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Various physical, mental, and behavioral disorders are reported among individuals who witness violence. This study was designed to examine university students' risky health behaviors after witnessing domestic violence. In this study, 2,509 university students, selected using the stratified sampling method in terms of sex and study year, were included. Path analysis was performed to examine the relationships between sociodemographic variables and risky health behaviors. We found that witnessing domestic violence directly increased substance abuse and alcohol consumption in the entire study population and partner violence among female participants. By adding the variable of witnessing domestic violence to the equation as a mediator, the effect of sociodemographic characteristics on risky health behaviors changed., (© 2024 Springer Publishing Company.)

Objectives: To evaluate the microstructural integrity of brain white matter tracts in patients with Neuro-Behcet's syndrome (NBS) and Behcet's syndrome (BS) without neurological manifestations using diffusion tensor imaging (DTI) and to investigate potential utility of DTI as a surrogate biomarker of neurocognitive functioning and disease severity., Methods: This cross-sectional study comprised 34 NBS patients and 32 BS patients without neurological involvement, identified based on the International Study Group of the Behcet's disease (ISGBD) and the International Consensus Recommendation (ICR) criteria, as well as 33 healthy controls. Cognitive functions, including attention, memory, language, abstraction, executive control, visuospatial skills, and sensorimotor performance were assessed using standardized questionnaires. DTI data were analyzed using tract-based spatial statistics (TBSS) and automated probabilistic tractography to investigate inter-group differences. Subsequently, correlations between tensor-derived parameters of white matter tracts, neurocognitive test scores, and disease severity measures were examined., Results: DTI revealed decreased fractional anisotropy and increased radial diffusivity, mean diffusivity, and axial diffusivity in both supratentorial and infratentorial white matter in NBS patients, indicating widespread loss of microstructural integrity. Moreover, this loss of integrity was also observed in BS patients without neurological manifestations, albeit to a lesser extent. In NBS patients, certain white matter tracts, including cingulum bundle, were associated with poor cognitive performance across multiple domains and disease severity., Discussion: DTI findings might potentially serve as a neuroimaging marker to predict the extent of neurocognitive impairment and disease severity associated with central nervous system involvement in BS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Crossing Y-stent-assisted coiling (CYSAC) is a feasible yet technically challenging technique for the treatment of wide-neck bifurcation aneurysms (WNBAs)., Objective: To present mid-term results of Y-stent-assisted coiling (YSAC) using the LVIS EVO stent and to describe our "drill turn" technique for stent crossing., Methods: This retrospective, observational study included 37 consecutive patients treated with YSAC using LVIS EVO stents at five centres between September 2020 and March 2023., Results: Immediately after treatment, 31 of the 37 patients (83.8%) achieved Raymond-Roy occlusion classification (RROC) Class I occlusion, while 5 patients (13.5%) had Class II and 1 patient (2.7%) had Class III occlusion. The mean follow-up period was 32.8 months (range: 11-41 months), and all patients underwent follow-up imaging after ≥ 6 months. On follow-up imaging, 34 patients (92%), including all those with immediate RROC Class I occlusion, 2 with Class II, and 1 with Class III, showed Class I occlusion. One patient with RROC Class II occlusion demonstrated a gradual decrease in residual filling, while one large partially thrombosed middle cerebral artery aneurysm and one large basilar tip aneurysm (8%) with residual neck filling remained unchanged on the 6-month digital subtraction angiograph., Conclusion: Utilizing the described drill turn technique, CYSAC with LVIS EVO stents was found to be feasible and safe for WNBA treatment, with high and stable occlusion rates observed during mid-term follow-up., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: In 2022, arterioectatic spinal angiopathy (AESA) of childhood was reported as a fatal, progressive, multi-segment myelopathy associated with a unique form of non-inflammatory spinal angiopathy involving diffuse dilatation of the anterior spinal artery and cord congestion in children. In this study, we present four more cases of AESA, using early and long-term conventional imaging and flat detector computed tomography angiography (FDCTA) imaging to assess the probability of disease regression and prevent unnecessary interventions., Methods: We retrospectively reviewed the clinical and radiological findings of four patients with AESA seen in two neuroradiology departments between 2014 and 2023., Results: The study included three boys and one girl. Two of the boys were siblings. Although the clinical and radiological presentation in the early stages of the clinical course overlapped the definition of AESA, the clinical course was more benign in three of the cases. The clinical courses of the two siblings with monosegmental cord involvement and largely reversible radiological findings suggest that some of the features in the initial definition of the disease cannot be standardized for all patients. The siblings had a mutation of the NDUFS gene, which is involved in mitochondrial function and clinical-radiological reversibility in these patients., Conclusion: Many mitochondrial diseases, such as this NDUFS mutation, present with myelopathy, and mitochondrial diseases can sometimes show spontaneous recovery. It is crucial to identify other genetic mutations or environmental factors that trigger the accompanying vascular ectatic findings in AESA in larger multicenter studies to prevent its potential lethal course and possible unnecessary surgical-endovascular interventions., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Intracranial aneurysms are rare in the pediatric age group, especially in neonates. This article presents a novel case of a neonate with a dissected and ruptured giant anterior cerebral artery aneurysm, focusing on diagnosis and endovascular treatment with a review of the literature., Case Description: A full-term female neonate presented with projectile vomiting, fever, and hyperkinetic movements. Diagnostic workup revealed a giant dissecting and partially thrombosed aneurysm along the anterior cerebral artery. The neonate underwent successful endovascular coil embolization., Results: The intervention led to the cessation of symptoms, and the patient was discharged and followed with mild hypotonia as the only neurological deficit at 9 months., Conclusion: This case highlights the rarity and complexity of diagnosing and treating giant dissected anterior cerebral artery aneurysms in neonates. It underscores the importance of considering intracranial aneurysms in differential diagnosis for neonates with relevant symptoms and suggests endovascular embolization as an effective treatment option., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Delayed enhancing white matter lesions are a rare complication that develops after endovascular treatment of cerebral aneurysms, the etiology of which remains unclear., Methods and Results: We present a 52-year-old female patient who was symptomatic with a seizure-like condition and showed reversible cranial parenchymal changes with high-dose cortisone treatment after endovascular stent-assisted coil embolization for an unruptured aneurysm in the internal cerebral artery., Conclusions: Clinicians should be alert to this rare complication and should follow patients for a long time due to its fluctuating and long-term course., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Differential diagnosis of hypothalamic-optic chiasmatic gliomas (HOCGs) and craniopharyngiomas on magnetic resonance imaging (MRI) can be quite challenging., Purpose: To compare the MRI features of HOCGs and cranipharyngiomas., Material and Methods: Patients diagnosed with HOCG or craniopharyngioma in histopathological evaluation between 2012 and 2022 and who underwent preoperative contrast-enhanced brain MRI were included. Various MRI features were retrospectively evaluated for each lesion: T2-weighted imaging and fluid attenuation inversion recovery hyperintensity, calcification, cystic change, T1-weighted (T1W) imaging hyperintensity of the cystic component, hemorrhage, involvement of sellar, suprasellar or other adjacent structures, lobulated appearance, presence of hydrocephalus, and contrast enhancement pattern. Apparent diffusion coefficient (ADC) values were also evaluated and compared., Results: Among 38 patients included, 13 (34%) had HOCG and 25 (66%) had craniopharyngioma. Craniopharyngiomas had a significantly higher rate of cystic changes, calcification, and T1W imaging hyperintensity of the cystic component than HOCGs ( P  <0.05). Of HOCGs, 92% had chiasm involvement, 23% had optic nerve involvement, and 31% had brain stem involvement. On the other hand, chiasm involvement was observed in 8% of craniopharyngiomas, but none had optic nerve and/or brain stem involvement ( P  <0.05). While 62% (8/13) of HOCGs had diffuse homogeneous enhancement, 80% (20/25) of craniopharyngiomas had a diffuse heterogeneous enhancement pattern. Mean ADC values were significantly higher in craniopharyngiomas compared to HOCGs (2.1 vs. 1.6 ×10 -3 mm 2 /s, P  <0.05)., Conclusion: Although some neuroimaging findings may overlap, features such as presence of cyst and calcification, brain stem and optic pathway involvement, different enhancement patterns, and ADC values may be helpful in the differential diagnosis of HOCGs and craniopharyngiomas., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Acute onset Facial palsy was reported in four vaccinated participants in the BNT162b2 (Pfizer-BioNTech) vaccine clinical trials published on December 10, 2020. So far, few cases of Facial palsy among the mRNA vaccine groups have been previously documented in the literature. Facial palsy is cited as medically attended adverse event following immunization on April 12, 2021, after the first dose of the approved Pfizer-BioNTech COVID-19 vaccines for preventive immunization for SARS-CoV-2 is administrated to the population in Turkey. This study is aimed to describe clinical and magnetic resonance imaging features of three patients, who developed acute onset peripheral facial paralysis after administration of the BNT162b2 vaccine, without any previous medical condition. The first patient presented with right sided facial palsy within the same day following the vaccine was administrated, while the second patient presented with left sided facial palsy 2 months after vaccination. The third patient, on the other hand, presented with right sided facial palsy and abducens nerve (CN VI) paralysis two days after vaccine was administrated., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The Dias-Tachdjian classification is the most commonly used system for the classification of pediatric ankle fractures, but its inter- and intra-observer reliability has not been studied in detail. Also, the impact of the clinician's experience and expertise on the reliability of this system is unknown. This study aimed: (1) to determine the intra- and inter-observer reliability of the Dias-Tachdjian classification and (2) to investigate the effect of the clinician's experience and expertise on the reliability of this system. Anteroposterior and lateral ankle radiographs of 56 children (34 male, 22 female) with ankle fractures, aged between 3 and 14 years, with open growth cartilages, were retrospectively identified and included in the study. Each patient radiograph was examined by 10 observers from two different specialties with different levels of clinical experience (two orthopedic surgeons with interest in pediatric orthopedics, three orthopedic surgeons with no interest in pediatric orthopedics, three orthopedic residents, and two radiology specialists) from two different specialties (orthopedics and radiology). All observers were then asked to classify pediatric ankle fractures at 6-week intervals per the Dias-Tachdjian classification system. Overall, intra-observer reliability as substantial to very good (κ = 0.77-0.95, P < 0.01), but inter-observer reliability as fair for both assessments (κ = 0.21, P < 0.01 and κ = 0.20, P < 0.01 for the first and second occasions, respectively). Inter-observer reliability among pediatric orthopedic surgeons as very good (κ = 0.90, 95% CI = 0.86-0.94, P < 0.01 and κ = 0.82, 95% CI = 0.71-0.93, P < 0.01 for the first and second occasions, respectively). Orthopedic surgeons with no special interest in pediatric orthopedics demonstrated substantial agreement in the first occasion (κ = 0.63, 95% CI = 0.53-0.72, P < 0.01) but moderate in the second one. Orthopedic residents exhibited moderate levels of agreement in each assessment period (κ = 0.58, 95% CI = 0.47-0.68, P < 0.01 and κ = 0.44, 95% CI = 0.37-0.51, P < 0.01 for the first and second occasion, respectively). Considering that the specialists dealing with pediatric orthopedics show very good consistency for Dias-Tachdjian classification, both within and between observers, consistency in the identification of the ankle fracture models increases as the interest in the field of pediatric orthopedics intensifies., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This study aimed to develop machine learning (ML) algorithms for the differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS) based on biochemical and radiological features., Methods: Logistic regression algorithms were used for ML, and the area under the receiver operating characteristics curve (AUROC) was used to measure performance. We used Shapley Contributed Comments (SHAP) values, which help explain the results of the ML models to identify the meaning of each feature and facilitate interpretation., Results: A total of 106 patients, 80 with Cushing's disease (CD) and 26 with ectopic ACTH syndrome (EAS), were enrolled in the study. The ML task was created to classify patients with ACTH-dependent CS into CD and EAS. The average AUROC value obtained in the cross-validation of the logistic regression model created for the classification task was 0.850. The diagnostic accuracy of the algorithm was 86%. The SHAP values indicated that the most important determinants for the model were the 2-day 2-mg dexamethasone suppression test, the > 50% suppression in the 8-mg high-dose dexamethasone test, late-night salivary cortisol, and the diameter of the pituitary adenoma. We have also made our algorithm available to all clinicians via a user-friendly interface., Conclusion: ML algorithms have the potential to serve as an alternative decision support tool to invasive procedures in the differential diagnosis of ACTH-dependent CS., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Aim: To reveal factors affecting 2-year mortality in geriatric patients hospitalized with COVID-19. Methods: Demographic characteristics, clinical and laboratory data, thorax computed tomography (CT) images, second-year survival status, and causes of death were analyzed. Results: The 2-year post-discharge mortality rate of 605 patients was 21.9%. Mean age of patients in the deceased group was 76.8 ± 8.1 years, which was shorter than the life expectancy at birth in Türkiye. Older age (≥85), delirium, some co-morbidities, and atypical thorax CT involvement were associated with a significant increase in 2-year mortality (p < 0.05). Conclusion: This is the first study to evaluate factors associated with 2-year mortality in older COVID-19 patients. Identifying risk factors for long-term mortality in geriatric COVID-19 patients is important.

