Radiological Appearance Research Articles

Calcification in a pulmonary hydatid cyst: a rare radiological appearance.

British Journal of Hospital MedicineEarly view Images in MedicineCalcification in a pulmonary hydatid cyst: a rare radiological appearanceYener Aydin, Ali Bilal Ulas, Atilla ErogluYener AydinCorrespondence to: Yener Aydin; E-mail Address: [email protected]Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, TurkeySearch for more papers by this author, Ali Bilal UlasDepartment of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, TurkeySearch for more papers by this author, Atilla ErogluDepartment of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, TurkeySearch for more papers by this authorYener Aydin; Ali Bilal Ulas; Atilla ErogluPublished Online:14 Jun 2023https://doi.org/10.12968/hmed.2022.0540AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Aydin Y, Ulas AB, Ince I et al.. Large case series analysis of cystic echinococcosis. Indian J Surg. 2021;83(S4):897–906. https://doi.org/10.1007/s12262-021-03061-0 Crossref, Google ScholarGarg MK, Sharma M, Gulati A et al.. Imaging in pulmonary hydatid cysts. World J Radiol. 2016;8(6):581–587. https://doi.org/10.4329/wjr.v8.i6.581 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 14 June 2023 Information© MA Healthcare LimitedPDF download

Metastases from gastric cancer presenting as colorectal lesions: a report of two cases and systematic review.

Gastric cancer is common with well-established routes of spread. Metastasis to the colon or rectum is rare; however, we have recently managed two patients with this clinical picture. We present these cases together with a literature review of current practice. A systematic review in PubMed using the terms 'gastric cancer' and 'colorectal metastasis' was performed. The identified papers were screened for relevance and the reference lists of relevant papers were also reviewed to ensure capture of all relevant reports. Twenty-four papers containing 26 cases of gastric cancer with metastasis to the colon or rectum were found. There was wide variation in presentation and practice in these cases, which tended to be in patients with poor histopathological features. Diagnosis is often challenging owing to the unusual radiological appearance and submucosal nature of the metastatic lesions. Treatment ranges from palliative care to radical resection. Colorectal metastases from gastric primary cancer are rare, but cases are reported and should be part of the index of suspicion during the work-up of patients with lower gastrointestinal symptoms and a history of gastric cancer. Treatment options range from aggressive surgical resection to palliative care and should be centred on the patient's fitness and wishes.

Unusual peritoneal metastases of femoral osteosarcoma

Introduction: Osteosarcoma is the most common malignant bone tumor in children, most often occurring in the lower extremity of the femur, and is known to be particularly aggressive, with a high risk of metastasis. The most frequent secondary localizations are pulmonary and bone metastases; peritoneal metastases are extremely rare and have a poor prognosis. Case Report: We report the case of a 14-year-old child with a history of a treated right femoral osteosarcoma, which presented with peritoneal and pulmonary metastases. Conclusion: Imaging plays a very important role in the management of patients with osteosarcoma, it allows an early detection of metastases through a rigorous clinicoradiological surveillance, metastases usually have the same radiological appearance as the primary tumor and the diagnosis of certainty is essentially based on anatomopathological study.

Exosomal miRNAs targeting NLRP3 inflammasome platform are associated with radiologic sequelae in survivors of COVID-19-associated acute respiratory distress syndrome

