High Signal Intensity Research Articles

Diffusion-Weighted MRI Over Standard MRI for Differential Diagnosis between Mucopyocele and Mucoceles.

To determine the accuracy of conventional and diffusion-weighted (DWI) MRI for the differential diagnosis between mucopyocele and mucocele using surgical diagnosis as a reference. This retrospective study included patients referred to our institution between March 2017 and February 2024 for paranasal sinus MRI to characterize an expansile non-enhanced sinus filling on CT. The T1 and T2 signal intensities were recorded, as well as the presence of restriction diffusion, of the penumbra sign, the double rim sign, and the presence of parietal micro-abscesses. Quantitative apparent diffusion coefficient values were also recorded. The study included 74 patients aged 18 to 88 years (mean age: 60.4 ± 17.7 years). Of these, 43 had a mucopyocele and 31 had a mucocele. The T1 high signal intensity was different amongst groups as an hypersignal was present in 35.5% of mucoceles and only 4.7% of mucopyoceles (p = 0.02). The T2 signal did not differ between the two groups (p = 0.59). The double rim sign and the presence of parietal micro-abscesses demonstrated 96.8% and 100% specificities, respectively, but were predominantly located in the maxillary sinus. The penumbra sign exhibited a sensitivity of 60.5% and a specificity of 67.7%. All mucopyoceles exhibited a diffusion restriction with an apparent diffusion coefficient of less than 0.78 × 10-3 mm2/s. DWI is the most useful MRI tool for the accurate differential diagnosis between mucopyocele and mucocele in non-enhanced sinus fillings. III (case-control study) Laryngoscope, 2024.

Synthesis of novel silica-encapsulated core-satellite nanotags for enhanced SERS detection

Developing a SERS nanotag with high signal intensity, excellent signal stability, and biocompatibility is of significant importance in the fields of food safety, drug testing, and virus detection. In this work, silica-encapsulated, indocyanine green (ICG)-modified Au octahedral core-small Au spherical nanoparticles (NPs) satellite nanostructures (Au/Au@ICG@SiO2) are uniformly synthesized as surface-enhanced Raman scattering (SERS) tags, which provide abundant “hot spots” and also increase the stability of Raman reporter molecule ICG to greatly facilitate subsequent functionalization and detection. Both experimental and numerical results demonstrate that this Au/Au@ICG nanostructure achieve a detection limit of 10⁻⁷ M for ICG in aqueous solution ascribed to the increased number of hot spots compared with Au octahedral NPs. As-prepared Au/Au@ICG@SiO2 SERS nanotags are further integrated with a lateral flow immunoassay (LFIA) for the detection of the SARS-CoV-2 nucleocapsid protein. Compared to the traditional bio-recognition method on LFIA strips with the detection limit of 8 pg/mL, the detection capability for the SARS-CoV-2 nucleocapsid protein is improved approximately 16 times (500 fg/mL) based on this novel SERS tag and custom-built adaptive Raman mapping spectrometer. This Au/Au@ICG@SiO2 SERS tag is expected to play a significant role in early detection, prevention, and control of similar infectious viruses in the future.

Multiparameter magnetic resonance imaging features of prostatic malakoplakia.

To summarize the multiparameter magnetic resonance imaging (mpMRI) features of prostatic malakoplakia. Eleven patients (median age 62 years; IQR 59-71 years) with pathologically confirmed prostatic malakoplakia were included in this study. MpMRI features of the lesions were retrospectively reviewed and summarized. The Prostate Imaging-Reporting and Data System (PI-RADS) scores of the patients were 4 or 5, with a medium diameter of 3.7 cm (IQR 2.0-5.2 cm). All the lesions involved the peripheral zone, of which 3 cases (3/11, 27.3%) involved the transition zone simultaneously. A diffuse symmetrical distribution was found in 5 cases, a focal distribution in 5 cases, and a focal symmetrical distribution in 1 case. Both the surgical capsule and prostatic margin were bulged and compressed, but no signs of infiltration were found. Nearly all the lesions had moderate hypointensity on T2-weighted images and slightly higher signal intensity on T1-weighted images. Among the lesions, early enhancement occurred in all cases, prolonged enhancement occurred in 8 cases, and ring enhancement persisted in 1 case. All lesions displayed periprostatic enhancement in the delayed phase. Lesions distributed diffusely and symmetrically in the peripheral zone with preserved surgical capsule and margin are characteristic features of malakoplakia as opposed to cancer, especially in those with slightly high T1 signal intensity and delayed periprostatic enhancement. Those locally distributed lesions with the above signs should also be suspected. Prostatic malakoplakia are more likely to distribute diffusely and symmetrically, with slightly high T1 signal intensity and delayed periprostatic enhancement.

