100 tinnitus patients who applied to …. Hospital between 01.01.2020 and 31.12.2020 were included in the study. All of the patients applied with the complaint of chronic subjective tinnitus. Otoscopic examination of the patients was normal. Patients with a pure tone mean of 20 dB or less in the audiometry test were included in the study. Complete blood count, biochemistry parameters, thyroid function tests, iron panel, lipid panel, vitamin 12 and folic acid levels were within normal limits. None of the patients participating in the study had a psychiatric disorder or a history of psychiatric drug use. All patients underwent Temporal Computed Tomography (CT), Temporal Magnetic Resonance Imaging (MRI), Brain MRI and Diffusion Brain MRI examinations. All examination and anamnesis information, CT and MRI results were recorded.
The volBrain system automatically calculated whether the ratio of the thalamus, hippocampus, amygdala volumes to the total brain volume was among the reference values according to the patients' age group and gender. We did not need a control group because the volBrain program uses its own database and compares with patients.
The Tinnitus Handicap Inventory (THI), which was created by Kuk et al.  in 1990 and adapted into Turkish by Aksoy et al.  in 2007, score was the sum of the 25 answers where a weight of 4 was given to the answer “Yes,” a weight of 2 to the answer “Sometimes,” and a weight of 0 to the answer “No.” Thus, the range of scores was between 0 and 100, where 100 was the maximum score that could be obtained for the sum of the 25 questions. Levels of handicap are estimated as follows: Grade 1 – slight handicap (THI 0–16), Grade 2 – mild handicap (THI 18–36), Grade 3 – moderate handicap (THI 38–56), Grade 4 – severe handicap (THI 58–76), Grade 5 – catastrophic (THI 78–100): Ability to carry out a normal life is seriously impaired. THI was performed on all patients and scores and grades were recorded. According to THI, patients were divided into 5 groups as Slight, Mild, Moderate, Severe, and Catastrophic.
Informed consent were obtained from patients who participated in clinical investigations.
Approval was obtained for the study from the … Clinical Research Ethics Committee (Meeting Number: 70, Decision Number: 1148, Date: 18 Nov 2020).
Brain MRI images of the patients included in the study were obtained on the Philips Ingenia 1.5 T (Eindhoven, Netherlands) device. The parameters used are T1WI FOV: 24x24 cm, TE 3.4 ms, TR 7.3 ms; T2W FOV: 24x24 cm, TE 245 ms, TR 1500 ms, FLAIR: FOV 23x24 cm, TR 11,000 ms, TE140 ms, Slice 4 mm, Gap 1mm.
Volumetric and Segmentation Reporting
A compressed T1WI dataset in NIFTI (Neuroimaging Informatics Technology Initiative) format was uploaded to the online MRI-T1WI system at www.volbrain.com (VolBrain version 1.0 for whole-brain segmentation and HIPS version 1.0 hippocampus segmentation). When automated processing is complete, a PDF report is generated with volumetric data on gray matter, white matter, CSF and subcortical gray matter, and hippocampus segmentation. We validate NIFTI files for all cases using ITK-SNAP Version 3.4.0 software. When the process was finished, we were notified by email so that we could download a package containing some image files and two reports that collect all the volumetric values calculated from the segmentations. The report also includes several snapshots of different labeling results as quality control. All volumes are presented as an absolute value (measured in cm3) and relative value. The volumes of the thalamus, hippocampus, amygdala were measured. In each patient, the ratio of these regions to their brain volumes and whether this ratio was within the reference values according to their age-sex group were examined (classified as normal, less, or more according to the reference values).
With volBrain system, the intracranial cavity; tissue volumes; brain, cerebellum, and brainstem volumes; the volumes of the lateral ventricles and subcortical structures (putamen, caudate, pallidum, thalamus, hippocampus, amygdala, and nucleus accumbens) can be measured . The volBrain system is an online system, and after uploading the data you have to the system, it can quickly give you the volume of the desired brain region in a few steps (fig. 1,2)
The traditional assessment was done using Philips ISP (Intellispace portal) for primary reporting. Patients with a mass, cyst, previously operated on extensive ischemic sequelae in conventional brain MRI examinations were not included in the study.
In the study, summary statistics of categorical variables were given in terms of frequency and percentage, while mean ± standard deviation was used for continuous variables. The conformity of the continuous variables to the normal distribution was tested with the Shapiro-Wilk and Kolmogorov Smirnov tests. The Chi-square test was used for the analysis of categorical variables. An independent t-test was used for the variables in the independent structure with two groups. In cases where the number of groups was more than two, a one-way analysis of variance was used together with Bonferroni's post-hoc analysis. The statistical significance level (p-value) of the study was determined as 0.05. Analyzes were made using the Statistica 13 package program.