Reports in Medical Imaging

Serena Cocca,1 Giulia Mignacco,2 Marco Mandalà,2 Caterina Giannitto,3 Andrea Alessandro Esposito,4 Simone Porcino2 1Department of Ear Nose Throat, Ospedale Misericordia, Grosseto, GR, 58100, Italy; 2Department of Ear Nose Throat, AOUS “S.Maria alle Scotte”-University Hospital of Siena, Siena, SI, 53100, Italy; 3Department of Radiology, Istituto Clinico Humanitas, Rozzano, MI, 20089, Italy; 4Department of Radiology, ASST Bergamo Ovest- Ospedale “Treviglio-Caravaggio”, Treviglio, BG, 24047, ItalyCorrespondence: Serena CoccaDepartment of Ear Nose Throat, Ospedale Misericordia, Via Senese 161, Grosseto, 58100, ItalyTel +39 3201525334Fax +39 0577585470Email serena.cocca@gmail.comAndrea Alessandro EspositoDepartment of Radiology, ASST Bergamo Ovest- Ospedale “Treviglio-Caravaggio”, P.le Ospedale 1, Treviglio, 24047, BG, ItalyTel +39 3475476654Email andrea_esposito@asst-bgovest.itAbstract: Third window lesions are defined as abnormal communications of the inner ear with adjacent spaces, namely the middle ear or cranial cavity. These lesions can occur at multiple anatomic locations, including the superior, posterior, and lateral semicircular canals; vestibule and vestibular aqueduct; and scala vestibuli of the cochlea. Semicircular canal dehiscence (SCD) is the most common condition wherein the temporal bone adjacent to the vestibular apparatus thins or is interrupted completely. Normally, there are two mobile windows: the oval window and round window. SCD results in a third mobile window in the inner ear, which causes an abnormal transmission of acoustic energy (“third-window effect”) towards the vestibular end-organs and causes symptoms. Superior SCD is a well-described pathological condition with potentially debilitating symptoms, instead the dehiscence of the posterior canal is very rare. The diagnosis is difficult and often delayed because the symptoms can be absent or aspecific and confused with other diseases: vestibular disorders, cerebrovascular diseases, trauma, and tumors. We report a rare case about a “double” third window syndrome of twin sisters due to a bone defect of two different semicircular canals. A 34-year-old woman presented to the Otology Department of University Hospital with a worsening of tinnitus, autophony and vertigo. She had been treated for 3 years as if affected to Menière disease. An audiometric exam revealed a right mixed hearing loss with 20– 40 dB air bone gap from 250 to 4000 Hz. Vestibular examinations are unchanged compared to the past exams. But Valsalva maneuver induced pathological oscillopsia, vertigo and torsional up-beating nystagmus. Clinical manifestations may be like other diseases, such as Menière disease or perilymphatic fistula, confounding the diagnosis. Moreover, the appearance of the same symptoms in the patient’s twin sister, confirmed by the radiological investigation, suggested the familiarity for semicircular canal dehiscence. Audiometric and vestibular examinations are important even if diagnosis is impossible without radiological investigation. Indeed, we describe the history, clinical profile and management of twin sisters who had similar symptoms (worsening vertigo induced by pressure, autophony, tinnitus and hearing loss) and different bony labyrinth defects. Surgical management resulted in complete resolution in imbalance 3 months after the surgery. This surprising case of homozygous twin sisters suggests that there may be a genetic aspect to the disease.Keywords: vertigo, tinnitus, semicircular canals, hearing loss, dehiscence, third window

Steven Magera,1 Senai Goitom Sereke,1 Emmy Okello,2 Faith Ameda,1 Geoffrey Erem1 1Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Cardiology, Uganda Heart Institute, Kampala, UgandaCorrespondence: Steven Magera; Senai Goitom Sereke, Email magerasteven4@gmail.com; nayhersen@gmail.comBackground: The burden of cardiovascular diseases, such as aortic and degenerative diseases, grows in the aging population. Chest radiograph still plays an important role in the diagnosis of cardiovascular diseases. Aortic knob diameter in chest radiographs can be used to evaluate early changes of the aortic structure and together with clinical and laboratory findings. This study was aimed at determining the mean values of aortic knob diameter among healthy adults in Uganda.Methods: We conducted a descriptive cross-sectional study in three selected hospitals in Kampala Uganda. All participants had normal chest radiographs without radiological evidence of cardiovascular disease. Chest radiograph findings extracted included aortic knob diameter, aortic arch diameter, transverse heart diameter, and transverse thoracic diameter. All films were independently examined by two experienced radiologists.Results: We analyzed chest radiograph findings of 294 participants, of which 204 (69.4%) were male. Aortic knob diameter increased with age (p – 0.000). The mean aortic knob diameter of males was higher than for females (3.14± 0.34cm versus 2.77± 0.37cm, p – 0.000). The mean aortic knob diameter on the digital screen was higher than plain films (3.03± 0.393cm versus 2.96± 0.392cm, p – 0.000). Aortic knob diameter positively correlated with age (p – 0.000) and aortic arch diameter (p – 0.000). Aortic knob diameter also correlated positively with a transverse thoracic diameter (p – 0.05), transverse heart diameter (p – 0.05), and cardiothoracic ratios (p – 0.05).Conclusion: The aortic knob diameter was higher in males and there was a positive correlation with age, aortic arch diameter, transverse heart diameter, and transverse thoracic diameter. Aortic knob diameter measurements should be done on digital rather than printed x-ray films.Keywords: aortic knob, diameter, chest radiograph, cardiovascular, Uganda

