Tarkan Ergun

STIR Sequence for Depiction of Degenerative Changes in Posterior Stabilizing Elements in Patients with Lower Back Pain

OBJECTIVE The aims of this study were to investigate whether degenerative posterior paraspinal changes are a cause of lower back pain and to determine the age- and sex-related distribution of these changes on MR images acquired with a STIR sequence. SUBJECTS AND METHODS The lumbar MRI findings of 372 patients (141 men, 231 women; mean age, 51.2 years) with nonradicular lower back pain and of 249 healthy persons acting as controls (126 men, 123 women; mean age, 49.3 years) were analyzed. The sagittal STIR sequence was used for all MRI examinations. Presence of interspinous ligament edema, facet joint effusion, neocysts, paraspinal muscle edema, subcutaneous edema, disk herniation, and disk degeneration was evaluated, and the incidence of each finding was determined. All findings were grouped according to age and sex. Chi-square, Fishers exact, and independent-samples Students t tests and Spearmans rank correlation analysis were used for statistical analysis. RESULTS The incidences of facet joint effusion, interspinous ligament edema, neocyst formation, and paraspinal muscle edema were found to be statistically significantly higher in patients with lower back pain than in controls. The incidences of intervertebral disk degeneration, disk herniation, and subcutaneous edema in persons with and those without lower back pain were similar. Intervertebral disk degeneration, disk herniation, subcutaneous edema, and muscle edema were found to increase with age in both persons with and those without symptoms. CONCLUSION Degenerative changes in the posterior paraspinal structures were found in a higher percentage of subjects with lower back pain than in controls. Use of a STIR sequence with homogeneous fat suppression facilitates visualization of these changes.

Subpubic cartilaginous cyst: incidental finding detected by abdominopelvic computed tomography

Subpubic cartilaginous cysts are rare cystic lesions that have been radiologically identified only in recent years, and the our understanding of the cautions to be observed in the diagnostic approach and the radiologic characteristics is still incomplete. The medical literature search revealed three reported cases of a subpubic cartilaginous cyst diagnosed histopathologically and one case that was suggested by radiological findings. Definitive diagnosis of all the cases was confirmed by excisional biopsy. This report discusses the radiological features and the important issues necessary in the diagnostic approach of subpubic cartilaginous cysts.

Magnetic Resonance Imaging in the Visualization of Benign Tumors and Tumor-like Lesions of Hand and Wrist

The differential diagnosis of benign tumors and tumor-like lesions of the hand and wrist region is important with regard to choosing the therapy (medical versus surgical), or to decide to just follow-up the lesion. In most of the cases the proper analysis of MRI findings in correlation with the patients history is sufficient to meet a specific diagnosis. However, diagnostic confusion is not uncommon as there are numerous lesions affecting the hand and wrist region. This pictorial essay offers a practical radiological approach to benign tumors and tumor-like lesions of the hand and wrist region based on most frequently observed MRI findings.

The relation between sagittal morphology of the lumbosacral spine and the degree of lumbar intervertebral disc degeneration.

OBJECTIVES We investigated the relationship between the lumbosacral morphology and degree of intervertebral disc degeneration in a large sample of young patients. In addition, the relation between various morphological parameters (sacral table angle and sacral kyphosis) and lumbar disc herniation or degeneration was also evaluated. METHODS The magnetic resonance imaging (MRI) of low back pain patients referred to our department in 2008-2009 were retrospectively evaluated. Patients with prior lumbar spinal surgery, serious congenital anomalies on MRI, incomplete or complete lumbosacral trancision, severe scoliosis, spondylolysis, or spondylolisthesis were excluded from the study. A sample of 131 females between 20-30 years of age was studied. Patients were evaluated for the presence of intervertebral disc herniation or degeneration, and the degree of degeneration was assessed. Angles of lumbar lordosis, sacral table, and sacral kyphosis were also measured for each patient. RESULTS The degree of intervertebral disc degeneration increased in parallel to the decrease in the sacral kyphosis and lumbar lordosis angles, and to the increase in sacral table angle. A statistically significant difference with regard to the angles of lumbar lordosis, sacral kyphosis, and sacral table was determined between individuals with (23.37±7.09°, 163.09±9.48°, 104.34±5.47°, respectively) and without intervertebral disc degeneration (26.94±7.39°, 168.94±10.52°, 100.83±4.32°; p=0.006, p=0.001, p=0.0001, respectively). In addition, a statistically significant difference with regard to the angles of lumbar lordosis, sacral kyphosis, and sacral table was determined between individuals with (22.82±6.94°, 162.23±9.53°, 104.94±5.19°, respectively) and without intervertebral disc herniation (27.25±7.26°, 169.39±9.96°, 100.48±4.33°; p=0.001, p=0.0001, p=0.0001, respectively). CONCLUSION The degree and risk of intervertebral disc degeneration and herniation increases in parallel to the decrease in sacral kyphosis and lumbar lordosis, and to the increase in sacral surface angle.

