Imaging findings of breast leukaemia: a case series.

Aims/Background Breast leukaemia (BL) is a rare breast malignancy that is treated differently from other malignant conditions. However, it is easily confused with other conditions; therefore, how to accurately diagnose is crucial. We retrospectively analysed the imaging findings of 13 patients to provide a diagnostic reference. Methods From January 2015 to April 2023, 13 patients with BL confirmed by biopsy who underwent imaging in Peking University People's hospital were retrospectively analysed. The imaging findings obtained via ultrasound (US), mammography (MMG), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) were analysed, and the detection rates of these methods for diagnosing BL were compared. Results Twenty-nine lesions were detected in the 13 patients. These patients presented with palpable masses or breast swelling several months after treatment for leukaemia, mainly involving the bilateral breasts. Ultrasonography was performed for 13 patients, and all lesions were detected. Most of the identified masses were hypoechoic and had indistinct boundaries, irregular shapes, no enhancement of the posterior echo, and no abundant blood flow. MMG was performed for five patients, revealing breast masses, architectural distortion, and no abnormalities. MRI was performed for four patients, and all lesions were detected; most of the lesions were hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging and diffusion-weighted imaging, with a decreased apparent diffusion coefficient and inhomogeneous enhancement. The enhancement curves were mostly inflow patterns. PET/CT was performed for four patients; two patients had hypermetabolism, and the other two had no obvious radioactive uptake. Conclusion Compared to MMG and PET/CT, US and MRI have higher detection rates. Furthermore, compared to MRI, US is inexpensive, convenient and efficient; therefore, it should be the first choice for diagnosing BL.

Prevalence of Neurological Symptoms and Imaging Findings in Von Hippel-Lindau Patients Referred to Rasool Akram Hospital, 2018-2021.

This study aimed to assess the prevalence of neurological symptoms and related imaging findings in patients with von Hippel-Lindau (VHL) at Rasool Akram Hospital from September 2018 to September 2021. This analytical observational study examined eligible patients over the period from September 2018 to September 2021. We collected demographic information (age, gender) along with imaging findings and results of neurological and eye examinations. Comparison between qualitative variables was also done using the Chi-square test or Fisher's exact test. Also, an independent t-test was used to compare quantitative variables between the two groups. SPSS version 22 software was used for statistical analysis of data. A significant level was considered less than or equal to 0.05. Of the 54 examined patients (48.1% were male and 51.9% were female) with an average age of 36.42 ± 13.37 years. A significant majority (87.0%) reported a positive family history of the disease. The most common type of disease was Type 1 observed in 94.4% of cases and Type 2A was the next most frequent (3.7%). The most common pattern of retinal pathological lesions seen in the examination was related to bilateral lesions (79.6%). The most common pathological finding was related to the presence of a mass in cerebellar magnetic resonance imaging (48.1%). Considering the findings of the present study, which highlight a significant frequency of bilateral retinal lesions as well as masses in the central nervous system and endocrine system, it is evident that patients require careful follow-up and various interventions after being diagnosed with the disease. This approach is essential to manage and potentially mitigate the complications associated with these conditions.

Multimodal imaging findings of primary liver clear cell carcinoma: a case presentation.

Primary clear cell carcinoma of liver (PCCCL) is a special and relatively rare subtype of hepatocellular carcinoma (HCC), which is more common in people over 50 years of age, with a preference for men and a history of hepatitis B or C and/or cirrhosis. Herein, we present a case of a 60-year-old woman who came to our hospital for medical help with right upper abdominal pain. The imaging examination showed a low-density mass in the right lobe of his liver. In contrast enhanced computed tomography (CT) or T1-weighted imaging, significant enhancement can appear around the tumor during the arterial phase, and over time, the degree of enhancement of the tumor gradually decreases. The lession showed obviously increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography/CT. These imaging findings contribute to the diagnosis of PCCCL and differentiate it from other types of liver tumors.

COVID-19-Associated Rhino-Orbito-Cerebral Mucormycosis: A Single Tertiary Care Center Experience of Imaging Findings With a Special Focus on Intracranial Manifestations and Pathways of Intracranial Spread.

