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This report describes a case of radiographically unstable knee juvenile osteochondritis dissecans (JOCD) that healed without surgery. The authors utilize objective measurements of serial magnetic resonance imaging (MRI) to evaluate healing of the JOCD lesion and inform the decision to continue the course of conservative care or proceed to surgery. A 15-year-old soccer player presented with a 1-month history of worsening left knee pain. Magnetic resonance imaging showed an osteochondral lesion of the lateral femoral condyle with highly specific signs of instability including multiple cyst-like lesions (CLL) and large CLL diameter. An approach involving low-impact, low-intensity rehabilitative exercises and other modalities was implemented. Follow-up MRIs were performed at 3, 6, and 8 months to monitor changes and recalculate healing probability using a previously published nomogram. Clinical improvement was measured using outcome assessments. Follow-up MRIs showed a progressive reduction in size and number of CLLs and a resulting increase in healing probability from 20 to 70%. The patient successfully returned to play at just over 8 months after diagnosis. This case highlights that significant healing in knee JOCD is possible during a carefully monitored course of non-operative care, despite imaging signs of instability such as multiple and large CLL.

Background There is limited knowledge of morphologic changes of the anterior cruciate ligament (ACL) during childhood. The purpose of the study is to describe normal ACL growth in pediatric patients. Methods We performed retrospective review of patients under 19 years of age with at least 2 serial magnetic resonance imaging (MRI) examinations of the same knee without ACL tear. The parameters measured included length of the ACL, width of the ACL in sagittal and coronal planes, physeal status, ACL-tibial inclination angle, Notch Width Index, ACL tibial attachment width and midpoint, and anterior to posterior length and height of the tibial epiphysis. Pearson correlation coefficients were calculated to determine the strength of correlation of each parameter relative to age. Growth curves were calculated for individual parameters, producing a predictive model for growth of the ACL over time. Results One hundred forty-seven patients (365 MRIs) were included. The average age at initial MRI was 12.2 years (range: 1.2 to 18.4 y). The Pearson correlation coefficient for each parameter was statistically significant relative to age. Younger patients had more oblique, anteriorly attached ACLs. Three distinct phases of growth were observed: patients age 1.5 to 5.75 years average 2.25 mm of growth per year; patients aged 6 to 11.5 average 1.46 mm of growth per year; growth slows at age 11.75, stopping by 18.5 years. The growth model for ACL sagittal width increased 0.45 mm/y from age 1.5 to 14.5 after which it plateaus, whereas coronal width increased 0.22 mm/y from age 1.5 to 18.75. Conclusions In the pediatric patient, the ACL grows in length and width in a predictable manner until age 18. This model aids clinicians in predicting normal ACL parameters for anatomic reconstruction procedures in the skeletally immature patient. Level of evidence Level IV.

Vestibular schwannomas (VSs) were proposed to arise from the glial-Schwann cell junction within the internal auditory canal (IAC). However, otopathology studies indicate that VS may arise anywhere along the course of the vestibular nerve. Recent studies suggested that the majority of tumors are located centrally within the IAC with an equal distribution near the porus acusticus and the fundus. However, these studies analyzed tumors of all sizes, obscuring their precise origin. Herein, we aim to quantify the position of small intracanalicular tumors (

In most patients with intracerebral hemorrhage (ICH), the hematoma and perihematomal area decrease over the subsequent months but patients continue to exhibit neurological impairments. In this serial imaging study, we characterized microstructural and neurophysiological changes in the ICH-affected brain tissues and collected the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Score (mRS), two clinical stroke scale scores. Twelve ICH patients were serially imaged on a 3T MRI at 1, 3, and 12 months (M) after injury. The hematoma and perihematomal volume masks were created and segmented using FLAIR imaging at 1 month which were applied to compute the susceptibilities (χ), fractional anisotropy (FA), mean diffusivity (MD), and cerebral blood flow (CBF) in the same tissues over time and in the matching contralesional tissues. At 3 M, there was a significant (p < 0.001) reduction in hematoma and perihematomal volumes. At 1 M, the χ, FA, and CBF were decreased in the perihematomal tissues as compared to the contralateral side, whereas MD increased. In the hematomal tissues, the χ increased whereas FA, MD, and CBF decreased as compared to the contralesional area at 1 M. Temporally, CBF in the hematoma and perihematomal tissues remained significantly (p < 0.05) lower compared with the contralesional areas whereas MD in the hematoma and χ in the perihematomal area increased. The NIHSS and mRS significantly correlated with hematoma and perihematomal volume but not with microstructural integrity. Our serial imaging studies provide new information on the long-term changes within the brain after ICH and our findings may have clinical significance that warrants future studies.

