Primary renal osteosarcoma (PRO) is a rare extraskeletal malignancy, accounting for less than 1% of soft-tissue sarcomas and fewer than 50 reported cases to date. We present the case of a 47-year-old male who presented with six months of progressive right flank pain and an abdominal lump. Initial imaging with plain radiography and contrast-enhanced computed tomography urography revealed a large, heterogeneously enhancing right renal mass characterised by extensive, confluent, dense intratumoral calcifications with a bone-like appearance, mediastinal displacement of adjacent viscera, calcified retroperitoneal lymph nodes, and peritoneal deposits suggestive of metastatic disease. The radiologic differential diagnosis included renal cell carcinoma with dystrophic calcification, calcified renal tuberculosis, and stone disease. Diagnostic laparoscopy with biopsy revealed pleomorphic spindle-to-epithelioid cells in disorganised sheets with characteristic lace-like eosinophilic osteoid. Immunohistochemical analysis confirmed the diagnosis by demonstrating SATB2 positivity and negativity for MDM2, cytokeratin, PAX8, and CD34, with a high Ki-67 proliferation index, supporting a mesenchymal origin rather than sarcomatoid carcinoma. In view of peritoneal and lymph node involvement indicating metastatic disease, the patient was initiated on platinum-based combination chemotherapy with doxorubicin and cisplatin, completing three cycles with good tolerance. This case highlights the clinical, radiological, and pathological features essential for diagnosing PRO, a uniformly aggressive malignancy that typically presents at an advanced stage with poor prognosis. Definitive diagnosis requires comprehensive histopathological examination combined with targeted immunohistochemical panels to exclude alternative etiologies, including sarcomatoid renal cell carcinoma and renal tuberculosis. Multimodal management with radical surgical resection and platinum-based chemotherapy represents the current standard of care, though long-term outcomes remain limited.

Moyamoya Disease (MMD) is a rare, progressive cerebrovascular disorder characterised by stenosis of the terminal internal carotid arteries and development of fragile collaterals, “moyamoya” vessels, predisposing to ischaemic and haemorrhagic stroke. Haemorrhagic manifestations are more frequent in Asian populations, and the impact of concomitant vertebrobasilar (VB) involvement is insufficiently established. This case highlights the complex clinical presentation of MMD with involvement of both the anterior and posterior circulations, particularly the VB system, which is rare in MMD. A 31-year-old woman with childhood-onset seizures and no other comorbidities presented with a seven-day history of headache, altered sensorium and generalised tonic-clonic seizures accompanied by abnormal limb movements and facial deviation. Non-Contrast Computed Tomography (NCCT) of the head revealed pan-ventricular haemorrhage with secondary hydrocephalus and a chronic infarct in the left frontal lobe. Computed Tomographic Angiography (CTA) and Magnetic Resonance Angiography (MRA) demonstrated multifocal narrowing of intracranial arteries involving both anterior and posterior circulations, with marked narrowing of the supraclinoid internal carotid, middle cerebral, vertebral, and basilar arteries and extensive collateralisation, consistent with bilateral MMD (Suzuki stage 3). Brain MRI showed an additional acute infarct in the splenium of the corpus callosum. The patient was managed conservatively with antiepileptics, blood pressure optimisation, and supportive care, without the placement of an external ventricular drain. Serial NCCT scans demonstrated progressive resolution of intraventricular haemorrhage (IVH) and hydrocephalus, with complete clearance by day 20; she was discharged neurologically stable and seizure‑free and remained seizure‑free at 1-month follow‑up, with planned surgical revascularisation. This case illustrates the coexistence of haemorrhagic and ischaemic manifestations in bilateral MMD with extensive VB involvement, presenting as pan‑ventricular IVH and acute splenial infarction. It underscores the need for comprehensive evaluation of both the anterior and posterior circulations in MMD, careful control of blood pressure and seizures, and early consideration of revascularisation to optimise long‑term stroke prevention.

