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Purpose: The aim of this study was to characterize the frequency and location of left atrial diverticula by using multidetector computed tomography (MDCT)., Materials and Methods: Cardiac imaging was performed for 454 patients using 64MDCT. Most patients were being examined for coronary artery disease. All images were interpreted by two radiologists on a three-dimensional workstation using multiplanar reformatting, maximum intensity projection, and volumerendering. Diverticula were characterized by localization and diameter., Results: A total of 207 atrial diverticula were diagnosed in 186 (41%) of the 454 patients in this study. The diameters of left atrial diverticula ranged from 2 mm to 16 mm, with an average diameter of 5.2 mm. Left atrial diverticula were located anterosuperiorly in 166 patients (36.6%), anteriorly in four patients (0.9%), anteroinferiorly in three patients (0.7%), inferolaterally in one patient (0.2%), inferomedially in two patients (0.4%), laterally in two patients (0.4%), posterosuperiorly in one patient (0.2%), and superiorly in seven patients (1.5%)., Conclusion: Left atrial diverticula are frequently detected during routine cardiac computed tomography angiography examinations. From the Departments of Radiology, and Cardiology, GATA Haydarpasa Teaching Hospital, İstanbul, Turkey.

Transient osteoporosis of the hip (TOH) is a rare clinical condition with usually an unknown aetiology and which typically develops in middle-aged men, or in women in the third trimester of their pregnancy. It is characterized by transient osteopenia and by gradually increasing pain associated with a limitation of the range of motion of the hip. Bone marrow oedema is a typical but nonspecific finding in TOH. A 33-year-old female patient presented with severe hip pain one month after delivery. Her history was unremarkable except for a Hashimoto's Disease of 8 years' duration. Magnetic resonance imaging (MRI) showed significant bone marrow oedema with increased signal intensity in the femoral head on T2-weighted images. A diagnosis of TOH was made and the patient received a total of 30 sessions of hyperbaric oxygen (HBO) at 2.4 ATA, 2 hours each, in a multiplace chamber. Over the course of HBO treatment, her pain was gradually relieved and she became asymptomatic after one month together with a complete recovery of the range of motion of the hip. MRI of the hips 10 weeks after onset of HBO therapy showed normal signal intensity on T2-weighted images.

Objective: The purpose of this study is to determine the effectiveness of the diffusion-weighted magnetic resonance imaging (DWI) of the differentiation of benign and malignant testicular masses., Methods: Fifteen male patients who admitted to our clinic with the diagnosis of testicular mass detected by ultrasound were enrolled to this study. The patients were between 20 and 61 years old (mean 25.7). Apparent diffusion coefficient (ADC) values were measured from ADC maps of lesion and normal testicular tissue. In addition, mean signal intensity (SI) measurements were obtained by using b: 1,000 of normal testicular tissue and lesion with three regions of interest (ROI). SI ratio values are obtained by dividing the value lesion SI to the normal testicular parenchyma SI. Histopathology of orchiectomy materials and ADC values and lesion SI rates were compared statistically., Results: There were no significant correlation (p = 0.97) between ADC values of benign and malign lesions and histopathological diagnosis in Student's t test. There were statistically significant relationship with the histopathology of the lesion and the SI ratio in Student's t test (p = 0.027)., Conclusions: DWI is an effective method in differentiation of benign and malignant testicular masses. Important information can be obtained about nature of testis masses with quantitative measurements of the ADC and ratio of SI.

Hydatid disease (Echinococcosis) is a common parasitic infection caused by Echinococcus granulosus mainly in sheep-raising areas of the world. Liver, lungs and brain are the predominantly involved organs. However, 0.5-1% of the hydatid disease involves the spine and in 90% of the cases it is confined to the bone and the epidural space. Although intramedullary involvement is extremely rare, in this report, we present a 55-year-old female patient who was diagnosed with a cervical intramedullary hydatid cyst during magnetic resonance imaging of the cervical vertebrae. Accordingly, we imply that particularly in endemic areas, hydatid cyst disease should be kept in mind for the differential diagnosis of spinal mass lesions.

Hibemoma is a rare benign soft tissue tumor derived from brown fat.The tumor is also known as "fetal lipoma, lipoma of embryogenic fat and lipoma of immature adipose tissue. Hibemomas are slow-growing, painless soft tissue tumors which do not recur after surgical resection. Preferred locations are brown fat containing sites as thigh, interscapular region, shoulder, axilla, and mediastinum.The tumor occurs most commonly in adults, with a mean age of 38 years (age range, 2-75 years). We present a rare case of hibernoma with radiological and pathological findings.

