Enhancing Lesions Research Articles

Lumbar Spinal Meningioma- A common tumor in an uncommon location: A case report

Meningioma in the spinal canal commonly appears as intradural extramedullary spinal tumors at the dorsal and cervical region but is rare in the lumbar area. A 36-year-old man presented to us with complaints of left sciatica, weakness, and difficulty in movements of his left toes for a couple of months. Magnetic Resonance Imaging revealed an enhancing oval-shaped lesion at the level of L4, and histopathology revealed a meningioma. The complete removal has been done with hemilaminectomy for this common tumor in an uncommon location. J Shaheed Suhrawardy Med Coll 2023; 15(1): 78-82

Frequency and outcomes of new or suspicious MRI findings on breast MRI for patients on neoadjuvant therapy.

To assess the frequency and outcomes of indeterminate enhancing findings on breast MRI unrelated to the index primary tumor(s) in patients on neoadjuvant therapy (NAT). This retrospective review identified all diagnostic breast MRIs performed to evaluate response to NAT at our institution between 2017 and 2020. All exams with indeterminate enhancing findings (BI-RADS 3-5) unrelated to the index tumor(s) for which follow-up imaging or tissue diagnosis was recommended were included. Cases lacking a pre-treatment MRI or those with insufficient follow-up were excluded. Imaging of all post-NAT breast MRIs were re-reviewed. The electronic medical record was reviewed to evaluate patient and lesion characteristics and outcomes. Between 2017 and 2020, 614/4042 (15.2%) breast MRIs were performed to evaluate response to NAT. After exclusions, 38 of these exams (6.2%) identified 42 indeterminate enhancing findings unrelated to the index tumor for which follow-up imaging (15 exams) or tissue diagnosis (23 exams) was recommended. Fifteen of 42 (35.7%) of the findings were new compared to the pre-treatment baseline MRI, 8/42 (19.0%) increased and 19/42 (45.2%) were present on pre-treatment MRI. Most findings were contralateral to the index tumor (28, 66.7%). Findings were masses (17, 40.4%), focus (15, 35.7%), and non-mass enhancement (10, 23.8%). Of the 42 findings, 19 (45.2%) underwent percutaneous biopsy, 10 (23.8%) underwent surgical biopsy or mastectomy, and 13 (31%) were followed by imaging. Thirty-seven were benign, 4 were high-risk lesions without upgrade (atypical ductal hyperplasia, atypical lobular hyperplasia, and papillomatosis with atypical ductal hyperplasia), and one (2.4%) was malignant (invasive lobular carcinoma), which was non-mass enhancement present on the pre-treatment MRI. Indeterminate enhancing lesions unrelated to the index tumor(s) on breast MRIs performed to assess response to neoadjuvant chemotherapy are uncommon. When present, these lesions have an extremely low likelihood of malignancy, especially when new compared to the pre-treatment MRI. Because incidental indeterminate enhancing lesions on breast MRI at post-NAT follow-up are rarely malignant, radiologists should be judicious in recommending follow-up or tissue diagnosis for such lesions after NAT.

Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study

BackgroundNon-ischemic cerebral enhancing (NICE) lesions have been reported as a rare complication of various neuroendovascular procedures, but information on their incidence after flow diversion is scant. It is unclear if...

Contrast-Enhanced Digital Mammography for the Diagnosis and Determination of Extent of Disease in Invasive Lobular Carcinoma: Our Experience and Literature Review.

Contrast-enhanced imaging, including magnetic resonance imaging and, more recently, contrast-enhanced digital mammography (CEM), is indicated for the precise diagnosis of invasive lobular carcinoma (ILC). The aim of our study was to further validate the use of CEM for evaluation of extent of disease in ILC cases, with digital breast tomosynthesis (DBT) as an adjunct. A retrospective, institutional review board approved study was conducted in a tertiary medical center. All CEM examinations performed on ILC patients between 2017 and 2023 were reread by 2 dedicated breast radiologists. Clinical data and pathology reports were retrieved from electronic medical records. The longest diameter of the enhancing lesion was correlated to pathology findings. In addition, for each case, the readers provided brief commentary on the added value of DBT. Twenty-four CEM examinations were evaluated. The subjects in the study cohort were on average older than expected for ILC patients (74 vs 63 years) and were unable to undergo breast magnetic resonance imaging due to advanced age and comorbidities. Three subjects were treated with neoadjuvant therapy and thus were excluded from the correlation to pathology analysis. Enhancing lesions, ranging from 4-75 mm, strongly correlated to pathology results, with statistical significance. This was demonstrated for mass and nonmass lesions (r = 0.94, P < 0.001 and r = 0.99, P = 0.002, respectively). For most lesions (17/24, 71%), readers remarked that the addition of DBT allowed for improved characterization of lesion margins, mainly detecting architectural distortion. When compared with the pathology findings, ILC was accurately diagnosed and assessed using CEM. The addition of DBT was reported by the interpreting radiologists as a valuable adjunct for margin analysis.

