Brain Abnormalities in Schizophrenia: A Comparative Imagistic Study.

Background and Objectives: Neuroimaging reveals a link between psychiatric conditions and brain structural-functional changes, prompting a paradigm shift in viewing schizophrenia as a neurodevelopmental disorder. This study aims to identify and compare structural brain changes found during the first schizophrenia episode with those found after more than 5 years of illness. Materials and Methods: This prospective study involved 149 participants enrolled between 1 January 2019 and 31 December 2021. The participants were categorized into three groups: the first comprises 51 individuals with an initial psychotic episode, the second consists of 49 patients diagnosed with schizophrenia for over 5 years, and a control group comprising 50 individuals without a diagnosis of schizophrenia or any other psychotic disorder. All participants underwent brain CT examinations. Results: The study examined all three groups: first-episode schizophrenia (FES), schizophrenia (SCZ), and the control group. The FES group had a mean age of 26.35 years and a mean duration of illness of 1.2 years. The SCZ group, with a mean age of 40.08 years, had been diagnosed with schizophrenia for an average of 15.12 years. The control group, with a mean age of 34.60 years, had no schizophrenia diagnosis. Structural measurements revealed widening of frontal horns and lateral ventricles in the SCZ group compared to FES and the FES group compared to the control group. Differences in the dimensions of the third ventricle were noted between SCZ and FES, while no distinction was observed between FES and the control group. The fourth ventricle had similar measurements in FES and SCZ groups, both exceeding those of the control group. Our results showed higher densities in the frontal lobe in schizophrenia patients compared to FES and the control group, with the control group consistently displaying the lowest densities. Conclusions: In summary, our comparative imaging analysis of schizophrenia patients, first-episode schizophrenia, and control patients revealed distinct ventricular patterns, with SCZ showing greater widening than FES and FES wider than the control group. Frontal lobe density, assessed via cerebral CT scans, indicated a higher density in the SCZ group in both anterior and posterior cortex portions compared to FES and the control group, while the left posterior cortex in FES had the highest density. These findings highlight unique neuroanatomical features across groups, shedding light on structural differences associated with different stages of schizophrenia.

Diagnosis and management of occult non-missile penetrating brain injury.

Penetrating brain injury (PBI) is a subtype of traumatic brain injury (TBI) that has been steadily increasing in prevalence and causing significant mortality in trauma patients. In an emergent setting, it is important to determine the mechanism of injury and decide whether a PBI or a blunt TBI has occurred in order to guide diagnostic imaging and subsequent treatment. In cases where a PBI has been likely or has occurred, it is important to initiate treatment expeditiously as rapid interventions have been shown to lead to better outcomes. However, in cases of unwitnessed pediatric trauma, it can be difficult to ascertain the specific method of injury due to a lack of reliable sources. In such cases of unwitnessed trauma, PBI should be included in the differential of any orbitocranial injury. In this series, we present two cases of unwitnessed pediatric orbitocranial injury that highlight the importance of gathering a detailed history, obtaining appropriate imaging studies, and using physician intuition.

Site matters: Image-guided percutaneous sampling of intervertebral disc results in increased positive diagnostic yield in spondylodiscitis.

Spondylodiscitis is a common referral to spinal on call services. Identification of the causative organism is vital in order to dictate the appropriate antibiotic treatment. In this context, the surgical and interventional radiology team is often asked to perform a diagnostic biopsy. The aim of the present study was to assess whether the sampling location affects the diagnostic yield. Our results suggest that the overall positive diagnostic yield was 35%. When disc material was included in the sample the diagnostic yield significantly improved to 47%. Bone sampling alone had a positive yield of 15%. Age, pre-biopsy CRP, pre-biopsy use of antibiotics did not seem to affect the likelihood of obtaining a positive yield. These results suggests that when performing image guided biopsies for suspected cases of spondylodiscitis the inclusion of disc material is important.

A chronic eyelid lesion in a child: multi-disciplinary approach to diagnosis, treatment and management of a highly atypical histiocytic lesion.