Background The natural course of syringomyelia is unpredictable. Only a few cases of adults with spontaneous resolution of syringomyelia associated with Chiari malformation type I (CM-I) have been reported. The timing of surgical intervention for syringomyelia remains controversial. The present report has documented a case with the longest medical history of syringomyelia reported, the associated imaging findings over 16 years, the mild symptom progression after the spontaneous resolution of syringomyelia, and a review of the relevant reported data. The natural history of our patient provides a unique view regarding the factors that might lead to the development and spontaneous resolution of syringomyelia. Case Description We present the case of a 36-year-old woman who had been monitored for 16 years for mild symptomatic CM-I and syringomyelia. After regular follow-up examinations for the initial 10 years, magnetic resonance imaging revealed partial spontaneous resolution of the syringomyelia and unchanged symptoms. However, after 6 additional years of follow-up examinations, her symptoms had mildly progressed, and the size of the syringomyelia had obviously decreased. Conclusions The findings from our patient suggest that the natural course of mild symptomatic CM-I in adult patients will be benign and nonprogressive. Patients will commonly present with very few or mild symptoms, despite the presence of a large syrinx. It would be reasonable to observe patients with similar mild symptoms and syringomyelia. Surgery will be indicated by the type, severity, and duration of symptoms at the first clinical visit. Periodic follow-up examinations are also essential after spontaneous resolution because the pathophysiology of syringomyelia is incompletely understood and recurrence possible.

Objectives: The objective of this study was to evaluate the incidence of osteolysis around the bioabsorbable and nonabsorbable anchors using serial magnetic resonance imaging (MRI) and to determine the relationship between osteolysis and the retear rate after arthroscopic rotator cuff repair. Methods: From July 2012 to July 2014, 50 patients [28 men and 22 women; mean age, 56.4 (range: 45–56) years] underwent arthroscopic rotator cuff repair for a medium-to large-size tear with double-row suture-bridge technique. The bioabsorbable anchors used in the medial row comprised hydroxyapatite-polylactic acid enantiomer, and the nonabsorbable anchors in the lateral row were polyetheretherketone (PEEK)-type anchors. All patients underwent MRI evaluation at 3, 6, and 12 months postoperatively to determine osteolysis and identify any retear. Results: The incidences of osteolysis at 3, 6, and 12 months postoperatively were 1%, 4%, and 6% with nonabsorbable anchors and 13%, 29%, and 39% with bioabsorbable anchors, respectively. The incidences of osteolysis were significantly higher with the bioabsorbable anchors than with the nonabsorbable anchors (P

