Radiological Features Research Articles

The Varying Faces of MOGAD: A Case Series.

Myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG)-associated disease (MOGAD) is an immune mediated demyelinating disorder initially described as a subtype of neuromyelitis optica spectrum disorder with antibodies against MOG. Recently, it has been described as a separate disease entity with unique clinical and radiological features. We herein report the clinical details of eight MOG-IgG-positive patients to highlight the peculiar and varied clinical and radiological features of this condition. Encephalitis was the most common presenting feature in our study, especially in pediatric cases. Tremors and parkinsonism were noted in four cases, of which one was a child. Monophasic course was noted in seven patients. Relapsing course was noted only in a single patient who was initiated on immunosuppressants. The clinical pictures highlight the importance of screening for anti-MOG in individuals with encephalitic and multiaxial symptoms in spite of having normal imaging. Acute demyelinating encephalomyelitis such as imaging features in the pediatric age group may also be a consideration for MOG testing.

Imaging the main molecular biological subtypes of breast cancer: comparison of mammographic data and histological findings

Background. Breast cancer (BC) stands as one of the most prevalent malignancies affecting women, posing a significant threat to health and life. Timely diagnosis and treatment of BC play a pivotal role in enhancing patient survival rates.Aim. To explore such a method of visualization of BC as mammography and the correlation of its results with the data of histological and immunohistochemical studies, and their significance in planning organ-conserving operations.Materials and methods. The study involved 217 patients diagnosed with nodular BC (T1-2N1M0). AH patients underwent digital mammography, histological examination of biopsy and surgical specimens, and immunohistochemical analysis of tumor tissue (determination of the expression of sex hormone receptors (estrogen and progesterone), HER2/neu status and the status of the Ki-67 marker, reflecting the proliferative activity of tumor cells).Results. Comparison of mammographic and histological/immunohistochemical findings revealed significant differences in tumor visualization among major molecular subtypes of BC. A statistically significant association (p <0.001) was established between carcinoma in situ and radiological features such as spiculated margins and calcifications on mammography.Conclusion. Mammography emerges as an objective and accessible visualization method for BC, enabling assessment of tumor size and peritumoral region. However, for planning breast-conserving surgery for luminal and HER2-positive BC subtypes, a multimodal diagnostic approach is recommended to assess tumor spread, incorporating ultrasound and contrast-enhanced magnetic resonance imaging.

A descriptive analysis of 21 patients with pulmonary amyloidosis: An observational study.

Pulmonary amyloidosis is an extremely rare disease, often detected incidentally because of its asymptomatic nature and potential to result in fatal outcomes. In this study, we aimed to present the clinical and radiological features of patients diagnosed with pulmonary amyloidosis by biopsy. This descriptive study included 21 patients with pathologically diagnosed pulmonary amyloidosis. Pulmonary amyloidosis was classified as diffuse alveolar-septal amyloidosis (DASA), cystic amyloidosis (CPA), tracheobronchial amyloidosis (TBA), nodular amyloidosis (NPA), and extraparenchymal pulmonary amyloidosis (pleural and mediastinal lymph node). Clinical, bronchoscopic, and radiological specific characteristics were presented in detail to be used for differential diagnosis. The median age of the patients was 63 (40-83) years, and 14 (66.7%) were male. Twenty patients (95.2%) presented with at least 1 comorbidity. All patients diagnosed with tracheobronchial amyloidosis were symptomatic at presentation, whereas those diagnosed with NPA/extraparenchymal amyloidosis were often asymptomatic. The patients included 1 case of DASA, 1 case of CPA, 10 cases of NPA, 6 cases of TBA, and 3 cases of extraparenchymal amyloidosis involving the mediastinal lymph node and pleura. Sixteen patients (76.2%) were classified as localized amyloidosis, while 5 patients (23.8%) were classified as systemic amyloidosis following the diagnosis of multiple myeloma, monoclonal gammopathy of undetermined significance, systemic lupus erythematosus, Sjogren's syndrome, and B-cell lymphoma. Bronchoscopic biopsies were sufficient for diagnosis, and notably, even transbronchial needle aspiration could be a useful diagnostic method. During the follow-up, we observed that the disease remained stable without progression. However, it is important to note that patients with concurrent malignancies experience fatal outcomes. In conclusion, it is crucial to distinguish pulmonary amyloidosis from other pulmonary diseases such as malignancies, infectious diseases, and interstitial lung diseases, which may have similar clinical and radiological findings. Bronchoscopic diagnostic methods are usually sufficient for the diagnosis. Although patients with pulmonary involvement mostly remain stable during long-term follow-up without progression, it is important to consider the risk of malignancy.

