Isointense Lesions Research Articles

SPIN-02 AN INTRAMEDULLARY MYXOPAPILLARY EPENDYMOMA: A RARE OCCURANCE IN THE CERVICO-THORACIC SPINE

Abstract BACKGROUND Spinal myxopapillary ependymomas are a rare variant of spinal ependymoma that are considered to occur exclusively in the conus medullaris and filum terminale. They account for about 13% of all spinal ependymomas and have a slight male predominance. Case presentation: We report a case of 38-year-old male, Muganda, that presented at the Neurosurgery department Mulago National Referral Hospital with progressive paresthesia and paraparesis, of the upper limbs and chronic neck pain for 2years. MRI showed an isointense lesion on TIWI extending from C4 to T2 levels and exhibited heterogenous enhancement on gadolinium administration. The lesion was hyperintense on T2WI with a syrinx above the tumor. A radiological diagnosis of an intramedullary neoplastic process was made with differentials of Ependymoma, Schwanomma, and Astrocytoma. The patient underwent posterior laminectomy, and the tumor was completely excised. He is currently under follow up by the Neurosurgery team. CONCLUSION This case underscores the rarity of intramedullary myxopapillary ependymomas highlighting diagnostic challenges and the critical role of tailored surgical interventions in managing rare spinal neoplasms.

Lesions hyper- to isointense to surrounding liver in the hepatobiliary phase of gadoxetic acid-enhanced MRI.

Hyper- or isointensity in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI has high specificity for focal nodular hyperplasia (FNH) but may be present in hepatocellular adenoma and carcinoma (HCA/HCC). This study aimed to identify imaging characteristics differentiating FNH and HCA/HCC. This multicenter retrospective cohort study included patients with pathology-proven FNH or HCA/HCC, hyper-/isointense in the HBP of gadoxetic acid-enhanced MRI between 2010 and 2020. Diagnostic performance of imaging characteristics for the differentiation between FNH and HCA/HCC were reported. Univariable analyses, multivariable logistic regression analyses, and classification and regression tree (CART) analyses were conducted. Sensitivity analyses evaluated imaging characteristics of B-catenin-activated HCA. In total, 124 patients (mean age 40 years, standard deviation 10 years, 108 female) with 128 hyper-/isointense lesions were included. Pathology diagnoses were FNH and HCA/HCC in 64 lesions (50%) and HCA/HCC in 64 lesions (50%). Imaging characteristics observed exclusively in HCA/HCC were raster and atoll fingerprint patterns in the HBP, sinusoidal dilatation on T2-w, hemosiderin, T1-w in-phase hyperintensity, venous washout, and nodule-in-nodule partification in the HBP and T2-w. Multivariable logistic regression and CART additionally found a T2-w scar indicating FNH, less than 50% fat, and a spherical contour indicating HCA/HCC. In our selected cohort, 14/48 (29%) of HCA were B-catenin activated, most (13/14) showed extensive hyper-/isointensity, and some had a T2-w scar (4/14, 29%). If the aforementioned characteristics typical for HCA/HCC are encountered in lesions extensively hyper- to isointense, further investigation may be warranted to exclude B-catenin-activated HCA. Hyper- or isointensity in the HBP of gadoxetic acid-enhanced MRI is specific for FNH, but HCA/HCC can also exhibit this feature. Therefore, we described imaging patterns to differentiate these entities. FNH and HCA/HCC have similar HBP intensities but have different malignant potentials. Six imaging patterns exclusive to HCA/HCC were identified in this lesion population. These features in liver lesions hyper- to isointense in the HBP warrant further evaluation.

