Ahmet Yesildag

Intracranial lipomas: importance of localization

Intracranial lipomas are rare congenital malformations. They are usually pericallosal asymptomatic midline lesions. Other brain malformations are often seen in association with intracranial lipomas. We describe the findings of imaging studies, including computed tomography (CT), magnetic resonance (MR) imaging, and MR angiography, along with a brief review of the literature. The frequency and the spectrum of the associated brain malformations are also discussed. We retrospectively reviewed CT and MR findings of 24 patients (14 female, 10 male, mean age 38.6 years) diagnosed with intracranial lipoma between December 2000 and June 2004 in two different radiology departments. Seventeen of the patients were diagnosed using cranial MR and seven with cranial CT. The CT density of all lesions was measured. Imaging characteristics of lipomas, morphological findings and associated malformations were described. The intracranial locations of the lipomas were left-sided quadrigeminal cistern (n=3), right-sided quadrigeminal cistern (n=4), interpeduncular cistern (n=1), sylvian fissure (n=3), interhemispheric fissure (n=3), choroid plexus (n=2), intercerebellar fissure (n=3), corpus fornicis (n=1) and the periphery of the corpus callosum (n=4). Eighteen of the intracranial lipomas were tubulonodular; six were curvilinear. Associated anomalies were observed in six patients. All of the patients with sylvian fissure lipoma had seizures. The two preferential sites of intracranial lipomas were pericallosal and dorsal mesencephalic. Most intracranial lipomas are found incidentally during neuroradiological investigations. CT and MR examination usually lead to the diagnosis, because of the very low attenuation values of lipomas on CT and the short T1 and T2 on MR. Midline anomalies and other malformations such as aneurysms are frequently associated with intracranial lipomas. Careful radiologic evaluation is therefore necessary to evaluate associated pathologies. Sylvian fissure lipomas should be considered in the differential diagnosis of patients with epilepsy.

Bilobed gallbladder diagnosed by oral cholecysto-CT.

Morphological anomalies of the gallbladder are rare and are characterized by a large variety of configurations depending on the size and degree of fusion of the lobes, and on the number and position of the cystic ducts. We presented a case of bilobed gallbladder incidentally detected during abdominal ultrasonography. Oral cholecystography and computed tomographic examination after oral cholecystography (Oral Cholecysto-CT) were performed to confirm this abnormality. This is a quite rare anomaly consisted of complete duplication of the fundus and partially duplication of the corpus and separated lobes both of which entered a single infundibulum and cystic duct.

Carotid CT-angiography: Low versus standard volume contrast media and low kV protocol for 128-slice MDCT

Availability and utilization of computed tomography angiography has been increasing recently. We aimed to assess the effectiveness of low amount of contrast media and low kV value in order to reduce possible side effects of contrast media and to provide optimization of kV value in the evaluation of the carotid artery with multi-detector computed tomography angiography. Forty one patients were randomized into two groups. Contrast media was administered at a dose of 1 ml/kg in group A patients and of 0.5 ml/kg in group B patients. kV value of 120 in group A and 100 in group B were chosen. Bolus tracking technique was used. Attenuation values of certain arterial segments were measured, and values over 200 HU were considered as significant. North American Symptomatic Carotid Endartherectomy Trial criteria were utilized in the evaluation of stenosis. Image quality in arterial segments of all cases was found to be sufficient for diagnosis. Arterial attenuation values were found to be higher in group B than group A. When compared separately in all arterial segments, there was no statistically significant difference between the groups. For stenosis, 615 arterial segments were evaluated. Moderate stenosis in eight segments and severe stenosis in three segments were identified in group A. Occlusion in three segments, severe stenosis in three segments, and moderate stenosis in 25 segments were detected in group B. Better image quality can be obtained, and the amount of contrast media can be reduced using low kV technique in carotid artery multi-detector computed tomography angiography examination.

Magnetic resonance imaging and diffusion-weighted imaging in methylmalonic acidemia.

Methylmalonic acidemia (MMA) is an inborn disorder of amino acid metabolism, often presenting with neurological symptoms. We present the results of magnetic resonance imaging (MRI) and diffusion‐weighted imaging (DWI) of the brain in a 16‐month‐old male patient with classic neurological and laboratory findings for MMA. MRI demonstrated the hyperintensity within globi pallidi both on T2‐weighted image and DWI during the acute episode of metabolic acidosis.

Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone.

Pulsatile tinnitus (PT) although an infrequent otologic symptom. PT can be objective (auscaltable) or subjective (non-auscultable). It has been suggested that subjective PT could occasionally be associated with vascular disorders such as arteriovenous malformation, traumatic or spontaneous carotico-cavernous fistula, intracranial aneurysms, vascular tumors of the temporal bone and cerebellopontine angle, fibromuscular dysplasia, cervical venous hums and high jugular bulb. To our literature knowledge, it has not been reported subjective PT due to extensive pneumatization of temporal bone around internal carotid artery (ICA). In this report, we present a case of subjective PT, which was caused by resonance due to extensive pneumatization of temporal bone particularly peripheral to the ICA.

