Distinct Imaging Features Research Articles

Parosteal Lipoma.

Teaching Point: Recognizing the distinct imaging features of parosteal lipoma.

Spinal Involvement in Patients with Chronic Non-Bacterial Osteomyelitis (CNO): An Analysis of Distinctive Imaging Features

Spinal involvement by chronic non-bacterial osteomyelitis (CNO) has been increasingly reported in recent years, often being presented as a diagnostic dilemma requiring differential diagnosis with bacterial spondylodiscitis and/or neoplasia. This study was aimed at identifying the imaging features of CNO facilitating its differentiation from other spinal diseases. Two radiologists assessed the imaging studies of 45 patients (16 male and 29 female, aged from 6 to 75 years, 15 children) with CNO collected from 5 referential centers. Spinal lesions were found in 17 patients (2 children and 15 adults), most often in the thoracic spine. In children, the lesions involved short segments with a destruction of vertebral bodies. In adults, the main findings were prominent bone marrow edema and osteosclerosis, endplate irregularities, and ankylosing lesions extending over long segments; paraspinal inflammation was mild and abscesses were not observed. In both children and adults, the involvement of posterior elements (costovertebral and facet joints) emerged as an important discriminator between CNO and neoplasia/other inflammatory conditions. In conclusion, a careful inspection of imaging studies may help to reduce the number of biopsies performed in the diagnostic process of CNO.

Correlation between migraine and cerebral small vessel disease: A case-control study.

Microcirculatory pathology is one of the pathophysiological theories of migraine, which may present as visually subclinical lesions. Image markers of cerebral small vessel disease (CSVD) have been investigated in elderly migraineurs. However, past studies looked at only part of image features, and the conclusions may have been hindered by confounding factors. The relationship between migraine and CSVD signs needs reliable demonstrations. We conducted a case-control study by recruiting episodic young migraineurs from a tertiary headache centre, with tension-type headache (TTH) and healthy controls. Distinct image features of microvascular damage and baseline characteristics across groups were assessed, and multivariate linear regression was performed to evaluate the risk factors for image abnormalities in migraineurs. Forty-eight migraineurs, 32 TTHs and 49 healthy controls were included. The median age was 32 year-old. 58.7% of the participants were female. The Scheltens score and volume of white matter hyperintensities (WMHs) in migraineurs, and the number of Virchow-Robin spaces (VRSs) in both migraineurs and TTHs were different from those in normal controls. No lacunar infarct-like lesions (ILLs) or cerebral microbleeds (CMBs) were found. Age, education level (high level: β = -2.23, lobar WMHs), attack duration (long duration: β = 3.81, lobar WMHs) and attack frequency were independent risk factors for Scheltens score and volume of WMH in migraineurs. Migraine aura (β = -2.389), attack frequency and education level were correlated with the number of VRSs. Migraine was associated with WMHs and VRSs. Aura, attack duration, attack frequency, age and education level were risk factors for image abnormalities of CVSD in migraineurs. This study provides a novel and comprehensive landscape of CSVD MRI features in young migraineurs, and it fills the blank of CMBs and VRSs which received less attention, with more persuasive, more reliable and stronger evidence of the association between CSVD and migraine. Our results also imply some new feature of TTH and the possible pathophysiology of the migraine course as well as new clues for the early management of migraine in terms of visual brain damage.

Chronic Central Serous Chorioretinopathy in Elderly Subjects: Structure and Blood Flow Characteristics of Retina and Choroid.

