Gokhan Polat

Correlation of diffusion MRI with the Ki-67 index in non-small cell lung cancer.

Abstract Background. The primary objective of the study was to evaluate the association between the minimum apparent diffusion coefficient (ADCmin) and Ki-67, an index for cellular proliferation, in non-small cell lung cancers. Also, we aimed to assess whether ADCmin values differ between tumour subtypes and tissue sampling method. Methods. The patients who had diffusion weighted magnetic resonance imaging (DW-MRI) were enrolled retrospectively. The correlation between ADCmin and the Ki-67 index was evaluated. Results. Ninety three patients, with a mean age 65 ± 11 years, with histopathologically proven adenocarcinoma and squamous cell carcinoma of the lungs and had technically successful DW-MRI were included in the study. The numbers of tumour subtypes were 47 for adenocarcinoma and 46 for squamous cell carcinoma. There was a good negative correlation between ADCmin values and the Ki-67 proliferation index (r = −0.837, p < 0.001). The mean ADCmin value was higher and the mean Ki-67 index was lower in adenocarcinomas compared to squamous cell carcinoma (p < 0.0001). There was no statistical difference between tissue sampling methods. Conclusions. Because ADCmin shows a good but negative correlation with Ki-67 index, it provides an opportunity to evaluate tumours and their aggressiveness and may be helpful in the differentiation of subtypes non-invasively.

A sesamoid ossicle of the nuchal ligament mimicking spinous avulsion fracture.

A 25-year-old man who suffered a traffic accident was admitted to our emergency department. Computer tomography was performed. Computer tomography images showed an osseous structure mimicking avulsion fracture at the level of C5–C6 (Fig. 1). There was no bone defect corresponding to spinous process and so, the diagnosis was consistent with sesamoid ossicles of the nuchal ligament. Sesamoid ossicles of the nuchal ligament are an anatomical variant that are usually asymptomatic. Prominent differential diagnosis includes avulsion fractures of the spinal processes and myositis ossificans. Focal well-defined osseous masses, well-circumscribed with regular shape, are in favor of sesamoid ossicle of nuchal ligament, whereas triangular dense bony fragment with bony defect of the adjacent spinous process are in favor of spinous process fracture. Ihsan Yuce, MD Berhan Pirimoglu, MD Gokhan Polat, MD Recep Sade, MD Mucahit Emet, MD Mecit Kantarci, MD, PhD Department of Radiology, School of Medicine Ataturk University 25100 Erzurum, Turkey Department of Emergency Medicine, School of Medicine Ataturk University 25100 Erzurum, Turkey

Complicación infrecuente de un quiste hidatídico de pulmón: neumomediastino, hidroneumotórax y enfisema masivo de tejidos blandos

Un varón de 15 años se presentó en el servicio de urgencias con una historia de 3 dı́as con dolor torácico intenso y disnea. La tomografı́a axial computarizada (TAC) torácica sin contraste mostró neumomediastino, enfisema de tejidos blandos, hidroneumotórax y un quiste hidatı́dico gigante con rotura de membranas en el lóbulo inferior del pulmón izquierdo (figs. 1A y B; flecha: rotura de membranas). Como resultado de estos hallazgos, el paciente fue diagnosticado de un quiste hidatı́dico roto. El tratamiento consistió en toracotomı́a, cistectomı́a y vaciado del neumomediastino. En el seguimiento del paciente no surgieron complicaciones. c i r e s p . 2 0 1 6 ; x x ( x x ) : x x x – x x x

A very rare cause of abdominal pain.

It is evident from the family history that the condition is autosomal recessive. Silvery hair is a unique finding in three closely similar conditions known as Silvery hair syndromes: Chediak-Higashi syndrome, Griscelli syndrome and Elejalde disease. But the presence of giant granules points to Chediak Higashi syndrome which is a hallmark of this disease. Light microscopy of skin and hair shafts aids in further differentiation. Chediak-Higashi syndrome results from mutations in the lysosomal trafficking regulator (LYST) gene located on chromosome 1q42.1-42.2. The mutation leads to disturbances in lysosomal trafficking leading to aberrant fusion of diverse intracellular organelles, giving rise to the abnormally giant granules seen in several tissues. The main features are generalised hypopigmentation, silvery hair, immunodeficiency, progressive peripheral neuropathy and bleeding tendency. These patients usually die due to recurrent infections. They can also develop haemophagocytic lymphohistiocytosis, and bone marrow transplantation is the only curative treatment. Griscelli syndrome is also characterised by partial albinism, silvery hair, variable cellular and humoral immunodeficiency and neurological impairment. Elejalde disease is closely similar but with normal immunological function and early-onset severe neurological dysfunction. Images of the Month