Malignant histiocytic neoplasm with histiocytic sarcoma phenotype is a rare malignant neoplasm, distinguished by malignant cells with phenotypic characteristics of mature tissue histiocytes. Histiocytic sarcoma typically presents as a primary malignancy, although can also present as a secondary malignancy, and is rarely seen in the pediatric population. Due to the rarity of this condition, diagnosis of histiocytic sarcoma is difficult and considered a diagnosis of exclusion. We describe a unique case of a chronic upper eyelid lesion with biopsy findings of a highly atypical histiocytic neoplasm initially concerning for histiocytic sarcoma; however, after integration of clinical findings, non-progressive and quiescent molecular profile, concluded to be an atypical juvenile xanthogranuloma in a child treated with excision and observation alone. This report highlights the importance of an integrated team approach to diagnosis of unusual histiocytic neoplasms.

Deep features to detect pulmonary abnormalities in chest X-rays due to infectious diseaseX: Covid-19, pneumonia, and tuberculosis.

Chest X-ray (CXR) imaging is a low-cost, easy-to-use imaging alternative that can be used to diagnose/screen pulmonary abnormalities due to infectious diseaseX: Covid-19, Pneumonia and Tuberculosis (TB). Not limited to binary decisions (with respect to healthy cases) that are reported in the state-of-the-art literature, we also consider non-healthy CXR screening using a lightweight deep neural network (DNN) with a reduced number of epochs and parameters. On three diverse publicly accessible and fully categorized datasets, for non-healthy versus healthy CXR screening, the proposed DNN produced the following accuracies: 99.87% on Covid-19 versus healthy, 99.55% on Pneumonia versus healthy, and 99.76% on TB versus healthy datasets. On the other hand, when considering non-healthy CXR screening, we received the following accuracies: 98.89% on Covid-19 versus Pneumonia, 98.99% on Covid-19 versus TB, and 100% on Pneumonia versus TB. To further precisely analyze how well the proposed DNN worked, we considered well-known DNNs such as ResNet50, ResNet152V2, MobileNetV2, and InceptionV3. Our results are comparable with the current state-of-the-art, and as the proposed CNN is light, it could potentially be used for mass screening in resource-constraint regions.

Benefits of iterative metal artifact reduction and dual-energy CT towards mitigating artifact in the setting of total shoulder prostheses.

OBJECTIVE: To determine the utility of iterative metal artifact reduction and 130 keV dual-energy virtual monoenergetic images to improve bone and soft tissue visualization in CT scans affected by metal artifacts. MATERIAL AND METHODS: Thirteen females and 6 males with a history of total shoulder prosthesis who underwent dual-energy shoulder CT were included. Four sets of images were reconstructed for each patient: (1) original polychromatic kV images reconstructed with weighted filtered back projection; (2) polychromatic kV images with iterative metal artifact reduction; (3) 130 keV dual-energy virtual monoenergetic; (4) combined iterative metal artifact reduction and 130 keV dual-energy virtual monoenergetic. Three readers blindly reviewed all image sets and graded the extent of artifact and image quality. RESULTS: Mean artifact score and median overall image quality score were better in 130 keV dual-energy virtual monoenergetic with iterative metal artifact reduction compared with those in original polychromatic kV images (3.02 vs 4.28, P < 0.001 and 3.00 vs 4.33, P < 0.001, respectively). The median difference in CT numbers between regions affected by artifacts and normal regions was lowest in 130 keV dual-energy virtual monoenergetic with iterative metal artifact reduction compared with that in original polychromatic kV images (72.28 vs 252.08, P < 0.001 for bony regions and 15.09 vs 324.38, P < 0.001 for soft tissue). CONCLUSION: In patients with metal artifacts due to shoulder replacement surgery, the use of dual-energy monoenergetic images and iterative metal artifact reduction reconstruction significantly improves both subjective and objective indicators of image quality.

Mixed oxide nanotubes in nanomedicine: A dead-end or a bridge to the future?