Objective: Our aim was to evaluate the contribution of diffusion-weighted imaging to the differentiation of hydatid cysts (HCs) from the simple cysts and to the identification of the HC subtypes., Materials and Methods: A total of 37 patients were included in this retrospective study. Fifty of these patients had diagnosed liver cysts (28 HCs and 22 simple cysts) of at least 1 cm in size. All of the cysts were examined with sonography and magnetic resonance imaging, and the HCs were classified according to the World Health Organization criteria., Results: Twenty-eight of the total 50 cysts were HCs, and 22 were simple cysts. When the apparent diffusion coefficient (ADC) values of all HCs were compared with the ADC values of the simple cysts, a statistically significant relationship was found (P=.001). The optimal ADC threshold value was established as 2.5 s/mm(2). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates were 60%, 95%, 94%, 65% and 76%, respectively., Conclusion: Diffusion-weighted imaging-magnetic resonance imaging is a considerably helpful technique for differentiating between HCs and simple cysts and for differentiating between HC subtypes., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI)., Materials and Methods: Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm(2)b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed., Results: The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively., Conclusion: We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules., (Copyright © 2012. Published by Elsevier Inc.)

Tuberous sclerosis (TS) is an autosomal-dominant disorder characterized by a variety of hamartomatous lesions in various organs. Various organ involvements can be detected with radiology: neurologic involvement (cortical tubers, subependymal nodules and white matter abnormalities), renal involvement (angiomyolipoma) and pulmonary involvement (pulmonary lymphangioleiomyomatosis, multifocal micronodular pneumocyte hyperplasia). Here, we are reporting a case of tuberous sclerosis with multiple organ involvement and massive bilateral AMLs in a 49-year-old female patient.

Introduction: Due to the increasing popularity in recreational diving long-term health consequences of this sport have aroused interest in the diving community. Although not as important as dysbaric osteonecrosis, ischemic brain lesions, or neurophysiological symptoms, paranasal sinus mucosal hypertrophy (PSMH) has also been discussed as being more prevalent among divers. In this study, we used magnetic resonance imaging (MRI) to compare asymptomatic divers with control subjects for PSMH., Methods: We enrolled 79 male divers (34.0 +/- 5.7 yr) and 79 nondiving age- and sex-matched controls (33.8 +/- 6.1 yr). We used a questionnaire to elicit diving history. Divers with a history of sinus barotrauma, subjects with a history of chronic sinusitis or nasal allergies, and those with retention cysts, nasal polyps, or mastoiditis were excluded. T1-, T2-weighted axial and coronal images of the paranasal sinuses were taken with a 1.5-T MRI device. The threshold for PSMH was defined as mucosal thickness above 3 mm., Results: MRI revealed PSMH in 33 (41.8%) divers and 18 (22.8%) controls. There were no significant differences between the groups with respect to age, smoking history, or alcohol consumption. PSMH identified in divers did not show an association with age or diving history., Discussion: The higher rate of PSMH identified in divers suggests that diving may cause changes in the paranasal sinus mucosa.

The aim of this report was to present the orthognathic surgical planning of a patient with maxillary retrusion, mandibular prognathism, and midline shift on a three-dimensional stereolithographic biomodel. A patient who complained about facial deformity and difficulty in chewing was referred to our department. After a short-term presurgical orthodontic treatment, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were performed. Triangular axial gaps occurred anteriorly and posteriorly between the proximal and distal segments of the osteotomized mandible. These gaps were filled with bone grafts in accordance with templates that were constructed on a three-dimensional stereolithographic biomodel. Rotational movement of the distal mandibular segment around the y axis caused axial triangular gapping between the proximal and distal mandibular segments. In the presented case, orthognathic surgical planning was performed on the three-dimensional solid models, and templates were reconstructed according to these gaps. These templates were used to determine the size of the bone grafts during the surgical approach. The patient was diagnosed with lateral cephalometric and posteroanterior cephalometric analysis in postretention for 2 years, and it was determined that long-term results were perfect and skeletal relapse did not occur after 2.5 years of surgery. Movement at the site of the osteotomy is usually the main cause of relapse after orthognathic surgery. In the presented case, a three-dimensional stereolithographic biomodel was used to plan the orthognathic surgery and to reconstruct the templates to determine the size and shape of the bone grafts. Using bone grafts established close contact between proximal and distal osteotomized bone segments, enhanced bone healing, and diminished relapse risk.

