The Uniform Cortex Sign: A Diagnostic Sign of Diffuse Cortical Injury on MR Imaging of the Brain at 1.5 T.

BACKGROUND: To introduce the "uniform cortex sign" (UCS) and evaluate its performance as a diagnostic test for the presence of diffuse cortical injury (DCI). METHODS: The study was approved by our institutional review board. Three experienced neuroradiologists were given a tutorial on the UCS. They were subsequently presented with 14 cases (7 control patients and 7 DCI patients with the UCS) in random order and asked to determine whether the UCS was present. Each case consisted of selected DWI, T2-weighted, and FLAIR images from unenhanced 1.5T MRI examinations. A consensus result for each case was determined by unanimity or majority rule. RESULTS: All control patients were correctly identified as normal by all neuroradiologists (7/7). The UCS was correctly identified in 86% of DCI patients (6/7). UCS interrater agreement was high (multirater κ=0.81). CONCLUSIONS: This small study shows that the UCS can identify DCI, especially in patients with hypoxic-ischemic encephalopathy. The UCS can be subtle, hence the reader must be vigilant for this finding. The accuracy of the UCS may depend on the extent of cortical injury and time between injury and MRI. Also, a UCS may be reversible, as in our case of viral meningoencephalitis.

Knowledge, Attitude, and Practice of Diagnostic Radiology Among Clinical Year Medical Students.

Background Nowadays, radiology is considered one of the most important disciplines of medicine as it guides physicians to reach the proper diagnosis by using many types of medical imaging modalities, such as x-ray radiography, computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI). These modalities are used to create dynamic images of different parts of the human body, which are being used to accurately diagnose and follow up on a variety of medical conditions. Moreover, in recent decades, radiology has experienced substantial growth and transformation, establishing itself not just in diagnostics but also in the domain of medical interventions, which includes the increasingly recognized discipline of interventional radiology. Methodology A descriptive cross-sectional study was conducted at Umm Al-Qura University (UQU) in Makkah from October 2022 to April 2023. The population size of medical students from the fourth to sixth year at Umm Al-Qura University is about 820 students. Results The total number of participants was 359, but two did not fill out properly. Hence, data was analyzed for (n=357), whereas more than half of them were female, 195 (54.6%). About 133 (37%) of the students were in their sixth year, while 106 (29%) were in their fourth year. Regarding their grade point average (GPA), 209 (58%) had >3.5, and 119 (33%) had 3.0-3.5. The maximum number of females 77 (57.9%) students were in the sixth year. Regarding knowledge, 291 (81.5%) had heard about interventional radiology before, while 66 (18.5%) had never heard about interventional radiology before. Moreover, 270 (75.6%) believe that the years in radiology residency are the same as other specialties. Regarding perceived knowledge about radiology, 183 (51.3%) said it is adequate. Conclusion This study showed that medical students at Umm Al-Qura University have a positive attitude towards radiology. However, the majority of the students do not have adequate knowledge regarding radiology as well as radiation hazards. We can improve this by increasing radiology experience in our institutions. Also, courses should be designed and incorporated into the curriculum to increase the knowledge of medical students about ionizing radiation.

Public Attitudes Towards Lung Cancer Screening in Saudi Arabia: A Cross-Sectional Study.

Objective: Lung cancer is one of the leading causes of death worldwide, and it is ranked as the first cause of death in more than 100 countries around the world. The aim of this study was to explore the knowledge and attitude of the general population in Saudi Arabia toward lung cancer screening. Methods: A cross-sectional study employing an online survey was conducted between November 2021 and February 2022 in Saudi Arabia. This study utilized a previously developed questionnaire instrument. Logistic regression was used to identify predictors of positive attitude toward lung cancer screening. Results: A total of 473 participants were involved in this study. The majority of the study participants (74.6%) reported that they are current smokers. Almost 31.5% of the study participants reported that if lung cancer is detected early, the person's chance of surviving is poor to very poor. The majority of the study participants reported that they would be willing to do tests to diagnose lung cancer if you were invited by the Ministry of Health or their doctor. Males, participants aged (24-34 years), and current smokers were more likely to have positive attitude towards lung cancer screening (p ≤ 0.05). On the other hand, patients aged 46 years and over and those with higher education had less positive attitude towards lung cancer screening (p ≤ 0.05). Conclusion: This is the first study to look into the general public's attitudes toward lung cancer screening in Saudi Arabia. According to our findings, the majority of people believe that early detection of lung cancer can lead to improved results and have a favourable attitude toward lung cancer screening if it is indicated. Thus, incorporating lung cancer screening into the local guidelines in at-risk population is highly recommended and considering the launch of nation-wide lung cancer screening program is advised.