Pulmonary hypertension in patients carrying FLNA loss-of-function variants.

Pulmonary hypertension (PH) is an unusual complication of X-linked disease caused by loss-of-function (LOF) variants in the filamin A (FLNA) gene. Patients with FLNA LOF may also present dysmorphic facial features, aortic dilation, thrombopenia, and periventricular nodular heterotopia (PVNH). We reported clinical, functional, radiologic, and hemodynamic characteristics of patients with FLNA LOF variants and PH from the French PH Network. Nine patients were identified with a female to male ratio of 8:1. PH was diagnosed at a median age of 36 [0-69] years. Associated conditions included epilepsy (n=5), PVNH (n=7), valvular heart disease (n=8), congenital heart diseases (n=4), thrombocytopenia (n=4), and hyperlaxity (n=4). Right heart catheterisation confirmed moderate-to-severe precapillary PH with a median mPAP of 33 [22-49] mmHg and PVR of 4.7 [2.4-8.0] WU. The DLCO was markedly decreased (48 [22-64] %pred) and five patients had obstructive ventilatory disorder. High-resolution CT showed heterogeneous parenchyma (n=8), emphysema (n=3), presence of a peripheral hyperclear band (n=3) and aortic ectasia (n=4). Pathologic assessment available in one patient revealed significant remodelling of small pulmonary arteries, interstitial edema, and irregular alveoli shapes. During follow-up, three patients died, including two from right heart failure. No patient died from aortic rupture. Precapillary PH, likely due to multiple mechanisms, may complicate the course of patients with LOF FLNA variants and may be the presenting symptom leading to diagnosis. The combination of PH with parenchymal involvement and extrapulmonary symptoms (epilepsy, congenital heart diseases, valvular and aortic involvement, thrombocytopenia) should prompt genetic screening for FLNA.

The impact of early surgery on mortality and functional recovery in older adults with traumatic intracranial lesions: a propensity score-based analysis.

There is skepticism about the benefit of surgery in elderly patients affected by traumatic brain injury (TBI) due to the negative effect of age on the outcome and surgical complications. However, there are few studies that have investigated differences in patient's outcome between surgically and conservatively managed patients after adjusting for the imbalance in preinjury characteristics and clinical and radiological features. The primary aim of this study was to evaluate the effect of early surgery on mortality and functional recovery in a cohort of older adults with acute traumatic intracranial lesions after adjustment by Propensity Score (PS) matching. MATERIALS AND METHODS: We conducted a retrospective cohort study on older adult patients (≥ 65 years) admitted for TBI between 2013 and 2023 to a single level 1 trauma center. Patients were categorized based on whether they underwent early surgery (< 48h after TBI) for a space-occupying lesion evacuation. PS model was constructed based on age, frailty, comorbidities (Charlson comorbity index and American Society of Anaesthesiologists score), anticoagulants, hypoxia, shock, pupillary abnormalities and GCS motor response upon admission, midline shift, basal cistern effacement, volume of subdural and intracerebral hematomas, and limitation of life-sustaining treatment decisions.The effect of early surgery on 30-day mortality and unfavorable functional outcomes (GOSE 1-3) at 6 and 12 months were investigated after matching by paired test. We identified and reviewed 301 patients who met all inclusion criteria and contained no exclusions. After matching, 62 patients (31 pairs of conservative and surgical patients) remained as the matched datasets. Our key finding was that older adult TBI patients who underwent early surgery had a statistically significant reduction in the risk of 30-day mortality (OR 0.313, 95% CI 0.114-0.853, p = 0.023) and unfaourable outcome at 12 months after TBI (OR 0.286, 95% CI 0.094-0.868, p = 0.027). Early surgery was associated with decreased 30-day mortality and better functional outcome at 12 months after TBI in older adults with few comorbidities and good functionality when clinically affected by acute traumatic intracranial lesions with mass effect.

