografi ve manyetik rezonans görüntüleme bulgularinin karsilastirilmasi.

OBJECTIVES: We compared the preoperative findings of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) with those observed during surgery to determine their value for cochlear implant patients. PATIENTS AND METHODS: A retrospective assessment was made on preoperative HRCT and MRI scans of 124 cochlear implant patients (71 males, 53 females; mean age 15 years; range 2 to 63 years). Congenital cochlear anomalies, cochlear ossification, new bone formation in the middle ear, and structures in the internal auditory canal were evaluated and compared with intraoperative findings. RESULTS: Cochlear anomalies detected in five patients by HRCT and MRI were confirmed intraoperatively. Cochlear ossification encountered in six patients during surgery was only demonstrated in four patients; HRCT and MRI scans only showed a narrow basal turn in the remaining two patients. During surgery, eight patients were found to have cochlear fibrosis: this finding was documented in five patients (62.5%) by MRI, and in none by HRCT scans. CONCLUSION: Although HRCT provides valuable information for surgical planning, its limitations may justify the additional use of MRI before cochlear implantation.