Background: There is limited understanding of the pathophysiology of post-acute pulmonary sequelae in COVID-19-associated acute respiratory distress syndrome (ARDS). We aimed at investigating the association of circulating microRNAs (miRNAs) involved in post-transcriptional regulation of NLRP3-inflammasome pathways and lung radiological features among COVID-19- associated ARDS survivors. Methods: We evaluated COVID-19-associated ARDS survivors at 4±2 months from clinical recovery. Patients were selected based on imaging pattern evolution according to chest high-resolution computerized tomography (HRCT) findings into “fully recovered” (FR), “pulmonary opacities” (PO) and “fibrosis-like lesions” (FL) according to radiological appearance. Plasma miRNA profiling was performed using real time quantitative polymerase chain reaction (RT-qPCR). The exosomal expression of NLRP3 inflammasome related miRNAs (miR-17-5p, miR-223-3p, miR-146a-5p) was evaluated. Results: 31 patients (33% men, mean age 60±6 years, mean BMI 31.1±6.6 Kg/m2) were selected for the present study. No statistically significant differences between FR, PO and FL patterns were observed according to clinical features. NLRP3-inflammasome-related miRNAs such as miR-17-5p, miR-223-3p and miR-146a-5p were significantly up-regulated in patients with PO when compared to patients with FL. miR-146a-5p was also up-regulated in patients with FL than in FR. Conclusions: In patients with long-term pulmonary radiological sequelae following COVID71 19- associated ARDS, a down-regulation of miRNAs inhibiting NLRP3 (miR-17-5p, miR-146a72 3p and miR-223-3p) correlated to fibrosis development in patients showing persistent hyper-reactivity to inflammatory stimulation. NLRP3-Inflammasome-related miRNAs could be a possible therapeutic target to prevent the fibrotic evolution of COVID-19-associated ARDS.

The effect of adjuvant cryotherapy added to well-performed high-speed burr curettage on the long-term surgical outcomes of chondroblastoma cases.

This study aims to investigate the effect of adjuvant cryotherapy added to well-performed high-speed burr curettage on the long-term surgical outcomes of chondroblastoma cases. Between January 2004 and December 2020, a total of 30 chondroblastoma cases (19 males, 11 females; median age: 18.6 years; range, 9 to 53 years) who were surgically treated were retrospectively analyzed. The pressurized-spray technique was performed using liquid nitrogen. Data including age, sex, radiological appearance, treatment modality, duration of follow-up, skin problems, and recurrence were recorded. All patients received adjuvant liquid nitrogen cryotherapy after extended intralesional curettage with high-speed burr. The bone cavity was filled with an autologous iliac crest bone graft, allograft, or polymethylmethacrylate (PMMA). The median follow-up was 54 (range, 19 to 120) months. The lesion was located around the knee in 16 (53.3%), in the shoulder in seven (23.3%), around the hip in five (16.6%), and in the ankle in two (6.6%) cases. The defect was filled with an autologous iliac crest bone graft in 28 (93.3%), an additional allograft in eight (26.7%), and PMMA in two (6.7%) cases. Local recurrence was observed in only two (6.7%) patients during follow-up. Two (6.7%) patients developed physeal growth arrest. Osteoarthritic changes were observed in two (6.7%) patients (one knee and one hip) due to the periarticular location of the tumor. Three (10%) patients had skin complications. None of the cases had a pathological fracture. A well-performed extended intralesional curettage with high-speed burr is the first and essential step in treating chondroblastoma. Adding adjuvant liquid nitrogen cryotherapy with high-speed burr can improve treatment outcomes and significantly reduce the recurrence rate of this disease.

Silicosis.

I was pleased to see the emphasis on silicosis in your recent issue, but sad that the lessons my generation has learned over the past six decades have had so little impact worldwide on prevention. These lessons are: Silicosis presents a variety of radiological appearances, depending on the intensity and duration of exposure and the mineral content of the dust. There is only one useful test for surveillance—chest radiography. Symptoms and pulmonary impairment only come late in the evolution of the disease. In this context, ‘late’ does not mean duration of exposure, since very heavy exposure to freshly generated silica can cause death within a year. The International Labour Office (ILO) classification of radiographs was not intended for diagnosis but for epidemiological purposes, to reduce the inevitable variation between x-ray readers. Rather, it allows description of the changes seen in relation to standard ‘normal’ films. Diagnosis in individuals depends also on taking account of clinical factors, notably exposure to, and type of, dust.

Fibrous dysplasia mimicking skeletal involvement in Lymphoma.

