Radiological Findings Research Articles

The diagnostic value of MRI findings in pediatric idiopathic intracranial hypertension: a case-control study.

Idiopathic intracranial hypertension (IIH) is a rare medical condition in children. Based on the different radiological findings reported in various studies in pediatric IIH, this study was conducted to determine the diagnostic value of MRI findings in diagnosing IIH in children. In this retrospective study, the medical records of all children aged 1 to 18 years who visited Ghaem Hospital in Mashhad, Iran, between 2012 and 2022 and were diagnosed with IIH were gathered. Forty-nine cases of children with IIH and 48 control cases of children with the first unprovoked seizure with no indications of increased intracranial pressure for comparison were selected. Patient demographic information and MRI findings were extracted. The comparison between different MRI findings in the case and control groups was conducted using statistical tests. In the case group, the mean diameter of the subarachnoid space expansion around the optic nerve was 5.96 ± 1.21, compared to 4.79 ± 0.33 in the control group, with statistically significant difference (P < 0.001). All the patients with flattening of the posterior globe or transverse sinus stenosis were in the case group, and the frequency of these findings in the case group was significantly higher than in the control group (P < 0.001). The majority of patients (95.5%) classified under category 3 and 4 of empty sella were part of the case group, and the statistical test results indicated a significant difference between the two groups (P < 0.001). The optic nerve sheath diameter cut-off of 5.35 mm, when used for expansion of the subarachnoid space around the optic nerve, with a sensitivity of 82% and a specificity of 100% in diagnosing IIH. The most reliable diagnostic indicators for diagnosing IIH in children are perioptic subarachnoid space expansion with high sensitivity, and posterior globe flattening and transverse sinus stenosis with high specificity.

Diagnostic Accuracy of Preoperative Radiologic Findings in Papillary Thyroid Microcarcinoma: Discrepancies with the Postoperative Pathologic Diagnosis and Implications for Clinical Outcomes.

The diagnostic accuracy of preoperative radiologic findings in predicting the tumor characteristics and clinical outcomes of papillary thyroid microcarcinoma (PTMC) was evaluated across all risk groups. In total, 939 PTMC patients, comprising both low-risk and non-low-risk groups, who underwent surgery were enrolled. The preoperative tumor size and lymph node metastasis (LNM) were evaluated by ultrasonography within 6 months before surgery and compared with the postoperative pathologic findings. Discrepancies between the preoperative and postoperative tumor sizes were analyzed, and clinical outcomes were assessed. The agreement rate between radiological and pathological tumor size was approximately 60%. Significant discrepancies were noted, including an increase in tumor size in 24.3% of cases. Notably, in 10.8% of patients, the postoperative tumor size exceeded 1 cm, despite being initially classified as 0.5 to 1.0 cm based on preoperative imaging. A postoperative tumor size >1 cm was associated with aggressive pathologic factors such as multiplicity, microscopic extrathyroidal extension, and LNM, as well as a higher risk of distant metastasis. In 30.1% of patients, LNM was diagnosed after surgery despite not being suspected before the procedure. This group was characterized by smaller metastatic foci and lower risks of distant metastasis or recurrence than patients with LNM detected both before and after surgery. Among all risk groups of PTMCs, a subset showed an increase in tumor size, reaching 1 cm after surgery. These cases require special consideration due to their association with adverse clinical outcomes, including an elevated risk of distant metastasis.

Associations between COVID-19 and Glucose-6-Phosphate Dehydrogenase Activity in Brazil.

