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ABSTRACT: We discuss MRI findings in patients with thoracic outlet syndrome (TOS). A total of 100 neurovascular bundles were evaluated in the interscalene triangle (IS), costoclavicular (CC), and retropectoralis minor (RPM) spaces. To exclude neurogenic abnormality, MRIs of the cervical spine and brachial plexus (BPL) were obtained in neutral. To exclude compression on neurovascular bundles, sagittal T1W images were obtained vertical to the longitudinal axis of BPL from spinal cord to the medial part of the humerus, in abduction and neutral. To exclude vascular TOS, MR angiography (MRA) and venography (MRV) of the subclavian artery (SA) and vein (SV) in abduction were obtained. If there is compression on the vessels, MRA and MRV of the subclavian vessels were repeated in neutral. Seventy-one neurovascular bundles were found to be abnormal: 16 arterial-venous-neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial-venous, 3 arterial-neurogenic, and 8 venous-neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the CC, mostly secondary to position, and very rarely compressed in the RPM. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory.
Skeletal Radiology 07/2012; 41(11):1365-74. · 1.54 Impact Factor
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ABSTRACT: Although migraine has mainly been considered as a benign disease, there is cumulative evidence of silent changes in the brain, brainstem, or cerebellum and subtle subclinical cerebellar dysfunction. In this study, in order to investigate a possible neuronal and/or glial damage at the cellular level in migraine, we measured and compared serum levels of S100B which is a protein marker of glial damage or activation, and neuron specific enolase (NSE) which is a marker of neuronal damage, in migraine patients and control subjects. Serum levels of S100B and NSE were measured in blood samples from 41 patients with migraine-without aura taken during a migraine attack (ictal) and in the attack-free period between migraine attacks (interictal) and 35 age- and sex-matched controls. Patients with migraine-without aura had significantly higher ictal serum levels of S100B and NSE (P < 0.05, for both) than control subjects; whereas in the interictal phase, there was a significant increment only in S100B levels (P < 0.05) compared to controls. On the other hand, serum levels of S100B and NSE in ictal and interictal blood samples did not differ significantly. The findings of increased ictal serum S100B and NSE levels together with increased interictal levels of S100B suggested that migraine might be associated with glial and/or neuronal damage in the brain and a prolonged disruption of blood-brain barrier. Increased interictal serum levels of S100B might point out to an insidious and slow damaging process in migraine patients.
Cellular and Molecular Neurobiology 02/2011; 31(4):579-85. · 1.97 Impact Factor
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ABSTRACT: The purpose of this study was to determine the anatomic relation of the neural structures posteriorly crossing the ankle by use of classical ankle arthroscopy posterior portals and hindfoot endoscopy portals. The effect of ankle and hindfoot motions on portal-nerve distance was also determined.
This study included 20 feet and ankles in 20 adult volunteers who had no complaints regarding their ankle joints. To obtain 6 fixed positions of the ankle and hindfoot (neutral-neutral, neutral-varus, neutral-valgus, dorsiflexion-neutral, dorsiflexion-varus, and dorsiflexion-valgus) during magnetic resonance imaging examination, feet were positioned in a polycaprolactone splint that was shaped before examination. Magnetic resonance imaging examinations were performed at all 6 positions, and the shortest distance between the sural and posterior tibial nerves to the portals was measured at 2 different levels.
The mean distance between the posterior tibial nerve and the posteromedial portal was 16.5 +/- 5.6 mm and that between the sural nerve and the posterolateral portal was 13.1 +/- 3 mm at the hindfoot portal level. At the level of the posterior ankle arthroscopy portal, the mean distance from the posterior tibial nerve to the posteromedial portal line was 13.3 +/- 4.6 mm and that from the sural nerve to the posterolateral portal line was 9.7 +/- 2.9 mm. The differences in distances were statistically significant (P < .001) according to the paired t test. We determined that the sural nerve approached the posterolateral portal in the dorsiflexion-varus (P = .026), dorsiflexion-valgus (P = .014), dorsiflexion-neutral (P < .001), and neutral-varus (P = .035) positions, and all differences were statistically significant.
We found that the posterior medial and lateral portals created at the level of the tip of the fibula as described by van Dijk et al. while the foot was in a neutral-neutral position provided the greatest margin of safety. We found no advantage of placing the ankle and hindfoot in different positions to avoid neurologic complications.
These findings suggest that neurovascular structures draw away from the posterior portals of ankle arthroscopy distally; by lowering the level of portals toward the tip of the fibula and positioning the foot at neutral, arthroscopic surgeons will decrease the risk of iatrogenic lesions.
Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2009; 25(12):1442-6. · 3.02 Impact Factor
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ABSTRACT: Labyrinthitis ossificans is fibrosis or ossification of the membranous labyrinth. Tympanogenic, meningogenic, and hematogenous etiologies are more common than trauma in the development of labyrinthitis ossificans. We present a case complaining of right-sided hearing loss and symptoms of otitis media and positional vertigo resulting from perilymphatic fistulization. Imaging revealed labyrinthitis ossificans secondary to temporal bone fracture crossing through the otic capsule.
Diagnostic and interventional radiology (Ankara, Turkey) 10/2009; 15(4):239-41. · 1.10 Impact Factor
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ABSTRACT: This study aims to determine the frequency of maxillary sinusitis in the patients with traumatic head injury and nostrils free of any foreign body. In addition, the sensitivity and specificity of ultrasonography (US) for the detection of the presence of fluid in maxillary sinuses were evaluated.
Forty patients with severe traumatic head injury were included in the study. The patients who had displaced maxillary sinus fracture at the medial wall and naso-tracheal and/or naso-gastric tube were excluded. Paranasal computed tomography (CT) was performed along with the routine cranial CT scanning or in case of unknown source of infection and compared with the results of ultrasonographic examination of maxillary sinuses performed by a single radiologist who was unaware of the CT results. In the patients, who had clinical and radiological signs of sinusitis, a trans-nasal puncture was performed using sinoject (SinoJect, ATOS Medical, Sweden), a spring-activated puncture instrument, to take a sample for microbiologic examination and to drain maxillary sinuses.
Eighty-five percent of the patients were tracheotomised on the fifth day (on average) of their intensive care unit (ICU) stay. The frequency of sinusitis in the study group was found to be 32.5% (13 patients). The most frequently isolated species were Pseudomonas spp. (37.5%), Escherichia coli (20.8%) and Peptostreptococcus (16.7%). Five of the aspirates were polymicrobial. The sensitivity, specificity, positive predictive value and negative predictive value of B-mode US, compared with CT for the detection of fluid presence in maxillary sinuses in a 100 maxillary sinus examinations, were 92.2%, 81.6%, 83.9% and 90.9%, respectively.
Maxillary sinusitis should be considered as a source of infection or sepsis in patients with traumatic head injury because of its high frequency. US is likely to be used as the first-line diagnostic tool for the determination of fluid in maxillary sinuses, especially in patients who do not require CT or cannot be transported to a radiology unit for CT.
Injury 10/2009; 42(1):33-7. · 1.98 Impact Factor
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ABSTRACT: To analyze the anatomical basis of the scapula, acromion, os acromiale, coracoid process, coraco-acromial arch, and glenoid cavity in Turkish adults.
We performed the study at the Faculty of Medicine, Akdeniz University, Turkey between January 2004 and December 2005. A total of 90 dry bones of the scapula from human cadavers were randomly selected. The length, width, and anterior thickness of the acromion and the acromial facet of the acromioclavicular joint were measured with an electronic caliber and was examined visually. For the radiological evaluation, the posterior anterior and the lateral shoulder radiographs of 90 consecutive adult patients with normal findings were used. These films were evaluated and grouped according to the acromial arch morphology.
The distribution of the acromial morphologic types according to slope was type I (flat) 10%, type II (curved) 73%, type III (hooked) 17%. Type I was seen in 11%, type II 66%, type III 23% of the specimens. The morphological shape of the tip of the acromion was 31% cobra shaped, 13% square shaped, and 56% intermediate type. The scapulas, coracoid process and the coraco acromial arch were measured. In 72% of the specimen, the glenoid notch of the scapulas were absent and oval shaped, whereas in 28% the notch was well expressed and the glenoid cavity was pear shaped. The mean vertical length of the glenoid cavity was 36.3 +/- 3 mm, and the mean transverse length was 24.6 +/- 2.5 mm. Os acromiale is a rare anatomical condition. Its incidence has been documented in radiographic and anatomical studies to be between 1-15%. The presence of os acromiale was 1% in shoulder radiographs (os pre-acromiale), and in dry bones (os meta-acromiale)
We reported the exact morphological measurements of the bone structures of the scapula in Turkish adult population. Our results present an instructive figures of anatomical preparations and radiological cases that can be used to make a more precise radiological and a differential diagnoses.
