Resonance Imaging Appearance Research Articles

Low field magnetic resonance imaging of palmar osteochondral fragmentation of the distal phalanx

SummaryBackgroundThe presence of palmar osteochondral fragments of the distal phalanx is a newly recognised cause of foot lameness with only a few cases having been reported.ObjectivesTo describe the low field magnetic resonance imaging (MRI) appearance of palmar articular fragmentation of the distal phalanx and concurrent abnormalities of the distal interphalangeal joint (DIPJ); to investigate the prevalence of these fragments in a population of sports and pleasure horses and their potential clinical significance.Study designRetrospective descriptive case series.MethodsThis is a retrospective descriptive case series in which all Sports and Pleasure horses undergoing standing low‐field MRI of the feet between 2015 and 2023 were reviewed. Appearance, location and number of palmar articular fragments were recorded. When a palmar fragment was present, abnormal findings of the DIPJ were graded.ResultsA total of 855 horses underwent MRI examination of one or both front feet. Palmar osteochondral fragmentation of the distal phalanx was identified in four horses (0.4% prevalence), three Lusitanos and one Warmblood. The age range was 4–17 years old. All fragments were located along the palmarolateral margin of the glenoid of the distal phalanx in front feet. Concurrent imaging abnormalities of the joint were present in all four horses.Main limitationsLack of histopathology.ConclusionsThe prevalence of palmar articular fragments of the distal phalanx was low in this population of horses. Palmar osteochondral fragmentation must be considered when evaluating lameness localised to the foot, since it was identified only in lame limbs and associated with other imaging abnormalities of the DIPJ.

Impact of Postoperative Chemotherapy on Survival in Patients with Primary Central Nervous System Lymphoma: A Study Based on the SEER Database.

Aims/Background We aimed to investigate the impact of postoperative chemotherapy (POCT) on survival in patients with primary central nervous system lymphoma (PCNSL) using data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods This study included 786 PCNSL patients, of which 605 received chemotherapy after surgery, and 181 did not. Data from the SEER registry database (2007-2020) were used to analyze PCNSL. Baseline information, including age, sex, race, marital status, primary tumour site, histological type, summary stage, surgical procedures, chemotherapy, and radiotherapy, was analyzed. Propensity Score Matching (PSM) (1:1) was employed to balance the effects of confounding variables between the two groups. Subsequently, Cox regression and bidirectional stepwise regression were used to identify independent prognostic factors. Kaplan-Meier (K-M) survival curves were constructed to assess the impact of POCT on patient prognosis. Additionally, two cases of PCNSL with typical magnetic resonance imaging appearances were presented. Results Multivariate Cox regression results revealed that age older than 60 years (hazard ratio [HR] = 1.786; 95% confidence interval [CI]: 1.272-2.509; p = 0.001) and absence of POCT (HR = 2.841; 95% CI: 2.159-3.738; p < 0.001) were independent prognostic risk factors, while primary tumour locations in the meninges (HR = 0.136; 95% CI: 0.032-0.569; p = 0.006) and other nervous system regions (HR = 0.552; 95% CI: 0.326-0.936; p = 0.027), as well as histological morphologies such as diffuse large B-cell lymphoma (HR = 0.233; 95% CI: 0.128-0.425; p < 0.001) and non-Hodgkin lymphoma (HR = 0.559; 95% CI: 0.356-0.876; p = 0.011), were associated with favourable patient outcomes. K-M curves demonstrated that the group undergoing POCT had a significantly more favourable prognosis compared to the non-POCT group, before (HR = 0.454; 95% CI: 0.343-0.600; p < 0.0001) or after PSM (HR = 0.580; 95% CI: 0.431-0.780; p < 0.0001). For patients with PCNSL, those with tumours located in the infratentorial region (HR = 0.231; 95% CI: 0.078-0.682; p = 0.046), supratentorial region (HR = 0.250; 95% CI: 0.163-0.383; p < 0.0001), overlapping brain regions (HR = 0.201; 95% CI: 0.056-0.727; p = 0.0058), and those who underwent biopsy (HR = 0.740; 95% CI: 0.463-1.182; p = 0.003), subtotal resection (STR) (HR = 0.490; 95% CI: 0.265-0.906; p = 0.0064), or gross total resection (GTR) (HR = 0.613; 95% CI: 0.292-1.287; p = 0.0003) had better prognoses in the postoperative chemotherapy group compared to the non-chemotherapy group. Conclusion POCT significantly improves the prognosis of PCNSL patients and identifies the characteristics of the benefiting population. This information aids clinical practitioners in designing personalized treatment plans for individuals and advancing precise treatment.

