Neuroanatomical comparison of treatment-resistant and treatment-responsive schizophrenia patients using the cloud-based brain magnetic resonance image segmentation and parcellation system: An MRIcloud study

Recent developments in neuroimaging have improved our understanding of the biological mechanisms underlying schizophrenia. However, neuroimaging findings in treatment-resistant schizophrenia (TRS) remain unclear. In the present study, we aimed to explore potential neuroanatomical regions that may be associated with treatment resistance in schizophrenia patients by comparing neuroanatomical regions of TRS and non-TRS patients using the MRICloud method. A total of 33 schizophrenia patients (meeting DSM 5 diagnostic criteria for schizophrenia) were included in the study. Patients were dichotomized into TRS (n = 18) and non-TRS (n = 15) groups, and all patients underwent MRI. Neuroanatomical regions of TRS and non-TRS patients were compared using the MRICloud method. Disease severity was measured using the Positive and Negative Syndrome Scale (PANSS). Interestingly, a statistically significant greater left Corpus Collosum (CC) thickness was found in TRS patients compared to non-TRS patients. It is clear that further studies comparing TRS patients with non-TRS patients are needed, and these studies should focus on the circuits in the corpus callosum that are thought to play a role in treatment resistance. Further longitudinal studies are also needed to complement the cross-sectional studies, using a multimodal imaging approach in the patients with clearly defined TRS criteria.

Analysis of changes in brain morphological structure of taekwondo athletes by diffusion tensor imaging

OBJECTIVE

Taekwondo, which is the most preferred sport among the martial arts, is known to improve individuals physically, spiritually and mentally. The aim of this study is to reveal the effect of teakwondo sport on the brain and brain structures. DESIGN;: 30 taekwondo athletes and 15 control groups were included in this study. Diffusion tensor MR images of each participant were taken. The information was obtained by the self-declaration of the athletes, whether they were sports years, amateur or elite.

METHOD

Total brain volume and volumes of white matter, gray matter, frontal lobe, precentral gyrus, corticospinal tract, basal nuclei, postcentral gyrus, hippocampus and amigdala and the ratio of these volumes to total brain volume were evaluated statistically between the groups using MriCloud software and ROIEditor program.

RESULTS

An increase in total brain volume, gray matter, frontal lobe and precentral gyrus volume in athletes was associated with taekwondo training. When the ratio of brain parts to total brain volume was examined, it was determined that there was a difference in the ratio of gray matter, white matter volumes in amateur athletes, right frontal lobe, left corticospinal tract, right postcentral gyrus volumes in elite athletes, and left postcentral gyrus volumes of both athletes compared to sedentary individuals.

CONCLUSIONS

The increase in the volume of gray matter, frontal lobe, postcentral gyrus and corticospinal tract together with the brain volume shows that taekwondo exercise contributes to physical, spiritual and mental development.

Use of dual energy CT urography in evaluation of urinary stone and complex cyst

BACKGROUND

Dual-energy computed tomography scans can provide significant benefits to the urinary system. The aim of this study is to determine the limitations and benefits of using dual energy CT urography in patients with urinary system stones and cysts.

METHODS

In the analysis of the images, the virtual noncontrasted images obtained from the combined nephrogenicexcretory phase and the true noncontrasted images were evaluated. The true noncontrast images were accepted as the gold standard for stone detection.

RESULTS

Eighty-three different stones were detected in 26 of the 115 patients included in the study. Sensibilities of virtual noncontrast images in detecting urinary system stones were 66.7% and 65.4% according to the first and second radiologists, respectively. In this study, 32 hyperdense cysts were detected. According to iodine map images, there was no enhancement in 26 of 32 cysts; only 5 cysts showed minimal contrast enhancement. One patient could not decide on contrast enhancement.

DISCUSSION

As a result, if CT urography is performed with dual energy, it can provide additional information in patients with urinary system disorder.

Refractory obsessive-compulsive disorder with symptoms regressing after thalamic infarction: A case report

Obsessive compulsive disorder (OCD) is a common neuropsychiatric disorder involving predominantly the cortico-striato-thalamo-cortical loop. Although it is usually associated with various disorders of basal ganglia and thalamus, it is difficult to say what kind of impairment causes this situation exactly. Structural brain lesions may be one of the rare causes of refractory psychiatric symptoms. Analysis of such type of cases gives an idea about the neurobiology of psychiatric diseases. In this manuscript, we presented a case of refractory OCD with symptoms regressing after thalamic infarction and discussed with relevant literature.