To evaluate perfusion, diffusion tensor, and spectroscopy correlates of peritumoural brain oedema (PTBO) in intracranial meningiomas and identify imaging parameters associated with PTBO volume using multiparametric Magnetic Resonance Imaging (MRI). In this cross-sectional study of 66 adults, PTBO presence was defined as a T2-hyperintense peritumoural volume ≥ 10 mL (n = 26) and absence as ≤ 1 mL (n = 35); intermediate volumes were excluded (n = 5). Preoperative 1.5T MRI assessed relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC), fractional anisotropy (FA), and magnetic resonance spectroscopy (MRS). Independent predictors were identified via multivariable logistic regression. Diagnostic performance (Area Under the Curve, AUC) was estimated using 5-fold cross-validation. PTBO-associated tumours demonstrated significantly larger volumes, more frequent intratumoural necrosis, higher rCBV, elevated ADC, and increased choline ratios (p < 0.001 for all). Multivariable regression identified FA, rCBV, and tumour volume as independent predictors of PTBO presence. FA demonstrated superior discrimination (cross-validated AUC = 0.96; 95

OHVIRA syndrome is a rare Mullerian duct anomaly characterised by uterus didelphys, obstructed hemivagina, and ipsilateral renal anomaly, usually diagnosed in adolescence because of dysmenorrhea, pelvic pain, or a pelvic mass. Delayed diagnosis may lead to retrograde menstruation, hematosalpinx, and endometriosis, while associated cervical malignancy is exceptionally uncommon. This report describes a 34-year-old woman who presented with brownish vaginal discharge and was found to have OHVIRA syndrome complicated by deep pelvic endometriosis (DPE) and squamous cell carcinoma of the cervix. Pelvic examination showed a tender left-sided vaginal bulge. Contrast-Enhanced Magnetic Resonance Imaging (CEMRI) demonstrated uterine duplication, left hematometrocolpos, bilateral hematosalpinx, sigmoid endometriotic deposit, cervical growth with parametrial extension, pelvic nodal disease, and an absent left kidney. Septal incision and drainage exposed a necrotic cervical lesion, and histopathology confirmed squamous cell carcinoma. Since pelvic lymphadenopathy indicated FIGO stage IIIC1 disease, the patient was referred for primary chemoradiotherapy instead of upfront surgery. This case highlights the value of early MRI in obstructive Müllerian anomalies and the importance of evaluating for advanced endometriosis and rare coexisting malignancy.

Introduction: Vertebral artery (VA) anomalies are common in craniovertebral junction (CVJ) anomalies and pose a significant risk for iatrogenic injury during surgery. While computed tomography angiography (CTA) is the reference standard, it involves ionizing radiation and contrast. Three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) is a promising noncontrast, radiation-free alternative, yet its diagnostic utility in this specific population remains inadequately validated. The study aimed to evaluate the utility of 3D TOF-MRA for characterizing VA anatomy in CVJ anomalies and to correlate findings with available CTA and operative observations. Materials and Methods: This prospective cross-sectional study included 67 patients with CVJ anomalies. All underwent 3D TOF-MRA on 1.5T/3T scanners. Two radiologists independently analyzed VA course using a modified Sivaraju classification. Available CTA (n = 10) and operative findings (n = 7) were reviewed for correlation. Results: 3D TOF-MRA successfully delineated VA anatomy in all patients. Anomalous VA courses were present in 68.7% (left) and 64.2% (right) of patients, with Type 2b being most common. A highly significant association was found between atlanto-occipital assimilation and VA anomalies (100%, P < 0.001), with significant associations also for atlantoaxial dislocation (P = 0.049) and os odontoideum (P = 0.039). In all cases with available CTA (n = 10) and operative correlation (n = 7), 3D TOF-MRA findings showed 100% concordance. Conclusion: 3D TOF-MRA is a reliable, noninvasive modality for preoperative VA mapping in CVJ anomalies, demonstrating excellent diagnostic concordance with CTA and surgical findings. It offers a safe, effective alternative for preoperative planning, particularly beneficial for younger patients requiring serial imaging.

