Purpose To evaluate glymphatic dysfunction using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index in patients with low-grade gliomas (LGGs), high-grade gliomas (HGGs), and metastases, assess its feasibility as a non-invasive biomarker for tumour differentiation, and examine its relationship with tumour-specific characteristics. Material and methods This single-centre retrospective study examined patients with LGGs (n = 30), HGGs (n = 30), and metastases (n = 20), calculating the DTI-ALPS index. Tumour volume, peritumoral oedema, tumour volumeto-total brain volume ratio (TV/TBV), and peritumoral oedema-to-total brain volume ratio (PTE/TBV) were obtained using 3D segmentation. The DTI-ALPS index was compared across the 3 tumour groups, and its relationships with tumour-associated oedema, peritumoral oedema, TV/TBV, and PTE/TBV were analysed within and between the groups. Additionally, the DTI-ALPS index was compared between isocitrate dehydrogenase-1 (IDH1) mutant and IDH1 wild-type gliomas. Results There was a significant difference in the DTI-ALPS index between the 3 groups (p < 0.001), with HGGs having the lowest DTI-ALPS index values, followed by metastases and LGGs. Receiver operating characteristic (ROC)analysis showed that the DTI-ALPS index had excellent sensitivity and specificity for LGGs (> 1.3838) and HGGs (< 1.317). No significant correlation was found between the DTI-ALPS index and tumour volume, TV/TBV, PTE/TBV, or peritumoral oedema. Furthermore, the mean DTI-ALPS index in IDH1 wild-type gliomas (1.23 ± 0.08) was significantly lower than that observed in IDH1 mutant tumours (1.42 ± 0.10; p < 0.001). Conclusions The DTI-ALPS index provides valuable insights into glymphatic dysfunction in brain tumours. This study underscores its potential as a non-invasive biomarker in differentiating these tumour groups.

Purpose To compare the effectiveness of time-of-flight (TOF) magnetic resonance angiography (MRA) and magnetic resonance (MR) vessel wall imaging (VWI) in assessing the degree of vascular involvement in patients with moyamoya disease (MMD). Material and methods This was a single-time observational study carried out on patients with MMD before any surgical interventions. In addition to routine magnetic resonance imaging sequences, TOF MRA and VWI were performed. A total of 11 vascular segments (bilateral supraclinoid and terminal internal carotid arteries [ICA], anterior cerebral arteries [ACA], middle cerebral arteries [MCA], posterior cerebral arteries [PCA], and the distal basilar artery) were assessed in each patient for steno-occlusive changes on TOF MRA, and the presence of vessel wall thickening and enhancement on high-resolution VWI. Comparative analysis between the TOF MRA and VWI findings was conducted. Results A total of 40 cases were included, out of which 39 patients presented with infarcts, predominantly in multi-territorial distribution and only one patient presented with intracerebral hemorrhage. 440 vascular segments were assessed on TOF MRA and VWI, out of which TOF MRA revealed 38.8% stenotic (n = 171) and 30.2% (n = 133) occluded vascular segments. VWI revealed concentric vessel wall thickening in 97.5% of cases, with vessel wall contrast enhancement detected in 306 segments (69.54%). On comparison of TOF MRA and VWI findings, 69.09% of segments were abnormal on TOF MRA, while VWI detected 81.4% abnormal segments; notably, 11.8% of segments labeled normal on TOF MRA exhibited abnormal vessel wall traits on VWI. Conclusions This study highlights the valuable role of VWI as an important diagnostic tool and its superiority to TOF MRA for evaluating the extent of vascular involvement in patients with MMD.

