Hülya Aslan

Evaluation of possible prognostic factors of fulminant acute disseminated encephalomyelitis (ADEM) on magnetic resonance imaging with fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging.

Background: Acute disseminated encephalomyelitis (ADEM) may be a rapidly progressive disease with different clinical outcomes. Purpose: To investigate the radiological findings of fulminant ADEM on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) images, and to correlate these findings with clinical outcome. Material and Methods: Initial and follow-up magnetic resonance imaging (MRI) scans in eight patients were retrospectively evaluated for distribution of lesions on FLAIR images and presence of hemorrhage or contrast enhancement. DWI of the patients was evaluated as to cytotoxic versus vasogenic edema. The clinical records were analyzed, and MRI results and clinical outcome were correlated. Results: Four of the eight patients died, three had full recovery, and one had residual cortical blindness. The distribution of the hyperintense lesions on FLAIR sequence was as follows: frontal (37.5%), parietal (50%), temporal (37.5%), occipital (62.5%), basal ganglia (50%), pons (37.5%), mesencephalon (37.5%), and cerebellum (50%). Three of the patients who died had brainstem involvement. Two patients had a cytotoxic edema, one of whom died, and the other developed cortical blindness. Six patients had vasogenic edema: three of these patients had a rapid progression to coma and died; three of them recovered. Conclusion: DWI is not always helpful for evaluating the evolution or predicting the outcome of ADEM. However, extension of the lesions, particularly brainstem involvement, may have an influence on the prognosis.

Doppler ultrasonography findings of splenic arterial steal syndrome after liver transplant.

OBJECTIVES Splenic arterial steal syndrome is an important cause of morbidity and mortality after orthotopic liver transplant. Splenic arterial steal syndrome is characterized by arterial hypoperfusion of the graft; and if left untreated, causes ischemic biliary tract injury. Selective arterial embolization is important when treating splenic arterial steal syndrome. Doppler ultrasound has been used to follow-up liver transplant patients. This study sought to analyze alterations in portal vein velocity, peak systolic velocity, and resistivity index of the hepatic artery before diagnosis and after treatment of splenic arterial steal syndrome. MATERIALS AND METHODS We analyzed the Duplex Doppler ultrasonography results of 20 liver transplant recipients who developed angiographically proven splenic arterial steal syndrome between January 2005 and March 2009. Peak systolic velocity and resistivity index of the hepatic artery were noted during transplant surgery, before selective arterial embolization, and after embolization procedures. RESULTS A statistically significant decrease was found in peak systolic velocity and resistivity index of the hepatic artery between the intraoperative and pre-embolization values. In contrast to the statistically significant increase in peak systolic velocity of the hepatic artery, there were no significant changes in resistivity index after the selective arterial embolization. Portal vein velocity did not show a statistically significant change between intraoperative and preprocedure values. Portal vein velocity did show a tendency to decrease after coil embolization, but this was not significant. CONCLUSIONS Doppler ultrasound surveillance is a valuable tool in early detection of hepatic arterial complications. A decrease in peak systolic velocity and resistivity index compared to the corresponding intraoperative data should raise suspicion of splenic arterial steal syndrome. Also Doppler ultrasound can be effectively used to examine the hepatic arterial inflow after selective arterial embolization.

Idiopathic granulomatous mastitis: magnetic resonance imaging findings with diffusion MRI

Background Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease with unknown etiology which can mimic breast carcinoma, both clinically and radiologically. Magnetic resonance imaging (MRI) findings of IGM have been previously described; however there is no study evaluating diffusion-weighted MRI findings of IGM. Purpose To analyze conventional, dynamic contrast-enhanced, and diffusion-weighted MRI signal characteristics of IGM by comparing it with the contralateral normal breast parenchyma. Material and Methods A total of 39 patients were included in the study. On dynamic contrast-enhanced MRI, the distribution and enhancement patterns of the lesions were evaluated. We also detected the frequencies of involving quadrants, retroareolar involvement, accompanying abscess, and skin edema. T2-weighted (T2W) and STIR signal intensities and both mean and minimum apparent diffusion coefficient (ADC) values were compared with the contralateral normal parenchyma. Results IGM showed significantly lower mean and minimum ADC values when compared with the normal parenchyma. Signal intensities on T2W and STIR sequences of the lesion were significantly higher than the normal parenchyma. On dynamic contrast-enhanced MRI, 7.7% of the patients had mass-like contrast enhancement, 92.3% of the patients had non-mass-like contrast enhancement. Abscess was positive in 33.3% of the patients. Conclusion As a result, IGM showed commonly non-mass-like lesions with restricted diffusion. Although it is a benign pathology, it may show clustered ring-like enhancement like malignant lesions.