CEST 2022 - Differences in APT-weighted signal in T1 weighted isointense lesions, black holes and normal-appearing white matter in people with relapsing-remitting multiple sclerosis

PurposeTo evaluate amide proton transfer weighted (APTw) signal differences between multiple sclerosis (MS) lesions and contralateral normal-appearing white matter (cNAWM). Cellular changes during the demyelination process were also assessed by comparing APTw signal intensity in T1weighted isointense (ISO) and hypointense (black hole -BH) MS lesions in relation to cNAWM. MethodsTwenty-four people with relapsing-remitting MS (pw-RRMS) on stable therapy were recruited. MRI/APTw acquisitions were undertaken on a 3 T MRI scanner. The pre and post-processing, analysis, co-registration with structural MRI maps, and identification of regions of interest (ROIs) were all performed with Olea Sphere 3.0 software. Generalized linear model (GLM) univariate ANOVA was undertaken to test the hypotheses that differences in mean APTw were entered as dependent variables. ROIs were entered as random effect variables, which allowed all data to be included. Regions (lesions and cNAWM) and/or structure (ISO and BH) were the main factor variables. The models also included age, sex, disease duration, EDSS, and ROI volumes as covariates. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic performance of these comparisons. ResultsA total of 502 MS lesions manually identified on T2-FLAIR from twenty-four pw-RRMS were subcategorized as 359 ISO and 143 BH with reference to the T1-MPRAGE cerebral cortex signal. Also, 490 ROIs of cNAWM were manually delineated to match the MS lesion positions. A two-tailed t-test showed that mean APTw values were higher in females than in males (t = 3.52, p < 0.001). Additionally, the mean APTw values of MS lesions were higher than those of cNAWM after accounting for covariates (mean lesion = 0.44, mean cNAWM = 0.13, F = 44.12, p < 0.001).The mean APTw values of ISO lesions were higher than those of cNAWM after accounting for covariates (mean ISO lesions = 0.42, mean cNAWM = 0.21, F = 12.12, p < 0.001). The mean APTw values of BH were also higher than those of cNAWM (mean BH lesions = 0.47, mean cNAWM = 0.033, F = 40.3, p < 0.001). The effect size (i.e., difference between lesion and cNAWM) for BH was found to be higher than for ISO (14 vs. 2).Diagnostic performance showed that APT was able to discriminate between all lesions and cNAWM with an accuracy of >75% (AUC = 0.79, SE = 0.014). Discrimination between ISO lesions and cNAWM was accomplished with an accuracy of >69% (AUC = 0.74, SE = 0.018), while discrimination between BH lesions and cNAWM was achieved at an accuracy of >80% (AUC = 0.87, SE = 0.021). ConclusionsOur results highlight the potential of APTw imaging for use as a non-invasive technique that is able to provide essential molecular information to clinicians and researchers so that the stages of inflammation and degeneration in MS lesions can be better characterized.

E027 An outlandish presentation of IgG4-related disease

Abstract Background/Aims IgG4-related sclerosing disease is a systemic disease characterized by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs and tumour-like involvement of one or more exocrine glands or other extranodal sites. The major involved organs are the salivary glands, lacrimal glands, pancreas and retroperitoneal space. Cardiac masses in IgG4 disease include hematoma, tumours, vegetations, calcific lesions and other rare conditions. Cardiac tumours are rare and have a variety of benign and malignant entities. We herein report the case of a patient with antiphospholipid antibody syndrome with a mass lesion in the right atrium, histologically proven as IgG4-related disease. Methods A 52-year-old female, a known case of primary antiphospholipid antibody syndrome for 14 years, with five first trimester abortions and positive lupus anticoagulant, on anticoagulation with vitamin K antagonist, presented with: shortness of breath, bilateral lower limb swelling and exertional dyspnoea- grade 3, since one week before admission, associated with orthopnoea, without any h/o decreased urine output or facial puffiness. On examination, she had hypertension with raised JVP and loud P2 possibilities of myocarditis, hypertensive heart failure, and severe PAH with CCF were considered. Investigations showed iron deficiency anaemia, normal complements, and negative anti-dsDNA antibodies. she was treated with diuretics, PDE inhibitors and antihypertensives, 2D echo showed haziness in the right atrium, possible thrombus (1.5 × 2.3 cm), CTPA - showed enhancing mass lesion in right atrium wall, neoplastic origin was considered. Results To further evaluate the mass in the right atrium, a PET scan was performed, which showed a metabolically active isolated mass lesion in the right atrium, Cardiac MRI showed an ill-defined lobulated T1 hypointense, T2/STIR isointense lesion involving the right atrial wall, possible lymphoma/sarcoma. Planned for excision/debulking via sternotomy approach, intraoperative trans oesophageal echo showed right atrial mass of 25 cms possibility of lymphoma/sarcoma, during surgery mass could not be excised but a biopsy was taken and sent for histopathological analysis. The report was suggestive of IgG4 disease, plasma cells stain positive for IgG4 with ratio of IgG4 to IgG of 0.4. IHC results showed no evidence of malignancy. Serum IgG4 levels was 145mg/dl (&amp;lt;135mg/dl). Diagnosis of IgG4 disease was made and the patient was started on steroids, repeat 2D echo after 6 months showed that the mass in the right atrium had resolved and the patient was asymptomatic. Conclusion In conclusion, this was a rare case of primary antiphospholipid antibody syndrome, presenting as a cardiac mass which was difficult to distinguish from malignant lymphoma by a pathological examination alone, hence a biopsy was done to analyze the clonality of the cardiac tumour and accurate diagnosis of IgG4-RD was made. Disclosure K. Yerram: None. P. Devarasetti: None. L. Rajasekhar: None.

