Search

Introduction: The objective of this study was to compare the length ratios obtained on panoramic radiography and computed tomography (CT) to verify whether the former is adequate for diagnosing coronoid process hyperplasia., Methods: A case series of patients with coronoid process hyperplasia was investigated. Length ratios between the coronoid process and condyle were measured on panoramic radiographs by using the Levandoski method and on CT scans by using the methods described by Tavassol et al. and Stopa et al. The mean length ratios obtained using the three measurement methods were compared., Results: The mean length ratio measured with the Levandoski method was significantly lower than that measured with the method described by Stopa et al. (1.09 [0.09] vs. 1.21 [0.09]; P = 0.0001) and lower than that measured with the method described by Tavassol et al. (1.09 [0.09] vs. 1.34 [0.44]; P = 0.013)., Conclusion: Panoramic measurement of the coronoid process by using the Levandoski method tended to underestimate the length ratio, emphasizing the importance of using a scanographic measurement method at the slightest doubt to confirm the diagnosis of coronoid process hyperplasia., Competing Interests: Declaration of Competing Interest The authors have no financial or non-financial interests to disclose., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: We conducted this study to clarify the magnetic resonance imaging (MRI) characteristics of lobular endocervical glandular hyperplasia (LEGH) and Nabothian cysts., Methods: This study included 48 patients who underwent hysterectomy at our institution between 2016 and 2020 for suspected LEGH. Histopathological studies confirmed the presence of 25 Nabothian cysts and 23 cases of LEGH. We retrospectively analyzed five characteristic MRI findings: (1) located at the upper cervical canal, (2) positioned within the cervical stroma, (3) not circumscribing the cervical canal, (4) low- to iso-intensity on T1-weighted images (T1WI), and (5) "cosmos" or "microcystic" pattern. We compared the diagnostic accuracy of these findings for LEGH and Nabothian cysts using sensitivity, specificity, and predictive values. Combinations of findings were also calculated., Results: The characteristics "cosmos" or "microcystic" pattern, lesion not circumscribing the cervical canal, and low/iso-intensity on T1WI had a sensitivity and specificity greater than 50%. The sensitivity was 73.9% and specificity 84.0% when a combination of "cosmos" or "microcystic" pattern and lesion not circumscribing the cervical canal was present., Conclusion: The coexistence of a "cosmos" or "microcystic" pattern and not circumscribing the cervical canal was the most characteristic finding that distinguished LEGH from Nabothian cysts. When neither of these findings is present, Nabothian cyst can be suspected., (© 2024. The Author(s).)

Rationale and Objectives: This study explored the clinical value of dual time-point 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET) imaging for differentiating lymph node metastasis from lymph nodes with reactive hyperplasia., Methods: 250 lymph nodes from 153 bladder cancer patients who underwent 18 F-FDG PET/computed tomography (CT) delayed diuretic imaging were analyzed. The maximum and mean standardized uptake values (SUVmax and SUVmean, respectively), metabolic tumor volume (MTV), and related delay indices before and after PET delayed imaging were obtained. Relationships with outcomes were analyzed using nonparametric and multivariate analyses. Receiver operating characteristic curves and nomograms were drawn to predict lymph node metastasis., Results: Delayed PET/CT imaging showed better detection of hyperplasia and metastatic lymph nodes. Delayed imaging with a cutoff SUVmax of 2.0 or 2.5 increased the detection rate of metastatic lymph nodes by 4.1%, and 6.9%, respectively. Delayed imaging often showed speckle-like radioactive foci in lymph nodes with reactive hyperplasia and increased FDG uptake throughout the nodes in metastatic lymph nodes. The lymph node short-axis diameter, SUVmean, and delayed index of MTV (DIMTV) were independent predictors for differentiating metastatic lymph nodes from reactive hyperplasia, and their combination showed better differentiation performance than the individual predictors. In high-risk patients, the probability of lymph node metastasis was as high as 97.6%., Conclusion: Dual time-point imaging can detect more metastatic lymph nodes. Some lymph nodes with hyperplasia show speckle-like radioactive foci on delayed imaging. The lymph node short-axis diameter, SUVmean, and DIMTV are three important parameters for predicting lymph node metastasis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Objective: It was previously believed that atherosclerotic (AS) plaque starts to develop from the intima and that intraplaque vasa vasorum (VV) hyperplasia promotes adventitial VV (AVV) hyperplasia. However, recent studies have shown that arterial AVV hyperplasia precedes early intimal thickening, suggesting its possible role as an initiating factor of AS. To provide further insight into this process, in this study, we examine the evolution of AAV and VV development in a preclinical model of early AS with longitudinal ultrasound imaging., Methods: Models of early AS were established. Duplex ultrasound scanning and contrast-enhanced ultrasound were performed for diagnosis. Pearson correlation tests were used to analyze the relationships between AVV hyperplasia and VV hyperplasia, or between AVV hyperplasia and intima-media thickness (IMT)., Results: During 0-12 wk of high-fat feeding, AVV gradually increased and intima-media thickened gradually in the observation area; in the 2nd wk of high-fat feeding, the observation area showed obvious AVV proliferation; at the 4th wk, the intima-media membrane became thicker; at the 12th wk, early plaque formation and intraplaque VV proliferation were observed. There was a strong positive correlation between AVV proliferation and IMT thickening and a strong negative correlation between AVV proliferation and the change rate of vessel diameter., Conclusion: This study demonstrated that AVV proliferation in the arteries occurred earlier than IMT thickening and was positively correlated with IMT. At present, the indicators of ultrasonic diagnosis of AS, such as IMT, Intraplaque VV, Echo property, all appear in the advanced stage of AS. The AVV may be an innovative diagnostic target for the early stage of AS plaque., Competing Interests: Conflict of interest The authors declare that they have no competing financial interests or personal relationships that may have influenced the work reported in this study., (Copyright © 2024 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Papillary endothelial hyperplasia (PEH) or Masson's tumor is a rare benign vascular tumor that usually appears in the soft tissues of the head and neck, trunk and extremities, being extremely rare in the breast. Its diagnosis can be a challenge, especially in the follow-up of patients with previous disease of breast carcinoma. We present the case of a 65-year-old patient, with a history of bilateral breast cancer and reconstruction with implants, who presented a Masson's tumor during follow-up. An ultrasound scan was performed, showing a well-circumscribed mass in the left breast, located in the posterior contour of the implant. Subsequently, magnetic resonance imaging (MR) depicted an enhancing tumor, without infiltration of adjacent structures. Finally, the definitive anatomopathological diagnosis was obtained after surgical excision., (Copyright © 2023 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To investigate the role of magnetic resonance imaging (MRI) based on radiomics using T2-weighted imaging fat suppression (T2WI-FS) and contrast enhanced T1-weighted imaging (CE-T1WI) sequences in differentiating T1-category nasopharyngeal carcinoma (NPC) from nasopharyngeal lymphoid hyperplasia (NPH)., Materials and Methods: This study enrolled 614 patients (training dataset: n = 390, internal validation dataset: n = 98, and external validation dataset: n = 126) of T1-category NPC and NPH. Three feature selection methods were used, including analysis of variance, recursive feature elimination, and relief. The logistic regression classifier was performed to construct the radiomics signatures of T2WI-FS, CE-T1WI, and T2WI-FS + CE-T1WI to differentiate T1-category NPC from NPH. The performance of the optimal radiomics signature (T2WI-FS + CE-T1WI) was compared with those of three radiologists in the internal and external validation datasets., Results: Twelve, 15, and 15 radiomics features were selected from T2WI-FS, CE-T1WI, and T2WI-FS + CE-T1WI to develop the three radiomics signatures, respectively. The area under the curve (AUC) values for radiomics signatures of T2WI-FS + CE-T1WI and CE-T1WI were significantly higher than that of T2WI-FS (AUCs = 0.940, 0.935, and 0.905, respectively) for distinguishing T1-category NPC and NPH in the training dataset (Ps all < 0.05). In the internal and external validation datasets, the radiomics signatures based on T2WI-FS + CE-T1WI and CE-T1WI outperformed T2WI-FS with no significant difference (AUCs = 0.938, 0.925, and 0.874 for internal validation dataset and 0.932, 0.918, and 0.882 for external validation dataset; Ps > 0.05). The radiomics signature of T2WI-FS + CE-T1WI significantly performed better than three radiologists in the internal and external validation datasets., Conclusion: The MRI-based radiomics signature is meaningful in differentiating T1-category NPC from NPH and potentially helps clinicians select suitable therapy strategies., (© 2024. The Author(s) under exclusive licence to Japan Radiological Society.)

