Background. Intraspinal epidermoid cysts are rare lesions that may develop following spinal dysraphism surgery, such as myelomeningocele repair. These abnormalities are often associated with tethered cord syndrome, which presents significant diagnostic and therapeutic challenges. Epidermoid cysts can arise congenitally from ectodermal remnants or be acquired secondary to surgical implantation of epithelial elements. Early diagnosis and timely management are essential to prevent progressive neurological deterioration. Case presentation. We report a 3-year-old female who presented with left lower limb pain and gait disturbance three years after surgical repair of myelomeningocele. Neurological examination revealed increased tone, brisk reflexes, and a sensory level at T12. Magnetic resonance imaging (MRI) of the whole spine demonstrated a dorsal intramedullary cystic lesion at the L1–L3 level with characteristic T1 hypointensity, T2 hyperintensity, and diffusion restriction on diffusion-weighted imaging sequences. Management and outcome. The patient underwent laminectomy, complete surgical excision of the cyst, and detethering of the filum terminale. Postoperative recovery was uneventful, with full resolution of neurological deficits and neuropathic pain at six-month follow-up. Conclusion. Intramedullary epidermoid cysts should be considered in the differential diagnosis of neurological decline post-myelomeningocele repair. MRI including diffusion-weighted sequences is essential for diagnosis, and timely surgical intervention leads to favorable outcomes.

Reversible Cerebral Vasoconstriction Syndrome: A Review of Diagnostic Imaging and Mimics

Reversible cerebral vasoconstriction syndrome (RCVS) encompasses a group of clinical and radiological conditions characterized by acute onset recurrent thunderclap headaches and reversible cerebral angiopathy. The pathophysiology is largely unknown, nevertheless, research indicates several possible triggering factors and associated conditions such as stress, physical exertion, drugs or medications, and pregnancy. Neuroimaging may show multifocal narrowing and dilation of the cerebral arteries but often may be normal. Diagnosis remains difficult due to the wide range of differentials with similar clinical and imaging features. Outcomes are typically benign with supportive treatment; however, it is important for the radiologist to distinguish RCVS from other entities to exclude serious causes of morbidity and mortality to optimize management.

The Use of Virtual Reality for 3D Diagnostic Imaging Review Enhances Understanding and Education of Patients with Cancer.

Background. Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder characterized by the triad of capillary malformations, venous anomalies, and limb hypertrophy. It most commonly affects the lower limbs and presents with varied clinical severity, often necessitating multimodal imaging and multidisciplinary care. This case series aims to highlight the imaging features and clinical complexity of KTS through three distinct patient presentations. Case presentation. Three patients with confirmed KTS were evaluated. The first, a 16-year-old male, presented with progressive swelling and heaviness in the left lower limb since birth. CT and MR venography revealed soft tissue hypertrophy, deep venous hypoplasia, and anomalous venous drainage into the contralateral femoral vein. The second case involved a 32-year-old female with a chronic foot ulcer, right limb hypertrophy, and arteriovenous shunting demonstrated on imaging. CT angiography showed abnormal communications between the internal iliac artery and superficial femoral vein, with multiple varicosities and a limb length discrepancy. The third patient, a 31-year-old male, presented with long-standing swelling in the right leg. Imaging demonstrated extensive tortuous, multilobulated venous malformations with partial thrombosis, subcutaneous and intermuscular involvement, and localized gigantism. All patients were managed conserva­tively with compression therapy and wound care, and were evaluated for interventional planning as needed. Conclusion. KTS presents with diverse clinical and radiologic features, making diagnosis and management challenging. This case series emphasizes the vital role of multimodal imaging in diagnosis and preoperative planning. Conservative management remains the cornerstone of care, though targeted therapies and image-guided interventions are emerging as promising advances. Early recognition, individualized treatment, and longitudinal follow-up are key to improving quality of life and reducing complications in patients with Klippel-Trenaunay syndrome.

Anterior segment and iridocorneal angle evaluation is critical in the evaluation of glaucoma and is conventionally done using slit lamp and gonioscopy. Gonioscopy is still the “gold standard” for visualisation of the angle structures, despite a few limitations like learning curve, patient cooperation, and influence of environmental light on pupil size. Technological advancements have led to the development of ultrasound biomicroscopy and optical coherence tomography to better study and understand the pathophysiology of glaucoma. Often underutilised, these imaging technologies can improve our understanding of the disease pathogenesis, directly translating to better patient management and successful visual outcomes. This comprehensive review will highlight the principles and relevant updates in clinical utilisation of these devices in anterior segment diseases, with special focus on glaucoma.

One lingering effect of the COVID-19 pandemic created by SARS-CoV-2 is the emergence of Long COVID (LC), characterized by enduring neurological sequelae affecting a significant portion of survivors. This review provides a thorough analysis of these neurological disruptions with respect to cognitive dysfunction, which broadly manifest as chronic insomnia, fatigue, mood dysregulation, and cognitive impairments with respect to cognitive dysfunction. Furthermore, we characterize how diagnostic tools such as PET, MRI, EEG, and ultrasonography provide critical insight into subtle neurological anomalies that may mechanistically explain the Long COVID disease phenotype. In this review, we explore the mechanistic hypotheses of these neurological changes, which describe CNS invasion, neuroinflammation, blood-brain barrier disruption, and gut-brain axis dysregulation, along with the novel vascular disruption hypothesis that highlights endothelial dysfunction and hypoperfusion as a core underlying mechanism. We lastly evaluate the clinical treatment landscape, scrutinizing the efficacy of various therapeutic strategies ranging from antivirals to anti-inflammatory agents in mitigating the multifaceted symptoms of LC.