BACKGROUND: Patients with atrial fibrillation (AF) have a high incidence of cognitive impairment, which may be related to clinically silent microembolism causing cerebral infarctions. OBJECTIVE: To explore the occurrence and timing of silent brain lesions following electrical cardioversion (CV) of recent onset AF in anticoagulant-naïve patients and to study related effects on cognitive function and biomarkers of cerebral damage, S100b. METHODS: Patients with AF duration > 48 hours were prospectively included. Brain magnetic resonance imaging (MRI) and S100b, were obtained prior, after and 7-10 days following CV. Trail making tests (TMT-A and TMT-B) and their difference, ΔΤΜΤ, were assessed prior to CV, 7-10 days and 30 days after CV. RESULTS: Forty-three patients (84% males) with median CHA2DS2-VASc score 1 (interquartile range 0-1) were included. Sequential MRI, including diffusion weighted scans, showed no new brain lesions after CV. Chronic white matter hyperintensities were present at baseline in 21/43 (49%) patients. The S100b (µg/l) levels increased significantly from baseline, (mean ±SD) 0.0472±0.0182 to 0.0551±0.0185 after CV, p=0.001 and then decreased 7-10 days after CV to 0.0450±0.0186, p 1.96). CONCLUSIONS: New brain lesions could not be detected on MRI after CV, but the high incidence of white matter hyperintensities and the transient increase in S100b may indicate transient or minor brain damage undetectable by MRI thus heightening the need to reevaluate thromboembolic risk prior to CV even in low risk patients.

Change detection and progression assessment in multiple sclerosis (MS) by serial magnetic resonance imaging (MRI) are important, yet challenging tasks. Analysis algorithms such as Voxel-Guided Morphometry (VGM) enable detection and quantification of even minor changes of the brain at different time points. To shorten computation times and ameliorate clinical applicability, we developed a convolutional neural network based VGM (Deep VGM) providing a fast solution for intra-individual serial volume change analysis in MS.

Objectives:To report 2 additional cases of pyruvate dehydrogenase complex deficiency with reversible deep gray matter lesions following initiation of ketogenic diet and to perform a literature review of serial imaging in patients with pyruvate dehydrogenase complex.Methods:Clinical data on 3 previously unpublished cases of patients with pyruvate dehydrogenase complex deficiency and with serial magnetic resonance imagings (MRIs) before and after institution of ketogenic diet were reported. A systematic literature review was performed to search for published cases of patients with confirmed pyruvate dehydrogenase complex deficiency who underwent serial MRIs.Results:The 3 subjects in this series demonstrated clinical improvement on ketogenic diet. Two subjects showed reversal of some brain lesions on repeat MRI following initiation of ketogenic diet. Of the 21 published cases with serial MRIs, 13 patients underwent some form of treatment, and of this smaller subset 4 patients had repeat MRIs that showed definitive improvement. In both our described cases and those published in the literature, improvement occurred in lesions in the basal ganglia.Conclusions:In patients with pyruvate dehydrogenase complex deficiency, basal ganglia lesions on MRI are reversible with treatment in some cases and could serve as a biomarker for measuring response to treatment.

Introduction Identifying at what point atrophy rates first change in Alzheimer's disease is important for informing design of presymptomatic trials. Methods Serial T1-weighed magnetic resonance imaging scans of 94 participants (28 noncarriers, 66 carriers) from the Dominantly Inherited Alzheimer Network were used to measure brain, ventricular, and hippocampal atrophy rates. For each structure, nonlinear mixed-effects models estimated the change-points when atrophy rates deviate from normal and the rates of change before and after this point. Results Atrophy increased after the change-point, which occurred 1–1.5 years (assuming a single step change in atrophy rate) or 3–8 years (assuming gradual acceleration of atrophy) before expected symptom onset. At expected symptom onset, estimated atrophy rates were at least 3.6 times than those before the change-point. Discussion Atrophy rates are pathologically increased up to seven years before "expected onset". During this period, atrophy rates may be useful for inclusion and tracking of disease progression.

Although chronic arterial hypertension (CAH) represents the major comorbid factor in stroke, it is rarely integrated in preclinical studies of stroke. The majority of those investigations employ spontaneously hypertensive rats (SHR) which display a susceptibility to ischemic damage independent of hypertension. Here, we used a renovascular model of hypertension (RH) to examine, with magnetic resonance imaging (MRI), brain alterations during the development of hypertension and after brain ischemia. We also examined whether MRI-derived parameters predict the extent of ischemia-induced brain damage. RH was induced according to the two-kidney one-clip model and multiparametric MRI was performed at 3, 6, 9, and 12 weeks after hypertension and also at 10, 50, and 60 min following stroke. Blood pressure values increased progressively and reached a plateau at 6 weeks after RH induction. At 12 weeks, all hypertensive animals displayed spontaneous brain lesions (hemorrhages, deep and cortical lesions, ventricular dilatation), increased apparent diffusion coefficient (ADC) values in the corpus callosum and higher fractional anisotropy in the cortex. Following ischemia, these animals showed larger brain lesions (406 ± 82 vs. 179 ± 36 mm3, p

