Follow-up Scans Research Articles

Paramagnetic rim lesion formation is predicted by the initial gadolinium-enhancing lesion diameter.

Paramagnetic rim lesions (PRLs) are a magnetic resonance imaging (MRI) marker of compartmentalized intraparenchymal inflammation. The primary objective was to investigate clinical, demographic, and MRI factors that may be predictive of the future formation of PRL. This is a retrospective analysis of longitudinal data. Patients were included if they had ⩾1 gadolinium-enhancing lesion on any historical MRI and follow-up scan(s) ⩾6 months afterward on a standardized 3T MRI using the filtered phase component of a susceptibility-sensitive sequence ("SWAN"). Regression and machine-learning models were used to identify the predictive ability of demographic, clinical, immunological, treatment-related, and MRI predictors of PRL formation. A total of 64 patients having 229 contrast-enhancing lesions (CELs) were included. Among all predictors, the diameter of the initial enhancing lesion was the most influential for determining subsequent PRL formation; every millimeter increase in diameter increased the risk of PRL formation by 44%. Other factors did not contribute additional information; the administration of steroids was not associated with any effect. The long-axis diameter of a CEL is the best translational predictor of subsequent PRL formation at follow-up. This measure holds promise as a method to identify patients at high risk of chronic active lesion formation during the acute inflammatory window.

Prospective Head-to-Head Comparison of 18F-PSMA PET/CT and 18F-NaF PET/CT for Assessing Bone Metastases in 160 Patients with Newly Diagnosed High-Risk Prostate Cancer.

Prostate-specific membrane antigen (PSMA) PET/CT is increasingly used for primary staging in prostate cancer (PC), mainly because of its improved accuracy in detecting lymph node metastases compared with conventional imaging. However, the diagnostic benefit of PSMA PET/CT for detecting bone metastases is less well established. This study compares the diagnostic accuracy of 18F-PSMA PET/CT and 18F-NaF PET/CT for detecting bone metastases in patients newly diagnosed with PC. Methods: This prospective study included patients with histologically confirmed high-risk PC. All participants were referred from the department of urology to 18F-NaF PET/CT and underwent 18F-PSMA PET/CT within 3 weeks. Images were reviewed by 2 nuclear medicine physicians unaware of the results of the other imaging modality. Presence or absence of bone metastases and number of metastatic lesions were recorded. A reference standard was established at the patient level based on agreement between the 2 imaging modalities. In cases of concordance, both modalities were deemed correct. In cases of discordance, additional follow-up scans were performed. Diagnostic performance metrics, including sensitivity, specificity, and accuracy, were calculated. Results: In total, 160 participants were included. Sensitivity, specificity, and accuracy for detecting bone metastases at the patient level were 0.98, 0.99, and 0.99, respectively, for 18F-PSMA PET/CT, and 0.91, 1.00, and 0.97, respectively, for 18F-NaF PET/CT. No significant differences were found. The concordance rate of bone metastases between 18F-NaF and 18F-PSMA PET/CT at the patient level was observed in 154 patients (96.3%). 18F-PSMA PET/CT tended to identify more bone metastases per patient than 18F-NaF PET/CT. Conclusion: Both 18F-NaF and 18F-PSMA PET/CT exhibit high diagnostic accuracy for detecting bone metastases in newly diagnosed high-risk PC patients. 18F-PSMA PET/CT may detect additional metastatic lesions compared with 18F-NaF PET/CT. Subsequent 18F-NaF PET/CT may be redundant if no bone metastases are found on 18F-PSMA PET/CT.

Reducing Sedation for Pediatric Thoracic CT Imaging Using Volumetric Target-mode EKG Gating.

