Acetabular morphology variations in a Hispanic population.

BACKGROUND: Rotational abnormalities of the hip have been implicated in the etiology of diseases, such as hip dysplasia, osteoarthritis, and femoroacetabular impingement. Despite the extensive literature on hip morphology, there is a gap in knowledge regarding variations in the Hispanic population. PURPOSE: To describe the bony anatomy variations of the acetabulum in a Hispanic population. MATERIAL AND METHODS: This is a cross-sectional study. We studied 182 computed tomography (CT) images in patients aged older than 21 years, who had undergone pelvic CT for any condition, except hip fracture. Measurements of acetabular version, anterior and posterior acetabular sector angles (AASA/PASA) and horizontal acetabular sector angles (HASA) were made. Acetabular variations were then compared to weight and sex data. RESULTS: The mean acetabular anteversion was greater in women (P < 0.001). Women exhibited a greater PASA (P < 0.05); however, men had a greater AASA (P < 0.05). Underweight individuals had a smaller PASA (P < 0.01) and HASA (P < 0.05) than individuals with a normal weight. CONCLUSION: The Hispanic hip is morphologically similar to other populations previously reported in the literature; however, Hispanic men have less coverage of the femoral head by the posterior acetabular wall when compared to women of the same ethnicity. These abnormalities have a direct impact on management and surgical approach in patients treated for femoroacetabular impingement and hip dysplasia.

Generalizability of electroencephalographic interpretation using artificial intelligence: An external validation study.

OBJECTIVE: The automated interpretation of clinical electroencephalograms (EEGs) using artificial intelligence (AI) holds the potential to bridge the treatment gap in resource-limited settings and reduce the workload at specialized centers. However, to facilitate broad clinical implementation, it is essential to establish generalizability across diverse patient populations and equipment. We assessed whether SCORE-AI demonstrates diagnostic accuracy comparable to that of experts when applied to a geographically different patient population, recorded with distinct EEG equipment and technical settings. METHODS: We assessed the diagnostic accuracy of a "fixed-and-frozen" AI model, using an independent dataset and external gold standard, and benchmarked it against three experts blinded to all other data. The dataset comprised 50% normal and 50% abnormal routine EEGs, equally distributed among the four major classes of EEG abnormalities (focal epileptiform, generalized epileptiform, focal nonepileptiform, and diffuse nonepileptiform). To assess diagnostic accuracy, we computed sensitivity, specificity, and accuracy of the AI model and the experts against the external gold standard. RESULTS: We analyzed EEGs from 104 patients (64 females, median age = 38.6 [range = 16-91] years). SCORE-AI performed equally well compared to the experts, with an overall accuracy of 92% (95% confidence interval [CI] = 90%-94%) versus 94% (95% CI = 92%-96%). There was no significant difference between SCORE-AI and the experts for any metric or category. SCORE-AI performed well independently of the vigilance state (false classification during awake: 5/41 [12.2%], false classification during sleep: 2/11 [18.2%]; p = .63) and normal variants (false classification in presence of normal variants: 4/14 [28.6%], false classification in absence of normal variants: 3/38 [7.9%]; p = .07). SIGNIFICANCE: SCORE-AI achieved diagnostic performance equal to human experts in an EEG dataset independent of the development dataset, in a geographically distinct patient population, recorded with different equipment and technical settings than the development dataset.

Variantes de la normalidad del crecimiento infantil versus fallo de medro

Introducción: El fallo de medro es la incapacidad de un niño menor de 3 años de conseguir un desarrollo y crecimiento óptimo. A menudo es confundido con las variantes normales del crecimiento y desarrollo infantil. Objetivo: Examinar las variantes normales del crecimiento infantil y diferenciarlas del verdadero fallo de medro. Métodos: Se localizaron y seleccionaron estudios relevantes en las bases electrónicas Medline, Biblioteca Virtual de Salud, Google Académico, SciELO y en libros digitales. Para la búsqueda se emplearon los vocablos: fallo de medro, variantes de la normalidad del crecimiento y desarrollo infantil. Se hallaron 89 artículos publicados entre 2005-2020 sobre temáticas afines, se escogieron 41 que conformaron la muestra. Análisis y síntesis de la información: Se actualizaron diferentes aspectos del fallo de medro: definición, clasificación, criterios diagnósticos, factores de riesgo, causas potenciales, evaluación diagnóstica y conducta. Se examinaron las características clínicas de las variantes de la normalidad del crecimiento y desarrollo infantil que permiten diferenciarlas del fallo de medro. Conclusiones: El retardo constitucional del crecimiento y desarrollo, la talla baja familiar, la talla baja idiopática, la prematuridad, el crecimiento intrauterino retardado, la delgadez y el catch-down, constituyen variantes normales del crecimiento infantil que se diagnostican erróneamente como fallo de medro y genera medicalización injustificada, gastos innecesarios en análisis complementarios y angustia familiar. Diferenciar estas entidades del fallo de medro permitiría enfocar las acciones de salud hacia objetivos más concretos y ofrecer a cada niño un tratamiento individualizado de acuerdo a su condición real de salud.

