Imaging Differential Diagnosis Research Articles

Imaging features of juvenile xanthogranuloma.

Juvenile xanthogranuloma is rare in children and there are limited data on its imaging features. To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of juvenile xanthogranuloma in children. A retrospective review was performed of clinical and radiographic data of histologically confirmed juvenile xanthogranuloma between January 2009 and June 2020. Fourteen children (4 girls, 10 boys; age range: 1day to 13years, mean age: 73months) were included in thestudy: 4/14 had CT only, 5/14 had MRI only and 5/14 had CT and MRI. Sites of extracutaneous juvenile xanthogranuloma involvement included subcutaneous soft tissue (8/14), liver (2/14), lungs (2/14), kidney (2/14), nose (2/14), pancreas (1/14), central nervous system (1/14) and greater omentum (1/14), mainly manifested as single or multiple nodules or masses in different organs. On CT, the lesions mainly manifested as an iso-hypo density mass with mild or marked enhancement. On MRI, the lesions mainly manifested as slightly hyperintense on T1 and slightly hypointense on T2, with decreased diffusivity and homogeneous enhancement. Juvenile xanthogranuloma was not included in the imaging differential diagnosis in any case. Juvenile xanthogranuloma mainly manifests as single or multiple nodules or masses in different organs. Slight hyperintensity on T1 and slight hypointensity on T2 with decreased diffusivity and homogeneous enhancement are relatively characteristic imaging findings of juvenile xanthogranuloma. Combined with its typical skin lesions and imaging features, radiologists should include juvenile xanthogranuloma in the differential diagnosis when confronted with similar cases.

Application of texture analysis of CT and MR images to determine the histologic grade of hepatocellular cancer and it’s differential diagnosis: a review

In recent years, more foreign publications are devoted to the use of texture analysis or radiomics in solving certain diagnostic problems, including the diagnosis of hepatocellular cancer (HCC). This method of processing medical images allows for a comprehensive assessment of the structure of neoplasms by extracting a large number of quantitative features from medical images.The purpose of the study was to determine the role of texture analysis of CT and MR images in differential diagnosis and determination of the degree of differentiation of HCC based on a review and analysis of the results of publications.We searched for scientific publications in the PubMed information and analytical system for 2015–2021. by keywords: “HCC”, “texture analysis” (texture analysis), “radiomics”, “CT”, “MRI”, “grade”, “differential diagnosis”. After excluding reviews of publications and studying the full text of articles, 21 articles were selected for analysis.Despite the growing number of publications devoted to the successful use of textural analysis of CT and MR images, including non-invasive assessment of the histological grade of HCC and in the differential diagnosis of HCC with hypervascular neoplasms, metastases, regenerative and dysplastic nodes, the use of such type of analysis in routine practice is limited due to the lack of standardized methods for performing texture analysis, which leads to low reproducibility of the results. The parameters of image acquisition and methods of image preprocessing and segmentation affect the reproducibility of the obtained texture features. In addition, the presented studies were performed using different MR sequences and phases of contrast enhancement, as well as different software, which makes it difficult to compare the obtained data.The use of texture analysis certainly demonstrates promising results and requires further investigation to systematize and standardize the obtained data in order to develop an optimal diagnostic model for wide clinical use.

Case report: Thoracic and lumbar plasma cell myeloma mimicking hemangiomas on MRI and 18F-FDG PET/CT

