A Novel Fusion of Radiomics and Semantic Features: MRI-Based Machine Learning in Distinguishing Pituitary Cystic Adenomas from Rathke's Cleft Cysts.

Objectives: To evaluate the performances of machine learning using semantic and radiomic features from magnetic resonance imaging data to distinguish cystic pituitary adenomas (CPA) from Rathke's cleft cysts (RCCs). Materials and Methods: The study involved 65 patients diagnosed with either CPA or RCCs. Multiple observers independently assessed the semantic features of the tumors on the magnetic resonance images. Radiomics features were extracted from T2-weighted, T1-weighted, and T1-contrast-enhanced images. Machine learning models, including Support Vector Machines (SVM), Logistic Regression (LR), and Light Gradient Boosting (LGB), were then trained and validated using semantic features only and a combination of semantic and radiomic features. Statistical analyses were carried out to compare the performance of these various models. Results: Machine learning models that combined semantic and radiomic features achieved higher levels of accuracy than models with semantic features only. Models with combined semantic and T2-weighted radiomics features achieved the highest test accuracies (93.8%, 92.3%, and 90.8% for LR, SVM, and LGB, respectively). The SVM model combined semantic features with T2-weighted radiomics features had statistically significantly better performance than semantic features only (p = 0.019). Conclusion: Our study demonstrates the significant potential of machine learning for differentiating CPA from RCCs.

"Ring-shaped" meniscus and accompanying intermeniscal bridge meniscus: a rare combined variant resembling a bucket-handle tear.

Many anatomical variations have been described in the menisci, especially in the lateral meniscus. Among these, discoid meniscus is the most common variation. Others are described in the literature as double-layered meniscus, accessory meniscus, ring-shaped meniscus, and hypoplastic meniscus. Also, combined variations associated with ring-shaped meniscus have been described, and they can be confused with fragmented complex tears and cause unnecessary surgery. Increasing awareness of the imaging features of these accompanying combined variations may aid in the recognition and differentiation of this entity from meniscus tears. We report the case of a ring-shaped meniscus and accompanying intermeniscal bridge meniscus, which has not been described before in the literature, highlighting the MRI and arthroscopic imaging findings of it.

A mimicker of inflammatory breast carcinoma: Lupus mastitis and evolving imaging features.

Rare case of lupus mastitis in a 58-year-old female with discoid lupus erythematosus presented with fever, left breast swelling, and painful palpable lesion. Accurate imaging and histopathologic evaluation allowed for appropriate management and regression of breast findings with hydroxychloroquine treatment, emphasizing the need to avoid unnecessary biopsies and surgeries.

Differentiation of pure cystic sellar lesions on magnetic resonance imaging.

BACKGROUND AND PURPOSE: Cystic pituitary adenomas and cystic craniopharyngiomas may mimic Rathke cleft cysts when there is no solid enhancing component on magnetic resonance imaging (MRI). This study aims to investigate the efficiency of MRI findings in differentiating Rathke cleft cysts from pure cystic pituitary adenoma and pure cystic craniopharyngioma. MATERIALS AND METHODS: 109 patients were included in this study (56 Rathke cleft cysts, 38 pituitary adenomas, and 15 craniopharyngiomas). Preoperative magnetic resonance images were evaluated using 9 imaging findings. These findings include intralesional fluid-fluid level, intralesional septations, midline /off-midline location, suprasellar extension, an intracystic nodule, a hypointense rim on T2-weighted images, ≥ 2 mm thickness of contrast-enhancing wall, T1 hyperintensity and T2 hypointensity. p < 0.01 was considered statistically significant. RESULTS: There was a statistically significant difference among groups for these 9 findings. Intracystic nodule and T2 hypointensity were the most specific MRI findings in differentiating Rathke cleft cyst from the others (98.1% and 100%, respectively). Intralesional septation and thick contrast-enhancing wall were the most sensitive MRI findings ruling out Rathke cleft cysts with 100% sensitivity. CONCLUSION: Rathke cleft cysts can be distinguished from pure cystic adenoma and craniopharyngioma with the presence of an intracystic nodule, T2 hypointensity, the absence of the thick contrast-enhancing wall, and absence of intralesional septations.