Nanomedicine has seen a significant rise in the development of new research tools and clinically functional devices. In this regard, significant advances and new commercial applications are expected in the pharmaceutical and orthopedic industries. For advanced orthopedic implant technologies, appropriate nanoscale surface modifications are highly effective strategies and are widely studied in the literature for improving implant performance. It is well-established that implants with nanotubular surfaces show a drastic improvement in new bone creation and gene expression compared to implants without nanotopography. Nevertheless, the scientific and clinical understanding of mixed oxide nanotubes (MONs) and their potential applications, especially in biomedical applications are still in the early stages of development. This review aims to establish a credible platform for the current and future roles of MONs in nanomedicine, particularly in advanced orthopedic implants. We first introduce the concept of MONs and then discuss the preparation strategies. This is followed by a review of the recent advancement of MONs in biomedical applications, including mineralization abilities, biocompatibility, antibacterial activity, cell culture, and animal testing, as well as clinical possibilities. To conclude, we propose that the combination of nanotubular surface modification with incorporating sensor allows clinicians to precisely record patient data as a critical contributor to evidence-based medicine.

Spontaneous Regression of a Mandibular Plasmacytoma in a Juvenile Dog: A Case Report.

A 4 mo old female Finnish lapphund presented for further investigation of a swelling of the right rostral mandible. A computed tomography scan showed the swelling to be an expansile and osteolytic mandibular lesion. Histopathology revealed a poorly differentiated, moderately well-demarcated, unencapsulated, highly infiltrative round cell neoplasm, and immunohistochemistry was supportive of a plasmacytoma. Performance of a rostral partial mandibulectomy was initially discussed with the owners, but the lesion improved spontaneously both clinically and on repeated computed tomography scanning before surgery could be performed. It subsequently almost completely resolved 6 mo after diagnosis. Hypotheses for spontaneous regression of the lesion are discussed and the human literature is briefly reviewed.

Radiotherapy for the treatment of pituitary adenomas: A dosimetric comparison of three planning techniques.

AIM: Our goal was to compare conformal 3D (C3D) radiotherapy (RT), modulated intensity RT (IMRT), and volumetric modulated arc therapy (VMAT) planning techniques in treating pituitary adenomas. BACKGROUND: RT is important for managing pituitary adenomas. Treatment planning advances allow for higher radiation dosing with less risk of affecting organs at risk (OAR). MATERIALS AND METHODS: We conducted a 5-year retrospective review of patients with pituitary adenoma treated with external beam radiation therapy (C3D with flattening filter, flattening filter-free [FFF], IMRT, and VMAT). We compared dose-volume histogram data. For OARs, we recorded D2%, maximum, and mean doses. For planning target volume (PTV), we registered V95%, V107%, D95%, D98%, D50%, D2%, minimum dose, conformity index (CI), and homogeneity index (HI). RESULTS: Fifty-eight patients with pituitary adenoma were included. Target-volume coverage was acceptable for all techniques. The HI values were 0.06, IMRT; 0.07, VMAT; 0.08, C3D; and 0.09, C3D FFF (p < 0.0001). VMAT and IMRT provided the best target volume conformity (CI, 0.64 and 0.74, respectively; p < 0.0001). VMAT yielded the lowest doses to the optic pathway, lens, and cochlea. The position of the neck in extreme flexion showed that it helps in planning mainly with VMAT by allowing only one arc to be used and achieving the desired conformity, decreasing the treatment time, while allowing greater protection to the organs of risk using C3D, C3DFFF. CONCLUSIONS: Our results confirmed that EBRT in pituitary adenomas using IMRT, VMAT, C3D, C3FFF provide adequate coverage to the target. VMAT with a single arc or incomplete arc had a better compliance with desired dosimetric goals, such as target coverage and normal structures dose constraints, as well as shorter treatment time. Neck extreme flexion may have benefits in treatment planning for better preservation of organs at risk. C3D with extreme neck flexion is an appropriate treatment option when other treatment techniques are not available.

Thymic tumors and results of radiotherapy.