Desmoplastic Small Round Cell Tumor of the Spinal Canal: A Rare Presentation in a Female Pediatric Patient

AbstractDesmoplastic small round cell tumor (DSRCT) is a rare and aggressive malignancy primarily affecting young individuals, typically originating in the abdominal cavity. While spinal involvement by DSRCT is exceedingly rare, especially in pediatric patients, recognizing such atypical presentations is crucial for optimal management. Here, we present a case of DSRCT involving the spinal canal in a 3-year-old female child, representing one of the youngest documented instances in the literature. Initial symptoms included weakness, lower limb pain, and urinary incontinence. Magnetic resonance imaging revealed an enhancing soft tissue lesion in the spinal canal, prompting tumor excision and histopathological examination. The tumor exhibited characteristic features of DSRCT, including small round cells within a desmoplastic stroma. Immunohistochemistry confirmed the diagnosis, showing positivity for Wilms tumor 1, epithelial membrane antigen, desmin, and synaptophysin. This case highlights the challenges in diagnosing and managing rare tumors like spinal DSRCT, emphasizing the importance of a comprehensive approach to differential diagnosis and individualized treatment strategies.

The Role of Indocyanine Green With Near-Infrared Imaging for the Intraoperative Detection and Enhancement of Endometriosis Lesions: A Narrative Review.

Background: There is a clinical need for improved intraoperative detection of endometriosis, and the use of Indocyanine Green with Near-Infrared Imaging (NIR-ICG) is a novel technique for this purpose. The aim of this review is to determine whether NIR-ICG is an effective tool for endometriosis detection and establish an evidence-based methodology for its use.Methods: This review searches Ovid MEDLINE and Embase through July 2023 and considers primary literature published in English describing the use of NIR-ICG to detect endometriosis intraoperatively. Case studies, video demonstrations and articles describing NIR-ICG used for other surgical roles were not considered. Identified studies were screened independently by two authors, and data was extracted by a single author.Results: NIR-ICG was found to enhance the detection of endometriosis in six out of the nine included studies with additional lesion identification, and to have an unchanged or reduced efficacy compared to current standards in the remaining three. Across all studies there were lesions missed by NIR-ICG which were detected by conventional imaging. A greater duration of time between dye administration and visualisation of lesions was found to be more effective for detection. The ideal ICG protocol proposed from this review is a fixed amount of dye proportional to patient weight prior to surgery (0.25-0.3 mg/kg) followed by a longer waiting time before imaging (10-30 min).Conclusion: NIR-ICG has a possible role to enhance the identification of endometriosis intraoperatively as an adjunct to conventional white light imaging, particularly deeper infiltrating disease. However, substantial further research is required in this field.