Cauda Equina Cavernous Angioma

AbstractCavernous angiomas are rare vascular lesions, most occurring supratentorially, with spinal cavernomas being even rarer. They have a varied magnetic resonance imaging (MRI) appearance which is usually not diagnostic. A 42-year-old man presented with progressive low backache for the past 5 years and was found to have a mild right ankle weakness. MRI showed an intradural extramedullary lesion at the L1 vertebral body level. Intraoperatively, a dark reddish-blue mulberry-like lesion was found attached to a nerve root that had to be sacrificed during the excision. Histopathology confirmed that it was a cavernous angioma and the patient had no added deficits postoperatively. Cauda equina cavernomas are extremely rare and hence not thought of as a differential preoperatively. They are relatively simple to remove but will mostly need the sacrifice of the adherent nerve root. Most cases do well postoperatively with stable deficits and some improving.

Magnetic Resonance Imaging appearance of regenerative peripheral nerve interface

PurposeTo describe the MRI appearance of Regenerative peripheral nerve interface (RPNI) and the potential association between the MR appearance and RPNI revision. Material and methodsA retrospective assessment was undertaken of the MR appearance of RPNIs performed at our institution between 1/1/2010- 7/29/2023 with clinical correlation. Results14 patients (8 males, 6 females, age range 31-80 years, median age- 51 years) with technically adequate MRI of RPNIs were included in this study including 5 patients with below knee amputation (BKA) with 5 tibial and 4 CPN RPNI, 8 patients with above knee amputations (AKA) with sciatic RPNIs and one patient following forequarter amputation with a brachial plexus RPNI. Two patients had undergone revision RPNI surgery x3 (AKA-sciatic nerve) for a total of 6 RPNI revisions. On T1 weighted sequences, all RPNIs were isointense to muscle and blended with the surrounding scar and muscle tissues while on T2 weighted sequences, all RPNIs were hyperintense in signal compared to muscle. All but one RPNI underwent post contrast enhancement in variable patterns. No statistically significant difference in MR appearance was found between RPNIs with or without a following RPNI revision surgery. ConclusionRPNI on MRI typically have a bright and intermediate signal on T2 and T1 weighted sequences accordingly, and typically undergo postcontrast enhancement in variable patterns without a statistically significant difference between cases with and without a following RPNI revision. Enhancement of RPNI should not be misconstrued as pathological.

The potential role of breast MRI in evaluation of triple-negative breast cancer and fibroadenoma of less than 3 cm.

