Magnetic resonance imaging evaluation of head and neck involvement in IgG4-related disease

Objective:To evaluate the radiological features of IgG4-related disease(IgG4-RD)in the head and neck region.Methods:In this radiology-based study,radiological features,clinical,laboratory,pathological findings,and prognosis of nine patients with head and neck involvement diagnosed with IgG4-RD were investigated retrospectively.Results:The median age of the patients was 38 years(range:2.5-79 years),and there were six males and three females.The most common symptoms and clinical findings of the patients were eyelid and lacrimal gland swelling,painless exophthalmos,and ophthalmoplegia.The most common site of involvement on MRI was the orbit.Orbital involvement was followed by branches of the trigeminal nerve,sinonasal cavity,cervical lymph nodes,and dural involvement.The most common and remarkable imaging features were T2 hypointensity and diffuse homogeneous contrast enhancement.Conclusions:Head and neck involvement of the IgG4-RD,has specific imaging features that can help with diagnosis.Thus,early diagnosis and better outcomes can be achieved with increasing awareness of these features of this relatively new pathology.

The Usefulness of Renal Doppler Parameters in Chronic Kidney Disease: Is There a Cut-Off Value to Estimate End Stage Kidney Disease?

Aims: In this study, Doppler parameters were studied in patients with advanced stage renal disease, and the relationship between Doppler parameters and renal disease stage was investigated. Doppler values were evaluated for a cut-off value between normal and end-stage kidney disease group. Materials and methods: 50 patients with chronic kidney disease and 15 patients belonging to the same age group and with normal serum creatinine levels were comprised of the study and control groups. Resistivity and pulsatality indices were measured at the main renal arteries and interlobular arteries at both sides. Results: Statistically significant differences were found between the PI and RI values obtained from the main renal and interlobular arteries. PI sums were compared with those from the control group, and a cut-off value of 2.15 was found, with a sensitivity of 90% and a specificity of 86.7%. Conclusion: Any increase in the RI and PI values obtained from the main renal and interlobular arteries must bring to mind the possibility of advancing renal damage and interstitial fibrosis. Patients with and without renal parenchymal damage can be differentiated by means of comparing the total PI values obtained from the right and left main renal and interlobular arteries.

Marked elevation of troponin I without wall motion abnormality in a patient with myocarditis: Cardiac enzymes may not predict the outcome in myocarditis

A seventeen-year-old male presented with severe substernal chest pain after an episode of upper respiratory tract infection. On clinical grounds, a diagnosis of myocarditis was established. He had a peak troponin I level as high as 40.4 ng/dl but interestingly with no abnormal wall motion and normal ejection fraction in echocardiography. Coronary artery disease was excluded with normal coronary angiography. Diagnosis of myocarditis was confirmed with cardiac MRI. After one month, patient had no complaint and ejection fraction were still normal. Our case emphasizes that the troponin levels predict neither the early nor the late outcome of the left ventricular functions in myocarditis, therefore serum troponin I may not be helpful in determining the prognosis of patients with myocarditis.

Anterior sacral Meningocele Associated with Tethered Cord Syndrome Presenting with Constipation:US,CT,MRI and X-Ray Findings

Anterior sacral meningocele is characterized by the herniation of the thecal sac into the retroperitoneal space. A 33-year-old man was referred to our hospital with the complaints of a longlasting constipation and nonspecific lower abdominal pain. At ultrasound, a cystic mass was detected at the presacral space. Computed Tomography revealed a defect at the anterior aspect of the sacrum, together with a presacral cystic mass which showed a connection with the dural sac. At Magnetic Resonance Imaging, it was demonstrated that the cystic mass made an impression on the rectum, and did not possess any solid components. An anteroposterior pelvis radiogram demonstrated a sacral deformity and the scimitar sign. Upon these imaging findings, the patient got the diagnosis of an anterior sacral meningocele. The possibility of an anterior sacral meningocele must always be kept in mind in the differential diagnosis of a pelvic cystic mass.

The Evaluation of the Knee Joint in Terms of Magnetic Resonance Imaging Measurements in Osteoarthritis Patients:A Comparative Study Comprising a Control Group

The aim of this study was to assess the knee joints of osteoarthritis patients in terms of clinical and magnetic resonance imaging (MRI) measurements and draw definitive conclusions from these quantimetric data. In order to achieve the above-mentioned goal, the knees of individuals from two distinct groups were examined by MRI. One group consisted of osteoarthritis patients while the other comprised the control individuals. All individuals from both groups underwent clinical and MRI measurements concerning their knees. These data were compared by using the statistical software from the Statistical Package for Social Sciences (SPSS) v.15 program. Statistically significant differences were found between the control and patients groups in terms of the measurements of the second (short) diameter of the medial femoral condyle, and the intercondylar distance (p < 0.05). In addition to these findings, the Receiver Operating Characteristics (ROC) curve analysis gave statistically significant results for both of these measurements. The cutoff values for these criteria were as follows in sequence order: a sensitivity of 75% and a specificity of 52% for the medial femoral condyle, and a sensitivity of 70% and a specificity of 70% for the intercondylar distance. The ROC curve data may not be a deterministic outcome alone for this study. But it may in fact have a significant meaning when it is evaluated together with other statistically significant data. The t-test for Equality of Means, for example, gave significant results, concerning the measurements of the short axis of the medial femoral condyle and the intercondylar distance. It is well known that it is the medial portion of the knee joint which deteriorates the most during the process of osteoarthritis of the knee (OAK), and this complies with the results of this study.