Role of radiology in post COVID-19 rhinocerebral fungal infections

The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

Carotid Artery Thrombus in Antiphospholipid Antibody Syndrome.

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyCarotid Artery Thrombus in Antiphospholipid Antibody SyndromeZongli Han, Hui Qi Zongli Han, Hui Qi Author AffiliationsFrom the Department of Neurosurgery, Peking University Shenzhen Hospital, 1120 Lianhua Rd, Shenzhen 518036, PR China.Address correspondence to H.Q. (email: [email protected]).Zongli HanHui Qi Published Online:Mar 14 2023https://doi.org/10.1148/radiol.221836MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 23-year-old previously healthy woman presented with sudden-onset right-sided hemiparesis and paresthesia. Brain MRI scan demonstrated acute left frontal lobe embolic infarcts. High-spatial-resolution vessel wall MRI scan revealed an isointense peripherally enhancing lesion in the left common carotid artery with resultant severe luminal narrowing, compatible with an intraluminal thrombus (Figure, A–C). Contrast-enhanced US image confirmed free-floating thrombus with proximal attachment to the vessel wall (Figure, D). Endarterectomy was performed, and an organized thrombus was confirmed with pathologic process. Antibody serology tests were positive for anticardiolipin immunoglobulin G, β-2 glycoprotein immunoglobulin G, and lupus anticoagulants. The diagnosis of antiphospholipid antibody syndrome was established according to the Miyakis criteria (1,2). The patient was treated with warfarin and showed no signs of clinical or radiologic relapse at 1-year follow-up.Images in a 23-year-old woman with sudden-onset right-sided hemiparesis and paresthesia. (A–C) T1-weighted three-dimensional isotropic variable flip-angle fast spin echo MRI scans with black-blood technique with a 3-T clinical scanner (uMR 780; United Imaging Healthcare) show vessel walls. (A) Axial and (B) coronal T1-weighted images without contrast material show an intraluminal T1 isointense lesion within the left common carotid artery with resultant severe luminal narrowing (arrows). (C) Coronal contrast-enhanced T1-weighted image shows peripheral linear contrast enhancement of the thrombus (arrow). (D) Contrast-enhanced US image demonstrates a free-floating thrombus with microbubbles between the thrombus and the carotid vessel (*) with proximal attachment to the vessel wall (arrowhead).Download as PowerPointOpen in Image Viewer Antiphospholipid antibody syndrome is an autoimmune disease characterized by recurrent arterial or venous thrombosis, pathologic pregnancy, and positive antiphospholipid antibodies (3). Neurologic manifestations, especially cerebral ischemia, are frequently present; however, presentation with carotid thrombus is uncommon (4).Disclosures of conflicts of interest: Z.H. No relevant relationships. H.Q. No relevant relationships.AcknowledgmentsThe authors thank Hui Zhang from the Department of Radiology, who helped with the interpretation of the high-resolution MRI. They also thank Liya Wei from the Department of Ultrasound, who helped with the interpretation of the contrast-enhanced US image.