The majority of small-sized (<3 cm) triple-negative breast cancer (TNBC) exhibit smooth margins upon palpation and are often oval or rounded masses. Distinguishing these masses preoperatively from fibroadenomas (FAs) would be very meaningful for clinical practice. The aim of our study was to evaluate the magnetic resonance imaging (MRI) appearance of TNBC and differentiate it from FAs. In this retrospective single-center study, we included 37 patients with TNBCs and 36 patients with FAs who underwent breast MRI. We employed the χ2 test and t-test to compare the differences in morphological features, dynamic contrast-enhanced MRI (DCE-MRI) parameters, and apparent diffusion coefficient (ADC) values between the two groups. Additionally, we constructed non-parametric receiver operating characteristic (ROC) curves using ADC values, with pathological results serving as the gold standard. A total of 37 TNBC lesions and 39 FA lesions were included in the final analysis. TNBCs exhibited more frequent irregular shape, irregular margins, peritumoral edema, fast enhancement in the initial phase, rim enhancement, and time-signal intensity curve (TIC) type III compared to FAs (all P<0.05). Conversely, low-signal segregation in T2-weighted imaging (T2WI) and TIC type I were commonly found in FAs. The mean ADC value of TNBCs was significantly lower than that of FAs [(1.104±0.13)×10-3 vs. (1.613±0.16)×10-3 mm2/s, P<0.05]. The cutoff ADC for differentiating TNBCs from FAs was 1.239×10-3 mm2/s, yielding an area under the curve (AUC) of 0.997, a sensitivity of 94.6%, and a specificity of 100%. The morphological presentation of MRI, internal enhancement features of the mass, TIC curves, and ADC values provide valuable differential diagnostic information for TNBC and FA masses with a maximum diameter of less than 3 cm.

Management of patellar and trochlear cartilage lesions with matrix-induced autologous chondrocyte implantation in conjunction with patellofemoral realignment procedures improves patient-reported outcomes and magnetic resonance image appearance

ObjectivesThe aim of this study is to evaluate the relationship between the achievement of clinically significant improvement in patient-reported outcome measures (PROMs) and the postoperative magnetic resonance image (MRI) appearance of matrix-associated chondrocyte implantation (MACI), in conjunction with patellofemoral realignment procedures, for the treatment of grade-IV chondral defects about the patellofemoral joint. MethodsA retrospective review of patients undergoing MACI for grade-IV chondral defects of the patella or trochlea by a single sports-medicine-fellowship-trained surgeon from 2017 to 2020 was performed. Concomitant realignment procedures, including tibial tubercle osteotomy and medial patellofemoral ligament reconstruction, were also performed as needed. Patients with preoperative and minimum 1-year postoperative PROMs and postoperative knee MRI were included. MRI scans were obtained at 6.3 (interquartile range: 5.8, 7.5) months postoperatively. A fellowship-trained musculoskeletal radiologist assigned a Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score (range: 0–100, with 100 equating to complete graft healing) to each MRI. Achievement of the minimal clinically important difference (MCID) for International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Score—Quality of Life, and Kujala scores were determined for each patient. Paired t-tests or Wilcoxon rank-sum tests were used to evaluate for an association between achievement of the MCID for each PROM and MOCART score. The average follow-up time and time from surgery to PROMs were 2.7 ​± ​1.5 years and 1.7 ​± ​0.66 years, respectively. ResultsThirty patients were included. There was a significant improvement in all PROMs from preoperative to postoperative (p ​< ​0.001). More than two-thirds of patients achieved the MCID for each PROM. Patients who achieved the MCID for IKDC had significantly higher MOCART scores (66.5 ​± ​16.2) than those who did not meet the MCID for IKDC (50.6 ​± ​23.6, p ​= ​0.043). ConclusionMACI for the treatment of patellofemoral chondral injuries is associated with clinically significant improvement in PROMs at short-term follow-up. Clinically significant improvements in IKDC scores are associated with a more mature MRI appearance of the autologous chondrocyte implantation graft on postoperative MRI, as indicated by higher MOCART scores. Level of evidenceIV—Case Series.

