Pulmonary Histoplasmosis Mimicking Lung Cancer.

Teaching point: Due to the mass-like appearance of pulmonary histoplasmosis in the lung, radiological misdiagnosis may occur. Fungal infections should be considered in the differential diagnosis, especially in immune-compromised patients.

Prevalence of Bladder Cancers Incidentally Detected During Multiparametric MRI Scans of the Prostate Gland and the Clinical Significance of Scoring Them According to VI-RADS: A Pictorial Single-Centre Study.

Purpose: To determine the prevalence of incidentally detected bladder cancers (BCs) on multiparametric magnetic resonance imaging (mpMRI) of the prostate and to highlight the clinical importance of scoring them according to the Vesical Imaging-Reporting and Data System (VI-RADS). Materials and Methods: VI-RADS scores for incidental bladder lesions on mpMRI of the prostate were collected in 1693 patients with elevated prostate-specific antigen but no hematuria. The study included 19 patients with 28 incidental bladder lesions. Results: During this period, 39 incidental bladder lesions were found in 30 patients, representing 1.7% of cases. Of the 28 lesions, 11 were categorized by VI-RADS as VI-RADS 1, 14 as VI-RADS 2, 1 as VI-RADS 3, 1 as VI-RADS 4, and 1 as VI-RADS 5. Histopathological examination revealed 1 benign lesion, 24 non-muscle invasive BCs, and 3 muscle-invasive BCs in the 19 patients. Impressively, 97% of the incidental lesions detected by prostate mpMRI and categorized by VI-RADS were BCs without apparent prostate cancer invasion. Notably, 93% of these lesions were consistent with histopathological findings of muscle invasion and extravesical spread. Conclusion: Our study concludes the prevalence 1% incidental BC in prostate mpMRI. The research underscores a thorough bladder examination during prostate MRI scans. Utilizing mpMRI assists in distinguishing varying BC stages, aiding treatment decisions, and patient outcomes. VI-RADS categorization aligns with histopathological results, enhancing diagnosis, and healthcare communication. Early detection significantly influences patient care by enabling timely interventions and suitable treatment strategies, particularly for low-stage BCs linked to reduced progression and recurrence rates.

Isolated Intracranial Extramedullary Hematopoiesis in an Adult Patient.

This article describes the case of a 56-year-old male patient who presented with a headache and swelling on the left side of his head. Medical examinations, including non-contrast computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI), revealed the presence of an expansile soft tissue lesion in the frontoparietal bone structures, causing compression of the brain tissue. Further immunohistochemical analysis confirmed the diagnosis of extramedullary hematopoiesis (EMH) in the bone lesion, with predominant involvement of the myeloid series. EMH is a compensatory mechanism of the body to meet the demand for erythropoiesis. While EMH is commonly associated with thalassemia in children and myelofibrosis in adults, it can occur in various tissues throughout the body, including the intracranial region, although it is rare. The imaging findings of EMH on MRI typically show iso-hypointense signals on T1-weighted images and hypointense signals on T2-weighted images due to the presence of hemosiderin. However, in this case, the lesions appeared hyperintense on T2-weighted images, which posed a challenge in the differential diagnosis. The article highlights the importance of clinical evaluation and imaging findings in diagnosing EMH, as these lesions can resemble other conditions such as metastases, angiomatous meningioma, chloroma, or epidural hematoma. Teaching Point: Isolated cases of intracranial EMH should be considered as a differential diagnosis in adult patients as they may be radiologically confused with malignant conditions such as metastases, angiomatous meningioma, chloroma or epidural hematoma.

Intrascrotal Extratesticular Schwannoma: A Rare Cause of Scrotal Mass.

