BackgroundThe aim of the study was to investigate the value of diffusion weighted MR imaging in the diagnosis of Modic type 1 change, which may be confused with the acute infectious spondylodiscitis on conventional MR imaging.Patients and methodsTwenty-seven patients with erosive intervertebral osteochondrosis, Modic type 1 and 18 patients with spondylodiscitis were included in this retrospective study. All images were acquired using on 1.5 Tesla MR units. Lumbar spinal MR imaging of 45 patients were retrieved from a digital database of a radiology record system and evaluated by one experienced radiologist. Patients with Modic type 1 change had CT slices obtained from the diseased disc space and the affected vertebrae.ResultsBone marrow adjacent to the vertebral end plate in both Modic type 1 change and acute spondylodiscitis were hypointense on T1-weighted images. On T2-weighted images corresponding levels of vertebral end-plates showed hyperintense signal intensity in both group. All the patients with spondylodiscitis and Modic type 1 change were hyperintense and hypointense on diffusion-weighted MR images, respectively.ConclusionsOur findings suggest that diffusion weighted MR imaging is an useful method in differentiating Modic type 1 changes from acute spondylodiscitis, both of which may mimic each other, either on clinical or conventional MRI findings.

Glioblastoma multiforme (GBM) is the most common lethal primary central nervous system tumor in adults. GBM is rarely seen in childhood and adolescence as primary intraventricular tumors. Few cases of solitary intraventricular GBM in adolescence have been reported to date. We report a 16-year-old boy with progressive disorientation, diffuse headache, vomiting, and increased intracranial pressure. Computed tomography and magnetic resonance imaging confirmed that the tumor filled posterior body and occipital horn of the left lateral ventricle and also invaded the surrounding parenchyma. Incomplete removal of the lesion was achieved and a pathologic diagnosis of GBM was carried out. We present a case with an uncommon subtype of glial tumor (GBM) in childhood located in a very rare site. The clinical course, radiologic findings, and possible treatment regimens are reviewed.

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with indrawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrastenhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones.

Patients with acute infarcts have predominantly echolucent plaques, regardless of the degree of stenosis.

We present five new cases of van der Knaap's leukoencephalopathy, which is a rare abnormality characterized by infantile-onset white matter disease with swelling and mild clinical course. Based on the very rare histopathological data, this disease is considered a vacuolating myelinopathy with peripherally located intralamellar vacuoli. Although approximately 70 cases have so far been published, there are very limited data in the literature regarding diffusion-weighted imaging (DWI) findings of this recently discovered entity. In this paper, in addition to MRI, MRS and DWI findings in three patients are shown, apparent diffusion coefficient (ADC) maps are calculated, and ADC measurements made from various regions of interest are documented. MRI showed diffuse swelling and areas of T2 high signal in supratentorial white matter, sparing the cortex and central gray matter structures. MRS findings indicated some degree of neuronal loss. DWI and ADC maps showed increased diffusion rates, suggesting a different type of tissue damage than that would be expected in vacuolating myelinopathies. We believe that DWI and ADC mapping would be of help in providing a baseline for monitoring the progression of the disease.

Background Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging (MRI). Recently, increased signal intensity has been reported in specific brain areas after repeated administrations of GBCAs. Purpose To investigate the toxic effects of GBCAs on neuronal cells by using SH-SY5Y neuroblastoma cell cultures. Material and Methods For toxicity assays, SH-SY5Y cells were incubated with different doses (0–1000 µM) of several macrocyclic (gadoterate meglumine and gadobutrol) and linear GBCAs (gadoversetamide, gadopentetate dimeglumine, gadodiamide, and gadoxetate disodium) for 48 h. Cell viability and proliferation capacity were evaluated by using MTS assay, LDH assay, and colony-forming assay. In addition, Western blotting of Bcl-2 and Bax proteins and nuclear Hoechst 33258 staining were performed to evaluate apoptotic cell death. The results were expressed as mean ± SEM. The data were analyzed using Student’s t-test. A P value < 0.05 was accepted as statistically significant. Results Both macrocyclic and linear GBCAs significantly and dose-dependently reduced cell viability in neuronal cells compared to control. Cell viability was measured between 89.5% ± 4% and 61% ± 0.7% in GBCA-treated groups. In addition, neurotoxicity was more prominent in linear GBCA-treated cultures ( P < 0.0005). Bax protein levels were increased in GBCA-treated cells particularly with linear agents whereas Bcl-2 expression was decreased concomitantly. Conclusion The results of the present study indicated that exposure to specific GBCAs, even at low micro-molar concentrations, may have detrimental effects on neuronal survival. Further investigations are required to clarify the molecular mechanism underlying GBCA-induced cell death.

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Background Idiopathic intracranial hypertension (IIH) is a disease characterised by increased cerebral pressure without a mass or hydrocephalus. We aimed to differentiate migraine and IIH patients based on imaging findings. Results Patients with IIH ( n = 32), migraine patients ( n = 34) and control subjects ( n = 33) were evaluated. Routine magnetic resonance imaging, contrast-enhanced 3D magnetic resonance venography and/or T1-weighted 3D gradient-recalled echo were taken with a 1.5 T magnetic resonance scanner. Optic-nerve sheath distention, flattened posterior globe and the height of the pituitary gland were evaluated in the three groups. Transverse sinuses (TS) were evaluated with respect to score of attenuation/stenosis and distribution. Pearson chi-square, Fisher’s exact test and chi-square trend statistical analyses were used for comparisons between the groups. A p-value of <0.05 was considered statistically significant. Decreased pituitary gland height, optic-nerve sheath distention and flattened posterior globe were found to be statistically significant ( p < 0.001) in IIH patients. Bilateral TS stenosis was also more common in IIH patients than in the control group and migraine group ( p = 0.02). Conclusion Decreased pituitary gland height, optic-nerve sheath distention, flattened posterior globe, bilateral stenosis and discontinuity in TS are significant findings in differentiating IIH cases from healthy individuals and migraine patients. Bilateral TS stenosis may be the cause rather than the result of increased intracranial pressure. The increase in intracranial pressure, which is considered to be responsible for the pathophysiology of IIH, is not involved in the pathophysiology of migraine.