Hediye Pinar Gunbey

Structural brain alterations of Down's syndrome in early childhood evaluation by DTI and volumetric analyses.

AbstractObjectivesTo provide an initial assessment of white matter (WM) integrity with diffusion tensor imaging (DTI) and the accompanying volumetric changes in WM and grey matter (GM) through volumetric analyses of young children with Down’s syndrome (DS).MethodsTen children with DS and eight healthy control subjects were included in the study. Tract-based spatial statistics (TBSS) were used in the DTI study for whole-brain voxelwise analysis of fractional anisotropy (FA) and mean diffusivity (MD) of WM. Volumetric analyses were performed with an automated segmentation method to obtain regional measurements of cortical volumes.ResultsChildren with DS showed significantly reduced FA in association tracts of the fronto-temporo-occipital regions as well as the corpus callosum (CC) and anterior limb of the internal capsule (p < 0.05). Volumetric reductions included total cortical GM, cerebellar GM and WM volume, basal ganglia, thalamus, brainstem and CC in DS compared with controls (p < 0.05).ConclusionThese preliminary results suggest that DTI and volumetric analyses may reflect the earliest complementary changes of the neurodevelopmental delay in children with DS and can serve as surrogate biomarkers of the specific elements of WM and GM integrity for cognitive development.Key Points• DS is the most common genetic cause of intellectual disability. • WM and GM structural alterations represent the neurological features of DS. • DTI may identify the earliest aging process changes. • DTI-volumetric analyses can serve as surrogate biomarkers of neurodevelopment in DS.

A rare cause of obstructive sleep apnea syndrome: lingual thyroid

Thyroid tissue descends to its normal pretracheal location on the seventh week of fetal life via the thyroglossal duct connected to the tongue base from the foramen cecum from which it originates during embryological development. Ectopic thyroid tissue develops as the result of exposure of thyroid tissue totally or partially to a defective descent related to the embryological defect of the tongue base. Lingual thyroid is the most common location of ectopic thyroid tissue and often located on the juncture of the buccal and pharyngeal parts of the tongue [1]. While 90% of ectopic thyroid tissues are seen on the tongue, they have also been reported in sublingual, submandibular, prelaryngeal, tracheal, mediastinal, cardiac, esophageal, diaphragmatic, and peripharyngeal sites. Although the prevalence of lingual thyroid has been reported between 1:100,000 and 1:300,000, its incidence among patients in whom hypothyroidism has been detected is between 1:4,000 and 1:10,000. It is seen at a 7-fold greater frequency in women [2]. Although the patients are usually asymptomatic, it can lead to symptoms such as dysphonia, dysphagia, and sensation of foreign body in the throat, or it can mimic a lingual tumor [2, 3]. Obstructive sleep apnea syndrome (OSAS) is an important clinical condition resulting from anatomical narrowings developing in the upper respiratory tract during sleep, affecting the quality of life substantially, leading to serious complications. Herein, we present a 24-year-old male patient with OSAS caused by lingual thyroid, and along with this rare case, we discuss the clinical features of lingual thyroid, imaging methods, and therapeutic approaches.

Is preoperative paranasal sinus computed tomography necessary for every patient undergoing septoplasty

The aim of this study was to determine whether anterior rhinoscopy (AR), nasal endoscopy (NE) and paranasal sinus computed tomography (PNS CT) can predict other sinonasal obstructive pathologies in the setting of nasal septal deviation (NSD), and to evaluate the impact of preoperative PNS CT on the decision for a surgical procedure in patients with NSD.

Primary malignant mucosal melanoma of the nasopharynx: an unusual cause of unilateral hearing loss.

There are many causes of unilateral hearing loss, and making the correct differential diagnosis, especially in elderly patients, is difficult. A primary malignant mucosal melanoma of the nasopharynx is extremely rare and can cause a variety of symptoms. Hearing loss, as a presenting symptom of mucosal malignant melanoma of the nasopharynx, has not yet been defined in the literature. Herein, we report a case of primary mucosal malignant melanoma of the nasopharynx presented with unilateral hearing loss in a 70-year-old man.

A rare cause of dysphagia in children: lymphangiomatous polyp of the palatine tonsil.

Oropharyngeal and tonsillar masses are a very rare cause of dysphagia in children. In this article, we describe a rare cause of dysphagia in children, a lymphangiomatous lesion of the palatine tonsil, and discuss the clinical and histopathologic features of these lesions.