We present the case of a 19-year-old male with nodular sclerosing classical Hodgkin lymphoma, who had an incidental finding of fibrous dysplasia of the bone. This caused 18-F-fluorodeoxyglucose (18-F-FDG) avidity on positron emission tomography-computed tomography (PET-CT) scan leading to incorrect initial staging. This patient presented with a 4-month history of enlarging cervical lymph nodes, without B symptoms. He had no prior medical history. His initial diagnostic 18-F-FDG PET-CT demonstrated moderately avid left cervical and superior mediastinal lymphadenopathy and two partially sclerotic, partially lytic bone lesions. These were moderately avid, one in the proximal right humerus (SUV 6.1) and the second in the posterior distal humerus (SUV 8.1). There was no other avid lymphadenopathy (see Figure 1). He had a magnetic resonance imaging (MRI) scan and an orthopaedic opinion was sought; the lesions were felt likely to be skeletal involvement of his Hodgkin lymphoma. Therefore, his staging was 4A, with an international prognostic score of 2, and treatment was commenced following a RATHL approach starting with ABVD chemotherapy. The interim PET-CT scan following cycle 2 of ABVD demonstrated a complete metabolic response within the cervical and mediastinal lymphadenopathy, but persistent avidity within the right humeral shaft lesions which were essentially unchanged in size with a mild reduction in 18-F-FDG avidity (see Figure 2). He did report some aching in the right arm. This discrepant radiological response prompted further investigation. The bone lesions were evaluated with a CT and MRI scan, and his case was discussed again with the orthopaedic team who at that point felt the radiological appearances were suggestive of fibrous dysplasia. He had a biopsy of the bone lesion and histological examination confirmed the diagnosis of fibrous dysplasia with no evidence of Hodgkin lymphoma or other primary bone malignancy. The patient's staging was therefore amended to stage 2A early favourable (ESR 4 mm/h at diagnosis), and treatment was changed to combined modality chemo-radiotherapy. He had already completed 2 cycles of ABVD and so proceeded to receive 20 Gy in 10 fractions of consolidation radiotherapy. His end-of-treatment PET-CT scan is awaited but clinically he remains in complete remission. He will require surveillance imaging of the bony lesions. Fibrous dysplasia of the bone (FD) is an uncommon genetic disorder causing benign fibroosseous bone lesions. It is diagnosed predominantly in children and young adults. It has a wide spectrum of presentations but is often asymptomatic and can be found incidentally. Malignant transformation can rarely occur. Radiological features can vary from classical ground glass lesions to cystic or sclerotic lesions. FD lesions can show a large variability in 18-F-FDG uptake on PET-CT, and avidity in FD may change over time. There are several other case reports of FD mimicking skeletal involvement in lymphoma. In conclusion, discrepant responses to treatment should be further investigated. Careful interpretation of 18-F-FDG avid bone lesions is required to avoid misdiagnosis or overtreatment. FD should be considered within the differential diagnosis, especially in younger patients. Orla Gildea: conception, literature review and writing—original draft preparation Claire Burney: supervision and writing—review and editing Julian Kabala: resources, visualisation The authors declare no conflict of interest. Self. N/A. Uploaded. N/A. Not applicable to this article as no new data were created or analysed.

Adrenal cysts: an emerging condition.

Adrenal cysts are rare lesions representing approximately 1-2% of adrenal incidentalomas. The majority of these rare lesions are benign. Rarely, phaeochromocytomas and adrenal malignant masses can present as cystic lesions and can occasionally be difficult to distinguish from benign cysts. Histologically, adrenal cysts are subdivided into pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. The radiological appearance of an adrenal cyst is generally similar to that of cysts in the kidney. They are thus well demarcated, usually rounded, with a thin wall and homogenous internal structure, low attenuating (<20 Hounsfield Units) on CT, low signalling on T1-weighted MRI sequences and high signalling on T2-weighted MRI sequences, and anechoic or hypoechoic on ultrasonography. Benign adrenal cysts have a slight female predominance and are usually diagnosed between the ages of 40 and 60. Most adrenal cysts are asymptomatic and are detected incidentally, although very large adrenal cysts can lead to mass effect symptoms, with surgery required to alleviate the symptoms. Thus, conservative management is usually recommended for asymptomatic cysts. However, when uncertainty exists regarding the benign nature of the cyst, additional work-up or follow-up is needed. The management of an adrenal cyst should preferably be discussed at an adrenal multidisciplinary team meeting.

