Sila Ulus

Evaluation of the placenta with relative apparent diffusion coefficient and T2 signal intensity analysis.

PURPOSE We aimed to test the null hypothesis that relative apparent diffusion coefficient (rADC) and relative signal intensity values (rSI(HASTE)) do not change in the evaluation of placental maturation with advancing gestational age. MATERIALS AND METHODS Fifty-six fetuses with diffusion-weighted magnetic resonance imaging (DW-MRI) data were enrolled in this retrospective study. Fetuses were analyzed in three different gestational age groups: group 1, 18-23 weeks; group 2, 24-28 weeks; and group 3, 29-38 weeks. The rADC (mean ADC/ADC(globe)) and rSI(HASTE) values (mean SI(HASTE)/SI(globe)) were obtained. Two radiologists experienced in fetal MRI who were blinded to the patient information reviewed MRI images independently. Kruskal-Wallis Test was used to compare the rADC and rSI(HASTE) with gestational age groups. The agreement between the two blinded readers was tested using Krippendorffs alpha ratio. RESULTS Both placental rADC values and placental rSI(HASTE) values were not significantly different between the gestational age groups (P = 0.688 and P = 0.280, respectively). rADC and rSI(HASTE) measurements were reproducible with a good agreement between the two readers (Krippendorffs alpha ratio was 0.613 and 0.778, respectively). CONCLUSION The rADC and rSI(HASTE) values do not change with advancing gestational age.

Reversible intracranial parenchymal changes in MRI after MCA aneurysm treatment with stent-assisted coiling technique; possible nickel allergy

Dear Sir, We would like to bring to your attention our experience with a 41-year-old female with reversible cranial parenchymal changes in magnetic resonance imaging (MRI) of a possible hypersensitivity reaction presenting with headache and visual disturbance of flashing lights, occurring 1 month after endovascular stent assisted coil embolization with the Ystent technique for an unruptured saccular aneurysm in the left middle cerebral artery (MCA). The aneurysm had a wide neck and saccular sizes of the aneurysm were 5×4×3.5 mm. One stent was placed in the upper and the other in the lower truncus of the left MCA (Enterprise stent, Codman Neurovascular, Raynham, MA, USA), and stent-assisted coil embolization was performed. Ten GDC platinum coils were used (Boston Scientific, USA). Embolization was successful with no complications (Fig. 1). One month later, the patient presented to our hospital with headache and visual disturbance of flashing lights. MRI revealed multiple subcortical and cortical, noncoalescent, maximum 4 cm and nonhomogeneous in size, patchy parenchymal lesions in the left frontal, parietal, temporal, and occipital lobes, i.e., in the watershed areas. The lesions were inhomogeneously hyperintense on T2-Wand fluid attenuation inversion recovery (Fig. 2a) images and hypointense in T1-W images. Since the lesions showed no diffusion restriction, they most probably corresponded to vasogenic edema. Some of the lesions showed nodular contrast enhancement especially in the cortical part with a subtle leptomeningeal contrast-enhancement adjacent to the lesions (Fig. 2b). Cerebral digital subtraction angiography (DSA) showed total occlusion of the aneurysm. In the distal arterial segments there were no signs of vasculitis or occlusion. Blood tests for the exclusion of vasculitis were normal except for a mild increase in the erythrocyte sedimentation rate (33 mm/h) and C-reactive protein (CRP; 0.62 mg/dl) values. No specific treatment was given and patients’ symptoms gradually decreased over the next 2–3 weeks and finally resolved completely. The control MRI performed after 2 months showed almost complete regression of the signal changes defined in the previous MRI (Fig. 3). Parenchymal and leptomeningeal enhancement had resolved completely. Sedimentation and CRP values were back to normal. Another control MRI performed 6 months later was likewise normal. The “Y” stenting technique is a safe and effective option in the endovascular reconstruction of unruptured complex intracranial aneurysms [1, 2]. In our case, “Y” stenting technique was used because of the wide neck of the aneurysm. Enterprise stent is a widely used, self-expanding nitinol stent with a closed-cell design, designed for the treatment of wide-necked aneurysms [3, 4]. Nitinol is composed of 55 % nickel and 45 % titanium, and there has been a great deal of concern in the medical industry regarding the release of nickel, a known allergen [5]. When properly treated, nitinol forms a very stable protective TiO2 layer that S. Ulus : E. Kararslan Department of Radiology, Acibadem University Medical Faculty, Istanbul, Turkey