This study investigated the effects of a long bout of aerobic exercise on hunger and energy intake and circulating levels of leptin and acylated ghrelin. Ten healthy male subjects undertook two, 4 h trials in a randomized crossover design. In the exercise trial subjects ran for 105 min at 50% of maximal oxygen uptake and the last 15 min at 70% of maximal oxygen uptake followed by a 120 min rest period. In the control trial, subjects rested for 4 h. Subjects consumed a buffet test meal at 180 min during each trial. Hunger ratings, acylated ghrelin, leptin, glucose and insulin concentrations were measured at 0, 1, 2, 3 and 4 h. No differences were found at baseline values for hunger, acylated ghrelin, leptin, insulin and glucose for both trials (p > 0.05). The estimated energy expenditure of the exercise trial was 1550 ± 136 kcal. Exercise did not change subsequent absolute energy intake, but produced a significant decrease (p < 0.05) in relative energy intake. A two-way ANOVA revealed a significant (p < 0. 05) interaction effect for hunger and acylated ghrelin. In conclusion, this exercise regimen had a positive effect on reducing appetite which is related to reduced acylated ghrelin responses over time. This finding lends support for a role of exercise in weight management. Key pointsPhysical exercise is a strategy used to counteract obesity, since it lowers the energetic balance by increasing energy expenditure. However, because any energy expended in exercise elevates the intensity of hunger and drives food consumption, it is pertinent to ask how effective exercise could be in helping people to lose weight or to prevent weight gain.The effects of exercise on hunger sensations and food intake are fairly controversial and depend on the intensity and duration of exercise.120 min prolonged treadmill exercise with mix intensity, temporarily decreased hunger sensations, acylated ghrelin and relative energy intake.Variations in exercise intensity should theoretically be a useful means of weight loss.

Objective: The objective of this study was to determine the different vascularization patterns of the posterior interventricular sulcus (PIS) with coronary CT angiography., Materials and Methods: Three hundred and fifty-six coronary CT angiograms (CCTA) were retrospectively analyzed in 248 men and 108 women (mean age, 54.9 years ± 13.6 [standard deviation]). The PIS was divided into three segments from the crux cordis to the notch of the cardiac apex according to the American Heart Association classification (basal, mid ventricular and apical), and the artery or arteries supplying each segment were recorded. The relative frequency of the different vascularization patterns was calculated and the distribution of dominance types was recorded., Results: Blood was supplied to the PIS by one or more branches of the right coronary artery (RCA), the left circumflex artery (LCX), or the left anterior descending artery (LAD). We observed 25 different irrigation patterns. In the most frequent pattern (31.3%), the basal and mid-ventricular segments were perfused by a single arterial branch originating from the RCA at the crux, and the apical segment was perfused by the LAD traveling beyond the notch of the cardiac apex and entering the posterior interventricular sulcus. Of the 356 cases, the circulation was right dominant in 310 (87.1%), left dominant in 34 (9.5%), and balanced in 12 (3.4%) cases. Individual segments were perfused by a single artery in 288 (80.9%) cases, and by more than one in the remainder., Conclusion: CCTA allows detailed assessment of the arterial supply of the PIS, and allowed to describe 25 subtypes. This information is of potential value to both cardiac surgeons and interventional cardiologists who plan bypass surgery or angioplasty aiming at the posterior interventricular artery.

The adrenal gland is a common site of disease, with an abnormality prevalence as high as 9% in autopsy series. With the increasing use of CT, adrenal lesions are frequently found in the daily practice of radiology and are diagnosed in up to 5% of CT examinations performed for varied reasons. Imaging features on CT can establish a specific diagnosis of many of these lesions, including myelolipoma, hematoma and cysts. Once a diagnostic dilemma, now adenomas can be accurately diagnosed using unenhanced CT, chemical shift magnetic resonance imaging and CT contrast washout analysis. Because the adrenal gland is also a frequent site of metastasis, recent literature has focused on imaging characterization of adrenal masses for differentiation of adenomas from metastases. In patients without known malignancy, most adrenal lesions are benign and a specific diagnosis can now be made on the basis of imaging features. It is important to understand the prevalence of adrenal abnormalities because the gland is a common site of disorders, and the increased use of cross-sectional imaging has increased the frequency of detection of adrenal lesions. The prevalence of disease is important in predicting the risk of malignancy when an adrenal mass is discovered in a patient without known cancer. Detection of adrenal gland diseases has increased substantially with the advent and widespread use of imaging techniques. Although several imaging modalities can be used, CT has a central role in both detection and differential diagnosis of an adrenal lesion. The aim of this article is to review the CT findings of adrenal gland diseases.