Progressive MRI findings of West Nile virus encephalitis in a patient with diabetes mellitus.

A man in his 70s was admitted to our hospital with complaints of fatigue, loss of appetite and fever. His neurological examination was normal. He had a medical history of diabetes mellitus for 25 years. Urine analysis showed many leucocytes. Empirical antibiotic treatment was started for urinary system infection. Three days later, his mental status worsened with confusion and disorientation. MRI of the brain was normal. Two days later, the patient was intubated because of respiratory insufficiency. MRI showed restricted diffusion in bilateral thalamic nuclei. Encephalitis and ischaemia were considered in the differential diagnosis. Cerebrospinal fluid IgM antibody for West Nile virus was positive. Sixteen days later, cranial nerve reflexes were lost. MRI showed restricted diffusion and increased T2 signal intensity in the dorsal medulla and increased T2 signal intensity without diffusion restriction in bilateral substantia nigra and dentate nuclei. He died of cardiac arrest 40 days after hospitalisation.

The Value of Immunohistochemical Methods and Preoperative Magnetic Resonance Imaging Findings in Diagnosis of IDH1 Mutant Glioblastomas.

AIM: To assess the presence of isocitrate dehydrogenase (IDH) 1 mutation in glioblastomas using real-time polymerase chain reaction (RT-PCR), which is the gold standard in the diagnosis of IDH1 mutation; by immunohistochemistry (IHC), which is available in most of the pathology laboratories; and by preoperative magnetic resonance imaging, which is a non-invasive method. We also investigated the relationship between these methods and their usability in routine practice. MATERIAL AND METHODS: RT-PCR was performed to evaluate the presence of IDH1-R132H mutation on the blocks of 70 patients diagnosed with glioblastoma, and IDH1 stain was applied to the same blocks as IHC. Radiologically, preoperative magnetic resonance images of the patients were reviewed in terms of tumor size, localization, and presence of non-contrast-enhancing solid tumor component. RESULTS: Evaluation by RT-PCR revealed that 15 (21.4%) patients were IDH-mutant, whereas IHC examination revealed 13 (18.6%) and radiological evaluation revealed 11 (15.7%) patients were IDH-mutant. There was a statistically significant difference between the IDH1 mutation detected by RT-PCR and by IHC or radiological methods (p=0.034 and p=0.000, respectively). The sensitivity and specificity of IHC method in detecting IDH1 mutation were 86.6% and 100%, respectively, whereas those of radiological methods were 33.3% and 89%, respectively. CONCLUSION: Conclusively, radiological and IHC methods can be used in cases where RT-PCR cannot be applied for detecting IDH1 mutation. However, the results need to be confirmed by RT-PCR when necessary as these methods may sometimes overlook some IDH-mutant patients.

PHACE Syndrome: A Rare Case.

PHACE syndrome (OMIM 606519) is a rare neurocutaneous vascular disorder, characterized by posterior fossa malformations, large cervicofacial infantile hemangiomas, arterial anomalies, aortic coarctation, cardiac abnormalities, and eye abnormalities. The long-term outcome of PHACE syndrome patients is unclear; however, it seems that they are at risk for childhood stroke. The radiologist has an important role on diagnosis of PHACE syndrome and in the assessment of potential complications. Investigation of infants with segmental craniofacial hemangiomas should include cranial magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the cerebral and cervical arteries. Brain MRI and MRA findings of a 5-year-old female patient with PHACE syndrome are presented.

Combined effect of parathyroid hormone and strontium ranelate on bone healing in ovariectomized rats.

