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Dengue is a common viral infection worldwide with presentation varying from clinically silent infection to dengue fever, dengue hemorrhagic fever, and severe fulminant dengue shock syndrome. Neurological manifestation usually results from multisystem dysfunction secondary to vascular leak. Presentation as hemorrhagic encephalitis is very rare. Here we present the case of a 13-year-old female admitted with generalized tonic clonic seizures. Plain computed tomography (CT) scan of head revealed hypodensities in bilateral deep gray matter nuclei and right posterior parietal lobe without any hemorrhage. Cerebrospinal fluid (CSF) and serology were positive for IgM and IgG antibodies to dengue viral antigen. Contrast-enhanced magnetic resonance imaging (MRI) revealed multifocal T2 and fluid attenuated inversion recovery (FLAIR) hyperintensities in bilateral cerebral parenchyma including basal ganglia. No hemorrhage was seen. She was managed with steroids. As her clinical condition deteriorated, after being stable for 2 days, repeat MRI was done which revealed development of hemorrhage within the lesions, and diagnosis of acute hemorrhagic encephalitis of dengue viral etiology was made. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to verify the sensitivity and specificity of the hyperdense middle cerebral artery sign (HMCAS) obtained by multidetector computed tomography (CT) in predicting acute stroke, using diffusion-weighted (DW) magnetic resonance imaging (MRI) as a reference. The location of the HMCAS, the extension of the ischaemic lesion and its prognostic value were also assessed. Materials and methods: The CT examinations of 654 patients with symptoms related to acute cerebral stroke were retrospectively reviewed. DW-MRI confirmed recent stroke in 175 patients. Two expert neuroradiologists analysed the CT examinations of these patients in four phases. Sensitivity, specificity and interobserver reliability was evaluated. Patients were divided into three groups according to the HMCAS site (M1-M2-M3) and the Alberta Stroke Program Early CT Score (ASPECTS) on DW-MRI was calculated. The ASPECTS average score was correlated with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) at 3 months. Results: In 41 patients, the presence of HMCAS was confirmed (71 % sensitivity; 100 % specificity; Interobserver reliability k, 84 %). An inverse correlation was found by comparing the ASPECTS and NIHSS scores (Rsq = −0.206). After logistic regression analysis, HMCAS was found to be independently associated with a poor outcome (mRS >2) at 3 months after adjusting for age, NIHSS on admission, risk factors and aetiology of stroke. Conclusions: Our study demonstrated that HMCAS obtained with multidetector CT can be detected in more than 70 % of patients with large acute ischaemic lesion and it is an unfavourable prognostic sign. [ABSTRACT FROM AUTHOR]

Aim Central nervous system involvement represents a serious and common complication of systemiclupus erythematosus ( SLE). We describe the characteristics of patients with neuropsychiatric ( NP) SLE complicated with reversible basal ganglia lesions. Methods We describe the cases of three NPSLE patients. Results They presented with NP manifestations such as headache, cognitive dysfunction, tremors, seizures, and mood disorder. The levels of autoantibodies to NMDA ( N-methyl- d-aspartate) receptor antibodies and antiribosomal-P antibodies were elevated, indicating the presence of an acute phase. Marked elevation of interleukin-6 in cerebrospinal fluid was noted when these patients showed NP symptoms. Moreover, the patients presented with high-intensity lesions in the basal ganglia on T2-weighted images, fluid-attenuated inversion recovery ( FLAIR) images, diffusion-weighted images ( DWI) and apparent diffusion coefficient ( ADC) maps. Following immunosuppressive treatment, almost complete improvement of the lesions was noted. Conclusion The reported cases indicate that reversible vasculopathies represent vasogenic edema localized in basal ganglia lesions and that activation of the autoimmune system and inflammation could lead to NP manifestations in SLE. [ABSTRACT FROM AUTHOR]