Plasma cell myeloma (PCM) is a malignant clonal disease of abnormal proliferation of plasma cells, which is the second most common hematological malignancy after leukemia. PCM often diffuses and involves the bones of the whole body, especially the spinal column, ribs, skull, pelvis, and other axial bones and flat bones. Herein, we present a 55-year-old man who came to the hospital seeking medical help for low-back pain and numbness in his lower limbs. Computed tomography (CT) was performed because the clinician suspected that the patient had a herniated disc, and the results showed that the 7th thoracic vertebrae and the 3rd lumbar vertebrae showed a low density of bone destruction with “honeycombing” changes. Magnetic resonance imaging (MRI) showed that the corresponding lesions presented long T1 and long T2 signals, and the lesions were significantly enhanced in contrast-enhanced T1WI sequences, and fluoro18-labeled deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed mild radioactive uptake in the lesions. Based on these imaging findings, the patient was considered for a diagnosis of hemangiomas, and surgery was performed because the affected vertebra was pressing on the spinal cord. However, intraoperative frozen section examination showed that the patient had plasma cell myeloma. Our case study suggests that PCM involving a single thoracic and lumbar spine is rare and should be considered as one of the imaging differential diagnoses of hemangiomas. Moreover, the diagnosis of PCM is difficult when the number of lesions is small, especially when the plasma cell ratio is within the normal reference range in laboratory tests.

Review of Mass-Forming Intrahepatic Cholangiocarcinoma

The incidence of intrahepatic cholangiocarcinoma (iCCA) is highest in Eastern countries, such as Thailand, South Korea, and China, but its incidence and mortality are increasing worldwide. Over recent decades, the worldwide age-standardized incidence for iCCA has been steadily increasing, whereas that for perihilar CCA and distal CCA has been decreasing. The macroscopic growth pattern of CCA is somewhat different according to the anatomic location of the tumor. iCCA can show three main patterns of growth: mass forming, periductal infiltrating, and intraductal growing. Morphologic classification is important to understand the mode of tumor spread, which is critical in predicting a tumor’s resectability and in planning the extent of surgery. Furthermore, different macroscopic growth types are resulting in different imaging findings and different list of differential diagnosis. This review provides a comprehensive and critical overview of current knowledge and what is envisaged on the horizon for iCCA, focusing on mas-forming type. 1. Tumor growth pattern 2. Histological subtype of iCCA 3. Imaging phenotype and differential diagnosis of iCCA 4. Staging of iCCA 5. Preoperative prognostic prediction of iCCA

Clinical experience and treatment strategy of leiomyosarcoma originating from the renal vein

BackgroundLeiomyosarcoma originating from the renal vein (RVLMS) is extremely rare. RVLMS lacks specific clinical manifestations and specific imaging features. This article discusses the epidemiological characteristics and diagnostic difficulties of RVLMS, as well as imaging features, differential diagnosis, treatment strategy, and prognostic factors of this disease.MethodA case of RVLMS at our center, and 55 cases from the literature based on the PubMed search.ResultsTotal operation time was 224 min, and total blood loss during the surgery was 200 ml. Resected tumor was irregular in shape, with negative margins. On the 6th day after the operation, the drainage tube was removed, and the patient was discharged from the hospital. Postoperative pathological results confirmed the renal vein leiomyosarcoma: spindle cell sarcoma, diffuse severe atypia, S-100 (-), SMA ( +), desmin ( +), CD34 (−), CD99 ( +). Twenty-seven months after the surgery, the patient is alive, and without local recurrence or distant metastases.ConclusionUnspecific clinical manifestations and imaging features make the diagnosis of RVLMS difficult. Most patients are diagnosed intra-operatively or following postoperative pathology. Differential diagnosis with paraganglioma (PG) and retroperitoneal sarcoma (RPS) should be made. Early and complete resection is considered as the first choice of treatment, and whether to preserve the kidney is based on the patient's condition. RVLMS is highly malignant, and may recur locally or metastasize to distant locations; therefore, adjuvant therapy and regular follow-up should be carried out after surgery.

Radiologic Diagnosis and Staging of Bladder Cancer: An Update.

Although cystoscopic biopsy is the standard of care for initial diagnosis and local staging of bladder cancer, radiologic imaging plays a major role in identifying local invasion, nodal status, distant metastasis, and posttreatment surveillance. Recent development of the Vesical Imaging-Reporting and Data System for interpretation of multiparametric magnetic resonance imaging of the bladder has expanded the role diagnostic imaging in the management of bladder cancer. This article reviews multimodality imaging appearances, staging, and differential diagnosis of bladder cancer.