OBJECTIVE: Parathyroid hormone (PTH) enhances bone healing. Strontium ranelate (SR) is an antiresorptive agent that increases bone formation. Reports about combined effects of PTH and SR on local bone regeneration in osteoporotic subjects are limited. We aimed at investigating the efficacy of PTH and SR for promoting new bone formation in critical-sized defects of ovariectomized rats. MATERIALS AND METHODS: Parathyroid hormone- and/or SR-containing poloxamer implant tablets with/without chitosan microparticles were delivered locally to calvarial defects of 90 Wistar rats. Biopsies were analyzed histologically and histomorphometrically at 4 and 8 weeks of healing. RESULTS: Histomorphometry revealed that PTH alone promoted new bone formation at 4 weeks but the efficiency declined in 8 weeks. There was no positive effect of SR alone on bone formation at 4 or 8 weeks. Calvarial defects treated with PTH+SR combinations showed statistically significant greater new bone formation than either treatment alone at both time intervals. Tissue responses were modest and supported the good biocompatibility of the biomaterials used. CONCLUSION: Parathyroid hormone and SR combinations can be effective for calvarial bone regeneration of ovariectomized rats. PTH plus SR may have potential use as bone graft material in orthopedic and dental surgery to enhance bone healing and osseointegration.

Low concentrations of adropin are associated with endothelial dysfunction as assessed by flow-mediated dilatation in patients with metabolic syndrome.

BACKGROUND: In individuals with atherosclerotic risk factors, endothelial dysfunction (ED) appears as an early phase in the development of clinical symptoms. Recent studies indicate that adropin, a newly identified peptide, participates in cardiovascular health through the regulation of several metabolic events including angiogenesis and blood flow. In this study, we aimed to determine the relation of adropin with biochemical and radiologic parameters which reflect ED such as endothelial nitric oxide synthase (eNOS), endothelin 1 (ET-1), nitric oxide (NO) and flow-mediated dilatation (FMD) along with the routine biochemical measurements in patients recently diagnosed with metabolic syndrome (MetS). METHODS: Fasting blood samples from 110 patients with MetS diagnosed according to the NCEP ATP III-2005 criteria were collected to measure the concentrations of adropin and other parameters including the lipid profile, insulin and glucose. Serum NOx concentrations were determined by measuring NO2 plus NO3. FMD test was performed by ultrasonography, and patients were stratified as FMD (+) or (-). Data were compared between these two subgroups and also with matching healthy controls (n=50). Biochemical data were evaluated using Student's t or Mann-Whitney U tests. RESULTS: Fifty-nine subjects had ED (+) and the remaining 101 subjects were ED (-). In the first group, adropin levels were significantly lower than the latter (2.13±1.05 vs. 3.41±1.63 ng/mL, respectively; p<0.001) and independently associated with FMD positivity as assessed by the logistic regression analysis. CONCLUSIONS: Low adropin level in circulation is related to ED and has a close association with FMD. Any alterations in its level may be of help in order to assess the development of ED before the occurrence of clinical symptoms in patients with metabolic syndrome.

Evaluation of Cell Counting in Body Fluids: Comparison of Two Automated Hematology Analyzers with Manual Microscopy.

BACKGROUND: Manual microscopic analysis (MMA) of body fluids has been widely replaced by automated systems. The aim of this study was to assess the performances of the Sysmex XN-1000 (XN-1000) and UniCel DxH800 (DxH800) for body fluid analysis and compare their results with MMA and with each other. METHODS: Red blood cell (RBC), WBC and WBC-differential counts of 142 body fluid samples (7 cerebrospinal, 28 pleural, 107 ascitic fluids) were performed using DxH800, XN-1000, and MMA. RESULTS: The within-run and between-days CVs% were lower than 10% for both systems except MONO of DxH800. Both analyzers demonstrated good linearity and minimal carry-over. The comparison of the XN-1000 and DxH800 with manual counting and each other revealed good correlation (r > 0.90 for both). CONCLUSIONS: Automated systems introduce standardized and accurate performances to analyze biologic fluids. They are also beneficial for reducing turn-around time and laboratory costs.