Mustafa Sirvanci

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.

MR imaging of infective liver lesions.

This article discusses MR imaging of infective liver lesions including pyogenic liver abscesses, amebic liver abscesses, echinococcal disease, hepatic fungal abscesses, granulomatous hepatic infections, schistosomiasis, and fascioliasis.

Intraspinal metalloma resulting in late paraparesis

The metal-related complications caused by orthopedic implants have long been a concern, but these problems have been considered mostly in the field of arthroplasty or internal fixation of fractures. The recent prevalence of spinal instrumentation has evoked a similar concern among spine surgeons. Here, we present a case of intraspinal metallosis adjacent to the pedicular hook occurring after treatment of vertebral fracture by posterior spinal instrumentation and fusion, and causing paraparesis at the 3rd postoperative year. Metallic granulomas can appear around the pedicular hooks as in the reported case. Crevice and fretting corrosion are results at the junctions of rod-screw, rod-hook, transverse connector rod and other connector rods in modular spinal implants. Adequate usage of transpedicular screws may inhibit the occurrence of such a complication. For this reason, further studies are necessary to increase metallic corrosive resistance to inhibit crevice and fretting corrosion.

Magnetic resonance imaging of tuberculous spondylitis.

The clinical and imaging findings of patients with a confirmed diagnosis of tuberculous spondylitis were retrospectively analyzed to assess the diagnostic value of magnetic resonance imaging (MRI) and determine the different patterns of spine involvement. Fifty-three patients with plain radiographs and MRI of the entire spinal column were included in the study. Sagittal T1- and T2-weighted MRIs of the entire spine and axial T1- and T2-weighted MRIs at the levels of interest were retrospectively evaluated. Plain radiographic correlation was obtained in all patients. The lower thoracic and thoracolumbar spine was the most commonly involved region. Magnetic resonance imaging is effective in the early diagnosis of tuberculous spondylitis. It also detects lesions, which may not be apparent on plain radiographs.

CT and MR characteristics of hibernoma: six cases

PURPOSE The purpose of this study was to describe the computed tomography (CT) and magnetic resonance (MR) imaging findings of hibernoma. MATERIALS AND METHODS We retrospectively evaluated imaging findings of CT and MR examinations of six patients (three men and three woman, aged 27-48 years) with histopathological diagnosis of hibernoma. RESULTS On CT examination, the lesions were slightly hyperdense, and on T1- and T2-weighted MR images, they were isointense or slightly hypointense compared to the subcutaneous fat. All of these lesions showed contrast enhancement and one out of the six lesions had internal linear septations. CONCLUSION Hibernoma has a wide spectrum of CT and MR imaging findings, which should be considered in differential diagnosis, especially with other lipomatous lesions.

An investigation of the association between coronary artery dominance and coronary artery variations with coronary arterial disease by multidetector computed tomographic coronary angiography.

Purpose: Depending on the perfusing interventricular septum of the arteries, there are 3 types of circulation dominance: right, left, and balanced. In this study, coronary artery branches supplying the ventricular septum were investigated in vivo in a large group of patients by multidetector computed tomography (MDCT) coronary angiography. In addition, the association of coronary artery variations with coronary arterial disease was investigated. Materials and Methods: The study included 325 consecutive patients (214 men and 108 women, with a mean age of 59 ± 14 years) who underwent MDCT coronary angiography. Multidetector computed tomography was performed with a 16-detector-row computed tomographic scanner. The type of dominance, coronary arterial diseases, and coronary artery variations were recorded. Results: In our study, the types of coronary circulation were right, left, and balanced in 227 (70%), 40 (12.5%), and 58 (17.5%) patients, respectively. Dominance of right circulation was detected in 150 of 217 (69%) of men and in 77 of 108 (71%) of women; dominance of left circulation was found in 26 of 217(12%) of men and in 14 of 108 (13%) of women; balanced/codominance circulation was found in 41 of 217 (19%) of men and in 17 of 108 (16%) of women. However, no significant differences were detected between the sexes for the type of coronary circulation. Coronary artery disease was determined in 68 patients (20.9%) by MDCT, and coronary artery variations were also determined in 34 patients (10.4%). Both the number and the rate of coronary artery variations were significantly higher among the patients with left artery dominance. Conclusions: Knowledge of coronary artery variations and pathologies is important in planning the treatment and in interpretation of findings of cardiovascular diseases. Our study indicated that, although right dominance circulation is more common in general population, both the coronary diseases and coronary artery variations are more common in individuals with left dominance circulation.

