Isolated Intracranial Extramedullary Hematopoiesis in an Adult Patient

This article describes the case of a 56-year-old male patient who presented with a headache and swelling on the left side of his head. Medical examinations, including non-contrast computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI), revealed the presence of an expansile soft tissue lesion in the frontoparietal bone structures, causing compression of the brain tissue. Further immunohistochemical analysis confirmed the diagnosis of extramedullary hematopoiesis (EMH) in the bone lesion, with predominant involvement of the myeloid series. EMH is a compensatory mechanism of the body to meet the demand for erythropoiesis. While EMH is commonly associated with thalassemia in children and myelofibrosis in adults, it can occur in various tissues throughout the body, including the intracranial region, although it is rare. The imaging findings of EMH on MRI typically show iso-hypointense signals on T1-weighted images and hypointense signals on T2-weighted images due to the presence of hemosiderin. However, in this case, the lesions appeared hyperintense on T2-weighted images, which posed a challenge in the differential diagnosis. The article highlights the importance of clinical evaluation and imaging findings in diagnosing EMH, as these lesions can resemble other conditions such as metastases, angiomatous meningioma, chloroma, or epidural hematoma. Teaching Point: Isolated cases of intracranial EMH should be considered as a differential diagnosis in adult patients as they may be radiologically confused with malignant conditions such as metastases, angiomatous meningioma, chloroma or epidural hematoma

Evaluation of pancreatic malign tumours with mangafodipir trisodium

Amaç: Organ spesifik ajan olan mangafodipir trisodyum (Mn-DPDP) kullanılarak yapılan manyetik rezonans görüntülemenin pankreas malign kitlelerinin incelenmesinde tanısal etkinliğini incelemek. Hastalar ve Yöntemler: Abdominal ultrasonografi ve bilgisayarlı tomografi bulguları ile pankreas tümörü düşünülen 17 hastanın (7 kadın, 10 erkek; ort. yaş 63.2±12; dağılım 36-80) manyetik rezonans görüntüleri, T1A SE, yağ baskılı T1A SE ve T1A GRE sekanslarının kullanımı ile sinyal-gürültü (S/N) ve kontrast-gürültü (C/N) oranları açısından Mn-DPDP uygulaması öncesi ve sonrası incelendi. Bulgular: Kontrast öncesi ve sonrası incelemelerde normal pankreasın S/N oranlarında artış T1A SE sekansta ortalama %22.81, yağ baskılı T1A SE sekansında %32.88 ve T1A GRE sekansında %20 olarak bulundu. Normal pankreas dokusu ve tümör kitlesi sinyal intensite değerlerinden hesaplanan C/N oranında ise yüzde artış T1A SE sekansı için ortalama %58.69, yağ baskılı T1A SE sekansta %125.41 ve T1A GRE sekansta %62.06 olarak saptandı. Ayrıca uygulanan sinyal intensite ölçümlerine göre her üç sekansta elde edilen kontrast öncesi ve sonrası C/N oranlarındaki artış istatistiksel olarak anlamlı idi (paired Student t testi p<0.0001). Sonuç: Kontrast madde olarak Mn-DPDP'nin kullanımı ile C/N oranlarındaki değişim pankreasın malign kitlelerinin incelenmesinde tanıya katkı sağlayabilir.Objectives: Our study aimed to assess the diagnostic capabilities of mangafodipir trisodium (Mn-DPDP)- enhanced magnetic resonance imaging for the evaluation of pancreatic malign mass. Patients and Methods: Magnetic resonance images of 17 patients (7 females, 10 males; mean age 63.2&plusmn;12 years; range 36 to 80 years) suspected of pancreatic tumor by abdominal ultrasonography and computed tomography findings, were examined in terms of signal to noise (S/N) and contrast to noise (C/N) ratios before and after administration of Mn-DPDP using T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences. Results: Before and after administration of Mn-DPDP, the increase in S/N ratios of normal pancreatic parenchyma were found as 22.81%, 32.88% and 20% in T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences, respectively. The increase in C/N ratios obtained from signal intensity values of normal pancreatic tissue and tumor were found as 58.69%, 125.41% and 62.06% in T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences, respectively. Furthermore, in all sequences, before and after contrast medium administration, the increase of C/N ratios were found statistically significant (paired Student's t test, p&lt;0.0001). Conclusion: The differences of C/N ratio using Mn-DPDP as a contrast agent may contribute to the diagnosis of pancreatic malign masses