P154 Real-world audit of patients with idiopathic inflammatory myositis-related interstitial lung disease in a European population

Abstract Background/Aims The British Society for Rheumatology (BSR) has released guidelines for managing idiopathic inflammatory myositis (IIM). Our centre operates specialist clinics for scleroderma and lupus, but to date, IIM patients are seen in a general CTD clinic. As part of work to establish a dedicated myositis clinic, we collated data on 71 patients under active follow-up with myositis spectrum disease deemed appropriate for follow-up within a specialist clinic. We aimed to review patients diagnosed with IIM-ILD and review serological immune profile, screening practices for pulmonary involvement, findings on CT/pulmonary function tests (PFTs) and pharmacological management. Methods We performed a detailed retrospective review of the notes of suitable patients, identified using diagnostic codes attached to clinic letters. Results 71 patients were identified: 14 with anti-synthetase syndrome (ARS), 21 with dermatomyositis (DM), 13 with polymyositis (PM), 3 with immune-mediated necrotising myopathy (IMNM) and 17 with overlap syndrome. 65% (46/70) of adult IIM patients were screened for pulmonary involvement. Screening practices of patients based on antibody profile and myositis subtype are further described in the table. 31% of patients (22/70) had IIM-ILD, of which 12 had ARS, 4 had PM, 1 had DM and 5 had overlap disease (2 PM/scleroderma, 1 DM/ARS, 1 DM/scleroderma and 1 scleroderma/ARS). 21/22 underwent PFTs; 53% of patients had active ILD over an average of 51.8 months. On imaging, 76.2% (16/22) had changes consistent with ILD. Ground glass change and reticulation were demonstrated in 50% of scans. In comparison, honeycombing and traction bronchiectasis was found in 22% and 44% of scans, respectively. A non-specific interstitial pneumonia (NSIP) pattern was described in 44% of scans, organising pneumonia (OP) pattern in 22%, and 17% had a mixed OP and NSIP pattern. 20/22 patients were prescribed high-dose steroids, csDMARD therapy or aggressive immunosuppression (cyclophosphamide or rituximab). Conclusion Our review demonstrates that 65% of patients with adult IIM were screened for ILD. NSIP and OP were the most common radiological appearances. Half of our cohort required aggressive immunosuppression, cyclophosphamide being the most commonly prescribed agent and mycophenolate being preferred for maintenance therapy. No patients were prescribed tacrolimus or ciclosporin. Despite treatment, 52% of patients had evidence of progressive disease on serial PFTs. Disclosure A. Loganathan: Grants/research support; Arthritis Australia. S. Sturney: None. N. Foley: None. T. Hartley: None. S. Tansley: None.

Uremic Leontiasis Ossea Secondary to Hyperparathyroidism in Three Patients with End Stage Renal Disease

Renal osteodystrophy is a common complication referring to the skeletal changes associated with the phosphocalcic disorders of chronic uremia in patients with end-stage kidney disease. Uremic leontiasis ossea (ULO) is a rare and severe form of renal osteodystrophy with characteristic overgrowth of the cranial vault and facial bones. Computed tomography (CT) findings are particularly characteristic and include serpiginous tunneling within the maxillofacial bones and cortical bone resorption. The recognition of its radiological appearance and abrupt management are essential to avoid its devastating esthetic and functional impairments. Today's better medical facilities have improved hemodialysis methods, and meticulous patient follow‐up has decreased the incidence of leontiasis. In this paper, we report three rare cases of patients with end stage renal failure who presented with multiple face swellings and were diagnosed with ULO.

