Increase of Epicardial Adipose Tissue (EAT) With Fat Infiltration of Right Ventricular Myocardium: Is it Always a High-Risk Stigmata or a Worrisome Feature?

Incidental epicardial adipose tissue (EAT) and subepicardial fat infiltration on CT scans are not uncommon and the differential diagnosis can be a challenge. Considering the vastness of the possible disorders, it is important to differentiate physiologic age-related condition from pathologic disease. We present a case of an asymptomatic 81-year-old woman in which according to ECG and CMR findings we considered as possible differential diagnoses arrhythmogenic cardiomyopathy (ACM) dominant-right variant, lipomatosis and physiological growth of epicardial fat. We focus on patient characteristics, location of the fat replacement, heart morphovolumetry, wall motion of the ventricles and absence of late gadolinium enhancement to diagnose pericardial fat hypertrophy and physiological fatty infiltration. The role of EAT is unclear and it could play a part in the development of atherosclerosis and atrial fibrillation. Therefore, the clinicians should not underestimate this condition even if it would be an incidental finding in asymptomatic patients.

Post-Operative Accelerated-Hypofractionated Chemoradiation With Volumetric Modulated Arc Therapy and Simultaneous Integrated Boost in Glioblastoma: A Phase I Study (ISIDE-BT-2).

BACKGROUND: Glioblastoma Multiforme (GBM) is the most common primary brain cancer and one of the most lethal tumors. Theoretically, modern radiotherapy (RT) techniques allow dose-escalation due to the reduced irradiation of healthy tissues. This study aimed to define the adjuvant maximum tolerated dose (MTD) using volumetric modulated arc RT with simultaneous integrated boost (VMAT-SIB) plus standard dose temozolomide (TMZ) in GBM. METHODS: A Phase I clinical trial was performed in operated GBM patients using VMAT-SIB technique with progressively increased total dose. RT was delivered in 25 fractions (5 weeks) to two planning target volumes (PTVs) defined by adding a 5-mm margin to the clinical target volumes (CTVs). The CTV1 was the tumor bed plus the MRI enhancing residual lesion with 10-mm margin. The CTV2 was the CTV1 plus 20-mm margin. Only PTV1 dose was escalated (planned dose levels: 72.5, 75, 77.5, 80, 82.5, 85 Gy), while PTV2 dose remained unchanged (45 Gy/1.8 Gy). Concurrent and sequential TMZ was prescribed according to the EORTC/NCIC protocol. Dose-limiting toxicities (DLTs) were defined as any G ≥ 3 non-hematological acute toxicity or any G ≥ 4 acute hematological toxicities (RTOG scale) or any G ≥ 2 late toxicities (RTOG-EORTC scale). RESULTS: Thirty-seven patients (M/F: 21/16; median age: 59 years; median follow-up: 12 months) were enrolled and treated as follows: 6 patients (72.5 Gy), 10 patients (75 Gy), 10 patients (77.5 Gy), 9 patients (80 Gy), 2 patients (82.5 Gy), and 0 patients (85 Gy). Eleven patients (29.7%) had G1-2 acute neurological toxicity, while 3 patients (8.1%) showed G ≥ 3 acute neurological toxicities at 77.5 Gy, 80 Gy, and 82.5 Gy levels, respectively. Since two DLTs (G3 neurological: 1 patient and G5 hematological toxicity: 1 patient) were observed at 82.5 Gy level, the trial was closed and the 80 Gy dose-level was defined as the MTD. Two asymptomatic histologically proven radionecrosis were recorded. CONCLUSIONS: According to the results of this Phase I trial, 80 Gy in 25 fractions accelerated hypofractionated RT is the MTD using VMAT-SIB plus standard dose TMZ in resected GBM.

Sagittal Normal Limits of Lumbosacral Spine in a Large Adult Population: A Quantitative Magnetic Resonance Imaging Analysis.

OBJECTIVES: The objective of this study was to determine, using magnetic resonance imaging (MRI) of the lumbosacral spine from L1 to S1, the values of the normal sagittal diameter of the spinal canal (SCD), sagittal diameter of the dural sac (DSD), and the normal values of dural sac ratio (DSR) in a large nonsymptomatic adult population and to discriminate whether a vertebral canal is pathological or nonpathological for dural ectasia and/or stenosis. MATERIALS AND METHODS: Six hundred and four patients were prospectively enrolled. All measurements were performed on MRI sagittal T1- and T2-weighted images. The 95% confidence interval (95% CI), defined as mean ± 1.96 standard deviation, was determined for each metric. The upper limit of 95% CI was considered the cutoff value for the normal DSR; the lower limit of 95% CI was considered the cutoff value for the normal SCD. RESULTS: SCD cutoff values from L1 to S1 ranged from 14.5-10.1 mm (males) to 15.0-9.9 mm (females). DSD ratios at S1 and L4 level show a significant difference in male and female groups: 11% of S1/L4 values exceeded 1 in male group while only 4% of S1/L4 values exceeded 1 in female group. Mean DSR at each level was significantly higher in female patients than in male patients (P < 0.001), ranging from 0.70 to 0.56 (male) and from 0.82 to 0.63 (female). CONCLUSIONS: We determined the cutoff values for the normal DSR and for the normal SCD. Our findings show the relevant discrepancies with respect to literature data for diagnosis of lumbar stenosis and/or dural ectasia.