AIM: The aim of this study was to evaluate thymic epithelial tumors (TETs) for treatment outcomes and prognostic factors on survival. BACKGROUND: TETs are very rare neoplasms and multidisciplinary approach is recommended according to prognostic factors. MATERIALS AND METHODS: Between 1995 and 2013, 31 patients were treated with median 5400 cGy (range: 1620-6596 cGy) radiotherapy (RT). Eleven patients received adjuvant or concurrent chemotherapy. There were 25 thymomas, 4 thymic carcinomas and 2 thymic neuroendocrin carcinomas. According to Masaoka, staging and WHO classification, cases were divided to good (n: 10), moderate (n: 9) and poor (n: 12) prognostic risk groups. Survival was calculated from diagnosis. RESULTS: In January 2016, 22 cases were alive with median 51.5 months (range: 2-170.5) follow-up. Recurrences were observed in 29% of patients in median 29.5 months (range: 6.5-105). Local control, mean overall (OS) and disease-free survival (DFS) rates were 86%, 119 and 116 months, respectively. There was a significant difference for R0 vs. R+ resection (81% vs. 43%, p = 0.06, and 69% vs. 46%, p = 0.05), Masaoka stage I-II vs. III-IV (75% vs. 52%, p = 0.001, and 75% vs. 37%, p < 0.001), and also prognostic risk groups (100% vs. 89% vs. 48%, p = 0.003, and 100% vs. 87% vs. 27%, p = 0.004) in terms of 5-year OS and DFS, respectively. CONCLUSION: In our study, prognostic risk stratification was shown to be a significant predictor of survival. There is a need to investigate subgroups that may or may not benefit from adjuvant RT.

Radiologic findings of Fusarium pneumonia in neutropenic patients.

In neutropenic patients, lungs are involved in 50%-80% of cases of fusariosis, but imaging of pulmonary fusariosis has been previously described as indistinguishable from other invasive mould diseases. Our attempt was to identify a radiological pattern that may distinguish pulmonary fusariosis from other mould diseases. We examined the CT findings of nine neutropenic haematology patients with invasive fusariosis. As control group for comparison, we examined 14 invasive mould diseases (11 aspergillosis, 3 mucormycosis) in haematology patients with similar underlying disease and timing of CT imaging. Chest-CT in invasive fusariosis showed small airways (7/9) or peribronchial (5/9) infiltrates, less frequently macronodular consolidations (4/9) with hypodense sign, but without halo sign or occluded-vessel sign. The control group presented macronodular consolidations with occluded-vessel sign in all of the cases; the halo and the hypodense signs were observed, respectively, in 100% and 82% of aspergillosis, and in 67% and 100% of mucormycosis. Sinusitis was documented by CT in 7/7 fusariosis, 2/2 mucormycosis and 5/7 aspergillosis; maxillary and ethmoid sinuses were involved in 7/7 fusariosis, in most of the cases with hyperdense opacification (rarely observed in the controls). We concluded that no radiological findings can discriminate between different mould infections, but invasive fusariosis should be suspected if chest-CT demonstrates pulmonary infiltrates with the hypodense sign, but without the halo or the occluded-vessel signs. Suspicion is greater in the presence of hyperdense maxillary and ethmoid sinusitis.

The impact of the introduction of PECARN head CT rules on the utilisation of head CT scans in a private tertiary hospital in Sub-Saharan Africa.

BACKGROUND: The decision to order head CT scans to rule out clinically significant traumatic brain injury in mild head injury in children is made on the basis of clinical decision rules of which the Paediatric Emergency Care Applied Research Network (PECARN) CT head rules have been found to be most sensitive. PURPOSES: The purpose of this study is to determine the proportion of head CT scans done for children with mild head injury and to determine disposition of patients from casualty after the introduction of PECARN head CT rules compared to the period before. The research question is "will introduction of the PECARN CT head rules reduce the proportion of head CT scans requested for children under 18 years with mild head injury at the AKUHN?" METHODS: A before and after quasi experimental study with a study population including all children under 18 years presenting to the AKUHN with mild head injury and a Glasgow coma scale of 14 and above on presentation. Sample size was 85. RESULTS: A total of 42 patients files were analysed in the before study while 43 patients were selected for the after study. The median age was 5 years. The proportion of head CT scans reduced from 56% in the before group to 33% in the after group with no missed clinically significant traumatic brain injury. More patients were discharged home after evaluation in the after group (81%) than in the before group (58%). CONCLUSIONS: The number of head CT scans ordered reduced without missing any clinically significant traumatic brain injury.