Purpose: Treatment of brain arteriovenous malformation (bAVM) includes microsurgical excision, stereotactic radiosurgery, endovascular embolization, or combination. With bAVM embolization, complete angiographic obliteration ranges from 12.5 to 51%, and higher total occlusion rate is seen in SM grades I to III, ranging from 96 to 100%., Methods: In this paper, we illustrate the use of 3D rotational angiography and dynamic (live) 3D roadmap functions in endovascular treatment of bAVM. A single dynamic 3D roadmap or two dynamic 3D roadmaps obtained help tremendously in navigation of microcatheters and wires along the parent artery and bAVM feeders., Results: This method eliminates the need for repeated 2D angiograms and roadmaps for new working projections every time the C-arm position is changed for cannulation of different feeders, thereby reducing radiation dose. No instances of misalignment error, vascular perforation, or thromboembolic phenomena were observed in the 21 embolization cases performed within the previous 2 years while utilizing this feature., Conclusion: The dynamic 3D roadmap is an extremely useful tool for multiple-feeder cannulation, by reducing the use of multiple 2D angiograms, providing intraprocedural live and adjustable 3D roadmap for better mental orientation to angioarchitecture of the bAVM, which further aids in the overall complete angiographic obliteration rate of bAVM in a single session especially in multiplug embolization technique., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Flow diverter (FD) devices provide a safe and effective treatment option especially for wide-necked intracranial aneurysms. One of the main concerns in patients treated with FD devices is patency of arterial branches jailed by the stent. However, there are no long-term data from magnetic resonance perfusion (MRP) studies regarding jailed branches. In this study we aimed to reveal the MRP findings in patients with jailed middle cerebral artery (MCA) cortical branches during long-term follow-up after flow diversion., Methods: Patients who underwent FD stent treatment for MCA aneurysms with a resulting jailed cortical branch were included. Follow-up clinical, angiographic, and MRP examination findings were recorded. Different MRP parameters were measured in the MCA territory regarding the jailed branches., Results: Eighteen patients treated endovascularly with flow diversion for a total of 20 MCA aneurysms were included. At angiographic follow-up (median 35 months, range 7-95 months) complete occlusion was observed in 13 (65%) aneurysms and partial occlusion was observed in 6 (30%). The mean transit time (MTT) prolongation, MTT ratio, time-to peak (TTP) prolongation, and TTP ratio were 1.34, 1.20, 1.18, and 1.06 s, respectively, when compared with the contralateral side in the MCA territory. MTT, TTP, and cerebral blood volume values of the patients showed statistically significant differences compared with the contralateral side (P<0.05)., Conclusions: Flow diversion treatment of complex bifurcation aneurysms can be effective and safe. MRP examination may reveal perfusion changes in the territory vascularized via a jailed branch, and these changes are rarely accompanied by clinical findings., Competing Interests: Competing interests: CI has a consulting and proctoring agreement with Medtronic, Inc., outside of this work. NK has a consulting and proctoring agreement with MicroVention, Inc. and Medtronic, Inc., outside of this work. OK has a consulting and proctoring agreement with Acandis GmbH and Stryker, Inc., outside of this work. The other authors have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The aim of this study was to investigate the efficacy of diffusion tensor tractography (DTT) of spinal cord on surgical planning and postoperative neurological outcomes in patients with spinal intramedullary tumors., Methods: The study was conducted retrospectively from the radiological and clinical data of our hospital database. Patients with intramedullary spinal cord tumors who underwent diffusion tensor imaging for spinal cord lesions were selected between 2019 and 2022. Demographic characteristics and intraoperative neurophysiological monitoring data were evaluated. The McCormick scale was used to grade the pre- and postoperative neurological status of the patients. The tumoral lesions were categorized into 3 types according to the fiber course on DTT., Results: Eleven patients were found to have radiological findings that were compatible with intramedullary tumor; eight (72.7%) of them ultimately underwent surgery following being approved as surgical candidates in the spinal diffusion tensor imaging studies. Six cases had Type 1, one case had Type 2, and 4 cases had Type 3 tumors according to the fiber course. All Type 1 tumors were classified as resectable and all of them were gross totally resected. Type 2 lesion that was rated as resectable by DTI was subtotally resected. Type 3 lesions were followed without surgery except the one with tumoral progression and neurological deficit. The postoperative neurological outcomes were compatible with intraoperative neurophysiological monitoring results., Conclusion: Diffusion tensor imaging and tractography may be beneficial regarding the selection of patients suitable for surgery and in the subsequent surgical planning., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The aim of this study is to present the clinical and imaging findings of 16 patients with intraventricular pilocytic astrocytomas (PAs)., Methods: 16 patients with histopathological diagnosis of intraventricular PA between February 2016 and January 2022 were evaluated retrospectively. Imaging and clinical findings of the patients, as well as apparent diffusion coefficient (ADC) measurements were analyzed., Results: Of 16 patients, 8 (%50) were male and 8 (%50) were female. The mean age of the patients was 20.8 years (2-44 years range). The most common symptoms in the patients were headache and ataxia. The mean long-axis size of lesions was found to be 48.19 ± 21.59 (range, 15-92 mm). 9 out of 16 lesions (56.2%) were located in the fourth ventricle. The majority of the lesions were iso-hypointense in T 1 W and hyperintense in T 2 W images. The mean ADC value of PAs was 1.57 × 10 -3 ± 0.2 mm 2 /s, while the mean thalamic ADC and white matter ADC values were found to be 0.78 × 10 -3 ± 0.04 and 0.76 × 10 -3 ± 0.06 mm 2 /s, respectively. There was a statistically significant difference between the ADC values obtained from the solid components of the lesions and the thalami/white matter ( p < 0.001)., Conclusion: PAs often originate from midline structures, however, they can also be located intraventricularly. Although intraventricular PAs are frequently seen in pediatric population, it should be kept in mind that they can also be seen in adults, albeit rarely., Advances in Knowledge: PA should be considered in the differential diagnosis of intraventricular neoplasms in case of high ADC values.

