Levent Onat

The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI.

IntroductionThe radiological diagnosis of cervical spondylotic myelopathy (CSM) has to be made as soon as possible, since surgery performed in earlier stages during the course of CSM was reported to be more successful when compared with later stages. We hypothesized that diffusion tensor imaging (DTI) may detect CSM in earlier stages, before the appearance of signal increase in T2-weighted sequences.MethodsA total of 16 patients with neurological signs and symptoms of CSM but without hyperintensity in spinal cord on T2-weighted sequences enrolled in the study. The magnetic resonance (MR) examinations were performed on a 3-T MR imaging system. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were generated on axial plane. The ADC and FA measurements in each individual were made at the level of most severe cervical canal stenosis and at a nonstenotic level. Student’s t test was used to compare FA and ADC values of the spinal cord in stenotic and nonstenotic segments. We also investigated if there was a correlation between DTI parametrics and duration of clinical symptoms by using Pearson correlation analysis.ResultsAll patients showed changes in DTI parametrics at stenotic segments. While FA values of the spinal cord at the stenotic level showed a statistically significant reduction, there was a statistically significant increase in the measured ADC values (p < 0.001). There was no statistical correlation between the duration of symptoms and DTI parametrics.ConclusionOur preliminary findings indicate that DTI may show abnormalities in the spinal cord before the development of T2 hyperintensity on conventional sequences in patients with CSM.

Primary epiploic appendagitis: CT manifestations.

Inflammation of an epiploic appendage is considered to be a rare cause of acute abdomen. Recently, it has been reported that typical computed tomography (CT) findings of primary epiploic appendagitis (PEA) provide a definitive diagnosis in most of the cases. However, since these papers are only few, they are easily overlooked by the practicing radiologists. Our purpose is to add four new cases to the existing literature and to perform a review of the literature.

Efficacy of Prophylactic Placement of Inferior Vena Cava Filter in Patients Undergoing Spinal Surgery

Study Design. Retrospective case series. Objective. To evaluate the safety and efficacy of prophylactic inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in high risk patients undergoing major complex spinal surgery. Summary of Background Data. PE has been reported to be the major cause of death after spinal reconstructive surgery. Mechanical prophylaxis alone is often not sufficient whereas anticoagulation therapy carries a significant risk of bleeding complications. Prophylactic IVCF placement is advocated in high-risk patients. Methods. A total of 129 high-risk patients undergoing complex spine surgery, having prophylactic IVCF were compared to a matched cohort of age, diagnosis, and risk factors of 193 patients for whom only mechanical prophylaxis was used. Patients were observed for potential complications related to the IVCF and also for clinical signs and symptoms of PE. Results. Eight cases (4.2%) of symptomatic PE were detected in the matched cohort control group (5 cases having combined anterior + posterior surgery and 3 patients having only posterior surgery). One of them died due to massive PE (0.5%). Symptomatic PE was detected in only 2 patients (1.5%), having combined anterior + posterior surgery due to lumbar spinal stenosis in IVCF group who responded well to medical treatment (P < 0.05). No complications were associated with filter insertion. Conclusion. Prophylactic IVCF is effective and safe in prevention of pulmonary embolism in patients with risk factors for PE.

Spontaneous retroperitoneal hemorrhage secondary to subcapsular renal hematoma: MRI findings

Spontaneous retroperitoneal hemorrhage is a rare intraabdominal bleeding. In this report we present a case of a nontraumatic retroperitoneal hemorrhage secondary to spontaneous subcapsular renal hematoma. A 54-year-old patient who was under warfarin therapy, developed subcapsular right renal hematoma. Subcapsular and retroperitoneal hemorrhage were low signal on T1- and T2-weighted images consistent with acute stage of blood. The source of subcapsular hematoma was shown to be the rupture of hemorrhagic renal cyst on MRI. Extension of hemorrhage into the retroperitoneal space anterior to right psoas muscle was also successfully shown on MRI. Patient underwent nephrectomy and retroperitoneal blood was evacuated.

Recurrent tuberculous pseudoaneurysm of the descending thoracic aorta : A case report

Tuberculous pseudoaneurysm of the aorta is a rare disease that is uniformly fatal if not treated properly. The authors present a case of a recurrent tuberculous false aneurysm of the descending thoracic aorta that was treated surgically with excision and primary repair of the lesion. To their knowledge, this is the first reported case of recurrent disease after a successful surgical treatment.

Intrahepatic arterioportal fistula: demonstration by dynamic 3D magnetic resonance angiography in under four seconds.

We report a case of a 35‐year‐old patient with clinical symptoms of portal hypertension that underwent dynamic contrast‐enhanced 3D magnetic resonance angiography (MRA) of the abdomen. On breath‐hold dynamic contrast‐enhanced MRA in less than 4 seconds, contrast passage from the arterial to the portal system was successfully demonstrated. Patient was managed according to MRA findings. J. Magn. Reson. Imaging 2002;16:94–96.