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Öğe Cerebrospinal Fluid Dynamics in Patients with Multiple Sclerosis: The Role of Phase-Contrast MRI in the Differential Diagnosis of Active and Chronic Disease(Korean Radiological Soc, 2018) Oner, Serkan; Kahraman, Aysegul Sagir; Ozcan, Cemal; Ozdemir, Zeynep Maras; Unlu, Serkan; Kamisli, Ozden; Oner, ZulalObjective: Multiple sclerosis (MS) is an inflammatory disease characterized by demyelinating plaques in the white matter. Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a new hypothesis for the etiopathogenesis of MS disease. MS-CCSVI includes a significant decrease of cerebrospinal fluid (CSF) flow through the cerebral aqueduct secondary to an impaired venous outflow from the central nervous system. This study aimed to determine whether CSF flow dynamics are affected in MS patients and the contributions to differential diagnosis in active and chronic disease using phase-contrast magnetic resonance imaging (PC-MRI). Materials and Methods: We studied 16 MS patients with chronic plaques (group 1), 16 MS patients with active plaques-enhanced on MRI (group 2), and 16 healthy controls (group 3). Quantitatively evaluation of the CSF flow was performed from the level of the cerebral aqueduct by PC-MRI. According to heart rates, 14-30 images were obtained in a cardiac cycle. Cardiac triggering was performed prospectively using finger plethysmography. Results: No statistically significant difference was found between the groups regarding average velocity, net forward volume and the average flow (p > 0.05). Compared with the controls, group 1 and group 2, showed a higher peak velocity (5.5 +/- 1.4, 4.9 +/- 1.0, and 4.3 +/- 1.3 cm/sec, respectively; p = 0.040), aqueductal area (5.0 +/- 1.3, 4.1 +/- 1.5, and 3.1 +/- 1.2 mm(2), respectively; p = 0.002), forward volume (0.039 +/- 0.016, 0.031 +/- 0.013, and 0.021 +/- 0.010 mL, respectively; p = 0.002) and reverse volume (0.027 +/- 0.016, 0.018 +/- 0.009, and 0.012 +/- 0.006 mL, respectively; p = 0.000). There were no statistical significance between the MS patients with chronic plaques and active plaques except for reverse volume. The MS patients with chronic plaques showed a significantly higher reverse volume (p = 0.000). Conclusion: This study indicated that CSF flow is affected in MS patients, contrary to the hypothesis that CCSVI-induced CSF flow decreases in MS patients. These findings may be explained by atrophy-dependent ventricular dilatation, which may occur at every stage of MS.Öğe Quantitative Evaluation of Normal Aqueductal Cerebrospinal Fluid Flow Using Phase-Contrast Cine MRI According to Age and Sex(Wiley, 2017) Oner, Zulal; Kahraman, Aysegul Sagir; Kose, Evren; Oner, Serkan; Kavakli, Ahmet; Cay, Mahmut; Ozbag, DavutThe aim of this study was cerebrospinal fluid (CSF) flow quantification in the cerebral aqueduct using phase-contrast cine magnetic resonance imaging (PCC-MRI) according to both sexes and three different age groups to obtain normative data. Seventy two volunteers with no cerebral pathology were included in this study. Subjects were divided into three age groups: 20-34 years, 35-49 years, and 50-65 years including equal gender groups. CSF flow's quantitatively evaluation was performed with images that were obtained by 1.5 T Magnetic Resonance (MR) unit from cerebral aqueduct level on the semi-axial plan. Between groups, peak velocity (cm sec21), average velocity (cm/s), forward volume (mL), reverse volume (mL), net forward volume (mL), and average flow over range (ml/ min)values of current flowing through aqueduct and average aqueductal areas were compared. There were no statistically significant differences in CSF flow parameters among different age groups and between sexes (P> 0.05). There was a statistically significant difference in average cerebral aqueduct area between the age group of 50-65 years and the other age groups (P50.002). The average aqueductal area was higher in the age group of 50-65 years. Normal aqueductal CSF flow parameters evaluated with PCC-MRI don't show a significant difference by age and sex. We have achieved the lower and upper values of these parameters would be useful in future clinical studies. The size of aqueductal area may also be explained by atrophy-dependent ventricular system dilatation in the elderly. (C) 2016 Wiley Periodicals, Inc.Öğe The right vertebral artery originating from the right occipital artery and the absence of the transverse foramen: a rare anatomical variation(Springer France, 2017) Oner, Zulal; Oner, Serkan; Kahraman, Aysegul SagirVariations in the origin of the vertebral artery (VA) is a congenital anomaly that occurs during embryological development. Multiple variations related to VA origin have been reported in the literature. Abnormal VA origin is usually determined as incidental findings during angiographic or postmortem anatomical studies. Although most of the cases are asymptomatic, in patients with VA anomaly symptoms such as dizziness have been described. The anomalous variation in the origin of the right VA is rare and separated into three categories: (1) originating from the aorta, (2) originating from the carotid arteries, (3) duplicated origin. In this case, we aimed to present the right VA originating from the right occipital artery and concomitant anomalies of the transverse foramen that have not been reported previously according to our knowledge in literature. In a 32-year-old female patient referred to our hospital because of dizziness, the right VA was not observed on magnetic resonance imaging and computed tomography angiography (CTA) examination was performed. CTA showed hypoplasia of the right transverse foramen at the levels of the C1, C5 and C6 vertebrae and aplasia of the right transverse foramen at the levels of the C2, C3 and C4 vertebrae. The right VA originating from the right occipital artery continues to its normal course by entering the cranium through the foramen magnum at the level of the atlantooccipital junction.
