Intermediate Signal Intensity Research Articles

Congestive Hepatopathy: Pathophysiology, Workup, and Imaging Findings with Pathologic Correlation.

Liver congestion is increasingly encountered in clinical practice and presents diagnostic pitfalls of which radiologists must be aware. The complex altered hemodynamics associated with liver congestion leads to diffuse parenchymal changes and the development of benign and malignant nodules. Distinguishing commonly encountered benign hypervascular lesions, such as focal nodular hyperplasia (FNH)-like nodules, from hepatocellular carcinoma (HCC) can be challenging due to overlapping imaging features. FNH-like lesions enhance during the hepatic arterial phase and remain isoenhancing relative to the background liver parenchyma but infrequently appear to wash out at delayed phase imaging, similar to what might be seen with HCC. Heterogeneity, presence of an enhancing capsule, washout during the portal venous phase, intermediate signal intensity at T2-weighted imaging, restricted diffusion, and lack of uptake at hepatobiliary phase imaging point toward the diagnosis of HCC, although these features are not sensitive individually. It is important to emphasize that the Liver Imaging Reporting and Data System (LI-RADS) algorithm cannot be applied in congested livers since major LI-RADS features lack specificity in distinguishing HCC from benign hypervascular lesions in this population. Also, the morphologic changes and increased liver stiffness caused by congestion make the imaging diagnosis of cirrhosis difficult. The authors discuss the complex liver macro- and microhemodynamics underlying liver congestion; propose a more inclusive approach to and conceptualization of liver congestion; describe the pathophysiology of liver congestion, hepatocellular injury, and the development of benign and malignant nodules; review the imaging findings and mimics of liver congestion and hypervascular lesions; and present a diagnostic algorithm for approaching hypervascular liver lesions. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Intrahepatic Mass-Forming Cholangiocarcinoma: Is There Additional Prognostic Value in Using Gd-EOB Enhanced MRI?

To investigate the prognostic value of enhancement patterns of intrahepatic mass-forming cholangiocarcinomas (IMCCs) during the hepatobiliary phase (HBP) in gadoxetic acid (Gd-EOB)-enhanced MRI. We retrospectively identified 66 consecutive patients with histopathologically proven IMCCs (reference standard: resection) and preoperative Gd-EOB-enhanced MRI. Gd-EOB retention area was subjectively rated based on areas of intermediate signal intensity. Lesions were classified as either hypointense (0-25% retention area) or significantly-retaining (>25% retention area). Clinical, radiological, and prognostic features were compared between these groups. The primary endpoints were recurrence-free survival (RFS) and overall survival (OS) after primary surgical resection. 73% (48/66) of lesions were rated as hypointense and 29% (19/66) as significantly-retaining. While the hypointense subgroup more frequently featured local and distant intrahepatic metastases (p = 0.039 and p = 0.022) and an infiltrative growth pattern (p = 0.005), RFS, OS, and clinical features did not differ significantly with estimated Gd-EOB retention area or quantitatively measured HBP enhancement ratios. Lymph node metastasis was an independent predictor of poor RFS (p = 0.001). Gd-EOB-enhanced MRI revealed two subtypes of IMCC in the HBP: hypointense and signal-retaining. The hypointense subtype is associated with more frequent intrahepatic metastases and an infiltrative growth pattern, indicating potential tumor aggressiveness. However, this did not result in a significant difference in survival after the primary resection of IMCC.

Presacral Schwannoma Resembling Lymph Node Metastasis in a Patient with Locally Advanced Prostate Cancer

Introduction: SSchwannomas originating in the pelvic region are rare and present diagnostic challenges when they coexist with malignancies. Case Presentation: A 58-year-old man with urinary frequency and an elevated prostate-specific antigen level underwent preoperative imaging. T2-weighted magnetic resonance imaging (MRI) of the prostate identified an irregular hypointense lesion with extracapsular invasion, as well as a presacral nodule resembling lymph node metastasis. The presacral nodule exhibited an intermediate signal intensity on the apparent diffusion coefficient map that was derived from diffusion-weighted images. Dynamic contrast-enhanced MRI revealed persistent enhancement in the presacral node, while the prostate tumor exhibited strong early enhancement followed by washout. Pathological and laparoscopic findings confirmed the coexistence of locally advanced prostate cancer and pelvic schwannoma. Conclusions: MRI is useful not only in detecting prostate cancer but also in differentiating lymph node metastases from schwannoma.