What effective technique to differentiate radiation brain necrosis from a tumor progression in patients treated with radiation: A monocentric retrospective study combining the MRI TRAMs technique and the (18F)-dopa PET/CT

PurposeBrain necrosis after radiotherapy is a challenging diagnosis, since it has similar radiological appearance on standard MRI to tumor progression. Consequences on treatment decisions can be important. We compare recent imaging techniques in order to adopt a reliable diagnostic protocol in doubtful situations. Patients and methodThis is a retrospective study comparing the performance of three imaging techniques after radiotherapy of brain metastasis: Perfusion-MRI, TRAMs technique and F-dopa PET-CT. The evolution of the treated metastasis volume was also analyzed by contouring all patients MRIs. All included patients were suspected of relapse and had the three exams once the volume of treated metastasis increased. ResultsThe majority of our patients were treated by stereotactic radiotherapy. Suspicion of relapse was on average around 17months after treatment. Four cases of radionecrosis were diagnosed and six cases of real tumor progression. Neurological symptoms were less present in radionecrosis cases. All of our radionecrosis cases had relative cerebral blood volume below 1. F-dopa PET-CT succeeded to set the good diagnosis in eight cases, although we found one false positive and one false negative exam. The TRAMs technique failed in one case of false negative exam. ConclusionsPerfusion-MRI showed high performance in the diagnosis of radionecrosis, especially when calculating relative cerebral blood volume rate. The TRAMs technique showed interesting results and deserves application in daily routine combined with the perfusion-MRI. F-dopa CT might induce false results because of different metabolic uptake according to tumor type, medication and brain blood barrier leak.

Teaching Neuro Images : Burkitt dural lymphoma mimicking a subacute subdural hematoma

A 59-year-old woman with no history of trauma presented with severe headaches and right-sided weakness. A CT scan showed a left hemispheric isodense subdural collection thought to be consistent with a subacute subdural hematoma (figure 1A). The patient underwent a single parietal burr hole for evacuation, but the neurosurgeon found subdural fleshy tissue and performed a biopsy. Immediate postoperative MRI showed a homogeneous hypercellular subdural mass (figure 1, B–F).1 Pathology was consistent with Burkitt lymphoma (figure 2). Retrospectively, the homogeneous density of the collection argued against hematoma. In nonemergent situations, an atypical radiologic appearance of a subdural hematoma may suggest the need for further radiologic investigations before surgical evacuation.2

Maxillary Aneurysmal Bone Cyst: About a Case

Introduction: Aneurysmal bone cyst (ABC) is a primary or secondary benign tumor, consisting of an intraosseous cavity, uni or multilocular, with hematic content. It can develop on all bones of the skeleton with, however, a predilection for the long bones and the spine. KOA mainly affects children and young adults, with a slight female predominance. Objective: The aim of this work is to reveal the diagnostic features at the imaging level. Case Report: This is an 11-year-old female patient with no previous pathological history who has presented for 1 year with diffuse maxillofacial pain, with intermittent fluid discharge in the oral cavity. Facial CT scan without and with contrast injection objective a lytic image centered on the lateral wall of the left maxillary sinus bulging into the sinus lumen with a spontaneously hypodense multicompartmental appearance without contrast gain after PDC injection. Conclusion: KAO is a very polymorphic lesion, which presents a diagnostic problem (Aspecific radiological appearance). In spite of the different therapeutic modalities proposed, it is the surgical treatment which exposes less risk of recurrence.