Background: Subdural (SDE) and epidural empyema (EDE) are life-threatening intracranial infections. They require immediate diagnosis and treatment. However, in some cases, magnet resonance imaging (MRI) is not able to contribute to diagnosis; therefore, surgical exploration is indicated. Hollow screws used for decompression of chronic subdural haematoma (cSDH) are valuable tools for minimally invasive biopsy in awake patients when SDE and EDE are suspected. Methods: Between 2006 and 2010, eight patients in our department underwent biopsy of a suspected SDE or EDE using hollow screws. In these cases, MRI or computed tomography (CT) were not able to provide sufficient diagnostic security to indicate primary craniotomy. Diagnostic and therapeutic efficacy was evaluated on preoperative and postoperative imaging. The focus was on qualitative parameters, such as contrast enhancement or impaired diffusion on diffusion-weighted images (DWI). Results: The application of the hollow screw under local anaesthesia permitted an exact diagnosis in all cases. In one case, the suspected diagnosis of cSDH could be refuted by diagnostic puncture. In four cases of uncertain diagnosis, the application of the hollow screw revealed a cSDH. Seven of eight patients previously received neurosurgical treatment; three of those cases were SDE or EDE and four were cSDH. Cases of SDE and EDE needed further craniotomy after diagnostic puncture, whereas patients with cSDH were sufficiently treated by hollow screws. Conclusions: Given their comparably wide diameter, hollow screws allow a sufficient sample size and, therefore, lead to precise diagnosis of SDE and EDE without significant operative risks or strains for the patient. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of diffusion-weighted imaging (DWI) methods, apparent diffusion coefficient (ADC) calculation methods, and selection of b-values on the ADCs and the measurement reproducibility of malignant hepatic tumors. Materials and Methods: Nineteen patients with pathologically confirmed malignant hepatic tumors underwent breath-hold DWI (b-values = 0, 50, 500 s/mm2) and respiratory- triggered DWI (0, 50, 300, 500, 1000 s/mm2) twice on a 1.5 T magnetic resonance imaging (MRI) scanner. ADCs were calculated using a two b-value and/or a multiple b-value method. The reproducibility of the ADC measurements was evaluated from the intraclass correlation coefficients (ICCs) and the 95% Bland-Altman limitof- agreement (LOA). Results: The ADCs were different according to the DWI methods (P = 0.040-0.282), ADC calculation methods (P = 0.003-0.825), and the choice of b-values (P < 0.001). The ADC tended to be more reproducible with use of breath-hold DWI (ICC: 0.898-0.933; LOA, 18.8%-24.0%) than respiratory-triggered DWI (ICC: 0.684-0.928; LOA, 15.0%-31.9%) (P = 0.008-0.122). For respiratory-triggered DWI, the multiple b-value method using five b-values had better reproducibility than the two b-value method for measurement of ADC (P = 0.009-0.221).Conclusion: The DWI method, ADC calculation method, and selection of b-values potentially influence the ADCs and the reproducibility of malignant hepatic tumors. ADCs calculated from breath-hold DWI are more reproducible than from respiratory-triggered DWI. A multiple b-value method may improve the reproducibility of respiratory- triggered DWI. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the diagnostic impact of echo planar DW imaging in distinguishing benign from malignant musculoskeletal soft-tissue masses using ADC mapping as a quantitative assessment tool. Patients and methods: We evaluated 73 tumors (21 bone tumors and 52 soft-tissue tumors). MR examinations were performed with a 1.5-T system. Diffusion-weighted single-shot EPI images were obtained in all patients. Apparent diffusion coefficients (ADCs) were calculated by using b factors of 0 and 1000s/mm2. ADC value measurements were compared with the histopathological findings. Results: The average ADC of benign tumors was 1.86±0.67×10−3 mm2/s, and that of malignant soft-tissue tumors was 0.97±0.35×10−3 mm2/s. ADC value of malignant tumors was significantly lower than that of the benign tumor group (p <0.0001). The highest ADC value was seen in the case of ganglion cyst (2.8±0.23×10−3 mm2/s) and cystic neurofibroma (2.5±0.04×10−3 mm2/s), and juxta cortical enchondroma (2.65±0.36×10−3 mm2/s) while the lowest one was seen in aggressive fibromatosis (0.37±0.05×10−3 mm2/s). For malignant soft-tissue masses, the highest ADC value was seen in mesenchymal chondrosarcoma (2.1±0.32) liposarcoma (intermediate grade) (1.4±0.21) while the lowest ADC value was seen in fibrosarcoma (high grade) (0.78±0.14). Conclusion: MR diffusion provides additional information to the routine MRI sequences rendering it an effective non-invasive tool in differentiating between benign and malignant soft-tissue tumors. [Copyright &y& Elsevier]