Introduction: There is some concern that over a period of years, diving may produce cumulative neurological injury even in divers who have no history of decompression sickness. We evaluated asymptomatic divers and controls for cerebral white-matter lesions using magnetic resonance imaging (MRI)., Methods: The study enrolled 113 male military divers (34.4 +/- 5.6 yr) and 65 non-diving men (33.1 +/- 9.0 yr) in good health. Exclusion criteria included any condition that might be expected to produce neurological effects. Patent foramen ovale was not assessed. A questionnaire was used to elicit diving history. A 1.5-T MRI device was used to acquire T1, T2-weighted, and fluid attenuated inversion recovery (FLAIR) images of the brain. A lesion was counted if it appeared hyperintense on both T2-weighted and FLAIR images., Results: MRI revealed brain lesions in 26 of 113 divers (23%) and in 7 of 65 (11%) controls, a difference that was statistically significant. There was no significant difference between the groups with respect to blood pressure, smoking history, or alcohol consumption, and no subject reported a history of head trauma or migraine. There was no relationship between MRI findings and age, diving history, or lipid profile in divers., Discussion: The higher incidence of lesions in the cerebral white matter of divers confirms the possibility that cumulative, subclinical injury to the neurological system may affect the long-term health of military and recreational divers.

Vitamin B12 deficiency causes haematological, gastrointestinal, psychiatric and neurological diseases. Subacute combined degeneration (SCD) of the spinal cord, characterised by degeneration of the lateral and posterior columns, is often found due to vitamin B12 deficiency. We report SCD occurring in a 57-year-old man who presented with a 2.5-month history of gradually progressing tingling in the fingers and toes and neck ache. Laboratory data revealed vitamin B12 deficiency and magnetic resonance (MR) imaging of the cervical spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior columns. In our case, follow-up MR imaging findings correlated well with clinical outcome after treatment with vitamin B12 supplements. Neurological symptoms in vitamin B12 deficiency are frequent. Early spinal MR imaging assists in the early diagnosis and treatment of the disease.

Purpose: To investigate the sonographic characteristics of the normal ulnar nerve in the cubital tunnel, as well as any differences related to age, sex, and dominant arm., Method: Two hundred twelve elbows in healthy volunteers were evaluated sonographically. The cross-sectional area (CSA) of the ulnar nerve within the cubital tunnel was measured with the elbow in extension and in flexion. The presence and number of fascicles was determined. The displacement of the ulnar nerve out of the cubital tunnel in full elbow flexion was also investigated., Results: The mean +/- SD CSA of the ulnar nerve was 6.6 +/- 1.7 mm(2) (6.7 +/- 1.8 mm(2) in men and 6.5 +/- 1.7 mm(2) in women). The mean CSA of the ulnar nerve was highest for subjects aged 50-59 years, and lowest for subjects aged 30-39 years. Forty-two of 212 (19.8%) ulnar nerves had 2 fascicles, and 5 (2.4%) had 3 fascicles. The remaining 165 (77.8%) nerves had 1 fascicle. During elbow flexion, 49 of 212 (23.1%) ulnar nerves showed subluxation, and 18 (8.5%) were dislocated., Conclusion: There were differences in the CSA of the ulnar nerve between some age groups, but there was no variation with sex or handedness. Sonography can evaluate the morphologic changes of the nerve during flexion of the elbow., ((c) 2008 Wiley Periodicals, Inc.)

Background: Prefrontal and/or temporo-limbic abnormalities associated with antisocial personality disorder (APD), high psychopathy scores and violent behaviours can readily be evaluated by neuroimaging methods., Objectives: In this study, we compared the brain metabolites in adult male military conscripts with APD, high psychopathy scores and serious violent crimes (n = 15) with age- and educational-level-matched healthy controls (n = 15) by means of magnetic resonance spectroscopy., Methods: All cases were diagnosed by means of the Diagnostic Statistical Manual-IV APD module of the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II) semistructured questionnaire in Turkish. The psychopathy scores were evaluated by means of the Hare Psychopathy Checklist-Revised translated into Turkish (PCL-R). PCL-R is a 20-item, reliable and valid instrument for assessment of psychopathy, both in categorical and dimensional natures. All patients had a total score of 29 (of possible 40) or higher from PCL-R, indicating a high degree of psychopathy., Results: Our results showed no significant differences in ratio of N-acetyl aspartate (NAA), creatine (Cr) and choline-related compounds in the right dorsolateral prefrontal cortex, anterior cingulate cortex (ACC) and amygdala-hippocampus regions of cases compared with controls. ACC NAA/Cr was significantly negatively correlated with both the PCL-R total score and the PCL-R factor I score (interpersonal/affective problems) among the cases., Conclusion: As ACC plays an important role in decision-making and emotional information processing, we postulate that the lower NAA/Cr ratio, suggesting impaired neural integrity, may increase the severity of interpersonal/affective problems of the psychopathy factor in male subjects exhibiting APD, high psychopathy overall scores and violent crimes.

