Elif Peker

Airway management can be challenging for patients undergoing cervical spinal surgery. This study aimed to evaluate how the duration of the cervical pathology associated with neck pain and numbness affects airway anatomy and airway management, and to correlate radiological measurements. This was a single-center prospective observational study. Eighty-two patients with American Society of Anesthesiologists I to III were selected from those undergoing surgery for cervical pathology. The patients’ symptoms and duration of cervical disease were assessed. Skin-epiglottis, skin-hyoid, epiglottis-vocal cord, and hyomental distance measurements were performed using ultrasonography. The bilateral multifidus and longus colli muscles, presence of prevertebral fluid, thickening of the prevertebral soft tissue, increase in muscle signal intensity, pre-epiglottic depth of field, distance between the vocal cords, and epiglottis were evaluated using magnetic resonance imaging. Patients were intubated using a videolaryngoscope. Intubation times, the percentage of glottic opening, the number of intubation attempts, and complications were recorded during intubation. Intubation quality was evaluated based on intubation time, number of attempts, and the percentage of glottic opening achieved during videolaryngoscopy. The correlation between symptom duration and intubation quality was assessed. Radiological measurements of the airway were compared with the symptom duration. Symptom duration did not affect intubation parameters ( P > .05). Skin-hyoid distance showed a positive correlation with pain duration ( r = 0.410, P = .001) and numbness duration ( r = 0.452, P < .001). The depth of the pre-epiglottic space increased with the duration of numbness ( r = 0.325, P = .034). Epiglottis-vocal cord distance correlated with intubation time ( r = 0.297, P = .026). Our study is significant in that it focuses on analyzing preoperative airway evaluation through radiological data and comparing these findings to the quality of intubation achieved with videolaryngoscopy. Radiological measurements such as skin-hyoid distance and pre-epiglottic space depth demonstrated measurable correlations with symptom duration, suggesting potential value in preoperative airway assessment. However, these anatomical variations did not significantly influence intubation performance when videolaryngoscopy was used.

Background/Objectives: Differentiating clinically suspected cardiac amyloidosis from hypertrophic cardiomyopathy (HCM) remains a significant clinical challenge, especially when contrast-enhanced imaging is contraindicated. This study evaluated the potential diagnostic utility of non-contrast cardiac MRI parameters, specifically native T1 and T2 mapping, as supportive indicators in this differential diagnosis. Methods: This retrospective single-center study included 20 patients with clinically suspected amyloidosis (based on combined clinical and echocardiographic assessment), 20 patients with HCM, and 20 healthy controls. Cine imaging and native T1/T2 mapping were analyzed. Myocardial, blood-pool, and liver T1/T2 values, along with morphological parameters, were recorded. N-terminal pro–B-type natriuretic peptide (NT-proBNP) and troponin levels, when available, were documented retrospectively for descriptive purposes. Receiver operating characteristic (ROC) analyses were performed to assess the discriminatory performance of imaging parameters. Results: Patients in the suspected amyloidosis group demonstrated significantly higher myocardial, blood-pool, and liver T1 values, as well as higher myocardial T2 values, compared with both the HCM and control groups (p < 0.001). Myocardial T1 showed strong discriminatory performance for differentiating suspected amyloidosis from controls (cut-off 1061 ms, AUC = 0.975). In distinguishing suspected amyloidosis from HCM, blood-pool T1 (AUC = 0.900) and myocardial T1 (AUC = 0.938) provided the highest diagnostic performance. Additionally, elevated NT-proBNP (>1000 pg/mL in 93% of tested cases) and troponin levels were observed in the suspected amyloidosis group, consistent with increased myocardial stress. Conclusions: Native T1 and T2 mapping may offer valuable supportive information in differentiating clinically suspected amyloidosis from HCM on non-contrast MRI. Myocardial and blood-pool T1 values appear to provide complementary tissue characterization, which may be particularly useful when gadolinium administration or invasive procedures are not feasible. These findings suggest a role for non-contrast mapping in the diagnostic workup but require further validation in larger, biopsy-confirmed multicenter cohorts.