Clinical case presentation on complex partial seizures diagnosis and treatment care services and outcomes in an adult patient

Complex partial seizure are often associated with impaired or loss of consciousness clinically proved to have an impact on masial temporal sclerosis (Hippocampus) region of brain. Seizures admits several etiopathophysiological events leading to several neuro functional changes in the reticulothalamocortical circuitry zones of the CNS .This paves the episodes of complex partial seizures events. A clinical case report of clinical partial seizures in a 47 years age adult patient came to the hospital with impaired consciousness. The brainmagnetic resonance imaging scanning of the patient detected a spectrum of findings more in favour of idiopathic intracranial hypertension and T1 ,T2 isointense lesion in the posterial mid line falx-2.falcine meningioma, focal area of glosis in the left high parietal lobe and age approximate bilateral cerebral atrophy it grade-1 fazellas white matter changes. The patient was conformed with Complex partial seizures, and she was treated with benzodiazepines twice a day. The patient was recovered from loss of impaired consciousness and she was called for follow up examination once in 1-month period.

Temporal evolution of new T1-weighted hypo-intense lesions and central brain atrophy in patients with a first clinical demyelinating event treated with subcutaneous interferon β-1a

ObjectiveEvaluate the effect of subcutaneous interferon β-1a (sc IFN β-1a) versus placebo on the evolution of T1-weighted MRI lesions and central brain atrophy in in patients with a first clinical demyelinating event (FCDE).MethodsPost hoc analysis of baseline-to-24 month MRI data from patients with an FCDE who received sc IFN β-1a 44 μg once- (qw) or three-times-weekly (tiw), or placebo, in REFLEX. Patients were grouped according to treatment regimen or conversion to clinically definite MS (CDMS) status. The intensity of new lesions on unenhanced T1-weighted images was classified as T1 iso- or hypo-intense (black holes) and percentage ventricular volume change (PVVC) was assessed throughout the study.ResultsIn patients not converting to CDMS, sc IFN β-1a tiw or qw, versus placebo, reduced the overall number of new lesions (P < 0.001 and P = 0.005) and new T1 iso-intense lesions (P < 0.001 and P = 0.002) after 24 months; only sc IFN β-1a tiw was associated with fewer T1 hypo-intense lesions versus placebo (P < 0.001). PVVC findings in patients treated with sc IFN β-1a suggested pseudo-atrophy that was ~ fivefold greater versus placebo in the first year of treatment (placebo 1.11%; qw 4.28%; tiw 6.76%; P < 001); similar findings were apparent for non-converting patients.ConclusionsIn patients with an FCDE, treatment with sc IFN β-1a tiw for 24 months reduced the number of new lesions evolving into black holes.

Invasive Sinu-Naso-Orbital Aspergilloma Following Dacryocystorhinostomy in an Immunocompetent Patient: A Rare Case Report and Literature Review

Background: Invasive sinu-naso-orbital aspergilloma is a rare disease with variable clinical features, but in an immunocompetent patient, it is rarely considered and often resulted in a poor prognosis due to its diagnostic and therapeutic challenges. In this article, we report a rare case of invasive sinu-naso-orbital aspergillosis with intracranial extension following dacryocystorhinostomy. To the best of our knowledge, this is the only reported case in the past 109 years. Case Description: A 61-year-old normotensive nondiabetic male was referred to us from an ophthalmologist with complaints of retro-orbital pain followed by progressive dimness of vision and later blindness on right eye after dacryocystorhinostomy. Diagnosis and Intervention: His MRI reveals an isointense lesion in the T1W and T2W images in the right maxillary, ethmoidal sinus with orbital and retro-orbital, and intracranial extension with heterogeneous contrast enhancement. A radiologist suggested a case of inflammatory pseudotumor, and initially he was treated with steroids due to a lack of clinical response; later, antifungal was given, but the patient still was nonresponsive. A right pterional craniotomy was performed on the patient to access the optic nerve and perform the biopsy. Aspergillus infection was seen by histopathology. Postoperatively, he was treated with voriconazole. Lessons: In immunocompetent individuals, invasive sino-orbital aspergillosis is uncommon. For effective care, early diagnosis is essential. Our advice is that a patient with vague symptoms or retro-orbital discomfort should encourage the doctor to investigate this diagnosis due to the diagnostic difficulties and greater mortality and morbidity rates.