Spontaneous superior mesenteric artery (SMA) branch pseudoaneurysms are exceedingly rare and should be kept as a diagnosis in patients with trauma, pancreatitis, anticoagulant use or surgery presenting with unexplained abdominal pain, sudden drop in haemoglobin or hypovolemia. Computed Tomography Angiography (CTA) and Digital Subtraction Angiography (DSA) both readily demonstrate the vascular abnormality, with DSA being advantageous for therapeutic purposes. Computed Tomography (CT) of the abdomen frequently identifies haemoperitoneum or a localised hematoma at the site of a vascular abnormality. Embolisation with glue and coil is a safe and less invasive technique for successful endovascular repair. A male patient in the sixth decade of life presented with unexpected haemoperitoneum during laparotomy for radical cystectomy. After abandonment of the surgery, the patient underwent a CT abdomen revealing a pseudoaneurysm arising from the transverse pancreatic branch of the SMA, leading to retroperitoneal haematoma and haemoperitoneum, and subsequently underwent successful glue embolisation. Retrospectively evaluated CT abdomen done for preoperative evaluation in the recent past was normal. This case report highlights SMA branch pseudoaneurysms presenting as unexplained haemoperitoneum and retroperitoneal haematoma in an asymptomatic patient, successfully treated by the endovascular route.

Hepatocellular carcinoma (HCC) is a clinically significant primary liver malignancy that predominantly occurs in patients with cirrhosis and chronic liver disease. Early detection and accurate, non-invasive diagnosis are critical for improving survival outcomes, guiding therapeutic decision-making, and determining eligibility for liver transplantation. Imaging plays a central role in this process and frequently allows definitive diagnosis without the need for biopsy. The Liver Imaging Reporting and Data System (LI-RADS), developed by the American College of Radiology (ACR), was created to standardize liver imaging acquisition, interpretation, categorization, and reporting in populations at risk for HCC. Since its introduction, LI-RADS has evolved to encompass ultrasound surveillance, contrast-enhanced ultrasound, multiphase computed tomography, magnetic resonance imaging, and treatment response assessment algorithms, including nonradiation and radiation-based therapies. This narrative review provides a comprehensive overview of LI-RADS, encompassing its evolution and the latest developments in its diagnostic, surveillance, and treatment response algorithms.

BACKGROUND:Chronic myeloid leukemia (CML) is a common hematological malignancy where patients present with varied clinical symptoms and are usually diagnosed with incidentally detected elevated total leucocyte counts in hemogram. The presence of pelvic hematoma at the presentation of CML is an uncommon finding. CASE PRESENTATION:Two male young adults presented with massive splenomegaly and pelvic hematoma. On evaluation for anemia and leukocytosis with massive splenomegaly, diagnosis of CML chronic phase (CML-CP) was made on peripheral smear, bone marrow examination including cytogenetic study and molecular methods (peripheral blood quantitative BCR: ABL1 by real- time PCR). The first patient underwent aspiration of hematoma, and the second patient presented late where the hematoma organized into a solid mass and no intervention could be possible. A basic available coagulation study revealed no abnormalities and was managed with tyrosine kinase inhibitors. CONCLUSION:Initial manifestation of CML with pelvic hematoma is uncommon and should undergo aspiration or drainage to avoid organization of hematoma and compressive symptoms locally.

AbstractHydatid disease (HD) can affect any organ, but most commonly involves liver parenchyma. Complications like rupture/infection can further complicate the scenario. Familiarity with variable imaging appearances of HD is very helpful in making the diagnosis. This may also aid in diagnosis of difficult or atypical cases. We retrospectively reviewed radiologic findings of HD in 11 patients, who presented to our department in last 1 year. There was involvement of the lung, pleura, mediastinum, liver, abdominal cavity, pelvic cavity, ovary, splenic parenchyma, renal parenchyma, spinal cord, and brain, with variable imaging features.

