Congenital cholesteatoma: what radiologists need to know.

Congenital cholesteatoma is a rare, non-neoplastic lesion that causes conductive hearing loss in children. It is underrecognized and often diagnosed only when there is an established hearing deficit. In the pediatric population, hearing deficiency is particularly detrimental because it can impede speech and language development and, in turn, the social and academic well-being of affected children. Delayed diagnosis leads to advanced disease that requires more extensive surgery and a greater chance of recurrence. A need to promote awareness and recognition of this condition has been advocated by clinicians and surgeons, but no comprehensive imaging review dedicated to this entity has been performed. This review aims to discuss the diagnostic utility of high-resolution computed tomography and magnetic resonance imaging in preoperative and postoperative settings in congenital cholesteatoma. Detailed emphasis is placed on the essential preoperative computed tomography findings that facilitate individualized surgical management and prognosis in the pediatric population.

Different facets of intracranial central nervous system lymphoma and its imaging mimics.

Lymphomas of the central nervous system (CNS) are broadly classified into primary CNS lymphoma (PCNSL) and secondary CNS lymphoma (SCNSL). PCNSL refers to lymphoma restricted to the brain, leptomeninges, spinal cord, or eyes without evidence of it outside the CNS at primary diagnosis, while SCNSL refers to secondary CNS involvement by systemic lymphoma. The brain is the most common site of involvement and intracranial CNS lymphoma has a highly variable imaging appearance and varies according to the patient's clinical profile and immunity. This pictorial essay aims to illustrate the different facets of intracranial CNS lymphomas on neuroimaging. This enables radiologists to be familiarized with their key diagnostic features and differentiate from their differential diagnoses, leading to early diagnosis, and treatment.

Gallium-67 Scan with Single Photon Emission Computed Tomography for the Evaluation and Monitoring of Infected Abdominal Aortic Aneurysms: A 10-Year Case Series.

PURPOSE: This study aimed to evaluate the role of gallium-67 single photon emission computed tomography (SPECT) with contrast computed tomography (CT) in the evaluation and monitoring of infected abdominal aortic aneurysms (IAAA). MATERIALS AND METHODS: A retrospective cohort analysis was performed using prospectively collected data of consecutive patients with IAAA in Princess Margaret Hospital in Hong Kong between January 2010 and December 2020. The patients were identified using the Radiology Information System. RESULTS: All five patients had proven IAAA on CT and/or metabolic imaging. Among them, three were further supported by positive blood culture results. Gallium- 67 SPECT with contrast CT was useful in the detection of residual disease, monitoring, and detection of recurrence. CONCLUSION: Gallium-67 SPECT with contrast CT is helpful for evaluating IAAA. It serves an important role in guiding management, especially during long-term follow-up.

Renal and splenic micro-infarctions following bronchial artery embolization with tris-acryl microspheres.

A bronchial artery embolization (BAE) is an important therapeutic method used to control acute and chronic hemoptysis. We report a case of multiple micro-infarcts involving both the kidneys and spleen, following a BAE with 500-700 microm crossed-linked tris-acryl microspheres (Embospheres) in a patient with bronchial artery pulmonary vein shunts. The superior penetration characteristics of the microspheres may have resulted in the greater tendency to cross the bronchial artery pulmonary vein shunts, which subsequently caused the systemic infarcts in our patient. We propose the use of larger sized microspheres (700-900 microm), which may aid in avoiding this complication.

Coexisting cerebral infarction in Alzheimer's disease is associated with fast dementia progression: applying the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences Neuroimaging Criteria in Alzheimer's Disease with Concomitant Cerebral Infarction.

OBJECTIVES: To determine whether patients with Alzheimer's disease (AD) and coexisting cerebral infarction (CI) that satisfy the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) neuroimaging criteria for vascular dementia (VaD) progress faster than those who do not satisfy the neuroimaging criteria. DESIGN: Retrospective cohort study. SETTING: Multidisciplinary memory clinic in a tertiary hospital. PARTICIPANTS: One hundred thirty consecutive patients with AD, with or without CI, followed up regularly for more than 1 year. MEASUREMENTS: The patients were classified according to the distribution and severity of CI as defined according to the NINDS-AIREN neuroimaging criteria into those with AD and no CI (AD-N), those with AD and CI not fulfilling neuroimaging criteria (AD-I), and those with AD and CI fulfilling neuroimaging criteria (AD-V), and their differences in dementia progression were tested. The loss of independence, indicated by institution admission or a clinical dementia rating (CDR) score of 3, was defined as the endpoint for a poor outcome. RESULTS: The mean age was 75.8, and 68.5% were women. The initial Mini-Mental State Examination (MMSE) score was 15.3+/-0.4, and the average duration of follow up was 30.4 months. Fifty-four patients had reached study endpoint at the time of analysis. AD-V (hazard ratio (HR)=3.1, 95% confidence interval (CI)=1.2-8.2), use of psychotropic drugs (HR=2.7, 95% CI=1.1-6.4), and initial MMSE score (HR=0.9, 95% CI=0.8-1.0) were independent predictors of poor outcome in the Cox regression model. CONCLUSION: In AD, co-occurrence of CI with distribution and severity as defined in the NINDS-AIREN neuroimaging criteria for VaD is associated with faster dementia progression.

Hybrid method in severe pulmonary embolism not suitable for systemic fibrinolysis.

Acute massive pulmonary embolism is known to be associated with high mortality, and treatment options may be limited if systemic fibrinolysis is contraindicated. We report the exciting results of a novel mechanical-pharmacological hybrid approach in 3 patients with life-threatening massive pulmonary embolism, in whom systemic fibrinolysis was contraindicated.

Early Enlargement of Aneurysmal Sac and Separation of EndoBags of Nellix Endovascular Aneurysm Sealing System as Signs of Increased Risk of Later Aneurysm Rupture.

Nellix Endovascular Aneurysm Sealing (EVAS) system is a new concept and technology of abdominal aortic aneurysm (AAA) repair. Elective EVAS using Nellix device was performed for a 83-year-old man with AAA. 2-month post-EVAS CTA surveillance demonstrated mild enlargement of aneurysmal sac and separation of the EndoBags, but without detectable endoleak. The patient developed sudden AAA rupture with retroperitoneal hematoma at about 4 months after EVAS. We postulated that early enlargement of aneurysmal sac and separation of EndoBags of Nellix devices after EVAS, even without detectable endoleak, might indicate significant aneurysmal wall weakening with increased risk of later AAA rupture. To the best of the authors' knowledge, this was the first reported case of aortic rupture after EVAS without detectable endoleak during and after the procedure.

Transient cortical blindness following vertebral angiography: a case report.

Transient cortical blindness (TCB) is a rare but well-known complication of cerebral angiography. Its pathophysiology remains uncertain. We would like to report a case of TCB in a patient during a follow up vertebral angiogram for post-coil embolization of left posterior inferior cerebellar artery aneurysm. Patient's vision was resumed spontaneously within 24 hours after angiography, with no residual neurological deficit in subsequent clinical follow up. Multi-modality imaging evaluation including vertebral angiography, brain CT and MRI performed on same day are presented.