Guner Sonmez

Sonographic appearances of the normal ulnar nerve in the cubital tunnel

To investigate the sonographic characteristics of the normal ulnar nerve in the cubital tunnel, as well as any differences related to age, sex, and dominant arm.

MRI findings of intracranial tuberculomas

PURPOSE Tuberculosis involvement of the central nervous system continues to represent a serious problem, particularly in developing countries. The aim of this study was to characterize the magnetic resonance imaging (MRI) findings of intracranial tuberculoma, a form of neurotuberculosis. METHODS We retrospectively reviewed the data of 27 patients with intracranial tuberculomas. These consisted of 17 women and 10 men with a mean age of 26 years (14-51). MRI was performed on all patients. RESULTS A total of 64 tuberculomas were found in these patients, of which 41 were distributed in the cerebral hemispheres, 17 in the cerebellar hemispheres, and 6 in the brainstem. Accompanied meningitis was detected in three patients, hydrocephalus in five patients, and hydrocephalus with meningitis in one patient. CONCLUSION MRI makes a significant contribution to diagnosis of intracranial tuberculomas and can objectively determine accompanying abnormalities.

Role of apparent diffusion coefficient values and diffusion-weighted magnetic resonance imaging in differentiation between benign and malignant thyroid nodules

OBJECTIVE The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI). MATERIALS AND METHODS Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm(2)b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed. RESULTS The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively. CONCLUSION We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules.

Value of diffusion-weighted MRI in the differentiation of benign and malign breast lesions.

ZusammenfassungEINLEITUNG: Ziel unserer Studie war es, zu prüfen, ob eine diffusionsgewichtete MR Bildgebung (DWI) in der Differenzierung von benignen und malignen Läsionen der Brust nützlich ist. MATERIAL UND METHODEN: Es wurden 41 Frauen in die Studie eingeschlossen. Bei 45 Läsionen wurde die Diagnose bioptisch gestellt, wobei 25 (55,5 %) malign und 20 (44,5 %) gutartig waren. Der apparente Diffusions Koeffizient (ADC) dieser Läsionen wurde prospektiv mit dem histopathologischem Ergebnis verglichen. ERGEBNISSE: Als Schwellenwert zur Erkennung maligner Läsionen wurde ein ADC von 1,0×10–3 mm2/s erhoben. Die Sensitivität dieses Wertes lag bei 95 %, die Spezifität bei 100%. Der positive Voraussagewert bei 100 %, der negative bei 94 %, die Treffsicherheit -Rate bei 97 %. SCHLUSSFOLGERUNGEN: Die DWI verbessert die diagnostische Treffsicherheit der konventionelle MRI der Brust. ADC Messungen können bei der Differenzierung von malignen und benignen Läsionen der Brust nützlich sein.SummaryINTRODUCTION: Our purpose was to determine whether diffusion-weighted MR imaging (DWI) could be used in differentiation of benign and malign breast lesions. MATERIALS AND METHODS: 41 women patients were included in the study. 45 lesions were diagnosed by biopsy; 25 (55.5%) of these lesions were malignant and 20 (44.5%) were benign. The apparent diffusion coefficient (ADC) values of these lesions were prospectively compared with their histopathological results. RESULTS: Differentiation of the malignant and benign masses revealed that the threshold value of the ADC was 1.0×10–3 mm2/s, its sensitivity was demonstrated as 95%, specificity as 100%, positive predictive as 100%, negative predictive as 94% and accuracy rate as 97%. CONCLUSIONS: DWI improves diagnostic accuracy of the conventional breast MRI. ADC measurements may be useful for differentiation of the malign and benign masses.

Split-cord malformation and accompanying anomalies.

OBJECTIVE To present the magnetic resonance imaging (MRI) appearances of spinal split-cord malformation (SCM) and to investigate the various types of congenital spinal disorders associated with SCM. MATERIALS AND METHODS MR examinations of 23 patients with SCM were carried out in our hospital between June 2002 and May 2007 and retrospectively analysed. RESULTS Nineteen (82.6%) patients were diagnosed as type I SCM, while four (17.4%) were diagnosed as type II SCM. The most commonly involved site of SCM was the dorsolumbar area (47.8%) while cervical involvement was the least common (4.3%). No accompanying congenital spinal disorders were detected in four patients (17.4%). In 19 patients (82.6%), congenital spinal disorders accompanying SCM were detected, the most common of which was a low-lying cord, found in 14 patients (60.9%). Other anomalies included hydromyelia in seven patients (30.4%), lipoma in six (26%), meningomyelocele in four (17.4%), thick filum in three (13%) and dermoid cyst in three (13%). CONCLUSION In preoperative planning for SCM, its characteristics and those of the accompanying anomalies should be determined. MRI is a valuable tool for making such determinations.

