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Spinal MR imaging is excellent for identifying details of spinal anatomy, including intraspinal contents, neural foramina, joints, ligaments, intervertebral discs, and bone marrow. Cortical bony structures of the spine are better imaged using CT. Conventional and CT myelography is an alternative to MR imaging in those with contraindications to MR imaging or in evaluation of spinal cerebrospinal fluid leaks. Motion- and flow-related artifacts may occur during imaging and should not be mistaken for lesions. With advancements in MR imaging hardware and software, spinal MR imaging can expand its role in the delineation of normal and abnormal spinal anatomy., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Historically, management options for spinal metastases include surgery for stabilization and decompression and/or external beam radiation therapy (EBRT). EBRT is palliative in nature, as it lacks accurate targeting such that the prescribed radiation doses must be limited in order to maintain safety. Modern advancement in imaging and radiotherapy technology have facilitated the development of stereotactic body radiation therapy (SBRT), which provides increased targeted precision for radiation delivery to tumors resulting in lower overall toxicity, particularly to regional structures such as the spinal cord and esophagus, while delivering higher, more effective, and radically ablative radiation doses.Over the past decade, SBRT has been increasingly utilized as a method of treating spinal metastases either as the primary modality or following surgical intervention in both de novo and reirradiation setting. Numerous studies suggest that SBRT is associated with an 80% to 90% rate of 1-year local control across clinical scenarios. For example, studies of SBRT as the primary treatment modality suggest long-term local control rate of 80% to 95% for spinal metastases. Similarly, SBRT in the adjuvant setting following surgery is associated with local control rates ranging from 70% to 100%. Furthermore, because SBRT allows for lower dose to the spinal cord, it has also been used in patients who have had prior radiation therapy, with studies showing 66% to 93% local control in this scenario.

We report the first identified transmission of Balamuthia mandrillaris through solid organ transplantation. Kidneys were transplanted from a donor with presumptive diagnosis of autoimmune encephalitis. Shortly after, the recipients developed neurologic symptoms. Magnetic Resonance Imaging of the brain from the donor and both kidney recipients demonstrated multiple ring enhancing lesions with surrounding edema and adjacent leptomeningeal extension. In addition most of the lesions demonstrated signal changes suggesting central hemorrhagic foci. Specimens were tested locally and at the Centers for Disease Control and Prevention. Histopathology revealed B. mandrillaris in either brain tissue and/or cerebral spinal fluid in the donor and recipients.

Background: MOG antibody and AQP4 antibody seropositive diseases are immunologically distinct subtypes of neuromyelitis optica spectrum disorders (NMOSD) with similar clinical presentations. MRI findings can be instrumental in distinguishing MOG antibody disease from AQP4 antibody NMOSD. Objectives: The aim of this study is to characterize the neuroradiological differences between MOG antibody disease and AQP4 antibody NMOSD with the aim to distinguish between the two entities. Methods: This is a retrospective study of 26 MOG and 25 AQP4 seropositive patients in which MRI features of the brain, spinal cord, and orbit were compared. Results: The majority of the abnormal findings in the MOG cohort were located on orbital MRIs, while spinal cord magnetic resonance (MR) abnormalities were more common in the AQP4 cohort. Brain abnormalities showed some overlap, but cortical gray/juxtacortical white matter involvement was distinct to MOG patients, while area postrema involvement was a rare feature. Conclusion: Cortical gray/juxtacortical white matter lesions on brain MRI might help distinguish MOG antibody disease from AQP4-positive NMOSD. These findings could be of value in distinguishing the two entities as early as the first presentation. [ABSTRACT FROM AUTHOR]