Factors associated with urinoma accompanied by ureteral calculi

Objective: Urinoma is a rare entity and mainly occurs due to acute obstruction such as ureteral stone. We aimed to demonstrate factors associated with urinoma accompanied by ureteral calculi. Material and methods: Data of 550 patients who were diagnosed with ureteral stone by computed tomography (CT) were analyzed retrospectively. In 20 patients perirenal urinoma was associated with ureteral calculi (group I), whereas in other 530 patients no urinoma was detected (group II). Gender, age, size, side and localization of the stone, hydronephrosis, fever, sepsis, urinary tract infections (UTIs), hematuria, serum creatinine, blood urea nitrogen (BUN), white blood cell (WBC), C-reactive protein (CRP), presence of diabetes mellitus (DM), hypertension (HT) and cronic kidney disease (CKD) of the two groups were compared. Results: The average age of the patients were 46.2 (20-71) and 44.9 (10-82) years in group I and group II, respectively (p > 0.05). According to our results leukocytosis, microscopic and macroscopic hematuria, UTIs, increase of serum creatinine, BUN and CRP, diagnosis of DM and HT were significantly associated with urinoma (p < 0.05). In addition, patients with distal ureteral stones are more prone to urinoma (p = 0.001). An interesting finding of the study was that the stone size in group I (median 5 mm [range 3-8]) was significantly smaller than in group II (9.3 mm [4-25]; p = 0.001). Conclusions: Small stone size, distal localisation of the stone in ureter, leukocytosis, hematuria, UTIs, increase of serum creatinine, BUN and CRP, presence of DM and HT are associated with perirenal urinoma

Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: accuracy and the factors affecting the results

PURPOSEWe aimed to investigate the accuracy of Vesical Imaging - Reporting and Data System (VI-RADS) in the detection of muscle-invasive bladder cancer (MIBC) and to determine which factors affect the results of this scoring system.METHODSA prospective data analysis of 80 patients who were detected to have bladder tumor was performed between March 2019 and October 2020. VI-RADS scoring was used to determine the probability of muscle invasion. The scores were compared with pathological results to evaluate the accuracy of the VI-RADS scoring system. Interobserver agreement was assessed by VI-RADS scoring of 20 randomly chosen patients by a different experienced radiologist.RESULTSUsing the VI-RADS scoring system, the sensitivity, specificity, positive predictive value, and negative predictive value of multiparametric magnetic resonance imaging (mpMRI) were 87.5%, 87.5%, 63.6%, and 96.6%, respectively. The interobserver agreement expressed as the interclass correlation coefficient (ICC) was 0.72 (95% CI: 0.44-0.84, P < .001). In addition, the flat appearance of the tumor was an important factor affecting the accuracy of the VI-RADS score (odds ratio: 5.3 [95% CI: 1.1-27.0] and relative risk: 1.87 [95% CI: 1.24-2.82]).CONCLUSIONThe mpMRI, used in conjunction with VI-RADS, has proven to be an effective imaging method for detecting muscle invasion in cases of bladder cancer. VI-RADS scoring system can distinguish whether there is a muscle-invasive and non-muscle invasive bladder cancer with acceptable accuracy. In addition, the flat appearance of the tumor is an important entity that can affect the accuracy of the VI-RADS scoring system

Osteoid osteoma of the iliac bone associated with bilateral sacroiliitis: a case report

