Solitary Eosinophilic Granuloma in the Lumbar Spine: Case Report

A case of a 3-year-old patient with osteolytic lesion in the lumbar region is presented. The clinic-radiological suspicion was infection, primary or metastatic tumor of spine. Subsequently, a CT guided biopsy proved an eosinophilic granuloma of bone. Following medical treatment after two month, there was improvement in patient medical status

Evaluating the Origin of the Brain Metastatic Tumors by Using DWI Parameters

Background: Brain metastases are the most common tumors in the human central nervous system (CNS), with an occurrence 10 times higher than primary brain tumors in adults. A radiologist usually diagnoses these tumors. Typically, magnetic resonance imaging (MRI) has been used to evaluate the status and number of metastases, the design of surgical treatment or radiotherapy, and the response to treatment. This study aimed to consider the origin of metastatic tumors of the brain using diffusion-weighted imaging sequence.Methods: In this study, 95 lesions observed in 51 patients with different types of brain metastasis who analyzed with standard brain MRI protocols such as T2-weighted fast spin-echo in sagittal, coronal and axial planes and T1-weighted spin-echo sequences before and after injection of contrast enhancement and diffusion-weighted imaging. The diffusion-weighted imaging included an echo-planar spin-echo sequence with two b values (0,1000 s/mm) and calculated apparent diffusion coefficient (ADC) maps. We measured the ADC-value on normalized ADC maps and compared them with different methods. ANOVA was used to compare ADC among all groups as well as T-test for every two groups.Results: The results showed that patients with lung cancer (squamous cell carcinoma, SCC) had the lowest mean ADC (658.70*10-3 mm2/s) and breast cancer patients with the highest mean ADC(935.52*10-3 mm2/s). This study demonstrated that most Brain metastases had low and intermediate ADC values. The analysis showed no significant difference among all groups. However, ADC values in breast cancer and kidney and lung (adenocarcinoma) were statistically higher in comparison to other groups. There were no critical discrepancies between ADC values in brain metastases from Breast cancer and lung cancer (adenocarcinoma) and kidney.Conclusion: It seems that evaluating the origin of the brain metastatic tumors by using diffusion imaging (DWI) parameters could be helpful to prevent invasive methods like biopsies in some situations. Although it needs more studies to achieve this purpose

Secondary Brain Lymphoma in a Case of Breast Diffused Large B-Cell Lymphoma: Case Report

Secondary central nervous system lymphoma (SCNSL) is known as a rare disease. The risk factor of developing SCNSL is primary lymphoma type and site of involvement. We present a patient with an altered mental status known case of breast diffused large B-cell lymphoma (DLBCL) who underwent stereotactic biopsy because of a left periventricular mass lesion, which diagnosed as secondary brain lymphoma after pathologic typing. Because of limited data about the secondary central nervous system, lymphoma and it is a risk factor, we reported an aggressive breast DLBCL with brain involvement

Assessment of stylohyoid ligament in patients with Eagle’s syndrome and patients with asymptomatic elongated styloid process: A cone-beam computed tomography study

BACKGROUND AND AIM: This study was performed to evaluate and compare the calcification patterns of the stylohyoid ligament in Eagle’s syndrome (ES) patients, and asymptomatic patients with elongated styloid process (SP) via cone-beam computed tomography (CBCT). METHODS: A total of 52 CBCT images in two symptomatic (ES) and asymptomatic groups (n = 26 per group) were assessed. The mean length and thickness of the SP, morphology, and pattern of calcification between the two sides in each group and between ES and asymptomatic groups were compared. The t-test was used for comparison. Fisher exact and chi-square tests were used to determine the relationship between different types of calcification pattern and morphology. The level of significance was considered at P < 0.050. RESULTS: The SP was thicker in the ES group than the asymptomatic group. However, the styloid length showed no significant difference among the ES and asymptomatic groups. The most common pattern of calcification in both groups was partially calcified with no significant difference between the two study groups. The most common morphology in the asymptomatic and ES groups was “segmented” and “elongated,” respectively. CONCLUSION: The morphology and thickness of the SP showed a significant difference between the ES and asymptomatic groups. This can be helpful in differential diagnosis of facial, pharyngeal, and tonsillar pain. KEYWORDS: Eagle Syndrome; Elongated Styloid Process Syndrome; Cone Beam Computed Tomograph

Anesthesia considerations in surgical deep brain stimulation for Tourette syndrome management

Tourette’s syndrome (TS) is a neuro-behavioral disease associated by phonic and motor tics with a high frequency of psychiatric co-morbidities. For these cases, deep brain stimulation (DBS) is a developing neuro-modulated treatment option since the first report on a successful surgery in 1999. A male thirty-one years old (77 kg, 178 cm) with diagnosis of Gilles De La Tourette syndrome admitted to neurosurgery ward. His medication included Aripiprazole, pimozide, buspirone, clomipramine, citalopram, phenytoin, Desmopressin and Lithium. The patient underwent implanting DBS (Deep Brain Stimulator) surgery and battery implantation in two steps with two weeks interval. General anesthesia with considerations and according to behavior of disease and drug interactions was performed. The cause and symptoms may be due to central dopaminergic hyperactivity or anomalous dopamine neurotransmission and interventions and anesthesia should be done considering these abnormalities

