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Malignant transformation of epidermoid cyst into squamous cell carcinoma (SCC) is rare. We report the case of a 39-year-old woman presenting with dizziness and cerebellar ataxia. MR scan revealed a mass in the left cerebropontine angle compressing the brainstem and the cerebellum, with two main components, a cystic and a solid one. The cystic component displayed imaging findings consistent with an epidermoid cyst. The solid component showed dense calcifications, low signal intensity on T1W, T2W and DW images and peripheral nodular enhancement. MR spectroscopy detected high lipid/lactate peaks and choline/creatine ratio. Imaging findings raised suspicion for malignant transformation, which was confirmed by histopathologic examination revealing an SCC. MR imaging with intravenous administration of gadolinium, DW images and MR spectroscopy can play a critical role in the diagnosis of malignant transformation of an epidermoid cyst.

The case of a 5-year-old boy with ground-glass pattern craniofacial fibrous dysplasia (FD) presenting with progressive swelling in the right frontal region is reported. The imaging findings with computed tomography and magnetic resonance imaging (MRI) findings are presented. The differential diagnosis with inspissated mucocele is discussed as well. Fibrous tissue could be hypo dense on CT. Post-contrast enhancement of the lesion on MRI is the key for diagnosis.

The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical team's clinical suspicion. We present a case series of two patients who suffered from MALS and were treated successfully. The first patient is a 32-year-old woman, presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years. The second patient, a 50-year-old woman, presented with similar symptomatology, with the symptoms lasting for the last five years. Both cases were treated by laparoscopic division of the median arcuate ligament fibers, which alleviated extrinsic pressure from the celiac artery. Previous cases of MALS were retrieved from PubMed, to assemble a better diagnostic algorithm and propose a treatment method of choice. The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice, along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice., Competing Interests: Conflict-of-interest statement: The authors declare no conflict of interests for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Hepatocellular carcinoma (HCC) is the sixth most common cancer. The main risk factors associated with HCC development include hepatitis B virus, hepatitis C virus, alcohol consumption, aflatoxin B1, and nonalcoholic fatty liver disease. However, hepatocarcinogenesis is a complex multistep process. Various factors lead to hepatocyte malignant transformation and HCC development. Diagnosis and surveillance of HCC can be made with the use of liver ultrasound (US) every 6 mo. However, the sensitivity of this imaging method to detect HCC in a cirrhotic liver is limited, due to the abnormal liver parenchyma. Computed tomography (CT) and magnetic resonance imaging (MRI) are considered to be most useful tools for at-risk patients or patients with inadequate US. Liver biopsy is still used for diagnosis and prognosis of HCC in specific nodules that cannot be definitely characterized as HCC by imaging. Recently the American College of Radiology designed the Liver Imaging Reporting and Data System (LI-RADS), which is a comprehensive system for standardized interpretation of CT and MRI liver examinations that was first proposed in 2011. In 2018, it was integrated into the American Association for the Study of Liver Diseases guidance statement for HCC. LI-RADS is designed to ensure high sensitivity, precise categorization, and high positive predictive value for the diagnosis of HCC and is applied to "high-risk populations" according to specific criteria. Most importantly LI-RADS criteria achieved international collaboration and consensus among liver experts around the world on the best practices for caring for patients with or at risk for HCC., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

BACKGROUND Pancreatic intraductal tubulopapillary neoplasm (ITPN) was first described by Yamaguchi in 2009 and was recognized by World Health Organization as a distinct entity in 2010. Since then few case reports and case series have been published. Little is known about its clinicopathologic features and treatment outcomes. We present the seventh case of total pancreatectomy for ITPN reported in the English literature. CASE REPORT Our patient was an 82-year-old male with a previous history of acute evolving-to-chronic pancreatitis. After 2 years of medical consultation, an abdominal magnetic resonance imaging was suspicious for multifocal pancreatic neoplasia. A computed tomography-guided biopsy of the lesion was performed which indicated pancreatic intraductal neoplasia with intermediate dysplasia. After oncology consultation, the patient underwent pylorus-preserving total pancreatectomy with splenectomy. The pathology report showed pancreatic ITPN with intermediate to severe dysplasia and associated invasive carcinoma. All 21 resected lymph nodes were non-metastatic (pT3N0). The postoperative course of the patient was uncomplicated. He received adjuvant gemcitabine (single agent) for 6 months. At 18 months after surgery he was diagnosed with hepatic metastases; he was still alive at the time of this reporting. CONCLUSIONS ITPN has been associated with previous history of acute pancreatitis in some patients. Early diagnosis, radical surgical resection, and adjuvant chemotherapy may lead to long-term survival rates even in cases with associated invasive component. Total pancreatectomy may be a preferable procedure for ITPN in selected patients.