The scapula ossifies from multiple ossification centres, with ossification in the scapular body seen at the time of birth. Ossicle inferior angle of the scapula (OIAS) is an anatomical anomaly resulting from non-fusion of the ossification centre of the inferior angle of the scapula. OIAS remains asymptomatic and is infrequently detected as a palpable and painful abnormality, leading to patient discomfort and a need for healthcare assistance. OIAS can be detected on radiography, with Computed Tomography (CT) reserved for cases with an alternative diagnosis, like in our case. A 14-year-old female patient presented with a palpable and occasionally painful bony hard swelling at the level of the anterolateral aspect of the right 5th and 6th ribs, confirmed to be OIAS on CT chest. The patient was assured of its benign nature and received no further management. OIAS is an anatomical variation to be kept in mind whenever a palpable bony hard abnormality is encountered around the inferior angle of the scapula, avoiding unnecessary medical and/or surgical management and patient apprehension.

Cytotoxic lesions of the corpus callosum (CLOCC) describe secondary reversible entities, infections being the forerunner aetiology, with metabolic forming another subset. Coronavirus disease-2019 (COVID-19) infection highlighted CLOCC due to its frequent occurrence in infected and post-vaccinated individuals. Cytokine-mediated response, with contribution from other pathways, affected particularly vulnerable splenium of the corpus callosum. Clinical presentation was typical of neurological affliction, including visual and auditory pathway involvement. Scattered cases of atypical neurological and other system involvement were seen. Magnetic resonance imaging (MRI) showed characteristic imaging findings, associated white matter and other changes. Complete recovery was the norm, with few exceptions. This study aimed to review pathogenesis, neurological and imaging manifestations of CLOCC concerning various aetiologies and differentials, the forerunner being COVID-19, and highlight a few instances of atypical presentation. Authors searched the PubMed database for articles published in the Last 5 Years using the keywords ‘Cytotoxic lesions of corpus callosum COVID-19 MRI’. Articles explaining pathogenesis, clinical symptomatology and imaging findings were included, with few articles depicting atypical neurological and imaging findings. Well-defined altered signal intensity lesion in the corpus callosum, showing diffusion restriction, confined to splenium in the majority. Involvement of the rest of the corpus callosum adjoining cerebral white matter is seen in a few cases with enhancement and haemorrhage. Neurological symptoms were dominant, with adjunct abdominal manifestations in a few. Complete clinical and imaging resolution was the norm in the vast majority.

The Ovarian-Adnexal Reporting and Data System magnetic resonance imaging (O-RADS MRI) is a standardized risk stratification system designed to enhance uniform interpretation and reporting of adnexal masses on MRI. A PubMed search was conducted using the keyword "O-RADS MRI," yielding 61 articles in the search results. After excluding eight articles, 53 articles were selected. Additionally, five articles were identified through a citation search. A total of 58 articles were included in this literature review. Ultrasonography (USG) is the primary imaging modality used for evaluating adnexal lesions, with MRI reserved for cases that require further evaluation. Based on both USG and MRI imaging, various scores are assigned to a particular lesion. Contrast imaging, utilizing both ultrasound USG and MRI, is employed for the better characterization of lesions in terms of internal morphology, with a primary focus on solid components. Additionally, internal septation, wall characteristics, and other soft tissue components, including fat, fibrous tissue, and blood products, are also evaluated. Advanced MRI techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced sequences, also help refine the final O-RADS score of a lesion. Contrast-Enhanced Computed Tomography (CECT) plays a predominant role in evaluating metastatic disease and has been established in five cases. This review article provides a comprehensive overview of O-RADS MRI, addressing its development, key imaging features, and practical application in a clinical setup. We discuss the diagnostic performance of O-RADS MRI in differentiating benign from malignant adnexal lesions, exploring its strengths in reducing inter-observer variability and guiding patient management. We also highlighted various comparative studies and trials that have shaped the evolution of the O-RADS MRI system over time. Furthermore, this article highlights the challenges associated with implementing O-RADS MRI, including potential pitfalls in interpretation, corroborations, and discordance with other imaging modalities, particularly USG, as well as the need for further validation studies.