Uterine Sarcoma or Degenerating Fibroid? Validating the New Consensus Magnetic Resonance Imaging Algorithm for Evaluating Atypical Uterine Masses.

The aim of the study is to assess the validity of a recently published consensus magnetic resonance imaging (MRI) diagnostic algorithm for differentiating degenerating leiomyomas from uterine sarcomas and other atypical appearing uterine malignancies. Atypical uterine masses on pelvic MRI were identified using a radiology report search engine and teaching files with the keywords "atypical leiomyoma," "atypical fibroid," and "sarcoma." All cases were pathology-proven. Two radiologists blinded to clinical, surgical, and pathologic reports retrospectively and independently reviewed 40 pelvic MRI examinations dated 1/2007-9/2022 to determine whether the masses appeared benign or malignant, using the 2022 consensus atypical uterine mass flow chart. Imaging features assessed included intermediate/high signal intensity (SI) at T2-weighted imaging, high diffusion weighted imaging SI (equal or higher SI than endometrium or lymph nodes on high b value imaging), apparent diffusion coefficient (ADC) value ≤0.905 × 10-3 mm2/s, peritoneal metastases, and abnormal lymph nodes. Among the 40 atypical uterine mass cases reviewed, 24 masses were benign (22 leiomyomas, 1 adenomyoma, and 1 borderline ovarian tumor) and 16 masses were malignant (6 leiomyosarcomas, 6 carcinosarcomas, 2 endometrial stromal sarcomas, 1 high-grade adenosarcoma, and 1 low-grade uterine sarcoma). Sensitivity, specificity, positive predictive value, and negative predictive value of whether a mass was benign or malignant were 75%, 95.8%, 92.3%, and 85% for reader 1, and 81.2%, 91.7%, 86.7%, and 88% for reader 2, respectively. Interrater agreement was strong, with a kappa statistic of 0.89. When excluding nonleiomyosarcoma uterine malignancies, sensitivity and negative predictive value improved to 100%. The new consensus pelvic MRI algorithm for evaluating atypical uterine masses has good specificity, sensitivity, positive predictive value, and negative predictive value for determining malignancy, particularly for uterine sarcomas that are leiomyosarcomas. However, if ADC value is near but not below 0.905 × 10-3 mm2/s, the mass may still be malignant, especially if a b value lower than 1000 is used. If the atypical uterine mass is predominantly endometrial, morphological features on T2 and postgadolinium sequences should guide suspicion, as some atypical appearing nonleiomyosarcoma uterine malignancies may have an ADC value greater than 0.905 × 10-3 mm2/s.

Membrane-Localized Orientation of NONPHOTOTROPIC HYPOCOTYL3 Affects the Necessity of Its Phosphorylation for Phototropism.

NONPHOTOTROPIC HYPOCOTYL3 (NPH3) is a key regulator of hypocotyl phototropism under both low- and high-intensity blue light (LBL/HBL), mediating phototropin1 (phot1) and phot2 signaling. NPH3 undergoes dephosphorylation and is released from the plasma membrane (PM) upon blue light irradiation. However, how its phosphorylation status and PM localization mediate phot1 and phot2 signaling in Arabidopsis (Arabidopsis thaliana) remains elusive. In this study, we found that fusing NPH3 with GFP at its C terminus (N3G) impaired its release from the PM, a defect exacerbated by a phosphorylation-deficient mutation, resulting in a dephosphorylated NPH3-GFP (N3AG). Unlike N3G, transgenic lines expressing N3AG exhibited defective hypocotyl phototropism under HBL, which could be rescued by myristoylation at the N-terminus of N3AG (mN3AG), indicating that NPH3 phosphorylation is not essential for HBL-induced phototropic responses when it is artificially anchored at the PM via its N terminus. Furthermore, genetic analysis revealed that N3AG anchored to the PM by its N terminus (as in mN3AG) only rescues phot1-mediated HBL responses, which require RPT2. However, N3AG failed to regulate phot2-mediated HBL signaling, regardless of its PM orientation. Taken together, our results revealed that NPH3 phosphorylation is essential for phot2-mediated hypocotyl phototropism under HBL, but is not required for phot1-mediated HBL signaling when the NPH3 N terminus is PM-anchored.