Background and objective The COVID-19 pandemic and mucormycosis epidemic in India made research on the radiological findings of COVID-19-associated mucormycosis imperative. This study aims to describe the imaging findings in COVID-19-associated mucormycosis, with a special focus on the intracranial manifestations.  Methodology Magnetic resonance imaging (MRI) scans of all patients with laboratory-proven mucormycosis and post-COVID-19 status, for two months, at an Indian Tertiary Care Referral Centre, were retrospectively reviewed, and descriptive statistical analysis was carried out. Results A total of 58 patients (47 men, 81%, and 11 women, 19%) were evaluated. Deranged blood glucose levels were observed in 47 (81%) cases. The intracranial invasion was detected in 31 (53.4%) patients. The most common finding in cases with intracranial invasion was pachymeningeal enhancement (28/31, 90.3%). This was followed by infarcts (17/31, 55%), cavernous sinus thrombosis (11/58, 18.9%), fungal abscesses (11/31, 35.4%), and intracranial hemorrhage (5/31, 16.1% cases). The perineural spread was observed in 21.6% (11/51) cases. Orbital findings included extraconal fat and muscle involvement, intraconal involvement, orbital apicitis, optic neuritis, panophthalmitis, and orbital abscess formation in decreasing order of frequency. Cohen's kappa coefficient of interrater reliability for optic nerve involvement and cavernous sinus thrombosis was 0.7. Cohen's coefficient for all other findings was 0.8-0.9. Conclusions COVID-19-associated rhino-orbito-cerebral mucormycosis has a plethora of orbital and intracranial manifestations. MRI, with its superior soft-tissue resolution and high interrater reliability, as elucidated in this study, is the imaging modality of choice for expediting the initial diagnosis, accurately mapping out disease extent, and promptly identifying and scrupulously managing its complications.

[Facial nerve protection in surgery for rare tumors of the internal auditory canal].

Objective:To explore strategies for preserving facial nerve function during surgeries for rare tumors of the internal auditory canal. Methods:A total of 235 cases of internal auditory canal tumors treated between 2010 and 2023 were included, encompassing vestibular schwannomas, cavernous hemangiomas, meningiomas, and other rare tumors. Various data, including clinical presentations, imaging classifications, and treatment processes, were meticulously analyzed to delineate the characteristics of rare tumors and assess pre-and postoperative facial nerve function. Results:Among all internal auditory canal tumors, vestibular schwannomas accounted for 91.9%. In rare tumors, facial nerve schwannomas constituted 5.3%, cavernous hemangiomas 26.3%, meningiomas 15.8%, and arterial aneurysms 10.5%. Significantly, patients with cavernous hemangiomas displayed pronounced invasion of the facial nerve by the tumor, in contrast to other tumor types where clear boundaries with the facial nerve were maintained. During surgery, individualized approaches and strategies for facial nerve protection were implemented for different tumor types, involving intraoperative dissection, tumor excision, and facial nerve reconstruction. Conclusion:Preservation of the facial nerve is crucial in the surgical management of rare tumors of the internal auditory canal. Accurate preoperative diagnosis, appropriate timing of surgery, selective surgical approaches, and meticulous intraoperative techniques can maximize the protection of facial nerve function. Personalized treatment plans and strategies for facial nerve functional reconstruction are anticipated to enhance surgical success rates, reduce the risk of postoperative facial nerve dysfunction, and ultimately improve the quality of life for patients.

Magnetic resonance imaging in rabies encephalitis, a case report, and review of the literature.

Rabies is an acute fatal disease of the central nervous system. Neuroimaging plays an important role, especially in establishing an early diagnosis and distinguishing it from other types of encephalitis. This case report aims to give a brief review of this condition and report the less common MRI findings of the disease. We herein report a case of a 61-year-old male bitten by a stray dog who presented with fever, vomiting, headache, sialorrhea, dysarthria, dysphagia, and upper limb weakness which progressed to lower limbs on the next day. T2W and FLAIR images demonstrated subtle bilateral hyperintense signal in the deep gray matter with more apparent increased signal intensity in the white matter of the frontal and parietal lobes which shows mild diffusion restriction but no postcontrast enhancement. The diagnosis of rabies encephalitis was made based on a typical history of exposure, a compatible clinical presentation, and MRI findings. Rabies diagnosis is essentially clinical. It is definitively confirmed by the isolation of the virus from biological samples such as saliva, CSF, hair, or detection of rabies antigens or antibodies. Magnetic resonance imaging (MRI) brain used as one of the modalities of investigation for distinguishing it from other encephalitis. Rabies per se does not have any characteristic features on the MRI brain.