Introduction: Failure to thrive is the inability of a child under 3 years of age to achieve optimal development and growth. It is often confused with the normal variants of child growth and development. Objective: To examine the normal variants of infant growth and differentiate them from true failure to thrive. Methods: Relevant studies were located and selected in the electronic databases Medline, Virtual Health Library, Google Scholar, SciELO and in digital books. For the search, the words used were: failure to thrive, variants of the normality of growth and child development. 89 articles published between 2005-2020 on related topics were found; 41 were chosen and made up the sample. Analysis and synthesis of information: Different aspects of failure to thrive were updated: definition, classification, diagnostic criteria, risk factors, potential causes, diagnostic evaluation and behavior. The clinical characteristics of the variants of the normality of child growth and development that allow them to be differentiated from the failure of growth were examined. Conclusions: Constitutional growth and development retardation, family short stature, idiopathic short stature, prematurity, delayed intrauterine growth, thinness and catch-down were normal variants of infant growth that are erroneously diagnosed as failure to thrive and generate unjustified medicalization, unnecessary expenses in complementary tests and family anguish. Differentiating these entities from the failure to thrive would allow health actions to focus on more specific objectives and offer each child an individualized treatment according to their real health condition.

MRI signal and morphological alterations of the suprapatellar fat pad in asymptomatic subjects: are these normal variants?

OBJECTIVE: To study the prevalence of suprapatellar fat pad (SPFP) MR alterations in asymptomatic subjects, in relation to a wide range of clinical/imaging parameters, including muscle performance tests and physical activity data. MATERIALS AND METHODS: We prospectively included 110 asymptomatic subjects as part of a cohort study. Inclusion criteria were no knee pain in the last year. Exclusion criteria were any medical/surgical history of a knee disorder. Subjects underwent knee and low-dose posture radiographs [EOS®], 3 T MRI, clinical examination including muscle performance tests, and physical activity monitoring. The presence/absence of SPFP alterations (hyperintensity and mass effect) were assessed through consensus reading on fluid-sensitive sequences. Differences between groups of knees with SPFP alterations and controls were tested for a total of 55 categorical/continuous clinical/imaging parameters, including SPFP relative-T2-signal, trochlear/patellar/lower-limb morphologic measurements. Wilcoxon-rank-sum and chi-square tests were used to compare groups of patients. The histological correlation was obtained in a cadaveric specimen. RESULTS: SPFP alterations were common in asymptomatic subjects: hyperintensity 57% (63/110) and mass effect 37% (41/110), with 27% (30/110) showing both. Among the 55 imaging, clinical, or activity parameters tested, only increased patellar tilt angle (p = 0.02) and TT-TG distance (p = 0.03) were statistically different between groups of SPFP alterations and controls. The histological correlation showed more abundant connective tissue in SPFP compared to the prefemoral fat pad. CONCLUSIONS: SPFP hyperintensity and mass effect are common MRI findings in asymptomatic knees, and they are not related to most imaging, clinical, and activity parameters. Care should be taken not to overcall them pathological findings as they most likely represent normal variants.

Update on imaging of the discoid meniscus.