Many children require sedation for imaging. We aimed to reduce sedation for thoracic (chest and cardiac) computed tomography (CT) scans in children 0-4 years old from 65% to 20% by December 2018 and to sustain. We counted baseline, intervention, and a follow-up period thoracic CT scans performed with sedation in children 0-4 years old. We developed a new volumetric target-mode electrocardiogram-gated CT imaging protocol to reduce scan time and control for factors that decrease image quality. Additional interventions included technologist training, communication to radiologists and clinicians, and eliminating a default request for sedation accompanying the electronic order for most thoracic CT scans. A statistical process control chart tracked data to study process changes over time. During the baseline and intervention periods, 232 of 357 and 217 of 794 scans required sedation. Interventions created 2 centerline shifts. Overall, thoracic CT scans in children 0-4 years old requiring sedation decreased from 65% to 24% and was sustained 5 years later. No patients during the baseline period, one (1 of 794, 0.1%) during the intervention period and 2 (2 of 480, 0.4%) during the audit period 5 years later, initially had nondiagnostic nonsedated scans that required an additional scan with sedation. We developed a volumetric target-mode electrocardiogram-gated CT protocol, eliminated default sedation ordering, and trained and educated staff to reduce sedation in young children undergoing thoracic CT scans. The frequency of sedation for thoracic CT in children 0-4 years old decreased from 65% to 24% and was sustained after revising imaging parameters and eliminating a default sedation order.

Optimizing Automated Hematoma Expansion Classification from Baseline and Follow-Up Head Computed Tomography

Hematoma expansion (HE) is an independent predictor of poor outcomes and a modifiable treatment target in intracerebral hemorrhage (ICH). Evaluating HE in large datasets requires segmentation of hematomas on admission and follow-up CT scans, a process that is time-consuming and labor-intensive in large-scale studies. Automated segmentation of hematomas can expedite this process; however, cumulative errors from segmentation on admission and follow-up scans can hamper accurate HE classification. In this study, we combined a tandem deep-learning classification model with automated segmentation to generate probability measures for false HE classifications. With this strategy, we can limit expert review of automated hematoma segmentations to a subset of the dataset, tailored to the research team’s preferred sensitivity or specificity thresholds and their tolerance for false-positive versus false-negative results. We utilized three separate multicentric cohorts for cross-validation/training, internal testing, and external validation (n = 2261) to develop and test a pipeline for automated hematoma segmentation and to generate ground truth binary HE annotations (≥3, ≥6, ≥9, and ≥12.5 mL). Applying a 95% sensitivity threshold for HE classification showed a practical and efficient strategy for HE annotation in large ICH datasets. This threshold excluded 47–88% of test-negative predictions from expert review of automated segmentations for different HE definitions, with less than 2% false-negative misclassification in both internal and external validation cohorts. Our pipeline offers a time-efficient and optimizable method for generating ground truth HE classifications in large ICH datasets, reducing the burden of expert review of automated hematoma segmentations while minimizing misclassification rate.

Impact of different antiretroviral therapy regimens on bone mineral density in people living with HIV: a retrospective and longitudinal study in China

BackgroundHIV infection and antiretroviral therapy (ART) are associated with bone loss of people living with HIV (PLWH), but limited studies exist on the impacts of ART regimens on bone mineral density (BMD) in China. This study evaluated BMD changes with three common ART regimens: tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + efavirenz (EFV), tenofovir alafenamide (TAF)-containing, and dolutegravir (DTG)-containing (non-TDF/non-TAF) therapies.MethodsIn this retrospective study, the prevalence of low BMD was analyzed in PLWH who underwent dual-energy X-ray absorptiometry (DXA) before ART initiation. BMD changes were assessed in participants who had follow-up DXA scans after ≥ 1 year of ART with TDF + 3TC + EFV, TAF-containing, or DTG-containing regimens. We used multivariate logistic regression to evaluate the impact of different ART regimens on > 3% BMD reduction, adjusting for demographic and clinical variables that were significant in univariate analysis (P < 0.10).Results22.99% (630/2740) of PLWH before ART initiation had low BMD. Among 571 individuals followed up for over 1 year, BMD at the femoral neck (FN) and total hip (TH) decreased significantly in the TDF + 3TC + EFV [FN: -0.03(-0.07, 0.00) g/cm2, TH: -0.02(-0.05, 0.00) g/cm2, P < 0.001 for both] and TAF-containing regimens [FN: -0.02(-0.05, 0.01) g/cm2, TH: -0.02(-0.04, 0.01) g/cm2, P < 0.001 for both]. Lumbar spine (LS) BMD decreased significantly only with TDF + 3TC + EFV [-0.02(-0.05, 0.01) g/cm2, P < 0.001]. TDF + 3TC + EFV caused greater BMD loss at the FN and LS than the TAF-containing regimen[FN: -3.66% (-8.05%, 0.34%) vs. -2.38% (-5.44%, 1.12%), P = 0.044; LS: -2.11% (-4.50%, 0.62%) vs.-0.06% (-2.05%, 2.57%), P < 0.001]. Compared to TDF + 3TC + EFV, DTG-containing regimens showed smaller BMD reductions across all sites [FN: -1.49% (-4.65%, 3.83%), TH: 0.00% (-3.98%, 3.18%), LS: 0.59% (-2.73%, 3.09%), P = 0.004, 0.008 and 0.004, respectively]. TAF-containing and DTG-containing regimens showed no significant differences in BMD changes. Multivariable logistic regression showed that TDF + 3TC + EFV, compared to DTG-containing regimens, had higher odds of > 3% FN and LS BMD reduction (FN: OR 2.91, 95% CI: 1.33 to 6.37, P = 0.009; LS: OR 2.93, 95% CI: 1.17 to 7.32, P = 0.022), while TAF-containing regimens were not independently linked to > 3% BMD loss (P > 0.05).ConclusionsTAF-containing and DTG-containing regimens caused less bone loss than TDF + 3TC + EFV, offering safer options for preserving bone health in Chinese PLWH.

