Radiologist Perspective Research Articles

Imaging in Erdheim-Chester Disease.

Erdheim-Chester disease (ECD) is a rare, multisystemic, inflammatory, non-Langerhans cell histiocytic neoplasm. The discovery of recurrent and somatic mutations in the mitogen-activated protein kinase signaling pathway, most commonly BRAFV600E, has led to a reclassification of ECD from an inflammatory disorder to a neoplastic process. It is now included in the revised 2016 World Health Organization classification of hematopoietic tumors and in the Langerhans group in the revised 2016 Histiocytosis Classification of the Histiocyte Society. When symptomatic, ECD most commonly manifests with bone pain and fatigue. Also, neurologic manifestations, central diabetes insipidus, exophthalmos, and periorbital xanthelasma-like lesions are frequently encountered. Pathologic findings may vary depending on the site of biopsy and may display a spectrum of features. Thus, due to the diverse clinical presentation and variable histologic findings, imaging can often show the first sign of the disease. Radiologic findings are, however, interpreted in conjunction with clinical and histologic findings to establish the diagnosis of ECD. From providing classic findings that facilitate diagnosis to helping radiologists determine the extent of disease and predicting a prognosis, the role of radiology in ECD has evolved with the understanding of the disease itself. Insights into the molecular pathogenesis and the development of targeted therapeutic agents along with approval of vemurafenib and cobimetinib have necessitated revision of the guidelines for the management of ECD. The authors discuss various radiologic findings of ECD and differential diagnoses by using an organ system-based approach and briefly describe the revised consensus recommendations for evaluation, diagnosis, and treatment based on the International Medical Symposia on ECD from a radiologist's perspective. ©RSNA, 2024 Supplemental material is available for this article. The full digital presentation is available online.

Explainable Reverse Verification of Goodness of Classification of MRI Images by Clinical Experts.

Radiology offers a presumptive diagnosis. The etiology of radiological errors are prevalent, recurrent, and multi-factorial. The pseudo-diagnostic conclusions can arise from varying factors such as, poor technique, failures of visual perception, lack of knowledge, and misjudgments. This retrospective and interpretive errors can influence and alter the Ground Truth (GT) of Magnetic Resonance (MR) imaging which in turn result in faulty class labeling. Wrong class labels can lead to erroneous training and illogical classification outcomes for Computer Aided Diagnosis (CAD) systems. This work aims at verifying and authenticating the accuracy and exactness of the GT of biomedical datasets which are extensively used in binary classification frameworks. Generally such datasets are labeled by only one radiologist. Our article adheres a hypothetical approach to generate few faulty iterations. An iteration here considers simulation of faulty radiologist's perspective in MR image labeling. To achieve this, we try to simulate radiologists who are subjected to human error while taking decision regarding the class labels. In this context, we swap the class labels randomly and force them to be faulty. The experiments are carried out on some iterations (with varying number of brain images) randomly created from the brain MR datasets. The experiments are carried out on two benchmark datasets DS-75 and DS-160 collected from Harvard Medical School website and one larger input pool of self-collected dataset NITR-DHH. To validate our work, average classification parameter values of faulty iterations are compared with that of original dataset. It is presumed that, the presented approach provides a potential solution to verify the genuineness and reliability of the GT of the MR datasets. This approach can be utilized as a standard technique to validate the correctness of any biomedical dataset.

The Spine is the Tree of Life: A Systematic Review and Meta-Analysis of the Radiographic Findings Related to Spinal Injuries in Athletes.

