Fetal brain maceration score on postmortem magnetic resonance imaging vs. conventional autopsy.

BACKGROUND: Postmortem fetal magnetic resonance imaging (MRI) has been on the rise since it was proven to be a good alternative to conventional autopsy. Since the fetal brain is sensitive to postmortem changes, extensive tissue fixation is required for macroscopic and microscopic assessment. Estimation of brain maceration on MRI, before autopsy, may optimize histopathological resources. OBJECTIVE: The aim of the study is to develop an MRI-based postmortem fetal brain maceration score and to correlate it with brain maceration as assessed by autopsy. MATERIALS AND METHODS: This retrospective single-center study includes 79 fetuses who had postmortem MRI followed by autopsy. Maceration was scored on MRI on a numerical severity scale, based on our brain-specific maceration score and the whole-body score of Montaldo. Additionally, maceration was scored on histopathology with a semiquantitative severity scale. Both the brain-specific and the whole-body maceration imaging scores were correlated with the histopathological maceration score. Intra- and interobserver agreements were tested for the brain-specific maceration score. RESULTS: The proposed brain-specific maceration score correlates well with fetal brain maceration assessed by autopsy (τ = 0.690), compared to a poorer correlation of the whole-body method (τ = 0.452). The intra- and interobserver agreement was excellent (correlation coefficients of 0.943 and 0.864, respectively). CONCLUSION: We present a brain-specific postmortem MRI maceration score that correlates well with the degree of fetal brain maceration seen at histopathological exam. The score is reliably reproduced by different observers with different experience.

Acute Abdomen Caused by Infected Mesenteric Cyst.

Teaching point: Computed tomography is essential for timely diagnosing infected mesenteric cysts as a cause of acute abdomen, ultimately requiring complete excision to confirm diagnosis given the potential of malignant transformation.

Atypical MRI Presentation of High-Grade Chondrosarcoma in the Proximal Femur.

Teaching Point: Although magnetic resonance imaging (MRI) plays a considerable role in the detection and differentiation of chondrosarcoma (e.g., by cortical breakthrough, peritumoral soft tissue edema, and extra-osseous extension), it is important to be aware of atypical features of common bone tumors.

Cardiac MRI after Sudden Cardiac Arrest in a Young Woman Prompts Diagnosis of Familial Dilated Cardiomyopathy.

Teaching Point: Familial dilated cardiomyopathy (DCM) predisposes to malignant ventricular arrhythmias and sudden cardiac death, and magnetic resonance imaging (MRI) has important diagnostic value in demonstrating non-ischemic patterns of late gadolinium enhancement (LGE).

Extramedullary Acute Myeloid Leukemia Tumor Presenting in the Radial Nerve.

Teaching Point: Extramedullary acute myeloid leukemia tumor belongs to the differential diagnosis when a tumor develops in a patient with a history of leukemia, and magnetic resonance imaging is of diagnostic value by demonstrating iso-intensity and hyperintensity compared to skeletal muscle respectively on T1- and T2-weighted images and homogeneous contrast enhancement.

Insidious Onset of Pulmonary Langerhans Cell Histiocytosis During Oncological Follow-Up.

Teaching Point: Pulmonary Langerhans cell histiocytosis (PLCH) has to be included in the differential diagnosis of cystic pulmonary lesions on chest computed tomography (CT). CT has important diagnostic value by demonstrating initial centrilobular nodules that in time cavitate and transform into cysts, typically sparing the costophrenic angles.

Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) in Common Variable Immunodeficiency (CVID).

Teaching Point: Granulomatous lymphocytic interstitial lung disease is a non-infectious complication of common variable immunodeficiency. Computed tomography (CT) has an important diagnostic value by demonstrating pulmonary nodules, ground glass opacities, bronchiectasis, subpleural reticulations, lymphadenopathy and splenomegaly.

PURSUING OPTIMAL RADIATION DOSE IN PEDIATRIC CARDIAC CT: A REPORT FROM UNIVERSITY HOSPITAL LEUVEN.

BACKGROUND: Computed tomography (CT) balances between high resolution and low radiation dose. Given the greater radiosensitivity of children, it is appropriate to use child-friendly CT-protocols that reduce radiation dose at acceptable image quality.This article states the radiation dose in pediatric cardiac CT-examinations at university hospital Leuven (Belgium) and compares with findings published by similar medical centers. The diagnostic accuracy was simultaneously compared, as it correlates with radiation dose. MATERIAL AND METHODS: his retrospective observational study analyzed 58 CT-scans of 52 patients. The radiation dose was calculated in effective dose. The image quality was scored qualitatively with a 5-point scale. The diagnostic accuracy, a derivative representation of the image quality, was checked with findings from surgery or conventional angiography. RESULTS: The mean effective dose in our study population was 1.3 ± 0.4 mSv. The qualitative image quality was on average 'good', elaborated with a score of 4.0 ± 0.2. The diagnostic accuracy was 92%. Comparative literature study provides a mean effective dose of 1.5 mSv and the reported diagnostic accuracy from other centers reaches ≥90%. CONCLUSIONS: At our center pediatric cardiac CT-scans are obtained with good-to-excellent image quality and high diagnostic accuracy at low radiation doses. These results meet the radiation dose and diagnostic accuracy as published by comparable medical centers.

Teenage Neurologic Manifestation of a Complex Brain Malformation Consisting of Gray Matter Heterotopia, Schizencephaly and Absent Septum Pellucidum.

Teaching point: Since some minor congenital brain defects manifest long after birth, even in adults they should be kept in the differential of new epileptic seizures or focal neurologic deficits.

MRI of Wallerian Degeneration in the Brainstem: A Pictorial Essay.

Wallerian degeneration of the cerebral peduncle is a common MRI finding after cerebral injury. The degree of peduncular atrophy reflects the extent of damage in the corticospinal tract. The acute phase of Wallerian degeneration is visible with Diffusion-Weighted-Imaging. New investigation with Diffusion-Tensor-Imaging quantifies Wallerian degeneration in the subacute ischemic phase and is a good predictor for later functional recovery after stroke.

Glomangiomyoma of the Knee: A Rare Juxtasynovial Presentation: Juxtasynovial glomangiomyoma in the joint capsule is a rare location for glomus tumors that should be considered in the differential diagnosis of hypervascular synovial-based tumors.

Glomus tumors are benign tumors typically located in the subcutis or deep dermis of the subungual region of the fingers. Histologically, glomus tumors are divided into three subtypes, in descending order of frequency: solid glomus tumor, glomangioma and glomangiomyoma. We report a case of a symptomatic intracapsular juxtasynovial glomangiomyoma of the knee. To the best of our knowledge, this location of this uncommon histological subtype of glomus tumor has not been reported previously. Although the final diagnosis is made by histopathology, the radiologist should consider this rare lesion in the differential of highly vascularised synovial-based masses.

Correction: Glomangiomyoma of the Knee: A Rare Juxtasynovial Presentation.

[This corrects the article DOI: 10.5334/jbsr.2051.].