A 13-month-old intact female poodle dog presented with an acute history of circling and seizure episodes. On the basis of the results of neurologic examination combined with magnetic resonance imaging and cerebrospinal fluid analysis (CSF), meningoencephalitis of unknown etiology (MUE) was suspected. Therapy with mycophenolate mofetil plus prednisolone was initiated, following which the clinical signs showed improvement for only one month before gradually worsening again. Acute progression of the clinical disease was observed, and the patient was euthanized 91 days after initial presentation. This case was definitively diagnosed as necrotizing meningoencephalitis (NME) according to the results of post-mortem histopathological examination. This report describes the clinical findings, serial magnetic resonance imaging (MRI) characteristics, and histopathological changes in a case of acute NME.

Placenta percreta is a rare condition that presents a risk of massive intraoperative hemorrhage. To decrease maternal morbidity in such cases, conservative management was recently adopted as an option. Nevertheless, severe morbidity occurs in 42% of cases. In addition, the clinical course of conservative management remains unclear. We encountered a case of placenta percreta that was successfully treated by conservative management without complications or other clinical interventions. Serial magnetic resonance imaging (MRI) was performed to investigate the natural course of conservative management of placenta percreta. MRI on postoperative day (POD) 99 showed a decrease in placental size without gadolinium enhancement. MRI on POD 162 showed that the residual placenta was approximately 4 cm in size without gadolinium enhancement. On POD 265, the placenta had almost disappeared. This is the first series of MRI of conservative management of placenta percreta without clinical interventions. We present our case and a literature review.

Background Cerebral cavernous malformations are more common than generally thought, affecting approximately 1 in every 250 adults. Most of these lesions are asymptomatic or have a relatively benign course, but a small minority behave aggressively and present with recurrent episodes of symptomatic hemorrhage. A safe and effective medical treatment option for the management of this latter group would be useful. Propranolol has recently been shown to be effective in the treatment of infantile hemangioma, a close pathologic counterpart of cavernous malformations. These results suggest a potential role for propranolol treatment in the management of patients with symptomatic cavernous malformations. Methods Low-dose propranolol (20 mg, three times daily) was used to treat 2 adult female patients in their mid- to late fifties, both of whom had symptomatic cavernous malformations and a history of repeated hemorrhage. Serial magnetic resonance imaging studies after the initiation of propranolol demonstrated regression of the lesions and no evidence of recurrent hemorrhage. Conclusions Propranolol may offer a safe and effective treatment for patients who have cavernous malformations with symptomatic hemorrhage. Additional studies are needed to confirm these findings.

To date, there is no consensus regarding which type of cortical suspension device is biomechanically superior during anterior cruciate ligament reconstruction. Retensioning or knotting has been reported to improve the biomechanical profile of adjustable-length devices, although fixed-length devices demonstrated overall superior biomechanical properties. Intraoperative or postoperative loop slippage and graft displacement should be investigated in future clinical and radiographic studies including serial magnetic resonance imaging.

We report a case of a 7-month-old infant with serial magnetic resonance imaging (MRI) confirmation of the neonatal hypoglycemia induced brain damage. Cranial MRI on day 17 revealed T1 and T2 prolongation of cortical and white matter in the parietal and occipital lobes bilaterally. A control cranial MRI on the seventh month showed shrunken and atrophied cortex and underlying white matter of the occipital and parietal lobes. Early and accurate diagnosis is critical in these patients, brain MRI is useful to assess the severity of brain damage associated with neonatal hypoglycemia. Besides detection of hypoglycemia, it is very important to find out underlying disorder to prevent sequelae.