Efficiency of B-mode Ultrasound and Strain Elastography in Differentiating Between Benign and Malignant Cervical Lymph Nodes

Purpose The purpose of this study was to evaluate the diagnostic accuracy and efficiency of ultrasonography (US), especially when combined with strain elastography (SE), in differentiating between benign and malignant cervical lymph nodes (LNs). Methods Forty-one LNs were examined by B-mode US, power Doppler US, and SE. The following imaging features were analyzed: shape, echogenicity, echogenic hilum, calcification, intranodal vascular pattern, elasticity scores (5 categories), and strain ratio. The average strain ratio was calculated as the mean strain of the adjacent sternocleidomastoid muscle divided by the mean strain of the target LN. The results of the US and SE features were compared with the histopathologic findings. Results The imaging features that were significantly associated with malignant LNs were an increased short-to-long axis diameter ratio, abnormal or absence of hilum, microcalcification, type 2-3-4 vascularity, 3-4-5 elasticity scores, and a high level of strain ratio (P < 0.05). The cutoff value of the strain index was detected as 1.18. According to this, there was a significant difference (P = 0.004) in the strain index between benign and malignant LNs. Conclusions Strain elastography is useful in differentiating between benign and malignant cervical LNs, thereby informing decisions to perform a biopsy and/or surgery, and facilitating follow-up.

Limbic-Auditory Interactions of Tinnitus: An Evaluation Using Diffusion Tensor Imaging

ObjectiveTinnitus is defined as an imaginary subjective perception in the absence of an external sound. Convergent evidence proposes that tinnitus perception includes auditory, attentional and emotional components. The aim of this study was to investigate the thalamic, auditory and limbic interactions associated with tinnitus-related distress by Diffusion Tensor Imaging (DTI).MethodsA total of 36 tinnitus patients, 20 healthy controls underwent an audiological examination, as well as a magnetic resonance imaging protocol including structural and DTI sequences. All participants completed the Tinnitus Handicap Inventory (THI) and Visual Analog Scales (VAS) related with tinnitus. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained for the auditory cortex (AC), inferior colliculus (IC), lateral lemniscus (LL), medial geniculate body (MGB), thalamic reticular nucleus (TRN), amygdala (AMG), hippocampus (HIP), parahippocampus (PHIP) and prefrontal cortex (PFC).ResultsIn tinnitus patients the FA values of IC, MGB, TRN, AMG, HIP decreased and the ADC values of IC, MGB, TRN, AMG, PHIP increased significantly. The contralateral IC-LL and bilateral MGB FA values correlated negatively with hearing loss. A negative relation was found between the AMG-HIP FA values and THI and VAS scores. Bilateral ADC values of PHIP and PFC significantly correlated with the attention deficiency—VAS scores.ConclusionIn conclusion, this is the first DTI study to investigate the grey matter structures related to tinnitus perception and the significant correlation of FA and ADC with clinical parameters suggests that DTI can provide helpful information for tinnitus. Magnifying the microstructures in DTI can help evaluate the three faces of tinnitus nature: hearing, emotion and attention.

Imaging of unilateral adrenal hemorrhages in patients after blunt abdominal trauma: Report of two cases

Adrenal hemorrhage following blunt abdominal trauma is extremely rare. Most of the lesions are unilateral and right sided. Although often asymptomatic, life-threatening adrenal insufficiency may develop in the bilateral adrenal gland hemorrhage. Isolated adrenal injuries are very rare. They are often associated with other organ injuries. The mortality rates of patients range from 7% to 32%. In this report, we present the computed tomography and magnetic resonance imaging findings of unilateral adrenal hemorrhages in two patients with a history of fall from a height.

Incidental Persistent Falcine Sinus

This 14-year-old boy was admitted with a two month history of headache. His examination was normal. Magnetic resonance imaging showed a normal brain parenchyma. In addition, an incidental falcine sinus was observed on T2-weighted sagittal images (Figure A). Contrast-enhanced T1-weighted axial images (Figure B) revealed that the sinus connected the junction of the middle and posterior thirds of the superior sagittal sinus and the straight sinus. The posterior third of the superior sagittal sinus was enlarged and the straight sinus was hypoplastic. A magnetic resonance venography confirmed the presence of the persistent falcine sinus between the straight and superior sagittal sinus (Figure C).

Magnetic Resonance Imaging Evidence of Varicella Zoster Virus Polyneuropathy: Involvement of the Glossopharyngeal and Vagus Nerves Associated With Ramsay Hunt Syndrome.

The involvement of lower cranial nerve palsies is less frequent in Ramsay Hunt syndrome caused by varicella zoster virus (VZV). The authors report 1 of extremely rare patients of radiologically proven polyneuropathy of VZV infection with magnetic resonance imaging findings of VII, IX, and X cranial nerve involvement is a 62-year-old female patient, who initially presented with Ramsay Hunt syndrome. Varicella zoster virus infection should be considered even in patients who show unilateral palsy of the lower cranial nerves associated with laryngeal paralysis. Thin-section T2W and T1W images with a contrast agent should be added to the imaging protocol to show the subtle involvement.