Hydatidosis Following Giant Cerebral Hydatid Cyst Operation

BACKGROUND Hydatid cysts (HCs) are caused by parasites, the larvae of Echinococcus granulosus. They usually affect the liver and lung, but primary brain involvement is rarely seen. HCs may cause a mass effect in the brain. For this reason, surgical excision must be performed. Complications may rarely occur after surgery. Recognition of complications is of vital importance. CASE DESCRIPTION A 45-year-old man presented with complaints of personality disorder and severe, long-standing headache. The patient had no neurologic deficit. However, there were symptoms associated with increased intracranial pressure. Radiologic examination revealed intracranial HCs. Complications did not develop during the operation. Six months following the surgery, the patient came back after experiencing unconsciousness. Control cerebral magnetic resonance imaging showed multiple cerebral cysts. CONCLUSIONS Surgical resection should be applied carefully in the treatment of cerebral cysts. Complications may occur later in patients who do not develop complications at the time of operation. For this reason, follow-up of the patients should definitely be done by magnetic resonance imaging.

The Use of Dynamic Contrast-Enhanced Perfusion MRI in Differentiating Benign and Malignant Thyroid Nodules

To investigate the efficacy of perfusion magnetic resonance imaging (MRI) in benign-malignant differentiation of thyroid nodules. Images from 24 patients with thyroid masses were obtained using dynamic contrast enhanced MRI (DCE-MRI) at 3-T MR. DCE-MRI images were evaluated by post-processing of selected regions of interest (ROIs) on software, thus eliciting quantitative data for each voxel within the ROI. Ktrans, Ve, Kep, iAUC and chi2 were calculated automatically. The DCE-MRI values of benign and malignant lesions were then compared. Mean Ktrans and iAUC values in malignant lesions were significantly lower than those in benign lesions (p = 0.028 and 0.049). Ktrans, Kep, and iAUC values in malignant lesions were statistically significantly lower than normal parenchyma values. In contrast to other tissues, the perfusion MRI findings of thyroid masses exhibit a decrease in Ktrans and iAUC values as malignancy increases. Perfusion MRI may be useful in differentiating benign and malignant thyroid nodules once a cut-off value has been determined by other studies.

Intraosseous Meningioma Presenting as Occipital Bone Mass: Headache

A 61-year-old female patient was admitted to a neurology clinic with complaints of increased headache, gait disturbance, and weakness. There was a slight swelling in the occipital region of the patient. Cranial magnetic resonance imaging (MRI) revealed a mass lesion in the occipital region and both intracranial and extracranial expansion. The lesion was isointense relative to the cerebral gray matter at T1-weighted, and hyperintense for T2-weighted fluid-attenuated inversion recovery. The lesion was well defined and lobulated (Fig. 1). MR spectroscopy was performed to distinguish between bone and neuronal source. The MR spectroscopic examination revealed there was a reversed alanine peak and the presence of a significant choline peak. Peak values of the reverse double-alanine peak were observed around 1.47–1.48 ppm (Fig. 2). The available spectroscopy parameters supported meningioma. The rCBV and rCBF maps showed significant perfusion enhancement in the lesion (Fig. 3). Perfusion parameters also supported the diagnosis of meningioma. Meningioma was diagnosed via histopathology. Meningiomas are usually benign tumors and originate from the meninges. Intradiploic meningiomas constitute about 2% of all meningiomas and are classified as extradural meningiomas. Few cases have been reported in the literature. Intradiploic meningiomas can be confused with primary calvarial bone tumors. As intraosseous meningioma is rarely seen, intraosseous meningiomas are misdiagnosed because of insufficient preoperative evaluations. MR spectroscopy and perfusion MR imaging give important findings in the differential diagnosis. Perfusion increases in meningiomas at perfusion MRI. The significant increase in choline and the significant decrease in creatinine and NAA levels are important findings on MR spectroscopy. In addition, the increase

Cerebral and Spinal Tuberculous Leptomeningitis: Advanced Magnetic Resonance Imaging Findings

At diagnosis of the cerebral and spinal tuberculous meningitis magnetic resonance (MR) imaging is the primary imaging technique. Magnetic resonance images reveal cerebrospinal fluid collection and obliteration of the spinal subarachnoid space. The contrast-enhanced MR imaging shows nodular and thick intradural enhancement. Herein, the authors reported advanced MR imaging findings of the cerebral and spinal tuberculous leptomeningitis.

Rare and Serious Complications of Sinusitis in Pediatric Patients: Epidural Abscess

Abstract Intracranial abscess has serious mortality. Therefore, early diagnosis and treatment is important. Intracranial abscess is rarely seen as a complication of sinusitis. Specially in children it has been reported rarely. Fever and headache can indicate complications in children.

Nontraumatic tumoral calcinosis

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 21 septembre 2016