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MR Imaging Findings in Brachial Plexopathy with Thoracic Outlet Syndrome

SUMMARY: The BPL is a part of the peripheral nervous system. Many disease processes affect the BPL. In this article, on the basis of 60 patients, we reviewed MR imaging findings of subjects with brachial plexopathy. Different varieties of BPL lesions are discussed.

MRI findings in thoracic outlet syndrome

We discuss MRI findings in patients with thoracic outlet syndrome (TOS). A total of 100 neurovascular bundles were evaluated in the interscalene triangle (IS), costoclavicular (CC), and retropectoralis minor (RPM) spaces. To exclude neurogenic abnormality, MRIs of the cervical spine and brachial plexus (BPL) were obtained in neutral. To exclude compression on neurovascular bundles, sagittal T1W images were obtained vertical to the longitudinal axis of BPL from spinal cord to the medial part of the humerus, in abduction and neutral. To exclude vascular TOS, MR angiography (MRA) and venography (MRV) of the subclavian artery (SA) and vein (SV) in abduction were obtained. If there is compression on the vessels, MRA and MRV of the subclavian vessels were repeated in neutral. Seventy-one neurovascular bundles were found to be abnormal: 16 arterial–venous–neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial–venous, 3 arterial–neurogenic, and 8 venous–neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the CC, mostly secondary to position, and very rarely compressed in the RPM. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory.

Effect of Joint Motion on Safety of Portals in Posterior Ankle Arthroscopy

PURPOSE The purpose of this study was to determine the anatomic relation of the neural structures posteriorly crossing the ankle by use of classical ankle arthroscopy posterior portals and hindfoot endoscopy portals. The effect of ankle and hindfoot motions on portal-nerve distance was also determined. METHODS This study included 20 feet and ankles in 20 adult volunteers who had no complaints regarding their ankle joints. To obtain 6 fixed positions of the ankle and hindfoot (neutral-neutral, neutral-varus, neutral-valgus, dorsiflexion-neutral, dorsiflexion-varus, and dorsiflexion-valgus) during magnetic resonance imaging examination, feet were positioned in a polycaprolactone splint that was shaped before examination. Magnetic resonance imaging examinations were performed at all 6 positions, and the shortest distance between the sural and posterior tibial nerves to the portals was measured at 2 different levels. RESULTS The mean distance between the posterior tibial nerve and the posteromedial portal was 16.5 +/- 5.6 mm and that between the sural nerve and the posterolateral portal was 13.1 +/- 3 mm at the hindfoot portal level. At the level of the posterior ankle arthroscopy portal, the mean distance from the posterior tibial nerve to the posteromedial portal line was 13.3 +/- 4.6 mm and that from the sural nerve to the posterolateral portal line was 9.7 +/- 2.9 mm. The differences in distances were statistically significant (P < .001) according to the paired t test. We determined that the sural nerve approached the posterolateral portal in the dorsiflexion-varus (P = .026), dorsiflexion-valgus (P = .014), dorsiflexion-neutral (P < .001), and neutral-varus (P = .035) positions, and all differences were statistically significant. CONCLUSIONS We found that the posterior medial and lateral portals created at the level of the tip of the fibula as described by van Dijk et al. while the foot was in a neutral-neutral position provided the greatest margin of safety. We found no advantage of placing the ankle and hindfoot in different positions to avoid neurologic complications. CLINICAL RELEVANCE These findings suggest that neurovascular structures draw away from the posterior portals of ankle arthroscopy distally; by lowering the level of portals toward the tip of the fibula and positioning the foot at neutral, arthroscopic surgeons will decrease the risk of iatrogenic lesions.

Venous drainage patterns in carotid cavernous fistulas.

Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.

Sacroiliac joint involvement in psoriasis

Psoriasis is a skin disorder that is associated with arthritis. Sacroiliac joint involvement is considered to be less frequent than the other types of psoriatic arthritis. Additionally, the psoriatic sacroiliitis is considered to be asymmetric in general. We aimed to define the frequency and type of sacroiliac involvement in patients with psoriasis. Patients with psoriasis were included the study. Characteristics of skin, nail and articular involvement were noted. Psoriasis area and severity index was calculated. Antero-posterior pelvic X-rays were obtained and graded by two rheumatologists and a radiologist independently. One hundred and thirty-three patients were included. Thirty-seven of patients (27%) have articular involvement symptomatically. The sacroiliac joint involvement was observed in 34 (26%) of patients. More than one-half of sacroiliac involvement was bilateral while less than one-half was in symptomatic patients regarding sacroiliitis. Fifty-seven percentages of all patients have psoriatic nail involvement. Sacroiliac joint involvement did not show any significant association with psoriatic nail involvement or the severity of skin disease. We found higher frequency of sacroiliac joint involvement and bilateral sacroiliitis in patients with psoriasis. This is in contrast to present information about the association of psoriasis and sacroiliitis. These findings need confirmation by further studies and with more sophisticated techniques such as magnetic resonance imaging.