This review article explores spinal injuriesin athletes participating in various sporting activities. It also highlights the various mechanisms of injuries that contribute to spinal injuries in each sport. Electronic databases such as PubMed, Cochrane Library, Web of Science, Embase, MEDLINE Ovid, and Google Scholar were searched for articles from 2000 to 2022 on spine injuries in sports and radiological studies discussing the various injury patterns among athletes. Studies werescoured in accordance with the inclusion criteria, and relevant data such as the number of participants, sporting activities, spine injuries, and outcomes were retrieved. Fifteen articles that met the inclusion criteria were included in the study. Cervical spine injuries are common in athletes who participate in contact sports such as football. Similarly, athletes in collision sports such as football, rugby, and hockey are likely to suffer stingers due to traction and compression injuries. Players engaged in such assoccer, baseball, and swimming, are likely to suffer from spondylolysis. Soccer players are more prone to multiple lesions compared toathletes in sports such as baseball because the sport involves training exercises such as jogging and running without kicking any ball. In swimmers, spondylolysis is common in breaststroke and butterfly styles since they involve repeated flexion and hyperextension of the lumbar spine. CT is essential for diagnosing spondylolysis as it demonstrates the lesions more accurately. Ice hockey is associated with a significant incidence of cervical spine injuries, mostly due to players being constantly checked/pushed from behind. Spine injuries are common in elite athletes across several sports. About 10% of spinal injuries in the United States result from sports activities. In diagnosing spine injuries, imaging modalities such as MRI, CT, or plain radiographs are essential. From a radiologist's perspective, these testshelp immensely in deciding which treatment is required for a particular athlete or how the injury can be optimally managed. Achieving recovery from a specific spine injury usually depends on the kind of injury and the rehabilitation process the athletes undergo before returning to play.

Imaging of calcific tendinopathy: natural history, migration patterns, pitfalls, and management: a review.

Calcific tendinopathy is characterized by the deposition of calcium hydroxyapatite crystals in various tendons of the body. Terms like calcium tendinitis, tendinosis, and tendinopathy are used interchangeably. Calcific tendinopathy is a common and well-documented ailment in the literature. Although common, the natural history, aetiology, and progression of calcific tendinitis are poorly understood. The treatment options include conservative and interventional measures. However, these measures cannot be applied as a blanket and are often tailored depending on the stage/phase of the disease. Out of the recognized stages of the disease, the resorptive stage causes the utmost symptoms when the calcium is rather soft and unstable. During this stage, the calcium may migrate beyond expected resorption and get deposited in the adjacent tissues contiguous with the calcium focus. The common destinations include bursal migration, intraosseous migration, muscular migration, and other less common migration sites. Such atypical presentations can lead to dilemmas in the diagnosis, prolongation of the diagnostic pathway, unwarranted apprehension, and treatment delay. Radiologists' role in this situation is to correctly recognize the imaging findings of atypical presentations of calcific tendinopathy and prevent unnecessary diagnostic and interventional studies. In this review article, we describe the pathogenic pathway and natural history of calcific tendinopathy from a radiologist's perspective and discuss different migratory patterns of calcium in calcific tendinopathy not only around the shoulder but also in other areas of the body on different imaging modalities. We also show a few examples of mimics and pitfalls on imaging. Finally, we discuss the appropriate management option of this condition.

Progressive residual lung abnormalities as final outcome in recovered severe COVID-19 pneumonia with lung function abnormalities in spirometry: Pulmonologist and radiologist perspective

ABSTRACT Coronavirus coronavirus-related (severe acute respiratory syndrome-corona virus-2) global pandemic has caused significant mortality and morbidity globally in the last 3 years. Although the pandemic has weaned off since last year, we are not in great peace of relief due to lingering effects of COVID-19 persisted even after 2 years of illness. These long COVID-19 manifestations are documented selected cases of COVID-19 pneumonia in pulmonary and extrapulmonary systems with variable impact on quality of life. In the present case report, a 57-year-old male, presented in the outdoor unit for shortness of breath on exertion, on oxygen supplementation at home during ambulation with a history of severe COVID-19 pneumonia resulted in acute respiratory distress syndrome with hospitalization in the intensive care unit 12 months back and required high flow nasal cannula with noninvasive ventilatory support for 3 weeks. His clinical and radiological severity were very well correlated with highly raised inflammatory markers such as C-reactive protein, interleukin-6, ferritin, lactate dehydrogenase, and D-Dimer. He was offered oxygen supplementation at home with antifibrotics for 3 months and observed significant improvement in clinical and radiological outcomes with persistent requirement of oxygen during ambulation and persistent respiratory symptoms even after 1 year of discharge from hospital. Rheumatological workup documented antinuclear antibody (ANA) and rheumatoid factor positive with inconclusive ANA profile reports. His high-resolution computerized tomography thorax documented at 1 year of discharge from the hospital revealed typical interstitial opacities labeled as progressive residual lung abnormalities (PRLAs) which are predominantly reticular and linear opacities in peripheral parts of lungs with honeycombing within typical pleural-based areas with parenchymal bands and altered lung architecture and decreased lung volume in both lungs. Honeycombing is a typical feature of progressive type of RLAs. We recommend these radiological outcome phenotypes as progressive radiological abnormalities (RLAs) at 1 year should be considered pulmonary fibrosis of unclassified type from a pulmonologist perspective due to pattern and presentation after COVID-19 which is not enrolled into interstitial lung disease classification as of now and progressive pulmonary fibrosis as per radiologists’ perspective due to progressive nature of the disease.