The image of urachus adenocarcinoma on Doppler ultrasonography

Malignant urachal lesions are exceedingly rare and occur predominantly in adult life. In this case report, an adult patient with urachal carcinoma is presented with abdominal plain film, intravenous urography, gray-scale ultrasonography (US), Doppler US, and computed tomography (CT). Doppler US successfully showed the neovascularity with low resistive index value in the urachus tumor. We believe that Doppler US examination is helpful in the differential diagnosis of urachal carcinoma.

Erdosteine modulates radiocontrast-induced hepatotoxicity in rat.

It has been suggested that reactive oxygen species (ROS) plays an important role in radio contrast media (RCM)‐induced ischemia reperfusion tissue injury although antioxidants may have protective effects on the injury. We investigated the effects of erdosteine as an antioxidant agent on RCM‐induced liver toxicity in rats by evaluation of lipid peroxidation (as TBARS), catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH) and glutathione peroxidase (GSH‐Px) values and histological evaluation. Twenty‐one rats were equally divided into three groups as follows: control, RCM, and RCM plus erdosteine. RCM was intraperitoneally administered for 1 day. Erdosteine was administered orally for 2 days after RCM administration. Liver samples were taken from the rats and they homogenized in a motor‐driven tissue homogenizer. TBARS levels were significantly (p < 0.005) higher in RCM group than in control although SOD activities significantly (p < 0.05) decreased in RCM group. TBARS levels were lower in RCM plus erdosteine group than in control although SOD activity and GSH level increased (p < 0.05) in liver as compared to RCM alone. Erdosteine showed also histopathological protection (p < 0.0001) against RCM induced hepatotoxicity. GSH‐Px and CAT activities were not statistically changed by the erdosteine. According to our results, it can be concluded that radiocontrast media can induce oxidative stress in liver as suggested by previous studies. Erdosteine seems to be protective agent on the radiocontrast media‐induced liver toxicity by inhibiting the production of ROS via the enzymatic antioxidant system. Copyright

Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome?

Background Superficial venous insufficiency is a common problem associated with varicose veins. Endovenous laser ablation (EVLA) and concomitant ultrasound (US)-guided foam sclerotherapy are recent treatment methods alternative to surgery in the treatment of superficial venous insufficiency. Purpose To compare the effectiveness of EVLA and concomitant US-guided foam sclerotherapy prospectively in two different subgroups of the disease (isolated truncal vs. truncal with perforating vein insufficiency). Material and Methods The study was approved by the institutional review board. Fifty-five patients with symptomatic saphenous vein insufficiency and varicose veins were included in the study. Seventy-three EVLA and concomitant foam sclerotherapy were performed for 60 lower extremities. To determine the severity of the venous disease, Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were carried out before and 6 months after the treatment. Patients were followed up clinically and with Doppler ultrasonography for 6 months after the procedures. Results At the sixth month of the follow-up; the total occlusion rate for the saphenous veins was 98.64% (72/73), and re-canalization rate was 1.36% (1/73). The total occlusion rate for the perforating veins was 75% (18/24), re-canalization rate was 25% (6/24). There was no notable major complication. VCSS and VAS scores were decreased significantly following the treatment (p < 0.05). The patients who had isolated saphenous vein insufficiency (Group I: 36/60) and those who had saphenous and perforating vein reflux (Group II: 24/60) were compared. VAS scores were more prominently decreased after the treatment in the isolated saphenous vein insufficiency group (p < 0.05). VCSS were also decreased more prominently in Group I when compared to Group II. Conclusion EVLA and concomitant US-guided foam sclerotherapy are effective, safe, and minimally invasive treatment options, yielding good cosmetic and clinical results in both isolated truncal and truncal with perforating vein insufficiency groups. However, clinical results and satisfaction of the patients were remarkably superior in cases with isolated truncal vein insufficiency compared to truncal and perforating vein insufficiency.

Biliary fascioliasis: Sonographic appearance patterns

To describe the sonographic findings of biliary fascioliasis.

Lhermitte-Duclos disease associated with neurofibromatosis type-1 and non-ossifying fibroma.

Lhermitte‐Duclos disease (LDD) is a rare cerebellar disorder of uncertain pathogenesis characterized by enlargement of cerebellar folia. Magnetic resonance imaging is the diagnostic modality of choice and usually distinguishes the LDD by its characteristic “striated or laminated pattern” appearance. Various additional abnormalities have been reported in association with LDD. We report a case of LDD coexisting with neurofibromatosis type 1 (NF‐1) and non‐ossifying fibroma.