Assessment of women who applied for the uterine transplant project as potential candidates for uterus transplantation.

To review the medical charts of women who applied for the uterine transplant project from June 2008 to June 2011 in our hospital retrospectively (18–40 years).

Posttraumatic labyrinthitis ossificans with perilymphatic fistulization.

Labyrinthitis ossificans is fibrosis or ossification of the membranous labyrinth. Tympanogenic, meningogenic, and hematogenous etiologies are more common than trauma in the development of labyrinthitis ossificans. We present a case complaining of right-sided hearing loss and symptoms of otitis media and positional vertigo resulting from perilymphatic fistulization. Imaging revealed labyrinthitis ossificans secondary to temporal bone fracture crossing through the otic capsule.

TIP EĞİTİMİNDE EĞİTİM STRATEJİLERİ İLE METABİLİŞ BECERİLERİNİN GELİŞTİRİLMESİ VE AKADEMİK BAŞARIYA ETKİSİ

Giris: Metabilis, bireyin kendi bilis sistemi, yapisi, calismasi hakkindaki bilgisidir. Metabilis yasla birlikte ve uygun egitim ile gelisebilmektedir. Bu calismanin amaci, mudahale grubunda uygulanan ogrenme stratejilerinin metabilis farkindalik olceginde yarattigi degisimi izlemektir. Bu yazi uc yillik bir projenin ilk sonuclarini icermektedir Gerec ve yontem: Calisma 2014-2015 egitim doneminde Akdeniz Universitesi Tip Fakultesinde egitim goren ikinci sinif ogrencilerinin bir bolumuyle ile yurutulen mudahale arastirmasidir. Matabilis farkindaligini arttiracak egitim stratejileri uygulanmistir. Degisimin izlenmesi icin Metabilis farkindalik olcegi ( MAI) kullanilmistir. Bulgular: Mudahale grubunda kontrol grubuna gore olcek puanlarinda istatistiksel olarak anlamli bir artis gozlenmistir. Baslangicta MAI puani ve basari puanlari arasinda bir korelasyon bulunmazken, Egitim verilen grupta MAI ve ortalama basari arasinda anlamli ve bir iliski bulunmustur. (p<0,05, r=,474) Sonuc: C alismanin sonucunda, egitime katilan ogrencilerin, katilmayanlara gore MAI olcegi puanlarinin egitim oncesinden sonrasina gore, anlamli farklilik gosterdigi gorulmustur.

Correlation of Minimum Apparent Diffusion Coefficient and Maximum Standardized Uptake Value of the Primary Tumor with Clinicopathologic Characteristics in Endometrial Cancer

Objective: To explore the correlation of the primary tumor’s maximum standardized uptake value (SUVmax) and minimum apparent diffusion coefficient (ADCmin) with clinicopathologic features, and to determine their predictive power in endometrial cancer (EC). Methods: A total of 45 patients who had undergone staging surgery after a preoperative evaluation with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) were included in a prospective case-series study with planned data collection. Multiple linear regression analysis was used to determine the correlations between the study variables. Results: The mean ADCmin and SUVmax values were determined as 0.72±0.22 and 16.54±8.73, respectively. A univariate analysis identified age, myometrial invasion (MI) and lymphovascular space involvement (LVSI) as the potential factors associated with ADCmin while it identified age, stage, tumor size, MI, LVSI and number of metastatic lymph nodes as the potential variables correlated to SUVmax. In multivariate analysis, on the other hand, MI was the only significant variable that correlated with ADCmin (p=0.007) and SUVmax (p=0.024). Deep MI was best predicted by an ADCmin cutoff value of ≤0.77 [93.7% sensitivity, 48.2% specificity, and 93.0% negative predictive value (NPV)] and SUVmax cutoff value of >20.5 (62.5% sensitivity, 86.2% specificity, and 81.0% NPV); however, the two diagnostic tests were not significantly different (p=0.266). Conclusion: Among clinicopathologic features, only MI was independently correlated with SUVmax and ADCmin. However, the routine use of 18F-FDG PET/CT or DW-MRI cannot be recommended at the moment due to less than ideal predictive performances of both parameters.

A case of plastron appendicitis mimicking malignant cecal tumor in flourodeoxyglucose-positron emission tomography/computed tomography study

In recent years, flourodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) has been used intensively in the field of oncology. However, an increase in FDG uptake has been observed both in malignant tissues, and inflammatory processes. Therefore false-positive results have appeared. We present a 70-year-old male patient who presented to the hospital with right lower quadrant pain. A right lower quadrant mass was observed with conventional methods, and PET/CT was performed which revealed a hypermetabolic mass in the right lower quadrant. The patient was referred to the surgery with a suspect malignant mass whose histopathological report indicated plastron appendicitis. Although FDG PET/CT is a reliable method in the evaluation of oncological cases, false-positivities should be taken into consideration in inflammatory processes.