6574 Pheochromocytoma In A Patient With ESRD; Clinical Challenges And Lessons From A Successful Evaluation

Abstract Disclosure: S. Younes: None. A. Sayed: None. K. Selk: None. L.A. Willard: None. Introduction: Pheochromocytomas are rare tumors that arise from the chromaffin cells in the adrenal medulla, that secrete norepinephrine, epinephrine and dopamine. Common presentations include resistant hypertension (HTN) and adrenergic spells with headaches, sweating and tachycardia. The literature has few cases of pheochromocytoma in the setting of end stage renal disease (ESRD). Case: A 46-year-old male with a history of resistant HTN on amlodipine, lisinopril, and labetalol, complicated by ESRD on hemodialysis (HD) and secondary hyperparathyroidism initially presented with gross hematuria. The patient reported sporadic, intermittent headaches associated with palpitations and sweating. A renal ultrasound revealed a left-sided complex renal cystic mass. CT abdomen/pelvis demonstrated an enhancing left adrenal lesion and MRI abdomen/pelvis confirmed an enhancing 4.6 x 2.8 cm adrenal mass. Laboratory studies revealed elevated normetanephrine of 1186 pg/mL (ref &amp;lt;149 pg/mL), elevated metanephrine at 139 pg/mL (ref &amp;lt;57 pg/mL) and elevated epinephrine at 128 pg/mL (ref &amp;lt;95 pg/mL). Given the laboratory and imaging findings in conjunction with clinical presentation, an excision of the adrenal mass was set. Two weeks prior to the surgery, alpha blockade was started with doxazosin 1mg daily with a goal blood pressure &amp;lt;130/80. He was admitted to the hospital with a goal to keep him 1-1.5kg above his dry weight. His dry weight was 81.5kg close to admission weight, so he was started on gentle IV hydration. He had a left robotic assisted adrenalectomy and was given stress dose steroids and a steroid taper given no preoperative Cushing’s screen was completed. No postoperative complications reported, and doxazosin was discontinued. 2 weeks later, he reported his adrenergic spells had resolved. Surgical pathology confirmed pheochromocytoma and he was referred for genetic consultation. Conclusion: Although there is little in the literature regarding management of a pheochromocytoma in patients with ESRD, similar principles of management in patients with normal renal function apply, including blood pressure control, alpha blockade, and establishment of euvolemia with recommendation of a high-sodium diet and 1-2 liters of saline the day prior to the procedure. This case highlights successful perioperative management with traditional use of alpha blockade but also incorporated maintaining the patient 1-1.5 kg above their dry weight for surgery to limit postoperative hypotension. Presentation: 6/3/2024

7085 Myoclonus Seizure with Pseudo-Adrenal Insufficiency as the Clinical Manifestations Leading to the Diagnosed Multi-focal Insulinomas that Mimic Multiple Endocrine Neoplasia Type 1 Syndrome

Abstract Disclosure: P. Kiatpanabhikul: None. Background: Insulinoma is a rare disease that presents with varying symptoms and can be sporadic or associated with hereditary syndromes (1). These rare points of views of insulinoma-patient on clinical manifestations, hormonal responses and surgical pathology result for final diagnosis and management. Clinical Case: A 59-year-old woman presented with myoclonic seizure of right arm with consciousness duration 5-10 minutes every midday twice a week for 6 months and generalized convulsion for 20 minutes ago. She had a low FPG level (59 mg/dL; n 70-100) and was admitted to doing 72-hour fasting test that revealed hypoglycemia at 12-hour of fasting with a nadir glucose level of 55 mg/dL, insulin 3.7 uIU/mL (cutoff &amp;gt; 5), C-peptide 0.4 ng/mL (cutoff &amp;gt; 0.6), cortisol 6.22 mcg/dL (n 5-25) and normal morning ACTH level (29.8 pg/mL; n 10-65). These were appropriated response of endogenous insulinemia with inappropriate response of serum cortisol level in hypoglycemic feature. MRI pituitary gland was considered to evaluate secondary hypocortisolism which showed a small less enhancing lesion left anterior lobe 0.3x0.45-cm without any pituitary hormonal abnormalities that were considered non-functioning pituitary microadenoma which could not explain inappropriate response of cortisol level to hypoglycemic period in this patient. Five months later, she presented at the emergency room with myoclonic seizure on her extremities, blurred consciousness and slurred speech after having lunch for 1-2 hour and revealed CPG 30 mg%, severe hypoglycemia (26 mg/dL), hypocortisolism (4.49 mcg/dL), with endogenous hyperinsulinemia (insulin 55.2 uIU/mL, C-peptide 2.5 ng/mL). 250-mcg ACTH stimulation test was done and showed normal response of her HPA-axis function (serum cortisol level at 0, 30, 60 min was 9.12, 17.87, 18.61 mcg/dL). CT pancreatic protocol showed several arterial enhancing nodules scattering at pancreatic tails isoattenuation to pancreatic parenchyma on portovenous phase up to 1.7*1.6 cm. She was operated on to distal pancreatectomy with intraoperative insulin/glucose ratio monitoring. Surgical pathology confirmed 4-well-differentiated pancreatic neuroendocrine tumors with insulin-producing, sizes 0.5-1.7 cm in diameter. Her final diagnosis was multi-focal insulinomas with non-functioning pituitary microadenoma that mimic MEN-1 syndrome without secondary adrenal insufficiency. She underwent successful surgical resection with complete resolution of symptoms during 4 years of followed-up with no recurrence and no having any hypercalcemia and hyperprolactinemia. Conclusion: Multi-focal insulinomas can be presented as sporadic, more severe hypoglycemia and endogenous hyperinsulinemia during period after meal with myoclonic seizure and pseudo-adrenal insufficiency in older-aged, non-diabetes person without recurrence after treatment for 4-year of followed-up. Presentation: 6/2/2024