Prognostic factors for recurrent instability in recreational athletes following arthroscopic Bankart repair: a retrospective study with an average 4.1-year follow-up

BackgroundExtensive research has been conducted to investigate the short-term and long-term outcomes of arthroscopic Bankart repair, yielding varying results across different populations. However, there remains a dearth of studies specifically focused on evaluating outcomes in recreational athletes.MethodsA retrospective case series study was conducted on recreational athletes who underwent isolated arthroscopic Bankart repair between 2013 and 2021. The primary outcome assessed was recurrent instability, defined as dislocation or subluxation. Secondary outcomes included patient satisfaction, rates of returning to the same sports (RTS) and RTS at preinjury level, and patient-reported outcomes. Evaluation of the Rowe score, Constant score, American Shoulder and Elbow Surgeons score, and VAS pain score were performed. Prognostic factors for recurrent instability, including demographic and clinical characteristics, as well as postoperative magnetic resonance imaging (MRI) appearance of the labrum were analyzed.ResultsA total of 191 patients met the selection criteria, with 150 (78.5%) available for the final follow-up. Recurrent instability occurred in 10.7% of patients, with a mean follow-up duration of 4.1 years. Younger age at surgery and more critical glenoid bone loss were significantly associated with recurrent instability (p = .038 and p = .011, respectively). The satisfaction rate regarding surgery was 90.0%. Rates of return to the same sports (RTS) and RTS at preinjury level were 82.0% and 49.3%, respectively. Clinical outcomes measured at the final follow-up were as follows: Rowe score − 92.8; Constant score − 98.0; ASES score − 98.3; VAS pain score − 0.2. Patients with recurrent instability had significantly inferior outcomes in terms of satisfaction rate, RTS at preinjury level rate, Rowe score, and Constant score (p = .000, p = .039, p = .000, and p = .015, respectively). A total of thirty-seven patients underwent MRI examination six months after surgery in our institution. The T2-weighted anterior labrum morphology was found to be poorer in patients with recurrent instability. No significant difference was observed between patients with or without recurrent instability in terms of anterior Slope, anterior labral glenoid height index (LGHI), inferior Slope, inferior LGHI, and T2-weighted inferior labrum morphology.ConclusionArthroscopic Bankart repair can yield satisfactory medium-term outcomes for recreational athletes. Younger age at surgery, more critical glenoid bone loss, and poorer T2-weighted anterior labrum morphology assessed six months postoperatively were significantly associated with recurrent instability.

The Role of Radiation Therapy in the Management of Prostate Cancer and Posttreatment Imaging Appearances

AbstractProstate cancer remains a significant global health concern, necessitating continuous research and innovation in treatment modalities. This review explores the currently employed techniques in radiation dose planning and tumor irradiation in the context of prostate cancer management. In addition, we delve into the nuances of expected posttreatment magnetic resonance imaging (MRI) appearances within the gland or in the prostate bed, postradiation tumor recurrence, and its mimics.Radiation therapy (RT) has evolved as a cornerstone in prostate cancer treatment, offering both curative and palliative solutions. Recent developments have seen the emergence of advanced techniques such as intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), allowing for precise targeting of cancer cells while minimizing damage to surrounding healthy tissue.The avoidance of normal tissue dose through more conformal dose distribution as in IMRT or proton therapy, improved imaging modalities as in multiparametric magnetic resonance imaging (mpMRI) and prostate positron emission tomography (PET), interventional separation of critical structures from the prostate target, and many other techniques can greatly reduce the side effects of RT. These advancements enhance treatment efficacy and reduce the risk of side effects, promoting improved patient outcomes.

Rotator cuff tear patterns: MRI appearance and its surgical relevance.

A new perspective on rotator cuff anatomy has allowed a better understanding of the patterns of the different rotator cuff tears. It is essential for radiologists to be aware of these different patterns of tears and to understand how they might influence treatment and surgical approach. Our objective is to review the arthroscopy correlated magnetic resonance imaging appearance of the different types of rotator cuff tears based on current anatomical concepts.Critical relevance statement Knowledge of the characteristics of rotator cuff tears improves our communication with the surgeon and can also make it easier for the radiologist to prepare a report that guides therapeutic conduct and serves as a prognosis for the patient.Key points• There is no universally accepted classification for RC tears.• New patterns such as delamination or myotendinous junction tears have been defined.• The most difficult feature to assess in full thickness tears on MRI is the pattern.• Fatty infiltration of the RC tendons is crucial in the prognosis and outcome.• The radiological report is an effective way of communication with the surgeon.