Spinal calcifying pseudoneoplasms of the neuraxis: A case report and review of the literature.

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare, non-neoplastic, slow-growing tumors that can present anywhere throughout the central nervous system. While the etiology of these lesions remains unknown, the mainstay of treatment is surgical excision. We describe a case of CAPNON at our institution in a 66 year-old female patient who presented with 5 months of pain and burning sensation in her thigh. On MRI, an intradural extramedullary lesion was identified at the level of T11-T12. The mass was surgically excised and the patient reported resolution of her symptoms by her six week follow-up appointment. We reviewed 79 spinal CAPNON cases, covering all cases reported in the literature thus far. In summary, we find that spinal CAPNON are most commonly lumbar and extradural in location, with pain as the most common presenting symptom. Lesions are well-defined and hypointense on T1 and T2 MRI sequence. The majority of cases had favorable surgical outcomes with near complete resolution of pain and associated symptoms.

Pseudomyxoma Peritonei: A Challenging Clinical Diagnosis. Case Report and Review of the Literature.

Background: Pseudomyxoma peritonei (PMP) is a clinical entity of subtle onset abdominal pain, ascites, and distention associated with characteristic imaging. In most cases, laparoscopic exploration will give the definitive diagnosis and histopathologic verification. However, usually there are difficulties in the diagnosis of this disease. Case Report: Herein, we present a case of a 51-year-old female who developed ascites over 5 months. An investigational laparotomy established the diagnosis of PMP, after the discovery of a mucinous, grey-brown tumor that was CK20 positive and CK7 negative. Subsequently, chemotherapy with oxaliplatin combined with 5-FU (FOLFOX4 regimen), was initiated and the patient survived for 30 months. We also present a comprehensive review of the English literature concerning the different symptoms and radiological findings of this rare entity. According to the literature review, 35 cases of PMP with different clinical and radiological findings have been described. In the majority of the cases, ultrasound, computed tomography or magnetic resonance imaging was orientating towards a proper diagnosis before a diagnostic laparotomy. Conclusion: The combination of a clinical picture with the characteristic imaging findings enables a prompt diagnosis of PMP, making prognosis more favorable.

Primary Pulmonary Malignant Meningioma: A Case Report and Literature Review Focusing on Imaging Findings.

BACKGROUND: Primary pulmonary meningioma (PPM) is an extremely rare primary tumor of the lung. The diagnosis should first exclude metastasis of central nervous system MPM by using imaging, and the final diagnosis depends mainly on the tissue pathology and immunohistochemical results. Malignant PPM is even rarer, and a clear pathological definition to distinguish between benign and malignant PPM is lacking. CASE PRESENTATION: A 47-year-old woman was admitted to the hospital after a lung mass was found during a physical examination one month earlier. The imaging findings for this patient showed a large mass in the lower lobe of the left lung with bronchial invasion. A contrast-enhanced MRI of the brain was normal. Bronchoscopy shows a mass at the opening of the left lower basal branch, with mucosal infiltration, protrusion, and stenosis of the opening. The patient underwent radical left lung cancer surgery, and the pathology specimens stained with hematoxylin-eosin demonstrated tumor cells with the focal invasion of the bronchial cartilage. Immunohistochemical staining was positive for epithelial membrane antigen(EMA), somatostatin receptor 2 (SSTR2), progesterone receptor (PR), Ki-67 (5%-10%), CD34, and D2-40 and weakly positive for p53.The pathologic diagnosis was primary pulmonary meningioma (PPM). The tumor marker CA-125 had significantly increased in the 2 months after surgery. CONCLUSION: Malignant PPM is rarer, and a clear pathological definition to distinguish between benign and malignant PPM is lacking. Potential cases should be comprehensively evaluated based on imaging, laboratory, and pathology results. A long-term regular follow-up will be required to rule out metastasis or recurrence of PPM.