Research on Design and Staged Deployment of LEO Navigation Constellation for MEO Navigation Satellite Failure

Low Earth orbit (LEO) satellites have unique advantages in navigation because of their high signal intensity and rapid geometric changes in a short period. In order to solve the problem of constellation performance degradation after a potential failure pertaining one or more medium Earth orbit (MEO) navigation satellites, this paper designs the LEO navigation constellation and considers the task requirements of different stages of constellation deployment. Firstly, the LEO navigation constellation is designed by a non-dominated sorting genetic algorithm II (NSGA-II). The average position dilution of precision (PDOP) is 1.676, which is an improvement compared to the average PDOP offered by the four traditional GNSS. Secondly, the staged deployment of constellation takes into account the degradation of constellation performance caused by the failure of MEO navigation satellites, and the Monte Carlo method is used to analyze the case of three simultaneous satellite failures. The results show that a single satellite failure within each orbital plane and adjacent satellites with close phase separation has a great impact on the performance of the MEO navigation constellation. On this basis, a staged deployment strategy was adopted in order to balance cost, risk, and performance. The three phases deploy 66, 156, and 288 satellites, respectively; as a make-up constellation under contingencies, a navigation enhancement constellation, and an independent navigation constellation, the deployment of the staged sub-constellations meets the mission requirements. The constellation design and staged deployment method proposed in this paper can provide reference for the future study of LEO navigation constellations.

A Case of the Anti-aquaporine-4 Antibody-negative Neuromyelitis Optica Spectrum Disorders Associated with Atopic Disease with High Concentration of Anti-IgE Autoantibody and HyperIgEemia

We report a 70-year-old male patient with the sero-negative neuromyelitis optica spectrum disorders (NMOSD) associated with atopic disease (AD). He was diagnosed with allergic rhinitis at the age of 20. When he was 61 years old, he subacutely developed orthostatic hypotension, bilateral optic neuritis, quadriparesis, urinary retention, and constipation. The laboratory results revealed allergen-specific IgE positivity for cryptomeria japonica and hinoki, hyperIgEemia, and Th (helper T cell) 1 dominance. The serological tests for autoantibodies revealed negative anti-aquaporine 4 antibody, and high concentration of anti-IgE autoantibody (anti-IgE AAb). Cerebrospinal fluid was negative for anti-myelin-oligodendrocyte glycoprotein antibody and glial fibrillary acidic protein antibody. Fluid-attenuated inversion recovery on brain magnetic resonance imaging (MRI) showed high signal intensities in bilateral cerebral deep white matter. T2 weighted image on spine MRI showed longitudinally extensive high signal intensities in the spinal cord, specifically involving C1 vertebral level to conus medullaris. Intravenous methylprednisolone (IVMP) and plasma exchange resulted in partial improvement. Following the onset of NMOSD, he had relapse of NMOSD four times. In each episode, IVMP was to be partially effective with anti-IgE AAb reduction. Anti-IgE AAb may be a reasonable clinical indicator of increased disease activity in the sero-negative NMOSD associated with AD.

First Detection of the Enigmatic Low Latitude 150‐km Echoes in the UHF Band

AbstractThrough applying a 4‐MHz linear frequency modulation waveform, which has high range resolution and signal intensity, we successfully detected for the first time the ionospheric 150‐km echo enhancement at 430–450 MHz of the Ultra‐High‐Frequency (UHF) band using the newly built Sanya Incoherent Scatter Radar (SYISR). The obtained low signal enhancement (less than 0.5 dB) explains why previous UHF experiments did not detect them. We also found that our measured fine structure shows a much wider forbidden region than previous results and covers a much larger altitudinal and local time region. In comparison with recent upper‐hybrid instability theory and simulation, our results confirmed the predicted higher altitude occurrence, wider gaps between enhancements, the turn corner feature around sunrise, and perhaps the weak enhancement, which provide an independent evaluation of the newly proposed mechanism in UHF band. Future UHF experiments could further improve the physical understanding of 150‐km echo phenomenon.

