[Show abstract][Hide abstract] ABSTRACT: Superior cerebellar artery (SCA) aneurysms are uncommon vascular lesions, thus data about their presentation and clinical management are limited. Our aim was to determine clinical presentation, angiographic findings and mid and long-term clinical and imaging results of endovascular treatment of 49 patients with SCA aneurysm.
Forty-nine patients with SCA aneurysms underwent endovascular treatment (25 female, 24 male; mean age 46.7 years; range, 21-79 years) in our institution. Both aneurysms arising at the origin of SCA and peripheral SCA aneurysms were included to our retrospective study. 73.5% of the patients were presented with subarachnoid hemorrhage. Forty-two of 49 (85.7%) aneurysms were located in the origin of SCA. Mean aneurysm size was 6.5 mm (range 2-16 mm).
Forty-seven (95.9%) of the aneurysms were coiled with detachable coils. In two peripheral aneurysms, liquid embolic agent was used. Overall control angiographic occlusion rates were as follows: 87.5% (34/40) total occlusion and 12.5% (6/40) dog-ear remnant. All peripheral SCA aneurysms were occluded with the parent artery. Procedure related mortality was seen in one patient (2%) due to the rupture of another aneurysm. There was no procedure related permanent morbidity.
Endovascular treatment is an effective and safe option in both peripheral and proximal SCA aneurysms.
Full-text · Article · Aug 2015 · Turkish neurosurgery
[Show abstract][Hide abstract] ABSTRACT: Lumbar disc herniation is characterized with low back and leg pain resulting from the degenerated lumbar disc compressing the spinal nerve root. The etiology of degenerative spine is related to age, smoking, microtrauma, obesity, disorders of familial collagen structure, occupational and sports-related physical activity. However, disc herniations induced by congenital lumbar vertebral anomalies are rarely seen. Vertebral fusion defect is one of the causes of congenital anomalies. The pathogenesis of embryological corpus vertebral fusion anomaly is not fully known. In this paper, a 30-year-old patient who had the complaints of low back and right leg pain after falling from a height is presented. She had right L5-S1 disc herniation that had developed on the basis of S1 vertebra corpus fusion anomaly in Lumbar computed tomography. This case has been discussed in the light of literature based on evaluations of Lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This case is unique in that it is the first case with development of lumbar disc herniation associated with S1 vertebral corpus fusion anomaly. Congenital malformations with unusual clinical presentation after trauma should be evaluated through advanced radiological imaging techniques.
[Show abstract][Hide abstract] ABSTRACT: We present a case of an arch anomaly in a 54-year-old female who was admitted to our hospital for magnetic resonance angiography (MRA) to evaluate her right-sided numbness. MRA revealed a truncus bicaroticus, right common carotid artery (CCA) originating right vertebral artery, right subclavian artery arising as the final branch of the descending aortic arch and arch originating left vertebral artery. The possible embryologic mechanism and clinical importance of this previously unreported variant are reviewed.
Preview · Article · Apr 2014 · JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)
[Show abstract][Hide abstract] ABSTRACT: Internal carotid artery dissection may occur spontaneously or following a blunt or penetrating trauma to the head and/or neck. Bilateral dissections and pseudoaneurysm formations are extremely rare and usually detected simultaneously. In this report, we present a trauma case with bilateral dissecting pseudoaneurysms of the carotid arteries; in whom, the one side was initially occult and then developed during the follow-up of the contralateral side.
[Show abstract][Hide abstract] ABSTRACT: An aortopulmonary window (APW) is a communication between the main pulmonary artery and the ascending aorta in the presence of two separate semilunar valves. APW is the rarest of the four types of septal defects. We report a case in which APW with ventricular septal defect (VSD), otherwise we define the "molar tooth sign" that is very indicative for APW at torax CT and MRI.
No preview · Article · Apr 2013 · Anatolian Journal of Clinical Investigation
[Show abstract][Hide abstract] ABSTRACT: Intracranial atherosclerotic disease is a major cause of isch- emic stroke. Stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAM- MPRIS) was terminated prematurely due to a high stroke and death rate in patients randomized for intracranial stent place- ment. However, for some patients, angioplasty and/or stent placement remains the best approach. Flow diverters (FDs) are designed to produce a hemodynamic flow diversion by constituting a laminar flow pattern in the parent artery and are mainly used in non-ruptured complex wide-neck aneu- rysms as well as in ruptured aneurysms. Herein, we present a case where an FD was used in a complicated angioplasty for basilar artery atherosclerosis. A 72-year-old female patient was admitted to our hospital with left side weakness and ver- tigo. Her diffusion magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed right-sided pontine and left-sided occipital acute infarcts with left-sided pontine and right-sided occipital chronic infarcted areas and preocclusive mid-basilar stenosis. The patient was under su- pervised medical treatment. Despite chronic brain stem and occipital infarcts her modified Rankin Scale (mRS) was 2. Di- agnostic angiography showed no posterior communicating arteries and no pial-pial collaterals and a critical mid-basilar artery stenosis. We decided to perform intracranial angioplas- ty to increase the perfusion of posterior circulation and re- duce the risk of additional embolic infarcts. Angioplasty was complicated with dissection and vessel perforation. We used an FD for rescue therapy to avoid rebleeding. The patient was discharged with good clinical and angiographic results.