Giulia Lastella,1 Andrea Esposito,2 Alice Scarabelli,3 Guido Giovanni Plensich,3 Elvira Stellato,3 Emanuele Avola,3 Caterina Giannitto,4 Massimo Castellani,5 Marco Cuzzocrea,6 Luca Bonomo,7 Gianpaolo Carrafiello5 1Unit of Radiology, Ospedale Città di Sesto San Giovanni, ASST Nord Milano, Sesto San Giovanni, Italy; 2Unit of Radiology, Ospedale Treviglio-Caravaggio, ASST Bergamo Ovest, Treviglio, Italy; 3Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy; 4Unit of Radiology, Istituto Clinico Humanitas, Rozzano, Italy; 5Unit of Nuclear Medicine, IRCCS Fondazione Cà Granda, Maggiore Policlinico Hospital, Milan, Italy; 6Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 7Clinica di Radiologia, Ente Ospedaliero Cantonale, Lugano, SwitzerlandCorrespondence: Andrea Esposito, Unit of Radiology, Ospedale Treviglio-Caravaggio, ASST Bergamo Ovest, Treviglio, Italy, Tel +393475476654, Email andrea_esposito@asst-bgovest.itPurpose: To compare the diagnostic performance of lung perfusion colormaps derived from computed tomography pulmonary angiography (cmCTPA) by novel semi-automatic post-processing software, with lung perfusion scintigraphy (LPS), for detection of lung perfusion defects (LPDs) in pulmonary embolism (PE).Patients and Methods: Consecutive patients from January 2016 to April 2020 who underwent both computed tomography pulmonary angiography (CTPA) and LPS within 7 days of each other, to rule out PE, were retrospectively enrolled. cmCTPA images were obtained from CTPA images using semi-automatic post-processing software (Pulmonary Artery Analysis, Intellispace Portal Release 11, Philips). The diagnosis of LPD was assessed on LPS images by two nuclear medicine physicians in consensus; CTPA and cmCTPA images were evaluated by two radiologists in consensus, blind to the LPS results. The spatial location of the LPD was assessed according to Boyden’s nomenclature. Agreement between LPS and cmCTPA in the diagnosis of LPD was tested using Cohen’s kappa.Results: Fifty-three patients were enrolled. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of cmCTPA were, respectively, 100%, 40%, 73%, and 100%; disease prevalence was 67%, accuracy was 77%, and positive and negative likelihood ratios were 1.67 and 0, respectively. An almost perfect agreement was found between cmCPTA and LPS in 13 segments (72%) and a substantial agreement was found in the remaining five segments (28%).Conclusion: cmCTPA, owing to its NPV (100%) and its overall high agreement in the number and location of LPDs compared to LPS, may have an upcoming role in the evaluation of lung perfusion in PE.Keywords: nuclear medicine, pulmonary embolism, perfusion imaging, computed tomography angiography, image processing, computer-assisted

Background: Magnetic field inhomogeneity in magnetic resonance imaging (MRI) is caused by the inherent properties of the main magnet, external ferromagnetic components surrounding the magnet, and the patient itself.Significant deviations from magnetic field inhomogeneity can create artifacts in MRI images, thereby compromising image quality.Optimizing magnetic field homogeneity improves image quality and helps to reduce artifacts.The goal of this article therefore is to help radiographers and operators of MRI understand the clinical basis of magnetic field inhomogeneity and its effects on MR images.This would assist them to appreciate the trade-offs between sequence parameters and image quality metrics towards optimizing magnetic field inhomogeneity.Methods: A narrative literature review was conducted from relevant databases using search terms such as MRI, magnetic field inhomogeneity, optimization, magnetic field inhomogeneity artifacts, and MRI shimming.Results: Minimizing field inhomogeneities in MRI is not straightforward but involves a multitude of factors and steps.Magnetic field homogeneity could be optimized to improve MR image quality by choosing the most appropriate pulse sequence/imaging parameters that could best minimize distortion and increase SNR based on the anatomical region of interest (or tissue types) while complementing it with shimming and use of dielectric pads.Conclusion: Future works to investigate the association between the MRI pulse sequence parameters and measurements of MR image quality metrics, based on individual tissue densities, could provide a new window for reducing magnetic field inhomogeneity due to susceptibility and chemical shift effects.

