Comparison of the biochemical and radiological criteria for lumbar disc degeneration

Background The relationship between radiological degeneration criteria on lumbar magnetic resonance imaging (MRI) and both the keratan sulfate (KS) and chondroitin sulfate (ChS) levels was examined in disc material taken from patients undergoing lumbar disc herniation (LDH) surgery. To examine whether the biochemical and radiological degeneration criteria testing the reliability of radiological degeneration findings agreed and to evaluate the contribution of the KS/ChS ratio to disc form (protruding or extruding). Methods This was a prospective experimental cohort study. Using enzyme-linked immunosorbent assay, KS and ChS levels were measured in the degenerate nucleus pulposus taken from 71 patients with a diagnosis of LDH who underwent surgery. The degeneration levels and disc form (protruding or extruding) were determined according to the Pfirrmann five-stage grading system on preoperative T2-weighted lumbar MRIs. According to the Pfirrmann system, 28 patients were grade III and 43 were grade IV. The relationship between radiological criteria and the KS/ChS ratio was statistically evaluated. Results The KS levels (p=0.046) and the KS/ChS ratio (p=0.001) were significantly higher in grade IV patients than in grade III patients. However, there was no difference between the KS and ChS levels and the KS/ChS ratio when patients were classified as protruding or extruding according to their disc structure. Disc structure and biochemical degeneration indicators were not correlated. Conclusions The KS level and the KS/ChS ratio were high in patients with marked radiological degeneration on lumbar MRI, demonstrating the sensitivity and reliability of the Pfirrmann five-stage grading system for showing radiological degeneration

Hemodiyaliz vasküler erişim yolu komplikasyonlarında tanısal ve girişimsel radyoloji

ÖZET Hemodiyaliz tedavisinin ana unsurlarından biri hastanın vasküler sistemine giri şimi sağlayan vasküler erişim yollandır (Vasküler akses). Cerrahi olarak oluştu rulan endojen arteriovenöz fîstüller, arteriovenöz greftler ve santral venöz kateterler, diyaliz işlemi için vasküler erişim yolu görevini görmektedirler. Zaten kronik böbrek yetmezliği nedeniyle, sistemik bir hastalıkla mücadele etmek zo runda olan bu hasta grubunun sorunlarına, diyaliz için gerekli olan vasküler akses komplikasyonlarıda eklenmektedir. Vasküler aksesleri, bu hastalar için hayatla bağlantıları olduğundan, komplikasyonlannda acil tam ve tedavi oldukça bbüyük öneme sahiptir. Radyoloji, bu hastaların yönetiminde hem tanısal (RDUS ve anjiografîk incele meler ile), hemde terapötik (stenoz ve tromboz gibi komplikasy onların perkütan girişimlerle tedavisiyle) öneme sahiptir. Girişimsel radyolojik prosedürlerin gelişimi, cerrahi tedavilere alternatif oluştur muştur. Günümüzde ise, vasküler akses komplikasyonlarmdaki en popüler terapötik yaklaşım haline gelmiştir. Bu çalışmada, hemodiyaliz vasküler akseslerinin komplikasyonlannda tanısal a- şamada RDUS ve anjiografinin, terapötik aşamada da girişimsel radyolojik iş lemlerin etkinliği araştınhnıştır. Akses kayıplarının ensık nedeninin trombozlar, akses disfonksiyonlaıın ise sıklıkla stenotik lezyonlara sekonder olduğu bulgu- lanmıştır. RDUS ile incelenen olgulann, anjiografi ile karşılaştınlmasmda RDUS' un özellikle trombotik ve arteriyel sisteme ait patolojilerde yüksek sensitiviteye sahip olduğu sonucuna vanlmıştır. Nativ fistüllerde, drenaj venlerinin anastomoza yakın alanlarında lokalize stenozlarda ve anastomotik yerleşimli stenotik lezyonlarda, RDUS' un sensitivitesi azalmaktadır. Nativ fistül, greftler ve santral venlerin incelenmesinde, fistülografi ve venografîk yöntemler hem tam koyduru- cu hem de tedavi planlanmı sağlayan işlemlerdir. Girişimsel radyolojik perkütan tedavi yöntemleri, özellikle stenotik ve trombotik komplikasyonlarda ilk denen mesi gereken, güvenli yöntemlerdir. 7

Cervical blood flow velocity values in patients with unilateral intracranial aneurysm: Preliminary results

Aim: Brain aneurysm is a balloon shaped dilatation of brain vessels as a result of attenuation of the vessel walls. The aim of this study was to evaluate the relationship between blood flow velocities in the right and left arterial vessels in an unruptured aneurysm and healthy group, and to investigate whether this analysis can help early diagnosis of aneurysm.Methods: Four aneurysm patients (four female, mean age 57.25 ± 0.75 years) and four healthy subjects (two female, 2 male male, mean age 36.35 ± 6.19 years) were included in the study. Blood flow velocity values ​​of right and left internal carotid arteries, vertebral artery and right and left internal jugular veins were obtained during a cardiac cycle with phase contrast technique. Spearman's correlation analysis was applied to flow velocity values. Statistically significant blood flow similarities between right and left brain were investigated.Results: In the aneurysm group, there was a significant difference between right and left cervical arterial blood flow velocity values (p=0.001). Spearman correlation coefficient values between right and left arterial blood flow velocity values and right and left side arteriovenous blood flow velocity values were lower in the aneurysm group compared to the control group however, there was no statistical significance (p≥0.05 for all). Conclusion:  The difference between the right and left arterial blood flow velocities obtained in the aneurysm group and the low correlation values may be useful in early diagnosis of aneurysm

