Vascular Leiomyoma Presenting as Anterior Knee Pain (Case Report)

Vascular leiomyomas or angioleiomyomas are rare benign solitary smooth muscle tumors that origin usually in the extremities. Most of these tumors are composed of venous vessels. Here in, we report a rare case of subcutaneous vascular leiomyoma of the right knee of a 38 year old woman who was presented with recurrent anterior right knee pain and soft tissue swelling. Clinical findings, magnetic resonance imaging and histopathologic findings of the tumor is discussed. Leiomyomas are not mostly considered in the differential diagnosis by radiologist due to its rarity. Typical imaging and clinical findings of a tumor is an important clue for an accurate and early diagnosis

CT dose management for neurologic events in patients with cardiac devices: Radiation exposure variation in patients with cardiac devices

PURPOSE:To compare the inter-center cranial computed tomography (CT) acquisition rates, CT findings, CT related radiation dose, and variability of CT acquisition parameters for neurologic events among patients with implantable cardioverter-defibrillator (ICD) or left ventricular assist device (LVAD).METHODS:A total of 224 patients [ICD group (n = 155) and LVAD group (n = 69)] who had at least one cranial CT scan were enrolled from three medical centers. The variability and effect of the number, indication, and findings of cranial CT scans as well as CT acquisition parameters including tube potential, tube current, tube rotation time (TI), slice collimation (cSL), and spiral or sequential scanning techniques on CT dose index volume (CTDIvol), total dose length product (DLP) were analyzed.RESULTS:The mean DLP value of Center A and mean CTDIvol values of Center A and C were significantly lower than Center B (p < 0.001). The mean CTDIvol and DLP values in the ICD group were substantially lower than the LVAD group (p<0.001). The most potent parameters causing the changes in CTDIvol and DLP were kV, mAs values, and CT scanning technique as sequential or spiral according to multivariate linear regression analysis.CONCLUSION:Cranial CT acquisition parameters and radiation doses vary significantly between centers, which necessitates optimization of cranial CT protocols to overcome the cumulative radiation dose burden in patients with neurologic events

Pseudoduplication of the optic disc in moderate myopia

We report a case of optic disc pseudoduplication without pathological myopia. A 79-year-old woman presented with gradually decreased vision. Fundus examination showed macular drusen in both eyes and subretinal haemorrhage in the left eye. Both optic discs appeared to be tilted and the left optic disc was seen to be inferiorly duplicated. Pseudodoubling of the optic discs can be caused by optic disc and peripapillary chorioretinal colobomas and pathological myopia. Considering that our patient did not have enough axial length to merit a diagnosis of pathological myopia and no pathological fundus lesions typical of elongated sclera, we suggest that acquired pseudoduplication is not a condition unique to pathological myopia, but can occur in all myopic patients. The clinical materials, including ophthalmological examination, fundus fluorescent angiography and MRI scan of the orbit, were reported, and its pertinent literatures were reviewed

Unexpected inconsistency of cranial MRI and cranial US measurements: new normative values in the neonatal period

Ultrazvuk (UZV) lubanje omogućava razlikovanje normalnog od nenormalnog u razumnom vremenu snimanja i bez zračenja. Međutim, nema dovoljno podataka o usporedbi mjerenja provedenih pomoću UZV-a glave i magnetskom rezonancom (MR) mozga za neke intrakranijske strukture u novorođenčadi. Cilj studije bio je procijeniti pouzdanost UZV glave u usporedbi s MR-om mozga. Također smo tražili referentne vrijednosti za hipofi zu i infundibulum, što je važno kad se procjenjuje postoji li zaostajanje u rastu ili nenormalan rast u ovoj populaciji. Normativna mjerenja širine 4. i 3. lateralnog ventrikula, dužina i širina korpusa kalozuma (CC), biventrikulska širina (BVW) i biparijetalni promjer (BPD) prospektivno su bilježeni u 95-ero zdrave terminske novorođenčadi na UZV-u glave i MR-u mozga. Uz te poznate strukture, na MR-u smo također mjerili visinu hipofi ze, debljinu infundibuluma, visinu i širinu cerebeluma. Usporedba UZV-a lubanje i MR-a mozga pokazala je dobru korelaciju za BPD, širinu splenija i koljena CC-a, anteroposteriornu dužinu CC-a i širinu 3. ventrikula (κ=0,88-0,99). Korelacija je bila slaba za BVW, širinu korpusa CC-a i širinu lateralnih ventrikula (κ=0,28-0,56). Nove normativne vrijednosti za visinu hipofi ze i debljinu peteljke u novorođenačkoj dobi novi su nalazi ove prospektivne studije. U zaključku, mjerenja zabilježena pomoću UZV-a lubanje i MR-a nisu bila dosljedna u nekim moždanim strukturama. Bitno je znati normativne vrijednosti i diferencirati prirođene i razvojne anomalije mozga u novorođečadi. Također su utvrđene nove referentne vrijednosti za hipofi zu i infundibulum u novorođenačkoj dobi.Cranial ultrasonography (US) enables diff erentiation of normal from abnormal in a reasonable scanning time and without radiation. However, there is not enough data comparing measurements of cranial US and magnetic resonance imaging (MRI) for some intracranial structures in the neonatal period. We aimed to assess the reliability of cranial US compared with brain MRI. We also sought reference values of the pituitary gland and infundibulum, which is important in searching for growth retardation or abnormal growth in this population. Normative measurements of the width of the 4th, 3rd and lateral ventricles, length and width of the corpus callosum (CC), biventricular width (BVW), and biparietal diameter (BPD) were prospectively obtained from 95 healthy fullterm neonates on both cranial US and brain MRI. Besides the well-known structures, the height of the pituitary gland, thickness of the infundibulum, height and width of the cerebellum were measured on MRI. Comparison of cranial US and brain MRI showed good correlation in the BPD, width of the splenium and genu of CC, anteroposterior length of CC, and width of the 3rd ventricle (κ=0.88- 0.99). Correlation was poor in BVW, width of the corpus of CC, and width of the lateral ventricles (κ=0.28-0.56). New normative values of the height of pituitary gland and thickness of the stalk in the neonatal period are novel fi ndings of this prospective study. In conclusion, cranial US and MRI measurements were not consistent in some brain structures. It is crucial to know the normative values, and to diff erentiate congenital and developmental brain anomalies in the neonatal period. The new reference values of the pituitary gland and infundibulum were also established in this period