Aim: To conduct a multi-lesional computed tomography (CT) analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) patients to determine volumetric changes in lesions over 5 years., Materials and Methods: A retrospective case-note review was undertaken to identify 16 patients with histological and radiological features of DIPNECH between 2012-2021. Area and volume were calculated for 17 sets of lesions identified on high-resolution CT. Clinical data were extracted from electronic patient records, which included demographic data, outpatient clinic letters, histology reports, and imaging reports., Results: One hundred and twenty-eight lesions were identified in 16 patients (one male, 15 female) and followed-up annually over a median 1,985 days (range 1,450-2,290). At year 1 follow-up, lesion area ranged from 1-48 mm 2, and lesion volume ranged from 8-18,380 mm 3 ; lesion area ranged from 1-45mm 2 and lesion volume ranged from 11-17,800 mm 3 and year 5. Half (8/16) of the patients had concomitant typical carcinoid tumours and one patient had an atypical carcinoid tumour. No statistically significant correlation (p<0.05) was found between lesion cross-sectional area or volume and duration of follow-up (years and days). No metastatic spread was observed at the time of analysis., Conclusions: No significant increase was observed in the size of over 100 lesions in patients with DIPNECH over a 5-year period and no metastasis occurred during the study period affirming the relatively indolent course of the disease., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Preoperative imaging before parathyroidectomy can localize adenomas and reduce unnecessary bilateral neck explorations. We hypothesized that (1) the utility of preoperative imaging varies substantially depending on the preoperative probability of having adenoma(s) and (2) that a selective imaging approach based on this probability could avoid unnecessary patient costs and radiation., Methods: We analyzed 3,577 patients who underwent parathyroidectomy for primary hyperparathyroidism from 2001 to 2022. The predicted probability of patients having single or double adenoma versus hyperplasia was estimated using logistic regression. We then estimated the relationship between the predicted probability of single/double adenoma and the likelihood that sestamibi or 4-dimensional computed tomography was helpful for operative planning. Current Medicare costs and published data on radiation dosing were used to calculate costs and radiation exposure from non-helpful imaging., Results: The mean age was 62 ± 13 years; 78% were women. Adenomas were associated with higher mean calcium (11.2 ± 0.74 mg/dL) and parathyroid hormone levels (140.6 ± 94 pg/mL) than hyperplasia (9.8 ± 0.52 mg/dL and 81.4 ± 66 pg/mL). The probability that imaging helped with operative planning increased from 12% to 65%, as the predicted probability of adenoma increased from 30% to 90%. For every 10,000 patients, a selective approach to imaging that considered the preoperative probability of having adenomas could save patients up to $3.4 million and >239,000 millisieverts of radiation., Conclusion: Rather than imaging all patients with primary hyperparathyroidism, a selective strategy that considers the probability of having adenomas could reduce costs and avoid excess radiation exposure., (Published by Elsevier Inc.)

Imaging with bone scans plays an important role in the diagnostic path of patients with unilateral condylar hyperactivity or unilateral condylar hyperplasia (UCH). The aim of this study is to perform a systematic review of the diagnostic performance of the bone SPECT and SPECT/CT scan for the diagnosis of UCH. PubMed, SCOPUS and EMBASE were searched electronically to identify diagnostic accuracy studies that assessed the diagnostic value of bone SPECT and SPECT/CT for the diagnosis of UCH, Meta-analyses were performed with Metadisc 1.4 and 2.0. A total of 14 studies, with a total number of 887 patients, were included in the qualitative analysis and 11 studies qualified for meta-analyses. The pooled sensitivity and specificity for the SPECT scan were 0.814 (95 % CI: 0.639-0.915) and 0.774 (95 % CI: 0.655-0.861), for the SPECT/CT scan these were 0.818 (95 % CI: 0.749-0.874) and 0.901 (95 % CI: 0.840-0.945). The summary receiver operating characteristics of the SPECT scan showed an area under the curve of 0.847 (95 % CI: 0.722-0.972) and that of the SPECT/CT scan was 0.928 (95 % CI: 0.876-0.980). CONCLUSION: Both bone SPECT scan and SPECT/CT scan provide a high diagnostic accuracy for UCH. The added value of the SPECT/CT scan is questionable and given the potential disadvantages of the SPECT/CT scan, including the increased radiation dose and costs, the diagnostic modality of first choice in patients with UCH should be a SPECT scan., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: The aims of this study were to investigate the ultrasound features of non-mass-type ductal carcinoma in situ (DCIS) of the breast and conduct a pathological analysis., Material and Methods: Ultrasound images of 32 cases of non-mass-type DCIS of the breast, collected between September 2014 and June 2016, were analyzed. The characteristics of the lesions, including border, internal echogenicity, local glandular hyperplasia, micro-calcification, and intra-tumoral blood flow resistance index (RI), were analyzed, and a concurrent pathological analysis was conducted., Results: Obvious local glandular hyperplasia was commonly observed in the 32 cases of non-mass-type DCIS of the breast. The internal echogenicity varied in intensity, exhibiting a "leopard pattern" or "zebra pattern." Color Doppler imaging revealed abundant blood flow signals within the lesion with an RI of >0.7. Isolated duct dilatation and micro-calcifications were occasionally observed within the lesions. High-grade DCIS was the predominant pathological type of non-mass-type DCIS., Conclusions: Non-mass-type DCIS of the breast often presents with obvious local glandular hyperplasia and varying internal echogenicity. High-grade DCIS is the frequent pathological type. Color Doppler imaging and RI measurement can assist in diagnosing non-mass-type DCIS of the breast., (Copyright © 2024 Copyright: © 2024 Journal of Cancer Research and Therapeutics.)

