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Objective: The aim of this study was to look for feasibility of non-contrast CT (NCCT) in detecting peripheral zone prostate cancer (PCa)., Methods: A retrospective analysis included 50 biopsy-proven PCa patients between April 2019 and March 2022 who underwent staging whole body prostate-specific membrane antigen (PSMA)/CT prior to treatment. The control subjects were 50 randomly selected adult male patients who underwent PET/CT for non-prostate malignancy during the same time period. Two readers independently calculated the Hounsfield unit (HU) of normal peripheral zone, central zone, and corresponding PSMA avid focus in cases., Results: No significant difference was seen in the mean HU value of normal peripheral zone between cases and controls. Significant difference in the mean HU was seen between the PSMA avid focus in cases (40.1 ± 6.2) and normal peripheral zone of cases (28.2 ± 7.0) and controls (27.7 ± 5.8). No significant difference was found between the mean HU values of high-grade PCa and non-high-grade PCa. Receiver operating characteristic (ROC) curve analysis revealed a mean HU cut-off of ≥35 for detecting PCa with a sensitivity and specificity of 86% and 90%, respectively, between cases and controls (AUC 0.88)., Conclusion: Detection of clinically significant PCa is possible on routinely performed NCCT scans. Radiologists should routinely look for and convey these findings to facilitate further work-up and early detection of PCa., Advances in Knowledge: Our study adds to the knowledge that NCCT scans performed for unrelated indications can serve as a screening tool for clinically significant PCa., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Institute of Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To investigate the value of DTI in differentiation of renal allograft rejection from well-functioning stable allograft, using fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values., Methods: In this prospective study, 22 transplant recipients with well-functioning stable allograft (group A) and 20 patients with renal allograft rejection (group B + C) were recruited over a period of 19 months from January 2018 to July 2019. DTI-MRI was performed in all the patients, and FA and ADC values were measured in cortical and medullary regions of the transplanted kidney. On biopsy, graft rejection was classified as acute (group B) ( n = 7) and chronic graft rejection (group C) ( n = 13) based on the BANNF scoring system. Statistical analysis was performed using STATA v.14.0., Results: Statistically significant difference between group A and group B + C was noted for cortical ( p < 0.001), and medullary ( p = 0.003) FA values, and cortical ( p = 0.020), and medullary ( p = 0.046) ADC values. Cortical( p < 0.001) and Medullary( p = 0.020) FA values showed statistically significant difference between group A and group C, and cortical FA value( p = 0.012) also showed statistically significant difference between group B and group C. AUC (to differentiate between renal allograft rejection and well-functioning stable allograft) for cortical, and medullary FA values and cortical and medullary ADC values were 0.853( p < 0.001), 0.757( p = 0.004), 0.709( p = 0.021) and 0.736( p = 0.009), respectively., Conclusion and Advances in Knowledge: DTI is a promising functional MRI technique for the non-invasive assessment of renal allograft function. Diffusion parameters, such as FA and ADC values, can be useful in the differentiation of renal allograft rejection from well-functioning stable allograft.

Renal hydatid is an uncommon finding, reported in less than 5% patients with hydatid infection. Hydatid involvement of ureter and urinary bladder is an even rarer entity. Renal hydatid is typically unilateral, solitary and arises from cortex. It is essential to be aware of the imaging features of the hydatid cyst for proper diagnosis. Knowledge of the imaging features of various stages is essential since treatment decision is based on cyst stage. Hydatid cyst can mimic several entities both benign and malignant. We present a pictorial review to illustrate the radiological imaging features of hydatid disease involving kidney, ureter and bladder region and its complications.

Objective: Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients., Methods: This was a case-control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated., Results: Ulnar nerve showed thickening with altered T 2 W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm 2 . Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 -3 mm 2 /s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm 2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 -3 mm 2 /s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 -3 mm 2 /s respectively., Conclusion: DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies., Advances in Knowledge: 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol.2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value.3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 -3 mm 2 /s respectively.

