The Diagnostic Performance of Magnetic Resonance Imaging in the Categorization of Pediatric Neck Lymph Nodes: Radiologic and Pathologic Correlations

BACKGROUND/AIM

To present MRI features of neck lymph nodes in benign and malignant conditions in the pediatric population.

MATERIALS AND METHODS

MRIs of the neck of 51 patients 1 to 18 years old (40 boys, 11 girls [10.08±4.73]) with lymph node biopsy were retrospectively analyzed. Those were grouped as benign including reactive (27 [52.9%]) and lymphadenitis (11 [21.6%]), and malignant (13 [25.5%]). The groups were evaluated multiparametrically in terms of quantitative and qualitative variables.

RESULTS

The long axis, short axis, area, and apparent diffusion coefficient (ADC) values of the largest lymph node were 21 (17 to 24) mm, 14 (12 to 18) mm, 228.60 (144.79 to 351.82) mm 2 , 2531 (2457 to 2714) mm 2 /s for reactive, 24 (19 to 27) mm, 15 (11 to 20) mm, 271.80 (231.43 to 412.20) mm 2 , 2534 (2425 to 2594) mm 2 /s for lymphadenitis, 27 (23.50 to 31.50) mm, 20 (15 to 22) mm, 377.08 (260.47 to 530.94) mm 2 , 2337 (2254 to 2466) mm 2 /s for malignant, respectively. Statistical analysis of our data suggests that the following parameters are associated with a higher likelihood of malignancy: long axis >22 mm, short axis >16 mm, area >319 cm 2 , ADC value <2367 mm 2 /s, and supraclavicular location. Perinodal and nodal heterogeneity, posterior cervical triangle location are common in lymphadenitis ( P <0.001). Reactive lymph nodes are distributed symmetrically in both neck halves ( P <0.001).

CONCLUSION

In the MRI-based approach to lymph nodes, not only long axis, short axis, surface area, and ADC, but also location, distribution, perinodal, and nodal heterogeneity should be used.

Coexistence of longitudinally extensive transverse myelitis and diffuse midline glioma in the brainstem in an adolescent boy with acute flaccid paralysis

We present the case of a previously healthy 13-year-old boy who was admitted to the emergency department with acute flaccid paralysis. Magnetic resonance imaging revealed radiological evidence of longitudinally extensive transverse myelitis. Additionally, homogeneous T2 signal increase was observed in the pons and medulla oblongata, initially indicating brainstem encephalitis. Subsequent evaluations confirmed a coexistence of diffuse midline glioma (DMG) in the brain stem alongside acute transverse myelitis (ATM). Children with ATM generally have a more favorable prognosis than adults. However, despite the implementation of advanced treatment methods, the patient's quadriplegia did not improve and resulted in spinal cord sequela atrophy. DMG exhibits an aggressive growth pattern and lacks a known curative treatment. This case represents an exceedingly rare synchronous occurrence of aggressive conditions, underscoring the importance of raising awareness among physicians. Furthermore, we aim to discuss the radiologic differential diagnosis, as this is the first documented instance in the literature.

Apparent diffusion coefficient (ADC) measurements and morphometric evaluation of the cranium in age-matched children with central precocious puberty

OBJECTIVES

Central precocious puberty (CPP) is one of the common reasons for referral to pediatric endocrinology. Magnetic resonance imaging (MRI) is used to rule out intracranial pathologies. However, there is insufficient information in the literature about bone marrow abnormalities on MRI in CPP cases. The aim of this study was to evaluate the apparent diffusion coefficient (ADC) values obtained from bone marrow diffusion weight images (DWI) of cranial bone structures and the status of sphenooccipital synchondrosis (SOS) in CPP.

METHODS

MRI data from 6-to 9-year-old girls with CPP and a healthy control group were evaluated. Anthropometric data, FSH, LH, and oestradiol tests were recorded, and the relationship between SOS status, DWI-ADC values of the clivus, parietal bone, and occipital protuberance were compared.