Diffuse-Type Tenosynovial Giant Cell Tumor: What Are the Important Findings on the Initial and Follow-Up MRI?

Tenosynovial giant cell tumor (TSGCT) is a rare soft tissue tumor that involves the synovial lining of joints, bursae, and tendon sheaths, primarily affecting young patients (usually in the fourth decade of life). The tumor comprises two subtypes: the localized type (L-TSGCT) and the diffuse type (D-TSGCT). Although these subtypes share histological and genetic similarities, they present a different prognosis. D-TSGCT tends to exhibit local aggressiveness and a higher recurrence rate compared to L-TSGCT. Magnetic resonance imaging (MRI) is the preferred diagnostic tool for both the initial diagnosis and for treatment planning. When interpreting the initial MRI of a suspected TSGCT, it is essential to consider: (i) the characteristic findings of TSGCT-evident as low to intermediate signal intensity on both T1- and T2-weighted images, with a blooming artifact on gradient-echo sequences due to hemosiderin deposition; (ii) the possibility of D-TSGCT-extensive involvement of the synovial membrane with infiltrative margin; and (iii) the resectability and extent-if resectable, synovectomy is performed; if not, a novel systemic therapy involving colony-stimulating factor 1 receptor inhibitors is administered. In the interpretation of follow-up MRIs of D-TSGCTs after treatment, it is crucial to consider both tumor recurrence and potential complications such as osteoarthritis after surgery as well as the treatment response after systemic treatment. Given its prevalence in young adult patents and significant impact on patients' quality of life, clinical trials exploring new agents targeting D-TSGCT are currently underway. Consequently, understanding the characteristic MRI findings of D-TSGCT before and after treatment is imperative.

Adult Intramedullary Mature Teratoma of the Spinal Cord: An Unusual Case with a Review of the Literature

Intraspinal teratoma is a rare subtype of spinal cord tumors, accounting for only 0.2% to 0.5% of cases. These tumors consist of a mixture of two or more germ cell layers, including the ectoderm, endoderm, and mesoderm. They often contain epithelial tissues, fatty tissues, and follicles derived from these three layers, which can be visualized on magnetic resonance imaging (MRI) in most cases. However, in our patient, a 35-year-old woman with an intradural oval intramedullary teratoma at the L4 level, the tumor exhibited features similar to those of a schwannoma. On MRI, the tumor appeared as a 2-cm mass attached to the end of the spinal cord, with intermediate signal intensity on T2-weighted images and iso-intensity without enhancement on T1-weighted images. L4 laminoplasty with tumor removal was performed under intraoperative monitoring. The tumor was found to be firm with a cyst containing mucoid and fatty tissue posteriorly. Near-total resection was achieved, although the tumor margin was indistinct. A literature review revealed spinal cord tethering and the presence of fatty tissue without MRI enhancement as characteristic findings of teratomas and dermoid cysts.

Subperiosteal Schwannoma of the Humerus: A Case Report and Review of Literature

There are numerous conditions that arise from the surface of bones including both neoplastic and non-neoplastic entities. Schwannoma had been reported to be one of those conditions originating from the bone surface with variable proposed theories on it’s origin. We present a unique case of subperiosteal schwannoma arising from the humerus in a 40 years old female with history of painful swelling for two years. Radiograph showed cortically based lytic lesion located in the lateral distal humeral metaphysis with periosteal reaction and cortical scalloping. MRI showed the same juxtacortical lesion with a large extraosseous soft tissue component. It demonstrates intermediate T1 signal intensity and high signal intensity on T2 weighted images with intense enhancement. US guided biopsy showed benign peripheral nerve sheath tumour, consistent with schwannoma. The patient underwent complete rescetion with no complications or documented recurrence till the latest follow-up. In conclusion, subperiosteal schwannoma should be kept in the differential diagnosis in patients presenting with bone surface lesions associated with unexplained vague pain and swelling for a prolonged period of time.

An imaging‑based diagnostic approach to vascular anomalies of the oral and maxillofacial region.