Tarsal coalition is a congenital abnormality that leads to a coalition between tarsal bones. This coalition can be bony, cartilaginous, or fibrous, with the talocalcaneal and calcaneonavicular joints commonly involved. The onset of symptoms is typically in the second decade of life and include pain, stiffness, reduced range of motion, and flatfoot deformity. Computed Tomography (CT) imaging depicts coalitions exclusively, with bony coalitions being straightforward to identify, whereas non-osseous coalitions manifest as secondary bony changes. Magnetic Resonance Imaging (MRI) shows signal changes parallel to the parent bone in cases of osseous coalition. In contrast, non-osseous coalitions exhibit variable intermediate to low signal changes, with bone marrow oedema displaying a high signal on fluid-sensitive sequences. The coalition can be located intraarticularly or extraarticularly. We present a case of an 18-year-old female who presented with right ankle pain. A CT scan of the right ankle showed an articulation between the talus and calcaneus along the medial aspect of the joint with an interspersed accessory ossicle. The extraarticular non-osseous Talocalcaneal Coalition (TCC) was diagnosed, along with the os sustentaculum located along the medial facet. In this case, we demonstrate TCC with an interspersed os sustentaculum forming an extraarticular TCC, which was detected incidentally during the evaluation of a young patient presenting with ankle pain and a visible bony deformity.

Objective Patients with traumatic brain injury (TBI) often continue to have symptoms of neuropsychological dysfunction. Studies have demonstrated cerebral perfusion (CP) deficits following TBI. There is limited literature on the association between CP and neuropsychological outcomes following TBI. This study aimed to analyze the correlation between neuropsychological outcome and CP in patients with mild to moderate TBI. Materials and Methods Patients with mild to moderate TBI and computed tomography (CT) scan suggestive of diffuse axonal injury underwent CT perfusion scan within 48 hours of injury. All patients were evaluated with various neuropsychological tests at 3 months of follow-up. The correlation between CP and neuropsychological outcome was assessed. Results Forty patients (21 with TBI mild and 19 with moderate TBI) were enrolled. Among 21 patients with mild head injury, 14 (66.7%) showed evidence of hypoperfusion in the right frontal lobe and 12 (57.1%) in the right parietal lobe. Among 19 patients with moderate head injury, 12 (63.1%) patients showed hypoperfusion in the right frontal lobe and 7 (36.8%) in the right parietal lobe. CP in the bilateral frontal and left temporal lobe white matters showed a statistically significant negative correlation with the number of mistakes committed in the Stroop A, B, and C tests. Perfusion in the left temporal white matter showed a negative correlation with the trail making test (parts A and B) and a positive correlation with the animal fluency test. The right parietal and left frontal lobes also showed a positive correlation with the AFT. Conclusion We found a significant correlation between CP of the white matter of different lobes during the acute phase of TBI and neuropsychological performance at 3 months after TBI.

AbstractThe spleen is the most commonly involved organ in abdominal trauma, especially in blunt mode of injury. High vascularity and a thin capsule predispose to rapid and fatal bleeding, which could be acute as well as delayed at onset. FAST is usually the first line of investigation required to see for fluid and screen patients suffering abdominal trauma. Triple-phase contrast-enhanced computed tomography of the abdomen further aids in diagnosing and grading splenic trauma as per the American Association for the Surgery of Trauma (AAST) guidelines. Hemodynamic stability and AAST grade are the main guiding parameters for management. Treatment options include surgical and nonsurgical (endovascular intervention) management. The recent concept of endovascular resuscitation and trauma management, which dwells on creating a hybrid suite, is coming up fast and will play a pivotal role in offering splenic preserving management in trauma cases. In this review article, authors have bought insights about managing splenic trauma as a multidisciplinary concept to achieve splenic preservation and maintain this vital organ's immunological functions.