Imaging Features of Rare Hepatic Tumors

AbstractHepatic lesions are commonly encountered in radiology practice. Lesions with classic imaging findings such as hepatocellular carcinoma, cholangiocarcinoma, hemangiomas, focal nodular hyperplasia, and adenomas are well described in literature and easily diagnosed by most experienced radiologists. In the appropriate context, metastases, which are one of the most common lesions encountered by radiologists who practice in predominantly cancer care settings, are also easily diagnosed. However, one may encounter rarer neoplasms which may be challenging to diagnose and manage. Often, these lesions have overlapping imaging features with those of the common lesions mentioned above. Diagnosis of these rarer tumors would require not only interpreting the images in the context of patient's demographics and clinical presentation but also recognizing the unique imaging features of these tumors. The literature is sparse in describing the radiological appearances of these tumors. Diagnosis based solely on imaging criteria is not advised in these instances. Histological confirmation or other prudent follow-up strategies are necessary for confirmation of imaging findings and interpretation. In this article, we will describe known imaging features of a few rarer primary malignant and benign neoplasms in the liver.

Knee Pain in Elite Dancers: A Review of Imaging Findings

Introduction: Musculoskeletal injuries are a frequent occurrence in dancers of all skill levels, and the knee is the most common anatomical location. Our purpose was to identify the specific knee injuries encountered in a large cohort of dancers presenting to a tertiary-level dance injury clinic with knee pain. The relevant imaging findings of the identified knee injuries are highlighted. Methods: All new patients referred to the specialist dance injury clinic between March 2012 and February 2017 were entered into a database. Those with a knee-specific injury were selected with documentation of relevant demographic information. Clinic notes were analyzed for information related to a preceding acute traumatic event, and any relevant imaging was reviewed. This formed the basis for the review with Pubmed being utilized to identify relevant papers on the specific pathologies including etiology, imaging findings, and management. Results: Data from a cohort of 197 dancers presenting with a knee complaint were reviewed, composed of 144 women and 53 men with an average age of 28 years (range: 12–75 years). The most common knee complaint was anterior knee pain (n = 111) followed by medial-side knee pain (n = 42). The most frequent diagnoses included patellofemoral pain syndrome (n = 69), medial meniscal injury (n = 29), and Hoffa’s fat pad impingement (n = 13). Conclusion: An anatomy--based approach with regard to the site of pain can be useful in identifying any potential abnormality. Knowledge of the radiological appearances of the most frequently seen knee abnormalities in dancers will aid in prompt and correct diagnosis.

PD22-02 HISTOPATHOLOGY-INFORMED RADIOLOGY BIOMARKERS IMPROVE ARTIFICIAL INTELLIGENCE-BASED DETECTION OF AGGRESSIVE PROSTATE CANCER ON MAGNETIC RESONANCE IMAGING

You have accessJournal of UrologyCME1 Apr 2023PD22-02 HISTOPATHOLOGY-INFORMED RADIOLOGY BIOMARKERS IMPROVE ARTIFICIAL INTELLIGENCE-BASED DETECTION OF AGGRESSIVE PROSTATE CANCER ON MAGNETIC RESONANCE IMAGING Indrani Bhattacharya, Karin Stacke, Richard Fan, James Brooks, Mirabela Rusu, and Geoffrey Sonn Indrani BhattacharyaIndrani Bhattacharya More articles by this author , Karin StackeKarin Stacke More articles by this author , Richard FanRichard Fan More articles by this author , James BrooksJames Brooks More articles by this author , Mirabela RusuMirabela Rusu More articles by this author , and Geoffrey SonnGeoffrey Sonn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003295.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Artificial Intelligence (AI) methods for aggressive prostate cancer detection on Magnetic Resonance Imaging (MRI) can help standardize radiologist interpretations. However, existing methods are often inaccurate, partly due to the use of radiology features alone without considering histopathology. Histopathology images contain definitive information about the presence and aggressiveness of cancer. Identifying correlations between radiology and histopathology images of the same tissue enables understanding the radiologic appearance of cancer and the discovery of histopathology-informed radiology biomarkers that emphasize cancer features, improving aggressive prostate cancer detection. METHODS: We developed an AI system that uses correlation learning to identify histopathology-informed MRI biomarkers using MRI and histopathology images of patients who underwent radical prostatectomy. The learned histopathology-informed MRI biomarkers are then used by the AI system to selectively identify and localize aggressive and indolent prostate cancer on MRI. Once trained, these MRI biomarkers can be extracted in new patients without pathology, aiding clinical diagnosis. We trained the system using 75 patients who underwent radical prostatectomy, and 24 patients with normal prostates (no cancer on biopsy). We evaluated the system on a lesion level using 40 patients who underwent radical prostatectomy. True positives were assessed using ground truth lesion outlines, while false positives were assessed using prostate sextants without cancer. RESULTS: Our proposed system improved aggressive prostate cancer detection over a baseline method without histopathology-informed MRI biomarkers (ROC-AUC: 0.90±0.22 vs. 0.86±0.28), correctly detecting 94% of aggressive cancers, while correctly predicting 51% of negative sextants as cancer-free. The system had fewer false positives and better overlap with cancer labels than the baseline method. CONCLUSIONS: MRI biomarkers that correlate with histopathology images emphasize aggressive cancer features and improve detection on MRI. These biomarkers can be identified from radiology and histopathology images, and do not need histopathology images during testing, making them clinically useful. Source of Funding: Departments of Radiology and Urology, Stanford University, National Cancer Institute of the National Institutes of Health (R37CA260346 to M.R, and U01CA196387, to J.D.B.), and the generous philanthropic support of our patients (G.S.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e664 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Indrani Bhattacharya More articles by this author Karin Stacke More articles by this author Richard Fan More articles by this author James Brooks More articles by this author Mirabela Rusu More articles by this author Geoffrey Sonn More articles by this author Expand All Advertisement PDF downloadLoading ...