RESULTS

The study included 146 girls, 79 CPP, and 67 healthy aged 6-9 years (median: 8 (2)). The diagnosis age was 8.30 ± 0.8 years. The ADC values were significantly lower on CPP than normal controls (p=<0.05). In the CPP group, pattern 1 was found at 2 % (n=2), pattern 2 at 3.5 % (n=3), and pattern 3 at 3.5 % (n=3) in clivus sphenooccipital synchondrosis. There was no correlation between the mean parietal, occipital, and clivus ADC values and any variable (p>0.05).

CONCLUSIONS

DWI-MRI ADC analysis can be used as a quantitative radiological marker for early detection of CPP, even before changes in sphenooccipital synchondrosis.

The effect of growth hormone addition protocols to poor ovarian responders in in vitro fertilization cycles

OBJECTIVE

In vitro fertilization failure (IVF) is high in women with poor ovarian response or non-responder. For this reason, the addition of adjuvant treatments to IVF protocols has come to the fore. We assessed to investigate the effects of adjuvant GH therapy initiated in the mid-luteal phase on IVF success in poor ovarian response or non-responder women.

PATIENTS AND METHODS

A retrospective study was performed in 93 poor ovarian response or non-responder women from a single center. GH treatment was added (GH-plus group) in the mid-luteal phase of the previous menstrual cycle to 47 of the women who underwent controlled ovarian stimulation with the flexible antagonist protocol. 46 women, as another group, were applied to a flexible antagonist-only protocol (GH-free group). The IVF outcome results were evaluated and compared within the groups.

RESULTS

The number of retrieved oocytes was statistically significantly higher in the GH-plus group (2.28±1.975) than in the GH-free group (1.24±1.728) (p=0.01). Although statistically insignificant (p=0.55), the clinical pregnancy rate was higher in the GH-plus group [(8/47), 17%] than in the GH-free group [(5/46, 11%]. The cancellation rate was statistically significantly higher in the GH-free group (65.2%) than in the GH-plus group (44.7%) (p=0.04). No oocyte retrieved cycle rate was higher in the GH-free group (56%) than in the GH-plus group (25%) (p=0.002).

CONCLUSIONS

Adjuvant GH therapy administration to IVF protocol in the mid-luteal phase gives poor ovarian response or non-responder women a chance to have a baby.

CT angiography evaluation of intracranial aneurysms: Distribution, characteristics, and association with subarachnoid hemorrhage

Aims

To investigate the distribution, characteristics, and association with subarachnoid hemorrhage (SAH) of aneurysms identified in Turkish adult patients with computed tomography angiography (CTA) performed with suspicion of intracranial aneurysms and/or SAH.

Subjects and Methods

A total of 356 patients (164 male, and 192 female) with a mean age of 55.6 ± 4.0 (range, 18-90) years were analyzed retrospectively. The dimension in millimeters, localization, type, and multiplicity of aneurysms were noted. The differences in these parameters between females and males were investigated. The correlations of sex, aneurysm size, multiplicity, and size with SAH were researched.

Results

On 356 CTA, 140 cases were identified to have aneurysm (39.3%) (56 males [40.0%], 84 females [60.0%]). The incidence of aneurysms and SAH in females was high relative to males. In 140 patients, a total of 187 aneurysms were present (mean size, 7.25 ± 2.56 mm). The highest number of aneurysms was found in the middle cerebral artery 64 (34.2%) while the least was in posterior circulation 20 (10.7%). There was no significant difference between genders in terms of aneurysm size, type, and multiplicity. Individuals with aneurysm site on the internal carotid artery had lower SAH incidence. Receiver Operating Characteristic curve analysis results determined that individuals with aneurysm size >13.5 mm had increased incidence of SAH.

Conclusions

The general properties of intracranial aneurysms investigated with CTA in Turkish adults had similarities to information defined in the literature. These results will likely be beneficial to direct approaches to aneurysm diagnosis and treatment in routine practice.

