Essential Considerations for Radiologists in Diagnosing Hidradenitis Suppurativa.

Hidradenitis suppurativa, also referred to as inverse acne, manifests as a persistent inflammatory skin disorder characterized by lesions such as deep nodules, abscesses, sinus tracts, and fibrotic scars. These manifestations predominantly occur in skin folds and intertriginous areas, notably in the axillary, inguinal, perianal, perineal, and inframammary regions. Due to similarities with other conditions in its initial stages, accurate diagnosis of hidradenitis suppurativa is often delayed, sometimes spanning several years. Diagnosis relies on identifying specific morphologic features (such as deep, inflamed, and painful nodules; sinus tracts; and scars), considering the affected sites (skin folds and areas with apocrine glands), and recognizing the chronic nature of the condition (persistent course with periods of exacerbation and remission). There are no definitive biologic or pathologic diagnostic tests, and biopsy of the affected area is not necessary. Treatment varies based on severity and may include topical and systemic antibiotics, hormonal therapy, immunomodulators, and surgery. Due to associated pain, increased site sensitivity, secretion drainage, odor, and scarring, this condition can have a negative psychosocial impact. Imaging studies, including high-frequency US and MRI with subsequent three-dimensional reconstruction, serve as valuable tools for precise staging, monitoring disease activity, and preoperative assessment. Currently, high-frequency US stands as the preferred method, incorporating sonographic classifications, while MRI and thee-dimensional imaging represent an emerging and promising approach. Imaging helps identify the extent of sinus tracts, assess involvement dimensions in advanced disease stages, and monitor proposed treatments. ©RSNA, 2024 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Isolated congenital arhinia: Fetal magnetic resonance imaging and pediatric computed tomography 3D reconstructions, long-term follow-up and review of the literature.

The complete absence of the nose, arhinia, is a malformation most often associated with severe brain malformations. However, arhinia can be isolated, but only a few cases have been described. The prenatal diagnosis of isolated arhinia is also rarely described, with only three cases describing their follow-up, mostly in the first months of life. In this case report, we describe the prenatal diagnosis of isolated arhinia and the long-term follow-up of 8 years with normal psychological and cognitive development. We also demonstrated the fetal magnetic resonance imaging and pediatric computed tomography three-dimensional reconstructions of the face.

Is there a role for magnetic resonance imaging in cesarean scar pregnancy after the first trimester?

Magnetic resonance imaging (MRI) can provide additional information in cases of cesarean scar pregnancy beyond the first trimester. MRI and 3D reconstructions can demonstrate the relationships between the uterus, cervix, bladder, and placenta, improving the spatial perspective of the pelvic anatomy in cases requiring surgical management. MRI and 3D reconstructions can also provide more comprehensive images for parental counseling, virtual and face-to-face multidisciplinary team discussion, and medical record storage.

Three-dimensional navigation inside a normal fetal heart in a virtual reality environment.

Three-dimensional navigation allows in a virtual reality environment across the fetal heart structures using glasses and joysticks. This technology allows virtual interactive discussions among multidisciplinary teams providing new perspectives on diagnosis and planning possible surgical corrections.

Fetal giant liver hemangioma: Ultrasound, magnetic resonance imaging, three-dimensional reconstruction findings and perinatal outcomes of two cases.

In this case report, we present two cases of fetal liver giant hemangioma assessed using ultrasound, magnetic resonance imaging and three-dimensional reconstructions with their respective postnatal outcomes.

Prenatal diagnosis of closed gastroschisis: What to expect in the most severe form of gastroschisis? Case report and literature review.

Closed gastroschisis (CG) and vanishing gastroschisis (VG) are the most severe forms of evolution of the malformation. In this case, a fetus presented with gastroschisis at 13 weeks, and the gastroschisis was not visualized at 22 weeks of gestation. Distal ileum, cecum, and ascending colon atresia were diagnosed at surgery, and the child is fully enteral-fed at 5 months of age. In a literature review of 43 cases of prenatal diagnosis of CS-VG, intrauterine death occurred in 4.5% of cases. 79.6% of the cases underwent surgical treatment. Of these cases, 20% of cases died due to complications of treatment, 26% were still under treatment and 54% are alive with enteral feeding. In 77% of the cases, the closure of the umbilical ring occurred after 26 weeks of gestation and the absence of prenatal diagnosis of CG-VG during pregnancy has a risk of 71% of death.

Placenta accreta: Virtual reality from 3D images of magnetic resonance imaging.

Image from a fragment of the video of virtual reality model evaluating a case of placenta accreta spectrum and placental invasion. In this image, the placenta (purple) goes through the uterus and reaches the bladder muscle and mucosa (pink).

Virtual segmentation of three-dimensional ultrasound images of morphological structures of an ex vivo ectopic pregnancy inside a fallopian tube.