Purpose Dural arteriovenous fistulas (DAVFs) are complex vascular malformations characterised by abnormal communications between the meningeal arteries and dural venous sinuses or cortical veins. They may be associated with underlying thrombotic associations such as the presence of cerebral venous sinus thrombosis (CVST) or transversesigmoid sinus (TSS) occlusion, which can affect prognostic outcomes. Additionally, the types of DAVFs may also have varying clinical and technical outcomes. Material and methods This study was a retrospective cohort analysis conducted on 27 DAVF patients from 2015 to 2023 who presented at Aga Khan University Hospital, Karachi. We examined the fistula types, clinical and technical success rates, complications, recurrence and the presence of concurrent CVST or TSS. Results Complete clinical and technical success rates were 44% and 63%, respectively. The rates of complications and recurrence were 18.5% and 19%, respectively. The presence of thrombotic associations (CVST and TSS occlusion) was associated with significantly lower clinical success rates in our cohort. Type II Cognard fistulas were significantly associated with the presence of CVST and TSS occlusion (p = 0.003 and p = 0.044 respectively) as well as lower clinical success as compared to type IV fistulas. Conclusions Our findings advocate for comprehensive recognition of thrombotic associations of DAVFs and their potential integration into classification systems to better determine prognostic outcomes. Large-scale multi-centre studies are required to validate these associations further and guide treatment strategies.

PurposeAccurate prediction of overall survival (OS) in glioma patients is crucial for optimising treatment decisions. Despite advancements in imaging and machine learning, challenges persist due to tumour heterogeneity and confounding factors. This scoping review systematically assesses state-of-the-art image-based OS prediction models for glioma, focusing on tumour characteristics, imaging modalities, preprocessing techniques, and machine learning methods.Material and methodsThis scoping review was conducted following the Joanna Briggs Institute guidelines, comprising five key stages: identifying the research question, searching for relevant literature, selecting studies, charting the data, and collating, summarising, and reporting the results.ResultsThe initial search identified 3238 records, of which 70 articles were included in the final analysis. Most studies originated from China, the United States, and India, with datasets averaging approximately 450 cases. To enhance predictive accuracy, various techniques were utilised, including image segmentation, multimodal magnetic resonance imaging (MRI) protocols, and advanced feature extraction methods. Notably, T1-weighted contrast-enhanced MRI and grade-specific glioma analyses improved model performance. Although deep learning models generally outperformed traditional methods, they required large, balanced datasets. Hybrid models showed promising potential; however, their performance was inconsistent due to challenges such as limited image quality and issues with model interpretability.ConclusionsIncreasing sample size alone does not guarantee improved accuracy in glioma prediction models, because data quality and feature selection are critical factors. Incorporating diverse imaging modalities can significantly enhance predictive performance. To ensure greater clinical reliability in decision-making, integrating clinical features with imaging data is essential.

Parsonage-Turner syndrome (PTS), also known as neuralgic amyotrophy (NA), is an idiopathic inflammatory neuropathy of the brachial plexus presenting with neuropathic pain and motor deficits of the shoulder girdle. Routinely, PTS must be differentiated from infectious variants of brachial plexitis, especially early manifestations of neuroborreliosis. Both conditions can quickly lead to significant disability, so early, targeted therapy based on a correct diagnosis is essential for a favourable clinical outcome. High-resolution ultrasound (HRUS) can quickly and non-invasively differentiate PTS from infectious forms of brachial plexitis by detecting nerve twisting and swelling with the so-called “hourglass-like” constriction sign. The following article presents the authors’ proposal for an HRUS protocol for the brachial plexus and shows typical ultrasound findings in PTS and brachial plexitis with Banwarth’s syndrome due to Borrelia infection.

PurposeThis study aims to compare the clinical, imaging, and pathological characteristics of benign and malignant solitary pulmonary cystic nodules, and identify key indicators associated with malignant risk and invasion depth, assisting clinicians in early detection and assessment of tumour invasiveness.Material and methodsThis study conducted a retrospective analysis of patients with pulmonary cystic nodules who underwent surgical treatment, and it classified them into benign and malignant groups based on postoperative pathological results. We collected patients’ clinical data, serum biomarkers, and CT imaging data and compared them using univariate analysis of variance. We included statistically significant indicators in a multivariate regression model to identify independent predictive factors for early malignant transformation of cystic lung cancer. Additionally, we collected the pathological types and tissue infiltration grades of the malignant group and further explored the relationship between imaging features and pathological grading by comparing the imaging characteristics corresponding to different pathological infiltration degrees, and visualised the results using a forest plot.ResultsFollowing multifactorial Cox analysis age, CA199, homogeneity of cyst wall thickness, cystic wall finish, number of cystic cavities, ground glass sign, and the nodule’s relationship to surrounding tissues (burr, pleural indentation sign) had a significant effect on the evolution of cystic malignant nodules. Finally, in the malignant nodule group, the presence or absence of the ground glass sign was statistically significant concerning the different pathologic grades.ConclusionsOur multivariate predictive study indicates that certain imaging features of pulmonary cystic nodules may suggest malignant progression and are associated with different levels of pathological invasion.