6419 Cushing’s Syndrome due to Metastatic Pancreatic Neuroendocrine Neoplasm With Incidental Pituitary Microadenoma

Abstract Disclosure: A. Ibrahim: None. L. Esper: None. R. Jain: None. N. El Asmar: None. Introduction: Pancreatic neuroendocrine neoplasms (PNENs) are rare with a reported incidence of 1-2/100,000. While the majority are non-functional, insulinomas and gastrinomas are the most common functional PNENs. Our case of ACTH-producing PNENs is extremely rare. Case presentation: A previously healthy 47-year-old female was hospitalized for worsening dyspnea. Her symptoms included rapid weight gain, skin hyperpigmentation, and lower extremity edema. Her exam was notable for elevated blood pressure of 181/120 mmHg, moon facies, purple abdominal striae, and proximal myopathy. Her lab analysis showed a cortisol level of 42 mcg/dL (6.2-19.4), ACTH of 254 pg/ml (7.2-63), DHEA sulfate of 171 mcg/dl (41-243), HbA1C 7%, K of 3 mmol/l and 24H urine cortisol &amp;gt;2100 mcg/24hrs. A post low-dose DST cortisol level was 42.7 mcg/dl. CT chest demonstrated an ill-defined hypodense lesion in the region of the pancreatic head. MRI abdomen revealed a 3 x 2.3 x 2.3 cm mass in the pancreatic head and many small enhancing lesions within the right lobe of the liver. Adrenal glands appeared normal. Subsequent PET CT scan with GA 68 DOTOTATE showed increased uptake in the pancreatic head mass and in the right hepatic lobe. Her pituitary MRI revealed a right pituitary gland 6 mm hypointense lesion, possibly a microadenoma. A high dose DST resulted in a cortisol level of 80 mcg/dl mostly consistent with ectopic ACTH secretion. EUS-guided biopsy of the pancreatic mass showed a well-differentiated neuroendocrine tumor that stained positive for ACTH, chromogranin, synaptophysin, and CD56. Treatment with Ketoconazole 600mg q6h and Octreotide 50mg q6h was started 3 days before surgery to control acute hypercortisolism as she developed acute psychosis. The patient subsequently underwent a Whipple procedure with successful resection of the pancreatic mass. Post-op, her ACTH levels dropped to 19 pg/ml with a cortisol level of 6 mcg/dl. Final pathology showed a well-differentiated grade 3 neuroendocrine tumor with a KI-67 labeling index greater than 20%. After surgery, the patient received a short course of stress dose hydrocortisone which was tapered off over the following 2 months. The patient is being followed for planning further intervention given the aggressive grade of the tumor and hepatic metastases. Conclusion: Ectopic ACTH-producing PNENs are rare. An accurate and timely diagnosis, while challenging, is key. Patients usually present with rapidly progressing symptoms that could cause life-threatening complications such as thrombosis and sepsis. We demonstrated the importance of utilizing a multidisciplinary team approach and starting cortisol-lowering medications early given the complexity of the disease, requiring rapid intervention and lifelong follow-up. Presentation: 6/3/2024