Saudi medical journal 10/2006; 27(9):1320-5. · 0.52 Impact Factor
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ABSTRACT: Behçet's disease (BD) is a multisystemic, recurrent, inflammatory disorder of unknown aetiology. Neurological involvement is characterised either by primary parenchymal lesions or secondary to major vascular involvement. Seizures are rarely seen in BD and their occurrence can be related to seizure provoking factors or exacerbation of the disease. We experienced a case of neuro-BD presenting with subacutely developing mental and behavioral changes, followed by left dominant tetraparesis with bilateral pyramidal signs, fever and left hand focal motor seizures with elementery clonic motor signs which later evolved into right hand epilepsia partialis continua (EPC) of Kojevnikov. The seizures were very resistant to antiepileptic drugs and 8 months after neurological involvement the patient died. The EPC evolving after neurological involvement is associated with high mortality rate.
Clinical Neurology and Neurosurgery 07/2006; 108(4):392-5. · 1.58 Impact Factor
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American Journal of Neuroradiology 09/2005; 26(7):1882; author reply 1882. · 2.93 Impact Factor
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ABSTRACT: To determine the effects of hormone replacement therapy (HRT) on ocular blood flow.
In a prospective controlled study, 40 healthy women who presented to the menopause clinic between December 2000 and December 2001 were randomly assigned into the study. The HRT-receiving group was administered estradiol 17-valerate 2 mg the first 11 days, and estradiol 17-valerate 2 mg plus ciproterone acetate 1 mg the next 10 days of the monthly cycle for 6 months. The control group did not receive any HRT for 6 months. The ocular colour Doppler analysis were performed at baseline and after 3 and 6 months. The ocular Doppler analysis was performed in the first half of the cycle in the HRT-receiving group.
Central retinal artery and ophthalmic artery basal Doppler index (peak systolic velocity, end-diastolic velocity, resistive index and pulsatility index) values of the two groups at the beginning of the study did not show any statistically significant difference. Both the right and the left central retinal artery pulsatility index (PI) values of the study group, who received HRT at the end of the third and sixth months, showed a statistically significant decline (paired-samples test, P < 0.05), while the decrease in the resistive indexes was not significant.
These results suggest that 6 months of combined hormone replacement therapy with estradiol 17-valerate 2 mg plus ciproterone acetate 1 mg improves ocular vascular Doppler indices which may be a reflection of cerebral vascular status.
Maturitas 04/2005; 50(4):282-8. · 2.77 Impact Factor
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ABSTRACT: To compare the effectivity of low (0.35 T) and high (1.5 T) field magnetic resonance imaging units in detecting meniscal tears.
Forty-eight knee MR imaging examinations performed in low field MR unit and 76 examinations performed in high field unit were retrospectively evaluated. MR results were compared with arthroscopy findings in all patients.
For medial meniscus tears, sensitivity, specificity and accuracy values were 93.7%, 87.5% and 91.6%, respectively in the low field unit. For lateral meniscus tears, these values were 87.5%, 95.0% and 93.7%, respectively. In the high field unit (1.5 T), sensitivity, specificity and accuracy for the detection of medial meniscus tears were 96.6%, 88.2% and 94.7%, respectively. For lateral meniscus tears, these values were 71.4%, 98.5% and 96.0%, respectively. There was no statistically significant difference between high and low field units in the detection of medial and lateral meniscus tears.
We think that low field MR units are as effective as high field units in the evaluation of meniscus tears.
Tanısal ve girişimsel radyoloji: Tıbbi Görüntüleme ve Girişimsel Radyoloji Derneği yayın organı 01/2005; 10(4):316-9.
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ABSTRACT: Our objective was to describe MR imaging findings of liver lesions in human fascioliasis. The MR imaging of the liver was performed in 29 patients with fascioliasis. Seventeen patients were women and 12 were men, with a mean age of 47.5 years (age range 17-75 years). Hepatic lesions were grouped into five types based on their signal characteristics. Three patients had normal imaging findings. One or more lesions were observed in the other 26 patients. The lesion types and the frequency of appearances were as follows: hyperintensity of the liver capsule on T2-weighted images (n=16, 55.2%); ill-defined slightly hyperintense areas on T2-weighted images (n=18, 62.1%); lesions which were hypointense on T1-weighted and hyperintense on T2-weighted images (n=10, 34.5%); hypointense on T1-weighted images and centrally hypo- or hyperintense, surrounded by peripherally less hyperintense area on T2-weighted images (n=4, 13.8%); and hypointense foci or ill-defined hypointense areas on T1- and T2-weighted images (n=10, 34.5%). We describe the MR imaging features of the disease. Our findings may help the differential diagnosis in which fascioliasis should be added to the list.
European Radiology 02/2003; 13(1):141-8. · 3.22 Impact Factor
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ABSTRACT: To evaluate orbital blood flow velocities with Doppler sonography in patients with acute unilateral optic neuritis.