Fat-forming solitary fibrous tumor of the orbit with typical imaging findings.

Purpose: We describe a case of fat-forming solitary fibrous tumor (SFT) of the orbit with typical findings on imaging that may improve the awareness of orbital fat-forming SFT. Observations: An 88-year-old female presented with exophthalmos and pain in her right eye. Preoperative imaging showed an oval, well-defined mass with soft-tissue density, interspersed with a well-circumscribed lesion. The lesion showed low-density in computed tomography (CT) scans, hyperintense in T1/T2 weighted images of magnetic resonance imaging (MRI) scans and hypointense in fat-suppressed images of MRI scans. The tumor was removed en bloc and diagnosed as low-grade malignant fat-forming SFT by pathological examination. There was no evidence of recurrence 9-month postoperatively. Conclusions: The imaging feature of orbital fat-forming SFT is a well-defined solid tumor interspersed with adipose tissue. Such findings are vital for the preoperative diagnosis and the choice of the treatment.

Imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma: A case series and literature review.

INTRODUCTION: This study aimed to investigate the imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma. MATERIAL AND METHODS: We retrospectively analyzed patients with pregnancy luteoma admitted to the First Affiliated Hospital of Sun Yat-sen University between January 2003 and December 2022. We recorded their imaging features, clinical characteristics and neonatal outcomes. Additionally, we reviewed relevant studies in the field. RESULTS: In total, 127 cases were identified, including eight from our hospital and 119 from the literature. Most patients (93/127, 73.23%) were of reproductive age, 20-40 years old, and 66% were parous. Maternal hirsutism or virilization (such as deepening voice, acne, facial hair growth and clitoromegaly) was observed in 29.92% (38/127), whereas 59.06% of patients (75/127) were asymptomatic. Abdominal pain was reported in 13 patients due to compression, torsion or combined ectopic pregnancy. The pregnancy luteomas, primarily discovered during the third trimester (79/106, 74.53%), varied in size ranging from 10 mm to 20 cm in diameter. Seventy-five cases were incidentally detected during cesarean section or postpartum tubal ligation, and 39 were identified through imaging or physical examination during pregnancy. Approximately 26.61% of patients had bilateral lesions. The majority of pregnancy luteomas were solid and well-defined (94/107, 87.85%), with 43.06% (31/72) displaying multiple solid and well-circumscribed nodules. Elevated serum androgen levels (reaching values between 1.24 and 1529 times greater than normal values for term gestation) were observed in patients with hirsutism or virilization, with a larger lesion diameter (P < 0.001) and a higher prevalence of bilateral lesions (P < 0.001). Among the female infants born to masculinized mothers, 68.18% (15/22) were virilized. Information of imaging features was complete in 22 cases. Ultrasonography revealed well-demarcated hypoechoic solid masses with rich blood supply in 12 of 19 cases (63.16%). Nine patients underwent magnetic resonance imaging (MRI) or computed tomography (CT), and six exhibited solid masses, including three with multi-nodular solid masses. CONCLUSIONS: Pregnancy luteomas mainly manifest as well-defined, hypoechoic and hypervascular solid masses. MRI and CT are superior to ultrasonography in displaying the imaging features of multiple nodules. Maternal masculinization and solid masses with multiple nodules on imaging may help diagnose this rare disease.

An atypical location of pineoblastoma RB1 subgroup without pineal or retinal tumor.

PURPOSE: To describe the clinical and imaging features of a sellar-suprasellar pineoblastoma RB1 subgroup without pineal or retinal involvement. CASE REPORT: An 11-month-old girl presented to the emergency department with fever, rhinorrhea, vomiting, altered level of consciousness, and one seizure. Head CT and brain MRI demonstrated a large lobulated mass with calcifications and heterogeneous enhancement in the suprasellar region causing mass effect to the ventricular system and hydrocephalus. Histology revealed a CNS embryonal tumor not otherwise specified (NOS) with small round nuclei with mitotic activity and necrosis. DNA methylation analysis classified the tumor in the pineoblastoma RB1 subgroup. CONCLUSION: Pineoblastoma RB1 subgroup should be considered in the differential diagnosis of large sellar-suprasellar masses with calcifications and heterogeneous enhancement in children younger than 18 months even in cases of absent pineal or retinal involvement. Molecular analysis with DNA methylation profiling is critical for diagnosis and management.