Chronic Thromboembolic Pulmonary Hypertension Presented with Dyspnea on Exertion: A Case Report

<p>慢性血栓栓塞性肺高壓是一種罕見、嚴重且持續惡化的肺部血管性疾病，隨病程進展，致死率極高，儘早鑑別診斷，方能提供準確治療計劃。本文是一位67歲女性案例，因活動呼吸喘就醫， 初步臆斷為心臟衰竭合併急性惡化，入院後藉由病史詢問、檢驗及理學檢查結果顯示BNP持續上升且心電圖呈現S1Q3T3，初步懷疑可能有肺栓塞併心衰竭，故安排心臟超音波檢查，結果發現有肺動脈高壓（肺動脈壓：62.3 mmHg）與右心衰竭，安排胸部電腦斷層攝影，顯示肺動脈栓塞，隨即召開家庭會議解釋病情後，接受右心導管合併肺動脈血管攝影檢查，最終確診為遠端型慢性血栓栓塞性肺高壓併右心衰竭。經由醫療團隊評估後，治療計劃即以藥物為主，故協助申請標靶藥物Riociguat。針對此類病人，即便臨床表徵不具特異性，仍可依病史詢問、檢驗及理學檢查預測肺栓塞的可能性，之後進入影像學鑑別診斷。換言之，雖然慢性血栓栓塞性肺高壓有其高致命的危險性，倘若能及早做出診斷與治療，便能降低死亡風險。</p> <p> </p><p>Chronic thromboembolic pulmonary hypertension is a rare, severe and continuous deterioration of pulmonary vascular disease which has high mortality rate along with disease progression. Earlier di­agnosis could contribute to a more accurate treatment plan. A case of 67-year-old female was admitted to hospital because of exertional dyspnea. She was initially suffering from heart failure with acute deterioration. After admission, the results of medical history inquiry, laboratory data and physical ex­amination revealed that BNP level kept raising and the electrocardiogram showed S1Q3T3, which pul­monary embolism with heart failure was suspected. Therefore, echocardiography revealed pulmonary hypertension (pulmonary artery pressure: 62.3 mmHg) and right heart failure. Pulmonary embolism was noticed on chest computed tomography. Soon after the family meeting of medical condition dis­cussion, the patient received right heart catheterization combined with pulmonary artery angiography, and the final diagnosed is distal chronic thromboembolic pulmonary hypertension with right heart failure. After medical team’s assessment, the treatment plan was based on armaceutical control. Thus, the target therapy of Riociguat was performed. For such type of patients, even with non-specific symptoms, the possibility of pulmonary embolism can still be predicted based on medical history, lab­oratory data, physical examination, and the imaging differential diagnosis. If diagnosis and treatment can be conducted as early as possible, the high mortality rate of chronic hromboembolic pulmonary hypertension can be reduced.</p> <p> </p>

A Systematic Review of the Current Status and Quality of Radiomics for Glioma Differential Diagnosis.

Simple SummaryGliomas can be difficult to discern clinically and radiologically from other brain lesions (either neoplastic or non-neoplastic) since their clinical manifestations as well as preoperative imaging features often overlap and appear misleading. Radiomics could be extremely helpful for non-invasive glioma differential diagnosis (DDx). However, implementation in clinical practice is still distant and concerns have been raised regarding the methodological quality of radiomic studies. In this context, we aimed to summarize the current status and quality of radiomic studies concerning glioma DDx in a systematic review. In total, 42 studies were selected and examined in our work. Our study revealed that, despite promising and encouraging results, current studies on radiomics for glioma DDx still lack the quality required to allow its introduction into clinical practice. This work could provide new insights and help to reach a consensus on the use of the radiomic approach for glioma DDx.Radiomics is a promising tool that may increase the value of imaging in differential diagnosis (DDx) of glioma. However, implementation in clinical practice is still distant and concerns have been raised regarding the methodological quality of radiomic studies. Therefore, we aimed to systematically review the current status of radiomic studies concerning glioma DDx, also using the radiomics quality score (RQS) to assess the quality of the methodology used in each study. A systematic literature search was performed to identify original articles focused on the use of radiomics for glioma DDx from 2015. Methodological quality was assessed using the RQS tool. Spearman’s correlation (ρ) analysis was performed to explore whether RQS was correlated with journal metrics and the characteristics of the studies. Finally, 42 articles were selected for the systematic qualitative analysis. Selected articles were grouped and summarized in terms of those on DDx between glioma and primary central nervous system lymphoma, those aiming at differentiating glioma from brain metastases, and those based on DDx of glioma and other brain diseases. Median RQS was 8.71 out 36, with a mean RQS of all studies of 24.21%. Our study revealed that, despite promising and encouraging results, current studies on radiomics for glioma DDx still lack the quality required to allow its introduction into clinical practice. This work could provide new insights and help to reach a consensus on the use of the radiomic approach for glioma DDx.