Radiographic descriptions of findings related to status epilepticus (SE) have been described for over 50 years. The initial description of changes on radiographic imaging was using pneumoencephalograms on children with seizures [1]. Eventually, neuroanatomic correlations to seizure foci were published as seen on computed tomography (CT) scan [2]. Now with the advent of magnetic resonance imaging (MRI), our ability to detect pathology related to the causes and sequelae of SE has dramatically increased.

PurposeTo measure orbital volume using serial magnetic resonance imaging (MRI) scans to determine the effect of enucleation on orbital growth over time.MethodsThe medical records of patients who underwent unilateral enucleation for retinoblastoma with a minimum of 2 MRIs were retrospectively reviewed. Orbital asymmetry was calculated using MRI measurements. Nonlinear and linear mixed effect regression models were used to predict the effect of age at time of enucleation on degree of orbital asymmetry.ResultsA total of 27 patients were included (mean age at enucleation, 2years; range, 2.5months to 5years). Age at scan (P=0.046) and age at enucleation (P=0.0006) were found to have a significant effect on orbital asymmetry. Change in orbital asymmetry over time was more pronounced after enucleation in children enucleated at

Medial migration of intracanalicular vestibular schwannoma (VS) with associated widening of the fundal cap is a rare phenomenon that, to our knowledge, has only been described in a patient following stereotactic radiation treatment. Herein, we present a case of a woman in her 60s with an untreated intracanalicular VS that demonstrated medial migration on serial magnetic resonance imaging (MRI) scans over the course of 30 months.

It is important to recognize the signs and symptoms of human African trypanosomiasis (HAT) in order to facilitate early diagnosis and treatment. A 36-year-old man developed encephalitis caused by HAT. This encephalitis can appear many years after well-tolerated systemic infection. The neurologic manifestations developed 7 years after he had emigrated from Cameroon to the United States. We demonstrate the magnetic resonance imaging before, during, and after his treatment with intravenous eflornithine. Clinical signs and symptoms of HAT can be nonspecific and precede abnormalities on magnetic resonance imaging. Human African trypanosomiasis should be considered in the differential diagnosis of patients who have lived in sub-Saharan Africa and have a clinical presentation of subacute encephalitis.

We present a case of Listeria monocytogenes cerebral abscess with axonal spread via the subcortical U-fibres and extreme capsule on magnetic resonance imaging, with follow-up studies demonstrating serial reduction in oedema and enhancement pattern of the white-matter fibre tracts following antimicrobial treatment. We discuss the microbiological mechanism of bacterial mobility to account for these unique imaging features. Recognition of this distinct pattern of spread of L. monocytogenes cerebral abscess may aid in diagnosis and enable early microbiological culture and treatment.

Background: Little is known about morphologic changes in the remodeling period after human meniscal allograft transplantation (MAT).Hypothesis: The gross structure of meniscal transplants may be altered significantly in width and thickness during early remodeling periods.Study Design: Cohort study; Level of evidence, 3.Methods: Thirty-one patients who underwent MAT (9 medial and 22 lateral menisci) between 2008 and 2009 were prospectively evaluated by serial magnetic resonance imaging scans 2 days, 6 weeks, and 3, 6, and 12 months after surgery. At each time point, the width and thickness of the menisci were measured. The relative degree of shrinkage after 1 year was categorized as minimal (50%). The Lysholm score and Tegner activity level were used for clinical outcome scales.Results: More apparent changes were observed at mid-body rather than at the posterior horn. Meniscal width at the mid-body decreased to 89% ( P < .01), whereas thickness increased to 115% ( P < .01) at 12 months. Shrinkage was observed for 3 months after MAT, but there were no significant changes thereafter. The thickness of the meniscal peripheral rim did not change before 3 months but increased afterward, for up to 1 year. Of the 31 patients, 20 (64.5%) had minimal shrinkage, 6 (19.4%) had mild shrinkage, 5 (16.1%) had moderate shrinkage, and none had severe shrinkage over 1 year. In the 5 cases of moderate shrinkage, the reduction occurred progressively for 1 year. However, the relative morphologic changes did not correlate with clinical outcome scales at postoperative 1 and 2 years ( P > .05). The preoperative alignment deviation, cartilage status (Outerbridge grade), age, gender, amount of extrusion, and time from previous meniscectomy did not affect the degree of shrinkage.Conclusion: Gross morphologic alterations, as determined by width and thickness, were observed during the first postoperative year. Substantial shrinkage at the mid-body occurred progressively for 1 year in 16.1% of the cases. No association was found between morphologic changes and short-term clinical outcomes.