Background: Primary adenoma (PA) and multi-gland hyperplasia (MGH) account for 85% and 15% of primary hyperparathyroidism (PHPT) cases, respectively. Near-infrared autofluorescence (NIRAF) enhances intraoperative parathyroid identification. We hypothesized that PA would display a more heterogeneous NIRAF pattern compared to MGH., Methods: Patients undergoing surgery for sporadic PHPT were categorized based on the presence of PA or MGH. To quantify heterogeneity, we utilized ratios of (1) mean parathyroid gland (PG) NIRAF over background NIRAF (mean ratio), (2) minimum and (3) maximum PG NIRAF over mean PG NIRAF (minimum and maximum ratios). Additionally, a heterogeneity score was quantified using mean ratio (mean PG NIRAF over background NIRAF), and overall NIRAF (mean NIRAF of eight random 15 × 15 pixel areas). A point was assigned to ratios <0.8 or >1.2. Images were quantified by ImageJ software. Mann-Whitney test was performed for all comparisons., Results: Of 78 patients, 63 had a single PA and 15 had MGH, totaling 102 PGs. There was no difference between their mean ratios. PA had a lower minimum ratio compared to that of MGH (0.86 ± 0.01 vs. 0.93 ± 0.01, p = 0.001) and a brighter maximum ratio (1.21 ± 0.02 vs. 1.12 ± 0.01, p = 0.0008). PA also scored higher on their heterogeneity scores compared to MGH (1.27 ± 0.23 vs. 0.33 ± 0.15, p = 0.001)., Conclusion: Single parathyroid adenomas display a more heterogeneous autofluorescence pattern compared to that of multi-gland hyperplasia. Intraoperative characterization of PGs by real-time NIR imaging patterns may be a beneficial adjunct during parathyroid surgery., (© 2023 The Authors. Head & Neck published by Wiley Periodicals LLC.)

Purpose: The purpose of this study is to determine computed tomography (CT) findings that aid in differentiating idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) from other colitides., Methods: Retrospective review of histiologic proven cases of IMHMV (n = 12) with contrast enhanced CT (n = 11) and/or computed tomography angiography (CTA) (n = 9) exams. Control groups comprised of CT of infectious colitis (n = 13), CT of inflammatory bowel disease (IBD) (n = 12), and CTA of other colitides (n = 13). CT exams reviewed by 2 blinded gastrointestinal radiologists for maximum bowel wall thickness, enhancement pattern, decreased bowel wall enhancement, submucosal attenuation value, presence and location of IMV occlusion, peripheral mesenteric venous occlusion, dilated pericolonic veins, subjective IMA dilation, maximum IMA diameter, maximum peripheral IMA branch diameter, ascites, and mesenteric edema. Presence of early filling veins was an additional finding evaluated on CTA exams., Results: Statistically significant CT findings of IMHMV compared to control groups included greater maximum bowel wall thickness, decreased bowel enhancement, IMV occlusion, and peripheral mesenteric venous occlusion (p < 0.05). Dilated pericolonic veins were seen more frequently in IMHMV compared to the infectious colitis group (64% versus 15%, p = 0.02). Additional statistically significant finding on CTA included early filling veins in IMHMV compared to the CTA control group (100% versus 46%, p = 0.008)., Conclusion: IMHMV is a rare chronic non-thrombotic ischemia predominantly involving the rectosigmoid colon. CT features that may aid in differentiating IMHMV from other causes of left-sided colitis include marked bowel wall thickening with decreased enhancement, IMV and peripheral mesenteric venous occlusion or tapering, and early filling of dilated veins on CTA., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The role of low-dose computed tomography (LDCT) in surgical planning can be assessed based on the correlation among bone density (BD/HU), radiographic values, and the histopathological appearance of hyperplastic overgrowth in mandibular condyles (hemimandibular hyperplasia/osteochondroma). The aim of this study was to evaluate the correlation between LDCT indices of bone-density measurements in surgical planning and histopathological specimens. The patients incuded in this study underwent detailed radiological evaluation as preparation for further clinical procedures. Excised condyles were evaluated in terms of bone density index using LDCT, and then histopathologically to investigate the accuracy of surgical procedures and set the basis for future surgical planning. An index value between both condyles' bone densities represented the relative difference between the healthy condyle and the side with hemimandibular hyperplasia (HH). Patients with unilateral condylar hyperplasia (UCH) showed a statistical correlation between condyle heads with increased bone density (BD) and scintigraphic (SCI) values (p < 0.001). On the other hand, correlation between BD and histopathological studies alone was significant (p < 0.001). With the increase in BD measured in HU in UCH condyles, the overall value of fibrous cartilage layer thickness decreased (p < 0.001). Furthermore, histopathological evaluation indicated that increased bone density on the UCH side resulted in increased total thickness (p > 0.001). The proposed index measurements in the mandibular condyles based on LDCT/BD can be used to estimate the degree of required surgical resection. Results from LDCT radiographic studies correlate with histopathological specimens more than scintigraphy., (Copyright © 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Aim: To review histologically confirmed diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) cases and carry out a detailed pathological-radiological correlation to see if computed tomography (CT) can be used to confidently identify DIPNECH., Materials and Methods: Twenty-three histologically confirmed DIPNECH patients in the shared database of two NHS Trusts were reviewed. CT images were reviewed by two independent radiologists, each of them with >10 years of experience in thoracic imaging. All histological specimens were reviewed by a single pathologist with >25 years of experience. The diagnosis of DIPNECH was made according to the current World Health Organization (WHO) definition included in the WHO 2015 classification of pulmonary tumours. The results on histology were compared to the presence of nodules and air trapping on CT. Demographic information and, when available, molecular imaging studies and pulmonary function tests were also considered., Results: There are prototypal clinical and radiological findings reflecting the presence of underlying histological DIPNECH: middle-aged women with multiple small and scattered nodules due to the clustering and proliferation of neuroendocrine cells. At least one larger, dominant, lung nodule reflecting a carcinoid tumour is very common and mosaic attenuation/air trapping is seen approximately in 50% of cases in inspiratory scans. Airflow obstruction is rarely associated with histological bronchial or peribronchial fibrosis, which suggests other mechanisms must be involved in its development., Conclusion: CT can be used to predict pathological DIPNECH in the appropriate clinical setting. It is important to consider DIPNECH to avoid overdiagnosis of more sinister conditions such as lung cancer or metastases., (Copyright © 2023. Published by Elsevier Ltd.)