7254 An Unusual Case Of Hypercalcemia

Abstract Disclosure: S. Shushtarian: None. M. Balogun: None. T. Kaur: None. Hypercalcemia varies depending on severity. Higher serum calcium levels and more severe symptoms may indicate primary hyperparathyroidism or a malignant cancer. This is a case of a 32 year old female who presented with recurrent history of nephrolithiasis, found to have hypercalcemia of 13.4 mg/dL and parathyroid hormone of 1928.9 pg/mL, with phosphorus of 1.5 mg/dL. Ultrasound of her thyroid revealed a complex nodule arising from the right parathyroid gland measuring 2.2 X 2.0 cm. CT chest revealed diffuse osseous sclerosis secondary to metabolic disorder. Sestamibi scan did not localize any parathyroid adenoma. MRI of the thoracic and lumbar spine showed multiple small enhancing lesions throughout the pelvis and in the left rib, likely brown tumors related to hyperparathyroidism. X-ray of bony prominence on the patient’s left knee revealed a large lytic lesion of the proximal tibial diaphysis measuring 5.1 X 1.9 cm, concerning for aggressive neoplasm. Subsequent left tibial bone biopsy revealed giant cell rich lesions consistent with brown tumor of hyperparathyroidism. Due to our patient’s high calcium levels and large nodule size, she was referred to a tertiary center as the concern for parathyroid carcinoma and post-op hungry bone syndrome was high. Pre-op PTH level was 1408 pg/mL and post-op PTH was 96 pg/mL. The tumor removed was 2.1 cm. Post surgical pathology was consistent with atypical parathyroid adenoma. Patient was referred for genetic testing. An atypical parathyroid adenoma (APA) only accounts for 1.2 to 1.3% of cases of primary hyperparathyroidism. 80-85% of primary hyperparathyroidism is due to typical adenoma, and 10 to 15% of cases are due to hyperplasia or multiple gland disease. APA can often be confused with parathyroid carcinoma (PC), as they both have a 1:1 male to female ratio, high serum calcium levels, symptomatic hypercalcemia, high PTH levels, and fragility fractures. There are studies showing that both APA and PC have loss of nuclear parafibromin immunoreactivity. In addition, neither APA nor PC have any correlation with menopause, hormones, or gene deletions, unlike typical adenomas. Biopsy is necessary for diagnosis as the histological and immunohistochemical differences can differentiate APA vs PC. Histological features include pseudo-capsular invasion, bands of fibrosis, pronounced trabecular growth, nuclear atypia, and prominent nucleoli. Also, APA has a strong membranous staining pattern of E-cadherin, whereas PC has a loss of membranous staining. These differences are essential as although APA and PC clinically present similarly, APA lacks the invasive growth and possibility for metastatic disease that PC has. The likelihood for relapse of APA is low. Presence of malignancy criteria are indicative that a mass is actually PC and not APA. Despite this, APA is still considered a tumor of uncertain malignant potential and requires follow up. Presentation: 6/3/2024

Concurrent Intracranial and Spinal Dural Metastases Demonstrated by 68Ga-DOTATATE PET/CT With Negative 123I-MIBG SPECT/CT in a Pediatric Neuroblastoma Patient.

Contrast enhancement MRI of the brain and spine showed abnormal enhancement in intracranial and spinal dural lesions in a 6-year-old boy with high-risk neuroblastoma, suggesting the possibility of dural metastases. 123I-MIBG SPECT/CT did not show any abnormal MIBG accumulation in these lesions. However, 68Ga-DOTATATE PET/CT showed obvious DOTATATE uptake in these metastatic lesions. Surgical pathology confirmed the diagnosis of intracranial dural metastasis. Concurrent intracranial and spinal dural metastases from neuroblastoma demonstrated by 68Ga-DOTATATE PET/CT with negative 123I-MIBG SPECT/CT have not been reported previously.

Neuroimaging feature in identifying acute myelopathy etiologies: comparison between neuromyelitis optica spectrum disorder and cervical spondylotic myelopathy

ObjectiveThe clinical symptoms of neuromyelitis optica spectrum disorder (NMOSD) and acute cervical spondylotic myelopathy (CSM) may overlap in some cases. This study aimed to investigate the differences in imaging features between NMOSD and CSM in acute myelopathy.MethodsWe included 78 patients in this retrospective study, including 28 NMOSD patients and 50 CSM patients. The demographic characteristics and clinical symptoms of the two groups of patients were compared. The T1 signal intensity, length of the spinal cord involved by T2 hyperintensity, degree of intervertebral disc degeneration, proportion of thoracic and lumbar cord involvement, proportion of brain involvement and lesion enhancement rate in magnetic resonance imaging (MRI) were compared between the two groups of patients. The number, length, location on the sagittal image, pattern on the sagittal image, and distribution on the axial image of the lesions in the contrast-enhanced MRI of the two groups were evaluated.ResultsThere were differences between NMOSD and CSM patients in the proportion of women, the proportion of bowel and bladder symptoms, mRS levels, the length of the spinal cord involved by T2 hyperintensity, degree of intervertebral disc degeneration, the proportion of thoracic and lumbar cord involvement, the proportion of brain involvement, the enhancement rate and number of lesions (p < 0.05). Among NMOSD patients, linear, patchy and ring or semi-ring enhancement were present in 8(30.8%) ,14 (53.8%) and 4(15.4%)patients, respectively, and axial gray and white matter were involved in 17 (65.4%) patients. Among patients with CSM, 9(36.0%) patients showed longitudinal oriented flake, 16 (64.0%) patients showed pancake-like enhancement, and 21 (84.0%) patients showed axial white matter involvement only. The differences in enhancement pattern on sagittal images and axial involvement were statistically significant (p < 0.05).ConclusionsEarly differential diagnosis of NMOSD and CSM in acute myelopathy can be made by analyzing images and the number, length, sagittal enhancement pattern, and axial involvement of gadolinium-enhanced lesions.