The accurate diagnosis of vascular anomalies (VAs) is considered a challenging endeavor. Misdiagnosis of VAs can lead clinicians in the wrong direction, such as the performance of an unnecessary biopsy or inappropriate surgical procedures, which can potentially lead to unforeseen consequences and increase the risk of patient injury. The purpose of the present study was to develop an approach for the diagnosis of VAs of the oral and maxillofacial region based on computed tomography (CT), magnetic resonance imaging (MRI) and dynamic contrast-enhanced MRI (DCE-MRI). In the present study, the CT and MR images of 87 VAs were examined, and the following imaging features were evaluated: Detectability of the lesion, the periphery of the lesion, the inner nature of the lesion, the density of the lesion on CT, the signal intensity of the lesion on MRI, the detectability of phleboliths and the shape of the lesion. A total of 29 lesions were further evaluated using the contrast index (CI) curves created from the DCE-MRI images. A diagnostic diagram, which is based on the imaging features of VAs and CI curve patterns, was subsequently extrapolated. The results obtained demonstrated that the VAs were detected more readily by MRI compared with CT, whereas the detectability of phleboliths was superior when using CT compared with MRI. VAs showed a propensity for homogeneous isodensity on CT, whereas, by contrast, they exhibited a propensity for heterogeneous hyperdensity on CE-CT. VAs also showed a propensity for homogeneous intermediate signal intensity when performing T1-weighted imaging (T1WI), heterogeneous high signal intensity when performing short tau inversion recovery MRI, and heterogeneous high signal intensity when performing fat-saturated CE-T1WI. The CI curves of VAs were found to exhibit a specific pattern: Of the 29 CI curves, 23 (79.3%) showed early weak enhancement, followed by a plateau leading up to 400-600 sec. An imaging-based diagnostic diagram was ultimately formulated. This diagram can act as an aid for radiologists when they are expecting to find a VA, and hopefully serve the purpose of simplifying the diagnostic process. Taken together, the findings of the present study indicated that DCE-MRI may be considered a useful tool for the diagnosis of VAs.

Nonoperative Treatment for Traumatic Partial Graft Rupture After Anterior Cruciate Ligament Reconstruction: A 2-Year Follow-up Study.

There are no studies on the nonoperative treatment of traumatic partial anterior cruciate ligament (ACL) graft rupture. The purpose of this study was to compare the clinical and radiological outcomes and failure rates between nonoperative treatment and revision ACL reconstruction for traumatic partial ACL graft rupture. We hypothesized that the outcomes and failure rates would be comparable and that nonoperative treatment of traumatic partial ACL graft rupture can produce satisfactory outcomes. Cohort study; Level of evidence, 3. We retrospectively evaluated 2114 patients treated for isolated ACL rupture between January 2000 and June 2020. Patients with traumatic partial graft rupture after ACL reconstruction with minimum 2-year follow-up data were included. Patients who met all the following conditions were candidates for nonoperative treatment: (1) Lachman or pivot-shift grade 0 or 1 at 6 months after ACL reconstruction, (2) ACL graft with low to intermediate signal intensity on 1-year postoperative magnetic resonance imaging (MRI), and (3) MRI after reinjury showing definite evidence of trauma, some fibers remaining in continuity of the ACL graft, and no anterior tibial subluxation in the sagittal plane. The patients were divided into 2 groups according to treatment method: nonoperative treatment (group A) and revision ACL reconstruction (group B). Clinical scores, laxity test results, radiological outcomes, and graft failures were compared between the groups. In total, 47 patients had traumatic partial graft rupture (group A, n = 10; group B, n = 37). There were no significant differences between the 2 groups in terms of clinical scores, laxity tests, radiological outcomes, or graft failure. The clinical and radiological outcomes of nonoperative treatment of traumatic partial graft rupture after ACL reconstruction were comparable with those of revision ACL reconstruction. Nonoperative treatment of traumatic partial ACL graft rupture can produce satisfactory outcomes in selected patients.