With advancements in imaging technology, researchers have been able to identify more distinctive imaging features of central serous chorioretinopathy (CSC). However, existing research primarily concentrates on young patients aged 50years and below, leaving a dearth of studies on elderly CSC patients. Previous studies indicate that elderly CSC patients may exhibit unique imaging characteristics and have a clinical prognosis that significantly differs from younger patients. This study aimed to evaluatethe characteristics of retina, choroid structure, and blood flow in elderly patients with chronic CSC (cCSC) examined multimode imaging and try to find new pathogenesis information of it. Using a cut-off age of 50years, patients with chronic central serous chorioretinopathy were divided into two groups: older and younger. The control group consisted of 40 healthy individuals, with their right eyes assigned. Various clinical features were recorded, including the incidence of ellipsoid zone rupture (EZ-), fibrin in the subretinal fluid (SRF), pachydrusen, subretinal drusenoid deposits (SDD), pigment epithelial detachment (PED), double-layer sign (DLS), and choroidal lipid globule cavern. Measurements were taken for the thickness of the outer nuclear layer (ONL), the length of the extended outer photoreceptor segment (POS), the height and width of SRF, the vascular density of each layer of the retinal capillary plexus, the central macular thickness (CMT), and the subfoveal choroidal thickness (SFCT). The proportion of females in the elderly group (43.75%) was significantly higher than that in the youth group (22.41%) (p = 0.034). The degree of hyperopia in the elderly group (1.03 ± 0.73) was higher than that in the youth group (0.26 ± 1.06), with a significant difference in BCVA (p = 0.05). The thickness of SFCT, CMT, ONL in the elderly group, and the length of photoreceptor outer segment in the elderly group were thinner than those in the youth group (p < 0.05). Choroidal capillary perfusion area (CCPA), macular area, and paramacular area were lower in the elderly group than those in the youth group in the full scan range (p < 0.05). The blood flow densities of deep capillary plexus (DCP), intermediate capillary plexus (ICP), and superficial capillary plexus (SCP) in the whole scan range, macular area, and paramacular area were lower in the elderly group than in the youth group, but the differences were not statistically significant. In conclusion, our data suggest that elderly patients with cCSC may experience different disease outcomes. Elderly cCSC patients exhibit less gender bias, poorer vision, more severe structural damage and ischemia in the choroid and retina, and have a higher risk of developing choroidal neovascularization.

Enhancing epidural needle guidance using a polarization-sensitive optical coherence tomography probe with convolutional neural networks.

Epidural anesthesia helpsmanage pain during different surgeries. Nonetheless, the precise placement of the epidural needle remains a challenge. In this study, we developed a probe based on polarization-sensitive optical coherence tomography (PS-OCT) to enhance the epidural anesthesia needle placement. The probe was tested on six porcine spinal samples. The multimodal imaging guidance used the OCT intensity mode and three distinct PS-OCT modes: (1) phase retardation, (2) optic axis, and (3) degree of polarization uniformity (DOPU). Each mode enabled the classification of different epidural tissues through distinct imaging characteristics. To further streamline the tissue recognition procedure, convolutional neural network (CNN) were used to autonomously identify the tissue types within the probe's field of view. ResNet50 models were developed for all four imaging modes. DOPU imaging was found to provide the highest cross-testing accuracy of 91.53%. These results showed the improved precision by PS-OCT in guiding epidural anesthesia needle placement.

Pediatric Acquired Demyelinating Syndrome (ADS)—A Proposed Flowchart for Imaging Diagnosis

AbstractPediatric acquired demyelinating syndromes (ADS) consists of a group of neuroinflammatory disorders, which include monophasic acute disseminated encephalomyelitis, multiple sclerosis, aquaporin-4 antibody-associated neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, and seronegative ADS. Various advances have been made in understanding their pathology, clinical, and imaging features for providing timely and precise diagnosis to ensure appropriate patient management. Imaging serves as an important tool in not only for diagnosis of demyelination but also helps in distinguishing them. In this case series, the authors have tried to assess distinctive imaging features of these disorders and arrive at an algorithmic approach for the diagnosis of various pediatric demyelinating disorders.

Usefulness of Ultrasound in Verrucous Venous Malformation: a Series of 103 Cases.

Verrucous venous malformation (VVM), previously called "verrucous hemangioma," is a rare type of vascular malformation. Little is known about the ultrasonographic characteristics of VVM. The present study aimed to show the conventional US and elastographic features of a VVM. The US findings in 103 patients with VVMs were retrospectively evaluated. On gray-scale ultrasound images, 98 (95.1%) lesions showed subcutaneous fat infiltration from skin across muscle to deep fascia. The other 5 (4.9%) sat in the subcutaneous layer with no skin involvement. Most (96.1%) lesions were hyperechoic. Furthermore, 71.8% of lesions were heterogeneous, 68.9% of which were with ill-defined margins. Calcifications and visible vessels were present in 5.7% and 10.7% of the VVM cases, respectively. By color Doppler ultrasound, all lesions were found with low vascular density and 4.9% showed enhanced blood flow after compression. Venous spectrum was observed in 67.0% of lesions. The elasticity score was 2.66 ± 0.48. Diagnosis of a VVM is challenging in the clinic. However, we found that most VVM lesions present distinctive ultrasound imaging characteristics. These ultrasound findings may well contribute to the accuracy of VVM diagnosis, especially in those with the absence of epidermal changes and the lack of dermal involvement.