Persistent residual lung abnormalities as final outcome in recovered severe COVID-19 pneumonia with lung function abnormalities in spirometry: Pulmonologist and radiologist perspective

Coronavirus-related (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) global pandemic has caused significant mortality and morbidity globally in the last 3 years. In the present case report, a 51-year-old man presented in the outdoor unit for shortness of breath on exertion with a history of severe coronavirus disease-2019 (COVID-19) pneumonia resulted in acute respiratory distress syndrome with hospitalisation in the intensive care unit 1 year back and required high-flow nasal cannula (HFNC) with noninvasive ventilatory support (NIV) for 2 weeks. He was offered oxygen supplementation at home with antibiotics for 3 months and there was no requirement of oxygen and some respiratory symptoms even after 1 year. His high-resolution computed tomography thorax documented at 1 year of discharge from the hospital revealed typical interstitial opacities labelled as persistent residual lung abnormalities (RLAs) that are predominantly reticular and linear opacities in peripheral parts of lungs without honeycombing within typical pleural-based areas with parenchymal bands and minimally altered lung architecture and preserved lung volume.

Neuroradiology intertwined with the Veena: A radiologist perspective

Music has had a distinguished position in human history; both as an art form and a medium for healing. Traditional Indian music has its roots in ancient scriptures of Vedas, which coincidently also form a basis of practice of Indian medicine. The Veena holds a revered place as an ancient plucked stringed instrument used in southern Indian classical music. The unique structure of the Veena has evoked descriptions and comparisons to the human body in various forms. We explore the resemblance of the Veena to human anatomy and provide a neurological correlation from a radiologist’s perspective.

The diagnosis of retroperitoneal tumors from a radiologist perspective: a case report of a giant intramuscular hemangioma in a 23-year old patient

Primary retroperitoneal tumors are a heterogeneous group of neoplasms with a prevalence of 0.02 to 1%. The results of diagnostic visualization of such tumors are usually ambiguous due to their diversity and similar radiological semiotics of malignant and benign tumor types. The paper describes a rare case of the diagnosis and management of a patient with one of retroperitoneal tumor, i. e. a giant intramuscular hemangioma.
 A 23-year old male patient was referred with complaints of episodic pains in the right inguinal area for 78 years. The multiaxial computed tomography showed a mass of 145 125 125 mm located in the trunk and pelvis, and spreading to the right thigh. The tumor structure was markedly heterogeneous and contained calcinates, adipose tissue, soft tissue and vascular components. The mass showed a heterogeneous contrast accumulation, with predominant delayed-phase enhancement. The tumor was surgically resected, with the histological investigation characteristic of intramuscular hemangioma.
 Rare retroperitoneal tumors are always challenging in the interpretation of the results of diagnostic visualization. Since their various types have similar radiological semiotics, the differential diagnosis is often impossible. Therefore, the main diagnostic issue should be the exact localization of the neoplasm, identification of the feeding vessels, and the assessment of the adjacent tissue abnormalities.

Pediatric Renovascular Hypertension: A Pediatric Interventional Radiologist's Perspective.