Abstract: Indices derived from diffusion tensor imaging (DTI) data, including the mean diffusivity (MD) and fractional anisotropy (FA), are often used to better understand the microstructure of the brain. DTI, however, is susceptible to imaging artefacts, which can bias these indices. The most important sources of artefacts in DTI include eddy currents, nonuniformity and mis-calibration of gradients. We modelled these and other artefacts using a local perturbation field (LPF) approach. LPFs during the diffusion-weighting period describe the local mismatches between the effective and the expected diffusion gradients resulting in a spatially varying error in the diffusion weighting B matrix and diffusion tensor estimation. We introduced a model that makes use of phantom measurements to provide a robust estimation of the LPF in DTI without requiring any scanner-hardware-specific information or special MRI sequences. We derived an approximation of the perturbed diffusion tensor in the isotropic-diffusion limit that can be used to identify regions in any DTI index map that are affected by LPFs. Using these models, we simulated and measured LPFs and characterised their effect on human DTI for three different clinical scanners. The small FA values found in grey matter were biased towards greater anisotropy leading to lower grey-to-white matter contrast (up to 10%). Differences in head position due to e.g. repositioning produced errors of up to 10% in the MD, reducing comparability in multi-centre or longitudinal studies. We demonstrate the importance of the proposed correction by showing improved consistency across scanners, different head positions and an increased FA contrast between grey and white matter. [Copyright &y& Elsevier]

We have studied the clinical and neuroimaging characteristics of transient and mild reduction of consciousness during febrile illness in children. We retrospectively evaluated 58 children admitted with mild reduction of consciousness within 12 h during febrile illness. 53 patients (91 %) had delirious behavior, and 5 (9 %) had no delirious behavior. We also compared the clinical characteristics, brain magnetic resonance imaging (MRI) findings, and electroencephalography (EEG) findings between patients with and without delirious behavior, and no statistically signifi cant diff erences were observed in any of them between the 2 patient groups ( P ≥ 0.05). MRI was performed 0-4 days after onset in 23 patients. Reversible splenial or callosal and white matter lesions were observed in 2 of 3 patients without delirious behavior vs . 4 of 20 patients with delirious behavior on diffusion-weighted images. EEG was performed 0-3 days after onset in 29 patients. Transient abnormal findings were observed in 3 of 4 patients without delirious behavior vs. 11 of 25 patients with delirious behavior. In conclusion, we consider that transient and mild reduction of consciousness during febrile illness is a unique clinical group that is constituted by children both with and without delirious behavior. [ABSTRACT FROM AUTHOR]

Abstract: Using single-channel amplitude-integrated electroencephalography (aEEG), we monitored clustered seizures in a 12-month-old boy suffering from acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). He was admitted to our hospital after losing consciousness and experiencing repeated seizures in association with fever. Although the patient’s state of consciousness improved the next day, it declined on the fifth day of illness, and clinical seizures were observed. Diffusion-weighted images revealed abnormal high intensities in the frontal area bilaterally. On the same day, aEEG monitoring revealed an unexpected cluster of subclinical seizures. Attending pediatricians, nurses, and other caregivers did not recognize the presence of these frequent subclinical seizures. The efficacy of antiepileptic drugs could also be objectively assessed from aEEG findings. aEEG is useful for continuous monitoring in children with acute encephalopathy, may disclose subclinical seizures, and can contribute to an objective evaluation of the efficacy of antiepileptic drugs. [Copyright &y& Elsevier]