We aimed to explore the value of ultrasonic elastic imaging in the diagnosis of parathyroid hyperplasia and adenoma in patients with secondary hyperparathyroidism and provide more evidence for clinical treatment. Forty patients who were on dialysis and underwent parathyroid surgery were selected All patients underwent routine ultrasound, ultrasound elasticity examination and blood biochemical examination before surgery, including calcium, phosphorus, parathyroid hormone (PTH), etc. According to postoperative results, adenoma group and hyperplasia group were divided into 2 groups. Receiver operating characteristic curve was drawn to evaluate the diagnostic efficacy and combined diagnostic efficacy of each index. The PTH levels significantly differed between the adenoma and hyperplasia groups (P < .001). The volume and blood flow grades significantly differed between the adenoma and hyperplasia groups (P < .001) The minimum of the adenoma group was 14.62 ± 6.79 kPa, mean was 19.42 ± 6.29 kPa, and maximum was 24.25 ± 6.35 kPa which were significantly different from those in the hyperplasia group (P < .05). The combinations of more than 6 indicators in the diagnosis of parathyroid adenoma resulted in an area under the curve of 0.892 (P < .001), and the sensitivity and specificity were 78.9% and 97.4%, respectively. Shear wave elastography can be used as an effective tool to distinguish secondary parathyroid hyperplasia from adenoma. When combined with PTH, conventional ultrasound blood flow grading and volume measurement, it has higher diagnostic efficacy., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare non-neoplastic disorder, which can mimic malignancy due to its indolent yet progressive nature. Here, we report a case of surgically proven PNLH that progressed over many years from a ground glass opacity to a solid cavitating lesion mimicking a slow growing primary lung carcinoma., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: When needle core biopsy (NCB) of the breast yields atypical ductal hyperplasia (ADH), excision is typically recommended. The natural history of ADH undergoing active surveillance (AS) is not well described. We investigate the rates of upgrade to malignancy of excised ADH and the rates of radiographic progression under AS., Materials and Methods: We retrospectively reviewed records of 220 cases of ADH on NCB. Of patients who had surgery within 6 months of NCB, we examined the malignancy upgrade rate. In the AS cohort, we examined rates of radiographic progression on interval imaging., Results: The malignancy upgrade rate among patients who underwent immediate excision (n = 185) was 15.7%: 14.1% (n = 26) ductal carcinoma in situ (DCIS) and 1.6% (n = 3) invasive ductal carcinoma (IDC). Upgrade to malignancy was less common in lesions <4 mm in size (0%) or with focal ADH (5%), and more common among lesions presenting with a radiographic mass (26%). Among the 35 patients who underwent AS, median follow-up was 20 months. Two lesions progressed on imaging (incidence 3.8% at 2 years). One patient without radiographic progression was found to have IDC at delayed surgery. The remaining lesions remained stable (46%), decreased in size (11%), or resolved (37%)., Conclusions: Our findings suggest that AS is a safe approach to managing ADH on NCB for most patients. This could spare many patients with ADH from unnecessary surgery. Given that AS is being investigated for low-risk DCIS in multiple international prospective trials, these results suggest that AS should also be investigated for ADH., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background and Purpose: Gastric reactive hyperplasia (RH) is a common benign lesion of the gastric mucosa that can be resolved by conservative treatment without endoscopic intervention. Some RH lesions are indistinguishable from low-grade intraepithelial neoplasia (LGIN) lesions of gastric mucosa under endoscopy. The aim of this study was to investigate the morphological features of RH lesions under magnifying endoscopy combined with narrow-band imaging (ME-NBI)., Methods: A retrospective study of 653 patients with superficial suspicious lesions of gastric mucosa was performed. According to the pathological results of biopsies, the final included lesions were divided into the RH group ( n  = 88) and LGIN group ( n  = 138). We analysed the microvascular and microsurface patterns of these lesions under ME-NBI, extracted the most significant combination of endoscopic features of RH lesions, and evaluated their diagnostic performance., Results: ME-NBI characteristics that could distinguish RH lesions from LGIN lesions after univariate analysis were included in multivariate logistic regression. The results showed that ten characteristics, including intervening part (IP) length homogeneity, type III gastric pit pattern and homogeneity of marginal crypt epithelium (MCE), were statistically significant. Receiver operating characteristic (ROC) analysis showed that the triad of these features was the best combination for diagnosing RH lesions with an AUC of 0.886 (95% confidence interval; 0.842-0.929), the sensitivity of 85.5% and specificity of 79.5%., Conclusions: The triad of IP length homogeneity, type III pit pattern and MCE homogeneity under ME-NBI helps endoscopists to identify gastric RH lesions, thereby avoiding unnecessary biopsy and repeat endoscopy due to misjudgment of neoplastic lesions.

Polymicrogyria (PMG) is a malformation of cortical development that occurs mostly in the perisylvian region bilaterally (60-70%), most often presenting with epilepsy. Unilateral cases are much rarer with hemiparesis being the predominant symptom. We report a case of a 71-year-old man with right perirolandic PMG with ipsilateral hypoplasia and contralateral hyperplasia of the brainstem, with only non-progressive left-sided mild spastic hemiparesis. This imaging pattern is thought to occur due to the normal process of withdrawal of the axons of the corticospinal tract (CST) connected to aberrant cortex, possibly with compensatory contralateral CST hyperplasia. However, the majority of cases is additionally present with epilepsy. We believe it is worthwhile to investigate imaging patterns of PMG with symptoms' correlation, particularly with the help of techniques such as advanced brain imaging to assist in the study of cortical development along with adaptive somatotopic organization of the cerebral cortex in MCD with possible clinical applications., (© 2023. Fondazione Società Italiana di Neurologia.)

