Non-traumatic brain injuries

Department of Radiology, Ege University Medical Faculty, Izmir, Turkey, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Non-traumatic brain injuries consist of many diverse pathologies of the brain and need urgent diagnosis and treatment. Non-traumatic brain injuries include vascular and non-vascular conditions like stroke, spontaneous intracranial hemorrhage, infections, tumors, intoxications, etc. Content: The aim of this presentation is to give information about common pathologies of non-traumatic brain injuries and imaging findings how to diagnose them correctly, thus enabling the appropriate treatment. The roles of different imaging modalities will be discussed and emphasized

Neurobrucellosis

Brucellosis is a multisystem infection with a broad spectrum of clinical presentations. Its nervous system involvement is known as neurobrucellosis. Neurobrucellosis (NB) has neither a typical clinical picture nor specific cerebrospinal fluid (CSF) findings. Its diagnosis is based on the existence of a neurologic picture not explained by any other neurologic disease, evidenced by systemic brucellar infection and the presence of inflammatory alteration in CSF. Imaging findings of NB is divided into four categories: (1) normal, (2) inflammation (recognized by granulomas, abnormal enhancement of the meninges, perivascular space, or lumbar nerve roots), (3) white matter changes, and (4) vascular changes

Neurobrucellosis

WOS: 000297401400013PubMed ID: 22032507Brucellosis is a multisystem infection with a broad spectrum of clinical presentations. Its nervous system involvement is known as neurobrucellosis. Neurobrucellosis (NB) has neither a typical clinical picture nor specific cerebrospinal fluid (CSF) findings. Its diagnosis is based on the existence of a neurologic picture not explained by any other neurologic disease, evidenced by systemic brucellar infection and the presence of inflammatory alteration in CSF. Imaging findings of NB is divided into four categories: (1) normal, (2) inflammation (recognized by granulomas, abnormal enhancement of the meninges, perivascular space, or lumbar nerve roots), (3) white matter changes, and (4) vascular changes

MRI assessment of pituitary Iron accumulation by using pituitary-R2 in beta-thalassemia patients

WOS: 000432868300016PubMed ID: 28882060Background: Patients with thalassemia major (TM) require repeated blood transfusions, which leads to accumulation of iron in a wide variety of tissues. Accumulation of iron in the pituitary gland can lead to irreversible hypogonadotropic hypogonadism (HH) in this group of patients. Purpose: To investigate the reliability of pituitary-R.2 as a marker to estimate the extent of pituitary iron load by comparing the pituitary magnetic resonance imaging (MRI) findings with hepatic iron load and serum ferritin levels. Material and Methods: A total of 38 beta-TM patients were classified into HH (group A, n = 18) and non-HH (group B, n = 17) groups. A third group, group C, consisted of 17 healthy participants. Each participant underwent 1.5-T MRI examinations. Pituitary gland heights (PGH), pituitary-R2 values, and liver-R2 values were measured by using multi-echo spin-echo sequences. Results: Pituitary-R2 values were significantly higher in group A compared with group B Rho < 0.05). A positive correlation was detected between the pituitary-R2 values and serum ferritin levels in TM patients Rho < 0. 01) A threshold value of 14.1 Hz for pituitary-R2 was found to give a high specificity and sensitivity in distinguishing the TM patients with HH from those with normal pituitary functions. PGH measurements were significantly lower in group A compared with group B Rho < 0.05). Conclusion: MRI-assessed pituitary-R2 seems to be a reliable marker for differentiating the TM patients with normal pituitary function from those with secondary hypogonadism due to iron toxicity

MRI perfusion findings in acute cerebral infarction and perfusion parameters used in the evaluation penumbra

WOS: 000393168200002Objective: In this trial, our objective is to emphasize the importance of the magnetic resonance perfusion in the early diagnosis and therapy of cerebral ischemia and to discuss the reliable perfusion maps for identifying peunumbra. Material and Methods: Participants of this trial have been selected among patients who applied to the Ege University Radiology Department with cerebrovascular event and had an acute infarct which was diagnosed by MR. Among 20 of these patients, dynamic suceptibilite contrast (DSC) imaging with 1.5 T MR Magnetom Vision, Siemens, Erlangen, Germany) was performed with standart head bandage. At contrast perfusion imaging a bolus of 0.1 mmol/kg Gadolinium was injected by a speed of 3ml/sec. Multishot echoplanar imaging (EPI) imaging was performed for determining the changes at T2* relaxation time. The DSC perfusion parametres and function maps were obtained and eveluated at the postprocessing stage. The precence of penumbra was diagnosed by comparing the perfusion maps with difusion images. Results: Seventy nine percent of the patients had a lesser degree of cerebral blood volume (CBV) and cerebral blood flow (CBF) at the infarcted area then contrary hemisphere but at 11% of the patients there was no difference with contrary hemisphere. Five percent of the patients had remarkable blood flow increase. This was thought to be cause of the important role of the brain's autoregulation function. There was an expected delay at 90% of the patients in contrast passing time and peak time. By comparing the diffusion with perfusion maps, the penumbra was diagnosed at 4 patients by mean transit time (MTT) and time to pic (TTP) maps, at 3 patients by CBF map and at 1 patient by CBV map. Conclusion: The early diagnosis and evaluation of acute ischemic stroke, improves the patients' quality of life. The perfusion MR has a pathfinder role in the diagnosis and therapy of acute infarct. Penumbra is a dynamic tissue and the treatment after the early identifying of the penumbra, defines the patients prognosis. The most reliable perfusion map for determining the penumbra is controversial and much more trials are need to be done about this subject. According to recent trials and our investigation, the penumbra area seems to be larger which is determined by using the TTP and MTT maps. This condition is due to the exaggerated appearance of the ischemic penumbra secondary to the benign oligemia with severe arterial occlusive changes. In the literature the most reliable maps are relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) maps for demonstrating the last infarct area and our findings are also in the same way

Reversibility of Cytotoxic Edema in Tacrolimus Leukoencephalopathy

WOS: 000283567300011PubMed ID: 20933182Posterior reversible encephalopathy syndrome, a serious neurotoxicity, may develop rarely in patients receiving tacrolimus. Because the underlying etiology of posterior reversible encephalopathy syndrome is vasogenic edema, it is generally accepted to be a reversible neurologic condition. Cranial magnetic resonance imaging techniques enable detection of the type of edema, and they are widely used in the differential diagnosis and prognostic prediction of posterior reversible encephalopathy syndrome. Presented here is a case of posterior reversible encephalopathy syndrome in which the patient recovered completely, despite radiologic findings indicating the coexistence of vasogenic and cytotoxic edema secondary to tacrolimus therapy after liver transplantation. (C) 2010 by Elsevier Inc. All rights reserved