Background and Purpose: This study aimed to investigate the potential contribution of quantitative measurements of dural venous sinuses to the diagnosis of idiopathic intracranial hypertension (IIH) and the relationship between IIH and dural venous sinus dimensions on 3D post-gadolinium T1-weighted magnetic resonance (MR) images., Material and Methods: A total of 129 individuals (57 IIH patients and 72 controls) who complained of headache and underwent both magnetic resonance venography (MRV) and precontrast/postcontrast 3D T1-weighted MR imaging between 2018 and 2021 were included in this retrospective study. Dural venous sinus and jugular vein diameters were measured in all cases using post-gadolinium 3D T1 TFE images. The presence of transverse sinus (TS) hypoplasia and occipital sinus variation, the number and size of arachnoid granulations in the TS, and the presence of brain parenchymal herniation were also evaluated. Cut-off values that maximized accurate diagnosis of IIH were established on the receiver operating characteristic curve. The sensitivity and specificity of the diagnosis of IIH based on quantitative measurements of the dural sinus were calculated., Results: The ratios of the maximum to minimum TS diameters and the minimum TS diameters to minimum sigmoid sinus (SS) diameters were significantly higher in IIH patients than in the control group (p < 0.001). The diagnostic sensitivity and specificity values of TS max /TS min and TS min sum /SS min sum parameters for the detection of IIH were 84.2%, 84.7% and 83.3%, 84.2%, respectively., Conclusion: Practical measurements from multiplanar T1 sequences can be useful for both quantitative assessment and overcoming misinterpretation due to anatomical variation., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Craniocervical dissection is one of the most common causes of stroke in children. Although the most common cause of dissection is trauma, spontaneous dissections in which no cause can be revealed may also occur. The diagnosis of this type of dissection in children can be challenging with the preferred non-invasive imaging methods (MRA, CTA). Intracranial vessel wall imaging is a promising novel method for identifying specific signs of dissection. We report an 11-year-old girl with spontaneous ICA dissection, whose diagnosis was confirmed by an MRI of the intracranial vessel wall. Vessel wall imaging has contributed substantially to the diagnosis and follow-up of this case., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: This study aimed to evaluate the feasibility, safety, and efficacy of Y-stent-assisted coiling (Y-SAC) using LEO Baby® stents in treating of bifurcation aneurysms., Methods: Patients who underwent Y-SAC using a braided stent (LEO Baby®, Montmorency, France) for wide-necked intracranial aneurysms between 2009 and 2019 and whose radiological and clinical follow-up data for at least 6 months could be obtained were evaluated. Data were obtained from patient records and analyzed retrospectively., Results: We evaluated 111 patients with a mean age of 56.0 ± 10.8 years (range, 25-88 years). Most of the aneurysms were detected incidentally. Three patients had ruptured aneurysms. LEO Baby deployment and coiling were successful in all patients. Immediate aneurysm occlusion rates were determined as modified Raymond-Roy classification (mRRC) I 95.5% (n = 106), mRRC II 3.6% (n = 4), mRRC IIIa 0.9% (n = 1). In the sixth month, aneurysm occlusion rates were found to be complete and nearly complete in all patients (mRRC I 94.6%, n = 105 and mRRC II 4.5%; n = 5, respectively). Follow-up data of 91 patients for > 2 years were obtained. Of these, 88 had MRRCI obstruction and 3 had MRRC II obstruction. The overall complication rate was 4.8%, and one patient died during the post-procedural follow-up., Conclusion: The long-term follow-up results of Y-stenting with LEO Baby revealed that it provides stable closure of the aneurysm sac while preserving the main arterial structures. Therefore, it is a safe, durable, and effective method for treating wide-necked and complex bifurcation aneurysms., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The aim of this study was to assess the effectiveness of a new quantitative index for the diagnosis of idiopathic normal pressure hydrocephalus., Methods: This retrospective study was conducted at İstanbul University Cerrahpaşa Medical Faculty between January 2016 and November 2022. A total of 31 patients diagnosed with idiopathic normal pressure hydrocephalus were included in the study group and 48 patients were included in the control group. Measurement via the new Index was performed on a coronal section of magnetic resonance imaging at the level of the anterior commissure., Results: The new Index's mean diagnostic performance was 1.16 ± 0.08 in the study group, significantly lower (p < 0.0001) than the mean of 1.43 ± 0.10 in the control group. When a cutoff value of 1.23 was used for the new index, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 96.1%, 90.7%, 80.6%, 98%, and 91.3%, respectively., Discussion: The new Index described here is an effective, feasible, reproducible, highly sensitive, and specific quantitative method that can contribute to the improved diagnosis of patients with idiopathic normal pressure hydrocephalus.