ESTRO-EANO guideline on target delineation and radiotherapy for IDHmutant WHO CNS grade 2 and 3 diffuse glioma

PurposeThis guideline will discuss radiotherapeutic management of IDH mutant grade 2 and grade 3 diffuse glioma, using the latest 2021 WHO (5th) classification of brain tumours focusing on: imaging modalities, tumour volume delineation, irradiation dose and fractionation. MethodsThe ESTRO Guidelines Committee, CNS subgroup, nominated 15 European experts who identified questions for this guideline. Four working groups were established addressing specific questions concerning imaging, target volume delineation, radiation techniques and fractionation. A literature search was performed, and available literature was discussed. A modified two-step Delphi process was used with majority voting resulted in a decision or highlighting areas of uncertainty. ResultsKey issues identified and discussed included imaging needed to define target definition, target delineation and the size of margins, and technical aspects of treatment including different planning techniques such as proton therapy. ConclusionsThe GTV should include any residual tumour volume after surgery, as well as the resection cavity. Enhancing lesions on T1 imaging should be included if they are indicative of residual tumour. In grade 2 tumours, T2/FLAIR abnormalities should be included in the GTV. In grade 3 tumours, T2/FLAIR abnormalities should also be included, except areas that are considered to be oedema which should be omitted from the GTV. A GTV to CTV expansion of 10 mm is recommended in grade 2 tumours and 15 mm in grade 3 tumours. A treatment dose of 50.4 Gy in 28 fractions is recommended in grade 2 tumours and 59.4 Gy in 33 fractions in grade 3 tumours. Radiation techniques with IMRT are the preferred approach.

Accuracy of Diagnosing Optic Neuritis Using DANTE T1-SPACE Imaging.

To evaluate the use of delay alternating with nutation for tailored excitation-prepared T1-weighted turbo spin echo (DANTE T1-SPACE) imaging for diagnosing optic neuritis and to analyze its correlation with clinical findings before and after treatment. Patients diagnosed with optic neuritis or non-arteritic anterior ischemic optic neuropathy (NA-AION) were evaluated at the Ophthalmology Department of Kyoto University Hospital. All patients underwent magnetic resonance (MR) studies before treatment initiation and ophthalmic examinations before and after treatment. Three ophthalmologists independently reviewed the MR scans for abnormalities. The magnetic resonance imaging (MRI) assessments included post-contrast DANTE T1-SPACE, post-contrast volumetric interpolated breath-hold examination (VIBE), and short T1 inversion recovery (STIR) scans. The presence of abnormalities in each sequence was determined. Of 36 eyes from 30 patients, 21 eyes from 17 patients were diagnosed with optic neuritis, and 15 eyes from 13 patients were diagnosed with NA-AION. DANTE T1-SPACE sequences showed better sensitivity for detecting optic neuritis than STIR sequences (100% vs 67%, p = 0.009). VIBE images did not confirm enhancement of lesions in some cases with optic neuritis. No differences were observed among the sequences for NA-AION. Lesion length evaluated by DANTE T1-SPACE sequences was associated with circumpapillary retinal nerve fiber layer thickness at the initial visit, eye pain, and the time interval from symptom onset to MRI scan. Contrast-enhanced DANTE T1-SPACE was better than other sequences of MRI for diagnosing optic neuritis.

UTILITY OF CONTRAST-ENHANCED T2-FLAIR FOR IMAGING OF BRAIN METASTASESUSING A HALF-DOSE HIGH-RELAXIVITY CONTRAST AGENT IN COMPARISON WITH ROUTINE DOSE CONTRAST-ENHANCED BRAIN IMAGING