Invasive Sinu-Naso-Orbital Aspergilloma Following Dacryocystorhinostomy in an Immunocompetent Patient: A Rare Case Report and Literature Review

Background: Invasive sinu-naso-orbital aspergilloma is a rare disease with variable clinical features, but in an immunocompetent patient, it is rarely considered and often resulted in a poor prognosis due to its diagnostic and therapeutic challenges. In this article, we report a rare case of invasive sinu-naso-orbital aspergillosis with intracranial extension following dacryocystorhinostomy. To the best of our knowledge, this is the only reported case in the past 109 years. Case Description: A 61-year-old normotensive nondiabetic male was referred to us from an ophthalmologist with complaints of retro-orbital pain followed by progressive dimness of vision and later blindness on right eye after dacryocystorhinostomy. Diagnosis and Intervention: His MRI reveals an isointense lesion in the T1W and T2W images in the right maxillary, ethmoidal sinus with orbital and retro-orbital, and intracranial extension with heterogeneous contrast enhancement. A radiologist suggested a case of inflammatory pseudotumor, and initially he was treated with steroids due to a lack of clinical response; later, antifungal was given, but the patient still was nonresponsive. A right pterional craniotomy was performed on the patient to access the optic nerve and perform the biopsy. Aspergillus infection was seen by histopathology. Postoperatively, he was treated with voriconazole. Lessons: In immunocompetent individuals, invasive sino-orbital aspergillosis is uncommon. For effective care, early diagnosis is essential. Our advice is that a patient with vague symptoms or retro-orbital discomfort should encourage the doctor to investigate this diagnosis due to the diagnostic difficulties and greater mortality and morbidity rates. Abbreviations: DCR: dacryocystorhinostomy, PL: Perception of light, PR: Projection of rays

Ischemic stroke can have a T1w hyperintense appearance in absence of intralesional hemorrhage.

Magnetic resonance imaging (MRI) signal changes associated with ischemic stroke are typically described as T2w and FLAIR hyperintense, and T1w isointense lesions. Intralesional T1w hyperintensity is generally attributed to either a hemorrhagic stroke, or an ischemic stroke with hemorrhagic transition, and has an associated signal void on gradient echo (GE) sequences. Cases of ischemic stroke with T1w hyperintense signal in absence of associated signal void on GE sequences have been sporadically demonstrated in human stroke patients, as well as in dogs with experimentally induced ischemia of the middle cerebral artery. This multicenter retrospective descriptive study investigates the presence of T1w hyperintensity in canine stroke without associated signal void on GE sequences. High field (1.5 Tesla) MRI studies of 12 dogs with clinical presentation, MRI features, and cerebrospinal fluid results suggestive of non-hemorrhagic stroke were assessed. The time between the observed onset of clinical signs and MRI assessment was recorded. All 12 patients had an intralesional T1w hyperintense signal compared to gray and white matter, and absence of signal void on T2*w GE or SWI sequences. Intralesional T1w hyperintensities were either homogenously distributed throughout the entire lesion (6/12) or had a rim-like peripheral distribution (6/12). The mean time between the recorded onset of clinical signs and MRI assessment was 3 days; however, the age range of lesions with T1w hyperintense signal observed was 1–21days, suggesting that such signal intensities can be observed in acute, subacute, or chronic stages of ischemic stroke. Follow-up was recorded for 7/12 cases, all of which showed evidence of neurological improvement while in hospital, and survived to discharge. Correlation of the age and MRI appearance of lesions in this study with similar lesions observed in human and experimental studies suggests that these T1w hyperintensities are likely caused by partial tissue infarction or selective neuronal necrosis, providing an alternative differential for these T1w hyperintensities observed.