Ali Alghamdi,1 Maaidah Algamdi,2 Khaledah Alatawi,2 Basmah Alghamdi,2 Hana Alanazi,2 Shumukh Alamri,2 Somiah Alamri,2 Zahra Albishi2 1Department of Radiological Sciences, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia; 2Department of Nursing, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi ArabiaCorrespondence: Ali Alghamdi, Department of Radiological Science, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, 47512, Saudi Arabia, Tel +966561587982, Email ah.alghamdi@ut.edu.saBackground: Magnetic resonance imaging (MRI) has become one of the most essential diagnostic medical imaging techniques. The most common disadvantage of MRI is that patients may feel anxious before the examination, which can negatively affect them, prevent them from attending or completing the examinations, and cause patient movement during the examination, which accordingly results in misinterpretation issues. Recently, several methods have been suggested to reduce MRI anxiety. Our study aimed to examine nurses’ roles in reducing the levels of patient anxiety during pre-MRI scans by using informative video.Methods: A cross-sectional and interventional study was conducted among MRI patients in Tabuk City. A convenience sample of 16 patients as the case group and 28 patients as the control group was included. A 2-minute informative video clip containing comprehensive instructions about MRI was recorded by the research team in the MRI room and introduced to patients 30 minutes before the scan in the waiting area. An Arabic version questionnaire (State-Trait Anxiety Inventory) was used to measure the pre-MRI-related anxiety of patients in the case and control groups. State-trait anxiety scores were analyzed and compared between groups. Median pulse, oxygen saturation, and blood pressure were also compared between the cases and control groups using a p-value of 0.05.Results: The state anxiety score was significantly higher in cases compared to controls. However, the trait anxiety score was not significantly different between cases and controls. Females showed significantly higher state anxiety scores in the cases than in the controls. Based on the previous MRI experience, the cases group who had undergone a previous MRI had significantly higher state anxiety scores than those in the control group. Based on the educational degree, cases with bachelor’s degree had higher state anxiety scores than their counterparts in the control group.Conclusion: The present study showed that the self-made visual tool used by nurses 30 minutes before MRI scan did not reduce the level of anxiety significantly in patients. However, state anxiety scores increased in females, patients with previous MRI experience, and patients with a higher educational degree. Healthcare professionals may need to consider the negative effect of informative video before MRI.Keywords: magnetic resonance imaging, MRI, anxiety, nurses’ role, informative video, patient, interventions, STAI-Y

Background The burden of cardiovascular diseases, such as aortic and degenerative diseases grows in the aging population. Chest radiograph still plays an important role in the diagnosis of cardiovascular diseases. Aortic knob diameter in chest radiographs can be used to evaluate early changes of the aortic structure and together with clinical and laboratory findings. This study was aimed at determining the mean values of aortic knob diameter among healthy adults in Uganda. Methods We conducted a descriptive cross-sectional study in three selected hospitals in Kampala Uganda. All participants had normal chest radiographs without radiological evidence of cardiovascular disease. Chest radiograph findings extracted included aortic knob diameter, aortic arch diameter, transverse heart diameter and transverse thoracic diameter. All films were independently examined by two experienced radiologists. Results We analyzed chest radiograph findings of 294 participants, of which 204 (69.4%) were male. Aortic knob diameter increased with age (p – 0.000). The mean aortic knob diameter of males was higher than for females (3.14±0.34cm versus 2.77±0.37cm, p – 0.000). The mean aortic knob diameter on the digital screen were higher than plain films (3.03±0.393cm versus 2.96±0.392cm, p – 0.000). Aortic knob diameter positively correlated with age (p – 0.000) and aortic arch diameter (p – 0.000). Aortic knob diameter also correlated positively with transverse thoracic diameter (p – 0.05), transverse heart diameter (p – 0.05) and cardiothoracic ratios (p – 0.05). Conclusion The aortic knob diameter was higher in males and there was a positive correlation with age, aortic arch diameter, transverse heart diameter and transverse thoracic diameter. Aortic knob diameter measurements should be done on digital screen than printed x ray films.