Glucose-6 phosphate dehydrogenase deficiency (G6PDd) was suggested as a risk factor for severe disease in patients with COVID-19. We evaluated clinical outcomes and glucose-6 phosphate dehydrogenase (G6PD) activity during and after illness in patients with COVID-19. This prospective cohort study included adult participants (≥18 years old) who had clinical and/or radiological COVID-19 findings or positive reverse transcription-polymerase chain reaction results. Epidemiological and clinical data were extracted from electronic medical records. Glucose-6 phosphate dehydrogenase activity was measured using SD Biosensor STANDARD G6PD® equipment on admission and 1 year after discharge. Samples were genotyped for the three most common single nucleotide polymorphisms for G6PDd in the Brazilian Amazon. Seven hundred fifty-three patients were included, of whom 123 (16.3%) were G6PD deficient. There was no difference between groups regarding the risks of hospitalization (P = 0.740) or invasive mechanical ventilation (P = 0.31), but the risk of death was greater in patients with normal G6PD levels (P = 0.022). Only 29 of 116 participants (25%) carried the African G6PDd genotype. Of 30 participants tested as G6PD deficient during disease, only 11 (36.7%) results agreed 1 year after discharge. In conclusion, this study does not demonstrate an association of G6PDd with severity of COVID-19. Limitations of the test for detecting enzyme levels during COVID-19 illness were demonstrated by genotyping and retesting after the disease period. Care must be taken when screening for G6PDd in patients with acute COVID-19.

Importance of preoperative HRCT temporal bone in the orientation of the cochlea and its relation to intra-operative difficulties in cochlear implantation – predicting the grades of difficulty

Objective: This study emphasizes the role of preoperative high-resolution computed tomography (HRCT) temporal bone in evaluating the variation in cochlear orientation and proposes a grading system to determine the level of intraoperative difficulties encountered. Methods: Preoperative correlation of middle ear and inner ear structures along with the basal turn angle (BTA) was done to assess the orientation. Patients were divided into three groups depending on BTA and radiology findings. Results: Group A (BTA = 55°-60°) had statistically significant (p < 0.05) correlation between middle ear to inner ear structures on HRCT, whereas group B (BTA >60°) and C (BTA <55°) had variations in the alignment of middle ear structures to their corresponding inner ear structures. Conclusion: The association of BTA to the correlation between middle ear and inner ear structures can determine the orientation of the cochlea. This evaluation makes the surgeon aware of intraoperative challenges and helps in surgical planning.

Imaging the acute complications of gender-affirming surgeries: a primer for radiologists in the emergency setting.

Gender-affirming surgery (GAS) is increasingly being performed. GAS is tailored to the patient leading to a diverse spectrum of radiologic post-operative findings. Radiologists who are unfamiliar with expected anatomic alterations after GAS may misdiagnose important complications leading to adverse patient outcomes. This collaborative multi-institutional review aims to: Describe relevant embryology and native anatomy. Describe relevant Gender-Affirming Surgery (GAS) techniques and expected neo-anatomy with associated complications, including common terminology. Review expected imaging appearance of neo-anatomy/postoperative findings. Review multi-modality [ultrasound, plain film, retrograde urethrogram, computed tomography] emergent imaging findings. Understand unique patient evaluation and imaging protocol considerations in the GAS population. Discuss pearls and pitfalls of imaging in the acute post-GAS setting.

Delayed diagnosis of mild mucopolysaccharidosis type IVA

BackgroundMucopolysaccharidosis IVA (MPS IVA) is a lysosomal storage disease caused by biallelic variants in the N-acetylgalactosamine-6-sulfatase (GALNS) gene and is characterized by progressive and multi-system involvements, dominantly with skeletal deformities. A mild form of MPS IVA often presents with atypical symptoms and can go unrecognized for years.MethodsThe diagnosis of MPS IVA was confirmed via GALNS enzyme activity testing in leukocytes. Clinical features were collected. Molecular analysis was performed by next generation sequence and Sanger sequencing of the GALNS gene. The pathogenicity of the deep intron variant was verified by mRNA analyses.ResultsThirteen patients with mild MPS IVA from six families were included. All probands first visit pediatric orthopedists and it took 5.6 years to be diagnosed after the disease onset. The most common symptoms in our series were waddling gait (85%), short neck (69%) and flat feet (62%). Radiologic findings indicated skeletal abnormalities in all patients, especially modification of the vertebral bodies (100%) and acetabular and femoral head dysplasia (100%). Five novel GALNS variants, including c.121-2_121-1insTTTGCTGGCATATGCA, E2 deletion, c.569 A > G, c.898 + 2 T > A, and c.1139 + 2 T > C, were identified. The most common variant, a deep intron variant NM_000512.5: c.121–210 C > T (NM_001323544.2: c.129 C > T, p.G43G), was revealed to result in an 11 bp deletion (c.128_138delGCGATGCTGAG, p.Gly43Aspfs*5) on GALNS mRNA in the GALNS transcript of NM_001323544.2.ConclusionsThis study provides significant insights into the clinical features and molecular characteristics that contribute to the early diagnosis of mild MPS IVA. On the basis of our cohort, orthopedists need to be able to recognize signs and symptoms of mild MPS IVA as well as the molecular and biochemical diagnosis so that an early diagnosis and treatment can be instituted.

