Gulnur Erdem

Diffusion‐weighted images differentiate benign from malignant thyroid nodules

To reveal the possible role of diffusion‐weighted images (DWI) in the differential diagnosis of benign and malignant thyroid nodules by comparing the results of fine‐needle aspiration cytology (FNAC).

Subacute sclerosing panencephalitis: Relationship between clinical stage and diffusion‐weighted imaging findings

To investigate the relationship between clinical stages and apparent diffusion coefficient (ADC) changes in the brain of patients with subacute sclerosing panencephalitis (SSPE).

Advanced MRI findings in patients with breast hamartomas.

PURPOSE Although it has been stated that breast hamartomas are rare tumors, radiologists frequently encounter them in their daily practices. Fat, glandular and fibrous tissues all produce a mass of disorganized but mature specialized cells. Because hamartomas do not have specific diagnostic histological features, the clinical and radiological findings are important in their diagnosis. The aim of this study is to present the advanced magnetic resonance imaging (MRI) findings of breast hamartomas. MATERIALS AND METHODS Eight patients with breast hamartomas were examined using MRI techniques in addition to ultrasonographic and/or mammographic findings. RESULTS Each of the lesions examined showed a gradual enhancement pattern in its time-signal intensity curve on dynamic contrast-enhanced MRI. On MR spectroscopy, water and lipid peaks were detected that resembled normal breast tissue. The diffusion features of the lesions were variable due to the different ratios of the tissue elements constituting them on diffusion-weighted imaging (DWI). CONCLUSION Advanced MRI findings may clarify diagnoses by providing additional information following sonography, especially in lactating or pregnant women, in whom mammographic examination is not preferred.

Nasal pyriform aperture stenosis in adults

Background Congenital nasal pyriform aperture stenosis (CNPAS) leading to respiratory insufficiency in infants has been well documented. Nevertheless, the nasal pyriform aperture stenosis (NPAS) entity in adulthood has not been discussed at all. The normative data of the width of the pyriform aperture, which has not been revealed before, is necessary for evaluation of the adult subjects with nasal bony inlet stenosis. The aim of this study was to define the normative data about the pyriform aperture width measured in 80 adult subjects with paranasal sinus symptoms without nasal obstruction and, additionally, to report the surgical results of two representative cases with NPAS. Methods The nasal bony inlet width measurements have been achieved in axial computerized tomographic sections to establish normative data. The maximal distance between the nasal processes of the opposite maxillary bones was measured. Two adult males complaining of nasal obstruction with overt pyriform aperture stenosis were treated surgically via a sublabial approach. Results The mean widest dimension of the nasal pyriform aperture was 21.6 6 2.2 mm (range, 17–27 mm) in 80 adult subjects. This width was 21.9 6 2.1 mm (range 18–27 mm) in men and 21 6 2.2 mm (range, 17–26 mm) in women. Stenotic pyriform apertures in two patients were widened surgically by drilling via a sublabial approach from 12 and 10 mm to 24 and 21 mm, respectively. Conclusion NPAS should be included in the list of differential diagnosis for nasal obstruction. Surgical enlargement using a sublabial approach was found an effective and adequate treatment in pyriform aperture stenosis.

Magnetic resonance spectral analysis of ovarian teratomas

Mature cystic teratomas are relatively common ovarian neoplasms that usually contain mature tissues of ectodermal mesodermal or endodermal origin. The presence in the pelvis of a detached and freely mobile ovarian teratoma is rare and often diagnosed incidentally. Following complete ovarian torsion and therefore interruption of its arterial blood supply the tumor undergoes atrophy necrosis and autoamputation. Magnetic resonance spectroscopy (MRS) utilizes the same hardware as magnetic resonance imaging (MRI) but it provides information about the biochemical metabolism of living cells. It is used to measure protoncontaining compounds such as amino acids organic acids and sugars in tissue specimens. There have been few reports of MRS use to evaluate ovarian teratomas. Two cases of ovarian teratoma of which one was a mobile calcified intrapelvic mass (the result of autoamputation) are presented and the value of MRS for ovarian teratoma is discussed. To our knowledge this is the first report of MRS use to assess an autoamputated ovarian teratoma. (excerpt)