Pleomorphic adenoma with lipomatous metaplasia: a case report.

Pleomorphic adenoma with lipomatous metaplasia is a rare type of pleomorphic adenoma. This paper reports a case of pleomorphic adenoma with lipogenesis. A 28-year-old female patient presented with a mass in front of the left ear for more than 2 years, accompanied by pain. Computed tomography and B-ultrasound examinations suggest the possibility of pleomorphic adenoma. Postoperative pathological results revealed a pleomorphic adenoma with lipomatous metaplasia, and fat accounted for 60% of the tumor. Basing on the literature, we discussed the naming of this tumor and systematically summarized its imaging manifestations, clinicopathological features, differential diagnosis, and treatment.

Ovarian fibromatosis: “The black garland sign”

The main objective in the imaging differential diagnosis of an ovarian mass is to establish whether it is cystic or solid; solid lesions are less common. Ovarian fibromatosis is a benign disease of the ovary that is rarely included in the differential diagnosis of solid ovarian lesions. Characteristic features of masses that have a fibrous component are low signal in T1-weighted MRI sequences and especially in T2-weighted MRI sequences. The presence of peripheral fibrotic tissue around the residual ovarian tissue is specific to ovarian fibromatosis; on MRI, this results in marked hypointensity on T2-weighted images that has been dubbed the “black garland sign”. This sign, together with slight peripheral enhancement after the administration of contrast material and the preservation of the ovarian architecture, facilitates the diagnosis, making it possible to avoid unnecessary surgical interventions.

Neuroimaging Pearls from the MDS Congress Video Challenge. Part 1: Genetic Disorders.

We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video Challenge for this review. While the event, as implicated by its name, was video-centered, we would like to emphasize the important role of imaging in making the correct diagnosis. We divided this anthology into two parts: genetic and acquired disorders. Genetic cases described herein were organized by the inheritance pattern and the focus was put on the imaging findings and differential diagnoses. Despite the overlapping phenotypes, certain described disorders have pathognomonic MRI brain findings that would provide either the "spot" diagnosis or result in further investigations leading to the diagnosis. Despite this, the diagnosis is often challenging with a broad differential diagnosis, and hallmark findings may be present for only a limited time.

Systematic review and meta-analysis of imaging differential diagnosis of benign and malignant ovarian tumors.