Right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a patient with Behçet’s disease: case report and review of the literature

Behçet’s disease is a multisystemic, chronic inflammatory disorder with diffuse clinical manifestations including the cardiovascular system. Endomyocardial fibrosis is a rarely seen complication of Behçet’s disease leading to progressive heart failure. We report a case of right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a 26-year-old male Turkish patient with Behçet’s disease, who had heart failure symptoms. In addition, the previously reported cases of endomyocardial fibrosis complicating Behçet’s disease are reviewed in this article.

Leiomyosarcoma of the Inferior Vena Cava Confirmed by Aspiration Biopsy With a Catheter During Digital Subtraction Angiography

Leiomyosarcoma of the vascular origin is a rare malignant tumor. It originates from the smooth muscle cells of the media with intra- or extraluminal growth, and in most cases it arises in the inferior vena cava. The diagnosis is often delayed because the clinical symptoms of this disease are often nonspecific. Accurate diagnosis of inferior vena cava leiomyosarcoma (IVCLMS) needs histologic confirmation. We report a case of IVCLMS histologically confirmed by aspiration biopsy with a catheter during digital subtraction angiography presenting with pulmonary emboli in a 65-year-old man.

Estimated radiation dose and image quality comparison of the scan protocols in dual-source computed tomography coronary angiography

Radiation exposure from computed tomography coronary angiography (CTCA) is of particular concern and several techniques have been introduced to lower the radiation dose. In this study, we aimed to compare the diagnostic image quality and estimated radiation dose of the three CTCA acquisition protocols in a recently introduced second generation dual‐source computed tomography.

Whole-Body MRI Screening in Asymptomatic Subjects; Preliminary Experience and Long-Term Follow-Up Findings

Summary Background The aim of this study is to describe the technique and to evaluate the results of whole-body magnetic resonance imaging in an asymptomatic population. Material/Methods Between March 2009 and December 2011, 118 consecutive subjects undergoing thorough medical check-up were prospectively included in the study. MRI was performed with a 205-cm moving table, parallel imaging and automatic image composing software. Results In 83 subjects (70%), 103 benign lesions were detected. Two malignant (adrenal and renal carcinoma) lesions and one precancerous (pancreatic mucinous carcinoma) lesion were detected. The most common lesions were renal cysts, liver hemangiomas, liver cysts, thyroid nodules, and uterine leiomyomas. Conclusions WB-MRI is able to cover area from head to toes in one diagnostic work-up, and besides the anatomic regions evaluated by conventional radiological modalities, i.e. brain parenchyma, bones and extremities, can be evaluated in one examination.

Magnetic resonance imaging evaluation of fetal maxillary sinuses.

Background and ObjectiveThe growth of maxillary sinus is closely connected to the development of facial structures. However, its definition and reference standards on fetal magnetic resonance imaging (MRI) have not been analyzed so far. In this study, the objectives were to define and evaluate the fetal maxillary sinus (fMS) formation with MRI. MethodsWe reviewed T2-weighted coronal MRI images of 75 fetuses. The MRI features, time of appearance, and boundaries of fMS were defined. Craniocaudal and transverse diameters of both maxillary sinuses and bone biparietal diameters were measured and statistically evaluated. ResultsIn 150 fMS site analysis, 91 fMSs were identified. The fMSs were visualized as a hyperintense structures on T2-weighted image above the tooth bud. It first appeared at the 22nd gestational week, and in 4% (3/75) of fetuses, there was unilateral development. Mean craniocaudal length was 2.84 mm (1.1–4.8 mm), and mean transverse diameter was 2.67 mm (1.5–4.2 mm). ConclusionsMagnetic resonance imaging features of fMS that should be sought for the assessment of craniofacial anatomy are identified in this study. Fetal maxillary sinuses can be observed as hyperintense structures on T2-weighted MRI images starting from 22 weeks of gestation. The growth of fMS follows a predictable course throughout gestation; however, the dimensions are larger than the previously reported ex vivo series.