Evaluation of CSF flow dynamics in patients with schizophrenia using phase-contrast cine MRI

Patients with schizophrenia show progressive clinical deterioration. Brain abnormalities have been suggested in these patients, including enlargement of the lateral ventricles, increased cerebrospinal fluid (CSF) volume and reductions in the frontal and temporal lobes. CSF flow pathology is a central factor in the development of many neurological disorders, but much less is known about the role of CSF flow dynamics in schizophrenia. In this study, parameters of CSF flow dynamics at the aqueduct level of 50 schizophrenic patients were compared to those of 50 controls using phase-contrast cine magnetic resonance imaging. Patients had lower peak velocity, lower net forward volume, and lower average flow over the range studied than controls. The average velocity was significantly lower in patients exhibiting violent behavior compared to non-violent patients. The aqueduct tendedto be larger in schizophrenic patients with earlier age of onset of the disorder. Furthermore, as the number of hospitalizations increased, the average velocity and flow over the range studied decreased commensurately. This study demonstrated that CSF flow dynamics are altered in patients with schizophrenia. The results indicated that additional studies of CSF flow dynamics in schizophrenia are needed, along with volumetric examinations of the brain, to elucidate the pathophysiology of the disease.

A case of high grade glioma following treatment of relapsing-remitting multiple sclerosis with fingolimod

Multiple sclerosis is a major cause of neurological disability, especially in young adults. There have been several case reports of an increased risk of cancer after long-term treatment for multiple sclerosis. Fingolimod is an immunomodulating agent used in the treatment of relapsing-remitting multiple sclerosis. The side effects commonly associated with fingolimod are cardiac side effects, macular edema, and elevated liver enzyme levels. Increased risks of infection and cancer have also been reported. High grade glioma is an aggressive primary brain tumor. There has been one case report of high grade glioma during fingolimod treatment. Here, we report the case of a 58-year-old woman diagnosed with glioblastoma multiforme after one year of fingolimod treatment for multiple sclerosis.

The effects of residual parotid volume on symptom-specific quality of life and complications in patients undergoing parotid surgery

PURPOSE

To measure postoperative residual parotid volumes in parotidectomy patients and to measure the effect of residual parotid volumes on the symptom-specific quality of life (SSQOL) and complications.

METHODS

Between January 2010 and December 2016, 148 parotid gland surgeries were performed, and 74 patients were included in the study. Bilateral parotid gland volumes were measured by Magnetic Resonance Imaging (MRI). Parotidectomy Outcome Inventory-8 and aesthetic scale questionnaire were applied to the patients. The volumetric averages obtained were compared with the questions in the SSQOL scale, the aesthetic scale data, and complications.

RESULTS

In the volumetric examination performed with MRI, the mean residual volumes of the operated parotid glands were 9.5 cm³, while the non-operated side was 28.8 cm³. The width of the surgery and the residual parotid tissue volume was inversely correlated. There was a statistically significant difference between the residual parotid gland volume and the pain related to the surgical area, depression in the surgical site, Frey's syndrome, incision scar, and numbness. As the residual parotid gland volumes decreased, the patients' cosmetic problems related to the surgical field increased significantly, and their SSQOL decreased.

CONCLUSION

Postoperative residual parotid tissue volume could be an objective parameter to measure patients' SSQOL and complications. After parotidectomy, the maximum amount of disease-free tissue of the parotid gland should be left in place to increase patients' quality of life and minimize complications.

Can T2 blackout effect be a marker of iron accumulation in brains of multiple sclerosis patients?

Objective :

T2 blackout (TBO) effect, which is a common finding in the brains of multiple sclerosis (MS) patients and older population that are imaged for other reasons on diffusion weighted imagings (DWI) and apparent diffusion coefficient (ADC) map show the existence of paramagnetic materials in the tissue. Because iron is known to accumulate in especially deep gray matter (DGM) structures in MS brains, we aimed to investigate the relationship between TBO and clinico-radiological parameters that may be iron-related in MS.