A rare clinical presence of Salter-Harris type II fracture of the distal femur in a newborn. The crucial role of imaging in depicting urgent anatomical alterations., Competing Interests: None declared.

Competing Interests: Competing interests: None declared.

A 43-year-old woman arrived to emergency unit of our hospital, referring intense deteriorated pain and swelling of midfoot. Rapid clinical evolvement of osteoarticular tuberculosis represents a potential clinical scenario. Clinicians should always include foot tuberculosis in differential diagnosis, in cases of severe clinical and radiological manifestations.

A 22-year-old male presented with progressive muscular weakness of the upper extremities. MRI of the cervical spine established the final diagnosis of Hirayama disease (HD). HD is a rare disease with benign progress. Neurologists and radiologists should be aware of the specific neuroimaging signs of this rare clinical entity.

Paragangliomas are benign neoplasms that arise from the autonomic nervous system and the associated paraganglia. Although benign, they have been shown to possess metastatic potential. Extra-adrenal retroperitoneal paraganglioma with vertebral metastasis is considered very uncommon. Here, we present a case of a functional extra-adrenal paraganglioma of the retroperitoneum giving metastasis to T4 vertebra after five years of follow-up in a 48-year-old man who had been initially treated with complete resection of the primary tumor. The condition of the patient improved significantly after radiosurgery and somatostatin analogs treatment, until lumbar spine lesions appeared six months later. Our case demonstrates that retroperitoneal paraganglioma is a rare condition which should be considered in the differential diagnosis of a retroperitoneal mass combined with vertebral lesions. Additionally, increased physician awareness and long-term follow-up is mandatory for all patients with history of retroperitoneal paraganglioma since metastases may occur after long latent intervals from the initial diagnosis.

Aims: The purpose of this study was to assess the incidence and predictors of graft failure prior to discharge. Multi-slice computed tomography has the ability to evaluate graft patency in a non-invasive way., Methods and Results: Of 145 consecutive patients who were screened, 73 were included in the study (78% male, mean age 65 years). A total of 206 grafts were analysed (2.8±0.9 grafts/patient). Of the 206 grafts, 126 were venous, 72 were left internal mammary, five were right internal mammary and three were radial grafts. We evaluated 100% of proximal anastomoses sites and 92% (190/206) of the distal anastomoses. We identified five patients (6.8%) who had at least one occluded graft. A total of seven out of 206 (3.4%) grafts were occluded. Independent predictors of successful graft outcome were left anterior descending artery as a recipient artery, good distal run-off as assessed by a surgeon and vessel size larger than 2 mm., Conclusions: The results demonstrate that the in-hospital acute graft failure rate is 3.4% (6.8% of patients). Multi-slice computed tomography is a robust technique to assess novel therapies to reduce the rate of graft attrition further, and might be clinically useful in patients with persistent or early recurrence of symptoms after CABG.

Purpose: To explore the role of Diffusion Tensor Imaging in preoperative glioma grading, as well as in differentiation between gliomas and metastatic brain tumors. We measured diffusion tensor variables in enhancement and edema regions, which were compared between the different subject groups., Materials and Methods: We performed DTI in 48 patients (11 Low Grade Gliomas, 27 High Grade Gliomas, 10 Single Metastatic brain tumors). We measured FA, λ1, λ2, λ3, ADC, Cl, Cp, Cs, RA, and VR in enhancing portions of tumors and edema regions. Additionally, ratios of enhancement to edema values were created for each variable., Results: In peritumoral edema, Cl and RA were proven to be significantly different in pair-wise comparisons, in addition to ADC, Cp, Cs and VR in enhancement regions. Enhancement to edema values were significantly different as well., Conclusion: Diffusion tensor indices could be used for the differentiation between low and high grade gliomas, as well as for distinction between gliomas and metastases., (Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Malignant transformation of epidermoid cyst into squamous cell carcinoma (SCC) is rare. We report the case of a 39-year-old woman presenting with dizziness and cerebellar ataxia. MR scan revealed a mass in the left cerebropontine angle compressing the brainstem and the cerebellum, with two main components, a cystic and a solid one. The cystic component displayed imaging findings consistent with an epidermoid cyst. The solid component showed dense calcifications, low signal intensity on T1W, T2W and DW images and peripheral nodular enhancement. MR spectroscopy detected high lipid/lactate peaks and choline/creatine ratio. Imaging findings raised suspicion for malignant transformation, which was confirmed by histopathologic examination revealing an SCC. MR imaging with intravenous administration of gadolinium, DW images and MR spectroscopy can play a critical role in the diagnosis of malignant transformation of an epidermoid cyst.