A rare case of paratesticular leiomyoma in a child

Leiomyomas are benign, slow-growing, smooth muscle tumors, which can occur at many locations in the body. The male genitourinary tract is seldom affected and scrotal leiomyomas are extremely rare. Most of the scrotal leiomyomas are localized in the testis, epididymis, spermatic cord, subcutaneous tissue, tunica albuginea, and scrotal skin and only a few of them are reported in the origin of isolated tissue without paratesticular structures in the paratesticular region. We are presenting a case of solitary paratesticular leiomyoma in a child, which is very rare in terms of lesion location and patient age, and describing the imaging features of this lesion.

Evaluation of choroid plexus with fetal magnetic resonance imaging: What happens in ventriculomegaly?

OBJECTIVES Diagnosis of ventriculomegaly (VM) and identification of choroid plexus (CP) can be challenging with fetal magnetic resonance imaging (MRI). Our aim is to create an adjunct method for supporting the diagnosis of VM by investigating the CP-ventricular wall separation distance in fetuses with and without VM (nV) with fetal MRI. METHODS T2-weighted fetal MRIs of 154 fetuses were retrospectively evaluated. The CP separation was defined as the distance between the medial wall of the dependent ventricle and distal tip of the CP glomus. The measurement was performed at the same plane with the dependent ventricle measurement by two blinded readers. RESULTS 41 fetuses with VM (mean gestational age 27 (19-35 weeks), and 44 nV fetuses (mean gestational age 28 (20-39 weeks) were included. Interobserver reliability was excellent for ventricle diameters (R = 0.99, confidence interval (CI) 95%) and the separation of CP (R = 0.98, CI 95%). Mean distance of CP separation was 10.7 mm ± 4.2 mm and 3.0 ± 1.6 mm in VM and nV fetuses, respectively (p < 0.001). The distance of CP separation to differentiate VM cases was 6.5 mm (sensitivity: 0.98, specificity: 0.98). Separation of CP was correlated to ventricle diameter in cases with (R = 0.674) and without VM (R = 0.805). For the cut-off value >0.65 cm for the distance between the medial wall of the dependent ventricle and the medial border of choroid plexus sensitivity is 97.56, specificity 95.45, positive predictive value (PPV) 95.20, negative predictive value (NPV) 97.70, and likelihood ratio (LR) (+) is 21.46. CONCLUSION Fetal CP can be efficiently evaluated with MRI, and the increase of CP-ventricular wall separation distance in correlation with the ventricle diameter is a reliable sign in the diagnosis of fetal VM.

Differentiation of secondary involvement of the breast by lymphoreticular malignancy from fibroadenoma using ultrasound elastography: A report of two cases

Extramedullary lymphoma infiltration of the breast by lymphoblastic lymphoma is very rare and most cases are of B-cell lineage; T-cell neoplasms represent less than 10% of all breast lymphomas. Here, we report one patient with lymphoblastic lymphoma and one patient with leukemia, who have similar lesions in breasts with different ultrasound elastography findings. Ultrasound-guided tru-cut biopsies were performed and the first lesion was confirmed as lymphoma infiltration and the second as fibroadenoma. In cases of breast mass presence in patients with a history of hematologic malignancies such as lymphoma or leukemia, breast infiltration should be kept in mind. Elastography findings can assist in the differentiation of these lesions and further investigations or biopsies can be avoided.