Methods:

We retrospectively reviewed the latest MR images of MS patients on 3 Tesla MR scanner between 2018 and 2019. TBO existence and severity on DWI–ADC was assessed by two radiologists and its correlation with several outcomes of MS was investigated.

Results:

No significant relationship was found between TBO and gender, subtype of MS whereas TBO was positively correlated with parameters such as black-hole lesions, cortical atrophy, duration of disease, age and extended disability status scale (EDSS) score.

Conclusions:

TBO shows correlation with the conditions which were revealed to be associated with iron accumulation in the brain of MS patients in the literature. Therefore, we concluded that TBO and its severity in DGM may represent iron accumulation in MS brains.

Advances in knowledge:

TBO effect as a frequent imaging finding in daily practice may be used as predictor of the disease course of MS due to possible effects of iron accumulation in brain and thereby may be useful in modifying treatment strategies.

Is amygdala size correlated with stress?

BACKGROUND

One of the important mechanisms that regulate the stress response of the body is hypothalamic pituitary adrenal axis. One of the structures activating this axis is amygdala. We have seen people around who react calmer and cooler to very stressful situations. Are people with smaller amygdala really calmer? Or, can we say that the bigger the amygdala, which is the trigger of the body's response to stress, the more a person panics? Aim of the study is to compare the saliva cortisol levels and amygdala volume.

MATERIALS AND METHODS

Study conducted with 63 male students. Magnetic resonance images of students were taken before their final exam to calculate amygdala volumes. Saliva samples of all students were taken two times to detect cortisol levels in saliva. First one was 20 days before the final exam and second one was on the exam day. We assumed that the students were stressful on exam day.

RESULTS AND CONCLUSIONS

No statistically significant correlation was found between saliva cortisol levels and amygdala volume in the study.

The Role of Insular Cortex in Response to Group Therapy in Vaginismus Patients: Magnetic Resonance Spectroscopy Study

OBJECTIVE

Disgust has been propounded as a potential etiological factor in certain sexual dysfunctions such as vaginismus. Studies reports that insular cortex is activated as a response to disgust. The present study aimed to investigate the predictive role of metabolites in insular cortex in response to group therapy among vaginismus patients.

METHODS

Study sample consisted of 51 vaginismus patients attended an ambulatory group therapy, of whom 26 benefited from 8-week group therapy and 25 were unresponsive to group therapy. All of the patients underwent H magnetic resonance spectroscopy (H-MRS), and insular cortex N-acetyl aspartate (NAA), Creatinine (Cr), Glutamine (Gln), Glutathione (GSH), Choline (Cho), Myo-inositol (mIns), Glutamate (Glu) and Lactate (Lac) concentrations were compared between the groups.

RESULTS

Comparing insular cortex metabolite concentrations between the groups, Cho was statistically significantly higher (p=0.005) but mIns was significantly lower (p=0.001) in the unresponsive to group therapy group.

CONCLUSION

MR spectroscopy findings of the present study indicated significant metabolic changes such as increased Cho/Cr ratio and decreased mIns/Cr ratio in the insular cortex of vaginismus patients who were unresponsive to group therapy. Our results support the studies suggesting that disgust is an important emotion in vaginismus patients and also that insula plays a role in the neurobiology of disgust.

A Pericallosal Lipoma Case with Abnormal Vasculature Mimicking Arteriovenous Malformation

Pericallosal lipomas (PCLs) are rare tumors of the central nervous system. They may be associated with some parenchymal and vascular anomalies of brain. Magnetic resonance imaging is the modality of choice to assess the extent of the PCLs and possible concomitant malformations such as callosal agenesis/disgenesis. Computerized tomography angiography may be indicated to evaluate the vasculature of the lesion. We report here a case of PCL with rare features including asymptomatic callosal agenesis, bilateral choroid plexus lipomas and abnormal vasculature.

Exercise is good also for a healthy hippocampus

OBJECTIVES

The aim of the study was to compare the hippocampus sizes of healthy medical faculty students, who were exposed to an intense data input and who underwent serious learning activity and those of healthy sport faculty students who did sports regularly by using MR images and to examine the relationship between a hippocampus size and intelligence.

METHODS

We made the study with 58 healthy young males (27 sport sciences faculty students and 31 medical faculty students). R. B. Cattell 3A Culture Fair Intelligence Test was administered to the volunteers. Following this, we got MR images of our volunteers.