CT appearances and classification of hepatic epithelioid hemangioendothelioma

BackgroundHepatic epithelioid hemangioendothelioma (HEH) is extremely rare, and CT features have never been analyzed in a large group of patients.MethodsA retrospective study was designed to review the contrast-enhanced CT images of HEH patients. Intrahepatic lesions were categorized into three types: nodular, locally coalescent (coalescent lesion contained in one segment) or diffusely coalescent (coalescent lesion occupied more than one segment). CT features were compared among lesions of different sizes and patients with different lesion types.ResultsA total of 93 HEH patients were included in this study, and 740 lesions were analyzed. The results of per-lesion analysis showed that medium lesions (2–5 cm) had the highest rate of lollipop sign (16.8%) and target-like enhancement (43.1%), while lesions in large group (> 5 cm) had the highest rate of capsular retraction (38.8%) and vascular invasion (38.8%). The differences on enhancement pattern and the rates of lollipop sign and capsular retraction were significant among lesions of different sizes (p < 0.001, respectively). The results of per-patient analysis showed that patients in locally coalescent group had the highest rates of lollipop sign (74.3%) and target sign (94.3%). All patients in diffusely coalescent group had capsular retraction and vascular invasion. CT appearances of capsular retraction, lollipop sign, target sign and vascular invasion differed significantly among patients with different lesion types (p < 0.001, p = 0.005, p = 0.006 and p < 0.001, respectively).ConclusionCT features variated among HEH patients with different lesion types, and radiological appearances of HEH should be classified into nodular type, locally coalescent type and diffusely coalescent type.

Assessing the implementation of COVID-19 structured reporting templates for chest radiography: a scoping review.