T2-star (T2*)-weighted magnetic resonance imaging of tenosynovial giant cell tumors

PurposeTenosynovial giant cell tumors (TSGCTs) are benign but aggressive lesions, and the treatment is resection. A low to intermediate signal intensity on both T1- and T2-weighted images of magnetic resonance imaging (MRI) is characteristic, which is similar to the signal intensity of muscle, and therefore can be challenging for lesion detection. T2-star (T2*)-weighted MR images reflect paramagnetic deoxyhemoglobin, methemoglobin, or hemosiderin. MethodsIn 23 TSGCT patients (6 male and 17 females), the T2*MRI findings were analyzed. The tumor locations involved 10 large joints including nine knees and one ankle, 10 small joints including six fingers and four toes, as well as three wrists/hands. ResultsTen diffuse and 13 localized tumors were predominantly located in the large joints and small joints, respectively. The T2*-weighted images indicated three signal patterns of low, iso and high signal intensity compared to muscle. Low-, iso- and high-signal intensities were seen in 22 (96 %), 23 (100 %) and 12 (52 %) of the locations, respectively. To distinguish TSGCTs from the surrounding tissue, the low intensity T2*-weighted images and low to intermediate intensity T1-weighted images when compared to muscle and fluid, respectively were useful for the large joints. Low to intermediate intensity on T1- or T2-weighted images was useful to distinguish TSGCTs from subcutaneous tissue in the small joints. ConclusionsMRI using T2*-, as well as T1- and T2-weighted images, may be useful to detect lesions and assess the extent of TSGCTs in a tissue-specific manner, which is important for surgical planning.

Fibrosis entropy is associated with life-threatening arrhythmia in non-ischaemic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ Trust and King’s College, the Centre of Excellence in Medical Engineering funded by the Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC; WT088641/Z/09/Z). M.J.B. is supported by a Medical Research Council New Investigator Grant (MR/N011007/1) and British Heart Foundation (Project grant PG/18/74/34077). This work was supported by EPSRC 2018/19 DTP - EP/R513064/1 grant. This work was supported by a National Heart and Lung Institute Foundation grant awarded to Professor Sanjay Prasad and Dr Richard Jones. Background Enhanced risk stratification for implanted defibrillator requirement represents an important area of research in patients with non-ischemic cardiomyopathy (NICM). Myocardial fibrosis represents the major underlying arrhythmic substrate in this population, and its identification on late-gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) is associated with life-threatening arrhythmia (LTA). Fibrosis entropy, a measure of scar texture heterogeneity, may confer important information regarding the underlying pro-arrhythmic mechanisms of both core scar and areas of intermediate signal intensity (Gray Zone [GZ]). Purpose We sought to: 1) evaluate whether LGE-CMR assessment of left ventricular (LV) tissue entropy had incremental utility to fibrosis presence for arrhythmic risk stratification of patients with NICM; 2) quantify the added utility of GZ entropy in such analysis. Methods This study involved a prospective observational cohort of consecutive patients with NICM and myocardial fibrosis detected on LGE-CMR. Epicardial and endocardial contours obtained from LGE-CMR data were used with a FWHM method to delineate core fibrosis (≥50% maximum signal intensity) and GZ fibrosis (≥35%-<50% signal intensity). Fibrotic masks were subsequently used, along with native dicom LGE-CMR images to compute tissue entropy, defined by the standard Shannon Entropy for core fibrosis, GZ fibrosis, and combined core+GZ fibrosis. Patients underwent adjudicated long-term follow-up for LTA (composite of sudden cardiac death, aborted sudden cardiac death or sustained ventricular tachycardia). Results Of 291 patients with NICM and mid-wall/subepicardial fibrosis, 38 patients (13.1%) experienced LTA over median follow-up of 6.3 years (interquartile range 4.6-9.1 years). On Cox regression analysis, core fibrosis entropy (Hazard ratio [HR] 1.77, 95% CI 1.25-2.54, p=0.001), GZ fibrosis entropy (HR 1.74, 95% CI 1.20-2.54, p=0.004) and combined fibrosis entropy (HR 1.98, 95% CI 1.30-2.52, p=0.001) were associated LTA after adjustment for variables used to guide ICD implantation (LVEF <35% and NYHA class >1) and remained associated in multivariable models accounting separately for core and GZ fibrosis mass. The addition of core fibrosis entropy, GZ fibrosis entropy and combined fibrosis entropy to a baseline clinical model improved the C-statistic from 0.49 to 0.59, 0.62 and 0.62, respectively. LVEF <35% was not associated with LTA (HR 1.45, 95% CI 0.77-2.74, p=0.25) on multivariable analysis. Conclusions Fibrosis entropy on LGE-CMR offers incremental utility to LVEF and fibrosis presence for arrhythmic risk prediction in patients with NICM. The combination of core and GZ fibrosis entropy offers the highest association with risk.

Menière's Syndrome Associated With Fibrous Dysplasia of the Temporal Bone.