Osama Jaafari,1 Helen Gallagher,2 Muhammed Alshehri,1 Khalid Hakami,1 Majedh AlShammari1 1Royal Commission Medical Centre, King Fahd, Al-Nakheel, Yanbu, Saudi Arabia; 2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, ScotlandCorrespondence: Osama JaafariRoyal Commission Medical Centre, King Fahd, Al-Nakheel, Yanbu, 46451, Saudi ArabiaTel +966-14-393-7700Fax +966143922483Email jaafario@rcymc.med.saBackground: Stroke is one of the most burdensome neurological conditions affecting young and older adult populations worldwide, and notably it has remained one of the leading causes of disability and premature mortality within its disease category. Timely and accurate diagnosis and characterization of stroke with cross-sectional imaging impacts significantly on treatment planning and patient outcomes, particularly with the advent of early reperfusion therapies. Recently, there has been growing recognition that perfusion-weighted MRI (PW-MRI) may offer a significant advantage in diagnosing and characterizing the ischemia induced by stroke, as it can detect diffusion–perfusion deficits that may influence treatment decisions to prevent infarction. This structured literature review sought to explore the diagnostic utility and accuracy of PW-MRI compared to other MRI protocols.Methods: A literature search was performed using Medline, Embase, and the Cochrane Library, with articles limited to the English language and publication in the last 15 years. Eligible articles were appraised using the QUADAS-2 framework, and given marked interstudy heterogeneity, the diagnostic outcomes were analyzed using a narrative approach.Results: A total of ten studies were reviewed — retrospective and one prospective — and found to observe a moderate–high risk of bias. The studies revealed that PW-MRI offers beneficial diagnostic capabilities when compared to other MRI sequences and ability to detect significant diffusion–perfusion mismatches. However, PW-MRI was found to overestimate the degree of oligemia and ischemia in brain tissue. As ischemia does not always progress to infarction, thrombolytic treatment may be unnecessary in some cases and expose patients to adverse effects.Conclusion: These findings indicate that PW-MRI should be considered for routine imaging as an adjunct to other MRI protocols and an alternative to CT thereby reducing ionizing radiation exposure.Keywords: perfusion–diffusion deficits, cross-sectional diagnostic imaging

Nguyen Ngoc Cuong,1 Pham Hong Canh,1 Le Tuan Linh,1,2 Nguyen Minh Duc,2– 4 Thieu Thi Tra My,1,2 Le Hoan5 1Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Ha Noi, Vietnam; 2Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam; 3Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; 4Department of Radiology, Children’s Hospital 2, Ho Chi Minh City, Vietnam; 5Respiratory Medicine Department, Hanoi Medical University Hospital, Hanoi, VietnamCorrespondence: Le HoanRespiratory Medicine Department, Hanoi Medical University Hospital, Hanoi, VietnamTel +84 372286666Email lehoan.hmu@gmail.comPurpose: This article described intranodal lymphangiography and embolization of patients with lymphatic leak post-operation of the groin region for various aetiologies (lymph node resection, femoral artery exposure).Materials and Methods: A retrospective analysis from 2018 to 2020 was performed and twelve consecutive patients underwent intranodal lymphangiography and intranodal lymphatic embolization to treat lymphorrhea or lymphocele post-operation of the groin. All the lymph nodes around the wound were punctured for lymphangiography. If the extravasation was found from the lymph node, the glue N-butyl cyanoacrylate (NBCA) diluted with lipiodol (ratio of 1:4) was injected to occlude the lymphatic vessel laceration.Results: All the lymph nodes around the wound were punctured with the median number of two lymph nodes for each patient (range from one to four lymph nodes); there were three patients with two leakage points. Intranodal lymphatic embolization was performed by glue NBCA diluted 1:4 with lipiodol. Additional treatment includes sclerotherapy (n=5) and percutaneous muscular flap operation (n=1). Clinical successful was achieved in twelve patients (100%) with no major complications. One patient experienced lymphedema which was was treated by compression stockings and rehabilitation therapy.Conclusion: Intranodal lymphangiography and embolization are effective methods to treat iatrogenic lymphatic leak while all the lymph nodes around the wound should be punctured to avoid missing lesions from other lymphatic vessels.Keywords: intranodal lymphangiography, intranodal lymphatic embolization, groin lymphatic leak, lymphorrhea

Pierino Spadafora,1 Andrea Esposito,2 Caterina Giannitto,3 Letizia Di Meglio,1 Nunzio Paolo Nuzzi,3 Gianpaolo Carrafiello2 1Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, 20122, Italy; 2Foundation IRCCS Ca’ Granda Maggiore Policlinico Hospital, Radiology Department, Milan, Italy; 3Humanitas Research Hospital, Radiology Department, Milan, 20013, ItalyCorrespondence: Pierino SpadaforaPostgraduate School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, Milan, 20122, ItalyEmail pierino.spadafora@unimi.itAndrea EspositoFoundation IRCCS Ca’ Granda Maggiore Policlinico Hospital, Radiology Department, Via F. Sforza 35, Milan, 20122, ItalyEmail andrea.esposito@policlinico.mi.itAbstract: Dysphonia is a frequent and often disabling condition that can be caused by a multitude of circumstances. Differential diagnosis of dysphonia comprehends many different etiologies and many causative agents (neoplasms, inflammations, traumatic injuries) that can occur in a large anatomical space (from the encephalic trunk to the upper mediastinum). It is fundamental to remember that vascular etiologies are responsible for some rare cases of dysphonia. In the radiological database of two urban academic hospitals, from 2012 to 2020, we sought patients who underwent CT or MRI for dysphonia, selecting only the ones with an underlying clinically confirmed vascular etiology. We present three emblematic cases with different vascular etiologies: a ductus arteriosus aneurysm, a left internal carotid artery dilatation, a laryngeal arteriovenous malformation (AVM). Vascular causes of dysphonia are rare, but especially in these cases an accurate and prompt diagnosis is fundamental, in particular considering that the underlying cardiovascular anomaly can often pose a higher risk for the patient than the hoarseness itself. Diagnostic imaging plays a fundamental role in detecting the most common causes of dysphonia but it is very important that radiologists take the vascular causes into account so as not to miss them and to obtain a correct diagnosis.Keywords: dysphonia, thoracic aorta, arteriovenous malformation, carotid artery, patent ductus arteriosus