4-year clinical outcomes of anterior acetabular wall reconstruction and cup revision for treatment of anterior acetabular wall defects with iliopsoas tendinopathy following total hip arthroplasty.

To assess clinical and radiographic outcomes of anterior acetabular wall reconstruction and cup revision in patients with anterior acetabular wall defects and associated iliopsoas tendinopathy (IPT) following total hip arthroplasty (THA). 7 patients with IPT (defined as groin pain that increased with active hip flexion) and pre-revision computed tomography (CT) scans showing anterior acetabular wall defects and cup-iliopsoas impingement were included. During cup revision, an autologous biconvex iliac crest graft was harvested and placed over the anterior acetabular wall defect before press-fitting a revision cup. Cup inclination and anteversion, axial and sagittal cup overhang, and iliopsoas muscle strength (0-5) were evaluated pre- and post-revision. Forgotten joint score (FJS; 0-100), Oxford hip score (OHS; 0-48), hip pain (0-10), satisfaction (0-10), graft osseointegration and resorption were evaluated post-revision. Pre-revision cup inclination was 43.7 ± 9.4°, anteversion was 30.4 ± 10.5°, axial overhang was 6.6 ± 7.9 mm, and sagittal overhang was 14.2 ± 4.8 mm. Immediate post-revision cup anteversion was 33.0 ± 7.9°, inclination was 45.3 ± 5.1°, while there was no axial or sagittal overhang. At 60.3 ± 5.6 (52-70) months follow-up, 6 of 7 patients were available for assessment (1 patient had died). Iliopsoas muscle strength increased from 3.9 ± 0.7 to 4.6 ± 0.9, FJS was 77.5 ± 32.8, OHS was 40.3 ± 12.8, hip pain on VAS was 0.2 ± 0.4 at rest and 2.3 ± 2.6 during activities. Patient satisfaction with surgery was 8.3 ± 2.3, but 1 patient was dissatisfied and reported persistent hip pain. Last follow-up CT scans were available for 4 of 7 patients, with 3 showing osseointegrated grafts and no graft resorption. Anterior acetabular wall reconstruction and cup revision resulted in satisfactory clinical outcomes at a minimum follow-up of 4 years in 5 of 7 cases. Most patients fully recovered their iliopsoas muscle strength, had minimal to no pain, excellent FJS, and an osseointegrated acetabular wall graft.