Background. Diffuse low-grade gliomas (LGGs) are infiltrative, slow-growing primary brain tumours that remain relatively asymptomatic for long periods of time before transforming into aggressive high-grade gliomas. Surveillance of tumour stability is performed primarily by serial imaging. Methods. We retrospectively identified LGG patients that were managed by observation with numerous (≥8) serial magnetic resonance imaging (MRI) studies. Tumour volumes were measured by manual segmentation on imaging. Demographic information, tumour histopathological data, and radiological interpretations were collected from electronic medical records. MRI radiology reports of tumour volume stability were classified into "growth" and "no growth" interpretations. Results. Of 74 LGG patients, 10 (13.5%) patients were included in the study. A median of 11 MRIs (range, 8-18) over a median of 79.7 months (range, 39.8-113.8 months) were analyzed per patient. Tumour diameter linearly increased at a median rate of 2.17 mm/year. Cox regression analysis showed that initial tumour volume predicted time to clinical intervention, and Mann-Whitney U test found that tumours of patients diagnosed before age 50 grew more slowly. Radiology interpretations that reported "no growth" (n=66) corresponded to a median measured growth of 3.90 mL and 11.0% compared to the comparison scan. Reports of "growth" (n=36) corresponded to median measured volume increases of 9.36 mL and 20.5%. Conclusion. We retrospectively analyzed the natural history of LGGs in serially-imaged patients at a single institution. Comparisons to the literature suggest that this is a subset of particularly slow-growing and low-risk tumours. We also highlight the clinical value of performing accurate LGG volumetric analyses.

114 Background: The utility of serial magnetic resonance imaging (MRI)/ultrasound (US) fusion targeted prostate biopsy in men with prostate cancer (PCa) on active surveillance (AS) have not been clearly defined. We sought to investigate the rate of Gleason upgrading both on sequential fusion targeted and systematic biopsies among men with low-risk PCa managed with AS. Methods: We retrospectively queried an institutional database of 800 patients undergoing MRI/US fusion biopsy to identify 209 patients on AS with at least two fusion biopsies between December 2013 and November 2016. Men with National Comprehensive Cancer Network (NCCN) very low-risk and low-risk criteria were included. Gleason upgrade was defined as detection of Gleason score >=3+4. The proportion of patients experiencing upgrade on systematic, fusion, or both biopsy techniques was tabulated. Associations of clinical, pathologic, and imaging factors with biopsy upgrade were analyzed by logistic regression. Results: Of 209 patients undergoing MRI/US fusion biopsy, 73 (35.0%) had at least two targeted biopsies (66% very low-risk and 34% low-risk PCa). The time between biopsies was 12.6 months (11.2-17.7). The median PSA and PSA density were 5.4 ng/mL (4.2-7.1) and 0.11 ng/mL/mL (0.07-0.18), respectively. 21 (29%) patients experienced Gleason upgrade on subsequent biopsy. Of those, 6 (8%), 5 (7%), and 10 (14%) had upgrade on systematic biopsy only, fusion biopsy only, and both systematic and fusion biopsy, respectively. Patients with upgrade on subsequent biopsy had higher PSA (p=0.02) and PSA density (p=0.02), and were among low-risk disease population (p=0.03). In logistic regression models, greater number of positive cores in systematic biopsy (OR 1.88; 95% CI 1.23-2.92; p=0.005) was associated with the total Gleason upgrade on repeated biopsy. Conclusions: In men with favorable risk prostate cancer managed with AS, Gleason upgrade was detected in a 29% of patients on a second MRI/US fusion biopsy including both targeted and systematic regions. These findings support the continued use of both MRI fusion and systematic biopsy during surveillance due to risks of reclassification over time.