Clinical and radiological features of atypical adrenal masses- a multicenter retrospective study.

The natural history and malignant potential of cases classified as atypical adrenal masses (AAMs) are unknown. To describe the radiological characteristics and clinical outcomes of AAMs. A multicenter retrospective study. Patients ≥18 years old with AAMs (diameter of 10-39 mm on first imaging study and pre-contrast attenuation of >10 Hounsfield units [HU] on computed tomography) were studied. We excluded adrenal metastasis, pheochromocytoma, sarcoma, lymphoma, infiltrative lesions, and adrenal hemorrhage, as well as patients with genetic predisposition to adrenal neoplasms. Data are presented as percentages and median values with interquartile ranges (IQRs). . We included 217 patients with 224 adrenal masses (61.3% women); the median age was 58 years (IQR, 49-65 years). The median size was 20.5 mm (IQR, 15-27 mm), with a median pre-contrast attenuation of 23.5 HU (IQR, 17-30 HU). The median AAM growth rate was 0.3 mm/year (IQR, 0-1.8 mm/year). Seventy-one masses (31.7%) underwent pathological evaluation. Adrenal adenoma (n=38; 17%) and adrenocortical carcinoma (ACC) (n=25; 11.2%) were the two most common diagnoses. For the adenomas, the growth rate was 0.3 mm/year (IQR, 0-2.3 mm/year) and for ACCs, the growth rate was 12.9 mm/year (IQR, 3.5-22 mm/year). The absolute contrast washout was >60% in 5 out of 7 (71.4%) ACC cases. The best growth rate cutoff for predicting malignancy was 2.68mm/year (AUC 0.939; sensitivity 87.5%, specificity 88.8%). AAMs carry significant malignant potential, and long-term follow-up is warranted when surgery is not pursued. Contrast washout is not reliable in predicting malignant potential of AAMs.

Segmentation of infarct lesions and prognosis prediction for acute ischemic stroke using non-contrast CT scans

Background and PurposeIschemic stroke is the most common type of stroke and the second leading cause of global mortality. Prompt and accurate diagnosis is crucial for effective treatment. Non-contrast CT (NCCT) scans are commonly employed as the first-line imaging modality to identify the infarct lesion and affected brain areas, as well as to make prognostic predictions to guide the subsequent treatment planning. However, visual evaluation of infarct lesions in NCCT scans can be subjective and inconsistent due to reliance on expert experience. MethodsIn this study, we propose an automatic method using VB-Net with dual-channel inputs to segment acute infarct lesions (AIL) on NCCT scans and extract affected ASPECTS (Alberta Stroke Program Early CT Score) regions. Secondly, we establish a prediction model to distinguish reperfused patients from non-reperfused patients after treatment, based on multi-dimensional radiological features of baseline NCCT and stroke onset time. Thirdly, we create a prediction model estimating the infarct volume after a period of time, by combining NCCT infarct volume, radiological features, and surgical decision. ResultsThe median Dice coefficient of the AIL segmentation network is 0.76. Based on this, the patient triage model has an AUC of 0.837 (95 % confidence interval [CI]: 0.734–0.941), sensitivity of 0.833 (95 % CI: 0.626–0.953). The predicted follow-up infarct volume correlates strongly with the DWI ground truth, with a Pearson correlation coefficient of 0.931. ConclusionsOur proposed pipeline offers qualitative and quantitative assessment of infarct lesions based on NCCT scans, facilitating physicians in patient triage and prognosis prediction.

Study of prediction model for high-grade meningioma using fractal geometry combined with radiological features.