Discoid menisci represent a range of morphological meniscal variants, most commonly involving the lateral meniscus. Clinical presentation ranges from an asymptomatic incidental finding to snapping, pain, swelling and reduced range of knee movement. Symptomatic presentation of discoid menisci is usually due to meniscal tears and instability resulting from abnormal meniscal morphology and ultrastructure, with absent peri-meniscal ligamentous and meniscocapsular attachments characteristic of the Wrisberg sub-type. This article reviews the current classification systems of discoid menisci, gross morphological characteristics of each sub-type and ultrastructure. Clinical presentation, arthroscopic findings and indirect radiological diagnostic criteria are described, as are the MRI findings of normal and pathological discoid menisci. Current concepts of surgical management and outcomes of the discoid meniscus are also briefly discussed.

18F-FDG PET/CT Imaging: Normal Variants, Pitfalls, and Artifacts Musculoskeletal, Infection, and Inflammation.

18F-FDG PET/CT is an integral part of modern-day practice, especially in the management of individuals presenting with malignant processes. The use of this novel imaging modality in oncology has been rapidly evolving. However, due to its detection of cellular metabolism, it is not truly tumor specific. 18F-FDG is also used in the detection of infective and inflammatory disorders. One of the challenges experienced with 18F-FDG PET/CT imaging is the correct differentiation of abnormal uptake that is potentially pathologic, from physiological uptake. Imaging readers, particularly the nuclear physicians, therefore need to be aware of normal physiological variants of uptake, as well as potential pitfalls and artifacts when imaging with 18F-FDG. This is true for musculoskeletal uptake, where more than often, infective and inflammatory processes should not be mistaken for malignancy. This article aims to provide a pictorial review and analysis of cases that depict musculoskeletal, infective, and inflammatory uptake as normal variants, pitfalls, and artifacts on 18F-FDG PET/CT imaging. The impact of this article is to help in the minimizing of poor imaging quality, erroneous interpretations and diminishes misdiagnoses that may impact on the adequate management of patients with undesirable consequences.

Anatomical variations of the circle of Willis in children.

BACKGROUND: The morphology of the circle of Willis in adults has been thoroughly discussed in scientific literature. However, the morphology of the circle of Willis in pediatric patients is under-researched. OBJECTIVES: We aimed to establish reference data for the morphology and variations of the circle of Willis in a population consisting of all pediatric age subgroups and to evaluate the possible temporal evolution of the circle of Willis in pediatric patients along with the variations between pediatric and adult populations. MATERIALS AND METHODS: Our patient cohort included 263 pediatric patients ages 1-215 months. A total of 273 magnetic resonance (MR) angiography images were retrospectively analyzed for all circle of Willis vessels to compare the incidence of complete cases and variation frequency based on gender and age group. RESULT: In our study of 273 MR angiograms from all age ranges in the pediatric population, we found a 56.1% circle of Willis completion rate. Overall completion rates were statistically significantly higher in the toddler and preschool age groups. The lowest completion rate was in the newborn-infant group (40%). CONCLUSION: Circle of Willis completion rates and variations in pediatric populations are similar to those in adult populations; completion rates rise in toddler and preschooler age groups and decline as children grow into the school-age and adolescent period.

Frequency of sternal variations and anomalies in living individuals evaluated by MDCT.

PURPOSE: The aim of this retrospective study was to present the frequency and MDCT appearances of sternal variations and anomalies, as well as to highlight their clinical significance. METHODS: This retrospective study was carried out on 1150 patients, who underwent chest MDCT. Axial planes, multiplanar and curved-planar reconstructed images were studied. Age and sex distribution of the variations was evaluated. RESULTS: Anatomical variations of the sternum were found in 74.1%. The most frequent variation was the double-ended xiphoid process (36.9%), followed by the single xiphoidal foramen (25.8%) and the sternal sclerotic band (12.8%). Other variations observed were: sternal notch (10.1%), xiphoidal ligament calcification (8.3%), sternal foramen (4.9%), complete manubriosternal fusion (4.1%) and sternoxiphoidal fusion (4.1%), triple-ended xiphoid process (3.7%), sternal cleft (1.5%), whereas the rest of the variations including sternoxiphoidal junction pseudoforamen, suprasternal bone, pseudocleft, suprasternal tubercle and absence of xiphoid process were in less than 1%. In our subjects, sternal and xiphoidal foramina were adjacent to: the pericardium (37.14%), the diaphragm (22.9%), the mediastinal fat (17.1%), the liver (11.4%), the lung (8.5%) and to the stomach (2.9%). CONCLUSIONS: Sternal variations are frequent, asymptomatic, detected incidentally at cross-sectional imaging and may be confused with pathologic conditions. Radiologists should be familiar with these variations in order to discriminate them from pathologies and avoid complications during interventional procedures. ADVANCES IN KNOWLEDGE: This study presents thoroughly the sternal variations' MDCT appearance, detected in a Greek population, correlates them with age and gender and discuss their clinical significance in detail.