Menière's Syndrome Associated With Fibrous Dysplasia of the Temporal Bone.

How can we differentiate supratentorial tumor recurrence from postradiation imaging changes in children treated for primary malignant brain tumors?

Distinguishing tumor recurrence from therapy-induced imaging changes (TIIC) on brain MRI in children treated for primary malignant brain tumors may be challenging. The authors aimed to assess the diagnostic ability of multimodal MRI in differentiating TIIC from tumor recurrence. The authors retrospectively included children with abnormal supratentorial brain MRI findings after treatment for primary malignant brain tumors (regardless of their localization) with complete resection and radiotherapy. A total of 18 patients with TIIC and 25 patients with tumor recurrence were compared, according to structural, apparent diffusion coefficient (ADC), and arterial spin labeling (ASL) imaging data accrued over time. TIIC were defined by a new MRI scan that was stable for at least 1 year or had regressed, or by histopathology findings in specimens obtained when the anomaly was surgically treated. The time interval between completion of radiotherapy and the appearance of abnormal brain MRI findings was significantly shorter in the TIIC group compared with the tumor recurrence group (median 6 vs 35 months; p < 0.001). TIIC appeared as foci of increased T2-weighted signal intensity, without nodule, associated with variable contrast enhancement. Tumor recurrence appeared as a well-defined nodule with intermediate signal intensity on T2-weighted images with nodular contrast enhancement. Relative ADC values were significantly higher in the TIIC group (median 1.43 vs 0.88; p < 0.001). Relative ASL-cerebral blood flow (CBF) values were significantly lower in the TIIC group (median 0.27 vs 0.43; p = 0.04). On follow-up MRI, TIIC could progress, regress, or remain stable. In most instances (72%), they decreased in size or remained stable at 4 years of follow-up. MRI features of TIIC include foci of increased signal intensity without a demonstrable nodule on T2-weighted images, high ADC values, and lower ASL-CBF values, whereas tumor recurrence appears as a well-defined nodule with low ADC values and higher ASL-CBF values.

Primary synovial sarcoma of the shoulder: Case report of the “triple sign” on proton density magnetic resonance imaging

The first case of synovial sarcoma was published in 1893. The disease is a type of primary malignancy of the soft tissues. It is a rare and aggressive neoplasm of unknown tissue origin, characterized by strong metastatic potential and poor prognosis. The present case of a 64-year-old male patient with pain and swelling in his right shoulder and progressive loss of movement demonstrates an uncommon location for the neoplasm. Magnetic resonance proton-density fat-suppressed turbo spin-echo sequences show a heterogeneous mass in the right shoulder. The lack of homogeneity in the signal has been described in medical literature as the "triple sign" and is represented by low, intermediate, and high signal intensity areas through the neoplasm. Visible serpentine vessels spread through the tumor. There was a visible metastatic disease in the regional lymph nodes and metastatic foci in the adjacent bones. Pathological analysis of the tumor confirmed the diagnosis of biphasic synovial sarcoma. An oncological committee advised chemotherapy and radiotherapy. More prominent magnetic resonance imaging findings in synovial sarcoma that may facilitate the diagnostic process are the inhomogeneity and "triple sign" in proton density and T2 sequences, multilobulated tumors, septa, irregular borders, serpentine vascular channels, engagement of the adjacent bones and bone marrow, and involvement of the joint synovia.

Unusual Diffuse and Heterogeneous FDG Uptake in Appendicular Bone Marrow Space in a Patient with Acute Lymphoblastic Leukemia.

We describe a case of F-18-2-fluoro-2-deoxyglucose (FDG) uptake in the appendicular bones on a positron emission tomography/computed tomography (PET/CT) scan in a 20-year-old woman with a diagnosis of acute lymphoblastic leukemia. An FDG PET/CT was performed on this patient because of fever of unknown origin, revealing diffuse and heterogeneous FDG uptake in the bone marrow space of both humeri, femurs, and tibiae. The patient underwent magnetic resonance imaging, which demonstrated bone infarction with heterogeneous high, intermediate, and dark signal intensities on T1- and T2-weighted images in the same areas.

Intramuscular granular cell tumor in the sternocleidomastoid muscle: A case report and literature review.