Ex vivo ultrasound (US) of human tissues has been used for decades on the study of the acoustic physical aspects of the US, to the study of the morphology of the organs. Using three-dimensional (3D) US, we demonstrate the possibilities to study surgical specimens from gynecological conditions. 3D images of the surgical specimen were collected and virtually segmented according to the contrast of its images, providing a 3D image of the ectopic pregnancy and its effects on the fallopian tube.

Craniopagus twin: pre- and post-natal 3-dimensional virtual and physical models and virtual navigation created with free or open source software-an option for low-resource centers.

BACKGROUND: Craniopagus twins represent a rare and complex congenital malformation characterized by conjoined twins fused at the cranium. Craniopagus is challenging for patients' families and surgeons, and accurate confirmation of the extent of cranial fusion is a complex process. Most information regarding the surgical anatomy of this rare condition is obtained through analysis of ultrasonographic, magnetic resonance, or computed tomographic images. A multidisciplinary team plays a key role in obtaining such information and in parental counseling and coordination of various complex processes for optimal postnatal care of these twins. The extent of fusion is usually determined based on conventional clinical methods, such as imaging studies. METHODS: Imaging software is being used in recent times to create three-dimensional reconstruction images and for virtual navigation to investigate the skulls and brains of craniopagus twins. However, the acquisition and maintenance costs of such sophisticated medical software may be unaffordable for medical centers in developing countries. To overcome this limitation, we investigated the role of open or free source software for accurate determination of complex malformations of the skull and brain of craniopagus twins.

Virtual navigation for the improvement of parents counseling and the planning of fetal endoscopic myelomeningocele repair.

BACKGROUND: Myelomeningocele (MMC) is the most severe form of spina bifida with intrauterine repairs becoming more prevalent. The development of three-dimensional ultrasound (3DUS) and magnetic resonance imaging (MRI) has drastically improved the visualization of fetal anatomy. METHODS: Virtual Navigation (VN) results from a technology that uses software generated realistic images to replicate the immersive feeling of a real environment. CONCLUSION: This report aims to demonstrate VN in a Chiari II malformation case, obtained from 3DUS and MRI files, comparing this with the fetal endoscopic surgery for MMC.

Congenital High Airway Obstruction Syndrome (CHAOS): Virtual Navigation in the Fetal Airways After Intrauterine Endoscopic Treatment.

BACKGROUND: Congenital high airway obstruction syndrome (CHAOS) involves the partial or complete obstruction of the fetal upper airways, usually caused by atresia or stenosis of the larynx or trachea. The obstruction of bronchial tree leads to lung distension, diaphragmatic eversion, and cardiac dysfunction, which can result in fetal death. CASE: A primigravid 19-year-old was diagnosed with CHAOS at 193 weeks gestation. Virtual navigation using magnetic resonance imaging (MRI) data was used to visualize the fetal airways after intrauterine endoscopic laser decompression. A perforation in the fetal larynx/trachea was identified and the diagnosis was modified to tracheal stenosis. Cesarean delivery occurred at 315 weeks using an ex utero intrapartum treatment (EXIT) procedure. The neonatology team were unable to perform intubation, suggesting a final diagnosis of tracheal atresia. The male newborn weighed 1920 g and died 1 hour later. CONCLUSION: 3D virtual bronchoscopy is a non-invasive approach to visualizing the fetal upper airways and can be used to diagnose and manage CHAOS.

Choledochal cyst theories going pear-shaped? Evolution of choledochal cyst during intrauterine life in a case evaluated using magnetic resonance imaging and postnatal outcomes.

A choledochal cyst is a rare abdominal malformation and was first reported almost three centuries before. There are few theories describing the evolution of the cyst through the lifespan of affected patients until diagnosis and prompt treatment; however, there is no image documentation of the evolution of the malformation. In this report, we demonstrate the evolution of a type I choledochal cyst in a fetus from the 24th to the 37th week of gestation using magnetic resonance imaging and perinatal outcomes with correlation with pathophysiological mechanisms.

A preliminary 3-D comparison of rapid and slow maxillary expansion in children: A randomized clinical trial.

BACKGROUND: This study compared the effects of rapid maxillary expansion (RME) and slow maxillary expansion (SME) using cone-beam computed tomography (CBCT). AIM: To evaluate the skeletal and dentoalveolar effects produced by two different maxillary expansion protocols. DESIGN: Eligibility criteria included maxillary transverse deficiencies in children (mean age, 8.18 years old), randomly assigned to either RME or SME. At the outcome analysis phase, a sample of 29 subjects were analysed (RME group, N = 16 and SME group, N = 13). CBCT scans taken before expansion and 6 months later were evaluated. Five posterior and 6 anterior transverse measurements were made at different vertical levels. Treatment changes were analysed using paired t tests; independent t tests were used to compare the two groups. RESULTS: There were statistically significant (P<.05) increases in maxillary width at the skeletal, alveolar, and dental levels for both groups, with significantly smaller increases at the more superior than inferior levels. The RME group exhibited statistically larger width increases than the SME group for all measures except interorbital width, anterior alveolar process width, and intercanine width. The group differences were greater for anterior than posterior apical base widths. CONCLUSIONS: Rapid maxillary expansion produced greater orthopaedic effects than slow maxillary expansion, with the greatest effects occurring in the anterior apical base.