Active tuberculosis of spine: Current updates

BackgroundSpinal tuberculosis (TB) is the most common extrapulmonary form of tuberculosis. In both developing and developed countries, TB has been on the rising trend due to factors such as increasing HIV coinfection, multidrug resistance of the organism, and global migration. Spinal TB, which most often affects the lower thoracic and thoracolumbar area, accounts for 50% of all musculoskeletal tuberculosis. MethodsUsing the Cochrane Database of Systematic Reviews, EMBASE, and PubMed, a systematic computerized literature search was performed. Analyses of studies published within the past 10 years were conducted. The searches were performed using Medical Subject Headings terms, with “spinal tuberculosis,” “diagnosis,” “epidemiology,” and “etiology”,“management,” “surgery,” and “therapy” as subheadings. ResultsProgressive collapse, kyphosis, and neurological deficiency are hallmarks of the disease because of its destructive effect on the intervertebral disc and adjacent vertebral bodies. The condition may be identified using laboratory testing and distinctive imaging features, but the gold standard for diagnosis is tissue diagnosis using cultures, histology, and polymerase chain reaction. Uncomplicated spinal TB is today a medical condition that can be adequately treated by multidrug ambulatory chemotherapy. Surgery is reserved for individuals who have instability, neurological impairment, and deformity correction. Debridement, deformity correction, and stable fusion are the cornerstones of surgical treatment. ConclusionsClinical results for the treatment of spinal TB are generally satisfactory when the disease is identified and treated early. However, the major health issue and the biggest obstacle in achieving the goals of the “End TB strategy” is the recent rise in the emergence of drug resistance. Hence strict vigilance and patient perseverance in the completion of the treatment is the main need of the hour.

Multi-omics analysis of adamantinomatous craniopharyngiomas reveals distinct molecular subgroups with prognostic and treatment response significance.

Adamantinomatous craniopharyngioma (ACP) is the commonest pediatric sellar tumor. No effective drug is available and interpatient heterogeneity is prominent. This study aimed to identify distinct molecular subgroups of ACP based on the multi-omics profiles, imaging findings, and histological features, in order to predict the response to anti-inflammatory treatment and immunotherapies. Totally 142 Chinese cases diagnosed with craniopharyngiomas were profiled, including 119 ACPs and 23 papillary craniopharyngiomas. Whole-exome sequencing (151 tumors, including recurrent ones), RNA sequencing (84 tumors), and DNA methylome profiling (95 tumors) were performed. Consensus clustering and non-negative matrix factorization were used for subgrouping, and Cox regression were utilized for prognostic evaluation, respectively. Three distinct molecular subgroups were identified: WNT, ImA, and ImB. The WNT subgroup showed higher Wnt/β-catenin pathway activity, with a greater number of epithelial cells and more predominantly solid tumors. The ImA and ImB subgroups had activated inflammatory and interferon response pathways, with enhanced immune cell infiltration and more predominantly cystic tumors. Mitogen-activated protein kinases (MEK/MAPK) signaling was activated only in ImA samples, while IL-6 and epithelial-mesenchymal transition biomarkers were highly expressed in the ImB group, mostly consisting of children. The degree of astrogliosis was significantly elevated in the ImA group, with severe finger-like protrusions at the invasive front of the tumor. The molecular subgrouping was an independent prognostic factor, with the WNT group having longer event-free survival than ImB (Cox, P = 0.04). ImA/ImB cases were more likely to respond to immune checkpoint blockade (ICB) therapy than the WNT group ( P <0.01). In the preliminary screening of subtyping markers, CD38 was significantly downregulated in WNT compared with ImA and ImB ( P = 0.01). ACP comprises three molecular subtypes with distinct imaging and histological features. The prognosis of the WNT type is better than that of the ImB group, which is more likely to benefit from the ICB treatment.

Troublemaking Lesions: Spinal Tumor Mimics.

There are various mass-like lesions that can mimic true neoplasms in the spine, including inflammatory, infectious, vascular, congenital, and degenerative etiologies. While some lesions have distinctive imaging features that suggest a correct diagnosis, others have overlapping characteristics that do not allow their differentiation based solely on their imaging findings. For entities with nonspecific imaging features, knowledge of the clinical and laboratory information is critical to provide an accurate diagnosis.