Evaluation of the placenta with relative apparent diffusion coefficient and T2 signal intensity analysis.

PURPOSE We aimed to test the null hypothesis that relative apparent diffusion coefficient (rADC) and relative signal intensity values (rSI(HASTE)) do not change in the evaluation of placental maturation with advancing gestational age. MATERIALS AND METHODS Fifty-six fetuses with diffusion-weighted magnetic resonance imaging (DW-MRI) data were enrolled in this retrospective study. Fetuses were analyzed in three different gestational age groups: group 1, 18-23 weeks; group 2, 24-28 weeks; and group 3, 29-38 weeks. The rADC (mean ADC/ADC(globe)) and rSI(HASTE) values (mean SI(HASTE)/SI(globe)) were obtained. Two radiologists experienced in fetal MRI who were blinded to the patient information reviewed MRI images independently. Kruskal-Wallis Test was used to compare the rADC and rSI(HASTE) with gestational age groups. The agreement between the two blinded readers was tested using Krippendorffs alpha ratio. RESULTS Both placental rADC values and placental rSI(HASTE) values were not significantly different between the gestational age groups (P = 0.688 and P = 0.280, respectively). rADC and rSI(HASTE) measurements were reproducible with a good agreement between the two readers (Krippendorffs alpha ratio was 0.613 and 0.778, respectively). CONCLUSION The rADC and rSI(HASTE) values do not change with advancing gestational age.

Cerebral white-matter lesions in asymptomatic military divers.

INTRODUCTION There is some concern that over a period of years, diving may produce cumulative neurological injury even in divers who have no history of decompression sickness. We evaluated asymptomatic divers and controls for cerebral white-matter lesions using magnetic resonance imaging (MRI). METHODS The study enrolled 113 male military divers (34.4 +/- 5.6 yr) and 65 non-diving men (33.1 +/- 9.0 yr) in good health. Exclusion criteria included any condition that might be expected to produce neurological effects. Patent foramen ovale was not assessed. A questionnaire was used to elicit diving history. A 1.5-T MRI device was used to acquire T1, T2-weighted, and fluid attenuated inversion recovery (FLAIR) images of the brain. A lesion was counted if it appeared hyperintense on both T2-weighted and FLAIR images. RESULTS MRI revealed brain lesions in 26 of 113 divers (23%) and in 7 of 65 (11%) controls, a difference that was statistically significant. There was no significant difference between the groups with respect to blood pressure, smoking history, or alcohol consumption, and no subject reported a history of head trauma or migraine. There was no relationship between MRI findings and age, diving history, or lipid profile in divers. DISCUSSION The higher incidence of lesions in the cerebral white matter of divers confirms the possibility that cumulative, subclinical injury to the neurological system may affect the long-term health of military and recreational divers.

Evaluation of cochlear nerve size by magnetic resonance imaging in elderly patients with sensorineural hearing loss