Computed tomography angiography of unilateral agenesis of the internal carotid artery: 2 cases report with focus on embryology, collateral pathways, and imaging.

Congenital absence of internal carotid artery (ICA) is a rare anomaly seen in around 0.01% of the population. High incidence of aneurysms is reported in these patients population. Many patients are asymptomatic as the development of a collateral circulation ensures cerebral perfusion. The embryology, the common collateral pathways, and the imaging findings associated with this anomaly are illustrated with 2 new cases. We reported the cases of 2 totally asymptomatic patients at the time of imaging in which ICA agenesis was proved on computed tomography angiography. On imaging, all the most important findings necessary for ICA agenesis diagnosis have been identified and described. Noninvasive imaging techniques are currently the mainstay of ICA agenesis diagnosis.

Sclerosing adenosis of the breast: report of two cases and review of the literature.

BACKGROUND: Sclerosing adenosis is a benign, usually asymptomatic lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast. It is commonly an incidental finding in perimenopausal women undergoing screening mammography. CASE REPORT: We reported on two patients with sclerosing adenosis assessed with mammography, ultrasound, and contrast-enhanced magnetic resonance imaging. Case 1 was a 21-year-old woman with a palpable lesion in her right breast that was depicted as an irregular mass on contrast-enhanced magnetic resonance imaging. Case 2 was an asymptomatic 42-year-old woman with suspicious ultrasound findings in her left breast; contrast-enhanced magnetic resonance imaging showed regional non-mass-like enhancement associated with increased vascularity. Both patients underwent ultrasound-guided vacuum-assisted biopsy. Sclerosing adenosis does not have distinctive radiological features and can mimic a malignant growth process, thus requiring a diagnostic biopsy. CONCLUSIONS: SA is a common, benign, generally asymptomatic proliferative lesion of the breast. It is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be elucidated. It does not exhibit distinctive MG, US or even MRI features. Since it may mimic a carcinoma it requires further investigation with a diagnostic biopsy.

Integrated imaging of breast hamartoma: two case reports.

Hamartoma of the breast is an uncommon, benign, slow-growing mass usually diagnosed in women in the fourth and fifth decade of life undergoing mammography (MX). Here we report two cases of hamartoma of the breast assessed by integrated MX, ultrasonography and magnetic resonance imaging (MRI) examination. Case 1 was an asymptomatic 47-year-old woman who had never been screened previously. A 90 mm mass was found in her left breast on MX. Case 2 was a 35-year-old woman with pain in her right breast where a 50 mm mass was found on MX. Both patients underwent MRI examination. Breast MRI is an adjunct to MX that can confirm hamartoma diagnosis and exclude rare malignant transformation.

MRI findings of large low-grade angiosarcoma of the breast with subsequent bone metastases: a case report.

We describe the magnetic resonance imaging (MRI) findings of 13 cm-sized low-grade angiosarcoma of the breast that occurred in a 23-year-old woman. Magnetic resonance examination revealed an ill-defined mass with marked high-signal intensity on T2-weighted images and persistent heterogeneous enhancement. Thirty months later she developed bone metastases, incidentally found on an MRI performed to evaluate the pelvis. There were well-defined bone lesions with high-signal intensity on T2-weighted images and persistent contrast enhancement on delayed phases. The metastases were not detected on previous computed tomography and fluoro-deoxyglucose positron emission tomography scans because the lesions were subtle osteoblastic type with a low proliferative index.

Primary lymphoma of the female urethra.

The case of a 69-year-old female patient come to our observation with the diagnosis of non-Hodgkin's lymphoma on histology and cystoscopy is discussed. Symptoms were characterized by dysuria, vaginal spotting and abdominal pain. CT and NMR for staging and control CT during chemotherapy were performed. They documented marked reduction of the neoformation protruding into the bladder and concentric urethral thickening associated with volumetric stability of intercavoaortic lymph node involvement and stable condition of the other localizations.