Transient global amnesia (TGA) is characterized by anterograde memory disturbance of sudden onset that lasts for 1 to 24 hours. The etiology and pathogenesis of TGA are still uncertain, although an hypoxic-ischemic origin has been recently suggested on the basis of infarct-like diffusion-weighted imaging (DWI) lesions in the hippocampus of some affected individuals. Recent diffusion-weighted imaging (DWI) studies have indicated the presence of focal hyperintensities involving the hippocampus in TGA patients. These lesions detected by DWI, which peak at 48 to 72 hours, are small and punctate (1-3 mm) and in most studies are reported as unilateral. We describe one TGA patient with high signal-intensity lesions in the bilateral hippocampus on DWI at the acute stage. The mechanisms related to the pathophysiology are discussed with emphasis on the hypoxic-ischemic origin underlying the observation of infarct-like diffusion-weighted imaging (DWI) abnormalities. [ABSTRACT FROM AUTHOR]

Wernicke encephalopathy (WE) is a serious neurological disorder caused by thiamine (vitamin B1) deficiency. We report a case of atypical and extensive location of abnormal signal lesions on magnetic resonance imaging (MRI) in a man with alcohol abuse with WE. MRI performed on the first hospital day showed signal intensity alterations extending in the whole brain stem and diencephalon; the mismatch between diffusion-weighted images and apparent diffusion coefficient map was highly suggestive of vasogenic edema. This report further supports the view that WE may represent a spectrum of radiological entities and can have a wide spectrum of manifestations on MRI; thus, clinical features are essential to diagnose it. [ABSTRACT FROM AUTHOR]

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare, transmissible prion disease of the brain, characterized by prominent neurological symptoms and progressive dementia. Early psychiatric manifestations as an initial or sole symptom of sCJD are relatively rare. The current report describes an elderly female patient with sCJD demonstrating anxiety as an initial symptom. The present patient was initially diagnosed with adjustment disorder and anxiety; however, the rapid deterioration of the patient's cognitive and neurological functioning led to a diagnosis of sCJD. Diffusion-weighted magnetic resonance images of the brain supported a diagnosis of sCJD, and it was posited that the abnormalities of gray matter that were observed within the bilateral cingulate cortex may be the pathophysiological basis of the anxiety associated with this case of sCJD. The patient eventually succumbed to inhalational bronchopneumonia 5 months after anxiety onset. The present case report emphasizes the importance of secondary causes of anxiety symptoms in elderly patients, and indicates that brain DWI is a non-invasive and useful examination in the early diagnosis of sCJD. [ABSTRACT FROM AUTHOR]

Abstract: We describe the clinical, EEG, and MRI features of children with reduced diffusion in the unilateral hemispheres. Seven patients with reduced diffusion in the subcortical white matter of the unilateral hemisphere alone were identified. Their median age was 32 months. Human herpesvirus 6 infection was virologically proven in 2 patients and human herpesvirus 7 in 1. The initial neurological symptom was a prolonged seizure in 4, a brief seizure in 2, and delirious behavior in 1. Three patients had biphasic clinical course. Laboratory tests were unremarkable in most patients. MRI showed no abnormal findings during the acute phase, whereas reduced diffusivity in the unilateral hemisphere was seen during the subacute phase. EEG during the acute phase demonstrated marked slowing in the affected hemisphere in 1 patient, mild slowing in 4, and relatively low voltage in 1. No patients died, but 6 patients had various degrees of neurological sequelae. Acute encephalopathy with reduced diffusion in the unilateral hemisphere may be one of the representative phenotypes of acute encephalopathy. [Copyright &y& Elsevier]