RESULTS

We could not find a statistically significant difference between medical faculty students and sport sciences faculty students in terms of hippocampus volumes. We could not find a correlation between IQ values and hippocampus volumes. Also, we could not find a significant difference between a right and left hippocampus.

CONCLUSION

While doing sport, blood flow increases in the hippocampus, as in all areas of the body. This increased blood flow creates a stimulating effect on neurogenesis. Neurons, which develop as the result of neurogenesis, mean an increase in volume (Tab. 4, Ref. 54).

Evaluation of Transcranial Magnetic Stimulation Efficiency in Major Depressive Disorder Patients: A Magnetic Resonance Spectroscopy Study

OBJECTIVE

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD). This study evaluated the antidepressant effect of rTMS and examined how it affected N-asetyl aspartate (NAA), choline (Cho), creatine (Cr), lactate (Lac), myoinositol (mIns), glutamate (Glu), glutathione (GSH), and glutamine (Gln) metabolite levels in the left dorsolateral prefrontal cortex (DLPFC) of MDD patients who were not receiving antidepressant medication.

METHODS

In total, 18 patients (10 female, 8 male) were evaluated. Each patient underwent H magnetic resonance spectroscopy (H-MRS) before and within 3 days of completion of TMS therapy. All patients completed 20 sessions of rTMS directed at the left DLPFC over a 2-week period. The Hamilton Depression Scale (HAMD) scores of patients were calculated, and their responses to treatment were assessed within 1-3 days of completion of TMS.

RESULTS

We found statistically significant differences in HAMD scores before and after rTMS. Moreover, the peak metabolite ratios of NAA/Cr, GSH/Cr, and Gln/Cr were significantly higher after rTMS compared to those before rTMS.

CONCLUSION

Increased understanding of the mechanism of action of TMS will improve its application and may stimulate development of new-generation therapeutic agents.

A Rare Presentation of Cranial Polyneuropathy Without Rash Caused by Varicella Zoster Virus

INTRODUCTION

Varicella Zoster Virus (VZV) is associated with many disorders of the central and peripheral nervous systems including neuralgia, meningitis, meningoencephalitis, cerebellitis, vasculopathy, myelopathy, Ramsay-Hunt syndrome, and polyneuritis cranialis. Cranial nerves V, VI, VII, VIII, IX, X, XI, and/or XII may be affected. The neurological disorders caused by VZV usually present with rash, but may rarely present without rash.

CASE REPORT

We herein present a case of polyneuritis cranialis without rash caused by VZV affecting cranial nerves VII, VIII, IX, and X. After excluding other causes of the condition, we diagnosed VZV infection based on VZV DNA in the CSF and an elevated anti-VZV IgG level in serum. The patient responded well to antiviral therapy.

CONCLUSION

VZV infection should be kept in mind during the differential diagnosis of polyneuritis cranialis; it is important to note that VZV re-activation may occur without rash.

Importance of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of the Treatment Efficacy in Multiple Sclerosis Patients with Acute Attacks

Background

We planned to investigate contribution of DWMR to the treatment efficacy with ADC values which were measured in acute and chronic plaque before and after MS treatment. ADC changes in normal appearing white matter (NAWM) in patients with MS and healthy volunteers were also evaluated in this study.

Material/Methods

25 patients with MS and 30 healthy subjects with normal brain MR findings were included to our study. Contrast enhancement in plaque was evaluated as an acute, and non-contrast enhancement in plaque was evaluated as a chronic. Also, ADC measurements were performed using the same parameters in NAWM in plaque neighborhood and volunteers. Results were compared with appropriate statistical methods.

Results

ADC values in acute and chronic plaques were decreased after the treatment, and these reductions were statistically significant for acute plaqus in b500 and for chronic plaques in b500 and b1000. The mean ADC values were measured as 1.53±0.49×10⁻³ and 1.43±0.58×10⁻³ in acute plaques and 1.40±0.35×10⁻³ and 1.34±0.36×10⁻³ mm²/sec in chronic plaques before and after the treatment.

Conclusions

We think that DWMR have important role due to quantitative measurement ability in the evaluation of the treatment efficacy of the MS patients with acute attack in addition to contrast-enhanced MR sequence.