Brown adipose tissue – magnetic resonance imaging (MRI) appearance of these physiological fat deposits in a newborn

Brown adipose tissue (BAT) is responsible for thermogenesis in neonates and infants in response to cold environment. 18F-fluorodeoxyglucose positron emission tomography is the reference for imaging of BAT, but it is a functional imaging modality and hence lacks sensitivity due to varying patient and environmental factors. Magnetic resonance imaging (MRI) lacks the use of radioactivity and ionizing radiation and can prove to be an excellent imaging modality to study the distribution of BAT. We report a neonate with sepsis whose MRI study of the neck and upper chest done to look for infective focus revealed classical distribution and signal intensity of BAT.

Multiparametric MRI characteristics of prostatitis and atrophy in the peripheral zone in men without prostate cancer

PurposeTo analyse multiparametric magnetic resonance imaging (mpMRI) characteristics and appearance of histopathologically proven non-cancerous intraprostatic findings focussing on quantity of prostatitis and atrophy in the peripheral zone. MethodIn this retrospective analysis consecutive patients with mpMRI followed by MRI/TRUS-fusion biopsy comprising targeted (TB) and systematic biopsy (SB) cores without prostate cancer (PC) at histopathology were included. Subgroup analysis was performed in younger men (≤50 years). The proportions of prostatitis and atrophy were quantified for each biopsy core based on histopathology. MRI findings in the peripheral zone (PZ) and index lesions (IL, most suspicious/representative lesion) were characterized regarding changes in T2w, ADC value, and enhancement of dynamic contrast enhancement (DCE) and correlated with quantity of prostatitis and atrophy. ResultsSeventy-two patients were analysed. The median baseline characteristics were PSA 5.4 ng/ml (4.0–7.9), PI-RADS classification 3 (2–4), prostate volume 43 ml (33–57), and PSA density 0.13 ng/ml2 (0.10–0.19). Prostatitis was found in 44 % (n = 32) and atrophy in 65 % (n = 47) of cases. The quantity of atrophy demonstrated a significant correlation to T2w changes, ADC increase and DCE enhancement (p = 0.05, p = 0.05, p = 0.01), whereas quantity of prostatitis did not show any significant correlation to the MRI changes (p = 0.68, p = 0.58, p = 0.95). Quantity of prostatitis and atrophy increased with PI-RADS classification. Younger men had lower PSA (4.4 vs. 7.8 ml/ng; p < 0.001), smaller prostate volume (40 vs. 59 ml; p = 0.001), and lower PI-RADS classification (2–3 vs. 3–4; p = 0.005) and prostatitis and atrophy were less frequently observed (p ≤ 0.01, p = 0.03). ConclusionsQuantity of atrophy and prostatitis had different influence on MRI characteristics and increased within higher PI-RADS classification. Younger men had diffuse hypointense changes at T2w images, but less quantity of prostatitis and atrophy.

“Leopard skin” sign: Magnetic resonance imaging appearance of Lhermitte-Duclos disease with histopathologic correlation

Dysplastic cerebellar gangliocytoma or Lhermitte-Duclos disease (LDD) is a rare hamartomatous malformation of cerebellum that can occur in isolation or as a component of Cowden syndrome. Although uncommon, the characteristic clinical symptoms and magnetic resonance imaging (MRI) features are highly suggestive of the condition and histopathological features confirm the diagnosis. We report a case of LDD, presenting with “Leopard skin” appearance of the lesion on MRI with a brief review of imaging, clinical, and histopathological features.