Frontal intradiploic encephalocele in a 44-year-old male patient: illustrative case.

Encephaloceles are protrusions of the cerebral tissue through a skull defect. They occur mostly in children and very rarely in adults. The authors present a case of a 44-year-old man presenting with a first-time generalized seizure. Computed tomography of the head showed bone destruction associated with a right frontal lesion. Magnetic resonance imaging scans demonstrated a largely isointense lesion in the intradiploic space that contained small, hyperintense nodular components and showed a low to moderate contrast agent enhancement. The patient underwent resection, during which the histological examination found the lesion to be an intradiploic encephalocele. The patient had an uneventful postoperative course with a cessation of seizures. The imaging and neuropathological findings as well as a literature review, together with a discussion on the etiology of intradiploic encephaloceles, are contained in this report.

A New Advanced MRI Biomarker for Remyelinated Lesions in Multiple Sclerosis.

ObjectivesNeuropathological studies have shown that multiple sclerosis (MS) lesions are heterogeneous in terms of myelin/axon damage and repair as well as iron content. However, it remains a challenge to identify specific chronic lesion types, especially remyelinated lesions, in vivo in patients with MS.MethodsWe performed 3 studies: (1) a cross‐sectional study in a prospective cohort of 115 patients with MS and 76 healthy controls, who underwent 3 T magnetic resonance imaging (MRI) for quantitative susceptibility mapping (QSM), myelin water fraction (MWF), and neurite density index (NDI) maps. White matter (WM) lesions in QSM were classified into 5 QSM lesion types (iso‐intense, hypo‐intense, hyperintense, lesions with hypo‐intense rims, and lesions with paramagnetic rim legions [PRLs]); (2) a longitudinal study of 40 patients with MS to study the evolution of lesions over 2 years; (3) a postmortem histopathology‐QSM validation study in 3 brains of patients with MS to assess the accuracy of QSM classification to identify neuropathological lesion types in 63 WM lesions.ResultsAt baseline, hypo‐ and isointense lesions showed higher mean MWF and NDI values compared to other QSM lesion types (p < 0.0001). Further, at 2‐year follow‐up, hypo‐/iso‐intense lesions showed an increase in MWF. Postmortem analyses revealed that QSM highly accurately identifies (1) fully remyelinated areas as hypo‐/iso‐intense (sensitivity = 88.89% and specificity = 100%), (2) chronic inactive lesions as hyperintense (sensitivity = 71.43% and specificity = 92.00%), and (3) chronic active/smoldering lesions as PRLs (sensitivity = 92.86% and specificity = 86.36%).InterpretationThese results provide the first evidence that it is possible to distinguish chronic MS lesions in a clinical setting, hereby supporting with new biomarkers to develop and assess remyelinating treatments. ANN NEUROL 2022;92:486–502

Role of Radiology in Mucormycosis: Recent Update

The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosisof rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging and clinical data of four males andone female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis andophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images.The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. Apattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistentlyobserved in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapidinvolvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebralmucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbitinflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging showsanatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery andantifungals.

Surgical Experience and Management of Intracranial Neurenteric Cysts: Single-Center Experience and Review of the Literature.