The size of brain ventricles is especially relevant in some brain diseases such as epilepsy, schizophrenia and other neurodegenerative diseases. Many studies have been conducted to assess the brain ventricles. To the best of our knowledge, however, there is no fourth, third and lateral ventricles volume study evaluating the efficiency and accuracy of point-counting and planimetry methods of the Cavalieri principle in the literature. In the current study, we estimated the volume of intracerebral ventricles in normal subjects using stereological methods. The volumes of fourth, third and lateral ventricle were estimated in 14 young Turkish volunteers ( 7 males and 7 females), aged between 18 and 36 years and free of any neurological symptoms and signs, using serial magnetic resonance imaging (MRI). Volumes of intracerebral ventricles were determined on MRIs using the point-counting and planimetry methods. The mean results of the point-counting method were 14.7 +/- 4.2, 8.7 +/- 3.0 and 131.8 +/- 33.1 mm(3) for the fourth, third and lateral ventricles, respectively. The mean results of the planimetry method were 15.4 +/- 3.4, 8.6 +/- 3.5 and 153.7 +/- 34.6 mm(3) for the fourth, third and lateral ventricles, respectively. Ventricle volumes obtained by the two different methods were not statistically different ( p > 0.05) and they correlated well with each other. Good agreement was found between results obtained with the point-counting and planimetry techniques. The findings of the present study using stereological methods could provide data for the evaluation of normal and pathological volumes of intracerebral ventricles., The size of brain ventricles is especially relevant in some brain diseases such as epilepsy, schizophrenia and other neurodegenerative diseases. Many studies have been conducted to assess the brain ventricles. To the best of our knowledge, however, there is no fourth, third and lateral ventricles volume study evaluating the efficiency and accuracy of point-counting and planimetry methods of the Cavalieri principle in the literature. In the current study, we estimated the volume of intracerebral ventricles in normal subjects using stereological methods. The volumes of fourth, third and lateral ventricle were estimated in 14 young Turkish volunteers (7 males and 7 females), aged between 18 and 36 years and free of any neurological symptoms and signs, using serial magnetic resonance imaging (MRI). Volumes of intracerebral ventricles were determined on MRIs using the point-counting and planimetry methods. The mean results of the point-counting method were 14.7 +/- 4.2, 8.7 +/- 3.0 and 131.8 +/- 33.1 mm(3) for the fourth, third and lateral ventricles, respectively. The mean results of the planimetry method were 15.4 +/- 3.4, 8.6 +/- 3.5 and 153.7 +/- 34.6 mm(3) for the fourth, third and lateral ventricles, respectively. Ventricle volumes obtained by the two different methods were not statistically different (p > 0.05) and they correlated well with each other. Good agreement was found between results obtained with the point-counting and planimetry techniques. The findings of the present study using stereological methods could provide data for the evaluation of normal and pathological volumes of intracerebral ventricles.