With the increasing incidence of gynecological ovarian tumors, the differential diagnosis of benign and malignant ovarian tumors is of great significance for subsequent treatment. Currently, ovarian examinations commonly use computed tomography (CT) or magnetic resonance imaging (MRI). This study sought to compare the value of CT and MRI in differentiating between benign and malignant ovarian tumors. The PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and Weipu databases were searched for published articles using the following terms "CT" or "Computed Tomography" or "MRI" or "Magnetic Resonance imaging" and "ovarian cancer" or "ovarian tumor" or "ovarian neoplasm" or "adnexal mass" or "adnexal lesion". The articles were screened and the data were extracted based on the inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies-2 recommended by the Cochrane Collaboration was used to assess the methodological quality of the included studies, and the network meta-analysis was performed by Stata 15.0. The results showed that the overall sensitivity and specificity of CT were 0.79 [95% confidence intervals (CI): 0.70-0.87] and 0.87 (95% CI: 0.80-0.92), respectively. The overall sensitivity and specificity of MRI were 0.94 (95% CI: 0.91-0.95) and 0.91 (95% CI: 0.90-0.93), respectively. The area under the curve of the CT and MRI summary receiver operating characteristics were 0.9016 and 0.9764, respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CT were 5.26 (95% CI: 2.78-9.93), 0.26 (95% CI: 0.13-0.50), and 22.19 (95% CI: 7.54-65.30), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of MRI were 8.69 (95% CI: 5.06-14.92), 0.07 (95% CI: 0.04-0.13), and 146.19 (95% CI: 68.88-310.24), respectively. Compared to CT, MRI has a stronger ability to differentiate between benign and malignant ovarian tumors. It's a promising non-radiological imaging technique and a more favorable choice for patients with ovarian tumors. However, in the future, large-sample, multi-center prospective studies need to be conducted to compare the performance of MRI and CT in distinguishing between benign and malignant ovarian tumors.

Non-invasive preoperative imaging differential diagnosis of pineal region tumor: A novel developed and validated multiparametric MRI-based clinicoradiomic model

BackgroundPreoperative differential diagnosis of pineal region tumor can greatly assist clinical decision-making and avoid economic costs and complications caused by unnecessary radiotherapy or invasive procedures. The present study was performed to pre-operatively distinguish pineal region germinoma and pinealoblastoma using a clinicoradiomic model by incorporating radiomic and clinical features. Methods134 pineal region tumor patients (germinoma, 69; pinealoblastoma, 65) with complete clinic-radiological and histopathological data from Tiantan hospital were retrospectively reviewed and randomly assigned to training and validation sets. Radiomic features were extracted from MR images, then the elastic net and recursive feature elimination algorithms were applied to select radiomic features for constructing a fusion radiomic model. Subsequently, multivariable logistic regression analysis was used to select the clinical features, and a clinicoradiomic model incorporating the fusion radiomic model and selected clinical features was constructed for individual predictions. The calibration, discriminating capacity, and clinical usefulness were also evaluated. ResultsSeven significant radiomic features were selected to construct a fusion radiomic model that achieved an area under the curve (AUC) value of 0.920 and 0.880 in the training and validation sets, respectively. A clinicoradiomic model that incorporated the radiomic model and four selected clinical features was constructed and showed good discrimination and calibration, with an AUC of 0.950 in the training set and 0.940 in the validation set. The analysis of the decision curve showed that the radiomic model and clinicoradiomic model were clinically useful for patients with pineal region tumor. ConclusionsOur clinicoradiomic model showed great performance and high sensitivity in the differential diagnosis of germinoma and pinealoblastoma, and could contribute to non-invasive development of individualized diagnosis and treatment of patients with pineal region tumor.

Non-Invasive Preoperative Imaging Differential Diagnosis of Intracranial Hemangiopericytoma and Angiomatous Meningioma: A Novel Developed and Validated Multiparametric MRI-Based Clini-Radiomic Model.

BackgroundAccurate preoperative differentiation of intracranial hemangiopericytoma and angiomatous meningioma can greatly assist operation plan making and prognosis prediction. In this study, a clini-radiomic model combining radiomic and clinical features was used to distinguish intracranial hemangiopericytoma and hemangioma meningioma preoperatively.MethodsA total of 147 patients with intracranial hemangiopericytoma and 73 patients with angiomatous meningioma from the Tiantan Hospital were retrospectively reviewed and randomly assigned to training and validation sets. Radiomic features were extracted from MR images, the elastic net and recursive feature elimination algorithms were applied to select radiomic features for constructing a fusion radiomic model. Subsequently, multivariable logistic regression analysis was used to construct a clinical model, then a clini-radiomic model incorporating the fusion radiomic model and clinical features was constructed for individual predictions. The calibration, discriminating capacity, and clinical usefulness were also evaluated.ResultsSix significant radiomic features were selected to construct a fusion radiomic model that achieved an area under the curve (AUC) value of 0.900 and 0.900 in the training and validation sets, respectively. A clini-radiomic model that incorporated the radiomic model and clinical features was constructed and showed good discrimination and calibration, with an AUC of 0.920 in the training set and 0.910 in the validation set. The analysis of the decision curve showed that the fusion radiomic model and clini-radiomic model were clinically useful.ConclusionsOur clini-radiomic model showed great performance and high sensitivity in the differential diagnosis of intracranial hemangiopericytoma and angiomatous meningioma, and could contribute to non-invasive development of individualized diagnosis and treatment for these patients.