WOS: 000282599500012Osteoid osteoma is one of the infrequent causes of musculoskeletal pain. Rheumatic diseases such as ankylosing spondylitis are considered especially in cases of bilateral sacroiliitis. An association between these diseases is uncommon. Since both osteoid osteoma and sacroliitis response well to antiinflammatory therapy, radiological investigations, such as computed tomography (CT), have a significant role in diagnosis due to its superiority in visualizing the osseous tissue. Thus, this rare condition can not only be diagnosed, but also managed. This report presents a case of bilateral sacroiliitis in association with osteoid osteoma in a 23-year-old male patient, who was diagnosed and treated initially as bilateral sacroiliitis. CT was performed in order to evaluate the sacroiliac joint space and the accompanying osteoid osteoma was detected coincidentally. Turk J Phys Med Rehab 2010;56:152-4

Glomus jugulare tumor appeared wıth tınnıtus and hoarseness

Glomus jugulare tümörü temporal kemik üzerindeki jugular foramende, jugular bulbusdan çıkan ve orta kulağa yayılan, oldukça vasküler nöral kalıntı tümörüdür. Benign karakterde ve ender görülen bu tümör glomus tümörleri içerisinde gruplandırılır. Glomus karotikum, glomus vagale, glomus timpanikum ve glomus jugulareyi kapsayan bu hastalık grubu paraganglioma veya kemodektoma olarakta adlandırılır. Bayanlarda daha sık görülen bu tümör sıklıkla sol tarafta yerleşim göstermektedir. Yavaş ilerleyen ve semptomlarda geçici duraklama periyodları görülen glomus jugulare tümörü tanıda gecikmeye neden olmaktadır. 3 yıldır devam eden tinnitusu olan 62 yaşında bayan hasta, yeni gelişen ses kısıklığı nedeniyle hastaneye başvurdu. Bu çalışmada tinnitusun ender sebeplerinden olan ve kranial sinir tutulumu nedeniyle yeni gelişen ses kısıklığına yol açan glomus tümörü, radyolojik görüntüleme bulgularıyla birlikte irdelenmiştir.Glomus jugulare tumors are arising from the jugulare bulb in the jugular foramen of the temporal bone and may spread to the middle ear. Glomus jugulare is a rare and highly vascular neural residue tumors that have benign features and grouped in the glomus tumors. Glomus caroticum, glomus vagale, glomus tympanicum and glomus jugulare both are inside this disease group also called as paraganglioma or chemodectoma. Women are more often and left side localization is frequent in this tumor. Glomus jugulare tumor has a slow progression and temporary pause periods on the symptoms; therefore findings lead delays on the diagnosis. 62-year-old female patient with tinnitus for 3 years was admitted to hospital because of developing a new hoarseness. This study reveals a glomus tumor that is a rare cause of tinnitus and new developed hoarseness caused by cranial nerve infiltration and examined with radiological findings

Glomus Jugulare Tumor Appeared With Tinnitus and Hoarseness

WOS: 000311019000018Glomus jugulare tumors are arising from the jugulare bulb in the jugular foramen of the temporal bone and may spread to the middle ear. Glomus jugulare is a rare and highly vascular neural residue tumors that have benign features and grouped in the glomus tumors. Glomus caroticum, glomus vagale, glomus tympanicum and glomus jugulare both are inside this disease group also called as paraganglioma or chemodectoma. Women are more often and left side localization is frequent in this tumor. Glomus jugulare tumor has a slow progression and temporary pause periods on the symptoms; therefore findings lead delays on the diagnosis. 62-year-old female patient with tinnitus for 3 years was admitted to hospital because of developing a new hoarseness. This study reveals a glomus tumor that is a rare cause of tinnitus and new developed hoarseness caused by cranial nerve infiltration and examined with radiological findings

T2 ağırlıklı gradient eko manyetik rezonans görüntülemede serebral mikrokanamalar Cerebral microbleedings on t2 weighted gradient echo magnetic resonance imaging