Aim &amp; Objectives: This study aims to assess the efficacy of delayed contrast-enhanced T2 fluid-attenuated inversion recovery (CE-T2 FLAIR) by using half dose high relaxivity contrast agent to assess the degree of enhancement among the lesions and to detect additional metastatic brain lesions usually smaller lesions(&lt;5mm), which are significantly missed on routine-dose CE-T1 weighted imaging (CE-T1WI). Material &amp; Methods:The main source of data for this study was radiologically diagnosed lung cancer patients who were clinically suspected to have brain metastasis referred from various departments of Silchar Medical College and Hospital. The studywas carried out for a period of 1 year from March 1, 2023, to February 29, 2024, A total of 40 patients with brain metastases were scanned using a SIEMENS TIM AVANTO 1.5T scanner, routine MR pulse sequences pre- and post-contrast administration were acquired. Results: Out of 40 patients, males were more affected (57.5 %) than females (42.5 %). The highest number of cases were found between the 61-70 years age group with the lung (31 cases) being the most common primary malignancy causing brain metastases. A total of 90 lesions were detected among 40 patients which were grouped into A (25 lesions), B (36 lesions), and C (29 lesions) groups. A total of 6 lesions were missed on Routine dose contrast-enhanced brain imaging of which 2 lesions belong to group B (Rim enhancing lesions &gt;5mm) and 4 lesions belong to group C (Lesions &lt;5mm), however, these lesions were picked up on delayed half dose contrast-enhanced FLAIR images. The contrast ratio (CR) on 3 consecutive half dose CE-T2 FLAIR ranged between 59.09%-76.80%, suggesting that delay in imaging post-contrast administration resulted in a significant increase in the contrast ratio (CR) among metastatic lesions. Conclusions: CE-T1-weighted sequences and CE-T2 FLAIR sequences complement each other effectively in evaluating brain metastases. Bigger and homogenously enhancing lesions are best seen on CE-T1-weighted sequences. Smaller lesions and lesions showing rim enhancement are best visualized on delayed (5 min) CE-T2 fluid-attenuated inversion recovery (FLAIR) sequences with half the dose ofcontrast agent (gadobenatedimeglumine) compared to routine dose CE-T1-weighted sequences. This approach serves as a cost-saving measure for both patients and the healthcare system.

Fotemustine in recurrent high‑grade glioma: MRI neuro‑radiological findings.

The use of fotemustine (FTM) has been authorized in certain countries for the treatment of recurrent high-grade gliomas (HGG) after Stupp therapy. However, to the best of our knowledge, no studies have assessed changes in magnetic resonance imaging (MRI) during treatment with FTM monotherapy. The aim of the present study was to assess the neuroradiological findings in a cohort of patients with recurrent HGG treated with FTM monotherapy. Patients with HGG already undergoing the Stupp protocol were retrospectively included. MRIs (pre- and post-FTM treatment) were analyzed by two neuroradiologists in consensus: Volume and diffusion values of the contrast-enhanced component were measured on T1-weighted volumetric sequences after gadolinium injection and on apparent diffusion coefficient (ADC) maps, respectively. A total of 19 patients [median age, 49 years; interquartile range (IQR), 43-57 years] were included, 17 of whom had glioblastoma and 2 had astrocytoma isocitrate dehydrogenase-mutated grade 4. The median duration of FTM therapy was 4 months (IQR, 2-6 months). The median tumor volume measured on the contrast-enhanced component was 2,216 mm3 (IQR, 768-13,169 mm3) at baseline and 9,217 mm3 (IQR, 3,455-16,697 mm3) at the end of treatment, with a median change of +38% (IQR, -45-+574%). A total of seven patients showed a volume decrease. ADC value analysis of the enhancement area demonstrated no significant difference between the pre- and the post-FTM treatment periods (P=0.36); however, in three patients, the decreases in ADC levels were particularly marked. In conclusion, the present study described a series of patients with recurrent HGG treated with FTM in monotherapy, demonstrating a prevalent increase in lesion enhancement and three cases of marked restrictions on diffusion-weighted imaging. Further prospective studies are required to corroborate such preliminary results.

Three-Tesla Magnetic Resonance Imaging Characteristics of Hypertrophic Cardiomyopathy: A Comparison with Several Echocardiography Parameters.

Hypertrophic cardiomyopathy (HCM) is a primary cardiac disorder characterized by myocardial hypertrophy without increased afterload. This study set out to describe the cardiac magnetic resonance (CMR) imaging characteristics of HCM and to evaluate correlations of selected CMR parameters with echocardiography. This cross-sectional study enrolled 46 patients diagnosed at the Vietnam Heart Institute with HCM and underwent CMR at the Radiology Center, Bach Mai Hospital, from July 2021 to September 2022. A left ventricular outflow tract (LVOT)/aortic valve (AO) diameter ratio of ≥0.38 on CMR was consistent with an LVOT pressure gradient (PG) of <30 mmHg on echocardiography. The LVOT diameter and the LVOT/AO diameter ratio differed significantly between obstructive and non-obstructive HCM. The predominant phenotypes were diffuse asymmetric HCM (32.6%) and septal HCM (37%), followed by apical HCM (6.5%). Most late gadolinium enhancement (LGE) lesions were observed in the mid-wall of the hypertrophic segments. The mean LGE mass was significantly higher in the obstructive group than in the non-obstructive HCM group (p < 0.05). A strong negative correlation (r = -0.66) was found between the LVOT/AO diameter ratio on the CMR and the LVOT PG via echocardiography. Moreover, echocardiography detected morphologic risk factors for sudden cardiac death (SCD) in 80.4% of patients, whereas the corresponding proportion detected by CMR was 91.3%. Patients with systolic anterior motion (SAM) had a risk for a LVOT/AO diameter ratio <0.38, which was 5.7 times the risk observed in their counterparts without SAM. The LVOT/AO diameter ratio detected by CMR is a precise index for classifying hemodynamic HCM groups. CMR was better than echocardiography for SCD risk stratification.