Application of CT Imaging in Differential Diagnosis and Nursing of Endocrine Tumors.

In order to investigate the value of preoperative X-ray computed tomography (CT) in predicting the pathological grade of pancreatic neuroendocrine tumors. This paper retrospectively analyzed the CT image examination of pancreatic neuroendocrine tumors, the image characteristics of G-NEC detected by CT image, and the detection of GST by spiral CT. In order to clearly diagnose and evaluate the size and scope of the focus, whether there is adjacent tissue invasion, metastasis, and treatment effect, CT, MR, PET-CT, nuclide specific imaging, and other imaging methods are widely used in the medical treatment of pNEN patients. These imaging methods have the advantages of noninvasive, rapid imaging, objective image medium, and strong repeatability. If the pathological grade of pNEN patients can be obtained by imaging examination before operation, it will be of great benefit to the formulation of treatment strategies and the prediction of clinical outcomes. Combining CT image performance with imaging omics characteristics to establish a prediction model that can develop a better auxiliary decision-making tool for clinical practice. Different pathological grades prompt clinicians to provide personalized and accurate medical treatment for patients, and reduce excessive medical treatment or wrong judgment caused by unclear preoperative diagnostic information.

Pulmonary Heterotopic Ossification Simulating a Pulmonary Hamartoma: Imaging and Pathologic Findings and Differential Diagnosis

Pulmonary Heterotopic Ossification Simulating a Pulmonary Hamartoma: Imaging and Pathologic Findings and Differential Diagnosis

Intravascular papillary endothelial hyperplasia as a rare cause of cervicothoracic spinal cord compression: A case report

BACKGROUNDIntravascular papillary endothelial hyperplasia (IPEH) is a rare benign reactive vascular lesion that grows into an expansile compressing mass. It most commonly involves the skin and subcutaneous tissue. Spinal involvement is rare, with only 11 reported cases in the literature. We report, to our knowledge, the first case of IPEH in the cervicothoracic spinal canal and present a literature review.CASE SUMMARYA 27-year-old man presented with acute-onset neck pain, numbness, and weakness in his extremities. Magnetic resonance imaging showed an epidural mass in the cervicothoracic (C6-T1) spinal canal and vertebral hemangioma (VH) involving the C7 vertebral body. C6-T1 Laminectomy and radical excision of the mass were performed. Histopathological examinations revealed papillary proliferation of vascular endothelial cells with thrombus formation, and an IPEH diagnosis was made. By his 6-mo follow-up appointment, his symptoms were relieved without recurrence. The possible pathogenesis, clinical and imaging features, differential diagnosis, and management of IPEH were reviewed.CONCLUSIONWe report, to our knowledge, the first case of IPEH in the cervicothoracic spinal canal, treated via complete resection, and showing a favorable outcome. We found a causal relationship between spinal IPEH and VH; this partly explains the mechanism of IPEH.

Radiologic Reporting of Simple Hepatic Cyst Versus Biliary Cystadenoma May Lead to Unnecessary Surgery.