Derivation and validation of simple anthropometric equations to predict adipose tissue mass and total fat mass with MRI as the reference method.

The reference organ-level body composition measurement method is MRI. Practical estimations of total adipose tissue mass (TATM), total adipose tissue fat mass (TATFM) and total body fat are valuable for epidemiology, but validated prediction equations based on MRI are not currently available. We aimed to derive and validate new anthropometric equations to estimate MRI-measured TATM/TATFM/total body fat and compare them with existing prediction equations using older methods. The derivation sample included 416 participants (222 women), aged between 18 and 88 years with BMI between 15·9 and 40·8 (kg/m2). The validation sample included 204 participants (110 women), aged between 18 and 86 years with BMI between 15·7 and 36·4 (kg/m2). Both samples included mixed ethnic/racial groups. All the participants underwent whole-body MRI to quantify TATM (dependent variable) and anthropometry (independent variables). Prediction equations developed using stepwise multiple regression were further investigated for agreement and bias before validation in separate data sets. Simplest equations with optimal R (2) and Bland-Altman plots demonstrated good agreement without bias in the validation analyses: men: TATM (kg)=0·198 weight (kg)+0·478 waist (cm)-0·147 height (cm)-12·8 (validation: R 2 0·79, CV=20 %, standard error of the estimate (SEE)=3·8 kg) and women: TATM (kg)=0·789 weight (kg)+0·0786 age (years)-0·342 height (cm)+24·5 (validation: R (2) 0·84, CV=13 %, SEE=3·0 kg). Published anthropometric prediction equations, based on MRI and computed tomographic scans, correlated strongly with MRI-measured TATM: (R (2) 0·70-0·82). Estimated TATFM correlated well with published prediction equations for total body fat based on underwater weighing (R (2) 0·70-0·80), with mean bias of 2·5-4·9 kg, correctable with log-transformation in most equations. In conclusion, new equations, using simple anthropometric measurements, estimated MRI-measured TATM with correlations and agreements suitable for use in groups and populations across a wide range of fatness.

Cerebral Computed Tomographic Findings in Schizophrenia: Relationship to Second-Generation Antipsychotics and Hyperprolactinemia.

Antipsychotic medications are essential for managing severe mental illnesses like schizophrenia, which impacts about 1% of the global population. Despite efficacy, in some cases, they can induce hyperprolactinemia, affecting roughly half of the patients. The prevalence of this condition varies with the specific medication used. Although prolactinomas are rare among schizophrenia patients, treating them with dopamine agonists poses conflicts with antipsychotic medication, necessitating careful monitoring and adjustments. The aim of this study was to explore the presence of brain tumors, prolactinomas, and other structural brain changes in schizophrenia patients treated with second-generation antipsychotics using cerebral computed tomography (CT) scans. We conducted a cross-sectional study involving 152 hospitalized patients diagnosed between 1 January 2020 and 31 March 2024. Evaluations included cerebral CT scans, prolactin level assessments, and the monitoring of side effects. Patients, with an average age of 42.79 years and an illness duration of 17.89 years, predominantly received olanzapine (46.05%) and risperidone (36.84%). Side effects, reported by 61.78% of patients, included tremors, dizziness, and weight gain. Abnormal prolactin levels were observed in 53.95% of patients, more prevalent in females on risperidone and in both genders on olanzapine. No prolactinomas were detected on CT scans. Managing hyperprolactinemia in schizophrenia patients undergoing antipsychotic therapy is essential to prevent long-term complications and to ensure treatment compliance.

Long-Term Complete Response with Single-Agent Capecitabine in Her-2-neu-Positive Metastatic Breast Cancer-A Rare Case Report.