Coronary Arteries: Normal Anatomy With Historical Notes and Embryology of Main Stems.

Anatomy of subepicardial coronary arteries became a topic of investigation at autopsy in Florence (Italy) by Banchi in the early twentieth century, with the discovery of dominant and balanced patterns. Thereafter, in the 60's of the same century Baroldi in Milan did post-mortem injection with spectacular three-dimensional casts. Later Sones at the Cleveland Clinic introduced selective coronary arteriography for in vivo visualization of coronary arteries. In the present chapter we show these patterns, as well as normal variants of origin and course with questionable risk of ischemia, like myocardial bridge as well as origin of the left circumflex coronary artery from the right sinus with retroaortic course. As far as embryology, the coronary arteries and veins are epicardial in origin and finally connect the former with the aorta, and the latter with the sinus venosus. At the time of spongy myocardium, intramural blood supply derives directly by the ventricular cavities, whereas later, at the time of myocardial compaction, vascularization originates from the subepicardial network. The connection of the subepicardial plexus with the aorta occurs with prongs of the peritruncal ring, which penetrate the facing aortic sinuses. Septation of truncus arteriosus is not responsible for the final position of the coronary orifices. Infact in transposition of the great arteries coronary ostia are regularly located within facing sinuses of the anterior aorta.

Etiologies, profile patterns and characteristics of children with short stature in Jordan.

OBJECTIVES: Childhood growth influences their social and psychological behavior, and abnormal growth may reflect underlying pathological etiologies. It is important to diagnose children with short stature as early as possible to be able to manage treatable causes. We aim to study etiologies and characteristics of short stature in children in Jordan. METHODS: This is a cross-sectional retrospective review of the medical records of children diagnosed with short stature at a referral university hospital. Clinical characteristics, auxological, laboratory, and radiological investigations were collected and analyzed. RESULTS: Among a total of 551 children diagnosed with short stature, the number of boys was significantly higher than girls, 304 (55.2%) and 247 (44.8%), respectively with a p-value of 0.015. Average age at presentation for all patients was 10.24 ± 3.23, with no significant difference between boys and girls. Pathological etiology was higher than normal variants 55.7 and 44.3%, respectively with p=0.007. Constitutional delay of growth and puberty (CDGP) was the most frequent cause in the normal variant group, 59.8%. Among the pathological group, the most common etiology was growth hormone deficiency (32.2%) with mean age of presentation of 9.40 years and was not significantly different from the age in other etiological groups, 9.44 years and p=0.931. CONCLUSIONS: Growth monitoring of children should start at an early age for boys and girls. Referral to the pediatric endocrine clinic should be considered when growth problems are suspected for accurate diagnosis and etiology profiling.

Associations among palatal impaction of canine, sella turcica bridging, and ponticulus posticus (atlas arcuate foramen).

INTRODUCTION: The palatal impaction of canine (PIC) can be predicted by some head and neck skeletal anomalies or variants. Since studies on this regard (especially vertebral anomalies) are scarce, this study was conducted. METHODS: This case-control study was done on 46 PIC orthodontic patients (34 females, 12 males) and 46 control orthodontic patients (36 females, 10 males). The diagnosis of PIC was done on lateral cephalographs and panoramic radiographs. On cephalographs, sella turcica bridging (occurrence and severity) and ponticulus posticus (occurrence and severity) were assessed. Associations between PIC, sella bridging, and ponticulus posticus were examined statistically (α = 0.05, ß ≤ 0.2). RESULTS: Cases' and controls' mean ages were 17.7 ± 4.0 and 17.4 ± 3.5, respectively. Of the case subjects, 22, 22, and 2 had respectively types I (normal), II, and III of sella bridging, while these numbers were 34, 12, and 0 in controls (chi-square P = 0.023 for severity, 0.010 for occurrence). Ponticulus posticus was observed in 28 cases (7 completed) and 17 controls (6 completed, P = 0.022 for occurrence, 0.056 for severity). Sella bridging was not associated with ponticulus posticus (Spearman P = 0.150). According to binary logistic regression, sella bridging can increase the odds of palatal canine impaction for OR = 2.8 times, while ponticulus posticus for OR = 2.6. Age and sex did not affect sella bridging or ponticulus posticus. CONCLUSIONS: Both sella bridging and ponticulus posticus can predict an increased rate of PIC for more than 2.5 times.