Dermoid Cyst in the Posterior Fossa Associated With Dermal Sinus and Abscess Formation: A Case Report.

Posterior fossa dermoid cysts are rare intracranial tumors. Most are congenital and develop during early pregnancy but manifest later in life. We report a case of a congenital posterior fossa dermoid cyst in a 22-year-old patient presenting with fever and multiple neurological complaints. Imaging studies revealed a bony defect in the occipital bone suggestive of sinus formation, heterogeneous hypointensity on T1-weighted image (T1WI), and post-contrast peripheral enhancement suggestive of an infectious process and abscess formation. The histopathological examination was typical for a dermoid cyst containing adnexal structures. This report reviews the case with its unique location and unusual radiological features. Further, the clinical presentation, diagnosis modalities, and treatment outcomes are discussed.

The Role of Liquid Biopsy in the Diagnosis and Prognosis of WHO Grade 4 Astrocytoma.

Liquid biopsy, as a non-invasive diagnostic tool, has recently gained significant attention in the field of oncology. It involves the analysis of various biomarkers present in bodily fluids, such as blood or cerebrospinal fluid, to provide information about the underlying cancer. In the case of WHO grade 4 astrocytomas, liquid biopsy has the potential to significantly impact the diagnosis and prognosis of this aggressive malignant brain tumor. By detecting specific genetic mutations, such as IDH1 or EGFR, and monitoring levels of circulating tumor DNA, liquid biopsy can aid in the early detection and monitoring of disease progression. This innovative approach is gradually being acknowledged as a less invasive and cost-effective procedure for cancer diagnosis and management to improve patient outcomes and quality of life. Various kinds of biomarkers circulating in cerebrospinal fluid (CSF), such as circulating tumor cells (CTC) and different types of nucleic acids like cell-free DNA (cfDNA), cell-free RNA (ctRNA), and microRNAs (miRNA), have been identified. These biomarkers, which require dependable detection methods, are comparatively simple to obtain and allow for repeated measurements, making them significantly superior for disease monitoring. This review aims to compare the latest liquid biopsy analysis tools for both CSF and plasma in the central nervous system.

Extracranial metastasis of brain glioblastoma outside CNS: Pathogenesis revisited.

BACKGROUND: The most prevalent malignant tumor of the CNS in adults is glioblastoma. Despite undergoing surgery and chemoradiotherapy, the prognosis remains unfavorable, with a median survival period ranging between 15 and 20 months. The incidence of glioblastoma metastasis outside CNS is uncommon with only 0.4%-2% reported rate, compared to other tumors that exhibit a 10% incidence rate of metastasis to the brain. On average, it takes about 11 months from the time of initial diagnosis for the tumor to spread beyond CNS. Consequently, the prognosis for metastatic glioblastoma is grim, with a 6-month survival rate following diagnosis. FINDINGS: The rarity of extracranial metastasis is attributed to the blood-brain barrier and lack of a lymphatic drainage system, although rare cases of hematogenous spread and direct implantation have been reported. The possible mechanisms remain unclear and require further investigation. Risk factors have been widely described, including previous craniotomy or biopsies, ventricular shunting, young age, radiation therapy, prolonged survival time, and tumor recurrence. Due to the lack of understanding about extracranial metastasis of glioblastoma pathogenesis, no effective treatment exists to date. Aggressive chemotherapies are not recommended for metastatic glioblastoma as their side effects may worsen the patient prognosis. CONCLUSION: The optimal treatment for extracranial metastasis of glioblastoma requires further investigation with a wide inclusion of patients. This review discusses the possible causes, factors, and underlying mechanisms of glioblastoma metastasis to different organs.

The General Population's Perspectives on Implementation of Artificial Intelligence in Radiology in the Western Region of Saudi Arabia.