ÖZET İnfarkt hastalarında kanama eğilimli mikroanjiyopati, intraserebral hemoraji epizotu olan ya da olmayan hipertansiyon hastalarının tedavisinde son derece önemli bir klinik belirteç olarak kabul edilmektedir. Çalışmamızın amacı, manyetik rezonans görüntülemede T2A gradient eko sekansı kullanılarak laküner infarktlı hastalarda mikrokanama odaklarının sayısı ve dağılımı yanı sıra, periventriküler iskemi derecesi ile ilişkisinin araştırılmasıdır. İnme bulguları ve ön tanısıyla rutin MRG tetkikine ek olarak T2A gradient eko sekansı uygulanan 79 hasta ve nörolojik defisit saptanmamış 50 hasta kontrol grubu olarak çalışma kapsamına alındı. Laküner infarktlar çapı 2 cm'den küçük, T2A imajlarda yüksek ve T1A imajlarda düşük sinyal özelliğinde derin lezyonlar olarak, T2A gradient eko sekansında çapı 10 mm'den küçük hemosiderin birikimi ile uyumlu iyi sınırlı hipointens odaklar ise mikrokanama olarak tanımlandı. Periventriküler hiperintensite (PVH) skorlama sistemi kullanarak 4 derecede gruplandırıldı. Olgu grubumuzda %49,6 oranında bir ya da birden fazla mikrokanama odağı saptandı. Mikrokanama tanımlanan olguların %93,7'sinde laküner infarkt tanımlandı. Pearson ki-kare analizinde periventriküler iskemi derecesinin mikrokanama sayısı üzerine anlamlı bir etkisi olduğu görüldü (p<0,01). Spearman's korelasyon analizi ile laküner infarkt sayısı ve mikrokanama sayısı arasında (r=0,429; p<0,01), laküner infarkt sayısı ve periventriküler hiperintensite derecesi arasında (r=0,400; p<0,01) ve periventriküler hiperintensite derecesi ile mikrokanama sayısı arasında (r=0,773; p<0,01) anlamlı pozitif ilişki belirlendi. Sonuç olarak, çalışmamızda T2A gradient eko sekansında saptanan hipointens odakların laküner infarkt ve periventriküler ak madde iskemisi ile birlikteliği vurgulandı. Sekansın, orta ve ileri yaş grubunda, özellikle serebrovasküler patoloji ön tanılı hastalarda uygulanmasının tanıya ışık tutacağı ve tedavi planlamasında rol oynayacağı kanısına varıldı. Anahtar kelimeler: Mikroanjiyopati, Mikrokanama, T2 ağırlıklı gradient eko, Serebrovasküler lezyon, DemansCEREBRAL MICROBLEEDINGS ON T2 WEIGHTED GRADIENT ECHO MAGNETIC RESONANCE IMAGING SUMMARY Hemorrhage tendency microangiopathy in infarct patients accepted as a very important clinical sign on treatment of hypertension patients who had or had not had any intracerebral hemorrhage episodes. The purpose of our study is to research the relationship between the number and distribution of microbleeding focuses and degrees of periventricular ischemia on magnetic resonance imaging by using T2W gradient echo sequence in lacunar infarct patients. The study group which had findings and preliminary diagnosis of stroke contains 79 patients that had not had any neurological deficit and 50 patients in control group examined on MRI by using T2W gradient echo sequence. Lacunar infarcts were deep lesions had a diameter less than 2 cm and had a high signal on T2W images and low signal on T1W images; although microbleedings defined as a well bordered small hemosiderin deposits that were hypointense on T2W gradient echo sequence. Periventricular hyperintensity (PVH) grouped on 4 degrees by using scoring system. One or more microbleeding focus with 49.6% rate had found on T2 weighted gradient echo sequence in study group. 93.7% of microbleeding defined patients lacunar infarct had found. Pearson chi-square analysis revealed a significant relation with periventricular ischemia severity and the number of microbleedings (p<0,01). Spearman?s correlation analysis showed an advanced positive relationship between number of lacunar infarcts and number of microbleedings (r=0,429; p<0,01), number of lacunar infarcts and severity of periventricular hyperintensity (r=0,400; p<0,01) and severity of periventricular hyperintensity and number of microbleedings (r=0,773; p<0,01). In conclusion, our study revealed the relationship between lacunar infarct, periventricular white matter ischemia and hypointens focuses on T2 weighted gradient echo sequence. The sequence has a role that shining lights on diagnosis and planning of treatment in many pathologies especially cerebrovascular diseases in middle and advanced ages. Key words: Microangiopathy, T2 weighted graident echo, cerebrovascular lesion, dementi