The Resolution of Kaplan Fiber Injuries Is Observed in a Majority of Cases at 9 Months After Acute Primary Anterior Cruciate Ligament Reconstruction: A Radiological Study

Background: The natural history of Kaplan fiber (KF) injuries after acute primary anterior cruciate ligament (ACL) reconstruction (ACLR) remains unknown. Purpose/Hypothesis: The purpose of this study was to evaluate the temporal change in the magnetic resonance imaging (MRI) appearance of the KF complex after acute primary ACLR. It was hypothesized that KF injuries would resolve with time. Study Design: Case series; Level of evidence, 4. Methods: A retrospective MRI analysis was conducted on 89 patients with ACL-injured knees to assess the change in the radiological appearance of KFs after primary ACLR. Patients who had undergone index MRI and ACLR within 90 days of the injury and further MRI at 9 months after surgery were included. Diagnostic criteria to identify radiological evidence of a KF injury and its subsequent resolution were applied, including the presence of high signal intensity on fluid-sensitive sequences, which is indicative of a pathological process radiologically. The proximity of KFs to the femoral cortical suspensory device (CSD) was noted on MRI scans and quantified in millimeters. Results: A KF injury was identified in 30.3% (27/89) of patients, with isolated high signal intensity observed in an additional 18.0% (16/89). At 9 months, MRI evidence of the reconstitution of the KF complex was found in 51.9% (14/27) of patients, with persistent discontinuity in the remaining patients (13/27). All patients (16/16) with isolated high signal intensity had complete resolution on repeat MRI scans. KF thickening was observed in 26.1% (12/46) of patients with previously healthy KFs and in 25.0% (4/16) with isolated high signal intensity. The CSD was positioned in close proximity (≤6 mm) to the center of the KF attachment in 61.8% (55/89) of patients, and this was associated with increased rates of KF thickening. Conclusion: The KF injury resolved radiologically in over half of the patients at 9 months after acute primary ACLR. High signal intensity in the region of the KFs on index MRI scans resolved in all cases, with evidence of residual KF thickening in only one-quarter of cases on repeat MRI scans, equivalent to the rate in those with healthy KFs. As such, it is not advisable to use high signal intensity on preoperative MRI scans as the sole criterion for the diagnosis of a KF injury. The position of the CSD after ACLR was intimately related to the KF attachment in the majority of patients, which was associated with KF thickening on postoperative MRI scans.

MRI of rare vaginal tumors: Report of two cases

Tumors of the vagina are overall rare and unexplored entities and thus often pose diagnostic dilemmas. We report two rare malignant vaginal tumors and their magnetic resonance imaging (MRI) appearances. We describe two cases of rare vaginal malignancies. In the first case of a 29-year-old married, nulliparous woman, MRI revealed a T2 heterogeneous peripherally enhancing mass involving the upper vagina and the cervix. The uterus was uninvolved. A biopsy was obtained, which showed features of choriocarcinoma. In the second case of a 13-year-old adolescent girl, MRI revealed a T2 hyperintense, moderate to intensely enhancing mass within the vagina. The patient was examined, and tissue sampling was obtained, which showed embryonal rhabdomyosarcoma (RMS). Primary choriocarcinoma and embryonal RMSs of the vagina are extremely rare. Choriocarcinomas are treated by chemotherapy and RMSs by chemotherapy, surgery, and/or radiation therapy. Accurate characterization and staging on imaging help in appropriate intervention.

Magnetic resonance imaging of disorders with white matter changes in children and adolescents: a pictorial essay.

White matter changes are seen in a spectrum of disorders in children and adolescents. Understanding their distribution and appearance helps to reach diagnoses in daily radiologic practice. This pictorial essay will outline the magnetic resonance imaging (MRI) appearances of diseases with white matter changes including demyelinating diseases, dysmyelinating disorders/leukodystrophies, infections, autoimmune diseases, vascular causes, mitochondrial disorders and neurocutaneous syndromes, along with a brief overview of clinical aspects of the diseases such as typical age of presentation, etiology, symptoms and signs and treatment options. This article highlights important features in common white matter diseases in children and adolescents.