Evaluation of the clinical behavior of unclassified renal cell carcinoma and its imaging findings on computed tomography and magnetic resonance imaging based on World Health Organization (WHO) 2022.

OBJECTIVES: To ascertain the clinical behaviors of unclassified renal cell carcinoma (RCC) and its characteristic imaging findings on CT and MRI. METHODS: Subjects in this retrospective study were 10 patients who had received a histological diagnosis of unclassified RCC based on World Health Organization (WHO) 2022 and who had undergone CT and/or MRI prior to surgery. In terms of clinical behaviors, TNM classification, stage, postoperative recurrence, time to recurrence, and postoperative survival were evaluated. In terms of imaging findings, tumor size, growth pattern, CT density, dynamic contrast-enhancement (DCE) pattern, internal appearance, presence of a pseudocapsule, and signal intensity on MRI were evaluated. We compared clinical behaviors and imaging findings, and investigated associations between them. RESULTS: One patient could not be followed-up due to death from other causes. Postoperative recurrence was observed in 4 patients, all of whom had Stage 3 RCC. In the remaining 5 patients without recurrence, all 5 patients showed Stage 2 or below. On imaging, unclassified RCC tended to be large (58.7 mm) and solid (100%), and heterogeneous interiors (80%), cystic degeneration (80%) and high intensity on diffusion-weighted imaging (DWI) (71.4%) were common. Comparing patients with and without recurrence, the following findings tended to differ between recurrence and recurrence-free groups: tumor size (73.4 ± 33.9 mm vs. 50.2 ± 33.9 mm, P = 0.286), growth pattern (invasive: 100% vs. 0%, expansive: 0% vs. 100%, P = 0.008 each), DCE pattern (progressive enhancement pattern, 66.7% vs. 0%, washout pattern, 0% vs. 66.7%, P = 0.135 each) and presence of a pseudocapsule (25% vs. 80%, P = 0.167). CONCLUSION: The clinical behavior of unclassified RCC varies widely. Although imaging findings are also variable, findings of large, heterogeneous tumors with cystic degeneration and high intensity on DWI were common. Several imaging findings such as large size, invasive growth, progressive enhancement pattern and no pseudocapsule may enable prediction of prognosis in unclassified RCC.

Clinical profile,imaging findings and endoscopic surgical treatment of acquired lacrimal sac mucocele / 中国内镜杂志

Objective To report the clinical features,imaging findings and endoscopic dacryocystosinostomy(En-DCR)of acquired lacrimal sac mucocele(ALSM).Methods 63 patients(63 eyes)with ALSM treated with En-DCR combined with bicanalicular silicone tube intubation from January 2016 to March 2021 were reviewed.The clinical features,imaging findings,and surgical treatment of the included patients were analyzed by preoperative examination and 12 month postoperative follow-up.Fifty-seven patients(21 males and 36 females)were enrolled in this study at last,including 30 right eyes and 27 left eyes,25～71 years old,with an average age of(52.89±11.66)years old.All eyes with history of epiphora and purulent secretion.Results CT examination revealed enlargement of the lacrimal sac,but no destruction of the adjacent bone.MRI imaging showed enlargement of the lacrimal sac,fluid collection separated from adjacent tissues by a thin rim,corresponding to mucocele in the sac and increase in the sac diameters in all analyzed cases.The mass was found to shrink significantly when the lacrimal sac was opened during the surgery,and the swelling was completely relieved within 7 days post-operation.After 12 months of follow-up,the anatomical success rate of En-DCR was 92.98%(53/57),the functional success rate was 89.47%(51/57),no complications such as mucocele recurrence,diminution of vision and infection were found.Conclusion All the patients with ALSM had a history of previous lacrimal duct obstruction.Imaging examinations are valuable for the diagnosis of ALSM.En-DCR for ALSM is safe and effective,and worthy of clinical promotion.