Primary phenotypic features associated with caudal neck pathology in warmblood horses.

Detailed descriptions of clinical signs associated with radiological findings of the caudal cervical vertebral column are not available. Describe the clinical features associated with neck pain or stiffness, neck-related thoracic limb lameness, proprioceptive ataxia consistent with a cervicothoracic spinal cord or nerve lesion, and their frequency of occurrence compared with control horses. A total of 223 Warmblood horses. Case-control study. Controls and cases were recruited prospectively. All horses underwent predetermined lameness and neurologic examinations. The frequency of occurrence of each clinical feature was compared between cases and controls and relative risk (RR) were calculated. Ninety-six cases and 127 controls were included. Forty-seven (49%) of the cases were classified as neurologic, 31 (32.3%) had thoracic limb lameness, and 18 (18.7%) had neck stiffness or pain or both. Focal caudal cervical muscle atrophy (46, 47.9%), hypoesthesia (38, 39.6%), patchy sweating (16, 16.7%), hyperesthesia (11, 11.5%), and pain upon firm pressure applied over the caudal cervical articular process joints and transverse processes (58, 60.4%) were only observed in cases (P < .001). Sideways flexion of the neck was restricted in a higher proportion of cases (47/96, 49%) compared with controls (40/127, 31.8%; P = .009, RR 1.5). Hopping-type thoracic limb lameness was only observed in cases, (30, 31.6%). Deterioration in lameness after diagnostic anesthesia occurred in 13/31 (41.9%) cases. Systematic clinical evaluation using the methods described should enable clinical differentiation between horses with caudal cervical lesions and horses with other causes of gait abnormalities.

An Interesting Case of Pulmonary Tuberculosis with Hypoxemic Respiratory Failure Mimicking Interstitial Lung Disease

Hypoxemic respiratory failure is a rare presentation of active pulmonary tuberculosis (TB). Though tuberculous acuterespiratory distress syndrome (ARDS) is well documented in medical literature, non-ARDS respiratory failure is seldomreported in active pulmonary TB. We herein report a case, which posed a diagnostic dilemma as it clinically mimickedinterstitial lung disease. Imaging showed unilateral localized smooth interlobular septal thickening along with consolidationwithout significant mediastinal lymphadenopathy. To the best of our knowledge, this rare radiological finding has not beenreported in medical literature as being associated with hypoxemic respiratory failure in pulmonary TB patients.

Can conservative treatment be effective for thoracolumbar injuries patients with TLICS scores of 4 or 5? An analysis of initial radiological findings and clinical risk factors for treatment failure