Background: White matter is responsible for inter-neuronal connections throughout the brain that are a driving force in cognitive development. Diffusion tensor imaging (DTI) fiber tractography has been used to evaluate white matter development in the fetal brain; however, longitudinal studies of DTI fiber tractography to assess white matter development in the third trimester are lacking.Objective: To characterize in utero longitudinal changes in the fetal brain DTI fiber tracts of normal third-trimester fetuses.Materials and Methods: For this single-center prospective longitudinal observational pilot study, we recruited 28 pregnant females with normal third-trimester pregnancies who had routine prenatal ultrasound. MRI of the in utero fetal brain was performed with a Siemens 1.5-tesla (T) Espree scanner at 31 weeks, 33 weeks and 36 weeks of gestation, with 14 DTI tractography parameters quantified in 7 brain regions using DTI-studio version 2.4 (Johns Hopkins University, Baltimore, MD; n=98 measurements). We used multilevel mixed models to examine the relationship between longitudinal changes in DTI measurements and between 98 DTI measurements at 31 weeks and 4 routine fetal brain anatomical biometrics (n=392 assessments).Results: We observed statistically significant decreases in radial diffusivity and apparent diffusion coefficient in 13 of 14 brain regions from 31 weeks to 36 weeks of gestation (P<0.001 for all regions except the genu of the corpus callosum). Significant decreases in radial diffusivity from weeks 33 to 36 and weeks 31 to 36 were seen in the corticospinal tracts, centrum semiovale, posterior limb of the internal capsule, and crus cerebri (P<0.001 for all). When considering all possible combinations of DTI fiber tract measurements and the routine morphological fetal brain biometrics, only 6% (24/392) had a significant association (P<0.05), indicating relative independence of the DTI fiber tract measurements from anatomical biometrics.Conclusion: In utero longitudinal changes in fetal brain DTI fiber tractography are quantifiable in normal third-trimester fetuses and are largely independent of morphological brain changes. [ABSTRACT FROM AUTHOR]

Highlights • MOG antibody disease is an emerging entity that yet needs to be characterized. • Although previously thought to be a monophasic disease, relapsing course is a common presentation among such patients. • Most of imaging findings are localized within the optic nerves which correlates with optic neuritis as the most common clinical relapse. • The encephalopathic presentation with an ADEM-like MRI picture is more common among such patients and might help in its distinction from MS and AQP4 NMOSD. • Resolution of MRI findings on follow up might explain the relatively good long term recovery. Abstract Background MOG antibody disease is an autoimmune disease of the central nervous system (CNS) characterized by the presence of a serological antibody against myelin oligodendrocyte glycoprotein (MOG). MRI is instrumental in distinguishing neuromyelitis optica spectrum disorder (NMOSD) from multiple sclerosis (MS), but MRI features of MOG disease appear to overlap with NMOSD and MS. Objectives In this study we aim to characterize the radiological features of MOG antibody disease and compare the findings with those previously described. Methods This is a retrospective study of 26 MOG positive patients. We aim to describe their brain, spinal and orbital MRI features and compare our findings with those previously reported in the literature. Results The majority of the abnormal findings was located on orbital MRIs, with more involvement of the anterior structures and bilateral involvement of the optic nerves. Brain abnormalities were distinct from both NMOSD and MS lesions. Spinal cord was the least affected. Conclusions This is a dedicated radiological study aiming to characterize the features of MOG antibody disease which might aid in the proper investigation of cases presenting with acquired demyelinating disorders. [ABSTRACT FROM AUTHOR]

BACKGROUND: Placenta Accreta (PA) is the extension of chorionic villi into myometrium due to abnormality in decidua basalis which may lead to massive peripartum haemmorhage, hence putting the life of patient at risk. Therefore, antenatal diagnosis of PA is essential for which ultrasonography (USG) and magnetic resonance imaging (MRI) play a pivotal role. However, USG is an easily accessible and low cost imaging modality as compared to MRI and that is why it is more widely used for screening purposes. OBJECTIVE: To determine diagnostic accuracy of USG and MRI in prenatal diagnosis of placenta accreta taking operative findings as gold standard as limited local research has been done on this. METHODS: A prospective study was conducted in radiology department of Khyber Teaching Hospital, Peshawar from June, 2014 to June, 2016. Twenty five antenatal patients who were at high clinical risk of placenta accreta were identified and undergone USG and MRI for confirmation of diagnosis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated both for USG and MRI. RESULTS: Twenty five patients at risk of placenta accreta underwent both USG and MRI. Seven cases were diagnosed with placenta accreta per operatively (gold standard). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the USG were 85.7%, 83.3%, 66.7%, 93.8% and 84% respectively. While the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the MRI were 71.4%, 72.2%, 50%, 86.7% and 72% respectively. CONCLUSION: The study concluded that diagnostic accuracy of USG is higher than MRI for the antenatal diagnosis of place nta accre ta. [ABSTRACT FROM AUTHOR]