The aim of this study was to assess the diagnostic accuracy of single photon emission tomography (SPECT) in unilateral condylar hyperplasia (UCH). To this end, 3D morphometric changes of the mandibles in one year were assessed (T0 vs. T1) and compared over SPECT results in T1, in a sample of 40 patients. A contingency table was constructed based on these results for SPECT diagnostic accuracy evaluation, classifying patients as SPECT true-positive, true-negatives, false positives and false-negatives. Additionally, the morphometric analysis was used to describe the presentation of mandibular changes using principal component analysis (PCA) and non-parametric statistics. We obtained diagnostic accuracy results of sensitivity 81%, specificity 63%, positive predictor value (PPV) 59%, negative predictor value (NPV) 83% and accuracy 70%, showing that SPECT yields poor results regarding accuracy diagnostic performance. The morphometric analysis showed that individuals without progress of asymmetry and those with more progress differ particularly in a group of landmarks representing the mental region and the right mandibular body. Based on these landmarks, difference among the four SPECT-accuracy groups was statistically significant (p < 0.001), where the landmark showing the largest change within a year had a mean increase of 1.13 + 0.66 mm. Within the limitations of the study, it seems that SPECT alone is not suitable for making surgical decisions regarding condylectomy in active UCH. Follow up with morphological assessment methods are recommended for confirming an active UCH in combination with SPECT., Competing Interests: Declaration of competing interest None., (Copyright © 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: To develop a fully automated deep learning model for adrenal segmentation and to evaluate its performance in classifying adrenal hyperplasia., Methods: This retrospective study evaluated automated adrenal segmentation in 308 abdominal CT scans from 48 patients with adrenal hyperplasia and 260 patients with normal glands from 2010 to 2021 (mean age, 42 years; 156 women). The dataset was split into training, validation, and test sets at a ratio of 6:2:2. Contrast-enhanced CT images and manually drawn adrenal gland masks were used to develop a U-Net-based segmentation model. Predicted adrenal volumes were obtained by fivefold splitting of the dataset without overlapping the test set. Adrenal volumes and anthropometric parameters (height, weight, and sex) were utilized to develop an algorithm to classify adrenal hyperplasia, using multilayer perceptron, support vector classification, a random forest classifier, and a decision tree classifier. To measure the performance of the developed model, the dice coefficient and intraclass correlation coefficient (ICC) were used for segmentation, and area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used for classification., Results: The model for segmenting adrenal glands achieved a Dice coefficient of 0.7009 for 308 cases and an ICC of 0.91 (95% CI, 0.90-0.93) for adrenal volume. The models for classifying hyperplasia had the following results: AUC, 0.98-0.99; accuracy, 0.948-0.961; sensitivity, 0.750-0.813; and specificity, 0.973-1.000., Conclusion: The proposed segmentation algorithm can accurately segment the adrenal glands on CT scans and may help clinicians identify possible cases of adrenal hyperplasia., Key Points: • A deep learning segmentation method can accurately segment the adrenal gland, which is a small organ, on CT scans. • The machine learning algorithm to classify adrenal hyperplasia using adrenal volume and anthropometric parameters (height, weight, and sex) showed good performance. • The proposed segmentation algorithm may help clinicians identify possible cases of adrenal hyperplasia., (© 2022. The Author(s), under exclusive licence to European Society of Radiology.)

Background: During the past decade, 18 F-fluorocholine (FCH) PET/CT has been continuously performed at Tenon Hospital (Paris, France) for the detection of hyperfunctioning parathyroid glands (PT)., Methods: A cohort of 401 patients, deliberately referred for HPT since September 2012, has been analyzed. The aim of this real-life retrospective study was to determine the diagnostic utility of FCH in this setting, overall and in subgroups according to the type of hyperparathyroidism (HPT), the context of FCH in the imaging work-up and in the patient's history: initial imaging or persistence or recurrence after previous parathyroidectomy (PTX). The influence of the histologic type of resected PTs, hyperplasia or adenoma, on the preoperatory detection on FCH PET/CT has been studied as well., Results: Four hundred one FCH PET/CTs were included in the cohort, performed in 323 patients with primary HPT (pHPT), including 18 with familial HPT (fHPT), and in 78 patients with secondary renal HPT (rHPT). The overall positivity rate in the 401 FCH PET/CTs was 73%. The PTX rate was twice greater in patients whose FCH PET/CT was positive than negative (73% vs. 35%). Abnormal PT(s) were pathology proven in 214 patients: only hyperplastic gland(s) in 75 cases and at least one adenoma in 136 cases; FCH PET/CT sensitivity was 89% and 92%, respectively. Similarly, there was no significant difference in patient-based sensitivity whether FCH PET/CT was performed as 1 st line or later in the imaging work-up, or indicated for initial imaging or for suspicion of persistent or recurrent HPT. Gland-based sensitivity was significantly lower for hyperplasia than for adenoma (72% and 86%, respectively). The lowest gland-based sensitivity value was 65%, observed in case of hyperplasia and when FCH was performed late in the imaging work-up. FCH PET/CT correctly showed multiglandular HPT (MGD) in 36/61 proven cases, 59%. Results of ultrasonography (US) and 99m Tc-sestaMIBI (MIBI) imaging were available in 346 and 178 patients, respectively. For both modalities, the corresponding sensitivity values were significantly less than those of FCH PET/CT (e.g., overall gland-based sensitivity 78% for FCH, 45% for US, 30% for MIBI) and MGD was detected in 32% of cases by US and 15% by MIBI., Conclusions: Although FCH PET/CT has been performed since 2017 as 1 st line imaging for HPT at Tenon Hospital (Paris, France), a large majority of patients underwent prior US and/or MIBI in their preoperative work-up. Therefore, a selection bias is very likely, as most patients referred to FCH PET/CT had non-conclusive or discordant results of US and MIBI, explaining the low performance of those modalities in the present cohort compared to published results. Nevertheless, the superiority of FCH PET/CT over US and MIBI in detecting abnormal PTs reported in various comparative studies is definitely confirmed in this larger real-life cohort. The detection with FCH PET/CT of hyperplastic PTs was somewhat lower than that of adenomas but was better than using US or MIBI. The present results lead to recommend FCH PET/CT as the first line imaging modality in HPT when it is widely available or, if less available, at least in HPT with predominance of hyperplasia and/or MGD.