Purpose: Tuberculosis involvement of the central nervous system continues to represent a serious problem, particularly in developing countries. The aim of this study was to characterize the magnetic resonance imaging (MRI) findings of intracranial tuberculoma, a form of neurotuberculosis., Methods: We retrospectively reviewed the data of 27 patients with intracranial tuberculomas. These consisted of 17 women and 10 men with a mean age of 26 years (14-51). MRI was performed on all patients., Results: A total of 64 tuberculomas were found in these patients, of which 41 were distributed in the cerebral hemispheres, 17 in the cerebellar hemispheres, and 6 in the brainstem. Accompanied meningitis was detected in three patients, hydrocephalus in five patients, and hydrocephalus with meningitis in one patient., Conclusion: MRI makes a significant contribution to diagnosis of intracranial tuberculomas and can objectively determine accompanying abnormalities.

Introduction: Dysbaric osteonecrosis (DON) is regarded as an occupational disease for caisson workers, commercial, and military divers. Magnetic resonance imaging (MRI) was suggested for the surveillance of military divers for DON. This study aimed to determine the prevalence of DON in Turkish Navy divers., Methods: The shoulder, hip, and knee joints of 106 male divers were screened for DON with MRI. A questionnaire was used to obtain information about subjects' medical history and diving experience., Results: The mean age of divers was 34.3 +/- 5.8 yr. The divers had spent an average of 12.1 +/- 6.1 yr at their occupation. The average of total hours of diving was 834 +/- 458 h. The maximum diving depth was 53.0 +/- 18.4 m (175 +/- 61 ft) and the average diving depth was 13.3 +/- 8.4 m (44 +/- 28 ft). MRI examinations of divers did not reveal bone lesions consistent with osteonecrosis., Discussion: We concluded that the risk of DON is very low for military divers who strictly obey the decompression rules and who undergo periodic medical examination. The use of MRI for routine screening of military divers is not justified.

We present a case of malignant peripheral nerve sheath tumor of multicentric origin, an extremely rare condition. A 25-year-old man was admitted to hospital with presenting symptoms of cough, dyspnea and left lateral back pain. Computed tomography and magnetic resonance imaging revealed extrapleural masses in the left hemithorax in addition to synchronous left inguinal mass. After surgical resection of the masses from the thoracic and inguinal regions, histological examination confirmed the preoperative diagnosis of malignant peripheral nerve sheath tumor.

Objective: To determine the effect of oropharyngeal air column area, parapharyngeal fat pad thickness, pterygoid muscle thickness, and parapharyngeal wall thickness on snoring., Materials and Methods: Fifty-six individuals (35 men, 21 women) complaining of snoring in a questionnaire administered to patients attending the MR unit for cervical MR imaging were enrolled as the study group, and 39 (23 men, 16 women) individuals with no complaint of snoring were enrolled as the control group. Firstly, patients' body mass index (BMI) was determined. Then turbo spin echo T2-weighted MR imaging in the axial plane was performed, from the nasopharynx to the hyoid bone level, in both groups. From the MR images, oropharyngeal air column area, parapharyngeal fat pad thickness, pterygoid muscle thickness and parapharyngeal wall thickness measurements were made. Finally, the results were statistically analysed using SPSS (Statistical Package for Social Sciences) for Windows 10.0. Student's t-test was used as a complementary method in the analysis of the study data. The correlations between BMI and parapharyngeal wall thickness, and BMI and oropharyngeal air column area were determined by Pearson's correlation analysis., Results: No statistically significant difference was found between study and control groups in terms of mean age, pterygoid muscle thickness, or pharyngeal fat pad thickness (P>.05). Snorers' BMI levels (P<.01) and average parapharyngeal wall thicknesses (P<.05) were statistically significantly higher than those of the control subjects. Snorers' oropharyngeal air column area was significantly narrower than that of the control subjects, statistically (P<.01)., Conclusion: As a result of the study, it was concluded that only oropharyngeal air column area and parapharyngeal muscle thickness had an effect on snoring.