In order to examine the accuracy of magnetic resonance imaging (MRI)-based diagnosis of neuromyelitis optica (NMO) versus multiple sclerosis (MS), we performed a retrospective, rater-blinded review of 29 cases of NMO and 30 cases of MS using the criteria of long (more than three vertebral levels), continuous lesions with a central cord location for NMO and more peripheral and patchy lesions for MS. Using these criteria, two raters were able to distinguish the two conditions with a good degree of confidence, particularly when the imaging was performed at the time of an acute cord attack. The sensitivity and specificity for diagnosis of NMO were 86.2% and 93.3%, respectively, for Rater A and 96.4% and 78.6%, respectively, for Rater B, with a kappa value of 0.72. Thus there are significant differences in lesion characteristics that allow the distinction on spinal cord imaging between MS and NMO with a moderately high degree of confidence. The location of the lesion as evident on MRI of the spine can be regarded as a distinguishing diagnostic feature between MS and NMO. [ABSTRACT FROM AUTHOR]

Dendritic cell sarcoma, not otherwise specified (NOS), is an entity that is poorly defined because of its rarity and poorly understood pathogenesis. It is characterized by positive immunohistochemical staining for S-100 and CD1a, along with an absence of cytoplasmic Birbeck granules on electron microscopy. We report the case of a surgically inaccessible nasopharyngeal dendritic cell sarcoma, NOS, in a 34-year-old man. Treatment with chemotherapy along with adjuvant radiation therapy was successful in decreasing the size of the nasopharyngeal mass, and the patient remained free of any evidence of recurrence nearly 5 years after treatment. [ABSTRACT FROM AUTHOR]

Purpose: In patients with spinal instability, cord compression, or neurologic deficits, the standard of care is surgery followed by radiation therapy (RT). Recurrence rates after conventional RT remain high. The purpose of this study is to prospectively examine the efficacy of postoperative stereotactic body RT (SBRT) in patients who have undergone surgical intervention for spine metastases. We hypothesize that postoperative SBRT to the spine would be associated with higher local control than historical rates after conventional RT.Methods and Materials: Thirty-five adult patients with a Karnofsky Performance Status score ≥40 and spine metastases from solid tumors with no prior overlapping RT and target volumes ≤3 consecutive vertebral levels were enrolled. Thirty-three patients were treated. Two patients underwent treatment to 2 target volumes for a total of 35 target volumes. All patients received SBRT 30 Gy in 5 fractions. Patients were followed with neurological examinations and computed tomography and/or magnetic resonance imaging every 3 months. Neurologic function was assessed at the same time points using the American Spinal Injury Association (ASIA) impairment score. Pain was rated according to the 10-point visual analogue scale and MD Anderson Cancer Center brief pain index. Toxicity was recorded according to National Cancer Institute Common Toxicity Criteria for Adverse Events Version 4. The primary objective was the rate of radiographic local recurrence at 12 months after completion of SBRT.Results: Patient characteristics were as follows: 34.3% had radioresistant primaries; 71.4% were ASIA E and the remainder ASIA D; and the median baseline Karnofsky Performance Status score was 70 (range, 50-100). Radiographic and symptomatic local control at 1 year were 90% (95% confidence interval, 76%-98%). The median time to recurrence in these 3 patients was 3.5 months (range, 3.4-5.8 months), all had radiosensitive tumors, and all recurrences were epidural. No patients experienced wound dehiscence, hardware failure, or spinal cord myelopathy. The median time to return to systemic therapy was 0.5 months (range, 0-9.4 months).Conclusions: This prospective study of postoperative spine SBRT demonstrates excellent local control with low toxicity. These data suggest superior rates of local control compared with conventional RT; however, a formal comparative study is warranted. [ABSTRACT FROM AUTHOR]

Abstract: Silicone oil used for endotamponade of retinal detachment may migrate into the subarachnoid space of the brain, including the cerebral ventricles, presumably by extension through silicone oil-filled spaces in the optic nerve. Silicone oil has characteristic appearances on CT scans and MRI, which can be utilized to distinguish it from more ominous entities. We describe a case of intraventricular silicone in a patient who presented with seizures. [Copyright &y& Elsevier]