Huu Kien Pham,1,2 Tai Thanh Tran,2 Thanh Van Nguyen,2 Truc Thanh Thai3 1Department of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; 2Department of Otolaryngology – Head and Neck Surgery, University Medical Center, Ho Chi Minh City, Vietnam; 3Department of Medical Statistics and Informatics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VietnamCorrespondence: Truc Thanh ThaiDepartment of Medical Statistics and Informatics, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, VietnamTel +84 908 381 266Email thaithanhtruc@ump.edu.vnBackground: This study explored the prevalence of frontal cells and the relationship between different types of frontal cells classified using the International Frontal Sinus Anatomy Classification (IFAC) and frontal sinusitis.Methods: A retrospective cross-sectional study was conducted with 1006 CT scans of paranasal sinuses. Identification of frontal sinus cells was based on IFAC. The scans were classified into no frontal sinusitis, frontal sinusitis, isolated frontal sinusitis, no sinusitis.Results: Agger nasi cells were the most common (91.9%). The prevalence of supra agger cell (SAC) was 28.7%, while the supra agger frontal cell (SAFC) was only 15.8%, the supra bulla cell (SBC) was 59.7%, the supra bulla frontal cell (SBFC) was 25.8%. Supra orbital ethmoid cell (SOEC) and frontal septal cell (FSC) were identified in 6.9% and 14.3% of the cases, respectively. Patients with SAFCs and SBFCs were significantly more likely to develop frontal sinusitis (Odds Ratio (OR)=1.78, 95% confidence interval (CI) 1.24– 2.56 and OR=2.70, 95% CI 1.98– 3.66). Isolated frontal sinusitis was found in 10 scans and was associated with the presence of SAC (OR=3.76, 95% CI 1.02– 13.90).Conclusion: In Vietnamese adult patients, frontal cells based on IFAC were prevalent and were associated with frontal sinusitis development, including isolated frontal sinusitis.Keywords: International Frontal Sinus Anatomy Classification, frontal sinusitis, frontal cells, multiplanar computed tomographic analysis

Silvia Tortora,1 Andrea Esposito,2 Gianmarco Della Pepa,1 Michele Paternò,1 Giulia Anna Cagnoli,3 Claudia Cesaretti,3 Federica Natacci,3 Gianpaolo Carrafiello2 1School of Diagnostic and Interventional Radiology, University of Milan, Milan, 20122, Italy; 2Radiology Department, Foundation IRCCS Ca’ Granda Maggiore Policlinico Hospital, Milan, 20122, Italy; 3Medical Genetics Unit, Woman-Child-Newborn Department, Foundation IRCCS Ca’ Granda Maggiore Policlinico Hospital, Milan, 20122, ItalyCorrespondence: Silvia TortoraSchool of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, Milan, 20122, ItalyEmail silvia.tortora@unimi.itAndrea EspositoRadiology Department, Foundation IRCCS Ca’ Granda Maggiore Policlinico Hospital, Via F. Sforza 35, Milan, 20122, ItalyEmail andrea.esposito@policlinico.mi.itAbstract: Neurofibromatosis type 1 (NF1) is an autosomal dominant disease caused by the mutation of the tumour suppressor gene NF1 located on chromosome 17q11.2, occurring in approximately 1 in 2000– 2500 people. The diagnosis of NF1 is made according to the presence of two or more diagnostic criteria of the National Institute of Health Consensus Development Conference. We present six cases of NF1 with neck and thoraco-abdominal involvement that we studied with MRI. The patients we present in this case series are asymptomatic and have in common the presence of multiple neurofibromas ubiquitously distributed in various body districts, including nerve roots, mediastinum, abdominal cavity, skin and subcutaneous tissue. Currently, there are no clear indications on the use of imaging in the diagnosis and follow-up of patients with NF1, although there is increasing evidence of the usefulness of imaging techniques and in particular of MRI. MRI with DWI and ADC mapping is a technique that should be proposed as a new standard of care for patients with NF1 since it can be used to distinguish a benign from a malignant tumour in relation to tumour size and ADC map values.Keywords: neurofibromatosis 1, neurofibroma, plexiform neurofibroma, nerve sheath tumour, magnetic resonance imaging