Multi-parametric Ultrasound Evaluation of Pediatric Thyroid Dyshormonogenesis

The aim of this study was to assess the diagnostic contribution of gray-scale ultrasonography, color Doppler, superb microvascular imaging and shear wave elastography in thyroid dyshormonogenesis (TD). From October 2017 to February 2018, the prospective study included 31 patients (13.6 y; 11-14 y) diagnosed with TD based on thyroid scintigraphy and perchlorate discharge tests and 40 healthy pediatric volunteers (12.8 y; 10-16 y). Median resistive indices (RIs), peak systolic and end-diastolic velocities, vascularity indices (VIs) via superb microvascular imaging and shear wave elastography parameters were evaluated. Median VI values were significantly higher and median RI values were significantly lower in the study group than the control group. No significant difference was found between shear wave elastography parameters of the TD and control group. VI was significantly correlated with median total thyroid gland volumes (p = 0.002, r = 0.28), medication dosage (p = 0.03, r = 0.48) and 2-h radioactive iodine uptake values (p = 0.008, r = 0.57). VI is a clinically significant and novel parameter useful for diagnosing TD.

Effects of static stretching duration on muscle stiffness and blood flow in the rectus femoris in adolescents

AIMS

To compare the effects of 2 and 5 min of passive static stretching (SS) on stiffness and blood flow in the rectus femoris in adolescent athletes using shear wave elastography (SWE) and superb microvascular imaging (SMI).Material and methods: This prospective study included 20 male athletes with median age of 14.5 (12.5-16.5) years. The subjects were divided into two groups based on the SS duration as follows: 2 min (n=10) and 5 min (n=10). At rest and after 2 and 5 min of SS, stiffness and blood flow values were compared in the rectus femoris for each group. Inter-operator reliability was also analysed.

RESULTS

There was no significant difference between resting and 2 min of SS in terms of stiffness. The stiffness values decreased significantly from resting to 5 min of SS. The blood flow increased significantly from resting to 2 and 5 min of SS. Inter-operator reliability was moderate to perfect for SWE and SMI measurements (ICC: 0.52-0.83).

CONCLUSIONS

 SWE and SMI can be used to acquire reliable quantitative data about muscle stiffness and blood flow in adolescents. While stiffness parameters significantly decreased from resting after only 5 min, blood flow significantly increased both after 2 and 5 min. For physical rehabilitation protocols, 5 min of SS may be chosen to reduce stiffness. For competitions, 2 min of SS may be sufficient for warm-up exercise because it increases the blood flow optimally. Five min of SS may be preferred for the cool-down exercise to enhance recovery.

Severe Multisystem Involvement of Chronic Granulomatous Disease in a Pediatric Patient

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disorder identified by recurrent pyogenic and fungal infections infections secondary to defective nicotinamide adenine dinucleotide phosphate oxidase enzyme. In the present study, we demonstrated a case with a history of multiple segmental lung resections because of invasive bronchopulmonary aspergillosis, multifocal hepatic and splenic granulomas, bilateral adnexal calcific foci presumed to be related with old granulomatous infection and finally gastric outlet obstruction secondary to the involvement of the stomach wall thickening with granulomatous tissue. This is an extremely severe case of CGD with multiorgan involvement within a 10-year period after the diagnosis. Gastric antral involvement may mimic inflammatory bowel diseases in such cases, and intestinal involvement can reliably be demonstrated via ultrasonography. Spontaneous resolution of the antral involvement was observed in the follow-up.

Comparison of culture and real-time polymerase chain reaction methods for detection of Mycoplasma hominis in amniotic fluids samples

Background

Mycoplasma hominis is often present in the amniotic cavity with microbial invasion associated with spontaneous preterm labor. Conventional culture method is the gold standard for detection of Mycoplasmas, but real-time polymerase chain reaction (real-time PCR) has revolutionized the diagnosis of M. hominis.

Objective

The purpose of this study is the comparison of the culture methodology with real-time PCR for the detection of M. hominis in amniotic fluid samples.