Renovascular hypertension (RVH) contributes close to one-fourth of the secondary etiologies of hypertension in children and a delay in diagnosis can result in adverse clinical outcomes. RVH in children is clinically silent with elevations in blood pressure measurements sometimes as its sole manifestation. Only a high index of suspicion by the clinician can prompt its detection. Despite the availability of other imaging modalities like ultrasound, computed tomography, and magnetic resonance imaging, digital subtraction angiography is still considered the gold standard to make a diagnosis of RVH. Angioplasty is considered the treatment of choice in appropriately selected patients. In this article, we shall focus on the various imaging findings, and management of RVH in children, which requires a multidisciplinary approach with a special focus on the role of interventional radiology.

Nonvariceal Upper Gastrointestinal Hemorrhage: The Interventional Radiologist's Perspective

AbstractNonvariceal upper gastrointestinal (GI) bleeding is one of the most common diseases of the GI tract and represents a high percentage of emergency room admissions. Eighty percent to 90% of upper GI bleeds are nonvariceal, with a mortality of 1 to 10% of patients. Selective embolization of the arterial source can be achieved with many therapeutic alternatives available in the interventional radiologist's arsenal, such as particles, coils, liquid emboli, selectively infused vasoconstrictor agents, or a combination of these techniques. Up to 95% of patients can obtain initial hemostasis without angiographic intervention. However, rebleeding is common, occurring in up to 50% of patients and persistent hemorrhage has been described in 7 to 30% of patients with mortality rates up to 14%.

Prostate MRI and image quality: The radiologist's perspective

Multiparametric MRI (mpMRI) of the prostate plays an important role in the healthcare pathway of prostate cancer. The implementation of the guidelines resulted in an almost vertical increase in the number of prostate MRI examinations. High image quality is important in the diagnostic pathway of prostate cancer. Standardization of prostate MRI quality using objective and pre-defined criteria is of utmost importance.

Thyroid cancer in pregnancy: diagnosis, management, and treatment.

The evaluation and management of cancer during pregnancy requires special care to assure the health and safety of both the mother and fetus. The diagnosis and treatment of thyroid cancer in the non-pregnant patient often involves radioactive iodine exposure. However, radioactive iodine is contraindicated in pregnancy and surgical interventions pose risks to both the mother and fetus. Thus, the management of thyroid cancer during pregnancy is a unique clinical challenge. In this review, we discuss the imaging of thyroid nodules during pregnancy, including the role of CT, MRI, and nuclear Imaging, as well as that of Ultrasound and FNA. The staging and prognosis are discussed along with the management, treatment, and surveillance of thyroid cancer in pregnancy. Finally, the risks to the fetus through treatment are examined. Case examples are provided with an emphasis on the appropriate direction of care from a radiologist's perspective.

Case Series of Three Cases of Madura’s Foot with a Characteristic ‘Dot in Circle’ Sign: A Radiologist Perspective

Madura’s foot is a rare infectious granulomatous disease affecting the foot. The incidence of this disease has decreased in recent years due to improved living conditions. However, it can still be misdiagnosed by inexperienced surgeons as other similar conditions. Early and accurate diagnosis is crucial for optimal treatment and limb preservation. In this study, the authors present three unusual cases of Madura’s foot. A 23-year-old woman presented with swelling and draining sinuses in her left foot for six years. Imaging tests including Ultrasonography (USG), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) revealed the characteristic ‘dot in circle’ sign of Madura’s foot. However, her USG-guided biopsy did not confirm the diagnosis, and it was only through an excisional biopsy that actinomycetoma was confirmed. Another case involved a 60-year-old male with multiple soft tissue swellings on his right foot for 10 years, resulting in foot deformity. Radiographs showed multiple punched-out lytic lesions in the bones, while USG and MRI exhibited the typical ‘dot in a circle’ sign. Histopathological examination confirmed actinomycetoma. The third case involved a 36-year-old male with a chronic sinus discharging yellow pus and black granules on the volar side of his right foot. USG and MRI revealed the classic signs of Madura’s foot, and these findings were correlated with histopathological examination. The present cases confirm the specificity of the ‘dot-in-circle’ sign on MRI and USG, supported by histopathological correlation.