Validation of an algorithm that separates gaseous micro-embolic signals and artifacts during transcranial Doppler persistent foramen ovale examinations

ObjectivePersistent foramen ovale (PFO) is a risk factor for young stroke. Agitated saline serum is used to deliver small gaseous emboli to the brain in transcranial Doppler ultrasound (TCD) for the detection and grading of PFO. In this study we validated a PFO algorithm that can differentiate between gaseous emboli and artifacts. MethodsThe validation cohort comprised 18 patients with positive PFO examinations. The PFO algorithm uses a binary tree that separates high-intensity transients signals (HITs) into gaseous emboli or artifacts based on intensity, zero-crossing, and velocity parameters. ResultsThe cohort exhibited 385 macroscopic gaseous emboli meeting the >3 dB criterion. An additional 137 gaseous emboli were noticed below the 3-dB intensity cutoff value. The low-intensity gaseous emboli included both macroscopic and microscopic air bubbles observed in curtains. Nearly all emboli (98 %) above the 3-dB level showed overt frequency modulation. The overall accuracy of the PFO algorithm in discriminating macroscopic gaseous emboli and artifacts was 96.4 %, with a similar percentage of sensitivity and specificity (96.4 %). The inter-observer agreement of human experts was excellent (ic-CC 0.989 and 0.953). ConclusionsMacroscopic gaseous emboli and artifacts during PFO exams can be accurately discriminated by the PFO algorithm. The PFO algorithm cannot be used as a standalone system as microscopic air bubbles might escape proper identification. This knowledge will be important in the design of future PFO algorithms which should make it possible to classify the PFO grade without the interference of humans.

Clinical and Radiological Outcomes after Radial Tear Repair of the Meniscus

Abstract Background Radial meniscal tears cut through the longitudinal collagen bundles that extend from the free edge to the periphery, running perpendicular to the meniscal axis and tibial plateau. They, by default, contains an element extending to white-white and red-white zones. This is why they were once considered a non repairable tear and not capable of healing and they were usually menisectomized. Radial tears were found in 15% of patients with meniscal tears. Additionally, they were detected in 7% of arthroscopy-detected meniscal tears in patients with a preoperative diagnosis of knee OA and/or chronic meniscal tears. They are equivalent to total meniscectomy in terms of increasing focal contact pressure and excessive stress concentration and meniscal extrusion. Moreover, we know that the peripheral 1/3 of a meniscus has a blood supply adequate enough to bring healing nutrients to the area of the tear. Therefore, it was always assumed that only tears within the outer 1/3 of a meniscus would heal once they are repaired. Recent research has shown that tears with little blood supply are still capable of healing after they have been sutured. Methods From September 2020 to March 2023, we performed a prospective case series on 15 patients reviewed in our institutions hospital by history taking, trauma mode, clinical examination, magnetic resonance imaging, and subjective scores (Lysholm and International Knee Documentation Committee (IKDC)) to describe the functional and radiological outcome of radial meniscal tear repair with two horizontal suture configurations. All selected 15 patients had radial meniscal tears, with a mean time between injury and surgery is 2 month. All patients met the inclusion criteria, all cases are evaluated clinically and by the same examiner. The mean duration of follow up was 19.5 months(ranging from 18 to 28 months). Full history and clinical examination was done for all patients, followed by X-rays and MRI if needed. All patients were assessed regarding pain, ROM, IKDC, Lysholm, score and radiological outcomes. Postoperative complications were recorded. The evaluation was done preoperatively and each time of follow up with a minimum period of 18 months. Results Our study included 15 patients with radial meniscal tears who underwent arthroscopic repair either with outside in or all-inside technique. Our results showed improved clinical scores of the repair either with medial or lateral menisci. No differences were found in results with concomitant ACL tears or the use of fibrin clots. Also, different repair techniques did not show significant difference in functional outcomes. All patients had significant improvement in functional outcomes. Functional outcomes included functional scores and ROM. Regarding functional scores, we assessed IKDC and lysholm score prior to surgery, 6 months and 18 months following surgery. At 18 months follow up, we found significant improvement in all patients in both IKDC and lysholm score (p value of 0.025 and 0.023 respectively) and the mean difference of both sores measured 41.8 and 36.1 respectively. Most of the patients showed most of the improvement in IKDC and Lysholm scores at the first 6 months (mean difference between 0 and 6 months 40.92 and 34.2 respectively). Also, ROM and Joint line tenderness improved for 14 patients at 6 months postoperative. There was 1 patient who was 31 years old and had PHMM injury that was repaired using all-inside technique but showed persistent knee pain and limited ROM. MRI was done and it showed high signal intensity at the site of injury with no signs of healing. Therefore, we re-operated this patient after 7 months and his second look arthroscopy revealed no signs of healing and menisectomy was done. At 18 months follow up, ROM and JLT were improved. Conclusion Patients underwent arthroscopic repair of radial meniscal tears showed good short term functional outcomes. Being able to return to their previous level of activity with preservation of the meniscus.