BackgroundThis study aimed to assess the outcomes of conservative management in patients with thoracolumbar fractures classified with a Thoracolumbar Injury Classification and Severity (TLICS) score of 4 or 5, and to analyze initial imaging findings and clinical risk factors associated with treatment failure.MethodsIn this retrospective analysis, patients with thoracolumbar fractures and a TLICS score of 4 or 5, determined through MRI from January 2017 to December 2020, were included. Patients undergoing conservative treatment were categorized into two groups: Group 1 (treatment success) and Group 2 (treatment failure), based on initial and 6-month follow-up outcomes. Clinical data were compared between the two groups. Initial radiological assessments included three kyphosis measurements (Cobb angle, Gardner angle, and sagittal index [SI]), anterior and posterior wall height, and central canal compromise (CC). Additionally, risk factors contributing to treatment failure were analyzed.ResultsThe conservative treatment group comprised 84 patients (mean age, 60.25 ± 15.53; range 22–85; 42 men), with 57 in Group 1 and 27 in Group 2. Group 2 exhibited a higher proportion of women, older age, and lower bone mass density (p = 0.001–0.005). Initial imaging findings in Group 2 revealed significantly greater values for Cobb angle, SI, and CC (p = 0.001–0.045 or < 0.001; with cutoff values of 18.2, 12.8, and 7.8%, respectively), and lower anterior wall height (p = 0.001), demonstrating good to excellent interobserver agreement (0.72–0.99, p < 0.001). Furthermore, osteoporosis was identified as a significant risk factor (odds ratio = 5.64, p = 0.008).ConclusionAmong patients with TLICS scores of 4 or 5, those experiencing conservative treatment failure exhibited unfavorable initial radiological findings, a higher proportion of women, advanced age, and osteoporosis. Additionally, osteoporosis emerged as a significant risk factor for treatment failure.

Impact of circulating tumor DNA genomic mutations and circulating tumor cells biomarker duo on clinical concordance in localized, progressive, and metastatic disease.

e14546 Background: Genomic mutations have been identified from circulating tumor DNA (ctDNA) that correlates positively with clinical disease status. EGFR and intracellular cell progression/proliferation pathway-BRCA1/2 and TP53 genes drive high ctDNA load in progressive cancer patients. Circulating tumor cells (CTC) indicate Cellular Residual Disease (CRD). ctDNA and CTC as dual biomarkers offer prediction of tumor progression and metastasis implicative for early detection and treatment modifications. Methods: Retrospectively in 96 cancer patients (lung, colon-rectal, breast, stomach, etc.) who recently underwent treatment were investigated for presence of CTCs and genomic mutations from ctDNA using OncoMonitor Test. Libraries were prepared using a hybridization-capture method covering 1000 targets with mean sequencing depth 5000X on Illumina Nextseq 2000. Test detected genomic alterations from single nucleotide variation (SNVs), small insertions and deletions (INDELs), copy number variations (CNVs), and translocations (fusions) using a 96 gene panel. CTCs were isolated using the OncoDiscover platform, with CK18+, PD-L1+, CD45- in1.5 ml of blood. Results: In 96 pan-cancer patients, 15.6% patients (n=15) were identified with localized progressive disease with no metastasis from radiological findings, of which 60% (n=9) patients showed at least 1 genomic finding from ctDNA.12.5% (n=12) patients were identified as metastatic from their radiological findings of which 58.3% (n=7) showed presence of at least 1 CTC. 33.3% (n=4) patients showed 2 CTCs and 5 patients had no CTCs. In addition, these metastatic patients showed the presence of ctDNA load in 66.6% (n=8) patients with at least 1 genomic finding. In metastatic disease cohort, CTC enumeration showed concordance of 58.3% (n=7) with metastatic radiological findings and genomic findings from ctDNA showed concordance in 66.6% (n=8) patients with metastatic radiological findings. 23.9% (n=23) patients from the cohort were radiological identified with stable/treatment responsive disease of which 73.9% (n=17) patients were not detected with genomic mutations from ctDNA and 26.0% (n=6) patients were CTC -ve, concordant with radiological findings. 26.0% (n=6) patients had at least 1 genomic finding contributing to discordance with the radiological findings. Genomic findings from duo offered concordance with radiological findings in 26.6% (n=4) patients with progressive disease, 41.6% (n=5) in metastatic disease, and 17.3% (n=4) in patients with stable/treatment responsive disease. Conclusions: Patients with progressive and metastatic disease from radiological findings showed concordance with the dual ctDNA and CTC biomarkers. Concordance of ctDNA in progressive disease and CTC in metastatic disease is indicative of individual significance.