Simple liver cyst (SHC) is a benign condition with no malignant potential. They are typically discovered incidentally due to the increased use of abdominal imaging, but some patients may present with abdominal pain. A radiologist's differential diagnosis in cases of SHC will often include "rule out biliary cystadenoma." Under these circumstances, patients and surgeons are more likely to pursue surgical options even in asymptomatic cases. The aim of this study is to conduct a retrospective analysis of presentation, radiologic reporting, management plan, and histopathology of patients referred to a tertiary hospital in order to determine the correlation between radiology and histology. We retrospectively analyzed the clinical, radiological, and histopathological data of 20 patients operated for a diagnosis of a cystic lesion in the liver. The CT/MRI of 6 (30%) patients was reported as a biliary cystadenoma, 13 (65%) were reported as a simple hepatic cyst and 1 patient (5%) had hepatocellular carcinoma (HCC) with the additional diagnosis of multiple hepatic cysts. The lesion reported as HCC on the scan was separate from the cystic lesions. The modality of imaging for these cysts was evenly split, 50% of patients had a CT scan, and 50% had an MRI performed. All imaging studies were interpreted by an attending radiologist and most of them were discussed in multidisciplinary meetings. Nineteen patients (95%) had an intraoperative diagnosis of a simple liver cyst based on its visual appearance and clear fluid within the cyst. These patients underwent cyst wall fenestration and de-roofing with the cyst wall sent for histopathology. One patient (5%) with HCC underwent a non-anatomical liver resection. Histopathology was conclusive for a benign hepatic cystic lesion from the cyst wall biopsy. All 20 patients in this study underwent surgery, either due to symptoms or due to radiologic diagnosis of BCA. Four of the 20 cases (20%) were asymptomatic and out of these four cases, 3 (75%) were diagnosed as cystadenoma on the preoperative imaging studies. All 19 cases were diagnosed as a simple liver cyst on pathology. In summary, there is a growing trend of "ruling-out the diagnosis of biliary cystadenoma" in patients who present with liver cysts. Patients are appropriately more anxious after this preoperative diagnosis and the treating surgeons have medico-legal concerns regarding conservative management in asymptomatic patients diagnosed as BCA. This single center experience draws attention to the radiology criteria utilized for diagnosing a biliary cystadenoma and suggests that it is time to revisit the imaging interpretation and differential diagnosis.

Pachychoroid disease spectrum: review article.

The aim of this article is to do a comprehensive literature review about the current understandings of the pachychoroid disease spectrum, describing its multimodal imaging analysis, pathophysiology, differential diagnosis, and current types of management. This comprehensive literature review was performed based on a search on the PubMed database, of relevant pachychoroid published papers according to our current knowledge. The pachychoroid disease spectrum, according to some authors, includes the following: pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV)/aneurysmal type 1 neovascularization (AT1), and more recently focal choroidal excavation (FCE) and peripapillary pachychoroid syndrome (PPS). Each one of these entities will be described and discussed in this article. Significant advances in multimodal imaging have enabled a better understanding of the typical choroidal changes in pachychoroid disease spectrum. The clinical knowledge and managing options about this disease significantly increased in the last years. However, it is still unclear why some eyes with typical pachychoroid disease phenotype show no evidence of RPE damage and subretinal fluid (uncomplicated pachychoroid) while others present progressive tissue damage, neovascularization, and atrophy.

Juvenile psammomatoid ossifying fibroma with fluid\u2013fluid levels: an unusual presentation

BackgroundJuvenile ossifying fibroma is an uncommon benign fibro-osseous tumor commonly involving the craniofacial skeleton of young patients with locally aggressive behavior and a high recurrence rate. Depending on the site of involvement it can present clinically as nasal obstruction, facial swelling, or proptosis.Case presentationHere we present a case of juvenile ossifying fibroma with an aneurysmal bone cyst component in the left nasal cavity in a 15-year-old boy who presented with gradually progressing left-sided nasal obstruction. Imaging findings were consistent with juvenile ossifying fibroma. Endoscopic resection of the tumor was done, and histopathological examination revealed it to be a psammomatoid variant of juvenile ossifying fibroma. Here we discuss its imaging findings, differential diagnosis, treatment options, and histopathological features.ConclusionDespite being a slow-growing benign tumor, early diagnosis and treatment are necessary due to its locally aggressive nature and invasion of adjacent structures. Complete surgical resection is the mainstay of treatment because of the high recurrence rate.