Abstract: Pulmonary diffuse lymphoid hyperplasia (DLH), a nonneoplastic lymphoproliferative disorder (LPD), is extremely rare, and no PET/CT findings have been reported for pulmonary DLH. We observed slowly expanding irregular opacities with 18 F-FDG accumulation (SUV max , 3.64) in the right lower lobe of a 51-year-old asymptomatic man. The patient underwent video-assisted thoracoscopic biopsy on suspicion of malignant lesions. Histologically, no neoplastic cells were present, and the lesion was consistent with DLH. Six months later, the patient developed rheumatoid arthritis. DLH should be considered in the differentiation of PET-positive irregular opacities, even in the absence of known immune abnormalities., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The research aimed to evaluate the optimal Single-Photon Emission Computed Tomography (SPECT) cut-off value in differentiating condylar growth activeness, to observe 3-dimensional (3D) mandibular growth pattern, and to explore the potential correlation between 3D measurement parameters and SPECT uptake ratios in Chinese unilateral condylar hyperplasia (UCH) patients., Methods:  Data of fifty-four Chinese UCH patients were analyzed retrospectively. All patients underwent SPECT within 1 month before or after the first CT examination (CT1); and received a second CT examination at least 12 months later (CT2). Data from CT scans were analyzed by comparing bilateral differences between CT1 and CT2. The sensitivity and specificity of SPECT were calculated by the receiver operating characteristic (ROC) curve. Pearson's correlation analysis was performed to investigate whether the mandibular growth was correlated with SPECT value., Results: SPECT had a sensitivity of 68.00% and a specificity of 72.41%, with an area under the ROC curve being 0.709. The optimal SPECT cut-off value for evaluating condylar activity has been determined to be 13%. In patients with an active growing condyle, there was a significant increase in Co-Gn and Co-Go, but not in Go-Gn, Go-MF, or MF-Gn. Pearson's correlation analysis revealed no correlation between 3D measurement parameters and differences in relative condylar uptake ratios., Conclusion: SPECT showed good diagnostic performance in UCH with the cut-off value of 13%. For those with an active growing condyle, the mandible grows diagonally and vertically, while the relative condylar uptake ratio was not directly related to mandibular growth., (© 2023. The Author(s).)

A 72-year-old woman was referred for the examination of wall thickening of the bile duct and a polyp-like lesion on the gallbladder. The bile duct and gallbladder lesions were observed to be continuous on abdominal ultrasonography. We performed a bile duct biopsy, and pathological findings showed hyperplasia of the lymphoid follicles without malignancy. We considered these two lesions to be the same lesion, and laparoscopic cholecystectomy was performed to make a definite diagnosis. The pathological examination of the resected gallbladder also showed hyperplasia of the lymphoid follicles. We diagnosed the patient with lymphoid hyperplasia of the gallbladder extending to the bile duct.

Unilateral condylar hyperplasia (UCH) of the temporomandibular joint is a progressive deformation of the mandibular condyle of unknown origin. UCH is characterized by excessive growth of the condylar head and neck, leading to an increase in size and volume. The aim of this study was to investigate the characteristics of the bone in patients with UCH using microcomputed tomography (micro-CT), histology, and Raman microspectroscopy. The mandibular condyles of six patients with UCH were analysed using micro-CT, histology, and Raman microspectrometry and imaging, and the results were compared with those obtained for a normal control subject. Three-dimensional micro-CT models revealed focal abnormalities of the bone microarchitecture, with foci of osteosclerosis. Histological sections showed that these foci included islands of calcified cartilage matrix with live chondrocytes. Raman analysis revealed that the cartilage matrix was more heavily calcified than the bone matrix and that the cartilage could be identified by the phenylalanine (PHE) band of its matrix, as well as by its glycosaminoglycan (GAG) content. The persistence of foci of live and active chondrocytes within the bone matrix is intriguing and appears to be pathognomonic of UCH. These new findings on UCH could help to determine its pathophysiology and thus prevent this disease, which can lead to major facial deformity., Competing Interests: Competing interests None., (Copyright © 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: We evaluated the difference in parathyroid visualization on 18 F-FCH PET/CT images obtained at 5 and 60 min, and quantitatively analyzed the mode of FCH uptake at different time points, to determine the best imaging time for FCH PET/CT., Methods: This retrospective study included 73 patients with hyperparathyroidism (HPT) who underwent 18 F-FCH PET/CT imaging between December 2017 and December 2021. The diagnostic efficiency of 5- and 60-min dual time point imaging for the diagnosis of hyperparathyroidism and parathyroid adenoma and hyperplasia, were compared using visual and quantitative analyses., Results: Dual-time 18 F-FCH PET/CT imaging visual analysis had diagnostic value for HPT. The receiver operating characteristic curve of PET/CT quantitative parameters for the diagnosis of HPT and lesions showed that the parathyroid/thyroid SUVmax ratio for 60-min imaging had a higher sensitivity and specificity (based on patient, sensitivity: 90.90% and specificity: 85.71%; based on focus, sensitivity: 83.06% and specificity: 85.71%) compared to that for 5-min imaging. PET/CT quantitative parameters can distinguish parathyroid adenoma and hyperplasia. The 60-min parathyroid SUVmax value had the highest diagnostic value (cutoff: 3.945; area under the curve: 0.783)., Conclusion: The quantitative parameters of 60min 18 F-FCH PET/CT have more advantages in aiding in the pathologica diagnosis and clinical treatment of HPT., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Liu, Li, Pang, Zuo, Kong, Wang, Li, Xia, Wang and Xu.)