Metastatic Prostate Adenocarcinoma Masquerading as Invasive Fungal Sinusitis.

A 58 year old male with a history of prostate adenocarcinoma presented with diplopia, severe headaches, and eye pain, consistent with sinusitis. Imaging was concerning for invasive fungal sinusitis (IFS) and an urgent ENT consultation was requested. Endoscopic sinus surgery was performed revealing metastatic prostate adenocarcinoma to the sinuses and anterior cranial fossa. The distinctive imaging features in this case are very useful when considering the divergent management options of IFS and metastatic sinus disease. These entities are likely to be encountered more frequently as immunomodulating therapies expand and prostate cancer continues to be a leading cause of death in males.

Dynamic Imaging is the Ideal Modality for the Diagnosis of Popliteal Artery Entrapment Syndrome

Popliteal Artery Entrapment Syndrome (PAES) is a rare vascular condition with significant equipoise on how to properly diagnose and evaluate relevant imaging. This can lead to misdiagnosis and delay in surgical management. The objective of this study is to describe and compare distinct imaging features of dynamic versus static images to help determine the ideal imaging modality for diagnosis of PAES. This is a retrospective review of patients referred for PAES at a single institution. We reviewed non-invasive imaging studies, diagnostic arteriograms, and cross-sectional images which include computed tomography angiography (CTA) or magnetic resonance angiography (MRA). For each affected and unaffected extremity, the characteristic collaterals for PAES were named and measured on arteriogram using Picture Archiving and Communication Software (PACS). Available cross-sectional images were also analyzed and compared with arteriogram and intraoperative findings during surgical exploration. There were 23 patients referred for PAES who underwent diagnostic evaluation and surgical management between 2013 and 2022. All patients had a duplex ultrasound that revealed a mean popliteal peak-systolic velocity (PSV) of 78 cm/sec at rest. With forced plantar flexion, the PSV increased to a mean 175 cm/sec. A total of 12 extremities had complete loss of flow with provocation during duplex ultrasound. All patients underwent diagnostic angiography of 46 extremities. All limbs with PAES (n=35) exhibited complete popliteal artery occlusion during angiography with forced plantar flexion. Distinct angiographic findings on resting images included a well-developed medial sural artery in 100% of limbs with PAES with a mean diameter of 2.7 mm. In limbs without PAES, only 80% had a visualized medial sural artery on arteriogram with a mean diameter of 2.0 mm (p=0.1). A lateral sural artery was seen in 85% of affected extremities (mean diameter of 1.8 mm) while an anterior tibial recurrent artery was seen in 59% of affected extremities (mean diameter of 1.3 mm). In unaffected limbs, there were no visible lateral sural or anterior tibial recurrent arteries. The mean contrast used with diagnostic arteriograms was 58 milliliters (range 10-100 milliliters). Axial imaging was available for 9 affected extremities. Five had a previous MRA with only 1 being truly positive for arterial compression. Four extremities had previous CTA with 3 being falsely negative despite having type 3 PAES discovered during surgical exploration. Dynamic imaging with angiography provides immediate surgeon feedback by visualizing popliteal artery compression and enlarged sural collaterals during resting arteriography. The medial sural collateral is enlarged in patients with PAES and often the lateral sural and anterior tibial recurrent arteries can be visualized as well. CTA and MRA are associated with high false-negative rates and therefore cause delays in diagnosis and surgical management of PAES. Dynamic imaging should therefore be the gold standard for the diagnosis of PAES.

A novel co-culture model of human prostate epithelial and stromal cells for androgenic and antiandrogenic screening