Subcapital Femoral Neck Fracture in a Professionally Active Patient Undergoing Palliative Treatment for Endothelial Cell-Derived Epithelioid Haemangioendothelioma (EHE)

Background and Clinical Significance: Femoral neck fracture frequently occurs in the elderly population but may also present in patients diagnosed with primary cancer or bone metastases. A pathological, oligosymptomatic fracture associated with epithelioid haemangioendothelioma (EHE), a rare endothelial cell-derived sarcoma, is uncommon. Case Presentation: A 44-year-old patient underwent biopsy procedures three times (2010, 2012, 2013) for a focal lesion of the left ischium, none confirming its malignant nature. The last biopsy revealed a neoplastic tissue with features of discrete dysplasia. The lesion did not undergo medical follow-up for seven consecutive years. In August 2020, the patient presented with right lower limb pain. A CT scan, PET/CT scan, and biopsy confirmed EHE with spindle/sarcomatous features. In November 2020, chemotherapy (5xADIC) started (PET/CT confirmed a partial response). After its completion in July 2021, bone progression occurred and sirolimus-based therapy was started. After 3 months, a small liver metastasis was visualized on PET/CT, which did not result in the termination of treatment. In December 2021, pamidronate-based antiresorptive therapy was started. Liver metastasis remained stable in follow-up CT scans. Due to pelvic and spinal lesions, the patient was assisted by elbow crutches and underwent radiotherapy, remaining professionally active. The patient did not report any trauma, but in August 2023, a subsequent CT scan revealed a subcapital fracture of the left femoral neck in the fusion phase. Due to pelvic changes and the stable nature of the fracture, surgical treatment was abandoned. Conclusions: An oligosymptomatic femoral neck fracture, not requiring medical intervention is considered a rare complication of bone cancer.

Longitudinal changes in cardiac mIBG scintigraphy in mild cognitive impairment with Lewy bodies.

The aim of this study was to determine whether there was a significant change in cardiac [123I]-metaiodobenzylguanidine uptake between baseline and follow-up in individuals with mild cognitive impairment with Lewy bodies (MCI-LB) who had normal baseline scans. Eight participants with a diagnosis of probable MCI-LB and a normal baseline scan consented to a follow-up scan between 2 and 4 years after baseline. All eight repeat scans remained normal; however, in three cases uptake decreased by more than 10%. The mean change in uptake between baseline and repeat was -5.2% (range: -23.8% to +7.0%). The interpolated mean annual change in uptake was -1.6%.

Pseudoprogression in a patient with hepatocellular carcinoma treated with immunotherapy plus bevacizumab.

A 62-year-old male with hepatocellular carcinoma on a healthy liver underwent surgery in April 2022. Five months after, the patient complained of abdominal pain, with an alpha-fetoprotein (AFP) level exceeding 9000 ng/ml, and CT images showed liver metastases and multiple lung metastases, so treatment with immunotherapy atezolizumab plus bevacizumab was started in September 2022. After four cycles, hyperprogression was observed in liver and lung metastases at first CT evaluation. However, abdominal pain improved, and AFP decrease, raising suspicion of pseudoprogression. Treatment was therefore continued until radiological progression could be confirmed with a follow-up CT scan after 2 months, which revealed a complete response of the pulmonary metastasis and a partial response of the liver metastasis.

Pelvic/Sacral Chondrosarcoma with Brain Metastasis: A Case Report

Introduction: Chondrosarcomas are cartilaginous tumors primarily known for metastasizing to the lungs and bones. Their spread to the central nervous system is infrequent. Case Presentation: We present the case of a 32-year-old woman with a history of pelvic/sacral grade III chondrosarcoma (L4-S2; T3N0MX; Ki67; 30%), who underwent surgical resection and radiotherapy. She presented to the emergency department with a 2-day history of thunderclap headache accompanied by fever and chills. Computed axial tomography (CT) scan revealed a left occipital intraparenchymal lesion, subsequently confirmed as suggestive of a neoplastic lesion on magnetic resonance imaging. Ten days after admission, she experienced a two-minute generalized tonic-clonic seizure episode, followed by postictal stupor, tachycardia, hypertension, and anisochoric pupils. A follow-up CT scan demonstrated progression of the metastatic lesion, with evidence of uncal and foraminal herniation. Compression of the cardiorespiratory center at the bulbar level led to her death. Conclusion: This case report offers insight into the clinical presentation, behavior, and prognosis of a metastatic brain lesion derived from grade III chondrosarcoma. It is important to correlate the patient’s medical history with imaging findings to achieve an accurate diagnosis, especially in situations where biopsy may not be feasible.

