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    Comparison of brain magnetic resonance imaging findings before and after liver transplantation
    (2019) Kural Rahatli, Feride; Kahraman, Gokhan; Yildirim Donmez, Fuldem; Akdur, Aydincan; Agildere, Ahmet Muhteşem; Haberal, Mehmet
    Aim: The purpose was to compare the brain Magnetic Resonance Imaging (MRI) findings of the liver transplant recipients who had a neurological symptom, before and after liver transplantation. Material and Methods: Patients were evaluated in the terms of age, gender, etiology of chronic liver disease and the clinical symptoms. The brain MRI findings before and after liver transplantation were compared. Results: Thirty liver transplant patients with brain MRIs before and after liver transplantation were included. Hyper intensities on T1 weighted images which is compatible with manganese deposition in the basal ganglia was found from the first brain MRI of 18 patients. In thirteen of them the deposition was disappeared or decreased but in five of them the deposition persisted after transplantation. Hyper intensities on T2 weighted images which is compatible with copper deposition in the basal ganglia of four patients with Wilson’s disease persisted after transplantation. Five patients who had normal brain MRI findings before transplantation had posterior reversible encephalopathy syndrome (PRES) after the transplantation. One patient had focal cerebritis, three patients had acute infarct and one patient had intraparenchymal hemorrhage after transplantation. Conclusion: Most of the neurological symptoms during chronic liver disease are associated with the deposition of paramagnetic substances. After transplantation there could be regression in manganese deposition but the copper deposition stayed the same. Post-transplant PRES, central nervous system infections, infarct, and hemorrhage were not rare. Pre and post-transplant patients with neurological symptoms should be evaluated with brain MRI for rapid diagnosis and proper management.
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    Use of susceptibility weighted imaging to assess hemorrhage in brain metastases
    (2018) Kural Rahatli, Feride; Yildirim Donmez, Fuldem; Haberal, Kemal Murat; Agildere, Ahmet Muhtesem
    Aim: Detection of intratumoral hemorrhage in metastatic lesions leads to determination of treatment options.We evaluated the diagnostic value of precontrast SWI for the detection of blood products in brain metastases by comparing SWI to conventional sequences. Material and Methods: Brain magnetic resonance imaging (MRI) sequences were acquired between April 2014 and November 2015 from 21 patients with brain metastases, and were retrospectively evaluated for the presence of hemorrhagic elements. All examinations were performed on a 1.5 Tesla Siemens scanner. Our routine protocol included axial T1-weighted (T1W), T2-weighted (T2W), and FLAIR sequences, coronal and sagittal T2W sequences, post gadolinium axial and sagittal T1W sequences, and a coronal FSE T1W sequence, in addition to the precontrast SWI sequence. Results: Seventy-one intraparenchymal metastatic lesions (range: 0.5–3.5 cm) were detected. No hemorrhages were detected in 25 lesions (35.2%), while in 12 lesions (16.9%) hemorrhage was detected by SWI and T1 and/or T2 weighted images. In 34 lesions (47.88%) hemorrhage was detected only on the SWI sequence, and it was not seen on the conventional sequences. Conclusion: SWI provided better information for the evaluation of intratumoral hemorrhage than T1W and T2W sequencesof the inner structure of metastases. T1W and T2W images did not provide sufficient detection of hemorrhagic elements; SWI is therefore needed to detect intratumoral hemorrhage, and the sequence should be added to the protocol to allow better characterization.