A BRIEF RADIOGRAPHIC REPORT FROM TWO COMMON ODONTOGENIC CYSTS IN JAWS WITH FOLLICULAR RADIOLUCENT APPEARANCE

Objectives: Pericoronal radiolucencies are common pathologic findings in regular dental checkups. Since dentigerous cyst is the most common pathologic pericoronal radiolucency and as odontogenic keratocyst (OKC) is a common cyst also and an aggressive lesion with high recurrence, radiographic features of these lesions were discussed in this study using panoramic radiography and cone beam computed tomography.Materials and Methods: In this cross-sectional case series study, radiographs from 56 patients who were referred to  a private maxillofacial radiology center or  dentistry faculty in Mashhad/Iran from 2008 to 2013 in which radiolucent pericoronal lesion was observed in jaws with histopathologic results of dentigerous cyst or OKC were separately examined by two maxillofacial radiologists. Both observers were unaware of pathology results. Lesions were assessed based on their location, periphery, and impaction on the surrounding structures. Then, obtained data were analyzed using descriptive tables. Results: 56 lesions were identified in 56 patients. There were 20 odontogenic keratocyst and 36 dentigerous cysts. The majority of dentigerous cysts and OKCs occurred in the posterior mandible and showed a well corticated border. External root resorption was higher in OKC cases. In addition, displacement tendency of surrounding structures (other than tooth) such as nasal floor, mandibular canal, buccal and lingual cortex (in the form of expansion) as well as destruction of cortex, nasal floor or sinus walls was higher in OKC than in dentigerous cyst. Conclusion: Except of tooth displacement other parameters related to the effect on surrounding structures in this study showed higher frequency in OKC than dentigerous cyst

Diagnostic Efficacy of Digital Waters’ and Caldwell’s Radiographic Views for Evaluation of Sinonasal Area

Objectives: New digital two-dimensional imaging systems are considered as an easily accessible modality for sinonasal evaluation. The aim of this study was to assess the diagnostic efficacy of digital Waters’ and Caldwell’s radiographic views for evaluation of sinonasal area. Materials and Methods: A total of 273 patients fulfilling the inclusion criteria were enrolled in this descriptive-analytical study. Complete opacification or mucosal thickening of frontal, ethmoidal and maxillary sinuses and nasal septum deviation were assessed on digital Waters and Caldwell images. Considering cone beam computed tomography (CBCT) as the gold standard, accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for the plain films. Results: The sensitivity and specificity for the diagnosis of complete opacification were 89.47% and 95.66% (for frontal sinus), 100% and 97.59% (for ethmoidal air cells), and 100% and 96.42% (for maxillary sinuses), respectively. Regarding mucosal thickening, the sensitivity and specificity were 51.43% and 90.70% (for frontal sinus), 60.84% and 84.80% (for ethmoidal air cells) and 81% and 74.74% (for maxillary sinuses), respectively. The sensitivity of Waters and Caldwell images for detecting nasal septum deviation was 84.31% and 87.25%, respectively; whereas, their specificity was 100%. Conclusions: Digital Caldwell image performs well in detecting frontal and ethmoidal opacification and nasal septum deviation. It has moderate efficacy in assessing frontal and ethmoidal mucosal thickening while it has superior performance for detection of healthy cases. Digital Waters’ view is a reliable modality for maxillary sinus evaluation.

Glioblastoma Simultaneously Present with Adjacent Meningioma: Case report

In this article, we report a 49-year-old woman with simultaneous meningioma and astrocytoma occurrence in the same patients without radiotherapy, phacomatosis, or any genetic disorders. We aimed to define surgical management and the etiopathogenic correlations of meningioma with glioblastoma

Diagnosis of Simulated External Root Resorption Using Conventional Intraoral Film Radiography, CCD, PSP, and CBCT: A Comparison Study

Background: Diagnosis of external root resorption (ERR) cavities may be challenging, especially when no clinical signs are seen. Therefore, the aim of this study was to compare the efficacy of conventional intraoral film radiography, charge-coupled device (CCD) detector, photostimulable phosphor plate (PSP) detector, and cone beam computed tomography (CBCT) for the detection of ERR. Methods: The study sample comprised 54 maxillary first premolars. Cavities were created by using a low-speed handpiece with round diamond burs of 1 mm in diameter. Digital and conventional radiographs were taken from each tooth. Three observers examined all images for the presence of resorption cavities. Data were statistically analyzed with the χ2 test. The reliability and degrees of agreement were also determined by the mean of Cohen's Kappa analysis. Results: The differences between the imaging methods in correct detection of root resorption for all sizes were not significant. For locations of root resorption, significant differences were found between CBCT and other methods in the apical regions. Conclusions: CBCT was only useful for detection of cavities located in the apical one-third of the root, compared to other digital or conventional methods