Development and validation of a preoperative CT‑based radiomics nomogram to differentiate tuberculosis granulomas from lung adenocarcinomas: an external validation study

BackgroundAn accurate and non-invasive approach is urgently needed to distinguish tuberculosis granulomas from lung adenocarcinomas. This study aimed to develop and validate a nomogram based on contrast enhanced-compute tomography (CE-CT) to preoperatively differentiate tuberculosis granuloma from lung adenocarcinoma appearing as solitary pulmonary solid nodules (SPSN).MethodsThis retrospective study analyzed 143 patients with lung adenocarcinoma (mean age: 62.4 ± 6.5 years; 54.5% female) and 137 patients with tuberculosis granulomas (mean age: 54.7 ± 8.2 years; 29.2% female) from two centers between March 2015 and June 2020. The training and internal validation cohorts included 161 and 69 patients (7:3 ratio) from center No.1, respectively. The external testing cohort included 50 patients from center No.2. Clinical factors and conventional radiological characteristics were analyzed to build independent predictors. Radiomics features were extracted from each CT-volume of interest (VOI). Feature selection was performed using univariate and multivariate logistic regression analysis, as well as the least absolute shrinkage and selection operator (LASSO) method. A clinical model was constructed with clinical factors and radiological findings. Individualized radiomics nomograms incorporating clinical data and radiomics signature were established to validate the clinical usefulness. The diagnostic performance was assessed using the receiver operating characteristic (ROC) curve analysis with the area under the receiver operating characteristic curve (AUC).ResultsOne clinical factor (CA125), one radiological characteristic (enhanced-CT value) and nine radiomics features were found to be independent predictors, which were used to establish the radiomics nomogram. The nomogram demonstrated better diagnostic efficacy than any single model, with respective AUC, accuracy, sensitivity, and specificity of 0.903, 0.857, 0.901, and 0.807 in the training cohort; 0.933, 0.884, 0.893, and 0.892 in the internal validation cohort; 0.914, 0.800, 0.937, and 0.735 in the external test cohort. The calibration curve showed a good agreement between prediction probability and actual clinical findings.ConclusionThe nomogram incorporating clinical factors, radiological characteristics and radiomics signature provides additional value in distinguishing tuberculosis granuloma from lung adenocarcinoma in patients with a SPSN, potentially serving as a robust diagnostic strategy in clinical practice.

Classification of the relationship between suprasellar arachnoid cyst and hydrocephalus based on treatment modalities: shunting versus neuroendoscopic approaches.

Children diagnosed with suprasellar arachnoid cysts often concurrently have hydrocephalus. This study aims to classify the relationship between suprasellar arachnoid cysts and hydrocephalus, discussing surgical strategies-shunting or neuroendoscopic approaches-and their sequence, based on this classification. A retrospective analysis was conducted on 14 patients diagnosed with suprasellar arachnoid cysts and hydrocephalus, treated surgically by the first author between January 2016 and December 2020. Clinical features, radiological findings, surgical strategies, and outcomes were reviewed. The classification of the relationship between the suprasellar arachnoid cysts and hydrocephalus was developed and illustrated with specific cases. Recommendations for future surgical management based on this classification are provided. We classified the relationship between suprasellar arachnoid cysts and hydrocephalus into three categories. SACH-R1, the direct type, represents cases where the cysts cause obstructive hydrocephalus. Here, neuroendoscopic ventriculocystocisternostomy (VCC) effectively treats both conditions. SACH-R2, the juxtaposed type, involves concurrent occurrences of cysts and hydrocephalus without a causative link. This is further subdivided into SACH-R2a, where acute progressive communicating hydrocephalus coexists with the cyst, initially managed with a ventriculoperitoneal shunt, followed by VCC upon stabilization of hydrocephalus; and SACH-R2b, where the cyst coexists with chronic stable communicating hydrocephalus, first addressed with VCC, followed by monitoring and potential secondary shunting if needed. Key factors differentiating SACH-R2a from SACH-R2b include the patient's age, imaging signs of fourth ventricle and cisterna magna enlargement, and the rapid progression or chronic stability and severity of hydrocephalus symptoms. SACH-R3, the reverse type, describes scenarios where shunting for hydrocephalus leads to the development or enlargement of the cyst, managed via neuroendoscopic VCC with precautions to prevent infections in existing shunt systems. The simultaneous presence of suprasellar arachnoid cysts and hydrocephalus requires a nuanced understanding of their complex relationship for optimal surgical intervention. The analysis and classification of their relationship are crucial for determining appropriate surgical approaches, including the choice and sequence of shunting and neuroendoscopic techniques. Treatment should be tailored to the specific type identified, rather than blindly opting for neuroendoscopy. Particularly for SACH-R2a cases, we recommend initial ventriculoperitoneal shunting.