Varicocele Embolization: Interventional Radiologist's Perspective.

The goal of this article is to review the patient selection criteria, technical pearls, and outcomes of percutaneous varicocele embolization. This article will provide a brief overview of the history of the procedure, angiographic approach, and materials used in contemporary embolization. The success rates and complications of the varicocele embolization will also be discussed.

Incidental Thyroid Nodules on Computed Tomography: A Radiologist's Perspective.

None.

Thymic carcinoma vs. lung carcinoma—a radiologist perspective: extended abstract

Thymic carcinoma vs. lung carcinoma—a radiologist perspective: extended abstract

Imaging of shoulder disorders

The radiological evaluation of shoulder disorders has evolved to incorporate virtually all imaging modalities. This article discusses the varying roles of these modalities and includes key points for understanding the indications, diagnostic value, and limitations of each. Plain radiography, ultrasound, computed tomography, and magnetic resonance imaging (including magnetic resonance arthrography) are discussed, as well as recent innovations in these fields. The optimum imaging method for the diagnosis of specific shoulder pathologies, such as fracture, rotator cuff tendon disease and arthropathy, is discussed, while incorporating useful advice on diagnostic accuracy and availability from the radiologist's perspective. The purpose is to give an overview and a general approach to the imaging diagnosis of shoulder disorders to inform current and future orthopaedic practice.

The role of MRI in prostate cancer: current and future directions.

There has been an increasing role of magnetic resonance imaging (MRI) in the management of prostate cancer. MRI already plays an essential role in the detection and staging, with the introduction of functional MRI sequences. Recent advancements in radiomics and artificial intelligence are being tested to potentially improve detection, assessment of aggressiveness, and provide usefulness as a prognostic marker. MRI can improve pretreatment risk stratification and therefore selection of and follow-up of patients for active surveillance. MRI can also assist in guiding targeted biopsy, treatment planning and follow-up after treatment to assess local recurrence. MRI has gained importance in the evaluation of metastatic disease with emerging technology including whole-body MRI and integrated positron emission tomography/MRI, allowing for not only better detection but also quantification. The main goal of this article is to review the most recent advances on MRI in prostate cancer and provide insights into its potential clinical roles from the radiologist's perspective. In each of the sections, specific roles of MRI tailored to each clinical setting are discussed along with its strengths and weakness including already established material related to MRI and the introduction of recent advancements on MRI.

A Radiologist's Perspective on Treatment-Related Pseudoprogression: Clues and Hues

AbstractPseudoprogression refers to the initial apparent increase in tumor burden observed on imaging after cancer therapy, with subsequent delayed response to the same treatment, thus giving a false initial appearance of disease progression. It is essential to differentiate pseudoprogression from true progression to prevent the patients from getting deprived of the benefits of their ongoing cancer therapy owing to their early withdrawal. It also affects their recruitment for clinical trials. Pseudoprogression, albeit uncommon, has been observed after various types of cancer therapy; however, this phenomenon has gained momentum of late due to the emergence of immunotherapy for the treatment of various malignancies. Besides immunotherapy, pseudoprogression has predominantly been of concern in a few patients after radiation therapy for brain tumors and metastasis, after molecular targeted therapy for a variety of tumors, and after chemotherapy in metastatic bone lesions. This article reviews the available data on imaging of pseudoprogression from various types of cancer therapies, highlighting ways to suspect or identify it on imaging.

Imaging of Hockey-related Injuries of the Head, Neck, and Body.

Hockey is a demanding contact sport with growing popularity around the world. This article is part of a review series in this issue of Seminars in Musculoskeletal Radiology that summarizes epidemiological research on the patterns of ice hockey injuries as well as provides pictorial examples for a radiologist's perspective. We focus on non-extremity pathologies which encompass many of the most devastating injuries of hockey, namely those involving the head, neck, face, spine, and body.