Introduction Neurenteric cysts (NECs) are rare, congenital lesions lined by endodermal cell-derived columnar or cuboidal epithelium. Based on previous studies, gross total removal of the capsule has been presumed to be the ideal surgical goal. Objective This series was undertaken to further understand the risk of recurrence based on the extent of capsule resection. Methods Records were retrospectively reviewed for all patients with radiographic or pathological evidence of intracranial NEC from 1996 to 2021. Results A total of eight patients were identified; four of eight (50%) presented with headache, and four had signs of one or more cranial nerve syndromes. One patient (13%) presented with third nerve palsy, one (13%) had sixth nerve palsy, and two (25%) with hemifacial spasm. One patient (13%) presented with signs of obstructive hydrocephalus. Magnetic resonance imaging demonstrated T2 hyper- or isointense lesions. Diffusion-weighted imaging was negative in all patients (100%) and T1 contrast-enhanced imaging demonstrated minimal rim enhancement in two patients (25%). In three of eight (38%), a gross total resection (GTR) was achieved, while in four (50%), a near-total resection, and in one (13%), a decompression was performed. Recurrences occurred in two (25%) patients, one with decompression and another with near-total resection, among these 1/2 required repeat surgery after a mean follow-up of 77 months. Conclusion In this series, none from GTR group demonstrated recurrence, while 40% of those receiving less than GTR recurred, underpinning the importance of maximally safe resection in these patients. Overall patients did well without major morbidity from surgery.

Clinical Features and Outcomes of Patients with Orbital Schwannoma.

To report the clinical features, treatment, and outcome of 11 patients with orbital schwannoma in Korean patients. The medical records of 11 orbital schwannoma patients treated between April 2007 and April 2021 were retrospectively reviewed. The demographic data, clinical characteristics, radiological features, and outcomes were reviewed. The mean age at the time of diagnosis was 49.00 ± 14.45 years. The most common initial symptom was ocular protrusion (n = 7), and other symptoms were decreased visual acuity ( n = 5), restriction of eye movement ( n = 4), swelling ( n = 3), and pain ( n = 2). Locations of tumors were superomedial; followed by the orbital apex and inferolateral. The most common shape seen in our patients was beads like multilobulated appearance; followed by a round, oval, fusiform, and dumbbell shape. MRI of T1-weighted revealed isointense or hypointense, whereas the T2-weighted indicated hyper or isointense lesion. Five patients had optic neuropathy at presentation, and 1 of them showed improved vision after surgery. Complete or incomplete excision was performed for all. Surgical complications include decreased vision and paraesthesia. There has been no recurrence to date. Orbital schwannoma is a rare disease and it is difficult to distinguish it from other orbital tumors because the initial symptoms are nonspecific. Differential diagnosis by combining the shape, location, and contrast enhancement findings seen on computed tomography and magnetic resonance imaging can be helpful in surgical treatment. Complete excision gives the best results without recurrence, but if the patient is in an inaccessible location, only surgery to reduce the volume can satisfy the patient without recurrence.

Dental Scan and Mucormycosis: A Literature Review

The purpose of this study was to describe common radiographic patterns that may be useful in predictingthe diagnosis of rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging andclinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results:All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%)had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weightedimages was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomicinvolvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistentlyobserved in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion:Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contentsis the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern ofnasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosisof mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping insurgery planning. However, the prognosis is grave despite radical surgery and antifungals.

Radiological aspects in mucormycosis

The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

Role of Radiology in Mucormycosis: Recent Trends

Background and Objectives: The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. Methods:We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

T2 Relaxometry Evidence of Microstructural Changes in Diffusely Abnormal White Matter in Relapsing–Remitting Multiple Sclerosis and Clinically Isolated Syndrome: Impact on Visuomotor Performance

Axial sections of the last echo of the multi-echo spin echo (MESE) sequence (echo time = 214.4 MSEC), fluidattenuated inversion recovery (Flair) and T1 magnetization prepared - rapid gradient echo (MPRAGE) sequences (Upper Row), and maps of short t2, long t2, and myelin water fraction (MWF) values (Lower Row) from a representative relapsing–remitting multiple sclerosis (RR-MS) patient. Regions of interest were positioned in diffusely abnormal white matter (Red Circles) and posterior periventricular normal appearing white matter (NAWM) (Black Circles). Measurements were, also, made in focal lesions identified on T2-weighted images, varying on their intensity on T1-weighted images (see materials and methods section). In this section A T1 isointense focal lesion (White Circles) and a T1 moderate hypointense focal lesion (Yellow Circles) are shown. According to the results, MWF and T2 values were intermediate between the respective values of NAWM and T1 hypointense focal lesions, but not significantly different from T1 isointense lesions by papadaki et al (1077–1087)