Lutfi Incesu

Unbiased estimation of the liver volume by the Cavalieri principle using magnetic resonance images

OBJECTIVE It is often useful to know the exact volume of the liver, such as in monitoring the effects of a disease, treatment, dieting regime, training program or surgical application. Some non-invasive methodologies have been previously described which estimate the volume of the liver. However, these preliminary techniques need special software or skilled performers and they are not ideal for daily use in clinical practice. Here, we describe a simple, accurate and practical technique for estimating liver volume without changing the routine magnetic resonance imaging scanning procedure. MATERIALS AND METHODS In this study, five normal livers, obtained from cadavers, were scanned by 0.5 T MR machine, in horizontal and sagittal planes. The consecutive sections, in 10 mm thickness, were used to estimate the whole volume of the liver by means of the Cavalieri principle. The volume estimations were done by three different performers to evaluate the reproducibility. RESULTS There are no statistical differences between the performers and real liver volumes (P > 0.05). There is also high correlation between the estimates of performers and the real liver volume (r = 0.993). CONCLUSION We conclude that the combination of MR imaging with the Cavalieri principle is a non-invasive, direct and unbiased technique that can be safely applied to estimate liver volume with a very moderate workload per individual.

Dyke–Davidoff–Masson syndrome

We reported five cases of Dyke-Davidoff-Masson syndrome (DDMS) with different clinical and radiological findings. The evaluated parameters were the location of the lesions, midline structural shift effect, pathological and morphological changes on the ipsilateral calvarium, paranasal sinuses and mesencephalon, presence of compensatory contralateral hypertrophy. With the help of both magnetic resonance (MR) and computerized tomography (CT) images, changing degrees of all the evaluated parameters were observed in all five of our patients. In conclusion, no relationship was found between parenchymal and calvarial changes and between the time after onset of the disease and amount of the morphologic and pathological changes.

Relationship of condylar position to disc position and morphology.

INTRODUCTION/OBJECTIVE The purpose of this study was to assess whether condylar position, as depicted by magnetic resonance imaging, was an indicator of disc morphology and position. METHODS AND MATERIAL One hundred and twenty two TMJs of 61 patients with temporomandibular joint disorder were examined. Condylar position, disc deformity and degree of anterior disc displacement were evaluated by using magnetic resonance imaging. RESULTS AND DISCUSSION Posterior condyle position was found to be the main feature of temporomandibular joints with slight and moderate anterior disc displacement. No statistical significance was found between the condylar position, and reducing and nonreducing disc positions. On the other hand, superior disc position was found to be statistically significant for centric condylar position. CONCLUSION It was concluded that posterior condyle position could indicate anterior disc displacement whereas there was no relation between the position of condyle and the disc deformity.

Comparison of computed tomography and magnetic resonance imaging in the diagnosis of parotid tumors

OBJECTIVE: The role of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of parotid tumors was investigated. METHODS: Forty patients with the clinical suspicion of a parotid mass underwent both CT and MRI of the parotid region. Two radiologists independently assessed the CT and MRI results with respect to tumor localization, tumor margin characteristics, and infiltration of surrounding tissue. Histopathologic specimens were obtained in all cases and correlated with the radiologic findings. RESULTS: The sensitivity and specificity of CT and MRI were nearly the same for tumor location, tumor margin, and tumor infiltration. CONCLUSION: The 2 imaging techniques provided the same information with respect to the presurgical planning and contribute to the diagnosis and therapy planning of parotid tumors. (Otolaryngol Head Neck Surg 2003;129:726-32.)

Left hemisphere and male sex dominance of cerebral hemiatrophy (Dyke–Davidoff–Masson Syndrome)

Although radiological findings of cerebral hemiatrophy (Dyke-Davidoff-Masson Syndrome) are well known, there is no systematic study about the gender and the affected side in this syndrome. Brain images in 26 patients (mean aged 11) with cerebral hemiatrophy were retrospectively reviewed. Nineteen patients (73.5%) were male and seven patients (26.5%) were female. Left hemisphere involvement was seen in 18 patients (69.2%) and right hemisphere involvement was seen in eight patients (30.8%). We conclude that male gender and left side involvement are frequent in cerebral hemiatrophy disease.