Supra-sellar granular cell tumor: Report of a case with literature review.

INTRODUCTION AND IMPORTANCE: Granular cell tumor (GCT) originating from the sellar and suprasellar regions, specifically from the neurohypophysis, is a rare neoplasm. Distinguishing GCT from other pituitary tumors, including pituitary adenoma, pituicytoma, and spindle cell oncocytoma, poses significant challenges. Here, we present a rare case of GCT originating from the posterior pituitary in the supra-sellar region. CASE PRESENTATION: A 41-year-old woman, with no past medical history, presented to neurology department with decreased visual acuity and peripheral facial paralysis since 3 months. The MRI showed a well-defined supra-sellar, retrochiasmatic, oblong, hypothalamic expansive process. It was isointense T1-weighted, discretely hypotensive T2-weighted, measuring 19x17x16 mm, suggesting pituicytoma or craniopharyngioma. An endoscopic transsphenoidal surgical resection was performed. Microscopic examination showed a proliferation of diffuse architecture made up of rounded polyhedral cells with granular eosinophilic cytoplasm. On immunohistochemistry, tumor cells expressed diffusely TTF1, S-100 protein and SOX-10 confirming the diagnosis of supra-sellar GCT. DISCUSSION AND CONCLUSION: GCTs are rare neoplasms that predominantly exhibit benign behavior, while the malignancy rate remains at 2 %. Histopathology serves as the definitive diagnostic approach for GCTs. These tumors are resistant to radiotherapy and chemotherapy, necessitating surgical resection as the primary treatment modality. Due to the potential absence of distinct tumor masses and local tissue infiltration by tumor cells, complete excision is crucial, with resection extent extending beyond areas of infiltration.

Imaging findings and clinical relevance of 68Ga-Pentixafor PET in atherosclerosis: a systematic review.

OBJECTIVE: We aimed to perform a qualitative synthesis of evidence on the role of 68Ga-Pentixafor PET in atherosclerosis. METHODS: A systematic search of the PubMed and Embase databases for studies reporting the evaluation of atherosclerotic lesions by 68Ga-Pentixafor PET was performed with a search time frame from database creation to 2022-12-26. The diagnostic test evaluation tool QUADAS-2 was used to evaluate the quality of the included literature and to perform descriptive analyses of relevant outcome indicators. RESULTS: A total of 6 studies with 280 patients were included. One study reported only imaging outcome metrics, while the other five studies reported imaging outcome metrics and clinical correlation metrics. For imaging outcomes, three studies reported imaging results for 68Ga-Pentixafor PET only, and the other three studies reported imaging results for comparative analysis of 68Ga-Pentixafor PET with 18F-FDG PET. For clinical correlation, three studies reported the correlation between tracer uptake and cardiovascular risk factors, one study reported the correlation between tracer uptake and plaque calcification, and one study reported the correlation between all three: tracer uptake, cardiovascular risk factors, and plaque calcification. CONCLUSION: 68Ga-Pentixafor PET has a good imaging effect on atherosclerotic lesions, and it is a promising imaging modality that may replace 18F-FDG PET for atherosclerosis imaging in the future. In patients with atherosclerosis, there is a clear clinical correlation between cardiovascular risk factors, tracer uptake, and plaque calcification.

Sinonasal and Orbital Imaging Findings in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of COVID-19: A Retrospective Cohort Study in a Tertiary Hospital in Central India.

Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly Mucor, Rhizopus, and Rhizomucor. Rhizopus oryzae is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of Mucor, early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.

VERTEBRAL GA-68 DOTATATE UPTAKE MIMICKING LUNG NEUROENDOCRINE TUMOR METASTASIS.