Background: Limited data are available regarding the role of magnetic resonance imaging (MRI), particularly the new generation 3 Tesla technology, and especially diffusion-weighted imaging (DWI) in predicting liver fibrosis. The aim of our pilot study was to assess the clinical performance of the apparent diffusion coefficient (ADC) of liver parenchyma for the assessment of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD)., Methods: 18 patients with biopsy-proven NAFLD underwent DWI with 3 Tesla MRI. DWI was performed with single-shot echo-planar technique at b values of 0-500 and 0-1000 s/mm 2 . ADC was measured in four locations in the liver and the mean ADC value was used for analysis. Staging of fibrosis was performed according to the METAVIR system., Results: The median age of patients was 52 years (range 23-73). The distribution of patients in different fibrosis stages was: 0 (n=1), 1 (n=7), 2 (n=1), 3 (n=5), 4 (n=4). Fibrosis stage was poorly associated with ADC at b value of 0-500 s/mm 2 (r= -0.30, P=0.27). However it was significantly associated with ADC at b value of 0-1000 s/mm 2 (r= -0.57, P=0.01). For this b value (0-1000 s/mm 2 ) the area under receiver-operating characteristic curve was 0.93 for fibrosis stage ≥3 and the optimal ADC cut-off value was 1.16 ×10 -3 mm 2 /s., Conclusion: 3 Tesla DWI can possibly predict the presence of advanced fibrosis in patients with NAFLD.

Neuroimaging plays a crucial role in diagnosis of brain tumors and in the decision-making process for therapy. Functional imaging techniques can reflect cellular density (diffusion imaging), capillary density (perfusion techniques), and tissue biochemistry (magnetic resonance [MR] spectroscopy). In addition, cortical activation imaging (functional MR imaging) can identify various loci of eloquent cerebral cortical function. Combining these new tools can increase diagnostic specificity and confidence. Familiarity with conventional and advanced imaging findings facilitates accurate diagnosis, differentiation from other processes, and optimal patient treatment. This article is a practical synopsis of pathologic, clinical, and imaging spectra of most common brain tumors., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Pilocytic astrocytoma can be challenging to diagnose., Methods: Its clinical presentations can differ, directly related to its size and location, and are relatively unreliable. Similarly, imaging findings also vary with the location of the pilocytic astrocytoma., Results: This review provides an overview of the different imaging findings regarding pilocytic astrocytomas using both conventional and advanced magnetic resonance imaging sequences according to tumour location; the findings are strongly related to the tumour's tendency to infiltrate surrounding structures, being able to carry out gross total resection, and finally the prognosis., Conclusions: Knowledge of these imaging manifestations of pilocytic astrocytoma may be helpful to arrive at an accurate diagnosis., Teaching Points: • To recognise the various imaging findings of pilocytic astrocytoma on both conventional and advanced magnetic resonance imaging sequences. • To identify the characteristic imaging findings according to tumour location. • To discuss the relevant differential diagnoses of pilocytic astrocytoma in each tumour location.

The case of a 5-year-old boy with ground-glass pattern craniofacial fibrous dysplasia (FD) presenting with progressive swelling in the right frontal region is reported. The imaging findings with computed tomography and magnetic resonance imaging (MRI) findings are presented. The differential diagnosis with inspissated mucocele is discussed as well. Fibrous tissue could be hypo dense on CT. Post-contrast enhancement of the lesion on MRI is the key for diagnosis.

Brain irradiation has several well-known long-term side effects, including radiation-induced neoplasms and vasculopathy. In this case report, we describe an extremely rare case of meningioma and 15 cavernomas developing in a 29-year-old man, 19 years after cranial irradiation for posterior cranial fossa medulloblastoma. To our knowledge, this is the first case of a radiation-induced meningioma accompanied by this many radiation-induced cavernous angiomas.

The authors report the results of a retrospective study about computed tomography (CT)-guided percutaneous vertebral biopsies in 79 cases (44 males and 35 females, aged from 6 to 84 years old). Five biopsies were performed at the cervical level, 31 at the thoracic, 30 at the lumbar, and 13 at the sacrum. A diagnosis was obtained in 75 out of the 79 patients. Diagnostic yield was 95%, and diagnostic accuracy was 97.3%. Core needle biopsy under CT guidance for spinal lesions is a fast, relatively simple, minimally invasive, and low-cost method, with high levels of diagnostic accuracy and few complications. It plays a major role in the correct diagnosis and therapeutic planning. CT guidance allows safe and accurate biopsy of osseous lesions throughout the spine, obviating invasive open biopsy in most cases., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Neurotoxicity caused by intraarterial injection of low-dose low osmolar, iodinated contrast agents during radiologic studies is an extremely rare adverse event. Contrast medium induced disruption of the blood-brain barrier and a direct neurotoxic effect by contrast media have been proposed as a potential mechanism of neurotoxicity. This report describes an unusual case of transient neurotoxicity following diagnostic angiography mimicking clinically and radiologically subarachnoid hemorrhage. The patient recovered without any intervention after 4 days of conservative treatment.