Multimodal MR imaging findings of a congenital glioblastoma multiforme

Dear Editor: We wish to report a case of congenital glioblastoma multiforme which is a rare high-grade glial tumor, with diffusionweighted magnetic resonance images and MR spectroscopy. Published reports are mostly based on clinical, genetical, and pathological behavior of the tumor; reports of radiological appearance are relatively uncommon. The imaging in those reports most commonly involved antenatal diagnoses by ultrasound; we did not recognize any report of MRI with diffusion and spectroscopy so far. An 8-month-old female infant from North Iraq presenting with an enlarging head was admitted to our hospital. The parents stated that they were told that the head circumference was larger than normal limits at birth. No further investigation was made at that time. On her routine follow-up onthe second month,aheadCTwasperformedbecauseoftheenlargedhead which revealeda supratentorialmass.The parents didnot seek any treatment at that time. Six months later, the baby was seen at our hospital, with the complaint of increasing enlargement of the head circumference. On physical examination, the patient was fine, with normal reflexes and normal responses to the stimuli, except for the macrocephaly. An MRI of the brain revealed a huge mass in the right frontal and parietal lobes which contained multiple small and large cystic areas and solid components that were isointense to gray matter on both T1-weighted- (Fig. 1a) and T2-weighted images. The

The magnetic resonance spectroscopy findings of extrapontine myelinolysis in a patient with acute lymphoblastic leukemia.

The magnetic resonance (MR) spectroscopy findings of extrapontine myelinolysis have been rarely reported. Herein, we present MR spectroscopy findings as well as the conventional MR and diffusion MR findings of an acute lymphoblastic leukemia patient with extrapontine myelinolysis. Advanced MR imaging including diffusion-weighted imaging and MR spectroscopy may be helpful to exclude other pathologies in the differential diagnosis and make the diagnosis when there is a diagnostic difficulty on cases clinically suspicious for extrapontine myelinolysis.

Memenin benign ve malign lezyonlarının ayrımında kantitatif elastografi

Amac: Calismamizin amaci B- mod US’de saptanan meme lezyonlarinin benign ve malign ayriminda kantitatif elastografinin etkinligini arastirmak ve benign- malign meme lezyonlarinin shear wave hizlarini karsilastirarak, bu lezyonlarin ayriminda esik deger belirlemek idi. Gerec ve Yontem: Bu prospektif calismada B- mod ultrasonografide saptanan ve klinigimizde biyopsi uygulanan 237’si kadin, 3’u erkek olmak uzere 240 hastanin toplam 254 lezyonu dahil edilmistir. Her lezyona biyopsi oncesinde shear wave elastografi uygulanmistir. Hastalarin yas ortalamasi 44.7±13.2 yil bulunmustur. Radyoterapi ve/ veya neoadjuvan kemoterapi alan olgular calismaya dahil edilmemistir. Elastografi incelemeleri meme radyolojisi ile ilgilenen iki radyologtan biri tarafindan degerlendirildi. O rtalama ve ortanca shear wave hizlari ve standart sapma degerleri metre/saniye olarak olculdu. Ortalama ve ortanca shear wave hizlari ile histopatolojik tanilari karsilastirildi. Duyarlilik, ozgulluk ve receiver operating characteristic egrisi kullanilarak egri altinda kalan alan hesaplandi. Bulgular: Benign ve malign gruplar arasinda olgularin ortalama yasi, lezyon boyutu, ortalama ve ortanca shear wave hizlari arasinda istatistiksel olarak anlamli farklilik saptandi. Ortalama shear wave hizi benign ve malign lezyonlar icin sirasiyla 3.59±1.2 m/s ve 5.59±1.9 m/s idi. Benign- malign ayriminda ortalama shear wave hizi icin esik deger 4.08 m/s (%71.6 duyarlilik ve %69.6 ozgulluk) bulundu. Sonuc: Sonuc olarak, kantitatif elastografi benign ve malign lezyonlarin ayriminda katki saglayan, diger yontemleri tamamlayan, etkin bir goruntuleme yontemidir. Bu acidan shear wave elastografi yonteminin klinik kullaniminin yayginlastirilmasi gerektigi dusuncesindeyiz. US>Sonuc: Sonuc olarak, kantitatif elastografi benign ve malign lezyonlarin ayriminda katki saglayan, diger yontemleri tamamlayan, etkin bir goruntuleme yontemidir. Bu acidan shear wave elastografi yonteminin klinik kullaniminin yayginlastirilmasi gerektigi dusuncesindeyiz.