Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel.

Vaccination-associated adenopathy is a frequent imaging finding after administration of COVID-19 vaccines that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. To help the medical community address this concern in the absence of studies and evidence-based guidelines, this special report offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States. According to these recommendations, some routine imaging examinations, such as those for screening, should be scheduled before or at least 6 weeks after the final vaccination dose to allow for any reactive adenopathy to resolve. However, there should be no delay of other clinically indicated imaging (eg, for acute symptoms, short-interval treatment monitoring, urgent treatment planning or complications) due to prior vaccination. The vaccine should be administered on the side contralateral to the primary or suspected cancer, and both doses should be administered in the same arm. Vaccination information-date(s) administered, injection site(s), laterality, and type of vaccine-should be included in every preimaging patient questionnaire, and this information should be made readily available to interpreting radiologists. Clear and effective communication between patients, radiologists, referring physician teams, and the general public should be considered of the highest priority when managing adenopathy in the setting of COVID-19 vaccination.

Delayed posthypoxic leukoencephalopathy: a case series and review of the literature.

BACKGROUND: Delayed posthypoxic leukoencephalopathy (DPHL) is a rare and underrecognized entity where patients manifest a neurological relapse after initial recovery from an acute hypoxic episode. We sought to describe the magnetic resonance imaging (MRI) findings in a group of patients with DPHL and review the available literature. METHODS: Retrospective case series including patients who presented with neurological and/or psychiatric symptoms after recovery from an acute hypoxic episode. The history and clinical presentation were reviewed from the electronic medical records. MRI scans were evaluated from the picture archiving and communication system. We performed a comprehensive review of the English medical literature for prior published cases of DPHL and describe the key imaging findings that have been reported related to this condition. RESULTS: A total of five patients were identified, including four patients with respiratory failure due to drug overdoses from benzodiazepines, opioids, and/or barbiturates, and one patient who presented after cardiopulmonary arrest due to pulmonary embolism. All patients showed diffuse, extensive, and confluent white matter signal abnormalities including prominent restricted diffusion, extending to the subcortical white matter and respecting the U-fibers. There was no gyral edema or contrast enhancement. In one case histopathology was available, which highlighted patchy subcortical myelin loss with sparing of U-fibers and demonstrated prominent macrophage/microglial inflammation with extensive axonal damage. Of the other four patients, two were at their neurological baselines and two had persistent neurological deficits at the time of discharge. CONCLUSIONS: The described constellation of MRI findings is highly suggestive of DPHL in the appropriate clinical setting.

Anatomic considerations, nomenclature, and advanced cross-sectional imaging techniques for visualization of the cranial nerve segments by MR imaging.

Various methods of cross-sectional imaging are used for visualization of the cranial nerves, relying heavily on MR imaging. The success of the MR imaging sequences for visualization of cranial nerves depends on their anatomic context at the point of evaluation. The heterogeneity of opinion regarding optimal evaluation of the cranial nerves is partly a function of the complexity of cranial nerve anatomy. A variety of approaches are advocated and variations in equipment and terminology cloud the field. This article proposes a segmental classification and corresponding nomenclature for imaging evaluation of the cranial nerves and reviews technical considerations and applicable literature.

High-resolution CISS MR imaging with and without contrast for evaluation of the upper cranial nerves: segmental anatomy and selected pathologic conditions of the cisternal through extraforaminal segments.

The authors review the course and appearance of the major segments of the upper cranial nerves from their apparent origin at the brainstem through the proximal extraforaminal region, focusing on the imaging and anatomic features of particular relevance to high-resolution magnetic resonance imaging evaluation. Selected pathologic entities are included in the discussion of the corresponding cranial nerve segments for illustrative purposes.

Comparison of two methods for the estimation of subcortical volume and asymmetry using magnetic resonance imaging: a methodological study.

PURPOSE: The subcortical brain structures are associated with other structures of nervous system; therefore, they have major influence on sensory-motor, limbic and cognitive information processing. Magnetic resonance imaging provides a detailed knowledge of normal and diseased anatomical structures for medical research. The aim of the current study was to compare the volumes of subcortical brain structures and determine the probable volumetric asymmetry in healthy subjects using stereological (point-counting) and semi-automatic segmentation methods. METHODS: MR scans were obtained from 30 subjects (17 males, 13 females) free of any psychiatric, neurological or cognitive impairment. MR images were analyzed by using stereological (point-counting) and semi-automatic segmentation methods. RESULTS: We did not find any significant differences among the subjects with respect to gender using both methods. This study showed no significant asymmetry in subcortical structures according to methods. Also, no significant difference was found between point-counting and semi-automated segmentation methods for the volumes of subcortical structures (p > 0.05). CONCLUSION: From these results, it can be concluded that the semi-automated segmentation method and stereological technique can be used for reliable volume estimation of subcortical structures. However, the stereological method takes less time than semi-automated segmentation; it is simple, reliable and inexpensive. Further studies are required with larger samples in order to support these data.