Methods

Amniotic fluid samples were collected from 65 pregnant women (age range: 25-45 years) previously followed at an infertility clinic. They were collected by transabdominal genetic amniocentesis during 16-21 weeks of gestation. Amniotic fluids were inoculated in SP4 broth for 48-72 h, and after becoming alkaline, culture suspension was spread on A7 agar plate for 1 week till the typical colonies seen in "fried-egg" morphology under stereomicroscope. DNA was extracted using a QIAGEN Mini DNA kit. The real-time-PCR was performed using Rotor-Gene Q Real-time PCR instrument. A melting-curve analysis was also performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured by real-time PCR by taking culture as gold standard.

Results

Sixty-five women in 16-21 weeks of gestation, with a mean age of 33 ± 5.06 years, were enrolled into this study. M. hominis detected by culture and real-time PCR assay was 72% (47/65) and 69% (45/65), respectively. 66% (43/65) specimens were positive by both methods. Real-time PCR sensitivity was 91.5%, specificity 88.9%, PPV 95.6%, and NPV 80%.

Conclusion

Rapid detection of Mycoplasmas causing maternal complications such as neonatal infections and preterm labor in pregnancy by real-time PCR may be important and necessary. The high sensitivity and shorter time requirement of real-time PCR support its further development for diagnosis of Mycoplasma infections.

Shear wave elastography of parotid glands in pediatric patients with HIV infection

OBJECTIVES

Parotid gland (PG) involvement is common among the patients with HIV infection. Shear wave elastography (SWE) is a noninvasive method used to measure the tissue stiffness of several organs including PG. The aim of this study was to evaluate the tissue stiffness values of PGs of HIV-infected children via SWE and compare the results with the counterparts of healthy subjects.

MATERIALS AND METHODS

This single-center, prospective study included the PG examinations of 23 pediatric HIV patients and 40 healthy children via grayscale ultrasound and SWE. Independent sample T test and Mann-Whitney U test were used in statistical analysis.

RESULTS

Stiffness of both PGs was significantly higher in patients' group when compared with control subjects. In addition, when the patients were separated into two groups according to the appearance of PG on grayscale ultrasound as homogeneous and heterogeneous, stiffness values were increased in the patients with homogeneous parenchymal appearance. No significant difference was achieved in terms of median CD4 and CD8 counts, HIV RNA levels or median duration of illnesses.

CONCLUSIONS

PG examination of HIV-infected children via SWE reveals increased tissue stiffness when compared with healthy subjects. SWE can be used as an ultrasound-assisted noninvasive technique in this manner.

Assessment of paediatric Hashimoto's thyroiditis using superb microvascular imaging

AIM

To evaluate the role of superb microvascular imaging along with greyscale and Doppler imaging for thyroid gland evaluation in Hashimoto's thyroiditis (HT) versus control subjects.

MATERIALS AND METHODS

The study included 33 healthy volunteers with normal ultrasound and laboratory findings and 70 patients with HT based on laboratory and sonographic findings who were undergoing follow-up and receiving medical treatment. HT patients were classified based on the modification of the scheme proposed by Sostre and Reyes that incorporates the extent of hypoechoic foci or patchy infiltration as grade A (foci involving <50% of the gland) and B (foci involving >50% of the gland). Thyroid volume, mean resistive indices, peak-systolic and end-diastolic velocities based on Doppler imaging, and vascularity index via superb microvascular imaging were obtained using a Canon Aplio 500 ultrasound device using a linear 10-14 MHz transducer.

RESULTS

Patients with HT had significantly higher median thyroid volume and peak-systolic velocities (7.32 ml and 19 cm/s, respectively) compared to control subjects (4.62 ml and 16 cm/s, respectively). HT patients had significantly higher median vascularity index (VI; 13.5%) compared to control subjects (7.95%). A significant fair positive correlation with VI and anti-thyroglobulin antibody levels (r=0.356, p<0.05) and significant moderate positive correlation with VI and anti-thyroid peroxidase antibody levels (r=0.503, p<0.05) were found. In HT diagnosis, the optimal VI cut-off value was 10.58% with a sensitivity and specificity of 67.1% and 90%, respectively.