Cervicovertebral anomalies and/or normal variants in patients with congenitally bilateral absent maxillary lateral incisors.

OBJECTIVE: To determine whether there is a relationship between congenitally bilaterally absent maxillary lateral incisors (BAMLIs) and skeletal anomalies and/or normal variants. MATERIALS AND METHODS: The records of 86 patients (62 girls, 24 boys; age 12-17 years) with congenitally BAMLIs and 86 patients (55 girls, 34 boys; age 13-18 years) without any dental or skeletal anomalies were collected and evaluated retrospectively. The study was based on the evaluation of lateral cephalometric and orthopantomographic radiographs. Posterior arch deficiency of the atlas bone (PADA); atlanto-occipital ligament calcification, known as "ponticulus posticus" (PP); and interclinoid ligament calcification, known as "sella turcica bridging" were recorded for each participant. Pearson χ2 and Fisher exact tests were used to evaluate and compare skeletal anomalies and/or normal variants between patients with BAMLIs and the control group. RESULTS: The prevalence of cervicovertebral anomalies and/or normal variants seen in the lateral cephalometric radiographs was higher in patients with BAMLI than in the control group. The prevalence of PP was lower and that of PADA was higher in patients with BAMLIs than in the control group (P < .05). CONCLUSION: The prevalence of PADA was increased and that of PP formation was decreased in patients with BAMLIs. There was a significant relationship between skeletal anomalies and/or normal variants.

Neuroimaging findings in headache with normal neurologic examination: Systematic review and meta-analysis.

OBJECTIVE: To determine if pooled estimates of the prevalence of unexpected findings in patients with headache and normal neurologic examination support current expert opinion-based neuroimaging guidelines. METHODS: We searched PubMed and EMBASE for studies reporting neuroimaging findings in patients with headache and normal neurologic examination up to September 30, 2017. The overall and disease-specific prevalence of unexpected findings were pooled through random-effects meta-analysis. This study is registered with PROSPERO, registration number CRD42017079714. RESULTS: In forty-one studies including 15,760 participants, the overall prevalence of unexpected findings and normal variants was 17.5% (95% CI: 13.1-22.3). The prevalence was 26.6% (95% CI: 15.5-39.4) in studies using MRI only. The prevalence of vascular, neoplastic, and non-neoplastic findings was 6.6%, 1.4%, and 9.6%. The pooled disease-specific prevalence was 2.0% for stroke, 1.8% for aneurysms, 0.8% for subdural hematoma, 0.7% for hydrocephalus, 0.2% for glioma, and 0.1% for meningioma. In secondary analysis, there was 0.4% increase in the prevalence of vascular unexpected findings with each 1% increase in the proportion of migraine with aura (p-value for meta-regression = 0.005). CONCLUSIONS: In patients with headache and normal neurologic examination, important vascular and neoplastic unexpected findings are rare and better detected with MRI. This supports current American College of Radiology and European Headache Federation recommendations to avoid systematic imaging in such patients and prefer MRI when imaging is needed.

The association of single nucleotide polymorphisms (SNPs) with breast density and breast cancer survival: the Malmö Diet and Cancer Study.