Purpose: To determine the performance of a chest radiograph (CXR) severity scoring system combined with clinical and laboratory data in predicting the outcome of COVID-19 patients Materials and Methods: We retrospectively enrolled 301 patients who had reverse transcriptase-polymerase chain reaction (RT-PCR) positive results for COVID-19 CXRs, clinical and laboratory data were collected A CXR severity scoring system based on a qualitative evaluation by two expert thoracic radiologists was defined Based on the clinical outcome, the patients were divided into two classes: moderate/mild (patients who did not die or were not intubated) and severe (patients who were intubated and/or died) ROC curve analysis was applied to identify the cut-off point maximizing the Youden index in the prediction of the outcome Clinical and laboratory data were analyzed through Boruta and Random Forest classifiers Results: The agreement between the two radiologist scores was substantial (kappa = 0 76) A radiological score ≥ 9 predicted a severe class: sensitivity = 0 67, specificity = 0 58, accuracy = 0 61, PPV = 0 40, NPV = 0 81, F1 score = 0 50, AUC = 0 65 Such performance was improved to sensitivity = 0 80, specificity = 0 86, accuracy = 0 84, PPV = 0 73, NPV = 0 90, F1 score = 0 76, AUC= 0 82, combining two clinical variables (oxygen saturation [SpO2]), the ratio of arterial oxygen partial pressure to fractional inspired oxygen [P/F ratio] and three laboratory test results (C-reactive protein, lymphocytes [%], hemoglobin) Conclusion: Our CXR severity score assigned by the two radiologists, who read the CXRs combined with some specific clinical data and laboratory results, has the potential role in predicting the outcome of COVID-19 patients

Abdi Dandena,1 Samuel Sisay,1 Abebe Mekonnen,1 Kalkidan Beza2 1Department of Radiology, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Abdi Dibaba Tel +251 921566429Email abdidandena.add@gmail.comAbstract: In this paper, we will describe a week old neonate who was referred to Black Lion Referral Hospital with a diagnosis of ambiguous genitalia and was screened for associated congenital anomalies. The neonate was evaluated with Trans-fontanel Ultrasound and Brain MRI, which showed the absence of the lateral and third ventricles and associated Intracranial multiple anomalies.Keywords: brain malformations, aventriculy, rhomboencephalosynapsis, holoprosencephaly

Caterina Giannitto,1 Giuseppe Mercante,2,3 Giuseppe Spriano,2,3 Rossella Natoli,4 Francesca Gaino,2 Ludovica Lofino,1 Andrea Alessandro Esposito,5 Nino Giannitto,6 Giulia Vatteroni,1 Barbara Fiamengo,7 Antonello Vidiri,8 Letterio Salvatore Politi,1,3,* Luca Balzarini1,* 1Department of Diagnostic Radiology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy; 2Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Milan, Italy; 3Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; 4University of Milano-Bicocca, Milan, Italy; 5Department of Diagnostic Radiology, Foundation I.R.C.C.S Ca’ Granda Ospedale Maggiore Policlinico Hospital, Milan, Italy; 6Department of Pediatric Sciences, University of Messina, Messina, Italy; 7Pathology Unit, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Milan, Italy; 8Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy*These authors contributed equally to this workCorrespondence: Caterina GiannittoDepartment of Diagnostic Radiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, Milan, 20089, ItalyTel +39282247529Email caterina.giannitto@humanitas.itAndrea Alessandro EspositoDepartment of Diagnostic Radiology Foundation I.R.C.C.S Ca’ Granda Ospedale Maggiore Policlinico Milano, Via F. Sforza 35, Milan, 20121, ItalyTel +393475476654Email andrea.esposito@policlinico.mi.itBackground: Masson’s tumor (MT) is a rare benign vascular disease. In literature, detailed description of its radiological findings is not available and functional imaging such as diffusion weighted (DW)-MRI has never been described. We aim to summarize the CT and MRI findings in our representative case and to conduct a systematic review of the literature.Case Presentation: We reported a 54-year-old ex-smoker male patient who presented with a nodular mass to the left cheek. He denied any previous trauma. CT examination performed on initial presentation revealed a well circumscribed solid oval mass with soft tissue density, a calcified focus and no significative contrast enhancement after contrast administration. MRI showed a well circumscribed solid oval mass, with intermediate T2 signal intensity with areas of high T2 signal intensity and the presence of peripheral high-flow serpentine vessels, low T1 signal intensity. The mass showed a non-enhancing area with enhancing vessels after intravenous contrast administration. We surveyed CT and MRI findings of head and neck MT of English and French language papers, published from 1981 to 2019, together with our representative case. We included articles with a description of CT and/or MRI findings of head and neck MT.Conclusion: We have experienced one case and have evaluated imaging findings through systematic review. Only 36 articles were eligible. CT and MRI findings were reported in 27 and 23 articles, respectively. To date, no diffusion weighted imaging (DWI)-MRI findings have been described. The most frequent findings in CT were a well-defined mass with high or soft tissue density. The most frequent MRI findings were a non-homogeneous signal intensity in T1 and T2 weighted sequences, with foci of hyperintensity, multiple septations or flow voids. After contrast administration, the enhancement could be homogeneous, non-homogeneous, nodular or peripheral. In our case, we found a non-homogeneous hyperintensity in DWI-MRI with an area of restricted diffusion and low apparent diffusion coefficient (ADC) was observed (0.963 × 10− 3 mm2/s +\-0.12 SD). The imaging characteristics cannot provide a pre-operative identikit of MT and surgical removal is necessary to accurately differentiate it from malignant angiosarcoma but radiological evaluation is useful in surgical planning.Keywords: Masson’s tumor, case report, computed tomography, magnetic resonance imaging, diffusion weighted imaging