The standard treatment approach for metastatic breast cancer with HR- and Her-2-neu + disease is trastuzumab with systemic therapy. But in patients having severe cardiac dysfunction, trastuzumab is avoided. Various combination regimens are available in that setting, but no study has shown better efficacy of capecitabine monotherapy in this setting. We hereby present a case report of using capecitabine monotherapy in first-line setting, and the patient had complete resolution of lung metastasis from the last 2 years. A 64-year-old postmenopausal lady with a known case of breast carcinoma in the left side diagnosed in the year 2016 with hormone receptor-positive, Her2-negative disease completed chemoradiation and on is aromatase inhibitor from the last 5 years. She complained of breathlessness and fatigue lasting for 1 month in July 2021. On evaluation, chest CT scan revealed multiple bilateral lung metastases along with 3×3 cm right-sided breast lump with no metastasis elsewhere in the body. Core needle biopsy of breast lump and CT-guided left lung nodule biopsy were performed which revealed infiltrating carcinoma with immunohistochemical markers showing tumor cells positive for Her-2-neu with hormone receptor-negative disease. PET-CT scan was done which revealed FDG avidity in bilateral lung fields and right breast lump with no disease elsewhere. Her echocardiography showed ejection fraction of 40% owing to which injection trastuzumab was deferred and the plan to start tablet capecitabine 1000 mg twice BD days 1-14 cycles every 21 days was made. She showed improvement in symptoms with PET-CT scan revealing resolution of lung metastasis from the last 2 years. Trastuzumab in combination with pertuzumab and taxane is the standard of care for metastatic breast carcinoma with hormone receptor-negative and Her2-positive disease. But in patients who are elderly, frail with severe cardiac dysfunction, trastuzumab-based regimen is contraindicated. No study demonstrated efficacy of capecitabine monotherapy in this subset of disease. More prospective studies are required to identify patients who can benefit from capecitabine monotherapy in first-line setting in this subset of disease. Also capecitabine usage has several advantages mainly low cost and availability in oral form, and patients can be followed up on OPD basis.

Late-Onset Manifestations of Von Hippel-Lindau Syndrome: A Case Report.

Von Hippel-Lindau (VHL) syndrome is characterized by a range of tumors including phaeochromocytomas, pancreatic adenomas, cerebellar haemangioblastomas, and renal cell carcinomas. A 50-year-old male presented with a three-week history of headache. Additionally, the patient exhibited signs of hypertension. Ultrasonography (USG) abdomen and pelvis showed a solid mass lesion in the left adrenal gland, iso-echoic to the renal cortex. On contrast-enhanced computed tomography (CECT) of the brain, a well-defined solid cystic lesion was seen in the left posterior cerebellar hemisphere. Small nodular enhancing lesions were seen in the right cerebellar hemisphere. On further imaging with MRI brain contrast, the lesions in the cerebellum were diagnosed as multifocal hemangioblastomas. Laboratory investigations revealed elevated urinary metanephrines and normetanephrine, suggesting pheochromocytoma. Based on radiological and biochemical investigations, with the features of cerebellar haemangioblastomas and pheochromocytoma, a diagnosis of VHL syndrome was made.

Acute Intratonsillar Abscess in an Adult: A Case Report and Literature Review.

Intratonsillar abscess (ITA) is rarely reported. Here, we present an uncommon case of acute ITA in an adult, discuss the evaluation and treatment plan, and review the ITA literature.  The abscess reported in the present study was diagnosed through a combination of clinical findings and computed tomography imaging, and treatment included drainage, intravenous (IV) clindamycin, and IV dexamethasone. The literature reports 72 ITA cases with specified treatments: 21 (29.2%) in adults, 19 (26.4%) in children, and 32 (44.4%) in patients of unspecified ages. Among them, 25 (34.7%) responded to antibiotics alone, 11 (15.3%) to needle aspiration and antibiotics, and 36 (50.0%) needed further intervention. Based on the presented case and literature review, we suggest the use of IV antibiotics with needle aspiration as the primary treatment for acute ITA. Incision and drainage (I&D) with antibiotics should be reserved for cases unresponsive to initial measures, and tonsillectomy is recommended for recurrent post-I&D cases.

