Vasari Scoring System in Discerning between Different Degrees of Glioma and IDH Status Prediction: A Possible Machine Learning Application?

(1) The aim of our study is to evaluate the capacity of the Visually AcceSAble Rembrandt Images (VASARI) scoring system in discerning between the different degrees of glioma and Isocitrate Dehydrogenase (IDH) status predictions, with a possible application in machine learning. (2) A retrospective study was conducted on 126 patients with gliomas (M/F = 75/51; mean age: 55.30), from which we obtained their histological grade and molecular status. Each patient was analyzed with all 25 features of VASARI, blinded by two residents and three neuroradiologists. The interobserver agreement was assessed. A statistical analysis was conducted to evaluate the distribution of the observations using a box plot and a bar plot. We then performed univariate and multivariate logistic regressions and a Wald test. We also calculated the odds ratios and confidence intervals for each variable and the evaluation matrices with receiver operating characteristic (ROC) curves in order to identify cut-off values that are predictive of a diagnosis. Finally, we did the Pearson correlation test to see if the variables grade and IDH were correlated. (3) An excellent ICC estimate was obtained. For the grade and IDH status prediction, there were statistically significant results by evaluation of the degree of post-contrast impregnation (F4) and the percentage of impregnated area (F5), not impregnated area (F6), and necrotic (F7) tissue. These models showed good performances according to the area under the curve (AUC) values (>70%). (4) Specific MRI features can be used to predict the grade and IDH status of gliomas, with important prognostic implications. The standardization and improvement of these data (aim: AUC > 80%) can be used for programming machine learning software.

The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department.

BACKGROUND: The diagnosis of acute spondylodiscitis can be very difficult because clinical onset symptoms are highly variable. The reference examination is MRI, but very often the first diagnostic investigation performed is CT, given its high availability in the acute setting. CT allows rapid evaluation of other alternative diagnoses (e.g., fractures), but scarce literature is available to evaluate the accuracy of CT, and in particular of multi-detector computed tomography (MDCT), in the diagnosis of suspected spondylodiscitis. The aim of our study was to establish MDCT accuracy and how this diagnostic method could help doctors in the depiction of acute spondylodiscitis in an emergency situation by comparing the diagnostic performance of MDCT with MRI, which is the gold standard. METHODS: We searched our radiological archive for all MRI examinations of patients who had been studied for a suspicion of acute spondylodiscitis in the period between January 2017 and January 2021 (n = 162). We included only patients who had undergone MDCT examination prior to MRI examination (n = 25). The overall diagnostic value of MDCT was estimated, using MRI as the gold standard. In particular, the aim of our study was to clarify the effectiveness of CT in radiological cases that require immediate intervention (stage of complications). Therefore, the radiologist, faced with a negative CT finding, can suggest an elective (not urgent) MRI with relative serenity and without therapeutic delays. RESULTS: MDCT allowed identification of the presence of acute spondylodiscitis in 13 of 25 patients. Specificity and positive predictive value were 100% for MDCT, while sensitivity and negative predictive value were 68% and 50%, respectively, achieving an overall accuracy of 76%. In addition, MDCT allowed the identification of paravertebral abscesses (92%), fairly pathognomonic lesions of spondylodiscitis pathology. CONCLUSIONS: The MDCT allows identification of the presence of acute spondylodiscitis in the Emergency Department (ED) with a satisfactory accuracy. In the case of a positive CT examination, this allows therapy to be started immediately and reduces complications. However, we suggest performing an elective MRI examination in negative cases in which pathological findings are hard to diagnose with CT alone.

Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?

(1) Background: Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. Intracranial hemorrhage is one of the most serious clinical manifestations. In this paper the authors' goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); (2) a retrospective study of 26 patients with DAVFs who presented with intracranial hemorrhage to our institution was performed. The information reviewed included clinical presentation, location and size of hemorrhage, brain CTA and 3D DSA findings; (3) results: 61% (16/26) of DAVFs were identified by CTA. The vast majority of patients were male (69%, 18/26) and the most common presenting symptom was sudden onset headache. All DAVFs had cortical venous drainage and about one-third were associated with a venous varix. The most common location was tentorial (73%, 19/26); (4) conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs.

MR imaging features of liver involvement by Wilson disease in adult patients.

OBJECTIVE: To describe the magnetic resonance imaging (MRI) presentation of liver involvement in adult patients with Wilson disease (WD) and determine the most indicative appearance of this condition on MRI using a retrospective case-control study. MATERIALS AND METHODS: MRI examinations of 23 adult patients with WD (14 men, 9 women; mean age = 40.4 years) were analyzed by two blinded observers and compared to those obtained in 23 patients with chronic viral hepatitis (14 men, 9 women, mean age = 40.4 years) who were matched for age, gender and severity of chronic liver disease. Images were qualitatively and quantitatively analyzed with respect to imaging presentation. Comparisons were performed using univariate analysis. RESULTS: Honeycomb pattern of hepatic parenchyma was the most discriminating independent variable for the diagnosis of WD (odds ratio, 17.082; 95 % CI 2.092-139.497) (P = 0.0081) but had a sensitivity of 43 % (10/23; 95 % CI 23-66 %). Regular liver contours was the other variable that strongly correlated with the presence of liver involvement by WD (odds ratio, 11.939; 95 % CI 1.503-94.836) (P = 0.0190). CONCLUSION: The honeycomb pattern is the most discriminating independent variable for the diagnosis of liver involvement by WD but has limited sensitivity. Familiarity with this finding may clarify the cause of diffuse hepatic parenchymal abnormalities in patients with unknown WD.

MR imaging features of focal liver lesions in Wilson disease.

Hepatic involvement in Wilson disease (WD) manifests as a diffuse chronic disease in the majority of patients. However, in a subset of patients focal liver lesions may develop, presenting with a wide range of imaging features. The majority of focal liver lesions in patients with WD are benign nodules, but there are reports that have described malignant liver tumors or dysplastic nodules in these patients. Because of the possibility of malignant transformation of liver nodules, major concerns have been raised with respect to the management and follow-up of patients with WD in whom focal liver lesions have been identified. The assessment of liver involvement in patients with WD is generally performed with ultrasonography. However, ultrasonography conveys limited specificity so that magnetic resonance (MR) imaging is often performed to improve lesion characterization. This review was performed to illustrate the spectrum of MR imaging features of focal liver lesions that develop in patients with WD. It is assumed that familiarity with the MR imaging presentation of focal liver lesions in WD may help clarify the actual nature of hepatic nodules in patients with this condition.

[Chordoma: diagnostic considerations and review of the literature]. / Cordoma: considerazioni diagnostiche e revisione della letteratura.

Chordoma is a rare malignant tumor of the bone; it arises from embryonic remnants of the primitive notochord and occurs along the midline from the skull base to the sacrum. In this article, we reviewed the origin, location, clinical, histopatological and imaging features, treatment, and differential diagnosis of chordoma.