Distinct plasma lipids predict axonal injury and multiple sclerosis activity

BackgroundLipids are of particular interest for the study of neuroinjury and neuroinflammation as structural lipids are major components of myelin, and a variety of lipid species modulate inflammation. In this...

Assessment of the contribution of the ADC value to the Kaiser score in the differential diagnosis of breast lesions with non-mass enhancement morphology on MRI

PurposeTo investigate the effectiveness of diffusion-weighted imaging (DWI) as a supplementary tool to the Kaiser score (KS) in diagnosing breast cancer in non-mass enhancement (NME) lesions using breast magnetic resonance imaging (MRI). MethodsThis single-center, retrospective study analyzed 360 cases with NME on MRI images. Two breast radiologists independently evaluated each lesion using the Kaiser score (KS) and apparent diffusion coefficient (ADC) values, without knowledge of the pathological outcomes. NME lesions with a KS above 4 and an ADC value below 1.3 × 10-3mm2/s were classified as malignant. Inter-rater reliability was determined using Cohen’s Kappa (κ) statistics. The diagnostic performance of KS, DWI, and their combination was assessed by calculating sensitivity, specificity, and the area under the curve (AUC), and the results were compared across the benign and malignant groups. ResultsThe diagnostic performance of KS surpassed that of DWI in predicting the malignancy of NMEs (p = 0.003). The sensitivity of KS alone was 93 %; however, when ADC data was incorporated, the sensitivity decreased to 86 %, with no significant difference observed (p = 0.060). The specificity of the combined KS and ADC (94 %) was significantly higher than that of KS alone (89 %) and DWI alone (73 %) (p < 0.001). ConclusionOur findings indicated that although the combination of KS and ADC increased specificity and reduced unnecessary biopsies, the resulting decrease in sensitivity was unacceptable. Therefore, KS alone is superior to the KS-ADC combination in detecting malignancy in NME lesions.

Intraoperative Comparison Between Strain Elastography and Preoperative Magnetic Resonance Imaging Features in High-Grade Gliomas Using Fusion Imaging: A Pilot Study

To compare the elastographic patterns of high-grade gliomas (HGGs) solid portions and those of adjacent healthy brain parenchyma, on intraoperative ultrasound, with magnetic resonance image (MRI) characteristics. Clinical records and images of HGGs patients, operated between June and December 2018, were retrospectively reviewed. Fusion images were used to compare preoperative gadolinium-enhanced T1-weighted MRI/fluid-attenuated inversion recovery images (Gd-T1 MRI/FLAIR) to intraoperative strain elastography (SE). FLAIR/Gd-T1 MRI images were used to define: enhancement patterns (absent/whole lesion/peripheral) and lesions' characteristics (primary and secondary pattern, further subdivided in solid/necrotic/cystic/infiltrating). HGGs SE patterns were categorized as homogeneous/inhomogeneous, while lesions' primary and secondary patterns as stiff/intermediate/elastic. The SE motive of neighboring healthy brain parenchyma was defined similarly. 18 patients (M:F, 11:7; mean age: 53 years) harboring 14 glioblastomas (77.8%, GBMs) and 4 anaplastic astrocytomas (22.2%, AAs) were compared. GBMs typically enhanced peripherally and had a primary necrotic pattern (78.6% and 64.3%, respectively), while AAs did not enhance and were solid (75% both) at T1-Gd MRI and FLAIR images. At SE AAs had a homogeneous stiff primary pattern, whereas the majority of GBMs primary patterns were heterogeneous (85.7%) and intermediate (78.6%). Three major SE patterns defined HGGs and adjacent healthy brain parenchyma. SE patterns varied accordingly to HGG histotypes and Gd-T1 MRI/FLAIR characteristics.