Multiple rice body formation accompanying the chronic nonspecific tenosynovitis of flexor tendons of the wrist

Rice body formation is generally a rare disorder related to rheumatoid arthritis. It can also be observed in cases of systemic lupus erythematosus, seronegative arthritis, infectious arthritis (tuberculosis, atypical mycobacterial infection), nonspecific arthritis, and osteoarthritis. It is generally located within joints or bursae. Multiple rice bodies of tendon sheaths are rarely encountered. Rice body formation may also be encountered without underlying systemic disorders. We present a case of multiple rice body formation that accompanied chronic nonspecific tenosynovitis of the flexor tendons of the wrist.

The CT frequencies of various non-traumatic acute abdominal emergencies in hemodialysis, peritoneal dialysis patients and the general population

PURPOSE To investigate the frequency of non-traumatic acute abdominal emergencies in end-stage renal disease (ESRD) (peritoneal dialysis (PD) and haemodialysis (HD)) patients and in the general population as diagnosed by computed tomography (CT) imaging. METHODS The abdominal CT findings of ESRD patients with non-traumatic acute abdominal pain during the years 2001-2010 have been retrospectively evaluated. Thirty-three HD (14 females, 19 males, mean age: 62 ± 10.5) and 22 PD patients (12 females, 10 males, mean age: 59 ± 9.4) with acute abdominal pathology based on their CT scans have been included into the study. In addition, 127 individuals (68 females, 59 males, mean age: 40.7 ± 12.8) with normal renal functions who presented with non-traumatic acute abdominal pain diagnosed with an acute abdominal pathology based on their CT scans have been prospectively evaluated during the years 2009-2010. RESULTS While the most frequent etiology in PD patients was peritonitis (45.4%), acute pancreatitis (13.6%) and perforation (18.1), and in HD patients it was nonocclusive mesenteric ischemia (18.1%) and spontaneous intraabdominal bleeding (21.2%). The basic causes of acute abdomen in the general population were ureteral stone (34.6%) and appendicitis (18.1%). CONCLUSIONS The causes of acute abdominal pain in ESRD patients is significantly different when compared to the general population. And within this special patient population the etiology of acute abdomen differs depending on the renal replacement therapy modality they are receiving. Thus, the causes of acute abdomen in PD patients are mostly peritonitis, acute pancreatitis, and perforation, while being mostly nonocclusive mesenteric ischemia and spontaneous intraabdominal bleeding in patients receiving HD therapy.

Multiple extradural spinal arachnoid cysts causing diffuse myelomalacia of the spinal cord.

Introduction:Extradural spinal cyst is a rare cause of compression myelopathy. It is usually solitary and its typical location is posterior to the spinal cord. We present a case of multiple spinal arachnoid cysts causing diffuse myelomalacia secondary to a significant compression of the spinal cord with no symptom relief after surgical decompression. Case Report:A 35-year-old female patient presented to our hospital complaining of progressive weakness and numbness of both lower extremities for the last 2 months, being more prominent on the right side. Her history was significant for back pain that started after a vaginal delivery 1 year ago. Spinal MRI revealed multiple extradural arachnoid cysts and diffuse myelomalacia. A T4-T6 level laminectomy was performed. The cyst was nearly totally resected. There was partial symptomatic relief after surgery, but 5 months later her symptoms worsened. MRI revealed nodular syringomyelia and atrophy of the thoracic spinal cord. Conclusions:Extradural spinal arachnoid cyst is to be considered in the differential diagnosis of spinal cord compression. Vaginal delivery may accelerate the process and symptoms by a sudden increase in the cyst size. In cases of myelomalacia secondary to cyst pressure postoperative results are quite poor.