Granular cell tumor (GCT) is a rare soft-tissue neoplasm that originates from Schwann cells. Most cases occur in the subcutaneous or submucosal regions, and intramuscular GCT is even more uncommon. Herein, we describe an atypical GCT growing in the sternocleidomastoid muscle. A 41-year-old Chinese man was admitted to our hospital for a right neck mass. In magnetic resonance images, the mass showed higher signal intensity than the adjacent normal muscle on T2-weighted images and intermediate signal intensity on T1-weighted images. Slightly enhanced and higher signal intensity was observed in the peripheral rim on contrast-enhanced fat-sat T1-weighted images, and the "stripe sign" was evident. The tumor was completely resected, and pathological examination indicated an atypical GCT. The patient tolerated the procedure well. This is a rare case report of an intramuscular GCT from diagnosis to treatment. Magnetic resonance imaging might help diagnose such tumors, and we review different magnetic resonance imaging characteristics of intramuscular GCTs at other sites.

Matrix glycoconjugate characterization in multispecies biofilms and bioaggregates from the environment by means of fluorescently-labeled lectins.

Environmental biofilms represent a complex mixture of different microorganisms. Their identity is usually analyzed by means of nucleic acid-based techniques. However, these biofilms are also composed of a highly complex extracellular matrix produced by the microbes within a particular biofilm system. The biochemical identity of this extracellular matrix remains in many cases an intractable part of biofilms and bioaggregates. Consequently, there is a need for an approach that will give access to the fully hydrated structure of the extracellular matrix or at least a major part of it. A crucial compound of the matrix identified as carbohydrate-based polymers represents major structural and functional constituents. These glycoconjugates can be characterized by using fluorescently-labeled lectins in combination with confocal laser scanning microscopy. The lectin approach is defined previously, as fluorescence lectin barcoding (FLBC) and fluorescence lectin-binding analysis (FLBA), where FLBC is equal to the screening of a particular sample with all the commercially available lectins and FLBA is the actual analysis of the matrix throughout an experiment with a selected panel of lectins. As the application of immune-based techniques in environmental biofilm systems is impossible, the lectin approach is currently the only option for probing lectin-specific glycoconjugates in complex biofilms and bioaggregates. From all the commercially available lectins tested, the lectins such as AAL, HAA, WGA, ConA, IAA, HPA, and LEA showed the highest binding efficiency. Furthermore, 20 of the overall lectins tested showed an intermediate signal intensity, nevertheless very useful for the assessment of matrix glycoconjugates. With the data compiled, we shall virtually shed more light on the dark matter of the extracellular matrix and their 3-dimensional distribution in environmental biofilm systems. The results will be helpful in future studies with a focus on the extracellular matrix glycoconjugates present in environmental microbial communities.

Multiple intestinal lymphangiomas with episodic hemorrhage requiring partial laparoscopic resection: a case report

BackgroundLymphangioma is a non-epithelial tumor marked by aggregates of abnormally dilated lymphatics. Mesenteric occurrences account for < 1% of all cases, and < 0.05% involve the gastrointestinal tract. Most are confined to children, rarely affecting adults.Case presentationHerein, we describe an elderly Japanese woman with anemia, hypoalbuminemia, and episodic bleeding due to multiple intestinal lymphangiomas. Abdominal computed tomography revealed multiple low-density defects of mesentery, with areas of intermediate (T1 images) or high (T2 images) signal intensity similarly dispersed in magnetic resonance scanning sequences. Single-balloon enteroscopy was undertaken, enabling identification and tattooing of a small intestinal bleeding source. Laparoscopy-assisted resection at this site served to control related hemorrhage, removing a histologically confirmed hemolymphangioma. Having recovered uneventfully, the patient remained stable 2 months postoperatively.ConclusionsAlthough rare in adults, mesenteric or gastrointestinal lymphangiomas must be considered in a setting of anemia and hypoalbuminemia. Complete resection is advantageous to improve patient symptoms, but limited resection of multiple lesions may be equally effective.