Thoracic outlet syndrome (TOS) is a rare neurovascular compression disorder involving the brachial plexus and/or subclavian vessels at the cervicothoracobrachial junction. Clinical presentation is often nonspecific and may overlap with peripheral neuropathies, cervical spine disorders, and musculoskeletal conditions, making diagnosis challenging. Although clinical evaluation remains central to diagnosis, imaging plays a complementary role in supporting the diagnosis of TOS by identifying the affected neurovascular structures, localizing the site of compression, and elucidating the underlying anatomical or pathological causes. Moreover, imaging is essential for excluding alternative diagnoses, including thoracic malignancies and inflammatory or degenerative vascular diseases that may mimic TOS. This review provides a comprehensive overview of the radiological anatomy of the thoracic outlet, the etiological factors contributing to neurovascular compression, and the strengths and limitations of current imaging modalities used in the evaluation of TOS.

The Anatolian Journal of Cardiology - Peer-reviewed cardiology journal publishing original research, reviews, case reports. Impact Factor 1.5. The Anatolian Journal of Cardiology - Leading international cardiology journal with Impact Factor 1.5. Publishing original research, reviews, and case reports in cardiovascular medicine. Indexed in PubMed, Scopus, and Web of Science.

Background/Objectives: To characterize functional brain activation during smiling and to assess cognitive profiles in patients with Ochoa (Urofacial) syndrome (UFS). Materials and Methods: In a block-design fMRI paradigm, participants alternated between imitating a smiling emoji and viewing a fixation cross. Images were preprocessed and analyzed in SPM12; Smile > Rest contrasts were tested with a voxelwise threshold of p < 0.001 (uncorrected). Cognitive levels were assessed using age-appropriate Wechsler scales administered by certified psychologists. Results: Six patients (mean age 20 years; 50% female) with genetically/clinically confirmed UFS were included. Smile > Rest elicited robust activation in the supplementary motor area (highest Z = 4.70), insula (largest cluster), dorsal anterior cingulate, primary motor cortex, and frontal eye fields, among others. Five patients completed cognitive testing; Full-Scale IQ ranged 50–74, consistent with mild intellectual disability to borderline intellectual functioning. Conclusions: During voluntary smiling, UFS patients exhibit activation patterns that overlap extensively with those reported in healthy cohorts. Nevertheless, cognitive performance was limited in this sample. Given the rarity of UFS and the small cohort, findings should be interpreted cautiously and validated in multicenter studies.

Background/Objectives: Myocarditis is a recognized complication of COVID-19 infection, with potential long-term cardiac sequelae. While acute cardiac involvement has been frequently reported, late-stage myocardial effects remain less well characterized. Cardiac magnetic resonance (CMR) imaging, particularly T1 and T2 mapping, offers non-invasive tissue characterization for myocardial inflammation and fibrosis. This study aimed to evaluate segmental myocardial tissue changes in patients with late-stage COVID-19–related myocarditis using CMR and compare findings with patients with non-COVID-19 myocarditis and healthy controls. Methods: This retrospective, single-center study included 25 patients with clinically suspected COVID-19 myocarditis who underwent CMR between 36 and 565 days post-infection. T1 and T2 mapping values and late gadolinium enhancement (LGE) patterns were assessed and compared with 14 non-COVID-19 myocarditis patients and 19 healthy controls. Subgroup analyses were performed according to vaccination status and left ventricular ejection fraction (LVEF). Results: Patients with reduced LVEF had significantly higher T1 and T2 values in several myocardial segments. Compared to controls, the COVID-19 myocarditis group showed significantly elevated T1 values in all segments except 2 and 3. No significant difference in T2 values was observed. LGE was present in 61% of COVID-19 myocarditis patients, predominantly with a subepicardial pattern. No significant differences were observed between vaccinated and unvaccinated patients. Conclusions: Late-stage COVID-19 myocarditis is associated with persistent segmental myocardial tissue abnormalities, particularly elevated T1 values and subepicardial LGE. Segmental CMR mapping may provide additional diagnostic value in identifying residual myocardial injury in patients with ongoing cardiac symptoms after COVID-19 infection.