Giant Axonal Neuropathy: Diffusion-Weighted Imaging Features of the Brain

Giant axonal neuropathy is a rare autosomal recessive childhood disorder characterized by a peripheral neuropathy and features of central nervous system involvement. Magnetic resonance imaging (MRI) of an 11-year-old boy with giant axonal neuropathy revealed high signal intensity in the white matter of the cerebrum and cerebellum on T2-weighted imaging. An apparent diffusion coefficient map revealed increased apparent diffusion coefficient values in the periventricular, deep, and cerebellar white matter, basal ganglia, and thalamus. Increased apparent diffusion coefficient values in distinct locations suggest increased mobility of water molecules in the brain of a patient with giant axonal neuropathy. This finding could indicate a myelin disorder such as demyelination. Diffusion-weighted imaging should be performed to reveal apparent diffusion coefficient changes and determine brain involvement in patients with giant axonal neuropathy. (J Child Neurol 2006;21:912—915; DOI 10.2310/7010.2006.00211).

Microstructural Changes in Uterine Leiomyomas and Myometrium: A Diffusion-Weighted Magnetic Resonance Imaging Study

Although morphological and histopathological changes in uterine leiomyomas have been investigated in detail, the microstructural disruptions could not be studied in the living organism. Diffusion-weighted magnetic resonance imaging (DWI) is a novel tool to assess microstructural changes in vivo. The aim of this study was to investigate and characterize the diffusional property of leiomyomatous tissues with DWI. Sixteen females with a total of 21 leiomyomas were imaged with a 1.5-tesla clinical MR scanner. DWI images of leiomyomas, adjacent myometrial and myometrial tissues of healthy controls were obtained and quantified using apparent diffusion coefficient (ADC) maps. Mean ADC values of these groups were 1,201, 1,684, 1,661 mm2/s × 10–6, respectively. ADC values in leiomyomas were significantly lower than those observed in the myometrium (p < 0.001). Cut-off values produced 91% sensitivity and 100% specificity. As ADC values implied the presence of cytotoxic edema in leiomyomas, the technique was found to be promising in observing temporal variations in leiomyomas and to monitor even the most subtle effects of therapeutic interventions.

Synchronous Endometrial and Cervical Tumors in a 26-Year-Old Nullipara: Diagnostic Modalities Updated

Proton magnetic resonance spectroscopy (MRS), performed on conventional magnetic resonance imaging (MRI) scanners, provides useful information at the biochemical level. MRS has been used to measure tissue concentrations of proton-containing compounds such as organic and amino acids, and sugars in living tissues. We have used MRS in a 26-year-old female with suspected cervical and endometrial carcinomas. With the use of the above mentioned technique, biochemical differences in the endometrium and the cervix tissues were detected. The presented case is the first virgin patient in the relevant literature in whom endometrial and cervical carcinoma was detected. Choline (Cho), creatine (Cr), N-acetylaspartate (NAA), lipid and lactate region of the MRS spectrum suggested that the technique could be used as an indicator of metabolic alterations in the cervical and endometrial tumor cells.

Bilateral anterior inferior iliac spine avulsion in an adolescent soccer player: a typical imitator of malignant bone lesions.

Avulsion fractures are usually diagnosed easily in acutely presented cases. The diagnosis becomes definite if clinical and radiological follow up reflect the fractures healing phase. A 13-year-old soccer player with bilateral anterior inferior iliac spine (AIIS) avulsion, who had been examined in other institutions with a prediagnosis of malignancy, is reported. Clinically, such cases display the importance of medical management of athletic injuries by specially trained physicians. From the perspective of preventive medicine, the high incidence of AIIS injuries during soccer games, and the bilateral nature of the damage mandate a review of the training programs and shooting techniques for adolescent players.

Spontaneous intracranial hypotension with pituitary adenoma.

Spontaneous intracranial hypotension (SIH) is an unusual syndrome that is characterised by positional headache, neck rigidity, nausea and vomiting. The characteristic magnetic resonance imaging (MRI) findings are diffuse smooth pachymeningeal thickening and enhancement, downward displacement of posterior fossa structures and pituitary gland enlargement. An unusual case of SIH with pituitary macro–adenoma and subsequent subdural haemorrhage is presented, and its clinical picture, MRI findings and possible pathophysiological mechanism are discussed.