BACKGROUND: Schwannoma, also known as neurinoma, is the most common tumor of the peripheral nerves. Intrascrotal extratesticular schwannoma, which is not associated with schwannomatosis and neurofibromatosis-2, is a very rare entity, and few cases have been reported in the literature. In this paper, we have reported a case of extratesticular schwannoma, an extremely rare cause of scrotal mass, with ultrasound (US) and magnetic resonance imaging (MRI) findings. CASE REPORT: A 22-year-old male presented with painless left scrotal swelling. Scrotal US showed an extra-testicular heterogeneous hypoechoic mass with the lobulated contour in the inferior part of the scrotum. Scrotal MRI demonstrated well-defined extratesticular mass, which showed heterogeneous hypointense T2-weighted images compared to testis parenchyma. On contrast-enhanced images, the mass showed mild-to-moderate enhancement. The patient underwent surgery with the preliminary diagnosis of benign intrascrotal extratesticular mass. The lesion was removed with preservation of the testicles by urologists, and the final diagnosis was made as scrotal schwannoma by histological and immunohistochemical examination. CONCLUSION: Although there is no specific imaging finding of scrotal schwannoma, MRI can be used as a guide to surgery by helping to accurately determine whether the lesion is intra- or extratesticular. In addition, radiologists and urologists should keep schwannoma in mind in the differential diagnosis in the presence of an intrascrotal extratesticular mass.

A needful, unique, and in-place evaluation of the injuries in earthquake victims with computed tomography, in catastrophic disasters! The 2023 Turkey-Syria earthquakes: part I

SUMMARY OBJECTIVE: This study was carried out to evaluate the injuries in pediatric earthquake victims due to the 2023 Turkey-Syria earthquakes with computed tomography and determine the anatomotopographic distribution of injuries. METHODS: The material of this retrospective study consisted of the computed tomography findings of 257 pediatric cases injured in the 2023 Turkey-Syria earthquakes, and those were divided into subgroups based on their age group, i.e., 0-4, 5-9, 10-14, and 15-18 years, and the type of injury, i.e., head, maxillofacial, thoracic, abdominal, pelvic, and spinal injuries. RESULTS: Earthquake-related injuries had been detected in 102 (39.6%) patients. Of the 29 patients with multiple injuries, 17, 10, and 2 had injuries in two, three, and four topographic regions, respectively. The most common injury was a head injury, which was detected in 48 (18.7%) cases, followed by thoracic injury, spinal injury, pelvic fracture, abdominal injury, and maxillofacial fracture, which were detected in 40 (15.6%), 22 (8.5%), 19 (7.4%), 10 (3.9%), and 6 (2.3%) patients, respectively. The cranial bone fractures and intracranial injuries were significantly more frequent in the 0-4 years age group compared with other age groups (p=0.028 and p=0.024, respectively). The rib fractures with spinal and pleural injuries were significantly more common in the 15-18 years age group compared with others (p=0.016, p=0.004, and p=0.002, respectively). CONCLUSION: The head injury was the most common earthquake-related injury in pediatric cases. Herein, it was more common in younger children compared with other age groups, whereas rib, spine, and pleural injuries were more common in older children.

Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: accuracy and the factors affecting the results.

PURPOSE We aimed to investigate the accuracy of Vesical Imaging - Reporting and Data System (VI-RADS) in the detection of muscle-invasive bladder cancer (MIBC) and to determine which factors affect the results of this scoring system. METHODS A prospective data analysis of 80 patients who were detected to have bladder tumor was performed between March 2019 and October 2020. VI-RADS scoring was used to determine the probability of muscle invasion. The scores were compared with pathological results to evaluate the accuracy of the VI-RADS scoring system. Interobserver agreement was assessed by VI-RADS scoring of 20 randomly chosen patients by a different experienced radiologist. RESULTS Using the VI-RADS scoring system, the sensitivity, specificity, positive predictive value, and negative predictive value of multiparametric magnetic resonance imaging (mpMRI) were 87.5%, 87.5%, 63.6%, and 96.6%, respectively. The interobserver agreement expressed as the interclass correlation coefficient (ICC) was 0.72 (95% CI: 0.44-0.84, P < .001). In addition, the flat appearance of the tumor was an important factor affecting the accuracy of the VI-RADS score (odds ratio: 5.3 [95% CI: 1.1-27.0] and relative risk: 1.87 [95% CI: 1.24-2.82]). CONCLUSION The mpMRI, used in conjunction with VI-RADS, has proven to be an effective imaging method for detecting muscle invasion in cases of bladder cancer. VI-RADS scoring system can distinguish whether there is a muscle-invasive and non-muscle invasive bladder cancer with acceptable accuracy. In addition, the flat appearance of the tumor is an important entity that can affect the accuracy of the VI-RADS scoring system.