A 57 years old woman was diagnosed with well-differentiated lung neuroendocrine tumor (NET) by laboratory assessment, computed tomography (CT), contrast-enhanced magnetic resonance imaging (MRI) and bronchoscophy with transbroncial biopsy of nodular lung lesion located in the right lower lobe. Staging Ga-68 positron emission tomography-CT (PET-CT) showed two pathological uptake regions in the superior segment of the right lung lower lobe (SUVmax: 80.61) and 6th thoracic vertebral body (SUVmax: 3.70). Contrast-enhanced MRI findings suggested that vertebral lesion may be compatible with atypical hemangioma or osseous metastasis due to T1 isointensity, T2 hyperintensity and contrast-enhancement on the lesion. Therefore, characteristic imaging findings of hemangioma were seen on axial and sagittal or coronal sections of CT, respectively called as 'polka dot' and 'corduroy cloth'. Thus the mild vertebral Ga-68 DOTATATE uptake was accepted as false positive finding. Surgical intervention was decided. She underwent a right lung lobectomy. The last follow-up of the patient was done 2 years after the initial diagnosis. The follow-up Ga-68 DOTATATE PET-CT revealed no pathological increased uptake in the whole-body except the 6th vertebra showing similar uptake (SUVmax: 3.50) with the previous scan without size increase on CT. The patient was asymptomatic with normal serum chromogranin A level.

Urine pH and imaging findings of prostate useful predictors of prolonged duration of hematospermia.

Background: Few investigations regarding hematospermia duration have been reported thus far. The aim of this study was to identify clinical factors associated with the duration of hematospermia. Methods: Clinical data of 198 patients with hematospermia treated at Toho University Omori Medical Center from 2007 to 2022 were retrospectively evaluated. To identify independent predictors of hematospermia duration, uni- and multivariate Cox analyses were performed. Receiver operating characteristic analysis, Kaplan-Meier survival curves, and propensity score matching were applied for statistical evaluations. Results: Multivariate analysis of all 198 patients showed urine pH (UpH) level and any abnormal imaging finding of the prostate to be independent predictors of hematospermia duration. Based on the receiver-operating curve of UpH level for hematospermia improvement, the patients were divided into two groups using a threshold of 6.0 (Low-UpH 5.0-6.0, n=128; High-UpH 7.0-9.0, n=70). Kaplan-Meier curves indicated that patients in the High-UpH group or with any abnormal imaging finding had a higher rate of hematospermia persistence (both P<0.05). Even after matching between the groups classified by UpH (n=60 each), multivariate analysis showed that UpH level (hazard ratio 0.75, 95% CI: 0.61-0.92; P=0.006) and any abnormal imaging finding (hazard ratio 1.55, 95% CI: 1.04-2.31; P=0.033) were independent predictors of hematospermia duration. In Kaplan-Meier analysis findings of matched cohorts, High-UpH and presence of any abnormal imaging findings remained significantly correlated with higher rate of hematospermia persistence, while further stratification using a combination of these two factors identified a stepwise reduction in that rate (P=0.019). In addition, the proportion of patients with these two factors present simultaneously was significantly higher in the group with hematospermia for two months or more, and especially with a duration of greater than six months, than in the group with a duration of less than two months. Conclusions: Although further research is needed, both UpH level and imaging findings of the prostate are considered useful biomarkers for predicting prolonged hematospermia.

Imaging Features Following Breast Explant Surgery: A Pictorial Essay.

Breast implants can be removed with breast explantation surgery (BES) for various reasons, including patient dissatisfaction, capsular contracture, implant infection or rupture, breast implant-associated anaplastic large cell lymphoma, and a recently emerging phenomenon called breast implant illness. There is very limited data on the imaging appearance after BES. A retrospective chart review was performed for patients with BES findings on imaging reports for the period between October 2016 and October 2021. When assessing BES techniques, a key element is determining whether the implant's fibrous capsule requires removal. The second important question is if the patient requires an additional aesthetic procedure after BES. BES techniques include capsulotomy, and partial, total, or en bloc capsulectomy. Adjunctive aesthetic or reconstructive procedures after BES include fat grafting, mastopexy, augmentation, and reconstruction with flaps. The majority of post-BES breast imaging findings are related to the surgical scar/bed, thereby confirming that the type of explantation surgery is important. Imaging findings after BES include focal and global asymmetries, architectural distortions, calcifications, calcified and non-calcified fat necrosis, masses, hematomas, seromas, capsular calcifications, and silicone granulomas. Most importantly, since these patients have residual breast tissue, paying attention to imaging features that are suspicious for breast cancer is necessary.