To establish a prediction model combining fractal geometry and radiological features, which consider the complexity of tumour morphology advancing beyond the limitations of previous models. A total of 227 patients at the First Affiliated Hospital of Harbin Medical University from July 2021 to November 2023 were included. Fractal geometry was calculated and the radiomics features were extracted from regions of interest (ROIs). Weighted Gene Co-Expression Network Analysis (WGCNA) was employed for preliminary screening to identify those that were significantly associated with high-grade meningioma. In the training cohort, the least absolute shrinkage and selection operator (LASSO) regression was employed for further screening the radiomics features. Area under curve (AUC) was to evaluate models' performance. In entire patient cohort, low-grade meningiomas had significantly lower fractal dimensions (P = 0.01), while high-grade meningiomas had higher lacunarity (P = 0.049). Fractal dimension (OR 6.8, 95% CI 1.49-36.51, P = 0.017), lacunarity (OR 3.7, 95% CI 1.36-11.75, P = 0.014), and Rscore (OR 2.8, 95% CI 1.55-5.75, P = 0.002) were independent risk factors for high-grade meningiomas. The final results demonstrated that the "fractal geometry + radiological features (semantic features + radiomics features)" model exhibited the most optimal performance in predicting high-grade meningioma, with an AUC of 0.854 in the training cohort and 0.757 in the validation cohort. Significant differences in fractal dimension and lacunarity exist between high-grade and low-grade meningiomas, which can be potential predictive factors. The developed predictive model demonstrated good performance in predicting high-grade meningiomas.

Epidemiological, Clinical, Laboratory, and Radiological Characteristics of Children and Adolescents Diagnosed with Hashimoto's Thyroiditis: A Single-Center Experience.

This study aimed to investigate the epidemiological, clinical, laboratory, and radiological characteristics of children diagnosed with Hashimoto's thyroiditis and to present the experiences of a referral center. This study included 200 pediatric patients diagnosed with Hashimoto's thyroiditis between January 2020 and May 2024 at a single center. The data were extracted and compiled from the participants' medical records, including clinical information, physical examination findings, laboratory test results, and radiological imaging. Mean age of the study population was 11.3 ± 3.2 years at diagnosis, with a female predominance. At the time of clinical presentation, 8.5% of the study participants were 6 years of age or younger. The majority of patients, comprising 39.5% of the cohort, exhibited euthyroid thyroid function. Additionally, 33.5% of the patients were classified as having subclinical hypothyroidism, 22% demonstrated overt hypothyroidism, and 5% presented with hyperthyroidism. Approximately one-third of the study participants were referred for further evaluation due to the identification of abnormal thyroid function test results during routine screening examinations. 48% of the patients had a documented family history of thyroid disease. At diagnosis, 39.5% were prepubertal. The rate of overt hypothyroidism was higher in prepubertal patients compared to pubertal patients (41.8% vs. 9.1%, P < .005). Mean gland volume SDS was 2.61 ± 3.69, and 45.5% had goiter. Thyroid nodular lesions were identified in 5.5% of the study participants. Fine-needle aspiration biopsy was performed on five patients, revealing benign findings in three cases and atypia of undetermined significance in the remaining two cases. Patints with subclinical hypothyroidism who have a baseline TSH level exceeding 8.5 mIU/L at initial presentation and do not receive treatment are likely to progress to overt hypothyroidism during subsequent follow-up. Prepubertal cases were more frequently observed compared to previous reports, and the course of hypothyroidism was more severe in prepubertal patients. These findings suggest a potential shift towards earlier onset of autoimmunity in children. Further studies are warranted to substantiate this observation.