Differentiation of affected and nonaffected ovaries in ovarian torsion with magnetic resonance imaging texture analysis

SUMMARY OBJECTIVE: This study aimed to evaluate the feasibility of texture analysis on T2-weighted axial images in differentiating affected and nonaffected ovaries in ovarian torsion. METHODS: We included 22 torsioned ovaries and 19 healthy ovaries. All patients were surgically proven ovarian torsion cases. On T2-weighted axial images, ovarian borders were delineated by the consensus of two radiologists for magnetic resonance imaging-based texture analysis. Statistical differences between texture features of affected and nonaffected ovaries were assessed. RESULTS: A total of 44 texture features were extracted from each ovary using LIFEx software. Of these, 17 features were significantly different between affected and nonaffected ovaries in ovarian torsion. NGLDM_Coarseness and NGLDM_Contrast, which are the neighborhood gray-level difference matrix parameters, had the largest area under the curve: 0.923. The best cutoff values for the NGLDM_Contrast and NGLDM_Coarseness were 0.45 and 0.01, respectively. With these cutoff levels, NGLDM_Contrast had the best accuracy (85.37%). CONCLUSION: Magnetic resonance imaging-based texture analysis on axial T2-weighted images may help differentiate affected and nonaffected ovaries in ovarian torsion.

Comparison of the diagnostic accuracy and validity of biparametric MRI and multiparametric MRI-based VI-RADS scoring in bladder cancer; is contrast material really necessary in detecting muscle invasion?

PURPOSE: (1) To evaluate the accuracy and validity of the biparametric MRI (bp-MRI), including T2-weigthed image (WI) and DWI sequences, and the availability of an alternative to the multiparametric MRI (mp-MRI), for the muscle-invasiveness assessment of bladder cancer (BC). (2) To evaluate the diagnostic performance and agreement of readers with different experiences in the abdominal imaging of using both protocols. METHODS: Preoperative bladder mp-MRI was performed on 128 patients with a initial diagnosis of BC. Two sets of images, set 1 (bp-MRI) and set 2 (mp-MRI), were independently evaluated by both readers. Descriptive statistics, including sensitivity, specificity, accuracy, and area under the curve (AUC), for VI-RADS scores were calculated using ≥ 4 as the cutoff for muscle invasion for each reader and image sets. Inter-reader agreement was evaluated using the Cohen's kappa coefficient. RESULTS: The sensitivity ranged between 90.3-93.5% and 87.1-90.3%, specificity ranged between 96.6-99.1% and 91.6-96.6%, accuracy ranged between 96-97.3% and 91.3-94.6%, and AUC ranged between 0.947-0.951 and 0.919-0.921, for bp-MRI and mp-MRI, and reader 1 and reader 2, respectively. No significant differences were shown in diagnostic performance for either reader between both the protocols (p = 0.238 and 0.318). There was excellent agreement among the readers in the VI-RADS scores, using both protocols. CONCLUSION: A bp-MRI protocol has a diagnostic accuracy comparable to an mp-MRI protocol for the detection of muscle-invasive BC using the VI-RADS criteria. Also, in both MRI protocols, the reader's experience does not appear to significantly affect diagnostic performance when using the VI-RADS criteria.