PurposeWe aimed to determine any differences, if present, between the cross-sectional area of the cochlear nerve (CN) of elderly patients with sensorineural hearing loss (SNHL) and of young patients with normal hearing.Materials and methodsThe study group included ten patients with age-related SNHL. Fourteen volunteer individuals with normal hearing were recruited as the control group. T1-weighted, T2-weighted and parasagittal three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) reconstruction images of all cases were evaluated. Images were examined for any abnormality of CN. The data obtained for each ear with clinical, radiological and audiometric examinations were evaluated.ResultsThe mean CN cross-sectional area was measured as 0.0252 cm2 in the control group, whereas that in the SNHL group was 0.0232 cm2. Although speech discrimination scores showed significant differences, no statistically significant difference was observed for the CN cross-sectional area (p=0.0616). Likewise, there was no difference in CN calibre between male and female patients.ConclusionsThe 3DFT-CISS sequence yields superior results in CN imaging. Acquired SNHL may not present with significant changes in CN size on magnetic resonance imaging (MRI).RiassuntoObiettivoDeterminare se esistono differenze, in misure effettuate su sezioni trasversali di immagini di risonanza magnetica, tra l’area del nervo cocleare (CN) in pazienti anziani con perdita dell’udito di tipo neurosensoriale (SNHL) e soggetti giovani con udito normale.Materiali e metodiIl gruppo di studio comprende 10 pazienti con perdita dell’udito di tipo neurosensoriale. Sono stati reclutati, come gruppo di controllo 14 volontari con udito normale. Sono state effettuate acquisizioni T1 e T2 dipendenti e tridimensionali in steady state (3DFTCISS). Le immagini sono state valutate per la ricerca di qualsiasi anormalità del nervo cocleare. Sono stati valutati per ogni caso i dati clinici, radiologici e audiometrici.RisultatiL’area sulla sezione trasversale del CN nel gruppo di pazienti con SNHL era pari a 0,0232 cm2 mentre nel gruppo di controllo era pari a 0,0252 cm2. Sebbene i punteggi di discriminazione del linguaggio mostrassero differenze significative, non è stata evidenziata nessuna differenza statisticamente significativa per l’area trasversale del CN (p=0,0616). Altrettanto, non vi era alcuna differenza del calibro del CN tra soggetti di sesso maschile e femminile.ConclusioniLa sequenza 3DFT-CISS ottiene risultati superiori nella visualizzazione del CN. La SNHL acquisita può non presentare cambiamenti significativi delle dimensioni del CN alla risonanza magnetica.

Is it possible to differentiate between hydatid and simple cysts in the liver by means of diffusion-weighted magnetic resonance imaging?

OBJECTIVE Our aim was to evaluate the contribution of diffusion-weighted imaging to the differentiation of hydatid cysts (HCs) from the simple cysts and to the identification of the HC subtypes. MATERIALS AND METHODS A total of 37 patients were included in this retrospective study. Fifty of these patients had diagnosed liver cysts (28 HCs and 22 simple cysts) of at least 1 cm in size. All of the cysts were examined with sonography and magnetic resonance imaging, and the HCs were classified according to the World Health Organization criteria. RESULTS Twenty-eight of the total 50 cysts were HCs, and 22 were simple cysts. When the apparent diffusion coefficient (ADC) values of all HCs were compared with the ADC values of the simple cysts, a statistically significant relationship was found (P=.001). The optimal ADC threshold value was established as 2.5 s/mm(2). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates were 60%, 95%, 94%, 65% and 76%, respectively. CONCLUSION Diffusion-weighted imaging-magnetic resonance imaging is a considerably helpful technique for differentiating between HCs and simple cysts and for differentiating between HC subtypes.

Missed talar neck fractures in ankle distortions

OBJECTIVES Thirty-nine percent of the ankle and midfoot fractures in ankle distortions could be missed during initial evaluation in emergency department because of inadequate clinical and radiological evaluation in a limited time. We aimed to evaluate the follow-up and treatment outcomes of subjects with missed fractures, which were not diagnosed with plain radiographs obtained for ankle distortion, but with advanced imaging studies. METHODS Eight patients (4 females, 4 males) who were initially treated with a diagnosis of ankle distortion due to trauma between 2004 and 2008 were included in the study. Since there were no fractures in the initial radiographs reported by radiologists, conservative treatment was applied. However, the pain and swelling around the ankle were sustained and advanced imaging studies revealed talus fracture. All patients were evaluated with the scoring system of American Orthopedic Foot and Ankle Society (AOFAS). RESULTS Mean age of the patients was 22.37 years (range 20-40 years) at the initial fracture diagnosis. The talar neck fracture was diagnosed with computed tomography (CT) in 1 patient and with magnetic resonance imaging (MRI) in the remaining 7 patients. Mean follow-up time was 6 months (range 3-8 months), and mean AOFAS score at last follow-up was 93.7 (range 80-100). CONCLUSION Talus fractures can lead to serious complications because of its anatomical localization. Areas with edema, tenderness or pain should be defined on physical examination, and deep palpation should be applied on the lateral aspect of the talar neck. If there is pain in this area at late examination and no fracture was reported with conventional radiographs, the possibility of missed talar fracture should be considered and the patient should be evaluated with CT or MRI.