Concurrent Myocardial Bridging and Coronary Artery Disease: A Study of an Iranian Population

Background: Myocardial bridging (MB) has been associated with acute coronary syndrome, ischemia, arrhythmia, and even sudden death. This study investigated the prevalence of MB and its complications and manifestations. Methods: This cross-sectional study was conducted on symptomatic coronary patients who underwent angiography between March 2022 and March 2023 at Afshar or Shahid Sadoughi hospitals in Yazd, Iran. The angiographic reports of all patients were evaluated. Cases with MB were selected, and their angiographic films were assessed by an interventional cardiologist for diagnostic accuracy. Baseline, radiological, and clinical characteristics were also evaluated. Data were collected and analyzed using SPSS, version 20.0. The dependent variable was stratified based on independent variables using the χ2 test. Results: Out of 3750 symptomatic patients, 165 (4.4%) were diagnosed with MB. Among these, 111 (67.3%) were male, and the mean age was 56.87±10.06 years. A total of 152 patients had MB in the left anterior descending artery, representing the highest occurrence proportion at 92.1%. The most common types of coronary artery disease (CAD) diagnosed included mono-vessel disease and slow flow, accounting for 35.1% and 25.8%, respectively. There was no significant frequency distribution of CAD co-occurrence based on baseline and radiological features (P&gt;0.050). Conclusion: This study provides valuable insights into the prevalence of MB in Iran and its co-occurrence with CAD. While some findings align with previous research, certain discrepancies warrant further investigation.

Development and validation of a cross-modality tensor fusion model using multi-modality MRI radiomics features and clinical radiological characteristics for the prediction of microvascular invasion in hepatocellular carcinoma

ObjectivesTo develop and validate a cross-modality tensor fusion (CMTF) model using multi-modality MRI radiomics features and clinical radiological characteristics for the prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Materials and methodsThis study included 174 HCC patients (47 MVI-positive and 127 MVI-negative) confirmed by postoperative pathology. The synthetic minority over-sampling technique was used to augment MVI-positive samples. The amplified dataset of 254 samples (127 MVI-positive and 127 MVI-negative) was randomly divided into training and test cohorts in a 7:3 ratio. Radiomics features were respectively extracted from arterial phase, delayed phase, diffusion-weighted imaging, and fat-suppressed T2-weighted imaging. The least absolute shrinkage and selection operator was used for feature selection. Univariate and multivariate logistic regression analyses were employed to identify clinical and radiological independent predictors. The selected multi-modality MRI radiomics features, clinical and radiological characteristics were used to construct the CMTF model, single modality (SM) model, early fusion (EF) model. ResultsThe CMTF model demonstrated superior performance in predicting MVI compared to the SM and EF models. When integrating four MRI modalities, the CMTF model achieved a high area under the curve (AUC) with 95% confidence interval (95% CI) of 0.894 (0.820-0.968). Additionally, incorporating clinical and radiological characteristics further enhanced the predictive performance of CMTF model, the AUC (95% CI) value increased to 0.945 (0.892-0.998). ConclusionThe CMTF model showed promising performance in preoperative MVI prediction, providing a more effective non-invasive detection tool for HCC patients.

DUETS for Light's in separating exudate from transudate.

Fifty years since its inception, Light's criteria have aided in classifying pleural effusions (PEs) as exudates if 1 or more criteria are met. Thoracic ultrasound (US) emerges as a non-invasive technique for point of care use especially if pleural procedures are contemplated. We aimed to develop a score based on radiological and US features that could separate exudates from transudates without serum and pleural fluid biochemical tests necessary for Light's criteria. A prospective review of consecutive patients with PE who underwent thoracocentesis was performed. CXRs were evaluated for laterality followed by US for echogenicity, pleural nodularity, thickening and septations. PE was classified as exudate or transudate according to Light's criteria and corroborated with albumin gradient. A score combining radiological and US features was developed. We recruited 201 patients with PE requiring thoracocentesis. Mean age was 64 years, 51% were females, 164 (81.6%) were exudates, and 37 (18.4%) were transudates. Assigning 1-point for Diaphragmatic nodularity, Unilateral, Echogenicity, Pleural Thickening and Septations, DUETS ranged from 1 to 5. DUETS ≥2 indicated high likelihood for exudate (PPV 98.8%, NPV 100%) with 1% misclassification versus 6.9% using Light's criteria (p < 0.001). DUETS separated exudates from transudates with good accuracy, and could obviate paired serum and pleural fluid tests necessary for Light's criteria computation. Our study reflected real world practice where DUETS performed better than Light's criteria for PE that arose from more than one disease processes, and in the evaluation of patients with PE who have received diuretics.