Swati Goyal Department of Radiodiagnosis, Government Medical College & Hospital, Bhopal, Madhya Pradesh, IndiaCorrespondence: Swati Goyal D/16 Upant Colony, Bhopal, Madhya Pradesh, 462016 Tel +91 9424427774Email swati_97in@yahoo.comAbstract: This review article aims to discuss current trends, techniques, and promising uses of artificial intelligence (AI) in breast imaging, apart from the pitfalls that may hinder its progress. It includes only the commonly used and basic terminology imperative for physicians to know. AI is not just a computerized approach but an interface between humans and machines. Apart from reducing workload and improved diagnostic accuracy, radiologists get more time for patient care or clinical work by using various machine learning techniques that augment their productivity. Inadequate data input with suboptimal pattern recognition, data extraction challenges, legal implications, and exorbitant costs are a few pitfalls that AI algorithms still face while analyzing and giving appropriate outcomes. Various machine learning approaches are used to construct prediction models for clinical decision support and ameliorating patient management. Since AI is still in its fledgling state, with many limitations for clinical implementation, clinical support and feedback are needed to avoid algorithmic errors. Hence, both machine learning and human insight complement each other in revolutionizing breast imaging.Keywords: machine learning, augmented intelligence, ANN, CNN, CAD, GANs

Wongwaisayawan S, Suwannanon R, Kaewlai R. Reports in Medical Imaging. 2013;6:11– 27. On page 18, Figure 5 legend is incorrect. The correct legend is:Figure 5 (A-C) Bilateral facet fractures/dislocations.Notes: Sagittal-reformatted computed tomography images from right to left demonstrate a fracture of the right C7 superior articular process (short arrows), perched right C6/ 7 facet and grade II/III anterolisthesis of C6 on C7, and dislocation of the left C6/7 facet (long arrow). On page 22, Figure 9 legend is incorrect. The correct legend is: Figure 9 (A-C) Unilateral facet dislocation. An axial computed tomography image (A) reveals a reversed hamburger-bun sign (short arrow) of the left C6/7 facet. Sagittal-reformatted computed tomography images (B and C) show grade I anterolisthesis of C6 on C7 and a jumped C6/7 left facet (long arrow). On page 24, Figure 11, the legend is incorrect. The correct legend is: Figure 11 (A-D) Blunt vertebral artery injury. An axial computed tomography image (A) shows a severely comminuted fracture (arrow) of the left C6 articular pillar, pedicle, lamina, and transverse process. Axial (B) and curved reformat of the left vertebral artery (C) postcontrast computed tomography reveal absence of flow in the left vertebral artery at the level of fracture, above and below it (black arrows). Note and injury depicted on diagram D and a normal right vertebral artery in B (arrowhead). The authors apologize for these errors.Read the original article

Figure 5 (A-C) Bilateral facet fractures/dislocations. Notes: Sagittal-reformatted computed tomography images from right to left demonstrate a fracture of the right C7 superior articular process (short arrows), perched right C6/ 7 facet and grade II/III anterolisthesis of C6 on C7, and dislocation of the left C6/7 facet (long arrow). On page 22, Figure 9 legend is incorrect. The correct legend is: Figure 9 (A-C) Unilateral facet dislocation. An axial computed tomography image ( A ) reveals a reversed hamburger-bun sign (short arrow) of the left C6/7 facet. Sagittal-reformatted computed tomography images ( B and C ) show grade I anterolisthesis of C6 on C7 and a jumped C6/7 left facet (long arrow). On page 24, Figure 11, the legend is incorrect. The correct legend is: Figure 11 (A-D) Blunt vertebral artery injury. An axial computed tomography image ( A ) shows a severely comminuted fracture (arrow) of the left C6 articular pillar, pedicle, lamina, and transverse process. Axial ( B ) and curved reformat of the left vertebral artery ( C ) postcontrast computed tomography reveal absence of flow in the left vertebral artery at the level of fracture, above and below it (black arrows). Note and injury depicted on diagram D and a normal right vertebral artery in B (arrowhead). The authors apologize for these errors. Read the original article