Osteochondritis dissecans of the tarsal navicular.

A 27-year-old male athlete presented with chronic right dorsal midfoot pain and limitation in midfoot movements. Computed tomography and magnetic resonance imaging demonstrated an nondisplaced osteochondral fragment within the proximal articular surface of the tarsal navicular. Imaging findings of this disease are presented and discussed.

Gastrointestinal: Epiploic appendagitis

How did we get the word epiploic appendagitis? The word ‘epiploic’ is synonymous with omental. Appendagitis is more straightforward and means inflammation of a part that is subordinate in size or function to the main structure. Indeed, appendices epiploicae are small fatty projections covered by peritoneum that are scattered over the free surface of most of the large intestine. They are absent from the cecum, the appendix and the rectum. They have no known structural or functional purpose and have only rarely been associated with pathological changes or clinical syndromes. The images illustrated below were from an 18-year-old man who was admitted to hospital with pain in the left iliac fossa that radiated into the region of the umbilicus. Pain was aggravated by deep breathing and coughing. His temperature was normal and the only abnormal laboratory finding was a mild leucocytosis. A computed tomography (CT) scan was performed. The axial image (Fig. 1) revealed an oval-shaped lesion (arrows) with a rim of soft tissue that shows increased attenuation and fine stranding consistent with inflammation. The coronal reconstruction confirmed that the lesion was pericolonic (Fig. 2, arrows). The adjacent colonic wall and nearby segments were normal. The findings were consistent with epiploic appendagitis and his symptoms resolved after bed rest and analgesics for 5 days. The cause of epiploic appendagitis is torsion or venous thrombosis of an appendage causing ischemia or infarction. Similar radiological findings may be seen with acute diverticulitis. However, the latter disorder mostly occurs in patients greater than 50 years of age, and CT scans normally show additional features including unaffected diverticula and thickening of the colonic wall. Furthermore, some patients have radiological features of an abscess such as a pericolonic collection with gas bubbles or a fluid level.

Large thoracic extradural schwannoma atypically invading T2 vertebra

A 53-year-old woman presented with a complaint of back pain. Her medical history and physical examination were unremarkable. Magnetic resonance imaging of the thoracic spine showed a large extradural mass on the right side at the T2– T3 levels (Fig. 1). The lesion widened the right neural foramen and had a large extraspinal component with extension into the posterior mediastinum. The lesion invaded the posterior and right posterolateral parts of the T2 vertebral body (Fig. 2). It was heterogeneously hypointense to muscles on T1weighted, and hyperintense on T2-weighted images. Postcontrast images showed intense enhancement of the lesion. The tumor was resected, and T2 corpectomy was also performed. Histopathologic examination revealed the diagnosis of schwannoma without malignant transformation. Schwannoma is the most common spinal nerve sheath tumor, which is followed by neurofibroma and ganglioneuroma. Invasion and osteolytic expansion of the vertebral body by schwannoma is extremely rare. Schwannoma should be included in the differential diagnosis of large extradural lesion causing invasion and destruction of the spine, especially if it shows typical imaging findings such as neural foraminal widening and adjacent bony remodeling [1].

Pseudomeningocele in communication with the facet joint: demonstration by computerized tomography–arthrography

Pseudomeningocele is an uncommon but well-known complication of lumbar spine operations. Although it is mostly asymptomatic and managed conservatively in most cases, it is claimed as a causative factor of failed back surgery syndrome and requires surgery in some cases. Usually, its diagnosis is confidently done with imaging modalities such as magnetic resonance imaging, computed tomography and myelography. In this report, we describe a case of pseudomeningocele that communicated with a facet joint. The diagnostic approach for this unusual lesion and its probable causes are discussed.