Objective: To explore the utility of first-order MRI-texture analysis (TA) parameters in predicting histologic grade and muscle invasion in urinary bladder cancer (UBC)., Methods: After ethical clearance, 40 patients with UBC, who were imaged on a 3.0-Tesla scanner, were retrospectively included. Using the TexRAD TM platform, two readers placed freehand ROI on the sections demonstrating the largest dimension of the tumor, evaluating only one tumor per patient. Interobserver reproducibility was assessed using the intraclass correlation coefficient (ICC). Mann-Whitney U test and ROC curve analysis were used to identify statistical significance and select parameters with high class separation capacity (AUC >0.8), respectively. Pearson's test was used to identify redundancy in the results., Results: All texture parameters showed excellent ICC. The best parameters in differentiating high and low-grade tumors were mean/ mean of positive pixels (MPP) at SSF 0 (AUC: 0.897) and kurtosis at SSF 5 (AUC: 0.828) on the ADC images. In differentiating muscle invasive from non-muscle invasive tumors, mean/ MPP at SSF 0 on the ADC images showed AUC >0.8; however, this finding resulted from the confounding effect of high-grade histology on the ADC values of muscle invasive tumors., Conclusion: MRI-TA generated few parameters which were reproducible and useful in predicting histologic grade. No independent parameters predicted muscle invasion., Advances in Knowledge: There is lacuna in the literature concerning the role of MRI-TA in the prediction of histologic grade and muscle invasion in UBC. Our study generated a few first-order parameters which were useful in predicting high-grade histology.

Most of the adrenal masses are incidentally detected. Multiphasic CT forms the mainstay for diagnosis and characterization of adrenal masses. MRI can further be used if the masses are indeterminate on CT scan. But as these investigations are expensive with risk of radiation exposure, contrast-enhanced ultrasound (CEUS) is currently under evaluation to assess its utility to act as a screening modality to differentiate benign vs malignant adrenal masses This investigative modality is relatively safe and can be used in patients having renal dysfunction or allergy to CT contrast. We, hereby, present a pictorial review of imaging appearance of various adrenal lesions on CEUS with CT and MRI correlation.

Objectives: To assess the role of normalized apparent diffusion coefficient (ADC) in characterization of endometrial and subendometrial masses, measured as a ratio of the mean ADC of the pathology to mean ADC of two different internal controls, normal myometrium and gluteus maximus muscle, referred to as nADC m and nADC g respectively., Methods: 55 females with pathologically proven endometrial and subendometrial lesions, including 27 cases of endometrial carcinoma, and 28 cases of benign masses were enrolled in this prospective study and assessed with single-shot echoplanar diffusion-weighted imaging. The normalized and absolute ADC of the lesions, measured by two radiologists, were compared in different pathologies and receiver operating characteristics (ROC) performed to distinguish benign and malignant endometrial masses. In the endometrial carcinoma group, the ADC values were further compared with tumor grade and subtype., Results: There was good interobserver agreement (>0.800) for both internal controls, however it was higher for myometrium [intraclass correlation coefficient-0.92; confidence interval (0.86-0.95)] than gluteus maximus muscle [ICC-0.84; CI (0.72-0.90)]. There were statistically significant differences in absolute ADC ( p-0.02 ), nADC m ( p-0.02 ) and nADC g ( p < 0.0001 ) of benign and malignant endometrial masses., Conclusion: Normalized ADC is useful to distinguish benign and malignant masses with comparable accuracy as absolute ADC., Advances in Knowledge: Normalized ADC represents an easily measurable quantitative parameter which limits the influence of endogenous and exogenous factors that affect its reproducibility.

Central pontine myelinolysis (CPM) is a clinical condition characterized by myelin destruction in the rostral part of the pons. It is commonly found in association with alcoholism, rapidly corrected hyponatraemia and electrolyte abnormalities. We describe here an unusual case of CPM occurring in a patient with cerebral malaria.

Carcinoma in vesical diverticula is a rare clinical entity and rarer still is the herniation of the vesical diverticulum into the scrotal sac. Carcinoma arising within a vesical diverticulum often represents a diagnostic as well as a therapeutic challenge, with overall poor outcome despite all available forms of treatment. Multidetector CT helps in the diagnosis and detailed evaluation of carcinoma arising from the vesical diverticulum by allowing excellent reconstructions in any desired plane. We report here a case of transitional cell carcinoma arising in a herniated vesical diverticulum with hepatic metastasis.

Retroperitoneal fibrosis (RPF) is an uncommon entity that usually presents as a fibrous plaque-like lesion that encases the aorta and inferior vena cava below the level of the renal arteries. We present an unusual mass-like appearance of this disease simulating a tumour, with foci of calcification, seen in a young girl.

Mucormycosis is an opportunistic fungal infection occurring most often in immunocompromised patients. The most common clinical presentation of infection with the fungus is rhinocerebral, followed by primary pulmonary, disseminated, gastrointestinal and cutaneous manifestations. Renal involvement in disseminated mucormycosis is well described, however, there are only few case reports describing the isolated renal mucormycosis in literature. We present an unusual case of renal mucormycosis in a patient of aplastic anaemia who presented with right flank pain and, on imaging, was found to have renal infarction and thrombosis of renal vessels. Histopathology revealed fungal hyphae infiltrating the entire kidney, renal vessels and perinephric space.