BACKGROUND: Genetic factors are important in determining breast density, and heritable factors account for 60% of the variation. Certain single nucleotide polymorphisms (SNPs) are associated with density and risk of breast cancer but the association with prognosis is not clear. PURPOSE: To investigate associations between selected SNPs and breast cancer survival in the Malmö Diet and Cancer Study (MDCS). MATERIAL AND METHODS: A total of 724 unrelated women with breast cancer and registered radiological and pathological data were identified in MDCS 1991-2007, with genotyping available for 672 women. Associations among 15 SNPs, density, and breast cancer-specific survival were analyzed using logistic/Cox regression, adjusted for factors affecting density and survival. Variants significantly associated with either density or survival were validated in a large independent breast cancer cohort (LIBRO-1). RESULTS: Minor homozygotes of SNPs rs9383589, CCDC170 and rs6557161, ESR1 were associated with high breast density (adjusted odds ratio [AOR] 8.97, 95% confidence interval [CI] 1.35-59.57; AOR 2.08, 95% CI 1.19-3.65, respectively) and poorer breast cancer survival (adjusted hazard ratio [HRadj] 6.46, 95% CI 1.95-21.39; HRadj 2.30, 95% CI 1.33-3.96, respectively) compared to major homozygotes. For SNP rs3757318, ESR1, minor homozygotes (HRadj 7.46, 95% CI 2.28-24.45) were associated with poorer survival. We confirmed that rs6557161, ESR1 was significantly associated with both density and survival in the LIBRO-1 study. CONCLUSION: These findings support a shared genetic basis for density and breast cancer survival. The SNP significantly associated with both density and survival in both cohorts may be of interest in future research investigating polygenic risk scores for breast cancer risk and screening stratification purposes.

Child EEG (and maturation).

EEG changes during the perinatal period, infancy, childhood, and adolescence are concomitant with brain growth, myelination, expanding connectivity, and overall maturation, which are particularly fast during the first year of life. EEG aspects of early brain development are accessible in preterm during the third trimester of gestational age, and they evolve to full-term, infancy, and childhood EEG patterns. Each of these age periods shares specific EEG features that reach gross adult outlines in the first year. Interpreting EEG needs therefore a deep knowledge of pathological and normal EEG patterns with their variants belonging to each age range. Recording EEG during these periods also requires adapting the recording techniques to the specific age in order to obtain interpretable records. This chapter describes normal EEG features and variants, characteristic patterns of development, and some patterns that are unusual for age, from the neonatal period to adolescence.

Normal values of aortic dimensions assessed by multidetector computed tomography in the Copenhagen General Population Study.

AIMS: Accurate assessment of aortic dimensions can be achieved using contrast-enhanced computed tomography. The aim of this study was to define normal values and determinants of aortic dimensions throughout multiple key anatomical landmarks of the aorta in healthy individuals from the Copenhagen General Population Study. METHODS AND RESULTS: The study group consisted of 902 healthy subjects selected from 3000 adults undergoing cardiovascular thoracic and abdominal computed tomography-angiography (CTA), where systematic measurements of aortic dimensions were performed retrospectively. Individuals included were without any of the following predefined cardiovascular risk factors: (i) self-reported angina pectoris; (ii) hypertension; (iii) hypercholesterolaemia; (iv) taking cardiovascular prescribed medication including diuretics, statins, or aspirin; (v) overweight (defined as body mass index ≥30 kg/m2); (vi) diabetes mellitus (self-reported or blood glucose >8 mmol/L); and (vii) chronic obstructive pulmonary disease. Maximal aortic diameters were measured at seven aortic regions: sinuses of Valsalva, sinotubular junction, ascending aorta, mid-descending aorta, abdominal aorta at the diaphragm, abdominal aorta at the coeliac trunk, and infrarenal abdominal aorta. Median age was 52 years, and 396 (40%) were men. Men had significantly larger aortic diameters at all levels compared with women (P < 0.001). Multivariable analysis revealed that sex, age, and body surface area were associated with increasing aortic dimensions. CONCLUSION: Normal values of maximal aortic dimensions at key aortic anatomical locations by contrast-enhanced CTA have been defined. Age, sex, and body surface area were significantly associated with these measures at all levels of aorta. Aortic dimensions follow an almost identical pattern throughout the vessel regardless of sex.

18F-FDG uptake in the normal appendix in adults: PET/CT evaluation.