CONCLUSION

Superb microvascular imaging appears to allow assessment of subtle vascularity changes in early HT stages that cannot be detected by Doppler parameters. This technique demonstrates excellent visualization of the microvascular structures and quantitative assessment based on a novel parameter such as VI.

Diagnostic performances of superb microvascular imaging, shear wave elastography and shape index in pediatric lymph nodes categorization: a comparative study

OBJECTIVE

To determine the diagnostic utility of a vascularity index via superb microvascular imaging in lymph nodes of children with malignant lymphoma and acute lymphadenitis compared to normal lymph nodes.

METHODS

We performed a retrospective study for multiparametric lymph node (LN) evaluation. Malignant lymphoma diagnosed via histopathological examination and lymph nodes receiving an acute lymphadenitis diagnosis based on clinical and laboratory findings constituted the study subgroups. We calculated a shape index [SI (percent of shortest to longest diameter)] using grayscale ultrasonography and elasticity and velocity values via shear wave elastography (SWE) as well as a vascularity index (VI) using superb microvascular imaging (SMI) for comparison with normal lymph nodes.

RESULTS

45 lymph nodes diagnosed with malignant lymphoma, 72 lymph nodes diagnosed with acute lymphadenitis and 146 normal lymph nodes were evaluated. For differentiating lymphoma from normal lymph nodes, vascularity index cut-off values higher than 15% represented a diagnostic accuracy of 95%; cut-off elasticity values higher than 17 kPa exhibited a diagnostic accuracy of 99%. Optimal VI, elasticity, velocity and SI cut-off values in differentiating lymphoma from lymphadenitis were 15%, 17 kPa, 2.45 m sn^-1 (p < 0.001) and 65% (p < 0.002) with calculated diagnostic accuracies of 83, 87, 88 and 68%, respectively.

CONCLUSION

Vascularity index values obtained via superb microvascular imaging and SWE would be reasonably useful in differentiating malignant lymphoma and acute lymphadenitis from normal LNs. SWE would be more efficient in distinguishing malignant lymph nodes from acute lymphadenitis compared with superb microvascular imaging. Advances in knowledge: Vascularity index by superb microvascular imaging would be a novel Doppler parameter in differentiating both lymphoma from lymphadenitis and also lymphadenitis from normal lymph nodes.

Effects of passive muscle stiffness measured by Shear Wave Elastography, muscle thickness, and body mass index on athletic performance in adolescent female basketball players

AIMS

Athletic performance in basketball comprises the contributions of anaerobic and aerobic performance. The aim was to investigate the effects of passive muscle stiffness, using shear wave elastography (SWE), as well as muscle thickness, and body mass index (BMI), on both aerobic and anaerobic performances in adolescent female basketball players.Material and methods: Anaerobic and aerobic (VO2max) performance was assessed using the vertical jump and shuttle run tests, respectively, in 24 volunteer adolescent female basketball players. Passive muscle stiffness of the rectus femoris (RF), gastrocnemius medialis (GM), gastrocnemius lateralis (GL) and soleus muscles were measured by SWE, and the thickness of each muscle was assessed by gray scale ultrasound. The BMI of each participant was also calculated. The relationship between vertical jump and VO2max values, and those of muscle stiffness, thickness, and BMI were investigated via Pearson's correlation and multivariate linear regression analysis.

RESULTS

No significant correlation was observed between muscle stiffness and VO2max or vertical jump (p>0.05). There was significant negative correlation between GL thickness and VO2max (p=0.026), and soleus thickness and VO2max (p=0.046). There was also a significant negative correlation between BMI and VO2max (p=0.001). Conclusions: This preliminary work can be a reference for future research. Although our article indicates that passive muscle stiffness measured by SWE is not directly related to athletic performance, future comprehensive studies should be performed in order to illuminate the complex nature of muscles. The  maintenance of lower muscle thickness and optimal BMI may be associated with better aerobic performance.

Evaluation of parotid glands in healthy children and adolescents using shear wave elastography and superb microvascular imaging

OBJECTIVES

We aim to determine parotid gland elasticity values from healthy children and adolescents using shear wave elastography (SWE). We also define the degree of vascularity using superb microvascular imaging (SMI), power Doppler (PD), and color Doppler (CD) and compare SMI with CD and PD.