Abstract: We retrospectively reviewed electroencephalography and magnetic resonance imaging findings for 21 children exhibiting delirious behavior during febrile illness. Among these, five patients had transient callosal lesions with or without white matter lesions on diffusion-weighted images. We compared the clinical characteristics, duration, and components of delirious behavior, the duration and severity of reduced consciousness, and EEG findings among patients with or without callosal lesions. No significant differences were detected in these items according to the presence or absence of callosal lesions. Adding insight into the pathogenesis of this condition, our study revealed that callosal lesions are not uncommon in patients exhibiting delirious behavior during febrile illness. [Copyright &y& Elsevier]

Abstract: The authors describe the MRI findings, including diffusion-weighted imaging findings, of histopathologically proven uterine carcinosarcoma in four postmenopausal women. In three of four patients, diffusion-weighted images clearly revealed hypointense areas corresponding to hypocellular regions caused by intratumoral necrosis, and apparent diffusion coefficient (ADC) mapping images indicated that necrotic areas had high ADC values. In the remaining patient, diffusion-weighted and ADC mapping images clearly distinguished components of adenocarcinoma from sarcoma. In all patients, diffusion-weighted and ADC mapping images precisely reflected histopathological findings. Diffusion-weighted images were found to demonstrate complicated tissue components in carcinosarcomas of the uterus, and thus, which may be useful for the diagnosis of this disease. [Copyright &y& Elsevier]

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Despite recent advances in neuroimaging techniques, brain abscesses can be difficult to diagnose and may often require surgical intervention. The primary sources of infection are often difficult to locate; hence, even if an abscess is suspected, the organisms may remain unknown. In other patients, the location of the lesion may be in a site of the brain where surgical intervention may not be possible. The types of brain abscesses, their pathophysiology including predisposing conditions, and their characteristic radiologic features are discussed in this review, with particular emphasis on the indications and modes of medical management of brain abscesses. It discusses the use of antimicrobial agents that have the best central nervous system penetration and outlines a strategy for treatment of organisms likely to infect the brain with the different types of predisposing conditions. Also discussed are the indications for empirical therapy, and antimicrobial regimens for this purpose are suggested. [ABSTRACT FROM AUTHOR]

Introduction: Diffusion-weighted imaging (DWI) is usually performed before injection of intra- venous paramagnetic contrast medium. Occasionally, it may be necessary to perform or to repeat DWI after such administration. Our purpose was to evaluate the effect of intravenous gadodiamide (Gd [DTPA-BMA]) on DWI. Methods: DWI was performed on 88 brain lesions immediately before, immediately after, and 5- 10 mm following the end of 0.1 mmol/kg Gd [DTPA-BMA] administration. Signal-to-noise ratios (SNR5) and contrast-to-noise ratios (CNRs) of the lesions, and the SNRs of normal brain tissue were calculated on b=0 s/mm² and b=1,000 s/mm² DW images. Apparent diffusion coefficient (ADC) values of the lesions were measured on ADC maps. A paired (-test was used to determine the significance of differences between the values before and after administration of contrast medium. Results: The lesions consisted of 23 intraaxial and 11 extraaxial masses, 19 ischemic strokes, 15 intracranial hemorrhages and 20 demyelinating lesions. Images before and after contrast administration were not significantly different regarding SNRs and CNRs on DWI. This statement was also true for strongly enhanced lesions. However, ADC values significantly decreased after contrast medium injection on early post-contrast DWI in normal brain tissue (1%, P<0.049) and (3%, P<0.008) in lesions. By contrast, on late images, ADC values were normalized. Conclusion: Contrast medium injection had significant and time-dependent effects on ADC values. Therefore, only pre-contrast and late DW images should be used in quantitative ADC studies. [ABSTRACT FROM AUTHOR]