Correlation of Endolysmphatic Duct Signal Intensity With Clinical Features in Otological Diseases.

Bilateral high signal intensity (SI) in the endolymphatic duct (ED) on magnetic resonance imaging (MRI) has been reported as a common characteristic in ears with large vestibular aqueduct syndrome (LVAS). However, the significance of bilateral high SI in the ED remains unknown. The present study aimed to compare the correlation between SI in the ED and the clinical manifestations in various otological disorders and consider the significance of the MRI findings. Retrospective study. University hospital. The study included 2,450 ears from 1,225 patients with various otological disorders. All ears underwent 3T enhanced MRI and were evaluated for the degree of endolymphatic hydrops (EH) and the SI ratios (SIRs; i.e., the calculation between SIs in the ED and those in the cerebellum). The imaging findings were compared with their clinical symptoms. Ears with bilateral high SIRs in the ED tended to have considerably less occurrence of EH in both the cochlea and vestibule than those with bilateral low SIRs. Ears with SIR ≥8 showed significantly elevated hearing thresholds at lower frequencies on pure-tone audiometry, although they exhibited a markedly lower incidence of cochlear EH than those with SIR <8. Moreover, ears with vertigo exhibited notably higher SIRs than those without vertigo. Bilateral high SI in the ED on MRI may reflect pathophysiology underlying sensorineural hearing loss and vestibular symptoms, which are not associated with EH formation.

Awake Surgery for Right Frontal Lobe Glioma: Preserving Emotional Recognition and Facilitating Early Return to Work.

Many glioma patients struggle to return to work after surgery because of higher brain dysfunction. Although the right frontal lobe has historically been considered functionally silent, reports of performing awake surgery to evaluate higher brain functions in patients with tumors in this area have increased. We present two cases of patients who underwent awake surgery for malignant glioma in the right frontal lobe to preserve emotional recognition and facilitate an early return to work. Case 1 was a 48-year-old right-handed woman employed as a nursery school teacher and case 2 was a 21-year-old right-handed man employed in sales. Both had contrast-enhancing right frontal lobe tumors exhibiting high signal intensity on fluid attenuated inversion recovery imaging and underwent awake surgery. During the operation, cortical mapping was performed using the Reading the Mind in the Eyes, calculation, and motor tasks. Resection of sites involved in motor and emotional recognition functions was avoided. In case 1, all regions of high signal intensity were completely resected; in case 2, all regions exhibiting enhancement were resected. Both patients were discharged home without neurological deficits and returned to work within 21 days after surgery. It may be important to focus not only on overall survival and progression-free survival in glioma patients, but also on factors associated with life satisfaction, such as time to return to work after surgery and time until work becomes difficult. Awake surgery aimed at preserving higher brain functions is useful and may also improve life satisfaction.

Analysis of the results of optical coherence tomography to assess the effectiveness and safety of implantable bioresorbable stenting frames in the long term