Traumatic craniocervical junction ligamentous and brain stem injuries and retroclival hematoma: unusual combination of craniocervical junction injuries

Cervical spine injuries are common in pediatric population and usually seen in craniocervical junction due to the anatomical and physiological differences. Combination of rapid hyperextension/hyperflexion traumas due to highspeed motor vehicle accident are known to be the reason of ligamentous injury and retroclival epidural hematoma. Our aim is to describe a rare combination injury of the the apical ligament, retroclival epidural hematoma and the suspicion of brain stem slits, due to rapid hyperextension/hyperflexion and rotational trauma with high-speed motor vehicle accident in a 3 year 8 month old girl. The cervical spine was immobilized with a Philadelphia collar. She is still under treatment in the pediatric intensive care unit with a Glascow Coma Scale of 8 for six months

Synthetic MRI in children with tuberous sclerosis complex.

OBJECTIVE: The generation of numerous sequences and quantitative data in a short scanning time is the most potential advantage of Synthetic MRI (SyMRI). We aimed to test detection of the tubers and to determine underlying tissue characteristics, and morphometric alterations in the brain of pediatric tuberous sclerosis complex (TSC) patients, using SyMRI. METHODS: Conventional brain MRI (cMRI) and SyMRI were prospectively obtained from 10 TSC patients and 18 healthy control subjects (HCs). Two neuroradiologists independently evaluated tubers on both scans. Additionally, automatically segmented volume calculation and myelin quantification, including the subcortical part of the tubers and normal-appearing brain parenchyma (NABP) of patients, were carried out using SyMRI. RESULTS: The cMRI and SyMRI comparison showed a very good correlation on the detection of the tubers (k = 0.82-0.94). Automatic segmentation of Non-gray matter/white matter/cerebrospinal fluid (Non), %Non/brain parenchymal volume, and %Non/intracranial volume was significantly higher; however, %Myelin/intracranial volume and %Myelin/brain parenchymal volume were significantly lower in the TSC patients (p &lt; 0.05). The proton density values were significantly increased, and myelin fraction volume and myelin-correlated compound values were significantly decreased in the NABP in TSC patients on myelin maps (p &lt; 0.05). The white-matter volume, myelin and white-matter fractional volume, longitudinal relaxation rate, transverse relaxation rate, and myelin-correlated compound values were significantly decreased in the subcortical part of tubers on quantification maps (p &lt; 0.001) in TSC patients. CONCLUSION: SyMRI enables the detection of cortical tubers and is a developing tool in the quantification of morphometric and tissue alterations in pediatric TSC patients with a rational scanning time

Reduced myelin in patients with isolated hippocampal sclerosis as assessed by SyMRI.

PURPOSE: Synthetic MRI (SyMRI) enables to quantify brain tissue and morphometry. We aimed to investigate the WM and myelin alterations in patients with unilateral hippocampal sclerosis (HS) with SyMRI. METHODS: Adult patients with isolated unilateral HS and age-matched control subjects (CSs) were included in this study. The SyMRI sequence QRAPMASTER in the coronal plane perpendicular to the hippocampi was obtained from the whole brain. Automatic segmentation of the whole brain was processed by SyMRI Diagnostic software (Version 11.2). Two neuroradiologists also performed quantitative analyses independently from symmetrical 14 ROIs placed in temporal and extratemporal WM, hippocampi, and amygdalae in both hemispheres. RESULTS: Sixteen patients (F/M = 6/10, mean age = 32.5 ± 11.3&nbsp;years; right/left HS: 8/8) and 10 CSs (F/M = 5/5, mean age = 30.7 ± 7&nbsp;years) were included. Left HS patients had significantly lower myelin and WM volumes than CSs (p &lt; .05). Myelin was reduced significantly in the ipsilateral temporal lobe of patients than CSs, greater in left HS (p &lt; .05). Histopathological examination including luxol fast blue stain also revealed myelin pallor in all of 6 patients who were operated. Ipsilateral temporal pole and sub-insular WM had significantly reduced myelin than the corresponding contralateral regions in patients (p &lt; .05). No significant difference was found in WM values. GM values were significantly lower in hippocampi in patients than CSs (p &lt; .05). CONCLUSION: SyMRI revealed myelin reduction in the ipsilateral temporal lobe and sub-insular WM of patients with HS. Whether this finding correlates with electrophysiological features and SyMRI could serve as lateralization of temporal lobe epilepsy need to be investigated