MRI for acute neurologic complications in end-stage renal disease patients on hemodialysis.

Acute cerebrovascular disease is one of the most frequent causes of mortality and morbidity in patients on long-term hemodialysis therapy. Early recognition of cerebrovascular events improves the prognosis and quality of life of end-stage renal failure patients. This paper reviews the magnetic resonance imaging features of acute neurological findings in patients with end-stage renal failure.

Posterior Sternoclavicular Joint Dislocation with First Rib Fracture and Ipsilateral Vocal Cord Palsy

A 38-year-old man who was ejected from his car during a traffic accident was brought to our Emergency Department (ED). He had complaints of right shoulder and upper chest pain whenmoving his shoulder. On admission he was conscious but did not respond to questions. The physical examination revealed very limited and painful movement of the right shoulder, tenderness, and swelling of the right sternoclavicular joint, and difficulty speaking. Bony swelling appeared slightly superior to the contralateral sternoclavicular joint. Posterior displacement of the medial end of the clavicle was observed. Plain film of the chest and clavicles revealed only slight asymmetry between the clavicles but no clear evidence of dislocation (Figure 1). Computed tomography (CT) scan (Figure 2A) and three-dimensional CT scan (Figure 2B) revealed retrosternal dislocation of the right sternoclavicular joint, retrosternal hematoma, fracture-dislocation of the first rib with thickening, medial positioning of the right aryepiglottic fold, and anterior positioning of the right arytenoid cartilage consistent with vocal cord palsy (Figure 3). Twelve hours after injury hewas taken to the operating room. Closed reduction was attempted under general anesthesia using the method described by Rockwood and Green (1). The patient was positioned supine and a sandbag was placed between the scapulas. Powerful lateral traction was applied to the right arm in an abducted

Periaortic Fat Tissue: A Predictor of Cardiac Valvular Calcification, Malnutrition, Inflammation, and Atherosclerosis Components in Hemodialysis Patients

Cardiac valvular calcification (CVC) in end-stage renal disease is shown to be a component of malnutrition, inflammation, atherosclerosis, calcification (MIAC) syndrome. Thoracic periaortic fat tissue (T-PAFT) is shown to be increased in patients with end-stage renal disease (ESRD), and has positive correlation with MIAC. Negative correlation between CVC and vitamin D is shown in hemodialysis (HD) patients. In this study, we investigated a relationship between body composition, T-PAFT, metabolic and inflammatory parameters, and CVC in HD patients. Seventy-six HD patients (49M) were included. CVC is defined as bright echoes of >1 mm on one or more cusps on echocardiography. Results were expressed as the number of calcified valves (0,1,2). Calcium, phosphorus, parathyroid hormone (PTH), C-reactive protein (CRP), albumin and 25-hydroxy vitamin D levels were studied from predialysis blood samples. T-PAFT was calculated using a method with manual definition of borders on images from multislice computed tomography. Basal metabolic rate, muscle mass, total and truncal fat mass were measured by bioimpedance analysis. There were 65.8% of patients who had CVC. Patients with CVC were older (63.5 ± 14.6 ± 17, P = 0.02). T-PAFT (1599 ± 596, 739.7 ± 179 mm(2) , P = 0.001) and CRP (15.8 ± 11; 11.1 ± 13.2 mg/dL; P = 0.04) were higher in the group with CVC. T-PAFT had positive correlations with CRP, MIAC, body mass index (BMI) and number of calcified valves, negative correlation with left ventricular ejection fraction, and no correlation with albumin, calcium, phosphorus, and PTH. The logistic regression analysis revealed that T-PAFT was a significant predictor of CVC. In this study, T-PAFT showed a positive correlation with inflammation, CVC, and MIAC score in HD patients. T-PAFT was a significant predictor of CVC.