: Radiation pneumonitis is one of the most common toxicities following SBRT for lung cancer. Although local control rates are good, a recurrent tumour is dif fi cult to distinguish from radiation pneumonitis due to similar size and morphology. Therefore, early detection of a recurrent tumour is challenging, and moreover, it is crucial for affected patients, as early detection enables curative salvage therapy. Promising data exists to solve these challenges for late recurrences, for example, the analysis of high-risk CT features allows prediction of recurrence after 12 months. But particularly in cases of early recurrences and radiation pneumonitis, comprehensive data are lacking. Therefore, the aim of this study was to review the existing literature with special regard to radiological response assessment after stereotactic body radiotherapy and risk factors for predicting radiation pneumonitis or local recurrence. (PET) is encouraging. Huang et al developed a follow-up algorithm for response-assessment after SBRT, in which a PET is recommended in some cases, and Dong et al demonstrated that patients with high metabolic activity (described as SUVmax) before treatment had a worse overall survival. Nevertheless, the interpretation of a PET-scan should be done carefully as there is no optimal SUVmax threshold for predicting local recurrence or radiation pneumonitis. Another approach is to analyse of dosimetric parameters before performing SBRT, and indeed, some parameters seem to be associated with radiation pneumonitis, but again no speci fi c dose constraints are found yet. We found promising data in the literature, but the results are controversial, and a conclusion could not be drawn.

Samantha C Harrison,1,2 Douglas EH Hartley1–3 1NIHR Nottingham Biomedical Research Centre, Nottingham, UK; 2Hearing Sciences Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; 3Department of Otolaryngology, Nottingham University Hospitals National Health Service Trust, Nottingham, UKCorrespondence: Samantha C HarrisonNIHR Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UKTel +441158 232640Email Samantha.Harrison@nottingham.ac.uk Abstract: Imaging the auditory cortex can prove challenging using neuroimaging methodologies due to interfering noise from the scanner in fMRI and the low spatial resolution of EEG. Optical imaging provides a new and exciting option for exploring this key cortical area. This review presents a brief history of optical imaging, followed by an exploration of how advances in optical imaging technologies have increased the understanding of the functions and processes within the auditory cortex. In particular, the benefits and limitations of using functional near infrared spectroscopy (fNIRS) on complex populations such as infants and individuals with hearing loss are explored, along with suggestions for future research developments.Keywords: optical imaging, hearing loss, superior temporal gyrus, plasticity, auditory processing

Susana Calle,1 Lydia Dawood,2 Niroj R Tripathee,3 Chunyan Cai,4 Harleen Kaur,5 David Q Wan,5 Henry Ibekwe,6 Isis W Gayed51Neuroradiology Section, Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA; 2Department of Surgery, Baylor College of Medicine, Houston, TX, USA; 3Body Imaging Section, Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA; 4Clinical and Translational Sciences Section, The University of Texas Health Science Center at Houston, Houston, TX, USA; 5Nuclear Medicine Section, Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA; 6Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USAPurpose: To identify patterns of abnormalities using DaTscan™ single photon emissioncomputed tomography (SPECT) imaging of patients with non-Parkinson’s movement disorders.Materials and methods: A single institution retrospective evaluation was performed of consecutive patients who underwent DaTscan SPECT imaging for Parkinson’s-like movement disorders, excluding those who had scan findings consistent with Parkinson’s disease. Demographic and clinical data were collected for all patients. A single experienced reader graded the degree of decreased dopamine transporter activity using a semi-quantitative visual score. Additional quantitative analysis was utilized to generate z-scores in 101/104 patients. Data were analyzed to establish patterns and frequency of abnormalities on DaTscan. Correlation between quantitative and semi-quantitative visual scores was also performed.Results: A total of 104 patients were included, of which 77 patients (74%) had abnormal findings on semi-quantitative visual assessment of the DaTscan images and 27 patients (26%) had normal findings. Of the abnormalities, the majority were either mild or moderate decrease in tracer accumulation, in one or both putamina. The most common site of abnormality was the left posterior putamen followed by the right posterior putamen. Quantitative z-score analysis revealed that 14% of the patients exhibited an abnormality, while 86% had normal z-scores.Conclusion: Semi-quantitative visual DaTscan analysis of patients with non-Parkinson’s movement disorders most commonly reveals mild to moderate decrease in dopamine transporter activity, primarily involving the posterior aspect of one of the putamina.Keywords: DaTscan™, tremor, movement disorders, dopamine transporter, 123I-ioflupane