Objective: to evaluate the effectiveness and safety of implantation of everolimus-coated bioabsorbable vascular scaffolds (BSCs) based on the results of optical coherence tomography (OCT) in patients with coronary artery disease who have previously undergone percutaneous coronary intervention (PCI). Materials and methods: OCT data from 23 patients with coronary artery disease (CAD) were studied 10 years or more after intervention with BVS implantation. Standard criteria based on OCT analysis were used to evaluate the efficacy of BVS. The stented segment, proximal zone before the stent, and distal zone after the stent were the areas of interest. Results: in the long-term period, the structure of the artery in the area of the installed biodegradable scaffolds is a combination of fragments of an atherosclerotic plaque, a resorbed scaffold, and neointima. When visualized using coherence tomography, this structure appears as a monolayer with high signal intensity. In 42.3% of patients, structures similar to fragments of the stenting frame were visualized, but smaller in size, with a disconnected structure, without clear contours and the absence of a typical shape. In 15.4% of cases, pronounced positive remodeling of the coronary artery in the area of the installation of the bioresorbable frame was noted. Conclusions: analysis of coherence tomography data showed that the use of biodegradable frames is effective and safe, the process of degradation of the frames occurs with an increase in diameter in the stented zone and the formation of a protective monolayer, while maintaining the patency of all side branches in the implantation zone.

Magnetic resonance imaging characteristics of musculoskeletal hydatid disease

Background Hydatid disease is a parasitic infection seen in endemic areas. Musculoskeletal hydatid disease is rarely reported. Purpose To describe the magnetic resonance imaging (MRI) features of musculoskeletal hydatid disease and to highlight the specific findings in the diagnosis of hydatid cysts. Material and Methods The MRI scans of 29 cases diagnosed as musculoskeletal hydatid disease between 2000 and 2022 were retrospectively analyzed. The localization, size, appearance (unilocular or multilocular), signal characteristics, rim sign, presence of internal septa and membrane, and gadolinium enhancement pattern of hydatid cysts were evaluated. Results A total of 29 patients diagnosed with hydatid cyst were included in the study. Of the lesions, 18 were localized in bone and 11 were in soft tissue. The bone hydatid cysts on MRI showed heterogeneous low to intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images in the medullary bone. In 15/18 patients, there was also cortical destruction and extension into the adjacent soft tissue planes. In 8/11 cases where the cyst was located in muscle tissue, the “cyst or cysts within a cyst” appearance was observed on MRI. The rim sign was observed in 7/11 cases and the “water lily” sign was noted in 2/11 cases. Conclusion MRI provides valuable information for the diagnosis of hydatid disease with its distinctive imaging features. Knowledge of the different patterns of hydatid cysts on MRI may be helpful in the diagnosis of this disease.

A case of chronic contained rupture of abdominal aortic aneurysm mimicking a retroperitoneal tumor.

Chronic contained rupture of abdominal aortic aneurysm (CCR-AAA) is a rare subtype of abdominal aortic rupturethat can mimic other retroperitoneal lesions. We report a case of CCR-AAA in a man in his sixties who presented witha 10-month history of right low back pain and weight loss. Contrast-enhanced computed tomography (CT) revealed alobulated retroperitoneal mass around the abdominal aorta, initially misdiagnosed as a possible hemorrhagicretroperitoneal tumor. Despite multiple imaging studies including CT, magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucosepositron emission tomography (FDG-PET)/CT, as well as a CT-guided biopsy, the correct diagnosisremained elusive for 34 months. Key findings included subtle aortic wall irregularity on CT, high signal intensity onT1-weighted MRI suggesting hematoma, peripheral FDG uptake on PET/CT, and histological findings of biopsy tissueconsistent with organizing hematoma. Surgery confirmed the diagnosis, revealing an organized hematoma with adefect in the right wall of the abdominal aortic aneurysm. This case demonstrates that CCR-AAA can present withatypical radiological features, potentially leading to misdiagnosis. When encountering a para-aortic mass with ahemorrhagic component, careful observation of the AAA morphology and aortic wall contour is crucial for anaccurate diagnosis of CCR-AAA.

An unusual cause of liver neoplasm in an older female.

We presented a 66-year-old woman with T2DM who had a liver mass discovered incidentally during hospitalization. She was asymptomatic with a right upper abdominal mass that was smooth, mobile, and non-tender. Hepatitis virus markers and tumor markers were normal. The computed tomography (CT) images showed a 4.7×4.0 cm lesion in the left liver lobe with indistinct borders. Further magnetic resonance imaging (MRI) revealed low T1 and high T2 signal intensity with ring-shaped enhancement following contrast administration. Surgical resection was performed, and histology confirmed hepatic angioleiomyoma with thick-walled vessels and spindle cell proliferation. Immunohistochemistry was positive for SMA, desmin, caldesmon, CD31, and CD34. The patient had no recurrence during 5 years follow-up.