To develop a classification system which helps differentiate cystic intraductal papillary neoplasm of the bile duct from mucinous cystic neoplasm of the liver

ObjectiveTo establish a classification system which differentiates cystic intraductal papillary neoplasm of the bile duct (cystic IPNB) from hepatic mucinous cystic tumors (MCN) based on their radiological difference. MethodsA total of 75 patients pathologically diagnosed as MCN and IPNB in two major hospitals from 2015 to 2024 were enrolled. Radiological features were recorded and compared between these two tumors. Variables with significant differences were included in multivariate logistic regression (LR) analysis. A decision model was built and simplified based on importance ranking of variables. K-nearest-neighbor (KNN) model was introduced to learn distribution of individuals in main dimensions based on multiple correspondence analysis (MCA) and predicted diagnosis. The diagnostic efficacy of the classification system and the KNN model was compared. ResultsSignificant differences existed in Dmax-IVC angle, septation, mural nodule, upstream and downstream biliary dilatation, communication with bile duct between MCN and cystic IPNB. Downstream biliary dilatation and communication with bile duct were highly specific for IPNB (specificity, 97.9 % and 100 %, respectively), which could independently diagnose IPNB. Among four significant indicators in LR analysis, upstream biliary dilatation and Dmax-IVC angle were used for a simplified decision model to attain good applicability. The KNN model based on MCA data achieved highest accuracy (0.910) when K = 11. Overall, the classification system achieved an AUC of 0.882 (0.95CI: 0.797–0.966), compared with 0.911 (0.95CI: 0.818–1.000) in the KNN model, which demonstrated no significant difference (p = 0.655) in differential performance. ConclusionThe classification system combining four important indicators had equivalent performance to KNN model in discrimination, which was simple and applicable for clinical practice, and also accessible on unenhanced examinations.

Evaluation of Radiological and Anatomical Features of Cervical Vertebrae in Adult Persian Cat.

Radiographic studies of Persian cat's cervical vertebrae can provide us with valuable information used in identifying its anatomical features, investigating various species of Persian cats and evaluating their cervical pathologies. The present study aimed to investigate the anatomical and radiological features of cervical vertebrae in Persian cats to create a comprehensive and accurate reference for the normal range of cervical bones and joints that can be used for clinical decision-making and interpretation of radiographic findings in these cats. The present descriptive-cross-sectional study included 10 adult Persian cats, including 5 males and 5 females. All cats underwent radiography in the dorsoventral, ventrodorsal, left lateral and right lateral recumbency. Then, anatomical investigations were performed. According to our findings, Persian cats were different from other cat species in some cervical vertebral characteristics, which can be suggested as comparative anatomy in these species. The most important differences were as follows: the C3 and C7 had the lowest and highest spinous process height (SPH), respectively. The atlas had the highest transverse process width (TPW), which was significantly different with other cervical vertebrae (p ≤ 0.05). Moreover, the cervical vertebrae were not significantly different in vertical diameter of cranial vertebral foramen (VDCrVF) and transverse diameter of cranial vertebral foramen (TDCrVF) (p ≤ 0.05). The caudal surface of the atlantic vertebral arch had two dorsal and ventral tubercles. Also, the ventral crest of the axis was quite indistinct in the cranial part while becoming prominent in the caudal part. The C3 spinous process was a wide, small tubercle, while the C7 spinous process was extended vertically. Finally, the C6 transverse processes had a large ventrocranial tubercle forming a sagittal plate with cranial and caudal parts separated by a notch. The accurate and comprehensive standard ranges obtained from the present study can be used for the interpretation of imaging results, clinical decision-making, and finding the normal and abnormal sizes of the cervical vertebrae and their processes in Persian cats.

