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Transient splenial lesions (TSL) of the corpus callosum are uncommon radiologic findings that are seen in a number of clinical conditions with varied etiologies. They were first described a decade earlier in patients with epilepsy and hence were thought to be seizure or seizure therapy related. Subsequently, more cases were described by different observers in diseases with different etiologies, and the list is still increasing. Awareness of these lesions is necessary as they are an uncommon finding and have to be differentiated from other infective/noninfective causes. MRI is the imaging modality of choice as these lesions are not seen on routine noncontrast CT scan. The authors here describe two cases which showed TSL, with complete/partial resolution on follow-up scans. The authors also present a review of the literature.

Objectives: Neurocysticercosis, the commonest neuro-parasite, sometimes presents as complex ring enhancing lesion causing diagnostic dilemma. We aim to establish radio-histo-morphological equivalents of early events in degeneration of the parasite to explain such imaging phenotypes. Methods: We compared patterns of degeneration in 23 randomly selected complex NCC on MRI with histo-morphology in 30 cysts obtained from an unrelated post mortem brain. Results: The anatomy of the parasite and the degenerative patterns of the scolex (hydropic changes, calcification, evagination, and fragmentation) and the cyst wall (undulation, accessory loculi, and frank disruption) were well demonstrated on both. The intact scolex remarkably resembled head of intestinal Taenia. The complex lesions were conglomeration of multiple communicating cysts with a single parent cyst and multiple daughter cysts. The parent cysts contained a solitary variably degenerated scolex, had thicker walls and associated chronic inflammation. The remaining cysts of the lesion complex contained no scolex, had poorly organized walls, turbid contents, and florid perilesional enhancement with leakage of contrast. Three lesions assumed a multi-cystic pseudo-tumorous pattern, of which two resolved into solitary calcific remnants on follow up. Conclusion: Complex lesion in NCC result from degeneration of solitary parasite with perilesional gliosis, surrounded by multiple non-larval daughter cysts inciting acute intra and perilesional inflammation due to enhanced antigenic challenge. Possibly, attempted abortive asexual reproduction by the cellulose cyst as a preterminal event results in a "limited Racemose like transition." Correct interpretation has diagnostic and therapeutic implications as active lesions and their fibrocalcific residue may have greater epileptogenic potential. [ABSTRACT FROM AUTHOR]

Objective: Comparative evaluation of diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) using a whole-brain atlas to comprehensively evaluate microstructural changes in the brain of Alzheimer disease (AzD) patients.Methods: Twenty-seven AzD patients and 25 age-matched controls were included. MRI data was analyzed using a whole-brain atlas with inclusion of 98 region of interests. White matter (WM) microstructural changes were assessed by Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), Kurtosis fractional anisotropy (KFA), mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK). Gray matter (GM) integrity was evaluated using KFA, MK, RK, AK and MD. Comparison of the DKI and DTI metrics were done using student t-test (p ≤ 0.001).Results: In AzD patients widespread increase in MD, AD and RD were found in various WM and GM region of interests. The extent of abnormality for DKI parameters was more limited in both GM and WM regions and revealed reduced kurtosis values except in lentiform nuclei. Both DKI and DTI parameters were sensitive to detect abnormality in WM areas with coherent and complex fiber arrangement. Receiver operating characteristic curve analysis for hippocampal values revealed the highest specificity of 88% for AK <0.6965 and highest sensitivity of 95.2% for MD >1.2659.Conclusion: AzD patients have microstructural changes in both WM and GM and are well-depicted by both DKI and DTI. The alterations in kurtosis parameters, however, are more limited and correlate with areas in the brain primarily involved in cognition. [ABSTRACT FROM AUTHOR]

Background and Purpose: Dengue can present with variable neurological complications including encephalitis, encephalopathy, acute disseminated encephalomyelitis (ADEM), and ischemic and hemorrhagic stroke. Our study describes a pattern-based approach to recognize different brain MRI findings in dengue-seropositive patients with neurological symptoms.Materials and Methods: Thirty-six serologically proven dengue patients with neurological symptoms and undergoing brain MRI over a 6-month period were included in this study. The diagnosis of dengue encephalopathy or encephalitis was established by presence of signs/symptoms of acute encephalitic syndrome with the presence of Immunoglobin M (IgM) antibody against dengue antibody in the serum and/or presence of dengue antigen (NS1) in serum. The MRI brain along with diffusion weighted imaging and susceptibility weighted imaging sequences were evaluated by an experienced neuroradiologist.Results: Eleven patients had normal MRI finding. In the rest 25 patients, 12 were found to have encephalitic pattern, 4 had encephalopathic (seizure related/metabolic) pattern, 3 had features of ADEM, and isolated micro- or macro-hemorrhages were found in 6 patients. In the encephalitis group, eight had concomitant involvement of brainstem, cerebellum, and ganglio-thalamic complexes with additional involvement of cortex and subcortical white matter (WM) found in three. Isolated brainstem and cerebellar involvement were seen in three in this group, whereas one had isolated cerebellar involvement. Interspersed hemorrhage was noted in the structures involved in eight patients in encephalitis group.Conclusion: Radiologists should be aware of various MRI brain findings in dengue and a pattern recognition approach often helps in reaching the correct diagnosis albeit after exclusion of other differentials based on laboratory studies. [ABSTRACT FROM AUTHOR]