Background  Artificial intelligence (AI) is a broad spectrum of computer-executed operations that mimics the human intellect. It is expected to improve healthcare practice in general and radiology in particular by enhancing image acquisition, image analysis, and processing speed. Despite the rapid development of AI systems, successful application in radiology requires analysis of social factors such as the public's perspectives toward the technology. Objectives The current study aims to investigate the general population's perspectives on AI implementation in radiology in the Western region of Saudi Arabia. Methods A cross-sectional study was conducted from November 2022 and July 2023 utilizing a self-administrative online survey distributed via social media platforms. A convenience sampling technique was used to recruit the study participants. After obtaining Institutional Review Board approval, data were collected from citizens and residents of the western region of Saudi Arabia aged 18 years or older. Results A total of 1,024 participants were included in the present study, with the mean age of respondents being 29.6 ± 11.3. Of them, 49.9% (511) were men, and 50.1% (513) were women. The comprehensive mean score of the first four domains among our participants was 3.93 out of 5.00. Higher mean scores suggest being more negative regarding AI in radiology, except for the fifth domain. Respondents had less trust in AI utilization in radiology, as evidenced by their overall distrust and accountability domain mean score of 3.52 out of 5. The majority of respondents agreed that it is essential to understand every step of the diagnostic process, and the mean score for the procedural knowledge domain was 4.34 out of 5. The mean score for the personal interaction domain was 4.31 out of 5, indicating that the participants agreed on the value of direct communication between the patient and the radiologist for discussing test results and asking questions. Our data show that people think AI is more effective than human doctors in making accurate diagnoses and decreasing patient wait times, with an overall mean score of the efficiency domain of 3.56 out of 5. Finally, the fifth domain, "being informed," had a mean score of 3.91 out of 5. Conclusion The application of AI in radiologic assessment and interpretation is generally viewed negatively. Even though people think AI is more efficient and accurate at diagnosing than humans, they still think that computers will never be able to match a specialist doctor's years of training.

Simple approach for the histomolecular diagnosis of central nervous system gliomas based on 2021 World Health Organization Classification.

The classification of central nervous system (CNS) glioma went through a sequence of developments, between 2006 and 2021, started with only histological approach then has been aided with a major emphasis on molecular signatures in the 4th and 5th editions of the World Health Organization (WHO). The recent reformation in the 5th edition of the WHO classification has focused more on the molecularly defined entities with better characterized natural histories as well as new tumor types and subtypes in the adult and pediatric populations. These new subclassified entities have been incorporated in the 5th edition after the continuous exploration of new genomic, epigenomic and transcriptomic discovery. Indeed, the current guidelines of 2021 WHO classification of CNS tumors and European Association of Neuro-Oncology (EANO) exploited the molecular signatures in the diagnostic approach of CNS gliomas. Our current review presents a practical diagnostic approach for diffuse CNS gliomas and circumscribed astrocytomas using histomolecular criteria adopted by the recent WHO classification. We also describe the treatment strategies for these tumors based on EANO guidelines.

Association Between CD204-Expressed Tumor-Associated Macrophages and MGMT-Promoter Methylation in the Microenvironment of Grade 4 Astrocytomas.

Background: Tumor-associated macrophages (TAMs) are principal immune cells in glioma microenvironment which support tumor growth and proliferation. Our aim in this study was to assess the relationship between CD204-expressed TAMs and O6-methylguanine-DNA methyltransferase (MGMT)-promoter methylation in World Health Organization (WHO) grade 4 astrocytomas, and its impact on patient's clinical outcome. Methods: The expression of CD204 + TAMs was quantitively assessed on 45 samples of WHO grade 4 astrocytomas using immunohistochemistry. MGMT-promoter methylation was tested by methylation techniques. The relationship between TAMs, MGMT-promoter methylation, and recurrence-free interval (RFI) was statistically analyzed. Results: There were 10 cases (22.2%) with isocitrate dehydrogenase (IDH)-mutant grade 4 astrocytoma and 35 cases (77.8%) with IDH-wildtype glioblastoma. MGMT-promotor was methylated in 18 cases (40%), unmethylated in 15 cases (33%), and the remaining 12 cases showed no MGMT status because of nucleic acid degradations. The expression of CD204+ TAMs was high in 32 cases (71.7%) and low in 13 cases (28.8%). The relationship between IDH1 mutation and CD204+ TAM expression was insignificant (P = 0.93). However, the significant difference was found between MGMT methylation and CD204+ TAMs expression (P = 0.01), in which CD204+ TAMs were diffusely expressed in MGMT-methylated cases. There was no significant difference in RFI between CD204+ TAMs expression, MGMT-promoter methylation and treatment modalities. Conclusions: Grade 4 astrocytomas with diffusely expressed CD204+ TAMs are usually associated with MGMT-promoter methylation. Although this association is unclear, CD204+ TAMs may neutralize the effect of MGMT-DNA protein to loss its function, which contributes to tumor progression. This relationship had no significant impact on the patient's clinical outcome after different treatment modalities.