Background: Atypical ductal hyperplasia diagnosed on percutaneous breast biopsy typically undergoes surgical excision, upgrading to invasive breast cancer or ductal carcinoma in situ in 10% to 53%. In efforts to limit excision to those with highest upgrade risk, we sought to determine if breast magnetic resonance imaging has value in predicting upgrade. In this study, we will describe magnetic resonance imaging presentation of atypical ductal hyperplasia and assess magnetic resonance imaging accuracy in predicting upgrade., Methods: All female patients ≥18 years with atypical ductal hyperplasia on percutaneous breast biopsy undergoing magnetic resonance imaging from 2008 to 2020 were included. Patient demographics, imaging presentation, magnetic resonance imaging enhancement kinetic curves, and pathology features were captured. Categorical variables were analyzed using Fisher exact to test for association between variables and upgrade. Continuous variables were analyzed using t tests., Results: Magnetic resonance imaging was performed for 125 percutaneous breast biopsy with atypical ductal hyperplasia: 67 after and 58 before atypical ductal hyperplasia diagnosis. On magnetic resonance imaging, atypical ductal hyperplasia site had no enhancement in 45 (36%), nonmass enhancement in 50 (40%), and mass enhancement in 30 (24%). In total, 28% had atypical ductal hyperplasia diagnosed by magnetic resonance imaging-guided percutaneous breast biopsy. Surgical excision was performed for 96 (76.8%) and 15 (15.6%) upgraded (11 ductal carcinoma in situ, 4 invasive breast cancer). All 15 upgrades had enhancement. Any kinetic pattern enhancement was significantly associated with upgrade (P = .009) with upgrade most strongly associated with type III washout. The lowest risk for upgrade was pure atypical ductal hyperplasia and no magnetic resonance imaging enhancement (0%, n = 25)., Conclusions: Active monitoring may be safely offered to women with pure atypical ductal hyperplasia on percutaneous breast biopsy when magnetic resonance imaging shows no enhancement. Any enhancement at atypical ductal hyperplasia site, particularly type III washout kinetics, should continue to undergo excision., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Nuclear imaging plays an important role in the diagnostic path of patients with unilateral condylar hyperplasia (UCH). The purpose of this study was to determine the performance of single-photon emission computed tomography-computed tomography (SPECT-CT) in a large group of patients with suspected UCH. This study prospectively included 156 patients with a clinical presentation of progressive mandibular asymmetry. All patients underwent 99 m Tc-HDP SPECT-CT and extensive baseline and follow-up documentation. The relative activity of the ipsilateral condyle in relation to the contralateral condyle was calculated for both the mean and maximum count, and the diagnostic accuracy of different cut-off values was determined. The area under the receiver operating characteristic curve of the SPECT-CT scan was 0.892 for the mean count and 0.873 for the maximum count. The optimal cut-off of> 8% (SPECT-CT mean count) resulted in a sensitivity of 87.0% and a specificity of 88.6%. SPECT-CT showed good diagnostic performance in UCH; however the benefit of the CT scan is questionable and the potential disadvantages have to be weighed against the benefits when compared to standard SPECT scanning. When using SPECT-CT in the diagnostic path in UCH, a mean value cut-off of>8% for the relative activity between the condyles is most accurate., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Condylar hyperplasia is one of the causes of facial asymmetry and malocclusion, characterized by enlargement of the lower jaw due to excessive condyle growth activity. The aim of this study was to use micro-computed tomography (micro-CT) to evaluate the bone architecture of the condylar head and determine whether there are differences between patients with various forms of unilateral condylar hyperplasia (UCH): hemimandibular hyperplasia, elongation, and mixed form. The cohort consisted of 28 patients with a mean age of 21.9 years. All patients underwent surgical treatment (condylar shaving) for active pathological growth activity. The portion of the condylar head removed was imaged by micro-CT and subsequently evaluated. Micro-CT imaging and semiquantitative and quantitative evaluation of the bone structure (percentage bone volume, surface density, trabecular thickness, trabecular separation, degree of anisotropy, and porosity of the subchondral bone) did not reveal significant differences between the individual types of condylar hyperplasia (P > 0.05). There were no significant differences in bone structure between the anterior and posterior portions of the condylar head. No statistically significant differences between individual groups of UCH were found in the micro-CT evaluation of the condylar head bone architecture., (Copyright © 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

In-stent caliber reduction due to neo-intimal hyperplasia (NIH) is an underestimated event that may follow flow diverter stent (FDS) implantation. Although mostly asymptomatic, this vascular reaction is a well-known risk factor for delayed ischemic strokes. Here we report on the contribution of magnetic resonance vessel wall imaging (MR-VWI), performed on a 1.5 T scanner, to detect in-stent stenosis and mural inflammation in a 40-year-old woman with cerebral aneurysm previously treated with FDS and presenting with motor disturbances on follow-up. Digital subtraction angiography and cone-beam CT confirmed 1.5 T MRVWI findings, highlighting the potential value of this non-invasive imaging technique in investigating and detecting NIH.

Background: Intravascular papillary endothelial hyperplasia (IPEH) is a vascular tumor characterized by the proliferation of endothelial cells with papillary formation. It is a rare benign condition affecting the head and neck. Currently, no cases of IPEH of the spleen have been reported. Here, we report a case of IPEH of the spleen in a child and discuss its clinical manifestations, imaging features, and surgical treatment., Case Presentation: A 5-year-old female presented with a 4-month-old tumor in the left upper abdomen, abdominal pain, and constipation. She underwent radiography, barium enema, US, and MRI. A solid space-occupying mass was found in the left abdominal cavity on preoperative imaging, and it was diagnosed as angiosarcoma. The lesion was surgically resected. Histopathological analysis was consistent with IPEH., Conclusion: Clinicians should consider the possibility of IPEH in patients presenting with tumors in the spleen, which is curable by surgical resection. Malignant vascular tumors must be excluded in the differential diagnosis of IPEH to prevent misdiagnosis and inappropriate overtreatment., (© 2022. The Author(s).)