Despite known characteristic radiologic and clinical features, differentiation between Warthin's tumor (WT) and other parotid tumors remains challenging. The purpose of this study was to more precisely assess the MR imaging features of WT and to develop a scoring system combining the most specific characteristics. A total of 208 patients with parotid gland tumors and presurgical MRI were included. Tumors were divided into 5 histological subtypes, and different MRI features were compared between groups. An MRI scoring test was developed including MR parameters that contributed significantly in distinguishing WT from other tumors. The best MRI features for differentiating between WTs from other tumors included bilaterality (P = 0.002), multifocality (P < 0.001), ADC values <905.1 (P < 0.001), and high signal intensity on T1-W images (P < 0.001). Six or more points on the 14-point scoring MRI scale was associated with an area under the curve of 0.99 (Accuracy of 98%), while a cut-off value of 7 indicated 100% specificity and 100% positive predictive value. Ill-defined margins, low T1-W signal, and location in the upper 2/3 of the parotid gland excluded WTs in 100% of cases. The proposed scoring method allows WTs to be distinguished from other tumors with high accuracy. • Despite known characteristic radiologic and clinical features, differentiation between Warthin's tumor (WT) and other parotid tumors remains challenging. • The best MRI features for differentiating between WTs from other tumors included bilaterality, multifocality, ADC values <905.1, and high signal intensity on T1-W images. • Six or more points on the 14-point scoring MRI scale was associated with an area under the curve of 0.99, while a cut-off value of 7 indicated 100% specificity and 100% positive predictive value. • Differentiation between WTs and other parotid tumors remains challenging. • The best MR features of WT included bilaterality, ADC < 905.1, and T1 hyperintensity. • MRI score cut-off value of 7 indicated 100% specificity and 100% PPV for WTs. [ABSTRACT FROM AUTHOR]

Background: Current evidence suggests that dual-energy x-ray absorptiometry (DXA) scans, the conventional method defining osteoporosis, is underutilized and, when used, may underestimate patient risk for skeletal fragility. It has recently been suggested that other imaging modalities may better estimate bone quality, such as the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score which also may assess vertebral compression fracture risk in patients with spine metastases.Purpose: To evaluate whether VBQ score is predictive of fragility fractures in a population with pre-existing low bone density and at high-risk for fracture.Study Design/setting: Retrospective single-center cohort.Patient Sample: Patients followed at a metabolic bone clinic for osteopenia and/or osteoporosis.Outcome Measures: Radiographically-documented new-onset fragility fracture.Methods: Patients with a DXA and MRI scans at the time of consultation and ≥2-year follow-up were included. Details were gathered about patient demographics, health history, current medication use, and serological studies of kidney function and bone turnover. For each patient, VBQ score was calculated using T1-weighted lumbar MRI images. Univariable and multivariable analyses were used to identify the independent predictors of a new fragility fracture. To support the construct validity of VBQ, patient VBQ scores were compared to those in a cohort of 45 healthy adults.Results: Seventy-two (39.1%) study participants suffered fragility fractures, the occurrence of which was associated with higher VBQ score (3.50 vs. 3.01; p<.001), chronic glucocorticoid use (30.6% vs. 15.2%; p=.014), and a history of prior fragility fracture (36.1% vs. 21.4%; p=.030). Mean VBQ score across all patients in the study cohort was significantly higher than the mean VBQ score in the healthy controls (p<.001). In multivariable analysis, new-onset fracture was independently associated with history of prior fracture (OR=6.94; 95% confidence interval [2.48-19.40]; p<.001), higher VBQ score (OR=2.40 per point; [1.30-4.44]; p=.003), higher body mass index (OR=1.09 per kg/m²; [1.01-1.17]; p=.03), and chronic glucocorticoid use (OR=2.89; [1.03-8.17]; p=0.043). Notably, DXA bone mineral density (BMD) was not found to be significantly predictive of new-onset fractures in the multivariable analysis (p=.081).Conclusions: Here we demonstrate the novel, MRI-derived VBQ score is both an independent predictor of fragility fracture in at-risk patients and a superior predictor of fracture risk than DXA-measured BMD. Given the frequency with which MRIs are obtained by patients undergoing spine surgery consultation, we believe the VBQ score could be a valuable tool for estimating bone quality in order to optimize the management of these patients. [ABSTRACT FROM AUTHOR]

Three new cycloartane triterpenoids, commikuanoids A-C (1 – 3), together with four known compounds 4 – 7 , were isolated from the resin of Commiphora kua. Their structures were confirmed by advanced NMR techniques such as 1D (1H and 13C) and 2D (HMBC, HSQC, COSY, NOESY and NOE) and high-resolution mass spectrometry (HRMS). Five compounds (1 – 5) were screened for in vitro carbonic anhydrase II (CA II) inhibitory activity. All the tested compounds demonstrated significant activity against CA II with IC 50 values ranging from 4.9–19.6 μM. Moreover, the binding pattern of each compound in the binding site of CA-II was predicted through in silico molecular docking approach. It was observed that compounds 2 , 4 , and 5 binds with the Zn ion present in the active site of CA II, while compounds 1 and 3 mediated hydrogen bonding with Thr199 of CA-II, and all the compounds showed good binding score (> − 5 kcal/mol). [Display omitted] [ABSTRACT FROM AUTHOR]