Purpose Lumbar disc herniation is a prevalent condition that leads to lower back pain, weakness, and claudication. While microdiscectomy has long been the gold standard for surgical treatment, advances in technology have introduced endoscopic techniques, such as Unilateral Biportal Endoscopic spine surgery. Despite these advances, epidural fibrosis remains a common complication that, potentially hinders recovery and complicating revision surgeries. This study aimed to compare the extent of epidural fibrosis between microdiscectomy and UBE surgery with preserved flavum and flavectomy. Methods This retrospective study included 47 patients diagnosed with lumbar disc herniation who underwent surgery between August 2020 and July 2022 at two tertiary university hospitals. The patients underwent endoscopic surgery with flavum preservation (n = 16), flavum excision (n = 16), lumbar microdiscectomy with flavectomy (n = 15). Preoperative and postoperative imaging, including X-rays, computed tomography, and magnetic resonance imaging were performed. Functional scores (Visual Analog Scale, Japanese Orthopedic Association score, and Oswestry Disability Index were assessed. Postoperative magnetic resonance imaging was conducted at three months to evaluate epidural fibrosis. Results The rate of epidural fibrosis was significantly lower in the flavum sparing UBE (0.18 ± 0.17) compared to the flavum non-sparring UBE (0.38 ± 0.19) and the flavum non-sparring microdiscectomy (0.47 ± 0.18) (p < 0.001). Functional scores significantly improved postoperatively in all groups, with significant differences noted in JOA, Oswestry, and VAS scores (p < 0.01). Early functional score differences between the groups were found to be significant in favor of UBE, particularly in the flavum-sparing group. Conclusion The preservation of flavum during UBE surgery leads to significantly less epidural fibrosis compared to both flavum non-sparring UBE and microdiscectomy. Functional improvements were similar across groups, but flavum sparring UBE surgery demonstrated better early postoperative outcomes. The results suggest that preserving flavum during endoscopic spine surgery may reduce epidural fibrosis formation and promote better recovery, supporting the benefits of minimally invasive techniques in lumbar disc herniation surgery.

Objectives: Volumetric interpolated breath-hold examination (VIBE) sequence is a radio-frequency-spoiled gradient echo sequence that is mostly used in the evaluation of soft tissues, allows dynamic high-resolution images to be taken in 30 seconds of breath-holding time in MRI, and is used to create 3D images. In this study, we aimed to determine the detectability of cardiac masses and thrombi and their differentiation from the blood pool with the T1 VIBE imaging method. Methods: Precontrast, early and late postcontrast VIBE images were evaluated. Lesion contours were drawn with a free-hand regìon of ìnterest (ROI) in the phase in which the lesion was better depicted. All ROIs were placed in the phase where the lesion appeared best and then copied to other phases. Results: Sìgnal to noìse ratìo (SNR) was calculated as SI/SD of background intensity, CNR was calculated as SNR thrombus-SNR myocardium and SNR thrombus-SNR blood pool. SNR and CNR values of thrombus, blood pool, and myocardium measured at maps and contrast-enhanced images were compared with each other. Conclusions: There are many sequences used routinely to detect cardiac masses and thrombi. Many of these techniques require long acquisition time. With the VIBE sequence, precontrast, arterial, and venous images of the lesion can be obtained quickly. Although the SNR and CNR values obtained with VIBE images are lower than those with routine post-contrast images, our study can be considered a preliminary study for future studies to evaluate dynamic images. Advances in knowledge: For our knowledge, this is the first paper written on the visual assessment of cardiac masses on VIBE images.

Objectives: The objective of this study is to evaluate the diagnostic performance of neck fluorodeoxyglucose (FDG) PET/MRI in addition to whole-body PET/computed tomography (CT) and to compare it with MRI in the detection of suspicion of disease relapse in patients with differentiated thyroid cancer (DTC) who underwent total thyroidectomy and radioactive iodine therapy. Methods: Twenty-nine patients with DTC who underwent whole-body ¹⁸F-FDG PET/CT followed by neck PET/MRI because of increased serum thyroglobulin (Tg) or anti-Tg antibody levels and negative ¹³¹I whole-body scan were included. At least 6 months of clinical and radiological (neck ultrasound) follow-up or histopathological examination results were accepted as the gold standard. Lesion and compartment-based analyses were performed to evaluate the diagnostic performances of PET/CT, MRI, and PET/MRI. In addition, changes of clinical management were evaluated. Results: On lesion-based analysis, for PET/CT, MRI, and PET/MRI: sensitivity: 33.3, 33.3, and 37%; specificity: 90.1, 87.9, and 95.9%; accuracy: 87.5, 85.4, and 93.2 were calculated, respectively. Specificity of PET/MRI was significantly superior to PET/CT and MRI (P of0.001); however, sensitivity of PET/MRI was not significant to PET/CT and MRI (P of0.05). On compartment-based analysis, specificity of PET/MRI and MRI were comparable but significantly superior to PET/CT at levels 1 and 2; however, specificity of PET/CT and PET/MRI were comparable but significantly superior than MRI, especially at levels 3, 4, and 5. Conclusion: PET/MRI especially helps in the accurate exclusion of findings that are suspicious on PET/CT and MRI, and has the potential to change the clinical management by identifying uncertain neck findings.