Glucocorticoids (GCC) generally are administered to patients with brain tumors to relieve neurological symptoms by decreasing the water content in a peritumoral zone of edema. We hypothesized that diffusion imaging and apparent diffusion coefficient (ADC) values could detect subtle changes of water content in brain tumors and in peritumoral edema after GCC therapy. The study consisted of 13 patients with intra-axial brain tumor, and ADC was measured in the tumor, within peritumoral edema, and in normal white matter remote from the tumor before and after GCC therapy. ADC also was measured in normal white matter in four control patients with no intracranial disease who were treated with GCC for other indications. Conventional MR images showed no visually evident interval change in tumor size or the extent of peritumoral edema in any subject after GCC therapy, which nonetheless resulted in a decrease in mean ADC of 7.0% in tumors (P<0.05), 1.8% in peritumoral edema (P>0.05, not significant) and 5.8% in normal white matter (P<0.05). In patients with no intracranial disease, GCC therapy decreased mean ADC in white matter by 5.4% (P<0.05). ADC measurement can demonstrate subtle changes in the brain after GCC therapy that cannot be observed by conventional MR imaging. Measurement of ADC proved to be a sensitive means of assessing the effect of GCC therapy, even in the absence of visually discernible changes in conventional MR images. [ABSTRACT FROM AUTHOR]

Lhermitte-Duclos disease is a rare benign lesion of uncertain pathogenesis characterized by distortion of the normal cerebellar laminar cytoarchitecture. There is a characteristic MR imaging appearance of a nonenhancing mass in the cerebellar hemisphere with a striated pattern. We report two cases of Lhermitte-Duclos disease and describe findings on diffusion-weighted MR imaging. [ABSTRACT FROM AUTHOR]

Magnetic Resonance Diffusion-Weighted Imaging (DWI) has been reported to be helpful for the differential diagnosis between abscesses and cystic/necrotic brain tumors. However the number of patients is still limited, and the sensitivity and specificity of the method remain to be confirmed. The primary purpose of this study was to investigate a larger sample of patients, all investigated under the same experimental conditions, in order to obtain statistically significant data. Moreover, there is no consensus about the appropriate values of b required to use to make an accurate diagnosis from DWI. The secondary purpose of this study was to determine the discriminating threshold b values for raw diffusion-weighted images and for normalized diffusion-weighted images. On the basis of 14 abscesses, 10 high-grade gliomas and 2 metastases, we show that the calculation of accurate Apparent Diffusion Coefficient (ADC) values gives a specificity rate of 100%. Without ADC calculation, we show that image normalization is required to make an accurate differential diagnosis, and we highlight the ability of DWI to discriminate between brain abscesses and cystic/necrotic brain tumors using normalized signal intensity at lower b values (503 s/mm2) than usual. [Copyright &y& Elsevier]

Background: Grade of brain tumor is thought to be the most significant and crucial component in treatment management. Recent development in medical imaging techniques have led to the introduce non-invasive methods for brain tumor grading such as different magnetic resonance imaging (MRI) protocols. Combination of different MRI protocols with fusion algorithms for tumor grading is used to increase diagnostic improvement. This paper investigated the efficiency of the Laplacian Re-decomposition (LRD) fusion algorithms for glioma grading., Procedures: In this study, 69 patients were examined with MRI. The T1 post enhancement (T1Gd) and diffusion-weighted images (DWI) were obtained. To evaluated LRD performance for glioma grading, we compared the parameters of the receiver operating characteristic (ROC) curves., Findings: We found that the average Relative Signal Contrast (RSC) for high-grade gliomas is greater than RSCs for low-grade gliomas in T1Gd images and all fused images. No significant difference in RSCs of DWI images was observed between low-grade and high-grade gliomas. However, a significant RSCs difference was detected between grade III and IV in the T1Gd, b50, and all fussed images., Conclusions: This research suggests that T1Gd images are an appropriate imaging protocol for separating low-grade and high-grade gliomas. According to the findings of this study, we may use the LRD fusion algorithm to increase the diagnostic value of T1Gd and DWI picture for grades III and IV glioma distinction. In conclusion, this article has emphasized the significance of the LRD fusion algorithm as a tool for differentiating grade III and IV gliomas., Competing Interests: The authors report no declarations of interest., (© 2021 The Authors. Published by Elsevier Ltd.)