Clinical laboratory and radiological findings in COVID-19 patients with variable severity: King Fahad Medical City experience

Clinical laboratory and radiological findings in COVID-19 patients with variable severity: King Fahad Medical City experience

E-scooter-related imaging: a new emerging high-energy trauma patient.

To quantify the volume and nature of radiological imaging performed for e-scooter related trauma presentations in a tertiary referral centre and to identify common radiological pattern of injuries. Our study received institutional review board approval. We retrospectively reviewed all anonymised radiological imaging studies performed in our institution for the term 'scooter' or 'e-scooter' between July 2020 and July 2021. The patient demographics, number of imaging studies performed and modality type as well as the nature of injuries identified were recorded. Within the study period, 147 patients with e-scooter-related injuries were referred for radiological imaging. Forty-two (29%) of those patients had positive radiological findings. The vast majority of injuries on radiographs were upper limb injuries typical of a fall on outstretched hand (FOOSH) pattern. Thirty-two patients (22%) required advanced diagnostics with CT or MRI with 11 of these patients having positive findings. Four patients suffered significant head injuries including skull fractures and/or intracranial haemorrhage. Five patients suffered facial bone fractures, and 2 suffered spinal fractures. One patient suffered a handlebar abdominal trauma with a resulting large bowel injury ultimately requiring bowel resection. E-scooter-related injuries represent a new and emerging high-energy trauma patient. These patients demonstrate injury patterns similar to other high-energy trauma such as road traffic accidents. Although the most common injuries are musculoskeletal upper limb injuries typical of FOOSH, a large proportion of these require advanced diagnostic imaging (CT, MRI) which were commonly positive for significant injuries.

Effect of circulating tumor cells in clinically stable patients on the conundrum of recurrence with cellular residual disease.

e15040 Background: Despite no evidence of disease by radiological imaging, up to 30% breast cancer cases are known to relapse after treatment with a curative intent. The presence of CTCs in stage I-II cancer patients signals the activation of extravasation and invasion process leading to micro-metastasis and may lead to poor outcome. CTCs in blood circulation at any stage of cancer indicate detectable Minimal Cellular Disease (MCD). Thus the longitudinal investigation of patients with such biomarker remains highly implicative to predict the recurrence, therapy escalations, and dose modifications. The expression of Program Death - Ligand 1 (PD-L1) on CTCs is a dynamic biomarker and they may escape the elimination by immune system, indicative of progression of metastatic signature. Methods: Retrospectively, ina cohort of 20 cancer patients (e.g. lung, colon-rectal, breast, stomach, etc.) who recently underwent treatment were investigated for the presence of CTCs using CDSCO approved OncoDiscover platform having multi-components conjugated with anti EpCam antibody on magnetic nanoparticles. All patients represented clinically stable disease from previous radiological findings. CTCs enumeration assay was performed using CD45, EpCAM+, and CK18 and over-expression of PD-L1 in1.5 ml of peripheral blood using automated motorized Zeiss fluorescence microscopy. Results: In spite of 'no radiological' findings with clinically stable disease, out of 20 selected patients, 75% (n=15) showed at least 1 CTC. While, 55% (n=11) patients were detected with 1 CTC, 5% patients (n=1) with 2 CTCs, and 15% patients (n=3) were identified with 3 CTCs. In addition, 50% (n=10) of patients demonstrated with PD-L1 expression on CTCs; 1 patient exhibited a CTC cluster. Conclusions: Patients showed CRD in spite of a stable disease, which is an indication of progression of localized disease transforming from primary to secondary. The longitudinal monitoring of patients for CTCs with PD-L1 expression may reveal ‘real time’ residual disease, progression, regression, and actual response to the treatment. CRD monitoring can improve the curative intent by improving PFS and OS in solid cancers.