Serebral süperfisyal siderozis: MRG bulguları

Superficial siderosis of the central nervous system is a rare condition characterized by deposition of hemosiderin in the leptomeninges, subpial tissue and spinal cord. Magnetic resonance imaging provides prompt diagnosis of this entity. Three cases of cerebral superficial siderosis are presented in this study. On T2-weighted images, typical hypointense rims were observed under the brain surface. In one patient, there was also spinal superficial siderosis findings.Superficial siderosis of the central nervous system is a rare condition characterized by deposition of hemosiderin in the leptomeninges, subpial tissue and spinal cord. Magnetic resonance imaging provides prompt diagnosis of this entity. Three cases of cerebral superficial siderosis are presented in this study. On T2-weighted images, typical hypointense rims were observed under the brain surface. In one patient, there was also spinal superficial siderosis findings

İntrakranial kistik lezyonlarda difüzyon-ağırlıklı MR görüntüleme

The purpose of the study was to evaluate the signal intensities of cystic or necrotic intracranial lesions on diffusion-weighted MRI (DWI) and to investigate the contribution of apparent diffusion coefficient (ADC) values in differential diagnosis. In the study group, there were 24 consecutive patients with intracranial cystic lesions; seven pyogenic abscesses, six epidermoid cysts, four arachnoid cysts, five cystic glioblastomas, and two hydatid cysts. In the MR examinations, conventional spin echo sequences and diffusion-weighted MRI were performed. On DWI imaging, multislice axial plane, single shot, echo-planar spin echo sequence (b=1000 mm2/sn) were used. The intracranial cystic or necrotic lesion signals on DWI were evaluated comparing with normal appearing brain parenchyma. Quantitative ADC measurement were performed on ADC map images with ROI (region of interest). While the cystic portions of tumours, arachnoid cysts and hydatic cysts were hypointense, cystic parts of bacterial abscesses and epidermoid cysts were hyperintense compared to brain parenchyma on diffusion-weighted images. On ADC map images, the cystic portions of tumours, arachnoid cysts and hydatic cysts showed marked high ADC values. However, low ADC values were calculated from cystic parts of bacterial abscesses and epidermoid cysts. DWI is useful technique in evaluation of intracranial cystic lesions. DWI can differentiate pyogenic abscesses from cystic-necrotic tumors as well as epidermoid cysts from arachnoid cysts. Cerebral hydatic cysts and arachnoid cysts show same signals on DWI, but these lesions can be distinguished from others by their location (intraaxial/extraaxial).Bu çalışmanın amacı kistik yada nekrotik intrakranial lezyonların difüzyon ağırlıklı görüntülemede (DAG) sinyal intensitelerini değerlendirmek ve bu lezyonların apparent diffusion coefficient (ADC) değerlerini ölçerek ayırıcı tanıya katkısını araştırmaktı. Kistik yada nekrotik intrakranial lezyonu bulunan 24 olgu (7 baktehal abse, 6 epidermoid kist, 4 araknoid kist, 5 glioblastom, 2 kist hidatik) çalışmaya dahil edildi. Bu olgulara rutin MR görüntülerin yanısıra eko-planar difüzyon ağırlıklı görüntüme yapıldı. DAG için, aksiyel planda multipl kesitli, single shot, eko-planar spin-eko sekans b=1000sn/mma kullanılmıştır. DAG'de lezyonların kistik yada nekrotik kısımları beyin parankimi ile karşılaştırılarak değerlendirildi. ADC haritalarından ROI (region of interest) ile kantitatif ölçümler yapıldı. DAG'de araknoid kistlerin, kist hidatik lezyonlarının ve tümörlerin kistik bölümleri serebral paranklme oranla hipointens iken, bakterial apselerde ve epidermoid tümörlerde kistik komponent belirgin hiperintensti. ADC haritasında DAG'de hiperintens /z/enenen epidermoid tümör ve bakterial apseler düşük ADC değerine sahipken, DAG'de hipointens izlenen araknoid kist, kist hidatik ve glioblastomlar yüksek ADC değerine sahipti. İntrakranial kistik lezyonların ayırıcı tanısında DAG yararlı ek bilgiler vermektedir. DAG, bakteriyel abseien kistik-nekrotik tümörlerden, epidermoid kisti ise araknoid kistlerden ayırabilmektedir. Serebral kist hidatik ile araknoid kistin DAG'deki sinyal intensiteleri benzerlik gösterir ve bu iki lezyon arasındaki tek fark intrakranial yerleşimdir (intra/ekstraaksiyel)