Orbital Doppler sonography was performed in 20 patients with acute unilateral optic neuritis. Optic neuritis was diagnosed by a neurologist on the basis of clinical presentation, presence of decreased visual acuity, and assessment of visual evoked potentials. The peak systolic and end diastolic velocities and the resistive index were measured in the ophthalmic and central retinal arteries of both orbits. The values obtained from affected and unaffected orbits were compared by using the paired t test.
The peak systolic and end diastolic velocities in the ophthalmic artery were significantly increased in the affected orbits (for peak systolic velocity P <.001, for end diastolic velocity P <.05). Resistive indexes in the ophthalmic arteries did not differ (P >.05). The difference between the peak systolic and end diastolic velocities and resistive indexes in the central retinal arteries of affected and normal eyes was not statistically significant (P >.05).
Peak systolic and end diastolic velocities in the ophthalmic artery are increased in patients with acute optic neuritis.
Radiology 02/2003; 226(2):355-8. · 5.73 Impact Factor
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ABSTRACT: Aneurysmal bone cysts of the skull are rare, and orbital involvement of these cysts is even less frequent. We present CT, MR imaging, and histopathologic findings of an aneurysmal bone cyst of the orbit in a 13-year-old female adolescent. The tumor mainly involved the frontal bone. MR imaging findings of the aneurysmal bone cyst of the skull were highly suggestive of the diagnosis.
American Journal of Neuroradiology 03/2002; 23(2):319-21. · 2.93 Impact Factor
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ABSTRACT: To evaluate the efficacy of ultrasound (US) guided percutaneous sclerotherapy in the pediatric population, 14 hydatid liver
cysts (HLC) in eight male patients whose ages ranged between 6 and 16 years (mean 9.9 years) were treated. The maximum diameter
was 110 mm. Albendazole was administered orally to all patients for 1 week before percutaneous treatment and for 3–6 months
after the procedure to prevent dissemination of the disease. Cyst puncture was performed with 20 G Chiba needles using US
guidance. More than one-half of the estimated cyst volume was aspirated, then 20% hypertonic saline (7 cysts) or sterile 96%
alcohol (7 cysts) equivalent to one-third of the estimated cyst volume was injected into the cavity and left for 5–15 min.
Finally, all the fluid in the cavity was reaspirated. Catheterization was not performed. Follow-up US examinations were performed
every month during the first 6 months and every 3 months thereafter. The follow-up period ranged between 6 and 51 months (mean
15 months). No major complications were seen during or after the procedures. Two cysts in two patients completely disappeared.
Volumes of the 11 cysts in five patients who were followed for 6–21 months were markedly reduced (22%–64% of the initial volume)
and thick septations and solid debris-like structures were seen within the cyst cavities. There was no significant change
in 1 cyst. US-guided percutaneous sclerotherapy is thus a safe and effective treatment of HLC in children.
Pediatric Surgery International 01/2000; 16(5):346-350. · 1.25 Impact Factor
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ABSTRACT: We present a case with sclerosis of a single rib. The patient had trauma to her back long time ago. On radiographs and computed tomography, old compression fracture of the thoracic vertebra contiguous to sclerotic rib and costovertebral joint ankylosis were found. We suggest that ankylosis of the costovertebral joint at the level of compression fracture was the cause of rib sclerosis.
European Journal of Radiology Extra.
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ABSTRACT: The case of a 66-year-old man with extraskeletal osteosarcoma (ESOS) arising in the pretibial subcutaneous tissue is presented. On radiographs, there were no calcifications or ossifications within the soft-tissue mass. Magnetic resonance imaging (MRI) showed the tumor to be in the subcutaneous tissue anteriorly to the patellar tendon without attachment to the bone. Histologic examination revealed a cystic hemorrhagic cavity containing necrotic and viable tumor and a large solid component. A diagnosis of chondroblastic type extraskeletal osteosarcoma was made.
European Journal of Radiology Extra.
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ABSTRACT: We present imaging findings of a 45-year-old-male patient referred for increasing left hemiparesis during the last few days. CT and CT perfusion (CTP) revealed a mass lesion with reduced regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) with prolonged mean transit time (MTT), suggesting either irreversible infarction or a low grade tumor. MRI revealed a well defined cortically based homogenous nonenhancing tumoral mass. Surgical excision was performed and histology showed extraventricular neurocytoma (EVN), a low grade tumor composed of synaptophysin positive and glial fibrillary acidic protein (GFAP) negative neuron cells.
European Journal of Radiology Extra 69(2).