Sturge-Weber syndrome involved frontoparietal region without facial nevus

Classic Sturge-Weber syndrome is characterized by a facial nevus and hamartomatous lesion in the brain. Hamartomatous lesions are usually located in the ipsilateral occipital region of the facial nevus. The other lobes may be involved. A few cases of Sturge-Weber syndrome without facial nevus have been reported. A 9-month-old male was admitted with the complaint of afebrile seizures two times. We observed the third seizure, which was complex partial, in the clinic. There was no facial hemangioma. On computed tomography and magnetic resonance imaging of the brain we observed findings concordant with the angioma in the right frontoparietal region, although the occipital region was intact. This patient appears to be the first with Sturge-Weber syndrome without facial nevus, and with involvement of the frontoparietal region but not the occipital region. We do not know the embryologic basis of this association.

The incidence of gallbladder stones and gallbladder function in beta-thalassemic children.

Purpose: To determine gallbladder motor function and gallstone prevalence in beta-thalassemic children. Abnormalities in gallbladder function or bile acid metabolism may contribute to gallstone formation in these patients. Material and Methods: In 17 beta-thalassemic patients and 12 normal healthy children with similar age, sex and weight, gallbladder size was measured using real-time US, and volume was calculated using the ellipsoid method. Results: In the beta-thalassemic patients, cholelithiasis was present in 2 patients (11.8%). Sludge, which can be a predisposing factor for cholelithiasis and cholecystitis when it persists, was detected in 5 patients (29.4%). One of the patients had both cholelithiasis and sludge. Compared with the control group, beta-thalassemic children had larger fasting volume, residual volume, and smaller contraction index. Conclusion: Beta-thalassemic patients have enlarged gallbladders that retain an increased residual volume of bile. Gallbladder enlargement, bile stasis, and impaired emptying of sludge may be important events in the pathogenesis of pigment gallstones in beta-thalassemic patients.

Simplified gyral pattern with cerebellar hypoplasia in Sedaghatian type spondylometaphyseal dysplasia: A clinical report and review of the literature†

We report on a patient with Sedaghatian type spondylometaphyseal dysplasia (SSMD) who presented with metaphyseal dysplasia, congenital atrioventricular block, simplified gyral pattern, hypogenesis of corpus callosum, and severe cerebellar hypoplasia. We want to emphasize that in this rare congenital lethal skeletal dysplasia with unknown etiology, central nervous system malformations might be a major component of the disorder and should be evaluated in detail to possibly uncover the underlying pathophysiology.

Bilateral neurogenic thoracic outlet syndrome

We report a case of bilateral neurogenic thoracic outlet syndrome (TOS). Electrophysiological examination suggested the presence of bilateral lower brachial plexus neuropathy. Radiography showed rudimentary bilateral cervical ribs. In the cases reported in the literature to date, the clinical findings are typically unilateral despite the common presence of bilateral bony abnormalities. Neurogenic TOS should be considered in young women, even if they present with bilateral symptoms, when they have occupations requiring strenuous activity of the upper limbs. Muscle Nerve 29: 147–150, 2004

Magnetic resonance imaging of proximal aortopulmonary window

Aortopulmonary window was prospectively diagnosed by magnetic resonance imaging in a 9-month-old boy. The diagnosis was confirmed by cardiac catheterization, angiocardiography, two-dimensional and color doppler echocardiography. Spin-echo T1-weighted axial and coronal magnetic resonance images show a large windowlike communication between left ascending aorta and right wall of the main pulmonary arterial trunk. To our knowledge, this is the first time that the diagnosis of the aorticopulmonary window was achieved by magnetic resonance imaging.