MRI-based radiomics in distinguishing Kaposiform hemangioendothelioma (KHE) and fibro-adipose vascular anomaly (FAVA) in extremities: A preliminary retrospective study

ObjectiveTo investigate the pretreatment differentiation between Kaposiform hemangioendothelioma (KHE) and fibro-adipose vascular anomaly (FAVA) in extremities of pediatric patients. To build and validate an MRI-based radiomic model. MethodIn this retrospective study, we obtained imaging data from 43 patients. We collected and compared clinical information, sketched region of interest (ROI), and extracted radiomic features from fat-suppressed T2-weighted (T2FS) images of the two cohorts of 30 and 13 patients respectively (training versus testing cohort 7:3). To select features, we used two sample t-test and the least absolute shrinkage and selection operator (LASSO) regression. The support vector machine (SVM) classification was constructed and evaluated by receiver operating characteristic (ROC) analysis. ResultsThirty patients with KHE and 13 patients with FAVA in the extremities were included. Most lesions demonstrated low to intermediate signal intensity on T1-weighted images and hyperintense signals on T2-weighted ones. They also showed similar traits pathologically. Initially, 107 radiomic features were acquired and then three were finally selected. The support vector machine (SVM) model was able to differentiate the two anomalies from each other with an area under the curve (AUC) of 0.807 (95%CI 0.602–1.000) and 0.846 (95%CI 0.659–1.000) in training and testing cohort, respectively. ConclusionThe derived radiomic features were helpful in differentiating KHE from FAVA. A model which contained these features might further improve the performance and hopefully could serve as a potential tool for identification.

Comprehensive radiological features of laryngeal sarcoidosis: cases series and systematic review.

To comprehensively summarize the characteristic radiological findings of laryngeal sarcoidosis. We reviewed patients with laryngeal sarcoidosis who underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) and included 8 cases from 8 publications that were found through a systematic review and 6 cases from our institutions. Two board-certified radiologists reviewed and evaluated the radiological images. Almost all cases exhibited supraglottic lesions 13/14 (92.9%) and most of them involved aryepiglottic folds (12/13, 92.3%), epiglottis (11/14, 78.6%), and arytenoid region (10/14, 71.4%). Most lesions were bilateral (12/14, 85.7%). All cases showed well-defined margins and a diffuse swelling appearance (14/14, 100%). Non-contrast CT revealed a low density (4/5, 80%). The contrast-enhanced CT showed a slight patchy enhancement predominantly at the margin of the lesion in most cases (12/13, 92.3%). In one case, T2-weighted images showed high signal intensity peripherally and low signal intensity centrally (1/1, 100%). Gadolinium-enhanced MRI showed moderate heterogeneous enhancement predominantly at the margin of the lesion (2/2, 100%). In one case, diffusion-weighted imaging showed intermediate signal intensity; the apparent diffusion coefficient value was 2.4 × 10-3 mm2/s. The larynx was the only region affected by sarcoidosis in 57.1% (8/14) of the cases. Involvement of the neck lymph nodes and distant organs was observed in 4/14 (28.6%) patients, respectively. We summarized the CT and MRI findings of patients with laryngeal sarcoidosis. Knowledge of these characteristics is expected to facilitate prompt diagnosis and appropriate management.

Podometric and Magnetic Resonance Imaging Study of The Forelimb Feet in Normal Donkeys (Equus Asinus)

The study provided a standard database of normal podometric characteristics and magnetic resonance image (MRI) of the front feet in donkeys. podometric study was performed on twenty non lamed donkeys and podometric measurements for both front hooves were recorded using graduated tape and image analysis (Image-J). MRI was performed on twelve cadaver specimens. T1 weighted spoiled gradient echo (SPGR) and T2 weighted gradient echo (GRE) in sagittal, dorsal and transverse planes was done on recently euthanized cadaver. Results indicated some podometric differences between horse and donkey. On T1 weighted MRI images, the cancellous bone in the distal phalanx (DP) and the lower part of middle phalanx (MP) had intermediate signal intensity and appeared light grey while the cortical bone of such phalanges were hypo-intense and appeared darker. The synovial fluid appeared with low signal intensity and black in color. Deep digital flexor tendon (DDFT) within the foot appeared bilobate and its ensheathed fibers had low signal intensity with clearly demarcated margins. On T2 weighted images, all cancellous bones within the hoof, had intermediate signal intensity. The signal intensity of DP appeared heterogonous and ranged between black to white. DDFT appeared black in color. The articular cartilage of the coffin joint had an intermediate signal intensity and was distinguished from the synovial fluid which appeared hyper-intense and bright in such sequence. Donkeys were not similar to horse. MRI of donkeys’ foot provided an accurate noninvasive method for evaluation of the donkey's foot which help clinicians to perform better diagnoses.