Full-text · Article · Feb 2013 · Diagnostic and interventional radiology (Ankara, Turkey)
[Show abstract][Hide abstract] ABSTRACT: Bilateral globus pallidus and supratentorial white matter injury are common findings in the acute and chronic setting of carbon monoxide (CO) poisoning. However, isolated cerebellar lesions are extremely rare. In this case report, we shared our findings in siblings with cerebellar injury with different imaging patterns in the acute setting of CO poisoning.
No preview · Article · Feb 2013 · Emergency Radiology
[Show abstract][Hide abstract] ABSTRACT: Subclavian steal occurs when there is retrograde blood flow in the vertebral arteries and is associated with proximal ipsilateral subclavian artery stenosis or occlusion. However, in subclavian steal syndrome, retrograde blood flow from the vertebrobasilar artery supplies the arm instead and results in vertebrobasilar insufficiency. As the vertebrobasilar arterial system supplies the auditory and vestibular systems, it is possible that focal neurological deficits occur in this syndrome. In this case study, we describe a patient diagnosed with subclavian steal syndrome that presented with isolated vertigo. For patients that present with vertigo and are otherwise asymptomatic, it is imperative that the differential diagnosis includes subclavian steal syndrome.
[Show abstract][Hide abstract] ABSTRACT: Objective:
The purpose of this study is to determine the effectiveness of the diffusion-weighted magnetic resonance imaging (DWI) of the differentiation of benign and malignant testicular masses.
Fifteen male patients who admitted to our clinic with the diagnosis of testicular mass detected by ultrasound were enrolled to this study. The patients were between 20 and 61 years old (mean 25.7). Apparent diffusion coefficient (ADC) values were measured from ADC maps of lesion and normal testicular tissue. In addition, mean signal intensity (SI) measurements were obtained by using b: 1,000 of normal testicular tissue and lesion with three regions of interest (ROI). SI ratio values are obtained by dividing the value lesion SI to the normal testicular parenchyma SI. Histopathology of orchiectomy materials and ADC values and lesion SI rates were compared statistically.
There were no significant correlation (p = 0.97) between ADC values of benign and malign lesions and histopathological diagnosis in Student's t test. There were statistically significant relationship with the histopathology of the lesion and the SI ratio in Student's t test (p = 0.027).
DWI is an effective method in differentiation of benign and malignant testicular masses. Important information can be obtained about nature of testis masses with quantitative measurements of the ADC and ratio of SI.
No preview · Article · Sep 2012 · Wiener klinische Wochenschrift
[Show abstract][Hide abstract] ABSTRACT: An unusual case of late self-extraction of an impacted left maxillary third molar that was displaced into the left maxillary sinus after a traffic accident is described. The patient had been operated on for a maxillofacial trauma after a traffic accident in a plastic and reconstructive surgery department 18 years ago. He was admitted to our clinic 1½ years ago for obstruction and periodically purulent drainage from the left side of the nose. A displaced tooth in the middle meatus was diagnosed, and the patient refused a surgical procedure to remove the tooth. The tooth was self-extracted from the nasal cavity 1 year later. One week after the extraction, the patient was mostly healed and had no complaints.
No preview · Article · Jul 2012 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Endovascular treatment of intracranial aneurysms has been an effective treatment option. In this paper, we report our experience with the Silk stent (SS) for endovascular treatment of complex intracranial aneurysms and present periprocedural events, immediate results, delayed complications, and imaging and clinical follow-up results.
We retrospectively examined angiographic images and clinical reports of 76 consecutive patients with 87 intracranial aneurysms who were treated with SSs between March 2008 and June 2011.
All aneurysms could be successfully covered technically using implanted SSs, with an overall mortality of 6.6 %. Two transient morbidities (2.6 %) and three permanent morbidities due to embolic events (3.9 %) were observed. Unexpected procedural technical events occurred in 18 procedures (18/78, 23.1 %). Control angiographies were performed in all 71 patients with 82 aneurysms (100 %). Mean angiographic follow-up time was 17.5 ± 11.1 months [range 2-48 months]. Sixteen of the 71 patients with 19 aneurysms had only early angiographic controls in the first 6 months while remaining 55 patients with 63 aneurysms (77.5 %) had late controls after 6 months. Overall control angiographic occlusion rates were as follows: 87.8 % (72/82) total occlusion, 8.5 % residual aneurysm filling, and 3.7 % residual neck filling. The general in-stent stenosis rate in controls was 5.6 % and the stented parent artery occlusion rate was 4.2 %. Five (6.6 %) aneurysms ruptured after stent implantation in our series.
The Silk stent is an effective tool for the treatment of challenging aneurysms, which have previously demonstrated higher re-growth rates and technical problems, despite unexpected higher hemorrhage rates after treatment and deployment difficulties.