Evaluation of Image-Defined Risk Factor (IDRF) Assessment in Patients With Intermediate-risk Neuroblastoma: A Report From the Children's Oncology Group Study ANBL0531

Implementing a tertiary survey in the emergency general surgery population: Imitation is the sincerest form of flattery

3D Virtual Reality Volumetric Imaging Review in Cancer Patients’ Understanding and Education of their Disease and Treatment

A variety of surgical approaches are available for the treatment of spine diseases. Complications can arise intraoperatively, in the immediate postoperative period, or in a delayed fashion. These complications may lead to severe or even permanent morbidity if left unrecognized and untreated. Postoperative complications such as incomplete fusion, hardware failure, suboptimal positioning of instrumentation, infection, hematoma, and others may be detected at imaging. The article reviews the potential complications of spinal instrumentation, beginning with a description of biomechanics and an overview of surgical approaches and continuing with a discussion of various types of complications and their appropriate radiologic assessment. This systematic review describes the imaging features of immediate and delayed complications including instrumentation malpositioning.

The follow-up of an operated tendon is primarily clinical, although clinical examination may not be sufficient in the presence of certain complications. The imaging techniques are of great value not only in the diagnosis of tendon pathologies, but also as an adjunct to clinical evaluation. This is particularly true in the follow-up of patients submitted to surgical tendon reconstruction, by monitoring morphological effects of different interventions and evaluating tendon healing processes. Interpretation of imaging findings requires knowledge of the imaging appearance of the operated tendon during the healing phase, to distinguish between normal postsurgical changes and real pathology, as well as knowledge of surgical technique, postoperative course (including type of prescribed therapy) and possible postoperative complications. The most important imaging modalities to examine the Achilles tendon are ultrasound and magnetic resonance imaging. This article gives a review of some of the most common treatment strategies for Achilles tendon pathology, expected postoperative imaging findings and postoperative complications.

Abstract Background: Participation in multidisciplinary case conferences (MCCs) continues to be highly variable, in spite of proven benefits. One contention is the lack of perceived utility on patient management. Purpose: To evaluate the utility of MCCs on physician decision making in benign and malignant breast disease management. Methods: At the Foothills Medical Centre, diagnostic breast MCCs occur biweekly. Patients with interesting or challenging diagnostic or management issues were discussed by attending surgeons, radiologists, pathologists, nurse coordinators and oncologists. Prior to case discussion, the presenting physician was asked to specify his/her management plan. Their response was recorded and compared to the management plan consensus after the MCC discussion. For each case a clinical summary and question was provided by the presenting physician, followed by a review of diagnostic images and/or pathology. After group discussion, a management consensus was achieved and documented. A management change was defined as a difference compared to the pre-MCC plan or if there was no definite management plan prior to MCC. Results: From November 5th, 2014 to May 6th, 2015, 52 patients were discussed in 11 MCCs (1 to 8 patients per MCC). No MCCs were cancelled due to insufficient patients. Of these, 23 (44%) had a change in the management plan compared to the pre-MCC intent including 7 cases where there was no clear plan prior to MCC. Among the 23 cases with a management change, 12 (52%) were due to new or clarified information from radiology review, 6 (26%) were due to new or clarified details from pathology review and 5 (22%) changes occurred from both radiology and pathology review. All cases presented resulted in a consensus management recommendation. Conclusion: The MCCs had a substantial impact on physician decision making. Nearly half of cases presented resulted in a change in clinical recommendation, the majority of which were based on new/clarified diagnostic imaging or pathology information. Presentation of cases at MCCs should be encouraged given their clinical impact on patient care, especially for challenging diagnostic or management issues. Citation Format: Foster T, Bouchard-Fortier A, Olivotto I, Quan ML. Effect of multidisciplinary case conferences on physician decision making: Breast diagnostic rounds. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-02-07.

Abstract No. 403 - Long-term outcomes of endovascular treatment for aortic pseudoaneurysm in Behcet’s disease

Educational Exhibit Abstract No. 404 - CT-guided sacral and transsacral interventions for benign and malignant pathologies: a pictorial review

Julie Edmiston works in radiology in Hammond, Louisiana, and is the former department editor for Diagnostic Imaging Review. The author has indicated no relationships to disclose relating to the content of this article. Bryan Walker, MHS, PA-C, department editor

Snakes and lizards are considered ‘stoic’ animals and often show only non-specific signs of illness. Consequently, diagnostic imaging – along with clinical examination and laboratory tests – is gaining importance...

Real-time Peer Review Quality Assurance Conferences Incorporating Physical Examination for Head-and-Neck Cancer Radiation Therapy Result in Clinically Meaningful Target Volume Alteration: Results of a Prospective Volumetric Analysis

BackgroundEarly diagnosis and management of intestinal malrotation can potentially prevent the devastating complications associated with midgut volvulus. Atypical presentation of intestinal malrotation in older children frequently leads to a significant...

Julie Edmiston practices in radiology in Hammond, Louisiana, and is the department editor for Diagnostic Imaging review. the author has indicated no relationships to disclose relating to the content of this article.