Peer-assisted versus expert-assisted learning in virtual chest x-ray interpretation: A randomized controlled trial.

OBJECTIVES: To compare the effectiveness of peer-assisted learning (PAL) and expert-assisted learning (EAL) in terms of knowledge gain in virtual chest x-ray (CXR) interpretations. The secondary objective was to assess students' satisfaction levels between both groups. METHODS: In this randomized controlled trial, second-year medical students who met the inclusion criteria were randomly assigned to the PAL and EAL groups. The study was carried out from December 2020 to February 2021 at Umm Al-Qura University, Makkah, Saudi Arabia. The primary endpoint was the difference in the students' scores, which were determined by an independent reviewer. The secondary endpoint was students' satisfaction levels. RESULTS: A total of 166 second year medical students were included. The standard deviation and mean age of the population were 19.73±0.66 (males: 79 [47.6%]; females: 87 [52.4%]). Participants were allocated equally into two groups (83 in each group). Student scores did not differ significantly between the two groups (p=0.507). Students in the PAL group thought the session was useful (p=0.01), kept on time (p=0.043), and the tutor facilitated their learning process (p=0.011). They also felt that online teaching was as effective as traditional teaching (p=0.03). There was no significant difference in satisfaction scores on the other aspects of the questionnaire. CONCLUSION: Peer-assisted learning has equivalent efficacy compared to EAL in a virtual setting. The Students in the PAL group had higher level of satisfaction.

Immunolocalization of neurokinin 1 receptor in WHO grade 4 astrocytomas, oral squamous cell and urothelial carcinoma.

INTRODUCTION: Neurokinin-1 receptor (NK-1R) induces inflammatory reactions in peripheral tissues but its regulatory effects in target tissues is dependent on receptor signalling. Substance P (SP) has a high affinity for the NK-1R, to which it binds preferentially. We aimed to investigate the expression of NK-1R in World Health Organization (WHO) grade 4 astrocytomas as well as in oral squamous cell carcinoma (OSCC) and urothelial carcinoma, and its association with disease progression. MATERIAL AND METHODS: The study included tissue samples from 19 brain astrocytomas, 40 OSCCs and 10 urothelial carcinomas. NK-1R expression was quantitatively assessed in the tumour cells using immunohistochemistry. The relationship between NK-1R expression in astrocytomas and recurrence-free interval has been explored. RESULTS: The results showed that the NK-1R was intensely expressed in patients with WHO grade 4 astrocytoma, OSCC and urothelial carcinoma. However, cases clinically diagnosed as a low-grade cancer showed reduced NK-1R expression. CONCLUSIONS: NK-1R is overexpressed in all cases of WHO grade 4 astrocytoma, OSCC and urothelial carcinoma. The ubi-quitous presence of SP/NK-1R complex during tumour development and progression suggests a possible therapeutic key strategy to use NK-1R antagonist as an adjuvant therapy in the future.

Can oligodendrocyte transcriptional factor-2 (Olig2) be used as an alternative for 1p/19q co-deletions to distinguish oligodendrogliomas from other glial neoplasms?

AIM OF THE STUDY: Oligodendrocyte transcriptional factor-2 (Olig2) is an essential marker for oligodendrocytes expression. We aimed to explore the expression of Olig2 in different glial neoplasms and to investigate if diffuse Olig2 expression can replace 1p19q co-deletion for the diagnosis of oligodendroglioma. MATERIAL AND METHODS: Olig2 was performed on 53 samples of different glial neoplasms using immunohistochemistry (IHC). 1p/19q deletions were investigated using fluorescence in situ hybridization (FISH). RESULTS: Olig2 labelling of different glial neoplasms revealed various expressions, in which 26 tumours showed diffuse expression (≥ 60%) and 23 tumours showed partial focal expression (< 50%). Four tumours showed no expression. Of the 26 tumours, 6 oligodendrogliomas had 1p19q co-deletion and the remaining 3 oligodendrogliomas showed no co-deletion. Three non-oligodendroglial tumours were found to have 19q deletion. The FISH of the remaining tumours (14/26) showed no aberrations. There was no significant difference in the final diagnosis by using 1p19q co-deletion test among glial neoplasms with diffuse Olig2 expression (p = 0.248). CONCLUSIONS: Olig2 marker cannot be used as an alternative diagnostic method for 1p19q co-deletion to distinguish oligodendrogliomas from other glial neoplasms. Although some glial tumours showed diffuse Olig2 expression, 1p19q co-deletion testing is the best diagnostic method.