Surgical management of infected emphysema bulla: A case series.

An emphysema bulla is defined as a distension greater than 1cm of an airspace beyond the terminal bronchioles. Infection of an emphysema bulla is a common and serious complication of chronic obstructive pulmonary disease (COPD), which can lead to significant morbidity. Surgical intervention may be necessary in severe cases to prevent further complications. We present a case series of seven male patients with an average age of 46years, all diagnosed with infected emphysema bullae. The predominant clinical symptom was chest pain, often accompanied by fever and chills. Chest X-rays revealed hyperclarity occupying more than two-thirds of the pulmonary field in all patients. A follow-up CT scan confirmed the presence of large bullous emphysema. All patients received antibiotics for one to two weeks before surgery. Surgical management was performed in all cases due to the severity of the infection and the size of the bullae. Postoperative recovery was uneventful in four patients. Two patients experienced prolonged air leaks requiring extended chest drainage, and one patient developed atelectasis, which resolved favorably with conservative management. This case series highlights the role of timely surgical intervention in the treatment of infected emphysema bullae and the associated postoperative complications. Infected emphysema bullae represent a significant complication in patients with COPD. Surgical intervention, alongside antibiotic therapy, offers a safe and effective treatment option, resulting in favorable outcomes for most patients. Prompt diagnosis and management are crucial to avoiding severe complications.

Late intervention for type II endoleak is not determined by early sac diameter or volume changes after EVAR.

To compare the diagnostic accuracy and predictive value of aneurysm sac volume measurement versus maximum diameter measurement of abdominal aortic aneurysm sac after endovascular aneurysm repair (EVAR) in patients with type II endoleak. Retrospective study on a cohort of 103 patients who presented with a type II endoleak after EVAR for infrarenal abdominal aortic aneurysm. Maximum diameter and volumetric measurements were calculated on computed tomography follow-up scans at 3 months and 1 year after index surgery. Pearson correlation coefficient was used to determine linear association between diameter and volume; Mann-Whitney U test was used to compare patients with and without later intervention for type II endoleak with regard to diameter and volume change. The correlation between diameter and volume measurement was high (Rho: 0.890-0.980 with P < 0.0001). In 38 out of 103 patients (37%) with type II endoleak, a later intervention for endoleak management was performed; early diameter (P = 0.097), or volume (P = 0.387) change could not predict risk for later intervention. Both diameter and volume measurements can be used in the imaging follow-up of patients with endoleak type II after EVAR; however early changes in diameter or volume of the aneurysm sac cannot predict late intervention for type II endoleak.

Epigenetic age acceleration predicts subject-specific white matter degeneration in the human brain.

Epigenetic clocks provide powerful tools for estimating health and lifespan but their ability to predict brain degeneration and neuronal damage during the aging process is unknown. In this study, we use GrimAge, an epigenetic clock correlated to several blood plasma proteins, to longitudinally investigate brain cellular microstructure in axonal white matter from a cohort of healthy aging individuals. A specific focus was made on white matter hyperintensities, a visible neurological manifestation of small vessel disease, and the axonal pathways throughout each individual's brain affected by their unique white matter hyperintensity location and volume. 98 subjects over 55 years of age were scanned at baseline with 41 returning for a follow-up scan 2 years later. Using diffusion MRI lesionometry, we reconstructed subject-specific networks of affected axonal tracts and examined the diffusion cellular microstructure composition of these areas, both at baseline and longitudinally, for evidence of cellular degeneration. A chronological age-adjusted version of GrimAge was significantly correlated with baseline WMH volume and markers of neuronal decline, indicated by increased extracellular free water, increased intracellular signal, and decreased axonal signal within WMH. By isolating subject-specific axonal regions "lesioned" by crossing through a WMH, age-adjusted GrimAge was also able to predict longitudinal development of similar patterns of neuronal decline throughout the brain. This study is the first to demonstrate WMH lesionometry as a subject-specific precision imaging technique to study degeneration in aging and the first to establish a relationship between accelerated epigenetic GrimAge and brain cellular microstructure in humans.