Ultrasound accuracy in evaluating renal calculi in Maysan province.

Renal calculi are a common clinical presentation. While ultrasound (US) is a widely used imaging modality for kidney stone diagnosis due to its accessibility and lower cost, its accuracy compared to computerized tomography (CT), the gold standard, remains understudied. This cross-sectional study evaluated the diagnostic accuracy of ultrasound for detecting and characterizing kidney stones compared to computed tomography (CT). Fifty-six patients with suspected kidney stones based on flank pain underwent abdominal ultrasound to assess stone presence, size, location, and the severity of any hydronephrosis (kidney swelling). These findings were then confirmed with a subsequent non-contrast CT scan. There was a fair agreement between US and CT (Kappa = 0.368) for detecting the stone location. The US could not detect 7 (12.5%) stones, being less sensitive in the middle and upper calyx compared to CT. There was a fair agreement between the US and CT (Kappa = 0.394) for detecting the severity of hydronephrosis. The US was less sensitive to moderate and severe hydronephrosis compared to CT. The abdominal ultrasound demonstrated excellent reliability for stone size measurement (intraclass correlation = 0.924), with CT measurements only slightly larger on average (mean difference 0.9 mm). Although abdominal ultrasound provides reliable stone size assessment, its capacity to accurately localize stones and assess hydronephrosis severity is limited.

Role of MRI in Evaluation of Tongue and Hypopharyngeal Lesions.

Tongue is a complex, principally muscular structure extending from oral cavity to oropharynx. Hypopharynx extends from the level of hyoid bone and to the level of inferior margin of cricoid cartilage and is divided into pyriform sinus, posterior cricoid region and posterior pharyngeal wall. Lesions that can affect the tongue and hypopharynx include neoplastic, congenital, vascular and infectious etiologies. Imaging provides crucial details for diagnosis and the appropriate management of these lesions. To evaluate the role of MRI in characterisation of benign and malignant lesions of tongue, malignant lesions of hypopharynx and staging the neoplastic lesions. The study was performed on 60 patients suspected of tongue and hypopharyngeal lesions in Dr Ram Manohar Lohia Hospital, New Delhi from 1st January 2021 to 31st May 2022. The study was done on SEIMENS skyra MRI scanner. Radiological characteristics, clinical features were studied and statistical inference was interrogated. Out of 60 patients, 32 were of tongue cancer, 10 of base of tongue cancer, 8 of hypopharyngeal cancer, 8 of hemangioma tongue and 2 of thyroglossal cyst. The mean age of our study population was 42.87 years. The qualitative analysis between diffusion restriction and histopathological examination shows a strong and substantial agreement between the two variables and a p value of 0.0014. The overall diagnostic accuracy of MRI was 85.5% and for CT was 82.5%. MRI plays an important role in differentiation of benign from malignant lesions of tongue and hypopharynx and staging of the malignant lesions. The correlation between MRI and CT findings of malignant lesions of tongue and hypopharynx indicated that both CECT and MRI have high diagnostic accuracy in diagnosing and staging but MRI is better for T and N staging of the malignant lesions with a diagnostic accuracy of 85.5% which was higher than the diagnostic accuracy of CT (82.5%). Thus, in conclusion MRI has a remarkable role in characterization and staging of benign and malignant lesions of tongue and hypopharynx. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04532-y.

Beyond the Bony Fragment: A Review of Limbus Vertebra.

Vertebral limbus is a condition characterized by the intraspongious herniation of a portion of the nucleus pulposus. It is often asymptomatic, but it can sometimes cause nonspecific symptoms such as local pain and muscle spasm, or, in rare cases, radiculopathies, which is why it can be confused with vertebral fractures, spondyloarthropathies, infectious or tumoral processes. Early recognition of this pathology is preferable for a correct diagnosis and adequate treatment, the latter ranging from conservative approaches (such as personalized exercise programs and physical therapy) to surgical interventions reserved for severe cases with nerve compression.