Background: To compare the diagnostic accuracy of an abbreviated protocol (AP) with or without quantitative apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) and a full diagnostic protocol (FDP) in terms of the Breast Imaging Reporting and Data System (BI-RADS) classification of breast magnetic resonance imaging (MRI)., Methods: Our study sample consisted of 436 patients undergoing breast MRI from January to October 2015 in a clinical setting. The three reviews included a pre-contrast and the first single post-contrast T1-weighted (T1W) sequences (AP1), AP1 combined with quantitative DWI (AP2), and the FDP, the AP1 of which were assessed independently by a junior and senior radiologist. Agreement on the evaluation of the BI-RADS classifications (between the junior and senior radiologists, between AP1 and FDP, and between AP2 and FDP) was assessed using the kappa test statistic. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared between AP1 and FDP plus between AP2 and FDP. Diagnostic parameters of these reviews were examined using the McNemar test., Results: The study included 436 patients, with 251 breast cancers, 99 benign lesions, and 86 patients with benign or no lesions and followed up for at least 24 months. The agreement of the BI-RADS classifications between the junior and senior radiologists was very good (kappa =0.847). The agreement between AP2 and FDP (kappa =0.931) was higher than the agreement between AP1 and FDP (kappa =0.872) on evaluating the BI-RADS benign and malignant classifications. The sensitivity/specificity/PPV/NPV was 95.6%/83.8%/88.9%/93.4% for AP1, 98.0%/83.8%/89.1%/96.9% for AP2, 98.8%/83.8%/89.2%/98.1% for FDP, respectively., Conclusions: The addition of quantitative DWI to the abbreviated MRI protocol based on the pre-and first post-contrast sequence improved diagnostic performance for characterizing breast lesions. Quantitative DWI may be a useful adjunct to dynamic contrast enhancement (DCE) of breast MRI., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/gs-21-463). The authors have no conflicts of interest to declare., (2021 Gland Surgery. All rights reserved.)

Abstract: Neuroimaging findings are usually normal in children with benign partial epilepsy in infancy. However, we found a transient reduction of water diffusion in the corpus callosum in two patients with probable benign partial epilepsy in infancy. The patients were admitted to our hospital because of seizure clusters. No delay in the developmental milestones was seen, and no neurological abnormalities were observed during the interictal period. Interictal electroencephalography was normal in both infants. However, the diffusion-weighted images showed abnormal high intensities in both the genu and splenium in one patient and in the splenium only in the other. No diffusion abnormalities were observed in follow-up magnetic resonance imaging. The clustered seizures may be related to the transient callosal lesions seen in our patients. [Copyright &y& Elsevier]

Abstract: Encephalopathy related to idiopathic hypereosinophilic syndrome (HES encephalopathy) is a rare (but well-documented) syndrome. Magnetic resonance imaging (MRI) findings of HES encephalopathy, particularly diffusion-weighted images (DWI) findings, have not been reported. We report a case of HES encephalopathy in a 79-year-old male presenting with a focal neurological deficit and cognitive function disorders. Eosinophil number was >20,000/mm3. Initial DWI revealed multiple high-signal lesions that were clearer than on T2-weighted images. After corticosteroid therapy, symptoms improved and MRI-identified lesions decreased. This is the first report demonstrating DWI findings of HES encephalopathy. We suggest that lesions identified on MRI may be related to a combination of demyelination, inflammation and/or even small-vessel infarction due to local intimal lesions and clotting, secondary to eosinophilic toxicity. Investigation using DWI should therefore be done in patients with HES encephalopathy even if T2-weighted images are normal. [Copyright &y& Elsevier]

Cerebral fat embolism (CFE) syndrome is relatively rare in clinical practice. Currently, there is no uniform standard of magnetic resonance imaging for the diagnosis of the disease. In this report, we present head computed tomography and magnetic resonance images (T2-weighted images, fluid-attenuated inversion recovery images, diffusion-weighted images, and susceptibility-weighted images) in a case of CFE. This report explains the imaging characteristics of CFE and improves the clinician's understanding of this disease and its etiology.