Rationale and Objectives: To investigate the efficacy of the advanced imaging methods, superb microvascular imaging (SMI) and shear wave elastography (SWE) in predicting molecular subtypes in invasive breast carcinomas., Materials and Methods: A total of 210 biopsy-proven breast carcinomas in 200 patients who underwent ultrasound (US) imaging with SMI and SWE were included in this study. Quantitative analyses were performed using mean elasticity (E mean ) score by SWE and vascular index (VI) by SMI. For qualitative assessment of microvascularity, first, lesions were graded according to Adler's classification in four types. Then, a new morphological model was used to classify the microvascular architecture into six patterns: type one, no signal; type two, penetrant; type three, rim-like; type four, dot-like/linear/regional; type five, wheel-like and type six, irregular signals. The correlation between these variables and molecular subtypes, nuclear grade, the Ki-67 levels and axillary status was investigated., Results: The average VI and E mean values were relatively higher in non-luminal subtypes (VI, p = 0.002; E mean , p > 0.05). The two microvascularisation models were significantly able to differentiate the molecular subtypes according to the Kruskal Wallis test (p < 0.05). Rim-like, penetrant and regional patterns were primarily observed in luminal subtypes. The dominant pattern in non-luminal subtypes was wheel-like pattern. VI, E mean , Adler's classification and morphological vascularisation model were not significantly correlated with the nuclear grade, Ki-67 index or axillary status., Conclusion: The proposed microvascular categorization model may be more valuable in predicting molecular subtypes of breast carcinomas compared to VI and E mean and may contribute to the management of breast carcinomas as a non-invasive variable., (Copyright © 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Anterior falcotentorial junction dural arteriovenous fistulas (AFDAVFs) are the most deeply located and most complex type of tentorial fistula due to their location and vascular anatomy. We aimed to make new angiographic definitions of AFDAVF nidus and functionality of the deep venous system of the brain and thereby provide a safer approach for endovascular treatment., Methods: We retrospectively examined 18 patients with AFDAVF who received endovascular treatment at our neuroradiology department between June 2002 and May 2019. Pre- and post-treatment clinical assessments were performed using the modified Rankin Scale. AFDAVF niduses were defined as mixed-type or pure-dural-type on the basis of whether choroidal arteriovenous malformation was coexisting or not, respectively. The deep venous system was denoted as functional or nonfunctional., Results: We included 13 men and 5 women (mean (range) age, 47.2 (31-62) years). We evaluated 15 patients with pure-dural-type AFDAVFs and three with mixed-type AFDAVFs. Complete occlusion of the fistula was achieved in 15/18 patients. Three patients had transient neurologic symptoms. In two patients these were due to mild thalamic ischemia and in the third patient was due to tectal venous ischemia, all in mixed-type AFDAVF. One patient also developed Parinaud syndrome due to compression of the tectal plate by a thrombosed large vein of Galen. No patients died or developed permanent morbidity., Conclusion: Evaluating AFDAVFs as described here using our new subtyping model will help improve analysis of the malformation and development of a safer endovascular strategy, and hence may prevent periprocedural complications and improve treatment safety., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Detecting COVID-19 in computed tomography (CT) or radiography images has been proposed as a supplement to the RT-PCR test. We compare slice-based (2D) and volume-based (3D) approaches to this problem and propose a deep learning ensemble, called IST-CovNet, combining the best 2D and 3D systems with novel preprocessing and attention modules and the use of a bidirectional Long Short-Term Memory model for combining slice-level decisions. The proposed ensemble obtains 90.80% accuracy and 0.95 AUC score overall on the newly collected IST-C dataset in detecting COVID-19 among normal controls and other types of lung pathologies; and 93.69% accuracy and 0.99 AUC score on the publicly available MosMedData dataset that consists of COVID-19 scans and normal controls only. The system also obtains state-of-art results (90.16% accuracy and 0.94 AUC) on the COVID-CT-MD dataset which is only used for testing. The system is deployed at Istanbul University Cerrahpaşa School of Medicine where it is used to automatically screen CT scans of patients, while waiting for RT-PCR tests or radiologist evaluation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier B.V. All rights reserved.)