One of the common modalities used in imaging COVID-19 positive patients is chest radiography (CXR), and serves as a valuable imaging method to diagnose and monitor a patients' condition. Structured reporting templates are regularly used for the assessment of COVID-19 CXRs and are supported by international radiological societies. This review has investigated the use of structured templates for reporting COVID-19 CXRs. A scoping review was conducted on literature published between 2020 and 2022 using Medline, Embase, Scopus, Web of Science, and manual searches. An essential criterion for the inclusion of the articles was the use of reporting methods employing either a structured quantitative or qualitative reporting method. Thematic analyses of both reporting designs were then undertaken to evaluate utility and implementation. Fifty articles were found with the quantitative reporting method used in 47 articles whilst 3 articles were found employing a qualitative design. Two quantitative reporting tools (Brixia and RALE) were used in 33 studies, with other studies using variations of these methods. Brixia and RALE both use a posteroanterior or supine CXR divided into sections, Brixia with six and RALE with four sections. Each section is scaled numerically depending on the level of infection. The qualitative templates relied on selecting the best descriptor of the presence of COVID-19 radiological appearances. Grey literature from 10 international professional radiology societies were also included in this review. The majority of the radiology societies recommend a qualitative template for reporting COVID-19 CXRs. Most studies employed quantitative reporting methods which contrasted with the structured qualitative reporting template advocated by most radiological societies. The reasons for this are not entirely clear. There is also a lack of research literature on both the implementation of the templates or comparing both template types, indicating that the use of structured radiology reporting types may be an underdeveloped clinical strategy and research methodology. This scoping review is unique in that it has undertaken an examination of the utility of the quantitative and qualitative structured reporting templates for COVID-19 CXRs. Moreover, through this review, the material examined has allowed a comparison of both instruments, clearly showing the favoured style of structured reporting by clinicians. At the time of the database interrogation, there were no studies found had undertaken such examinations of both reporting instruments. Moreover, due to the enduring influence of COVID-19 on global health, this scoping review is timely in examining the most innovative structured reporting tools that could be used in the reporting of COVID-19 CXRs. This report could assist clinicians in decision-making regarding templated COVID-19 reports.

Fascial layers encountered in the lateral skull base region: A cadaveric and radiological analysis.

In our experience, the anterior carotid sheath forms an important plane of dissection when excising temporal bone region cancers. However, its anatomical composition, relationships, and radiological appearance remains unclear. Eight sides of cadaveric heads were dissected. Anatomical findings were correlated with a high-resolution baseline T1 MRI. The anterior carotid sheath was formed by the tensor-vascular-styloid fascia, stylopharyngeal fascia, buccopharyngeal fascia (BPF), and longus capitis fascia (LCF), and appeared as a hypointense line on MRI. Not previously described, the glossopharyngeal nerve pierced the sheath 9.0 mm (SD 2.1 mm) below the skull base and traveled through its LCF and BPF layers to exit near the pharynx. Multiple fascial layers formed the anterior carotid sheath at the skull base, and this was radiologically identifiable. Further studies are required to validate findings and investigate the role this fascial plane has in forming an effective barrier to spread of malignancy.

Paraneoplastic neurological syndromes of the central nervous system: a single institution 7-year case series.

Paraneoplastic neurological syndromes (PNSs) are nonmetastatic complications of malignancy, defined by the presence of onconeural antibodies (ONAs). ONAs may be found in 60% of patients with central nervous system (CNS) involvement, and they are directed against intraneuronal antigens or channels, receptors or associated proteins located at the synaptic or extra-synaptic neuronal cell membrane. Given its rare incidence, there are few epidemiological case series on CNS-PNS. We aim to discuss the variability of CNS-PNSs etiology, clinical features, management and outcome, highlighting the importance of early recognition and appropriate treatment, leading to significant reduction of mortality and morbidity. We retrospectively reviewed our 7-years single-center experience, and specifically discussed the underlying etiology, parenchymal CNS involvement, and the acute treatment response. Only cases fulfilling PNS Euronetwork criteria for definitive PNS were included. A total of 26 probable PNSs cases involving CNS were identified. We reported medical records of eleven (42.3%) illustrative cases, meeting the criteria of definite PNS and presenting variable clinical spectrum and different radiological appearances. Our series has a relative paucity of the most common syndromes and larger portion of clinical diagnosis with ONAs. Well-characterized ONAs had been detected in CSF of six patients. Our case series supports the utmost importance of early recognition of CNS-PNSs. Screening for occult malignancies should not be limited to patients with classical CNS syndrome. Empiric immunomodulatory therapy may be considered before the diagnostic evaluation is completed, in order to prevent unfavorable outcome. Late presentations should not discourage initiation of treatment.