Vestibular electrode position stability over time.

In vestibular implants (VI), the electrode position is thought to be important for optimal neural activation. The objective of this study was to evaluate the stability of the vestibular electrode position over time. Seven patients implanted with a VI were followed for one year. When possible, the fenestrations of the semicircular canals were kept very small (approximately 0.8mm) to stabilize the electrode lead. Additionally, the electrodes were fixed at their fenestration sites using bone cement. A temporal bone CT scan was performed intraoperatively, and one week and one year postoperatively. In one patient reliable analysis of the intraoperative CT scan was not possible due to a technical error. A displacement of the vestibular electrodes of more than 0.5mm was considered significant. Fourteen out of 18 electrodes did not show a significant displacement between the intraoperative scan and the first postoperative scan. In the remaining four electrodes, a displacement of ≥ 0.5mm occurred (mean 0.54mm, range 0.50-0.58mm). These four electrodes were found in the two first implanted patients. In both cases, the intraoperative CT scan had a slice thickness of 0.5mm and showed severe scattering. This might imply that the measured displacement was (partially) related to a higher measurement error. None of the vestibular electrodes migrated outside of the ampulla. No displacement was observed in any of the vestibular electrodes between the first postoperative scan and the one-year follow-up scan. The current surgical technique seems to securely stabilize the vestibular VI electrodes over time.

A rare early gastric mixed neuroendocrine-non-neuroendocrine neoplasms misdignosed to early gastric cancer.

Recently, mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) have attracted more attention. However, early gastric MiNEN is uncommon, and there are rare reports on the characteristics of it. As its clinical and endoscopic features are resemble to early gastric cancer (EGC), it can be easily misdiagnosed. The purpose of this article is to elaborate the endoscopic and pathological characteristics of early gastric MiNEN, which is of great significance for distinguishing it from EGC. A 67-year-old male patient underwent EGD revealing a 0-IIc+IIa lesion on the lesser curvature of the lower stomach body. The biopsy pathology indicated the lesion was an EGC. Endoscopic submucosal dissection (ESD) was subsequently applied to remove the lesion. According to postoperative pathological, the lesion was diagnosed as early MiNEN (tubular adenocarcinoma 50%, neuroendocrine carcinoma 50%), pT1b (submucosa 600 μm), pUL (1), Ly (0), v (1), pHM0, pVM0. And after that, surgical resection were added. A follow-up CT scan and endoscopy performed six months later revealed no metastasis or recurrence. This case highlights that early gastric MiNEN could mimic ECG. We deemed that ME-NBI combined with pathological biopsy could contribute to the identification of early gastric MiNEN.

Minimally Invasive Image-Guided Percutaneous Irreversible Electroporation of Adrenal Metastases.

A single-center retrospective study was performed to evaluate the safety and efficacy of minimally invasive irreversible electroporation (IRE) to treat metastatic adrenal tumors. This single-center study, approved by the Institutional Review Board, retrospectively analyzed six patients who underwent image-guided percutaneous IRE for adrenal metastases. Pre-procedural imaging included CT, MRI and/or 18F-FDG PET-CT scans. Primary outcomes measures included technical success, efficacy and safety, while secondary outcome measures were local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS). Follow-up scans were scheduled post-procedure, and data analysis employed Excel, SPSS and R. Patients had diverse primary tumor origins including renal cell carcinoma (2/6), colorectal carcinoma (1/6), non-small cell lung carcinoma (1/6), leiomyosarcoma (1/6) and urothelial carcinoma (1/6). Adverse events were minimal, with only one grade 1 complication reported. Tumor characteristics revealed tumors close to critical structures, with a median pre-ablation size of 23mm. Technical success was achieved in all procedures. At first follow-up, one patient had complete response, one patient had partial response of the right adrenal gland and complete response of the left adrenal gland, two patients had partial response and two patients had stable disease. Local tumor progression occurred in two out of seven tumors with a median LPFS of 10.9months, and distant progression was observed in four out of six patients. Percutaneous, minimally invasive IRE shows promise as a safe treatment option for unresectable metastatic adrenal tumors, demonstrating potential effectiveness. However, further studies with larger patient cohorts are needed to confirm its safety and efficacy.