Aims: In this study, we aimed to reveal mortality rates and factors affecting survival in geriatric patients infected with COVID-19., Methods: This is a retrospective study of 873 geriatric patients with COVID-19 who were hospitalized between March 11, 2020 and March 11, 2021. Demographic, clinical, laboratory data, and treatment options were obtained from electronic medical records. Multivariate logistic regression was used to explore the risk factors for in-hospital death., Results: During the specified period, 643 patients were discharged, and 230 patients died in the hospital. The mean age was 75.08 ± 7.39 years (mean ± SD) and 51.8% were males. We found that older age (≥ 85), polypharmacy, dyspnea, abnormal thorax computed tomography (CT), lower doses of anticoagulation, and high values of white blood cell, aspartate aminotransferase, C-reactive protein, lactate dehydrogenase, ferritin were associated with a significant increase in mortality (P < 0.001 for all). Although all of these values were significant in multivariate logistic regression analysis, the most important ones were dyspnea (Odds ratio (OR) 57.916, 95% confidence interval (CI) 23.439-143.104, P < 0.001), polypharmacy (OR 6.782, 95% CI 3.082-14.927, P < 0.001), and thorax CT classification (typical; OR 9.633, 95% CI 2.511-37.122, P < 0.001)., Conclusion: Older age, polypharmacy, dyspnea, and abnormal thorax CT were the most significant mortality criteria and in addition appropriate anticoagulant use was associated with reduced mortality. Identifying the risk factors to predict mortality in older adults with COVID-19 is important to treat future cases successfully., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: The aim of this study is to demonstrate the diagnostic effect of VWI in differentiating PACNS from other vasculopathies and its role in post-treatment follow-up in PACNS patients in this study., Methods: In this prospective study, we included patients with clinical suspicion of PACNS who presented with new-onset ischemic events and had significant intracranial large vessel stenosis on DSA or MRA. VWI was performed on all patients. The imaging findings and final diagnoses were recorded. Control VWI was performed on patients with PACNS diagnosis after at least 3 months of treatment, and the change in findings was also evaluated., Results: Twenty-three patients were included in the study had a median age of 40 (range 12-58). The most common clinical manifestations were focal neurologic deficits. According to the initial clinical evaluation, 10 patients (43.5%) were classified as PACNS and 13 patients (56.5%) as indeterminate for PACNS. After incorporating the VWI findings, the diagnosis of PACNS was confirmed in all clinically diagnosed PACNS patients. Concentric wall thickening and contrast enhancement were statistically significant in the PACNS group (p <0.001). According to concentric thickening and VWE features, sensitivity and specificity in distinguishing PACNS and other vasculopathies were 95.2%, 75% and 95.2%, 68.8%, respectively. Vessel wall enhancement regressed in 7 of 9 patients during a median follow-up period of 8 months (range 5.5-11.5) in PACNS patients who followed up., Conclusion: VWI seems a new and useful imaging method in the differential diagnosis of PACNS and might be a useful adjunct for post-treatment follow-up., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Indications for flow diversion stent (FDS) treatment are expanding. However, there is still a lack of evidence for the long-term outcome in distally located aneurysms in the M2 segment of the middle cerebral artery (MCA) and beyond., Methods: Consecutive subjects (from June 2013 to August 2020) with MCA aneurysms in the M2 segment or beyond treated with FDS were reviewed retrospectively. The primary endpoints for clinical safety were the absence of mortality, stroke event, re-rupture of the aneurysm, and worsening of clinical symptoms. The primary endpoint for treatment efficacy was complete/near-complete occlusion at follow-up after 12 months., Results: 23 patients were identified: 7 aneurysms were located in the M2 segment of the MCA, 4 in the M2-M3 bifurcation, 2 in M3, 3 in M3-4 branching, and 2 in M4; 5 aneurysms were located in M2 with extension into the M1-M2 bifurcation. 13 aneurysms were of fusiform morphology, 8 sacculofusiform, and 2 saccular. 16 aneurysms were of highly suspected dissecting etiology. The median diameter of the parent vessel was 2.1 mm proximally and 2 mm distally. The median time of the follow-up was 30 months (range 16 months to 6 years). Complete/near complete occlusion was observed in 14/20 patients (70%) and one stable remodeling (5%) was seen at 12 months. 22 patients (95.6%) had an excellent clinical outcome (mRS 0-1) at 6 months. Technical challenges associated with the deployment of FDS occurred in 8.7% of cases. Severe complications, intraparenchymal hemorrhage and re-rupture of the aneurysm occurred in 2 patients (8.7%)., Conclusion: Flow diversion of distally located aneurysms is technically feasible with low morbidity and mortality., Competing Interests: Competing interests: NK is a consultant for MicroVention (consultant and proctorship agreement) outside of this work., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Novel coronavirus disease 2019 is a viral infectious disease which commonly involve the lungs with primarily radiologic manifestations of atypical or organizing pneumonia. It can cause multisystemic involvement including central nervous system symptoms. One of these neurologic manifestations is posterior reversible encephalopathy syndrome (PRES). It is suggested that the increased levels of cytokines and inflammatory mediators in the course of the disease are responsible for cerebrovascular endothelial dysfunction and disruption of the blood-brain barrier. To the best of our knowledge, no pediatric PRES has been reported related to coronavirus disease 2019. Here, we present a pediatric PRES case associated with severe acute respiratory syndrome coronavirus 2 infection., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background/aim: We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19)., Materials and Methods: This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death., Results: A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107–20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473–14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012–1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000–1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001–1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126–1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811–0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065–0.874, P: 0.031)., Conclusion: The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully., Competing Interests: The authors have no conflicts of interest. There is no funding., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Purpose of Review: To give an overview regarding the potential usefulness of vessel wall imaging (VWI) in distinguishing various intracranial vascular diseases, their common imaging features, and potential pitfalls., Recent Findings: VWI provides direct visualization of the vessel wall and allows the discrimination of different diseases such as vasculitis, atherosclerosis, dissection, Moyamoya disease, and reversible cerebral vasoconstriction syndrome. Recent studies showed that concentric and eccentric involvement in the vessel wall, as well as the enhancement pattern were found important for the distinguishing these diseases and evaluating their activity., Summary: Most of the imaging techniques currently used are based on luminal imaging. However, these imaging methods are not adequate to distinguish different diseases that can demonstrate similar radiological findings. VWI is being increasingly used as a noninvasive imaging method to offset this limitation.

Central pontine myelinolysis (CPM) is a neurological disorder characterized by demyelination on the bottom of pons. CPM is known to be the most common clinical presentation of osmotic demyelination syndrome. Osmotic stress formed by rapid correction of hyponatremia in glia cells is thought to be important in pathogenesis. Oligodendroglias are more sensitive to dehydration and volume changes as they are tightly aligned in the pontine. Chronic alcohol use is a rare cause of osmotic demyelination. In chronic alcoholics, central pontine myelinolysis may be asymptomatic or mild symptoms may develop. We presented the case to emphasize that chronic alcoholism is a rare cause of central pontine myelinosis. Keywords: myelinolysis, central pontine, alcoholism.

Purpose: Intrathecal gadolinium-enhanced MR cisternography (IGE-MRC) has a high sensitivity to detect accurate localization of cerebrospinal fluid (CSF) leakage in otorhinorrhea patients. Our purpose in this study was to describe our experience in analyzing clinically suspected CSF leakage by IGE-MRC by using gadobutrol with emphasis on its safety and diagnostic performance., Methods: We retrospectively reviewed our imaging and clinical database for the evaluation of patients admitted to our clinic with complaints of otorhinorrhea between 2017 and 2019. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the follow-up., Results: Of the 85 patients included in the retrospective analysis, 82 (96.5%) had rhinorrhea and 3 (3.5%) had otorrhea. Overall, 29 patients (34.1% of all patients) underwent operation for repair of the CSF leakage site. Beta-transferrin test was available and positive in 33 patients (38.8%). Five (5.9%) patients complained headaches after the procedure and complaints were resolved with increased water intake. Postprocedurally, 3 patients (3.5%) had vertigo and 1 patient (1.2%) complained nausea but spontaneous regression were observed in a few hours. None of the patients experienced a significant complication or adverse reaction during follow-up period. Sixty-seven patients (78.8%) had medical record and telephone follow-up. Mean follow-up duration with call was 14.2 months., Conclusion: IGE-MRC is a minimally invasive and highly sensitive imaging technique. The current results during our follow-up demonstrate the relative safety and feasibility of IGE-MRC by using gadobutrol to evaluate CSF leakage.