Incidence of Tethered Cord Syndrome in Pediatric Patients With Neurofibromatosis Type 1

ObjectiveThe link between Tethered Cord Syndrome (TCS) and Neurofibromatosis Type 1 (NF1) remains unclear. To date, only two studies have indicated a high occurrence of TCS in the pediatric NF1 patient population. Our study aims to ascertain the incidence of TCS among Chinese pediatric patients with NF1. MethodsA single-institution, 8-year retrospective analysis at a tertiary-level children's hospital was conducted for patients with NF1 who underwent surgery for TCS. The clinical features, imaging characteristics, genetic testing outcomes, and histopathological findings of pediatric NF1 patients with TCS were analyzed. ResultsDuring the study period, a total of 115 pediatric patients were diagnosed with NF1. Among these 115 NF1 patients, 11 individuals, accounting for 9.6% of the sample, were confirmed to have TCS. This rate of occurrence is significantly higher than the incidence rate of TCS in the general population, which stands at 0.17%. All 11 of the pediatric NF1 patients underwent surgery for TCS. Out of the 11 patients who were advised to have tethered cord release surgery, 4 (which is 36.4%) were girls, and the average age of these 11 patients was 8.6 years old, with ages ranging from 2 to 17 years old. The conus medullaris position of the 11 pediatric NF1 patients ranged from L1 to L2, and 10 of them (91%) had a filum terminale lipoma, characterized by high signal intensity on T1-weighted magnetic resonance (MR) images. Another patient was diagnosed with Occult Tethered Cord Syndrome (OTCS). All 11 pediatric NF1 patients exhibited symptoms associated with TCS, such as neuromotor dysfunction, abnormalities in urination, defecation, skeletal system abnormalities, or pain. Eight of the 11 pediatric NF1 patients had undergone genetic testing, which is a crucial part of the diagnostic process for NF1. The histopathological examination of the 11 pediatric NF1 patients who underwent surgery revealed that 10 patients had fatty infiltration of the filum terminale (FT), while the remaining patient exhibited fibrosis of the filum terminale (FT). ConclusionsIn the group of pediatric patients with NF1, the incidence of TCS, presenting to the pediatric neurosurgery clinic for any reason, is significantly higher than that of the general population. However, the pathophysiological relationship between NF1 and TCS is still not clear. It is essential to provide counseling to NF1 patients and their families about the symptoms of TCS to make sure they are aware and can seek the necessary care when needed. This underscores the importance of not only diagnosing NF1 but also staying alert for related conditions like TCS, which may have a higher occurrence in this demographic.

Clinical analysis of 21 cases of children with ectopic bronchogenic cyst

Objective: To analyze the clinical characteristics, treatment, and prognosis of ectopic bronchogenic cysts in children. Methods: A retrospective analysis was conducted on the data including the clinical characteristics, auxiliary examination and treatment of 21 children with ectopic bronchogenic cysts diagnosed pathologically at Children's Hospital Affiliated to Zhengzhou University from July 2015 to December 2023. There were 16 males and 5 females, with a male-female ratio of 3.2∶1, and the age ranged from 4 days to 8 years old (median age 2 years and 8 months). Results: Among the 21 cases of ectopic bronchogenic cysts, 11 cases were found in the pharynx, with symptoms including dyspnea (4 cases), snoring during sleep (3 cases), and choking on milk(4 cases).Ten cases were found in the head, neck or anterior chest, 5 of these cases had infection history, and 5 showed progressive mass growth.Imaging and endoscopy showed 9 patients underwent preoperative color ultrasonography revealed cystic masses with well-defined boundaries. CT examination was performed on 13 patients, which showed round or nearly round masses with homogeneous density, smooth margins, and regular cyst walls. CT attenuation values ranged from 2 to 52 Hounsfield Units (HU). Four cystic lesions were assessed via MRI, 3 cases demonstrated long T1 and long T2 signals, while 1 case had a slight short T1 and long T2 signal, with high signal intensity on fat-suppressed images. Eleven cases of pharyngopharyngeal cysts were examined by electronic nasopharyngoscopy. The cysts appeared as spherical or ovoid masses with smooth surfaces, close to or slightly light in color with the surrounding tissue, with one cyst presenting with a bluish blue in the oropharynx. All 11 pharyngeal cysts were excised using low-temperature plasma under general anesthesia and intubation assisted by a nasal endoscope. The cysts were pulled and excised as completely as possible.Ten cases of neck and anterior chest cysts were completely excised. Postoperative histopathology confirmed bronchogenic cyst. Twenty-one children were followed up postoperatively for 4 months to 7 years without recurrence, except for 1 patient who was lost to follow-up. Conclusions: Ectopic bronchogenic cysts are uncommon and lack of typical imaging and clinical features.Combination of ultrasonography, CT and MRI is recommended for cases occuered in neck and anterior chest, while electronic nasopharyngoscopy complements pharyngeal evaluations. Surgical intervention is the preferred treatment choice for this disease.