BackgroundNo consensus has been reached with regard to the ideal timing of anterior cruciate ligament reconstruction in terms of reducing secondary meniscal tears in anterior cruciate ligament–deficient knees.HypothesisDelay in anterior cruciate ligament reconstruction increases the incidence and severity of medial meniscal tears.Study DesignCase series; Level of evidence, 4.MethodsThirty-one patients were evaluated with arthroscopic all-inside suturing of medial meniscal tears with concurrent anterior cruciate ligament reconstruction who had at least 2 preoperative magnetic resonance imaging studies. Patients were evaluated during the acute phase of injury, but anterior cruciate ligament reconstruction surgery was delayed at least 6 months. Mean interval between first and second imaging studies was 36.8 months. Subsequent medial meniscal tears were identified as longitudinal or bucket-handle types. Relationships between medial meniscal lesions and patient age, time interval between the date of initial injury and surgery, repetitive injury, and patient activity level were evaluated.ResultsDuring the first preoperative magnetic resonance imaging studies, 14 knees had no medial meniscal tear, 15 a longitudinal tear, and 2 a bucket-handle–type tear; during the second preoperative imaging studies, 5 knees had no medial meniscal tear, 19 a longitudinal tear, and 7 a bucket-handle–type tear. The incidence of medial meniscal tears increased from 55% in first studies to 84% in second studies for chronic anterior cruciate ligament–insufficient knees (P =. 0054). Eight knees without a tear during first studies had a longitudinal tear during second studies, 1 knee without a tear and 4 with a longitudinal tear in first studies had a bucket-handle–type tear in second studies. Thirteen knees (42%) had a worse meniscal status during the second studies.ConclusionDelayed anterior cruciate ligament reconstruction increases the likelihood of a medial meniscal tear, suggesting that early anterior cruciate ligament reconstruction should reduce or prevent additional medial meniscal injury. The findings show that further medial meniscal damage is common if surgery is delayed by 6 months or more.

An 18-year-old girl presented with central pontine myelinolysis (CPM) following surgery for craniopharyngioma. Postoperatively, the patient developed diabetes insipidus with remarkable fluctuation of serum sodium level, suffered a seizure, and developed mental state changes and quadriparesis. Magnetic resonance (MR) imaging obtained soon after the development of the symptoms showed no significant abnormalities. MR imaging obtained 2 months later demonstrated typical trident or bat-like signal abnormalities in the center of the pons, compatible with CPM. Serial MR imaging obtained at 7 and 10 months showed the lesion had decreased in size or almost completely resolved and the patient almost completely recovered. CPM is well known, but neurosurgeons should consider the possibility following surgery for craniopharyngioma.

To evaluate the effect activity has on the vaginal distribution of a 1200 mg miconazole nitrate gelatin encapsulated insert, an antifungal agent commonly used to treat vaginal vulvocandidiasis.Nine subjects underwent two sessions of serial magnetic resonance imaging after insertion of the insert. One session required that the subjects ambulate between images; the other session required the subjects remain supine between images. Vaginal distribution of the insert was quantified by calculating surface contact and linear distance in every image. Comparison of spread was then done between images taken in active subjects and images taken in resting subjects. Time until capsule dissolution was also compared between the two groups.No statistically significant difference was seen in spread of insert between the active and resting group. Activity also had no significant effect on capsule dissolution.Activity does not appear to hinder the spread of the insert, suggesting that this medication can be used daytime or nighttime.

Purpose: Intracranial aneurysm (IA) growth is associated with increased morbidity. We sought to establish a quantitative computational method based on contrast-enhanced MR angiography (CE-MRA) for estimating aneurysmal volume changes over time. Materials and Methods: Computational volume calculations were tested against a distensible phantom. Untreated patients with IA were followed longitudinally with annual MRI. Maximal linear dimensions along the longitudinal axis and two transverse axes were determined by visual review of maximum intensity projection (MIP) data, and aneurysm volume was approximated as (length x width x height)/2. Averages of the visual approximations were compared to the lumenal volume as determined with a computational algorithm using the MRI data. Results: MRI-based measurements accurately represented volume changes in the phantom (R-2 = 0.97, Y = 1.06x + 271 CM3). In the clinical study there were a total of 11 intervals of one-year follow-up in six patients (mean +/- SD age = 53 +/- 20 years). The raw one-year growth using the computational volume was 9% +/- 17%. The corresponding value for the averaged measurement of the reviewers was 8% +/- 14%. Neither the mean values nor the SDs were different (P = .51). Conclusion: MRI-based measurement of aneurysm volume appears feasible for longitudinal studies of aneurysm natural history.