Online supplemental material is available for this article.

Aim: Hypertension is a complex condition, and it is difficult to know whether inflammation is a cause or an effect. Information on the association between MRP-8/14 (myeloid-related protein) and hypertension is limited. In this study, we aimed to examine the relationship of MRP-8/14 with carotid intima-media thickness (CIMT) and albuminuria in hypertensive patients and to investigate whether early assay of MRP-8/14 levels could be helpful in assessment of renal damage and carotid atherosclerosis among hypertensive patients., Materials and Methods: 61 hypertensive patients and 40 age-, gender-, and body mass index-matched controls were included into the study. Blood samples including fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total protein, albumin, urea creatinine, uric acid, sedimentation, C-reactive protein (CRP), and MRP-8/14 were collected. 24-hour urine albumin excretion and CIMT measurements were also obtained., Results: All inflammatory variables including uric acid, CRP, sedimentation, MRP-8/14, and CIMT were statistically higher in patients with hypertension than in controls. MRP-8/14 was significantly higher in hypertensive patients with macroalbuminuria than in controls (339.3 (IQR (215.2 - 661.7)) ng/mL vs. 204.9 (IQR (140.1 - 339.3)) -ng/mL, p = 0.005, respectively). The levels of CIMT were the highest in macroalbuminuric hypertensive patients (controls vs. normoalbuminuria, microalbuminuria, macroalbuminuria groups, 0.57 (0.53 - 0.67) mm vs. 0.84 (0.76 - 0.89) mm, p = 0.000; 0.57 (0.53 - 0.67) mm vs. 0.87 (0.67 - 0.93) mm, p = 0.000; 0.57 (0.53 - 0.67) mm vs. 0.92 (0.85 - 0.97) mm, p = 0.000, respectively)., Conclusion: Plasma MRP-8/14 levels were elevated in hypertensive patients with macroalbuminuria, however, it could not serve as an early marker to determine renal damage and carotid atherosclerosis in patients with hypertension.
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Background: The rate of laboratory test utilisation has been increasing unsustainably. Evaluating inappropriately repeated laboratory tests is promising because objective criteria are available to measure the rates while causes can be manipulated easily. In this study, we aimed to evaluate the prevalence, associated factors and financial burden of inappropriate repeat tests., Methods: A cross-sectional study was conducted on the results of 26 types of laboratory tests recorded in a laboratory database of a tertiary hospital between 1 July 2014 and 30 June 2017. Minimum retest intervals were determined from the literature for each type of tests. If the time interval between the two tests was shorter than the minimum retest interval, then the later test was accepted an inappropriate repeat test. Binary logistic regression was performed after univariate analyses., Results: Of a total of 673 794 tests, 109 370 (16.2%) were inappropriate repeat tests. Male gender, being ≥65 years old, being an inpatient, high-volume test and surgical clinic as the test-requesting clinic were associated with inappropriate repeat tests. Also, it was determined that US$66 761.3 had been wasted on inappropriate repeat tests for 3 years., Discussion: There are several factors that increase the rate of inappropriate repeat tests. They should be considered during health policy making or planning interventions to reduce inappropriate repeat tests., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Endovascular techniques are frequently used for the treatment of intracranial aneurysms and flow diverter stents are relatively new and important devices in this field. The aim of our study is to report long-term follow-up results of flow diversion treatment., Methods: We retrospectively examined angiographic images and clinical reports of 133 patients (female, 112 [84%]; mean age, 46.3 years [range, 12-70 years]) who were treated with flow diverters between 2008 and 2013 and were followed up radiologically at least 1 year. The aneurysms treated with flow diverters were assessed according to technical problems, stent patency, residual filling, re-growth, and occlusion status, and the patients were assessed according to morbidity and mortality., Results: Except for ten patients, one aneurysm was treated per patient. Median duration of the follow-up was 927 days. Total occlusion rates in angiographic follow-up were found 76.2% for the sixth-month, 86.7% for the first-year, 93.6% for the third-year, 94.2% for the fifth-year, and 90.2% for entire follow-up period. Nine stent morphology changes were observed in the angiographic controls. Overall mortality and morbidity rates were 3.7% and 4.3%, respectively., Conclusion: Despite technical difficulties and delayed hemorrhages, flow diverter stents are effective tools for the treatment of challenging aneurysms in the long run. Nonetheless, long-term results of flow diversion treatment must be evaluated hemodynamically and clinically in multicenter studies.