Dissecting aneurysm of aberrant right subclavian artery associated with Kommerell diverticulum

Kommerell divertikülü (KD), aberan sağ subklavian arterin proksimal bölümünün desendan aortadan çıkışı düzeyinde gözlenen genişlemesidir. Bu genişleme fokal bir segmentten ibaret olup, KD ismini almaktadır. Aberan sağ subklavian arterin bu segment sonrasında çapının normale dönmesi beklenir. Ayrıca sol subklavian arter çıkımında benzer görünüm saptanabilir. Bu genişleme sağdaki aort arkından çıkan sol aberan subklavian arter kökünde görülebilir ve aort divertikülü olarak adlandırılmaktadır. Aberan subklavian arterin KD ile devamlılık gösteren anevrizmatik segmentinde tromboz ve disseksiyon gelişimi sonucu oluşan gerçek ve yalancı lümenlerin gözlenmesi oldukça enderdir. Sunulan olguda desendan aortadan köken alan sağ aberan subklavian arterin KD sonrası trasesinde görülen anevrizmanın, tromboz ve disseksiyonla birlikteliği incelenmiştir. Klin Deney Ar Derg 2011; 2 (3): 319-322.Kommerell diverticulum (KD) is an enlargement that occurs in proximal segment of aberrant right subclavian artey originating from descendent aorta. This dilatation consists in focal segment, therefore called as KD. Aberrant right subclavian artery has a normal diameter on later trace. Although left aberrant subclavian artery origins may show similar enlargement. This enlargement appears in origin of left aberrant subclavian artery from right sided aortic arcus and called aortic diverticulum. Aneurysm, trombosis in this dilated segment and dissection development with true and false lumens of aberrant subclavian artery after KD is very rare. This report presents coexistence of thrombosis and dissection with subclavian artery aneurism maintained from KD. . J Clin Exp Invest 2011; 2 (3): 319-322

Imaging of central nervous system tumors

Çoğu santral sinir sistemi (SSS) tümörlerinin ve tümör olmayan lezyonların oldukçabenzer görünümler sergilemesinden dolayı rutin Manyetik Rezonans Görüntüleme(MRG) sekanslarının özgüllükleri bunları ayırmada yetersizdir. SSS tümörlerinin ayırıcıtanısında anahtar unsurlar, lezyonun lokalizasyonu (intra- veya extra-aksiyel, infraveyasupra-tentoriyal) ile birlikte hastanın yaşıdır. Multiparametrik MRG tekniklerini(Spektroskopi, Difüzyon Ağırlıklı Görüntüleme, Difüzyon Tensor Görüntüleme, PerfüzyonAğırlıklı Görüntüleme, Fonksiyonel MRG), tümörün mikroskobik ve fonksiyoneldavranışına ilişkin (hücresel yoğunluk, neo-vaskularizasyon, kapiller sızıntıve metabolitler gibi) bilgiler sunar. İleri multiparametrik görüntüleme teknikleri SSStümörü olan hastaların teşhisi, yönetimi ve takibinde kesin ve güvenilir invaziv olmayanbir yöntem sunar.Many Central Nerve System (CNS) tumors and even non–tumoral lesions may showa very similar imaging appearance; therefore, routine Magnetic Resonance Imaging(MRI) are lack of specificity to differentiate these lesions. The key points in the differentialdiagnosis of CNS tumors are the location of the lesion (intra- or extra-axial,infra- or extra-tentorial) and the age of the patient. Multiparametric MRI techniques(Spectroscopy, Diffusion Weighted Imaging, Diffusion Tensor Imaging, PerfusionWeighted Imaging, Functional MRI) reveal the information about the microscopicand functional behaviors of the tumor (cellular density, neo-vascularization, capillaryleakage and metabolites, etc). Advanced multiparametric imaging tools support thediagnosis, management and follow-up of patients with CNS tumors as an accurateand reliable noninvasive technique