Intranodal Hemangioma: Case Report and Systematic Review

ABSTRACT Background: Intranodal hemangiomas are rare benign vascular tumors of the lymph nodes, often misdiagnosed as malignant lymphadenopathies due to their clinical and radiological features. This case report and systematic review aim to elucidate the epidemiology, clinical profile, and therapeutic interventions for intranodal hemangioma, enhancing diagnostic accuracy and management. Methods: A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted in PubMed, Scopus, Web of Science, and Google Scholar up to March 15, 2024, using keywords like “intranodal hemangioma,” “primary intranodal hemangioma,” “nodal hemangioma,” “vascular tumor,” and “lymph node hemangioma.” Inclusion criteria included studies on clinical presentation, diagnostic strategies, and therapeutic interventions for intranodal hemangioma in patients of all ages. Excluded were reviews, opinion pieces, non-English studies, cases of hemangioendothelioma, sclerosing hemangioma, and animal studies. Key aspects analyzed included demographics, clinical presentation, management strategies, and histopathological findings. Results: Our case involves a 3-year-old female with a submandibular mass, initially diagnosed with hemangioma. After no response to beta-blocker therapy and conflicting imaging results, surgical excision was performed. Histopathology confirmed intranodal hemangioma. From 233 records, 19 publications (36 patients, including our case) met the inclusion criteria. The review shows common clinical presentations as painless, slowly enlarging lymph nodes, primarily in the cervical and axillary regions. Diagnostic challenges often require imaging and biopsy to differentiate from malignancies. Conclusion: Recognizing intranodal hemangiomas, particularly in childhood, is crucial to prevent misdiagnosis and inappropriate treatment. The rarity of these tumors in childhood and their clinical presentation similar to malignancies in older patients make diagnosis challenging without widespread awareness. Surgical excision remains the mainstay of both diagnosis and treatment, often leading to favorable outcomes.

Navigating the Mysteries of CLIPPERS Syndrome: A Case Report of Long-Term Follow-Up.

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) syndrome is a rare central nervous system inflammatory disorder with an unknown pathophysiology. We present the case of a 51-year-old female exhibiting clinical and radiological features consistent with CLIPPERS syndrome. She manifested diplopia, vertigo, gait ataxia, and lower limb asthenia, accompanied by impaired tandem gait, right sixth nerve palsy, and coarse horizontal nystagmus during the physical examination. Magnetic resonance imaging (MRI) revealed punctate and curvilinear lesions centered in the pons. Treatment with glucocorticoids resulted in significant clinical improvement, and the patient was discharged with a maintenance dose of prednisolone. Throughout a four-year follow-up period, the patient remained symptom-free without any relapses using the low-dose corticosteroid. The CLIPPERS syndrome diagnosis remains challenging, but recent evidence supports an autoimmune pathogenesis. Although corticosteroid treatment has shown significant clinical improvement, there are no established guidelines or clinical trials on the optimal therapeutic regimen. Despite its rarity, clinicians should consider CLIPPERS syndrome in patients with compatible clinical and radiological features to prevent irreversible neurological damage.

Development of a Surgical Difficulty Score for Open Reduction Internal Fixation of Pilon Fractures.

To identify characteristics that contribute to surgical complexity in pilon fractures and to develop a machine learning (ML) Pilon Surgical Difficulty Score (PSDS) based on these factors. Retrospective cohort study. Academic Level I trauma center. Pilon fractures (OTA/AO Type 43) in adult patients treated with open reduction internal fixation. Various patient, injury, and radiological characteristics were assessed. Surgical difficulty was measured using 2 outcomes: (1) operative time and (2) perceived difficulty. Perceived difficulty was determined using the opinion of 16 fellowship-trained orthopaedic traumatologists on a 10-point scale. Significant predictors of difficulty were determined using univariate analyses. ML models were used to develop a PSDS for both operative time and surgical difficulty. One hundred operatively fixed pilon fractures were included. Predictors of operative time were age, OTA/AO classification, articular comminution, articular impaction, bone loss, delay to surgery, poor quality reduction, number of approaches, and number of articular fragments. Predictors of perceived difficulty included OTA/AO classification and delay to surgery. Operative time PSDS had a mean absolute error of 64 minutes and a 60-minute buffer accuracy of 59%. Perceived difficulty PSDS had a mean absolute error of 1.7 points and a 2-point buffer accuracy of 63%. ML was used to generate accurate PSDSs for operative time and difficulty for pilon fractures. Future work should aim to clinically validate these PSDSs, so they may improve patient outcomes. Level III Diagnostic.