OBJECTIVE: This study aimed to determine the level of 18F fluorodeoxyglucose (18F-FDG) activity in the normal adult appendix using positron emission tomography/computed tomography (PET/CT). MATERIALS AND METHODS: We performed a retrospective review of PET/CT images using 18F-FDG in 563 consecutive asymptomatic adult patients without appendiceal pathology. We excluded 257 patients for an undetected or obscured appendix and three patients for appendicitis found on CT imaging. FDG uptake in the appendix was qualitatively and quantitatively assessed. The maximum standardized uptake value (SUVmax) was calculated for quantitative analysis with SUVmax of the normal liver for comparison. A total of 303 patients (200 males, 103 females, mean age of 66 years) were included in this study. Medical charts and histories were evaluated for patients who showed positive FDG accumulation. Pearson's correlations between appendiceal SUVmax and age, body mass index, and blood glucose levels were analyzed. RESULTS: The mean appendiceal SUVmax was 1.14 (range 0.52-5.12) with an appendix-to-liver SUVmax ratio of 0.34 (range 0.06-1.28). Three patients qualitatively showed a positive FDG accumulation with appendiceal SUVmax greater than 3.00. There were no correlations between appendiceal SUVmax and age, body mass index, or blood glucose levels. CONCLUSIONS: FDG in the normal adult appendix shows a low activity level and is lower compared with normal liver. However, the normal appendix can rarely show high FDG accumulation. In such cases, differentiation from appendiceal pathology solely by PET/CT images would be difficult.

Significance of incidental intra-articular and peri-articular FDG avid foci on PET/CT.

BACKGROUND: Positron emission tomography/computed tomography (PET/CT) is a useful imaging adjunct in patients with sarcoma. Intra-articular and peri-articular 18F-fluoro-2-deoxy-D-glucose (FDG) avid lesions are often discovered incidentally. PURPOSE: To describe the etiology, appearance, and standardized uptake values (SUV) of incidentally detected FDG avid intra-articular and peri-articular foci in patients with sarcoma. MATERIAL AND METHODS: The institutional sarcoma database between November 2011 and November 2016 was retrospectively reviewed. Patients were included if a PET/CT scan was performed and an FDG avid intra-articular or peri-articular focus was found that was distinct from the primary sarcoma. RESULTS: The majority of FDG avid foci represented benign, non-physiologic conditions such as osteoarthritis, enthesopathy, bursitis, and post-surgical changes. Six patients each had radiographic features consistent with tenosynovial giant cell tumor (TSGCT) and metastatic disease, respectively. Lower SUV, bilateral findings, and the absence of metastatic disease elsewhere were associated with benign etiologies. There was a statistically significant difference between the mean SUV measured in patients with TSGCT and those with benign, non-physiologic conditions ( P < 0.001). The difference between the benign, non-physiologic cohort and the cohort with widespread metastatic disease did not reach statistical significance ( P = 0.07). CONCLUSIONS: In patients with soft-tissue or osseous sarcomas, isolated FDG avid intra-articular or peri-articular foci without additional metastatic lesions likely represent benign processes. Isolated intra-articular or peri-articular foci with significantly elevated SUV measurements were favored to represent TSGCT in this series.

Normal variations in cerebral venous anatomy and their potential pitfalls on 2D TOF MRV examination: Results from a private tertiary care hospital in Karachi.

OBJECTIVE: To assess normal venous anatomy of the cranium and its anatomical variants. METHODS: This retrospective study was conducted at Radiology Department of Dr. Ziauddin Hospital, Karachi, and comprised data of patients aged 2-75 years and having undergone magnetic resonance imaging of brain from April 2015 to April 2016. Magnetic resonance venography was reviewed to evaluate the cerebral venous system. All magnetic resonance venography examinations were performed using a contiguous two-dimensional time-of-flight venography technique, and were reviewed by two consultant radiologists.. RESULTS: Out of 204 patients, 96(47.05%) were males and 108(52.94%) were females. Overall Magnetic Resonance Venography examinations were found to be normal in 94(46.07%), patients, while 110(53.92%) had some of the normal anatomical variants. There was presence of superior sagittal sinus and straight sinus in 204(100%) cases. Inferior sagittal sinus was seen in 179(86.05%). Transverse sinus was hypoplastic in 8(3.92%) on the right and 80(39.2%) on the left side. Hypoplastic sigmoid sinus was present in 51(25%) patients and aplastic sigmoid sinus in 2(0.98%) patients. Flow gaps were also observed in 22(10.78%) patients. Occipital sinus was identified in 17(8.3%), vein of Trolard in 98(48.03%) and vein of Labbe in 105(51.47%). CONCLUSIONS: Two-dimensional time-of-flight magnetic resonance venography examination was found to be a useful imaging tool showing great sensitivity in determining the normal cerebral venous anatomy.