Childhood Posterior Fossa Tumours: Experience from a Tertiary Center in Nepal

Background: Brain tumour is a common problem in paediatric age group and posterior fossa is the commonest location. Treatment of these tumours is difficult due to a confined space and potential involvement of brainstem. The aim of this study is to analyse the clinical features, radiological findings, pathological diagnosis, surgical management, postoperative complications and outcome in 3 months in paediatric patients with posterior fossa tumours. Method: Retrospective chart review of 24 patients treated in the Department of Neurosurgery, TUTH, between 2019 April – 2023 April was done. The variables included were age, sex, clinical features, radiological findings, histopathological diagnosis, management and postoperative complications. Results: Twenty-four patients (30%) out of 80 childhood tumors were located in posterior fossa. The most common presenting symptoms was headache in 83.3% and vomiting in 75%. The most common location of tumour was the fourth ventricle in 66.7% while most common tumour histology was Type IV medulloblastoma in 45%. The commonest mode of treatment in 90% of cases was Ventriculoperitoneal (VP) shunting followed by surgical excision of tumour. Conclusion: Posterior fossa tumours are common tumour occurring in children. Majority of the patients presented with features of raised intracranial pressure and gait ataxia. Fourth ventricle and cerebellar vermis are the most common location. Most common histology types are medulloblastoma followed by pilocytic astrocytoma and ependymoma. Management involves addressing acute hydrocephalus followed by definitive surgery. Keywords: Medulloblastoma, Paediatrics, Posterior fossa, Surgery, Ventriculoperitoneal shunt

Posterior fossa primary intracranial extraosseous Ewing’s sarcoma: case report

BackgroundPrimary intracranial Ewing’s sarcoma (ES) is a type of primitive neuroectodermal tumour and is a rare malignant tumour in children and adolescents. The imaging features of ES overlap with other central nervous system embryonal tumours, making it difficult to pinpoint a specific diagnosis. We aim to explore the clinical, neuroimaging and differential diagnoses of this entity.Case presentationWe describe a 6-month-old infant who presented with complaints of enlarging the head size and poor feeding. Imaging revealed a contrast-enhancing large solid-cystic mass lesion with internal calcification, focal bone erosion and haemorrhage in the posterior fossa. Histopathological examinations, immunohistochemistry, and molecular analysis confirmed ES.ConclusionsThe confirmative diagnosis of primary intracranial ES requires histological examination, immunohistochemical analysis, and genetic detection, along with radiological findings. Surgical excision followed by combined radiotherapy and chemotherapy is the treatment of choice.

The Relationship Between the Circle of Willis Variations and White Matter Hyperintensities in Different Migraine Subtypes

It is known that the Circle of Willis (CoW) variations and white matter hyperintensities (WMHs) are common in migraine. This retrospective study aims to investigate the relationship between the CoW variations and WMHs in migraine without aura (MWoA) (n=38) and migraine with aura (MWA) (n=40) patients. Demographic, clinical and radiological findings (the CoW variations and WMH burden) of the patients were recorded, and the relationship between the variables was evaluated in both groups. The overall incomplete COW, incomplete anterior or vertebrobasilar portion of the CoW, or the presence of fetal PCA showed no significant difference between the MWoA and MWA groups (p &gt; 0.05). An incomplete posterior portion of the CoW was significantly higher in the MWA group than in the MWoA group (p = 0.034). In the WMA group, the visual aura was present in 72% of patients with the overall incomplete CoW; all of these were posterior portion variations of the CoW. When the WMH burden was compared, no significant difference was seen between the MWoA and MWA groups (p &gt; 0.05). Among patients with the CoW variations in the MWoA group, the rate of patients without WMHs was significantly higher (p = 0.030). No significant difference was observed between the CoW variations and WMH burden in the MWA group (p &gt; 0.05). In conclusion incomplete posterior portion of the CoW is common in MWA, and this variation is associated with visual aura but unrelated to WMH burden.