Pseudoangiomatous stromal hyperplasia causing bilateral galactomastia with short-term recurrence after surgery: a case report.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare, benign breast lesion characterized by collagen proliferation, often identified as an incidental microscopic finding. Clinically, it may present as a palpable, well-defined breast mass or, in rare instances, as a diffuse, bilateral process leading to significant breast enlargement. We herein report a case of extensive diffuse PASH with short-term recurrence following lesion resection at another hospital. Because of the severity of symptoms, the patient underwent bilateral mastectomy at our facility. This article reviews the clinical, radiologic, and pathologic features of PASH and emphasizes the importance of an accurate preoperative imaging diagnosis for guiding appropriate treatment.

Periapical cemento-osseous dysplasia masquerading as asymptomatic chronic apical periodontitis in a Chinese woman: A case report.

Cemento-osseous dysplasia (COD) belongs to a group of fibrous osseous disorders that can masquerade as periapical inflammatory conditions in the jawbones. We present a rare case of COD occurring in a patient who also had periapical periodontitis concurrently. When faced with a patient exhibiting no symptoms, diagnosis may be challenging. COD is a fibrous osseous disorder similar to periapical chronic inflammatory conditions and other cysts in the jaw bones on the radiograph. There is a rare case of COD occurring in a 49-year-old Chinese woman who also had chronic periapical periodontitis concurrently. The lesions were incidentally discovered in the mandibular anterior tooth region during the patient's imaging examination. The patient exhibited no symptoms, and diagnosing the conditions may be challenging due to the confusingly similar radiological features that present as a radiolucent lesion in the periapical region. The final diagnosis was made through pulp vitality tests, cone beam computed tomography (CBCT), and clinical examinations. The COD was recommended for annual follow-up. Root canal therapy has been performed for chronic apical periodontitis. According to the diagnostic process of COD, a thorough history check, multiple clinical examinations, and imaging studies should be emphasized to prevent misdiagnosis and avoid unnecessary or inappropriate therapies. The patient was followed up for 6 years. The recovery of chronic apical periodontitis in tooth #31 and the transformation of osteolytic and osteogenesis of COD had been observed in CBCT.

HarDNet-based deep learning model for osteoporosis screening and bone mineral density inference from hand radiographs

PurposeOsteoporosis, affecting over 200 million individuals, often remains unrecognized and untreated, increasing the risk of fractures in older adults. Osteoporosis is typically diagnosed with bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). This study aims to develop DeepDXA-Hand, a deep learning model using the efficient CNN-based deep learning architecture, for opportunistic osteoporosis screening from hand radiographs. MethodsDeepDXA-Hand utilizes a CNN-based, HarDNet, approach to predict BMD non-invasively. A total of 10,351 hand radiographs and DXA pairs were used for model training and validation. The model's interpretability was enhanced using GradCAM for hotspot analysis to determine the model's attention areas. ResultsThe predicted and ground truth BMD were significantly correlated with a correlation coefficient of 0.745. For binary classification of osteoporosis, DeepDXA-Hand demonstrated a sensitivity of 0.73, specificity of 0.83, and accuracy of 0.80, indicating its clinical potential. The model mainly focused on the carpal bones, such as the capitate, trapezoid, hamate, triquetrum, and the head of the second metacarpal bone, suggesting these areas provide radiological features for inferring BMD. ConclusionDeepDXA-Hand shows potential for the early detection of osteoporosis with high sensitivity and specificity. Further studies should explore its utility in predicting fracture risks. Mini abstractOsteoporosis affects millions and often goes undetected and untreated. DeepDXA-Hand, a HarDNet-based deep learning model, predicted bone mineral density with a correlation of 0.745 and classified osteoporosis with 0.80 accuracy. This model enhances early detection and has significant clinical potential as osteoporosis opportunistic screening tool.