MATERIALS AND METHODS

A total of 100 cases, comprising 50 girls and 50 boys, with ages ranging from 3 to 17 years were included in this prospective study. SWE, SMI, PD, and CD measurements were taken from both parotid glands, and the relationships with sex, age, and body mass index (BMI) were determined. The SMI was compared with the PD and CD.

RESULTS

The median elasticity values measured with SWE were 8.37 ± 2.09 kPa and 1.68 ± 0.26 m/s on the right and 8.33 ± 2.04 kPa and 1.69 ± 0.26 m/s on the left. There were significant positive correlations present for those aged below and above 10 years and for BMI with elasticity values. The median vascular spot numbers measured using SMI, PD, and CD were 5 ± 1.70, 3.5 ± 1.45, and 2 ± 1.1 on the right and 4 ± 1.7, 4 ± 1.43, and 2 ± 1.05 on the left, respectively. The median values obtained with SMI were significantly higher than the median values obtained with both PD and CD.

CONCLUSION

This study determined the reference SWE, SMI, PD, and CD values for normal parotid glands in healthy children and adolescents. Elasticity values were affected by age and BMI. There was no correlation between vascularity values and age, sex, or BMI. SMI provided more detailed information about vascularity compared with the other methods.

Coeliac trunk and common hepatic artery variations in children: an analysis with computed tomography angiography

BACKGROUND

Understanding the coeliac trunk (CeT) and hepatic artery anatomy is important not only in preventing iatrogenic injuries but also in planning surgical procedures in children. Therefore, the aim of this study is to analyse the prevalence of CeT and common hepatic artery (CHA) variations in the paediatric population.

MATERIALS AND METHODS

One hundred and seventy-four children who underwent abdominal multidetector computed tomography (MDCT) angiography, either because of trauma or liver transplantation, were analysed retrospectively. The patterns of CeT, CHA and their variant branches were revealed and compared with previous studies involving adults.

RESULTS

A total of 157 (90.2%) of the 174 patients had normal CeT anatomy, whereas 17 (9.8%) had variations. Five types of CeT variations were identified according to Song's classification in which 'hepatosplenic trunk + left gastric artery + superior mesenteric artery' was the most prevalent. One hundred-twelve (64.4%) of the 174 patients had normal CHA anatomy; however, 62 (35.6%) had variations. Six types of CHA variations were identified according to Michel's and Hiatt's classification. The most common was 'replaced left hepatic artery originating from left gastric artery'.

CONCLUSIONS

The prevalences of CeT and hepatic artery variations are high in children, as they are in older patients. Awareness of these variations is important in terms of avoiding iatrogenic injury and in promoting surgical procedure planning for liver transplantation or abdominal tumour surgery.

Time-series lipidomic analysis of the oleaginous green microalga species Ettlia oleoabundans under nutrient stress

BACKGROUND

Microalgae are uniquely advantageous organisms cultured and harvested for several value-added biochemicals. A majority of these compounds are lipid-based, such as triacylglycerols (TAGs), which can be used for biofuel production, and their accumulation is most affected under nutrient stress conditions. As such, the balance between cellular homeostasis and lipid metabolism becomes more intricate to achieve efficiency in bioproduct synthesis. Lipidomics studies in microalgae are of great importance as biochemical diversity also plays a major role in lipid regulation among oleaginous species.

METHODS

The aim of this study was to analyze time-series changes in lipid families produced by microalga under different nutrient conditions and growth phases to gain comprehensive information at the cellular level. For this purpose, we worked with a highly adaptable, oleaginous, non-model green microalga species, Ettlia oleoabundans (a.k.a. Neochloris oleoabundans). Using a mass spectrometry-based untargeted and targeted metabolomics' approach, we analyzed the changes in major lipid families under both replete and deplete nitrogen and phosphorus conditions at four different time points covering exponential and stationary growth phases.