Case Report: - Sudden sensorineural hearing loss and vertigo due to inner ear hemorrhage

Sudden deafness is a common cause of emergency consultation in otology. Usually, despite investigations, no etiology is known. Intracochlear hemorrhage is a rare cause of sudden sensorineural hearing loss (SSNHL) and may be associated with various labyrinthine disorders. In such cases, magnetic resonance imaging (MRI) is the clef of the diagnosis. We report the case of a 70-year-old patient who was referred to our department for sudden hearing loss, tinnitus, and vertigo. Otoscopic and neurological examinations were normal, and pure-tone audiometry revealed left profound sensorineural hearing loss. Videonystagmography (VNG) revealed left vestibular deficit. MRI demonstrated a high signal intensity inside the cochlea on unenhanced T1-weighted images, and no other abnormalities were found; in particular, no enhancement after intravenous administration of gadolinium. No etiology was identified. Vertigo disappeared rapidly with corticosteroid treatment and hyperbaric oxygen therapy, but hearing did not improve. Intra-labyrinthine hemorrhage causing SSNHL is rare, and the hearing prognosis is poor.

The Lateral Corticospinal Tract Sign: An MRI Marker for Amyotrophic Lateral Sclerosis.

Background Radially sampled averaged magnetization inversion-recovery acquisition (rAMIRA) imaging shows hyperintensity in the lateral corticospinal tract (CST) in patients with motor neuron diseases. Purpose To systematically determine the accuracy of the lateral corticospinal tract sign for detecting patients with amyotrophic lateral sclerosis (ALS) at rAMIRA MRI. Materials and Methods This study included prospectively acquired data from participants in ALS and other motor neuron disease imaging studies at the University Hospital Basel, Switzerland. All participants underwent 3-T axial two-dimensional rAMIRA imaging at four cervical intervertebral disk levels. The lateral CST sign was defined as spinal cord white matter hyperintensity dorsolateral to the anterior horns, with higher signal intensity than in the dorsal columns on axial rAMIRA images. Marker accuracy was assessed in a study data set and in an independent validation data set. Postmortem rAMIRA imaging and histopathologic analysis were performed in one participant who died during the study. Results Participants with ALS (study data set: 38 participants [mean age, 61 years; IQR, 15 years], 22 male participants; validation data set: 10 participants [mean age, 61 years; IQR, 21 years], seven male participants), post-polio syndrome (study data set: 25 participants [mean age, 68 years; IQR, 8 years], 12 male participants), spinal muscular atrophy (study data set: 10 participants [mean age, 43 years; IQR, 14 years], eight male participants; validation data set: five participants [mean age, 38 years; IQR, 19 years], two male participants), and healthy control participants (study data set: 60 participants [mean age, 57 years; IQR, 20 years], 36 male participants; validation data set: 10 participants [mean age, 44 years; IQR, 17 years], seven male participants) were included. The sensitivity and specificity of rAMIRA for ALS were 60% (23 of 38) and 97% (91 of 94) in the study data set and 100% (10 of 10) and 93% (14 of 15) in the validation data set, respectively. Histopathologic analysis showed distinct loss of myelinated axons in the localization of the hyperintensities observed at rAMIRA imaging performed in situ and after organ extraction. Conclusion The recently defined marker at rAMIRA MRI may be a promising tool for assessing upper motor neuron degeneration in the lateral CST in patients with ALS. Clinical trials registration no. NCT03561623, NCT05764434, NCT06137612 © RSNA, 2024 Supplemental material is available for this article.