Objective: Our purpose was to investigate the added diagnostic value of C-arm contrast-enhanced cone-beam CT (CE-CBCT) to routine contrast-enhanced MRI (CE-MRI) in detecting associated developmental venous anomalies (DVAs) in patients with sporadic intracranial cavernous malformations (ICMs)., Methods: Fifty-six patients (53 with single and three with double ICMs) met the inclusion criteria. All patients had routine CE-MRI scans performed at 1.5 Tesla. The imaging studies (CE-MRI and CE-CBCT) were retrospectively and independently reviewed by two observers, with consensus by a third. Group difference, intra- and interobserver agreement, and diagnostic performance of the modalities in detecting associated DVAs were calculated. Reference standard was CE-MRI., Results: On CE-MRI and CE-CBCT, 37 (66%; of 56) and 47 patients (84%; of 56) had associated DVAs, respectively. In 10 patients (52.6%; of CE-MRI negatives [n=19]), CE-CBCT improved the diagnosis. Nine patients (16%; of 56) had no DVA on both imaging techniques. Difference in proportions of associated DVAs on CE-MRI and CE-CBCT was statistically significant, p < 0.05. Sensitivity, specificity, positive likelihood ratio, and area under the curve of CE-CBCT were 100% (95% confidence interval [CI]: 90.5-100%), 47.3% (95% CI: 24.4-71.1%), 1.9 (95%CI: 1.240-2.911), 0.737 (95%CI: 0.602-0.845), respectively. Intraobserver agreement was excellent for CE-MRI, kappa (κ) coefficient = 0.960, and CE-CBCT, κ=0.931. Interobserver agreement was substantial for CE-MRI, κ=0.803, and excellent for CE-CBCT, κ=0.810., Conclusions: CE-CBCT is a useful imaging technique especially in patients with negative routine CE-MRI in terms of detecting associated DVAs. In nearly half of these particular patients, it reveals an associated DVA as a new diagnosis., Key Points: • Although it is known to be the gold standard, some of the DVAs associated with ICMs are underdiagnosed with CE-MRI. • In nearly half of the patients with negative routine CE-MRI, CE-CBCT reveals an associated DVA as a new diagnosis. • Intra- and interobserver agreement on CE-CBCT is excellent in terms of detecting associated DVAs.

Bullet embolism to the heart is a rare but serious complication of penetrating trauma. Distant migration of foreign bodies via the vascular system must be taken into consideration following penetrating gunshot trauma. Delays in diagnosis may result in poor management and subsequent complications that may lead to grave prognosis. Presently described was a conservatively managed case of asymptomatic intracardiac pellet embolization. Highlighted was the importance of serial scanning for intravascular migration of pellet following penetrating gunshot injury, in addition to conservative management in asymptomatic patients.

Purpose: We aimed to determine the correlations between the elasticity values of solid breast masses and histopathological findings to define cutoff elasticity values differentiating malignant from benign lesions., Materials and Methods: A total of 115 solid breast lesions of 109 consecutive patients were evaluated prospectively using shear wave elastography (SWE). Two orthogonal elastographic images of each lesion were obtained. Minimum, mean, and maximum elasticity values were calculated in regions of interest placed over the stiffest areas on the two images; we also calculated mass/fat elasticity ratios. Correlation of elastographic measurements with histopathological results were studied., Results: Eighty-three benign and thirty-two malignant lesions were histopathologically diagnosed. The minimum, mean, and maximum elasticity values, and the mass/fat elasticity ratios of malignant lesions, were significantly higher than those of benign lesions. The cutoff value was 45.7 kPa for mean elasticity (sensitivity, 96%; specificity, 95%), 54.3 kPa for maximum elasticity (sensitivity, 95%; specificity, 94%), 37.1 kPa for minimum elasticity (sensitivity, 96%; specificity, 95%), and 4.6 for the mass/fat elasticity ratio (sensitivity, 97%; specificity, 95%)., Conclusion: SWE yields additional valuable quantitative data to ultrasonographic examination on solid breast lesions. SWE may serve as a complementary tool for diagnosis of breast lesions. Long-term clinical studies are required to accurately select lesions requiring biopsy.

Objectives: To measure the median nerve (MN) stiffness by quantitative shear wave elastography (SWE) at the carpal tunnel inlet and to determine whether SWE can be used in the diagnosis of carpal tunnel syndrome (CTS)., Methods: The study included 37 consecutive patients (60 wrists) with a definitive diagnosis of CTS and 18 healthy volunteers (36 wrists). The MN cross-sectional area (CSA) by ultrasound and stiffness by SWE were studied. The difference between CTS patients and controls, and the difference among subgroups based on electrodiagnostic tests were studied by the Student's t test. Interobserver variability and ROC analysis were performed., Results: The MN stiffness was significantly higher in the CTS group (66.7 kPa) when compared to controls (32.0 kPa) (P < 0.001), and higher in the severe or extreme severity group (101.4 kPa) than the mild or moderate severity group (55.1 kPa) (P < 0.001). A 40.4-kPa cut-off value on SWE revealed sensitivity, specificity, PPV, NPV and accuracy of 93.3%, 88.9%, 93.3%, 88.9% and 91.7%, respectively. Interobserver agreement was excellent for SWE measurements., Conclusions: Median nerve stiffness at the carpal tunnel inlet is significantly higher in patients with carpal tunnel syndrome, for whom shear wave elastography appears to be a highly reproducible diagnostic technique., Key Points: • Clinical examination is important for diagnosis of carpal tunnel syndrome • Shear wave elastography (SWE) offers new clinical opportunities within diagnostic ultrasound • SWE is highly reproducible in evaluation of median nerve stiffness • Median nerve stiffness is significantly increased in carpal tunnel syndrome • Elastography could become useful in diagnosis of carpal tunnel syndrome.

A case of acute mesenteric ischemia due to thrombosis of superior mesenteric artery and vein in a 44-year-old woman following chemotherapy for invasive laryngeal carcinoma was diagnosed on a multi-detector CT scan. Although the link between malignancy and thromboembolism is widely recognized in patients with cancer, chemotherapy further elevates the risk of thrombosis. Acute mesenteric ischemia associated or not associated with chemotherapy rarely occurs in patients with cancer. Moreover, co-occurrence of superior mesenteric artery and superior mesenteric vein thrombosis is reported for the first time.

Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.

Herein, we describe a new carotid stenting approach for four patients with moderate-to-severe chronic renal insufficiency, who have a glomerular filtration rate (GFR) between 15 and 59 mL/min/1.73 m(2), using a minimum dose of contrast medium (12 mL at a 50% dilution) and SmartMask™ technology as an alternative to carotid endarterectomy., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery (VA) stenosis seems a safe, effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation, with a low complication rate and good long-term results. In patients with severe tortuosity of the vessel, stent placement is a real challenge. The new coronary balloon-expandable stents may be preferred. A large variability of restenosis rates has been reported. Drug-eluting stents may be the solution. After a comprehensive review of the literature, it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible, but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.