The purpose of this essay was to illustrate the radiological and pathological findings in a wide spectrum of dural lesions mimicking meningiomas. Familiarity with and knowledge of these findings will narrow the differential diagnosis and provide guidance for patient management. In this pictorial review, we describe the following entities: Solitary fibrous tumors, hemangiopericytoma, gliosarcoma, leiomyosarcoma, dural metastases, Hodgkin's disease, plasmocytoma, Rosai-Dorfman disease, neurosarcoidosis, melanocytic neoplasms and plasma cell granuloma.

Intracortical osteosarcoma is the rarest form of osteosarcoma. The lesion is histologically characterized as a sclerosing variant of osteosarcoma. In this study, a new case of pathologically proven tibia intracortical osteosarcoma in a 14-year-old girl is presented. Imaging findings on computed tomography and magnetic resonance imaging are discussed. The role of computed tomography-guided biopsy is emphasized.

Cerebrovascular deposition of amyloid (cerebral amyloid angiopathy CAA) is most commonly recognized as a cause of spontaneous lobar intracerebral hemorrhage. On the basis of the noninvasive new MR imaging we would propose superficial cortical hemosiderosis and subarachnoid hemosiderosis as potentially useful new criteria to facilitate the diagnosis of CAA.

Introduction: Pseudo-Meigs' syndrome is a rare pathological entity characterized by the presence of a pelvic mass other than an ovarian fibroma. The mass is associated with ascites with or without hydrothorax., Case Presentation: We describe the case of a 41-year-old Caucasian woman with a large uterine leiomyoma associated with massive ascites. A magnetic resonance imaging scan showed a large subserosal leiomyoma with multiple areas of cystic degeneration., Conclusion: To the best of our knowledge, this is the first reported case of pseudo-Meigs' syndrome caused by a uterine leiomyoma and diagnosed using magnetic resonance imaging. The pathophysiology of this syndrome and the role of magnetic resonance imaging are emphasized in this case report.

A rare case of an incidental nonfunctioning mediastinal paraganglioma is presented. The diagnosis of aorticosympathetic paraganglioma was established by histological examination after surgical removal of the tumor. The appearance of this rare tumor on multidetector coronary angiography is demonstrated and the differential diagnosis is discussed.

Littoral cell angioma is a rare primary splenic tumor that is difficult to differentiate preoperatively from other benign and malignant splenic lesions. We report a case of littoral cell angioma of the spleen in a 51-year-old woman that presented with long standing anaemia.

We describe the pertinent organ-specific clinical manifestations of gastrointestinal stromal tumors (GISTs) as well as the radiological appearances that allow optimal depiction of pathology and diagnosis. Radiologic features of GISTs vary depending on tumor size and organ of origin. They most commonly have an exophytic growth pattern and manifest as dominant masses outside the organ of origin. Intramural and intraluminal masses are less common radiologic manifestations. GISTs may contain areas of hemorrhage, necrosis, or cyst formation that appear as focal areas of low attenuation on computed tomographic images. Most metastases of GISTs involve the liver and peritoneum by hematogenous spread and peritoneal seeding. CT and MRI are considered to be the imaging modality of choice for the detection, staging, surgical planning and follow-up of patients with GIST. A reduction in tumor size, extensive cystic changes, and calcification in primary and metastatic GISTs on CT and MRI indicate disease response to therapy. Radiologists and clinicians must recognize the imaging features of GISTs, detect, characterize the lesions and evaluate the tumor response during specific treatment.

Introduction: We present a case of fibrovascular polyp, a rare submucosal tumour of the oesophagus that has been reported only sporadically in the literature. The biapproach for surgical removal of fibrovascular polyp has only been mentioned once in the literature., Case Presentation: A 65-year-old Greek man presented with a 9-month history of gradually progressive intermittent dysphagia. Radiologic work-up with oesophagogram and computed tomography revealed a large, sausage-shaped intraluminal polyp extending from the level of the cervical oesophagus to the level of the upper body of the stomach. The diagnosis of giant fibrovascular polyp was made radiographically and confirmed by endoscopic biopsy. The polyp was removed using a biapproach surgical technique: pharyngotomy and subsequent gastrostomy., Conclusion: Fibrovascular polyp is a rare submucosal tumour. Proper treatment depends on accurate assessment of the origin, size, and vascularity of the pedicle and the size of the tumour. Choice of the appropriate surgical approach depends on the correct diagnosis, which can usually be indicated radiographically by the presence of a smooth, sausage-shaped defect with a discrete bulbous tip.