Our rationale was to evaluate the role of 99mTc-methylene diphosphonate (99mTc-MDP) SPECT/CT for the detection of sacroiliitis in spondyloarthropathies by comparing it with clinical markers and MRI findings. Methods: We prospectively included 155 patients (83 men and 72 women; mean age, 35.80 ± 12.40 y; range, 18-60 y) diagnosed with spondyloarthropathies as per the criteria of the European Spondyloarthropathy Study Group. All patients underwent clinical evaluation (using the Bath ankylosing spondylitis disease activity index [BASDAI]), measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, planar 99mTc-MDP bone scintigraphy, SPECT/CT, and MRI of the pelvic region. Using MRI as the reference criterion, the diagnostic accuracy of the clinical and scintigraphic parameters was assessed. On planar bone scintigraphy and SPECT, a score of 0, 1, or 2 was assigned when tracer uptake in the sacroiliac joint was less than, equal to, or more than that in the sacrum. A score of 2 was considered positive for the diagnosis of sacroiliitis. Results: The sensitivity, specificity, accuracy, and positive and negative predictive values of 99mTc-MDP SPECT/CT were 90.0%, 80.0%, 87.0%, 92.0%, and 75.0%, respectively. The accuracy of SPECT/CT (87%) was better than that of ESR (58.1%), CRP (32.9%), BASDAI scoring (77%), and planar bone scintigraphy (53%). Similar results were found for sensitivity and negative predictive value. Regarding specificity, SPECT/CT (80%) was lower than BASDAI scoring (88.6%) and equal to planar bone scintigraphy (80%). Regarding positive predictive value, SPECT/CT (92%) was a bit lower than BASDAI scoring (93.6%). κ-values for planar 99mTc-MDP bone scanning and SPECT/CT were 0.167 and 0.673, respectively, indicating poor agreement for planar bone scanning and good agreement for SPECT/CT. A significant (P < 0.001) correlation (r = 0.659) was observed between SPECT/CT and MRI findings. Conclusion:99mTc-MDP SPECT/CT has diagnostic accuracy comparable to that of MRI for the evaluation of sacroiliitis in spondyloarthropathies and can thus be used as an alternative when MRI is contraindicated. SPECT/CT shows better accuracy than planar bone scintigraphy, ESR, CRP, and BASDAI scoring in the diagnosis of sacroiliitis. [ABSTRACT FROM AUTHOR]

This study sought to evaluate the radiological and clinical spectrum of posterior reversible encephalopathy syndrome (PRES) in pediatric population. A retrospective evaluation of the pediatric patients with posterior reversible encephalopathy syndrome seen over the last 5 years in the authors’ hospital was done. The magnetic resonance imaging (MRI) findings were analyzed, and a review of literature was performed. Out of 32 pediatric patients of posterior reversible encephalopathy syndrome, 10 (31.25%) were males and 22 (68.75%) were females, with a mean age of 10.6 years. Renal disease (62.5%) was the most common primary disease, followed by chemotherapy for hemato-oncologic malignancies (15.6%). Hypertension was present in 81.2% of cases. Atypical MRI findings were seen in 62.5% cases. Frontal involvement was common and seen in 56% of the cases. Overall, MRI findings considered atypical in adults were found to be common in the series of pediatric posterior reversible encephalopathy syndrome. The understanding of the clinical settings and familiarity with radiological findings in pediatric posterior reversible encephalopathy syndrome patients is important to adequately treat these patients and to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the neurodevelopmental outcome of acute bilirubin encephalopathy (ABE) in children who underwent double volume exchange transfusion (DVET). The 25 referred newborns of ≥35 weeks gestation with total serum bilirubin >20 mg dl−1 and signs of ABE were enrolled and followed up at 3, 6, 9 and 12 months. Denver Development Screening Test (DDST), Neurological examination along with MRI at discharge and brain stem evoked response audiometry (BERA) at 3 months were done. Abnormal neurodevelopment was defined as either (i) cerebral palsy or (ii) abnormal DDST or (iii) abnormal BERA. The mean bilirubin at admission was 37 mg dl−1. MRI and BERA were abnormal in 61% and 76%. At 1 year, DDST and neurological abnormality were seen in 60% and 27% and 80% had combined abnormal neurodevelopment. MRI had no relation (P = 0.183) but abnormal BERA had a significant association (P = 0.004) with abnormal outcome. Intermediate and advanced stages of ABE associated with significant adverse outcome in spite of DVET. [ABSTRACT FROM PUBLISHER]

Abstract: In order to reconstruct the face from a bare skull, the facial soft tissue thickness (FSTT) was determined at 29 standard anthropological landmarks by magnetic resonance imaging (MRI) in 173 male and 127 female adult subjects of northwest Indian origin. Repeatability and accuracy of the measurements was assessed by paired t-test and 95% confidence intervals. A stepwise discriminant function analysis selected nine landmarks for better sex classification in FSTT measurements. The thickness of soft tissue was different from that described in the literature and reported for samples from other countries. A correlation between skinfold thickness and body mass index (BMI) with that of FSTT was observed. The data of facial soft tissue thickness will help forensic experts in reconstructing the face from a skull for identification purposes. [Copyright &y& Elsevier]