Occult lipomatosis of the nerve as part of macrodystrophia lipomatosa: illustrative case.

Macrodystrophia lipomatosa (MDL) is characterized by progressive overgrowth affecting soft tissues and bony structures and is part of lipomatous overgrowth syndromes. MDL has been associated with lipomatosis of the nerve (LN), an adipose lesion of nerve that has a pathognomonic magnetic resonance imaging (MRI) appearance as well as a mutation in the PIK3CA gene. The authors present a case of occult LN in the setting of MDL. A 2-year-old boy with progressive soft tissue overgrowth of his proximal right lower extremity was initially diagnosed with neurofibromatosis type 1 (NF1). At our institution, NF1 as well as other overgrowth syndromes including PTEN hamartoma tumor syndrome were excluded. He was diagnosed as having so-called MDL. Upon reinterpretation of the patient's MRI studies, short-segment LN involving the proximal sciatic nerve and part of lumbosacral plexus was identified. He underwent 2 debulking/liposuction procedures for soft tissue overgrowth. Genetic testing of tissue revealed a mutation in PIK3CA. Thorough clinical examination (for signs of overgrowth) as well as an MRI study of the entire neural pathway is a critical part of the diagnostic workup to evaluate for LN. The authors believe that an increasing association of LN, even when occult, will emerge that will explain many cases with marked nerve-territory overgrowth.

Is Artificial Intelligence the Key to Revolutionizing Benign Prostatic Hyperplasia Diagnosis and Management?

Benign prostatic hyperplasia (BPH) is a prevalent condition among older men that is characterized by the enlargement of the prostate gland and compression of the urethra, which often results in lower urinary tract symptoms, such as frequent urination, difficulty in starting urination, and incomplete bladder emptying. The development of BPH is thought to be primarily due to an imbalance between cell proliferation and apoptosis, underlying inflammation, epithelial-to-mesenchymal transition, and local paracrine and autocrine growth factors, although the exact molecular mechanisms are not yet fully understood. Anatomical structures considered natural and benign observations can occasionally present multi-parametric magnetic resonance imaging appearances that resemble prostate cancer (PCa), posing a risk of misinterpretation and generating false-positive outcomes and subsequently, unnecessary interventions. To aid in the diagnosis of BPH, distinguish it from PCa, and assist with treatment and outcome prediction, various Artificial Intelligence (AI)-based algorithms have been proposed to assist clinicians in the medical practice. Here, we explore the results of these new technological advances and discuss their potential to enhance clinicians' cognitive abilities and expertise. There is no doubt that AI holds extensive medical potential, but the cornerstone for secure, efficient, and ethical integration into diverse medical fields still remains well-structured clinical trials.

240 A PEDIATRIC CASE OF BIVENTRICULAR END-STAGE ARRHYTHMOGENIC CARDIOMYOPATHY

Abstract Background Arrhythmogenic cardiomyopathy (ACM) is a rare heart muscle disease characterized by cardiomyocyte necrosis and fibro-adipose substitution which contribute both to the genesis of malignant ventricular arrhythmias and the morpho-functional alterations of the ventricles. ACM has always been considered a right ventricular disease with secondary involvement of the left ventricle, but recently a left dominant phenotype has been also described. Case report A 14-year-old patient was admitted to our hospital after out-of-hospital cardiac arrest due to ventricular fibrillation, which occurred when she was at rest. A family history of sudden death and dilated cardiomyopathy was retrieved (her brother died at the age of 18 with a dilated heart), but other family members had never been screened to date. Cardiac magnetic resonance imaging (cMRI) appearance was consistent with biventricular dilatation along with severe systolic dysfunction (left ventricular ejection fraction 20%; right ventricular ejection fraction 25%). It showed also thinning and bulging of the basal free wall of the right ventricle proximal to the outflow tract (up to 4 mm) and multiple foci of subepicardial, mid-wall and transmural late gadolinium enhancement (LGE) in both ventricles. Signs of acute decompensated heart failure and a high arrhythmic burden were present. After cardiopulmonary stabilization, she underwent the implantation of a cardioverter-defibrillator (ICD). Conclusion We herein report an uncommon case of biventricular AC (‘definite diagnosis’ according to both Task force criteria 2010 and Padua criteria) with advanced morpho-functional dysfunction occurring already in pediatric age, without any alerting symptom until the cardiac arrest (the typical onset of the ACM in children). It shows how severe biventricular involvement may affect young patients with a rapid progression of the disease. It also stresses the need for a strict follow-up of the family members of a proband since his first diagnosis, highlighting the pivotal role of cMRI in the diagnosis of pediatric disease. This has not been thoroughly studied and lacks sensitive and specific diagnostic criteria.