Introduction Renal lesions are common findings encountered in cross-sectional imaging. Ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) are available modalities for evaluating renal lesions. The Bosniak classification system aids in classifying a renal lesion into a particular category based on various imaging characteristics on contrast-enhanced CT (CECT). Materials and methods The CT report archives were searched for the keyword 'Bosniak' lesions, and six illustrative cases were selected to be included in the review. Results Six cases under Bosniak categories I to IV were included in the review. Operative follow-ups were added in cases where patients underwent surgery. Discussion We have reviewed the imaging features of various renal lesions with cross-sectional modalities, namely CT and MRI, with special emphasis on the Bosniak classification system, including its amendments. Conclusion The Bosniak system is widely used to classify and characterize renal lesions. The authors have presented a scoping review of the features of renal lesions and the Bosniak system.

Mesial temporal lobe epilepsy is one of the most common causes of refractory epilepsy worldwide. A good percentage of patients do not have detectable hippocampal atrophy on magnetic resonance imaging (MRI). The objective of this study is to evaluate whether T2 relaxometry can identify hippocampal pathology and lateralize the epileptic focus in patients with intractable temporal lobe epilepsy (TLE). T2 relaxometry can also be used to correlate the clinical severity of the disease with the relaxometry readings in those who have hippocampal atrophy as well as those who do not. Thirty two patients having clinical and electrophysiological features of TLE were enrolled and a MRI brain with T2 relaxometry was done. Hippocampal T2 relaxometry values were calculated in the head, body, and tail of the hippocampus and average T2 relaxometry values were calculated, and a comparison was done with the controls. For patients with unilateral involvement, the contralateral side was taken as control and in cases of bilateral involvement, controls were identified from normal subjects. T2 relaxometry is found to be superior to MR visual analysis in the early detection of cases of hippocampal sclerosis where there is no atrophy on visual analysis. Nine out of 32 patients (28%) were normal on MR visual analysis; however, showed increased values on T2 relaxometry, correlating with clinical and electrophysiological diagnosis. The rest of the patients with hippocampal atrophy showed a correlation of T2 relaxometry values with the degree of atrophy. The hippocampal T2 measurement is thus more sensitive and specific. The study was clinically significant (p < .0001). There was a mild female predilection of the disease and there was no significant correlation with comorbidities. There was a strong positive correlation with patients having a history of febrile seizures in childhood. T2 relaxometry may accurately lateralize the majority of patients with persistent TLE and offers evidence of hippocampus injury in those patients who do not show evidence of atrophy on MRI and also the T2 relaxometry values correlated with the degree of atrophy. Early identification of hippocampal sclerosis is crucial for prompt management which offers better outcomes.

Rosai Dorfman disease is a rare but benign and self-limiting disorder. A case of Rosai Dorfman disease in a 16-year-old female with classic radiological and pathological findings is presented. T2W hypointense signal of the soft tissue masses was a distinguishing MRI feature. Contribution: Rosai Dorfman disease is often overlooked in the differentials of lymphadenopathy and soft tissue masses on account of its rarity. This case report comprehensively discusses the imaging approach to this rare disorder.

It is crucial to clinically differentiate true aneurysms from pseudoaneurysms. Here, we are reporting a case of postintervention, iatrogenic distal radial artery pseudoaneurysm, which was successfully managed surgically. The present case scenario signifies the clinical features of pseudoaneurysm and relevant discussion with early treatment needs for this iatrogenic complication.