MRI morphological evaluation of humeral head bone profile inside region of the biceps pulley reflection.

OBJECTIVE: Evaluating humeral head bone profile inside biceps reflection pulley area in order to identify possible anatomical variants and any causes predisposing to tendon's instability of the long head of the biceps. MATERIALS AND METHODS: This retrospective study analyzed 326 patients, 183 males and 143 females (age 15-88 years; average 51.5 years), who underwent MRI examination between 2013 and 2019. Biceps pulley reflection area morphology of 192 right shoulders and 134 left shoulders was assessed analyzing 309 MRI and 17 MR arthrography (MRA) shoulder exams. We investigated age and gender and the frequency of morphological variants among the patient groups. RESULTS: Four possible morphological variants were identified: 95 with convex shape; 127 with flat shape; 77 with spiculated shape; and 12 with mixed morphology. Fifteen humeral bone profiles were not classifiable. CONCLUSIONS: MRI was effective in defining humeral head anatomic variants inside the biceps pulley reflection area. The most frequent variants were flat or convex types.

Bioptic prostatic inflammation correlates with false positive rates of multiparametric magnetic resonance imaging in detecting clinically significant prostate cancer.

INTRODUCTION: The aim of this article was to determine the impact of bioptic prostatic inflammation (PI) on the false positive rate of multiparametric magnetic resonance imaging (mp-MRI) in detecting clinically significant prostate ancer (csPCa). MATERIAL AND METHODS: Our prostate biopsy database was queried to identify patients who underwent mp-MRI before PB at our institution. A dedicated uropathologist prospectively assessed bioptic PI using the Irani scores. We evaluated the association between mp-MRI findings, bioptic Gleason grade (GG) and aggressiveness of PI, and PCa detection. RESULTS: In total, 366 men were included. In patients with Prostate Imaging Reporting and Data System (PIRADS) 4-5 lesions, the csPCa (GG ≥2) rate was significantly higher in those with low-grade than in those with high-grade PI (36% vs 29.7%; p = 0.002), and in those with low-aggressive than in those with high-aggressive PI (37.7% vs 30.1%; p = 0.0003). The false positive rates of PIRADS 4-5 lesions for any PCa were 34.2% and 57.8% for low- and high-grade PI, respectively (p = 0.002); similarly, they were 29.5% and 59.4% for mildly and highly-aggressive PI (p = 0.0003). Potential study limitations include its retrospective analysis and single-center study and lack of assessment of the type of PI. CONCLUSIONS: Bioptic PI directly correlates with false positive rates of mp-MRI in detecting csPCa. Clinicians should be aware that PI remains the most common pitfall of mp-MRI.

First things first: A late robotic approach to anamnesis, in a patient with a thymus hematoma.

Anterior mediastinal masses are generally asymptomatic until they grow and compress surrounding structures. Chest X-rays only suggest a mediastinal abnormality and contrast-enhanced CT scan and MRI are necessary for a better definition of the lesion. The classification of the anterior mediastinal masses is based on their etiology and it is sometimes a challenge to have an accurate differential diagnosis based only on radiological examinations: therefore, only the histopathological examination makes the correct diagnosis. Surgeons generally agree that symptomatic masses or those with progressive growth should undergo surgical resection. We report a case of an accidental finding of an organized thymic hematoma in a 46-year-old female. At first totally asymptomatic, the hematoma was misdiagnosed for a thymic cyst and resected when it increased in size and compressed surrounding mediastinal structures. A detailed anamnesis highlighted a minor thoracic trauma which turned out to be the cause. Retrosternal hematoma generally grows several months after trauma and initial stabilization; therefore, it is mandatory to include an organized hematoma in the differential diagnosis of the retrosternal neoformations.