Robotic thoracic surgery for neurogenic tumors.

Thoracic neurogenic tumors usually present as benign nerve sheath tumors that can be resected via transthoracic or posterior approaches, depending on the anatomical location. Robot-assisted thoracic surgery (RATS) is increasingly being used for the transthoracic approach, but evidence is very limited. The authors initiated the current study to evaluate the efficacy and safety of RATS for thoracic neurogenic tumors. This retrospective study is based on a prospectively created database that includes all RATS surgeries between 2018 and 2023. All patients with histologically confirmed neurogenic tumors were included in the study. The patients' medical and surgical records as well as radiological and pathological findings were analyzed. During a 5-year period, 27 patients underwent robotic resection of neurogenic tumors at a high-volume thoracic surgery center. Two patients had previously undergone posterior laminectomy for resection of the intraspinal components. The pathologies included schwannomas (18, 64%), ganglioneuromas (8, 29%), 1 paraganglioma, and 1 neurofibroma occurring close to a schwannoma unilaterally in the same patient. The median tumor size was 4.7 cm (range 0.9-11.4 cm). The median operating time was 69 minutes (range 27-169 minutes), and the median postoperative stay was 3 days (range 1-19 days). There was one conversion due to adhesions after a previous surgery. No major bleeding occurred. There was no perioperative mortality. Morbidity included a lymphatic fistula (n = 1), pneumonia (n = 1), prolonged air leak (n = 1), and 4 cases of postoperative pain persisting for more than 4 weeks. Neurological complications were mostly observed in patients with tumors located at the thoracic apex: 2 cases of Horner's syndrome, 2 cases with compensatory hyperhidrosis, 1 patient with paresis of the recurrent laryngeal nerve, and a T1 lesion resulting in a minor motor deficit of the small hand muscles (Medical Research Council grade 4) and hypoesthesia of the respective dermatome. RATS for thoracic neurogenic tumors is feasible and safe. Tumors at the thoracic apex are at high risk of neurological deficit and should be approached with care. Close interdisciplinary collaboration between neurosurgeons and thoracic surgeons is necessary for optimal patient selection and a good postoperative outcome.

White matter tract density index is associated with disability in multiple sclerosis

BackgroundThe association between common neuroradiological markers of multiple sclerosis (MS) and clinical disability is weak. Given that the disability in patients with MS may depend on the underlying structural connectivity of the brain, our study aimed to examine the association between white matter tracts affected by MS and the patients' disability using a new tract density index (TDI). MethodThis study included 53 patients diagnosed with MS, examined between 2019 and 2020. Manual lesion segmentation was performed on fluid-attenuated inversion recovery (FLAIR) images, and the density of white matter tracts encompassing the lesion (i.e., TDI) was calculated. Correlation analysis was employed to assess the association between TDI and disability. Additionally, the relationship between disability, TDI, and lesion-derived network metrics was examined by computing a partial correlation network. ResultsThe TDI significantly correlated with the expanded disability status scale (EDSS) (r = 0.30, p = 0.03). Furthermore, the patient's disability is linked solely through TDI to lesion-derived network metrics —a key metric that ‘bridges’ the gap between the brain lesion and disability. ConclusionsIn this study, MS lesions encompassing regions with high white matter tract density were associated and linked with severe physical disability. These findings indicate that TDI may be an outcome predictor that may connect radiologic findings to clinical practice.