The risk assessment of endocrine-disrupting chemicals (EDCs) greatly relies on in vitro screening. A 3-dimensional (3D) in vitro prostate model that can reflect physiologically-relevant prostate epithelial and stromal crosstalk can significantly advance the current androgen assessment. This study built a prostate epithelial and stromal co-culture microtissue model with BHPrE and BHPrS cells in scaffold-free hydrogels. The optimal 3D co-culture condition was defined, and responses of the microtissue to androgen (dihydrotestosterone, DHT) and anti-androgen (flutamide) exposure were characterized using molecular and image profiling techniques. The co-culture prostate microtissue maintained a stable structure for up to seven days and presented molecular and morphological features of the early developmental stage of the human prostate. The cytokeratin 5/6 (CK5/6) and cytokeratin 18 (CK18) immunohistochemical staining indicated epithelial heterogeneity and differentiation in these microtissues. The prostate-related gene expression profiling did not efficiently differentiate androgen and anti-androgen exposure. However, a cluster of distinctive 3D image features was identified and could be applied in the androgenic and anti-androgenic effect prediction. Overall, the current study established a co-culture prostate model that provided an alternative strategy for (anti-)androgenic EDC safety assessment and highlighted the potential and advantage of utilizing image features to predict endpoints in chemical screening.

Stellate Multiform Amelanotic Choroidopathy (SMACH). Clinical and Multimodal Imaging Features.

To describe the clinical and multimodal imaging features of stellate multiform amelanotic choroidopathy (SMACH; also known as serous maculopathy due to aspecific choroidopathy). Retrospective observational case series of eyes presenting with SMACH. Multimodal imaging including fundus photography, optical coherence tomography (OCT), OCT-angiography (OCTA), and indocyanine green angiography (ICGA) was analyzed. Eighteen eyes from 18 patients (mean age: 28±19 years) were included. The mean follow-up duration was 9 years. Ophthalmoscopy showed a yellowish-orange, dendriform choroidal lesion. At presentation, subretinal fluid (SRF) was seen in 10/18 cases (56%). Eight patients (44%) showed no evidence of SRF during a mean follow-up of 6 years. Cross-sectional OCT showed hyperreflective fibrous-like changes within the inner choroid with choriocapillaris flow preservation on OCTA. En face OCT showed a hyperreflective choroidal lesion with finger-like projections oriented in a stellate configuration. On ICGA, SMACH showed early and late hypofluorescence. None of the cases showed lesion growth. SMACH appears to be a unilateral choroidopathy characterized by distinctive multimodal imaging features. As SRF was absent in some cases, while a dendriform pattern was a consistent finding in all eyes, we propose renaming this entity "stellate multiform amelanotic choroidopathy", a name which retains its prior abbreviation "SMACH".

Abstract #1397957: Papillary Thyroid Carcinoma Arising from Malignant Struma Ovarii

Struma ovarii is a rare ovarian teratoma characterized by the presence of thyroid tissue. It can be functional leading to hyperthyroidism or transform into malignant thyroid cancer. We present a case of a 46-year-old woman without risk factors for thyroid cancer, who was found to have a cystic ovarian lesion suspicious for malignancy. Surgery revealed struma ovarii with papillary thyroid cancer. A 46-year-old woman presented with right lower quadrant abdominal pain associated with urinary incontinence. She was found to have palpable mass in the lower abdomen on physical examination. Abdominal/pelvic computed tomography (CT) scan showed a 12.7 cm right ovarian complex cystic lesion and a 5.9 cm left ovarian complex cyst. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, radical pelvic dissection, and omental biopsy. Pathology revealed struma ovarii of the right adnexa, with a 1.8 cm papillary thyroid cancer noted to be well to moderately differentiated without ovarian surface or fallopian tube involvement. It was staged as pT1aNxMx. BRAF mutation was negative. The contralateral ovary, fallopian tubes, and uterus were negative for malignancy. Post-operative labs included thyroglobulin antigen of 20.1 ng/ml, thyroglobulin antibodies were undetectable, thyroid stimulating hormone (TSH) of 3.53 mIU/L (0.4-4.5 mIU/L) and Free T4 of 1.1 ng/dl (0.8-1.8 ng/dl). Thyroid ultrasound (US) showed a 6 mm hypoechoic nodular lesion in the right isthmus. She was started on levothyroxine to suppress her TSH to the low normal level and she is planned to follow up on the small thyroid nodule with US in 3-5 years. The vast majority of struma ovarii are benign in nature and less likely to transform into malignant tissue. Most of the tumor transformation occurs in the form of papillary thyroid carcinoma, and the risk tends to be higher with larger-size ovarian teratomas >5 cm. The presenting symptoms are indistinguishable between benign and malignant tumors, and usually present with lower abdominal pain. Diagnosing papillary thyroid cancer in struma ovarii tumors is often challenging given the lack of distinct imaging characteristics and specific tumor markers. Additionally, cancer antigen 125 (CA-125) has no value. The mainstay for management is surgical resection. Regardless of the surgical strategy used, patients with malignant struma ovarii have an excellent disease-specific survival rate overall. However, staging is key to assessing if thyroidectomy and radioactive iodine are needed. Surveillance with thyroid imaging and biochemical markers is recommended, however, the disease is curable in most cases.

