Ali Yusuf Oner

Central nervous system aspergillosis: magnetic resonance imaging, diffusion-weighted imaging, and magnetic resonance spectroscopy features.

Aspergillus infection is invasive in nature in the immunosuppressed population and disseminates throughout the body, with the brain being a common site. Conventional magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) play a life-saving role in the early diagnosis and treatment monitoring of this potentially fatal infection. We present MRI, DWI, and MRS findings of a case of central nervous system aspergillosis with treatment follow-up.

Diffusion-weighted imaging of the appendicular skeleton with a non-Carr-Purcell-Meiboom-Gill single-shot fast spin-echo sequence.

OBJECTIVE The objective of our study was to prospectively evaluate the signal-to-noise ratio (SNR) improvement in diffusion-weighted imaging (DWI) of the appendicular skeleton with the use of a newly developed non-Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) sequence and to evaluate its effect on apparent diffusion coefficient (ADC) measurements. SUBJECTS AND METHODS DWI of the bone was performed in 32 patients with an echo-planar imaging (EPI)-based sequence followed by a non-CPMG SSFSE technique. SNR and ADC values were measured over a lesion-free right femoral head. A score was assigned for each set of images to assess image quality. When a bone lesion was present, contrast-to-noise ratio (CNR) and ADC were also measured. Paired Students t tests were used for statistical analysis. RESULTS The mean (+/- SD) SNR values were 9.89 +/- 2.20 and 81.68 +/- 4.87 for EPI and non-CPMG SSFSE DWI, respectively. SNR values associated with the non-CPMG SSFSE technique were found to be significantly higher than those measured with the EPI-based DWI technique (p < 0.01). Mean ADCs of the bone were 0.57 +/- 0.20 and 0.29 +/- 0.15 x 10(-3) mm2/s, respectively, for EPI and non-CPMG SSFSE DWI. Image quality scores were higher for the non-CPMG SSFSE DWI technique (p < 0.05) than for the EPI-based DWI technique. Overall lesion CNR was found to be higher in DWI performed with the non-CPMG SSFSE technique. CONCLUSION The non-CPMG SSFSE technique provides a significant improvement over the currently used EPI-based DWI technique and has the potential to be a powerful tool in imaging the appendicular skeleton.

Familial Mediterranean fever mimicking septic arthritis: distinguishing with diffusion weighted imaging

FMF arthritis is generally monoarticular in origin. The affected joint is hot, tender, red and mimics septic arthritis. Conventional imaging findings, including magnetic resonance imaging (MRI) and ultrasound, do not help differentiate between these two entities. The final diagnosis depends on culture of the synovial fluid, and therefore initiation of proper drug therapy can be delayed. Diffusion weighted imaging (DWI), with its ability to detect altered water-proton mobility, might play an important role as a fast and non-invasive problem-solving tool in this setting. We here present MRI and DWI findings of a case of FMF arthritis mimicking septic arthritis.

Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia.

The purpose of this study was to review the outcomes of transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe Type-III or IV developmental dysplasia. Seventy-three osteotomies were included in our study. Mean follow-up was 61 months. Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy, and femoral component stability were the criteria for evaluation. All complications were noted. The mean Harris hip score improved from 38.6 points to 83.7 points. The mean leg length discrepancy decreased from 56.5 mm to 10.7 at the latest follow-up. The mean union time was 5.2 months. We observed 4 non-unions. Transverse subtrochanteric shortening osteotomy is an effective and reliable method in restoration of a more normal limb.

Giant Vertebral Notochordal Rest: Magnetic Resonance and Diffusion Weighted Imaging Findings

A giant vertebral notochordal rest is a newly described, benign entity that is easily confused with a vertebral chordoma. As microscopic notochordal rests are rarely found in adult autopsies, the finding of a macroscopic vertebral lesion is a new entity with only seven previously presented cases. We report here radiological findings, including diffusion weighted images, of a patient with a giant notochordal remnant confined to the L5 vertebra, with an emphasis on its distinction from a chordoma.

Rosai-Dorfman disease with epidural and spinal bone marrow involvement: magnetic resonance imaging and diffusion-weighted imaging features.

Sinus histiocytosis with massive lymphadenopathy (SHML), or Rosai-Dorfman disease, is a rare histiocytic disorder that typically presents with chronic, self-limiting cervical lymphadenopathy. Although this disease mainly affects histiocytes, there are a few reports of bone marrow infiltration. Diffusion-weighted imaging (DWI) is a promising technology in differentiating between various bone marrow pathologies. We here present conventional magnetic resonance imaging and DWI features of a patient with SHML and bone marrow involvement.