T2/FLAIR mismatch and diffusion restriction as novel pathophysiological markers in MRI evaluation of central tegmental tract hyperintensity in pediatric patients.

Central tegmental tract hyperintensity (CTTH) on T2-weighted imaging is an uncommon neuroimaging finding in pediatric patients with unclear clinical significance. CTTH may represent either a physiological or pathological process. This study evaluates the relationship between CTTH and MRI sequences (FLAIR, DWI) to explore its diagnostic value. We retrospectively analyzed 3462 pediatric brain MRI scans conducted between July 2011 and January 2022, identifying 104 patients with bilateral CTTH. DWI, FLAIR sequences, and follow-up scans were visually assessed for T2/FLAIR mismatch and diffusion restriction. Clinical data were obtained from electronic patient records. Statistical analysis was performed using SPSS, with significance set at p < .05. A total of 104 pediatric patients with CTTH were included, ranging from 1 month to 16 years old (mean age: 31.34 months). Epilepsy, metabolic diseases, and cerebral palsy were the most common clinical diagnoses. Diffusion restriction was observed in 40.8% of patients, while 39.6% had FLAIR hyperintensity. T2/FLAIR mismatch, defined for the first time in CTTH, was found in 60.4% of patients. A significant correlation was found between T2/FLAIR mismatch and clinical diagnoses (p = .020), as well as between diffusion restriction and T2/FLAIR mismatch (p = .017). CTTH in pediatric patients may arise from two distinct processes: a transient, developmental phenomenon or a pathological process marked by irreversible myelin degeneration. T2/FLAIR mismatch and diffusion restriction provide valuable diagnostic markers, offering insights into the severity and chronicity of CTTH. Further studies are needed to validate these findings and their clinical implications.

Development of a deep learning method to identify acute ischaemic stroke lesions on brain CT

BackgroundCT is commonly used to image patients with ischaemic stroke but radiologist interpretation may be delayed. Machine learning techniques can provide rapid automated CT assessment but are usually developed from...

Natural history of spinal cord compression stage AFMS3 in infants with achondroplasia: retrospective cohort study

Background and objectiveForamen magnum stenosis (FMS) is a common, serious complication of achondroplasia in infancy and associated with sudden infant death. The Achondroplasia Foramen Magnum Score (AFMS; 0–4) is used...

Interhypothalamic adhesions: prevalence, structure, and location-based classification map in pediatric patients undergoing MRI.

Interhypothalamic adhesions (IHAs) have been reported only in the pediatric population, with unknown prevalence and histological composition. We aim to demonstrate their prevalence, assess their persistence through longitudinal imaging, classify IHAs by anatomical distribution, explore their structure, and report associated pathologies. A retrospective review was conducted on consecutive pediatric brain MRI studies obtained between January 2012, and December 2013. The presence of an IHA was only confirmed when observed on at least two planes. For each IHA, cross-sectional area was calculated, and signal intensities were measured at the center on sagittal T2WIs. Signal intensities were also measured in both cerebral white matter and gray matter for normalization and comparison. Patient demographics and clinical information were collected from electronic charts. Out of 1550 patients (0-17.9 years), 33 (19 males, 14 females) had an IHA, resulting in a 2.13% prevalence. Follow-up images were available for 19 IHA-positive patients, and IHAs were again seen in 92% of the follow-up scans (71/77). Normalized IHA signal highly correlated with normalized gray matter signal (r = 0.83, P < 0.001), but not with normalized white matter signal (r = -0.16, p = 0.494). Common co-occurring pathologies included hydrocephalus (n = 9), prematurity (n = 8), and corpus callosum abnormalities (n = 7). All type 3 IHAs (3/3) were accompanied by pituitary pathologies. IHAs have a prevalence of 2.13% in our cohort, and the majority persist in longitudinal studies. They showed gray matter signal intensity and Type 3 IHAs exclusively accompanied pituitary abnormalities.