Distinct imaging features of cerebral small vessel disease are related to rare NOTCH3 variants (S36.002)

<h3>Objective:</h3> To investigate the longitudinal imaging features of cerebral small vessel disease (SVD) in relation to rare <i>NOTCH3</i> variants, including spatial patterns, dynamic patterns, and the interaction between the cortical atrophy and white matter lesions. <h3>Background:</h3> Previous studies reported that rare <i>NOTCH3</i> variants were identified in over 10% of the general population and the carriers have a susceptibility to heavy SVD burden. The correlating imaging characteristics deserve in-depth investigation to uncover the important genetic predisposition in age-related SVD in the general population. <h3>Design/Methods:</h3> Rare <i>NOTCH3</i> variants were identified through Whole-Exome Sequencing. The White matter hyperintensities (WMH) volume and WMH probability maps were assessed through quantitative segmentation. Brain structural volumes and vertex-wise cortex maps were obtained from the longitudinal FreeSurfer analysis suite. Between-group differences were compared through data statistical analysis of global measurements, and voxel/vertex-wise analysis of WMH maps or cortex maps. <h3>Results:</h3> A total of 1054 patients were included in the baseline analysis (13.56% rare <i>NOTCH3</i> variant carriers), while 661 included in the longitudinal analysis (13.76% rare <i>NOTCH3</i> variant carriers). We found that rare <i>NOTCH3</i> variant carriers had heavier WMH burden (1.65 vs 0.85ml, P=0.025) and more presence of lacunes (23.78% vs 14.84, P=0.010). More importantly, rare <i>NOTCH3</i> variant carriers had a distinct WMH distribution and progression pattern in periventricular areas. These features appeared more prominent in the EGFr-involving subgroup. Also, we found that rare <i>NOTCH3</i> variant carriers showed susceptibility to worse cortical atrophy (β=−0.004, SE=0.002, adjusted for age and sex). Of most interest, the progressing of frontal brain atrophy is related to WMH progression, which indicated the role of rare <i>NOTCH3</i> variant in age-related SVD and a structural network disconnection phenomenon. <h3>Conclusions:</h3> Our findings posed a distinct MRI profile of age-related SVD in rare <i>NOTCH3</i> variant carriers and shed new light on the pathogenic mechanisms of rare <i>NOTCH3</i> SNPs. <b>Disclosure:</b> Zi-Yue Liu has nothing to disclose. Feifei Zhai has nothing to disclose. Jing-Yi Liu has nothing to disclose. Yi-Jun Zhou has nothing to disclose. Mei-jun Shu has nothing to disclose. Xiaohong Huang has nothing to disclose. Fei Han has nothing to disclose. Mingli Li has nothing to disclose. Lixin Zhou has nothing to disclose. Jun Ni has nothing to disclose. Ming Yao has nothing to disclose. Shuyang Zhang has nothing to disclose. Liying Cui has nothing to disclose. Zhengyu Jin has nothing to disclose. Yi-Cheng Zhu has nothing to disclose.

A Case Report: Simultaneous Presentation of Morphea and Multiple Sclerosis, a Diagnostic and Management Challenge. (P8-3.018)