Corpus callosum hematoma secondary to isolated inferior sagittal sinus thrombosis

A 45-year-old female was admitted with headache and vomiting. Cranial computed tomography (CT) demonstrated a callosal hematoma. Magnetic resonance imaging (MRI) showed no venous flow and thrombus replacing the inferior sagittal sinus (ISS) lumen. Under appropriate medical treatment and close follow-up she recovered quickly and, after 2 years, was doing well with corpus callosum infarcts. Isolated inferior sagittal sinus thrombosis is an extremely rare condition with only one previously reported case in the literature. Although it is very rare, isolated inferior sagittal sinus thrombosis should be considered in the differential diagnosis of non-traumatic corpus callosum hematoma.

The prevalence of femoroacetabular impingement as an aetiologic factor for end-stage degenerative osteoarthritis of the hip joint: analysis of 1,000 cases

Objective The main purpose of the present study was to determine the prevalence of FAI among patients who underwent total hip arthroplasty (THA) with the diagnosis of end-stage osteoarthritis (OA) of the hip joint in a tertiary referral centre. Design A retrospective search of the institutional archive database for patients who had undergone THA between the years 2005 and 2010 was conducted with the analysis of the recorded radiographic images. A total of 1,004 patients including 690 (68.7%) females and 314 (31.3%) males were identified. All radiographs were reviewed by 3 of the authors. Intra- and interobserver consistencies were calculated. The prevalence of femeroacetabular impingement (FAI) as a predisposing diagnosis resulting in end-stage degenerative joint disease treated with THA was determined. Results The most common diagnosis was developmental dysplasia of the hip (DDH). The predisposing aetiologic factor leading to end-stage degenerative hip disease treated with THA was undetermined for 26 patients (2.6%). The number of patients who were diagnosed as cam-type FAI by all of the observers was 83, whereas it was 16 for pincer-type FAI. Interobserver agreement was very high in the evaluation of the stated ethiologies of hip osteoarthritis. The contingency coefficient for the diagnosis of FAI was 0.71 between observers. Conclusions Our study may be a reference for further investigations to develop a better understanding of the underlying pathological factors in patients undergoing THA due to end-stage OA of the hip joint.

Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center

OBJECTIVE This study aimed to investigate the efficacy of resective surgery in children with focal lesional epilepsy by evaluating the predictive value of pre- and postsurgical factors in terms of seizure freedom. METHODS This study included 61 children aged between 2 and 18years who were admitted to the pediatric video-EEG unit for presurgical workup. Each patient was evaluated with a detailed history, video-EEG, neuroimaging, and postsurgical outcomes according to Engel classification to predict postsurgical seizure freedom. All the possible factors including history, etiology, presurgical evaluation, surgical procedures, and postsurgical results were analyzed for their predictive value for postoperative seizure freedom. RESULTS Of the 61 patients, 75% were diagnosed as having temporal lobe epilepsy (TLE), and 25% were diagnosed with extra-TLE. Two years after the surgery, 78.6% were seizure-free, of which 89% had TLE, and 50% had extra-TLE (p<0.05). Patients were more likely to have a favorable outcome for seizure freedom if they had rare seizure frequency, focal EEG findings, and focal seizures; had a temporal epileptogenic zone; or had TLE and hippocampal sclerosis. On the other hand, patients were more likely to have unfavorable results for seizure freedom if they had younger age of seizure onset, frequent seizures before the surgery, a frontal or multilobar epileptogenic zone, secondarily generalized seizures, extra-TLE with frontal lobe surgery, or focal cortical dysplasia. SIGNIFICANCE Resective surgery is one of the most effective treatment methods in children with intractable epilepsy. A history of young age of seizure onset, frequent seizures before surgery, secondarily generalized seizures, a multilobar epileptogenic zone, frontal lobe surgery, and focal cortical dysplasia (FCD) are the most important predictive factors indicating that a patient would continue having seizures after surgery. On the other hand, focal seizure semiologies, temporal lobe localization, and hippocampal sclerosis indicate that a patient would have better results in terms of seizure freedom.

Retropharyngeal hematoma secondary to whiplash injury in childhood: a case report

Whiplash Associated Disorders (WAD) has been reported as an adult phenomenon. Whiplash injury has classically been described as a cervical soft tissue hyperextension- flexion injury after a trauma such as a rear end impact car crash, contact sport injuries, blows to the head from a falling object or a punch and shaken baby syndrome and is mostly seen in adults . It is important as it may cause severe disability due to spinal cord injury, decrease work productivity and even retropharyngeal hematoma resulting airway obstruction and mortality due to bleeding amongst deep cervical fascias. We describe a case of retropharyngeal hematoma after whiplash injury in a childhood.