Magnetic Resonance Imaging Appearance of Giant Intracerebral Tuberculoma: A Retrospective Analysis

Background: Giant intracerebral tuberculomas are rare lesions but should be considered in the differential diagnosis of intracranial space-occupying lesion in an endemic region.Objective: The purpose of this study is to analyze the clinical data and magnetic resonance imaging (MRI) findings of giant intracerebral tuberculomas to improve the diagnostic precision.Material and Methods: The clinical and MRI findings of 22 patients of giant intracerebral tuberculoma were analyzed retrospectively. For the statistical analysis independent sample Student t-test was used.Results: For 22 patients included in this sample the giant intracerebral tuberculoma was of size more than 2.5cm. The majority of the giant tuberculomas (19 patients (86.4%))was located in the supratentorial area.T2-weighted hypointense core of giant tuberculoma was observed in 12 patients (54.5%) and T1 hyperintensities were observed in peripheral (wall) of the giant tuberculoma in 14 patients (63.6%). The mean ADC value of the peripheral (wall) of the giant tuberculoma was 1.034± 0.466[SD] x 10-3mm2/s and the core was 0.994± 0.455[SD] x 10-3mm2/s with a statistically significant difference (p-value &lt;0.0005) in between. MR spectroscopy showed raised lipid peak at 0.9 to 1.33 ppm in 10 patients (45.5%),raised lipid-lactate peak in 12 patients (54.5%),raised Choline/Cr ratio more than 1.2 in 14 patients(63.6%) and Choline/Cr ratio less than 1.2 in 5 patients (22.7%). Associated involvement of lung was observed in the 6patients (27.3%), cervical lymph node in 1 patient (4.5%) and spine in 1patient (4.5%).Conclusions: MRI plays a vital role in distinguishing giant intracerebral tuberculomas from other intracranial space-occupying lesions, thereby allows the early institution of anti-tubercular treatment (ATT), decreased patient morbidity, mortality, and prevents unnecessary neurosurgical excision.

Characteristic magnetic resonance imaging of leptomeningeal metastases of lung adenocarcinoma: Fluid‐attenuated inversion recovery and diffusion‐weighted imaging hyperintensity on brainstem surfaces

AbstractCytology of cerebrospinal fluid is the gold standard for diagnosing leptomeningeal carcinomatosis, despite its low sensitivity. Herein, we report a case of leptomeningeal carcinomatosis in a patient with relapsed lung adenocarcinoma who presented with tinnitus and hearing loss for 3 months. Magnetic resonance imaging revealed characteristic fluid‐attenuated inversion recovery and diffusion‐weighted imaging hyperintensities along the leptomeningeal surfaces of the brainstem. The ratio of the concentration of carcinoembryonic antigen in the serum and cerebrospinal fluid was 1.2:1. The cerebrospinal fluid cytology obtained at the fourth lumbar puncture revealed suspected malignancy, and a definitive diagnosis of metastatic adenocarcinoma was confirmed via brain biopsy. This case supports the utility of characteristic magnetic resonance imaging appearance and repeated lumber punctures as an evaluation for leptomeningeal carcinomatosis.