Secondary haemochromatosis among paediatric oncologic patients is associated with various long-term complications. The liver is the most important organ for assessment of iron overload because the iron concentration is linearly correlated with total body iron stores.In the paediatric population, liver biopsy is considered too invasive for routine use. Therefore, evaluation of iron overload with magnetic resonance imaging is an alternative method.Reliable assessment of iron burden is necessary for early detection and severity grading. In the last 2 decades multiple methods for iron quantification with magnetic resonance imaging (MRI) have been developed. Both gradient-echo and spin-echo imaging, including signal intensity ratio and relaxometry strategies, are in clinical use. However, there are no universally accepted MRI protocols for paediatric oncology patients suspected of secondary haemochromatosis. If diagnosed and treated early, haemochromatosis progression can be distinctively altered.Iron overload impacts hepatocytes, pancreas’s beta cells, heart, and spleen. Each organ displays distinct patterns of iron distribution, which require targeted imaging methods. This review will address the importance of using magnetic resonance imaging for iron measurements, as well as the evaluation for the liver, pancreas, and spleen.

PurposeAcute adrenal haemorrhage is a rare occurrence caused most commonly by trauma or ruptured neoplasms. In the case of the latter, rapid adrenal tumour growth resulting in elevated intracapsular pressure leads to capsular tear and massive retroperitoneal bleeding. Endovascular embolisation has been reported as a successful and safe method of treatment in selected patients. The aim of this paper was to report multicentre experience with endovascular treatment of patients presenting with acute adrenal gland haemorrhages caused by neoplasms.Material and methodsThis is a multi-centre retrospective study focusing on patients treated by endovascular embolisation because of malignant adrenal haemorrhages in an acute setting from 2012 to 2024.ResultsIn total, 13 patients (10 men and 3 women, mean age: 65.4 years) were included in the study. All subjects presented with neoplastic haemorrhages – 8 presented with adrenal metastasis and 5 were primary neoplasms. In all cases a contrast-enhanced computed tomography confirmed the bleeding. Procedures were performed under local anaesthesia via femoral access. Embolic agents were adopted according to the type of vessel lesion and operator preference. Technical success, defined as cessation of adrenal bleeding detectable at control angiography, was 100%; 1 patient required a second embolisation after 24 hours due to recurrence. Clinical success considered as haemodynamic stability and clinical improvement was obtained in 85% (11/13 patients). No major complications were observed.ConclusionsMalignant acute adrenal haemorrhages can be safely and effectively treated with endovascular means after thorough and careful anatomical examination of the arterial supply.

Magnetic resonance imaging (MRI) is an important diagnostic tool in oral and maxillofacial surgery due to its superior ability to visualise soft tissue and complex anatomical structures without ionising radiation. This narrative review, conducted using a structured literature search following PRISMA guidelines, aims to provide oral and maxillofacial surgery trainees with a structured guide for understanding and interpreting MRI of the head and neck region. Emphasis is placed on enhancing the ability to read common MRI sequences, particularly T1- and T2-weighted images, and on appreciating the value of MRI in diagnosing a range of conditions, including soft tissue lesions, temporomandibular joint disorders, vascular abnormalities, and tumours. To support learning, a selection of case examples is included to illustrate both normal structures and pathological changes. The review also draws attention to the current lack of formal MRI education in oral and maxillofacial surgery training and stresses the need for more organised, interdisciplinary teaching approaches.