[Show abstract][Hide abstract] ABSTRACT: Moyamoya disease is a cerebrovascular disease which is characterized with stenosis and occlusions at the distal part of internal carotid artery and at the proximal part of anterior and middle cerebral arteries. It rarely causes temporary or recurrent hemiparesis due to intracranial hemorrhage while symptoms like headache, convulsion, nystagmus, aphasia and ataxia may also occur. In this paper, we present a case of Moyamoya disease which was diagnosed with a 23 year old female patient who was admitted to our emergency department with headache, nausea and vomiting complaints and whose radiological findings showed occipital lobe hemorrhage.
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI).
Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm(2)b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed.
The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively.
We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules.
[Show abstract][Hide abstract] ABSTRACT: 50 year old male patient who was suffering from cooperation disorder and bilaterally blindness was admitted to our emergency service. He was addicted to alcohol and had excessive alcohol consumption the day before. Cranial nonenhanced CT was normal. T2 weighed MR imaging performed at 1,5 T unit showed high signal intensity in bilateral putaminal foci.In this localization diffusion-weighed images(DWI) were hyperintense due to restricted diffusion and low ADC values. After two weeks, drowsiness and confusion were appeared suddenly. Cranial nonenhanced CT was showed extensive subcortical white matter and basal ganglia abnormalities consistent with edema and hemorrhagic changes. The patient was transferred to intensive care unit and died after one day. In methanol intoxication, cerebral and intraventricular hemorrhage, cerebellar necrosis, diffuse cerebral edema, bilateral subcortical white matter necrosis and edema were defined It should also be known that 2 or 3 weeks after ingestion of methyl alcohol, the deterioration of the patient's general situation is responsible for cerebral subcortical hemorrhage. We have also thought that patients' mortality and morbidity can be reduced with radiological imaging due to early diagnosis.
No preview · Article · Jan 2012 · European Journal of General Medicine
[Show abstract][Hide abstract] ABSTRACT: Anterior cervical fusion procedures are among the most commonly performed spinal operations. Investigators have reported pseudoarthrosis rates ranging from 3 to 36% following anterior cervical fusion operations. The diagnosis of pseudoarthrosis has been based on the triad of pain, radiographic evidence of instability, and loss of correction or fixation. Scintigraphic imaging may be involved in pseudoarthrosis investigation by increase of nuclear agent uptake at the operated level but today it is not used in clinical practice as a routine imaging modality. MATERIAL and
Nine cases operated for degenerative disc disease on single level but suffering postoperative prolonged neck pain were involved in the study. All cases underwent 99mTc-hydroxymethylene diphosphonate (HMDP) bone SPECT later than postoperative twelfth month.
Results showed a correlation between severity of neck pain and fusion status.
Increased and prolonged uptake of nuclear agent should cause a suspicion on so-called fusion, proven by radiology.
No preview · Article · Oct 2011 · Turkish neurosurgery
[Show abstract][Hide abstract] ABSTRACT: Our purpose was to determine whether diffusion-weighted MR imaging (DWI) could be used in differentiation of benign and malign breast lesions.
41 women patients were included in the study. 45 lesions were diagnosed by biopsy; 25 (55.5%) of these lesions were malignant and 20 (44.5%) were benign. The apparent diffusion coefficient (ADC) values of these lesions were prospectively compared with their histopathological results.
Differentiation of the malignant and benign masses revealed that the threshold value of the ADC was 1.0 x 10(-3) mm(2)/s, its sensitivity was demonstrated as 95%, specificity as 100%, positive predictive as 100%, negative predictive as 94% and accuracy rate as 97%.
DWI improves diagnostic accuracy of the conventional breast MRI. ADC measurements may be useful for differentiation of the malign and benign masses.
No preview · Article · Sep 2011 · Wiener klinische Wochenschrift
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to determine the different vascularization patterns of the posterior interventricular sulcus (PIS) with coronary CT angiography.
Three hundred and fifty-six coronary CT angiograms (CCTA) were retrospectively analyzed in 248 men and 108 women (mean age, 54.9 years ± 13.6 [standard deviation]). The PIS was divided into three segments from the crux cordis to the notch of the cardiac apex according to the American Heart Association classification (basal, mid ventricular and apical), and the artery or arteries supplying each segment were recorded. The relative frequency of the different vascularization patterns was calculated and the distribution of dominance types was recorded.
Blood was supplied to the PIS by one or more branches of the right coronary artery (RCA), the left circumflex artery (LCX), or the left anterior descending artery (LAD). We observed 25 different irrigation patterns. In the most frequent pattern (31.3%), the basal and mid-ventricular segments were perfused by a single arterial branch originating from the RCA at the crux, and the apical segment was perfused by the LAD traveling beyond the notch of the cardiac apex and entering the posterior interventricular sulcus. Of the 356 cases, the circulation was right dominant in 310 (87.1%), left dominant in 34 (9.5%), and balanced in 12 (3.4%) cases. Individual segments were perfused by a single artery in 288 (80.9%) cases, and by more than one in the remainder.
CCTA allows detailed assessment of the arterial supply of the PIS, and allowed to describe 25 subtypes. This information is of potential value to both cardiac surgeons and interventional cardiologists who plan bypass surgery or angioplasty aiming at the posterior interventricular artery.
No preview · Article · Jan 2011 · Anatomia Clinica