RESULTS

Comprehensive analysis of the lipid metabolism highlighted the accumulation of TAGs, which can be utilized for the production of biodiesel via transesterification, and depletion of chlorophylls and certain structural lipids required for photosynthesis, under nutrient deprived conditions. We also found a correlation between the depletion of digalactosyldiacylglycerols (DGDGs) and sulfoquinovosyldiacylglycerols (SQDGs) under nutrient deprivation.

CONCLUSIONS

High accumulation of TAGs under nutrient limitation as well as a depletion of other lipids of interest such as phosphatidylglycerols (PGs), DGDGs, SQDGs, and chlorophylls seem to be interconnected and related to the microalgal photosynthetic efficiency. Overall, our results provided key biochemical information on the lipid regulation and physiology of a non-model green microalga, along with optimization potential for biodiesel and other value-added product synthesis.

Can we evaluate cranial aneurysms on conventional brain magnetic resonance imaging?

Purpose:

To evaluate the contribution of conventional brain magnetic resonance imaging (MRI) for the determination of intracranial aneurysms.

Materials and Methods:

Brain MRI and computed tomography angiography (CTA) of 45 patients (29 women and 16 men; age range, 32–80 years) with aneurysm were analyzed. A comparison was made between brain MRI and CTA based on size and presence of aneurysm. The comparisons between MRI and CTA were investigated through Bland-Altman graphics, receiver operating characteristic curve, and Kappa statistics.

Results:

Fifty-seven aneurysms were evaluated. Forty-five percent of 57 aneurysms on CTA were detected on conventional brain MRI. A significant correlation was found between CTA and brain MRI in the diagnosis of aneurysm (P < 0.05). In an analysis of the size measurement, a significant correlation was observed between CTA and brain MRI. Seventy-seven percent of aneurysms <4 mm was not detected and the efficiency of MRI in the detection of aneurysms <4 mm was found to be low.

Conclusion:

Aneurysms can also be appreciated on conventional brain MRI, and vascular structures should be reviewed carefully while analyzing brain MRI.

Does amnioreduction increase success of emergency cervical cerclage in cases with advanced cervical dilatation and protruding membranes?

OBJECTIVE

To investigate whether amnioreduction has any impact on emergency cervical cerclage outcome.

MATERIALS AND METHODS

Data of women who underwent emergency cervical cerclage for advanced cervical dilatation and protruding membranes were analyzed retrospectively.

RESULTS

During the study interval, a total of 56 women who were underwent amnioreduction (n=26) and who did not (n=30) were eligible for analysis of the study. Gestational age at cerclage, delivery, and prolongation of pregnancy interval were comparable between the groups (21.3 ±3.3 vs. 20.6 ±3.1 weeks; p = 0.44; 28.3 ±6.1 vs. 28.1 ±5.6 weeks; p = 0.74; 53.7± 46.1 vs. 47.3± 36.7 days; p = 0.56 respectively). Number of live birth rates and perinatal mortality rates were also not statistically significantly different between the groups (73.1% vs. 70.0%; p = 0.80; 15.4% vs. 13.3%; p = 0.83).

CONCLUSIONS

Emergency cerclage yields live take home baby rates in more than half of the patients. The decision to perform amnioreduction should be based on suspicion of chorioamnionitis and patient's motivation to know exactly what is the risk of chorioamnionitis.

Bilateral Internal Carotid Artery Occlusion as a Cause of Intraventricular Hemorrhage due to Pial Collateral Vessels

In patients with high-grade atherosclerotic stenosis or occlusion of the extracranial cerebral arteries, subarachnoid hemorrhage (SAH) may occur, potentially due to rupture of fragile dilated pial collateral vessels. This association has been well described in Moyamoya disease. There are only few cases in the literature that reported SAH due to bilateral carotid artery stenosis but intraventricular hemorrhage caused by dilated pial collateral has not been reported yet. We present a case of bilateral carotid artery occlusion presented with intraventricular hemorrhage. Based on the findings in the present case, carotid artery stenosis or occlusion may present with intraventricular hemorrhage due to rupture of the dilated, fragile collateral vessels.