<h3>Objective:</h3> To describe a unique case of a patient with multiple sclerosis and concurrent morphea complicating the diagnostic and therapeutic picture. <h3>Background:</h3> Localized scleroderma, also called morphea, is an inflammatory skin condition causing excess collagen deposition and thickened skin. Parry-Romberg Syndrome is one subtype characterized by linear facial involvement. Rarely, neurologic symptoms manifest as seizures, neuropathy, CNS vasculitis, and white matter abnormalities on MRI. Prior case reports of CNS involvement are associated with T2 hyperintense lesions, predominantly subcortical and juxtacortical, ipsilateral to the cutaneous lesions and often localized to one brain area. Multiple sclerosis (MS) is a primary CNS demyelinating condition, most frequently with a relapsing remitting presentation. It is characterized by white matter abnormalities on MRI, usually with periventricular, juxtacortical, cortical or brainstem and spinal cord lesions. We present a 41-year-old African American female previously diagnosed with MS and started on ofatumumab. She presented in hopes of switching therapies due to injection fatigue. On exam, she exhibited left facial discoloration and hemifacial atrophy, progressively worsening for years. She was referred to a dermatologist and subsequently diagnosed with morphea via skin biopsy. MRI showed bihemispheric periventricular, subcortical, and juxtacortical demyelinating lesions and global atrophy. She also had cervical and thoracic spinal cord involvement. Imaging was more suggestive of MS than CNS morphea, and the concomitant diagnosis of both conditions was made. Given that none of the disease modifying therapies approved for MS are compatible with treatment of morphea, this presented a challenging scenario. The patient was continued on a B-cell therapy for MS and started on monthly methylprednisolone infusions for morphea, with clinical stability to date. <h3>Design/Methods:</h3> NA <h3>Results:</h3> NA <h3>Conclusions:</h3> We present a unique diagnostic dilemma of concomitant presentation of MS and morphea versus CNS involvement of morphea. Ultimately, the distinct imaging features of both disorders on MRI guided this patient’s diagnosis and treatment. <b>Disclosure:</b> Dr. Thakkar has nothing to disclose. Dr. Sharkus has nothing to disclose. Dr. McMahon has nothing to disclose. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Focus group participant with Alexion. Olga Thon has nothing to disclose.

Neuroimaging mimics of anoxic brain injury: A review.

Diffuse cortical diffusion changes on magnetic resonance imaging (MRI) are characteristically ascribed to global cerebral anoxia, typically after cardiac arrest. Far from being pathognomonic, however, this neuroimaging finding is relatively nonspecific, and can manifest in a myriad of disease states including hypoxia, metabolic derangements, infections, seizure, toxic exposures, and neuroinflammation. While these various conditions can all produce a neuroimaging pattern of widespread cortical diffusion restriction, many of these underlying causes do have subtly unique imaging features that are appreciable on MRI and can be of clinical and diagnostic utility. Specific populations of neurons are variably sensitive to certain types of injury, whether due to differences in perfusion, receptor type density, or the unique tropisms of infectious organisms. In this narrative review, we discuss a number of distinct etiologies of diffuse cortical diffusion restriction on MRI, the unique pathophysiologies responsible for tissue injury, and the resulting neuroimaging characteristics that can be of assistance in differentiating them. As widespread cortical injury from any cause often presents with altered mental status or coma, the differential diagnosis can be enhanced with rapid acquisition of MRI when clinical history or detailed physical examination is limited. In such settings, the distinct imaging features discussed in this article are of interest to both the clinician and the radiologist.

Invasive cardiac aspergillosis in an immuno-competent patient: distinctive imaging features on 18F-fluorodeoxyglucose (FDG)-PET/CT and 99mTc-sestamibi SPECT myocardial perfusion imaging.

Invasive cardiac aspergillosis in an immuno-competent patient: distinctive imaging features on 18F-fluorodeoxyglucose (FDG)-PET/CT and 99mTc-sestamibi SPECT myocardial perfusion imaging.

Diagnosis of primary biliary melanoma with distinct imaging features: a case report and literature review

Primary biliary melanoma arises from proliferating melanocytes in the mucosal surface of the bile duct and is extremely rare. Since the vast majority of biliary melanomas represent metastases of cutaneous origin, accurate preoperative diagnosis of melanoma and exclusion of other primary sources are vital in cases involving primary lesions. Although melanomas with pigmented cells have typical signal characteristics, obtaining a non-invasive pre-treatment diagnosis remains difficult, due to their low incidence. Here, the case of a 61-year-old male Asian patient who presented with upper quadrant abdominal pain, swelling and jaundice for 2 weeks, and who was diagnosed with primary biliary melanoma following extensive preoperative blood analyses, computed tomography (CT) and magnetic resonance imaging (MRI), is described. Post-resection immunohistochemistry confirmed the diagnosis and the patient received six chemotherapy cycles of temozolomide and cisplatin, however, progression of multiple liver metastases was observed at the 18-month follow-up CT. The patient continued with pembrolizumab and died 17 months later. The present case of primary biliary melanoma is the first reported diagnosis based on typical MRI features and the exhaustive exclusion of a separate primary origin.