Prenatal diagnosis of Apert syndrome using ultrasound, magnetic resonance imaging, and three-dimensional virtual/physical models: three case series and literature review.

OBJECTIVE: This aimed to describe the prenatal diagnosis of three cases of Apert syndrome using two-dimensional (2D) and three-dimensional (3D) ultrasound, magnetic resonance imaging (MRI), and 3D virtual/physical models. METHODS: We retrospectively analyzed three cases of Apert syndrome at our service. The prenatal diagnostic methods used were 2D ultrasound, 3D ultrasound in conventional and HDlive rendering modes, T2-weighted MRI sequences, and 3D virtual/physical models from MRI or 3D ultrasound scan data. All imaging methods were performed by one observer. All prenatal diagnoses were confirmed by autopsy in cases of termination of pregnancy or genetic assessment during the postnatal period. RESULTS: Mean ± standard deviation of maternal and gestational age at the time of diagnosis was 36.5 ± 3.5 years and 32 ± 4.2 weeks, respectively. Main 2D/3D ultrasound and MRI findings were craniosynostosis, hypertelorism, low ear implantation, increased kidneys dimensions, and syndactyly of hands and feet. 3D virtual/physical models allowed 3D view of fetal head and extremity abnormalities. Termination of pregnancy occurred in two cases. CONCLUSION: Prenatal 3D ultrasound and MRI enabled the identification of all Apert syndrome phenotypes. 3D virtual/physical models provided both the parents and the medical team a better understanding of fetal abnormalities.

3-D Virtual Reconstruction of a Large Amniocele With Protrusion of Legs and Umbilical Cord Following Asymptomatic Uterine Rupture.

BACKGROUND: Complete uterine rupture is a rare and severe intrapartum complication with high rates of maternal and fetal mortality. Asymptomatic uterine rupture is a very rare condition with one unique previous case described in the literature. Three-dimensional virtual models allow an immersive virtual reality of maternal-fetal structures with better understanding by the parents and the medical team. CASE: We demonstrate a case of asymptomatic rupture uterine with a large amniocele and protruded legs and umbilical cord at 28 weeks of gestation by using a 3-D virtual model from ultrasound scan data. CONCLUSION: 3-D virtual models may be applied to the assessment of obstetric complications, thereby allowing a novel 3-D spatial view of maternal-fetal structures.

Clinical Outcome of an Impacted Maxillary Canine: From Exposition to Occlusion.

AIM: The aim is to report a case of impacted maxillary right canine successfully positioned into the occlusion line. BACKGROUND: Although the treatment of choice for an impacted canine is a combined surgical-orthodontic approach, there are differences in technique. The preorthodontic uncovering and autonomous eruption technique is a safe and predictable option for the treatment of palatally impacted maxillary canines in adolescents and adults as is the orthodontic creation of a space before minimal surgical exposure, the bonding of a small attachment (an eyelet), full-flap closure, and immediate traction. Although the mechanical management of impacted teeth is a routine task for most orthodontists, certain types of impaction can be frustrating. CASE DESCRIPTION: An 18-year-old adult patient presented for clinical examination with a mobile maxillary right deciduous canine, the absence of a maxillary right permanent canine, Angle Class I malocclusion, an overjet of 2.0 mm, an overbite of 3.0 mm, and rotated canine and left maxillary central and lateral incisors. Cephalometric measurements revealed a skeletal Class I relationship as well as upright maxillary incisors (1. NA = 18°) and mandibular incisors (1. NB = 16°, IMPA = 80°). The facial profile was concave. Clinically, a constricted maxillary arch was observed, and the patient had a nail-biting habit. CONCLUSION: The canine was aligned, leveled and positioned in the occlusion line. The esthetic, functional and periodontal results remained stable in the retention phase. CLINICAL SIGNIFICANCE: Various treatment strategies are available to treat impacted maxillary canines. The surgical, periodontal, and orthodontic considerations in the management of impacted canines must be clearly explained to the patient.

Prenatal Phenotype of Down Syndrome Using 3-D Virtual Reality.

BACKGROUND: Down syndrome is a chromosomal abnormality characterized by an additional acrocentric chromosome, resulting in an aneuploid number of 47 chromosomes (trisomy 21). Fetal face phenotype of Down syndrome is typical in the second trimester and characterized by plane face and a big and protruding tongue. CASE: We present a case of Down syndrome at 29 weeks of gestation in which the fetal face was created using 3-D virtual reality model from 3-D ultrasound scan data. CONCLUSION: A 3-D virtual model from 3-D ultrasound or magnetic resonance imaging scan data allowed an immersive real environment, improving the understanding of fetal congenital anomalies by the parents and the medical team.