Abstract: The coexistence of parathyroid hyperplasia and carcinoma is uncommon. Here we report findings of 99m Tc-sestamibi SPECT/CT study in a case of unilateral bifocal parathyroid carcinoma coexisting with parathyroid hyperplasia in a 49-year-old man. The images showed 4 foci of elevated activity around the thyroid. Histopathology confirmed the 2 lesions of the left side as parathyroid hyperplasia and the other 2 lesions of the right side as parathyroid carcinoma., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. Supported by Health and Family Planning Commission of Hebei Province (20190619) and Medical Science Research Project of Hebei Province (20221197)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Four-dimensional (4D) CT localization allows minimally invasive parathyroidectomy as treatment for primary hyperparathyroidism (PHPT), but false positive localization is frequent. We sought to characterize the ability of 4D CT to predict four-gland hyperplasia (HP) based on the size of candidate lesions., Study Design: We retrospectively analyzed patients with PHPT who underwent 4D CT imaging and parathyroidectomy between 2014 and 2020 from a prospectively collected institutional database. The cohort was stratified into two groups, HP vs single adenoma (SA) and double adenoma (DA), based on operative findings and pathology. Logistic regression models assessed the association between the greatest diameter of the dominant candidate lesion on 4D CT and the outcomes of four-gland hyperplasia vs SA and DA., Results: Among a cohort of 240 patients, 41 were found to have HP, and 199 had adenomas (SA = 155, DA = 44). Patients with HP were less likely to have a preoperative calcium level greater than 1 mg/dL above the upper limit of normal compared with patients with adenomas (63% vs 81%, p = 0.02) and more likely to report symptoms (61% vs 43%, p = 0.04). After adjusting for BMI, we found an estimated 13% reduction in odds of HP for every 1-mm increase in the greatest diameter of dominant candidate lesions identified on 4D CT scan (odds ratio 0.87, 95% CI 0.78 to 0.96, p = 0.009)., Conclusions: A smaller size of the dominant lesion on 4D CT scan is associated with an increased risk of HP in PHPT. Use of 4D CT imaging localization may provide evidence for differentiating HP from adenomas., (Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The aims of the study were to explore the feasibility of generating a monoexponential model (MEM), stretched-exponential model (SEM) based diffusion-weighted imaging (DWI), and diffusion kurtosis imaging (DKI) by applying the same set of reduced b values and to compare their effectiveness in distinguishing prostate cancer from stromal hyperplasia (SH) in the transition zone (TZ) area., Methods: An analysis of 75 patients who underwent preoperative DWI ( b values of 0, 700, 1400, 2000 s/mm 2 ) was performed. All lesions were localized on magnetic resonance images according to whole-mount histopathological correlations. The apparent diffusion coefficient (ADC), water molecular diffusion heterogeneity index (α), distributed diffusion coefficient (DDC), mean diffusivity (MD), and mean kurtosis (MK) values were calculated and compared between the TZ cancer and SH groups. Receiver operating characteristic analysis and areas under the receiver operating characteristic curve (AUCs) were carried out for all parameters., Results: Compared with the SH group, the ADC, DDC, α, and MD values of the TZ cancer group were significantly reduced, while the MK value was significantly increased (all P < 0.05). The AUCs of the ADC, DDC, α, MD, and MK were 0.828, 0.801, 0.813, 0.822, and 0.882, respectively. The AUC of MK was significantly higher than that of the other parameters (all P < 0.05)., Conclusions: When using the reduced b -value set, all parameters from MEM, SEM, based DWI, and DKI can effectively distinguish TZ cancer from SH. Among them, DKI demonstrated potential clinical superiority over the others in TZ cancer diagnosis., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Unilateral condylar hyperplasia (UCH) is a progressive, nonneoplastic overgrowth of the condyle of the temporomandibular joint. For treating active UCH, a popular method combines orthognathic surgery with high condylectomy and orthodontic treatment. The goal of this study was to introduce a new method to correct asymmetry for active UCH., Methods: Retrospectively, 47 patients with active UCH were divided into horizontal-type, vertical-type, and combined-type. All patients were treated with condylectomy plus postsurgery standard orthodontics (CPSO) with applied miniscrews implanted in infrazygomatic crest and hard palate to intrude affected side of maxillary molars and apply intermaxillary traction for contralateral molars. Cone-beam computed tomography was taken at presurgery, postsurgery, and the end of orthodontics (T3)., Results: In the vertical (n = 10) and combined (n = 28) types, deviation of the chin and the canting of the mandible and maxillary occlusal plane were significantly reduced at T3. A difference in the torque of bilateral maxillary first molar (U6) and bilateral mandibular first molar (L6) was significantly reduced at T3. The anterior, superior, and posterior joint spaces in the vertical-type and combined-type were significantly decreased at T3 compared with postsurgery. In contrast, in the horizontal-type group (n = 9), the deviation of the chin was corrected; however, the canting of the mandible and maxillary occlusal plane was significantly increased at T3 compared with presurgery., Conclusions: CPSO restored facial and occlusal symmetry for vertical-type and combined-type active UCH and returned affected-side condyle to the glenoid fossa. However, CPSO was not suitable for treating the horizontal-type UCH., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Abstract: A 50-year-old woman with end-stage renal disease presented with recurrent hyperparathyroidism after parathyroidectomy. 99mTc-MIBI scintigraphy did not show MIBI-avid lesion in the neck or mediastinum but in bilateral lung fields instead. On suspicion of malignancy, 18F-FDG PET/CT was performed and depicted no significant FDG uptake throughout the whole body. After resection of the pulmonary nodules, the final histopathology revealed benign parathyroid hyperplasia with pulmonary seeding, which is exceptionally a rare entity., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

We aimed to investigate the diagnostic and prognostic value of 68 Ga-pentixafor PET/CT imaging in noncancer patients with suspected adrenal masses. Methods: Sixty-four patients who had benign adrenal masses on CT were retrospectively included in our study. All patients underwent 68 Ga-pentixafor PET/CT, and 56 of these patients subsequently underwent adrenalectomy. The subtypes of 81 adrenal tumors, including 14 nonfunctioning adrenal nodules, 4 cortisol-producing adenomas, 41 aldosterone-producing adenomas, 5 cases of suspected unilateral adrenal hyperplasia, 15 cases of idiopathic aldosterone hyperplasia, and 2 pheochromocytomas, were determined by histology or follow-up evaluations. The diagnostic efficiency of functional lateralization was calculated by visual analysis. Semiquantitative parameters of these lesions, including SUV max , the ratio of lesional SUV max to normal liver SUV mean (LLR), and the ratio of lesional SUV max to contralateral adrenal tissue SUV mean (LCR), were also calculated. Dynamic analysis was also performed on 15 patients. In addition, clinical outcomes were assessed and compared in patients who underwent adrenalectomy. Results: The sensitivity and specificity of 68 Ga-pentixafor PET for functional lateralization in patients with adrenocortical lesions were 97.8% (45/46) and 87.5% (14/16), respectively. The 2 pheochromocytoma lesions had lower pentixafor uptake than the normal adrenal glands. Functioning (active) adrenocortical adenomas showed an elevated SUV max of 16.3 ± 7.9, in comparison to 4.4 ± 1.7 in nonfunctioning (inactive) adenomas and 5.5 ± 2.7 in hyperplasia lesions ( P  < 0.0001). To identify active adrenocortical adenomas, a cutoff of 7.1 for SUV max showed a sensitivity of 90.9% and a specificity of 85.3% (area under receiver-operating-characteristic curve, 0.96; P  < 0.0001); a cutoff of 2.5 for LLR showed a sensitivity of 95.5% and a specificity of 88.2% (area under receiver-operating-characteristic curve, 0.97; P  < 0.0001); and a cutoff of 2.4 for LCR showed a sensitivity of 88.6% and a specificity of 91.8% (area under receiver-operating-characteristic curve, 0.95; P  < 0.0001). The graphical influx rate constant of active adrenocortical adenomas was significantly higher than that of inactive adenomas. Uptake values for 68 Ga-pentixafor were significantly higher in patients with preferable outcomes (cured/improved) (SUV max , 15.5 ± 8.0; LLR, 6.5 ± 4.3; LCR, 6.2 ± 5.0) than in patients with nonpreferable outcomes (no improvement) (SUV max , 4.2 ± 0.5; LLR, 1.3 ± 0.2; LCR, 1.5 ± 0.6; all P  < 0.0001). Conclusion: 68 Ga-pentixafor PET/CT imaging exhibits great potential for noninvasive functional lateralization and characterization in patients with adrenocortical masses., (© 2022 by the Society of Nuclear Medicine and Molecular Imaging.)

Purpose: To evaluate the accuracy of single-photon emission computed tomography (SPECT) in diagnosing unilateral condylar hyperplasia (UCH) and to describe the condylar growth of patients with UCH., Materials and Methods: Using a retrospective study design, patients with UCH who had undergone SPECT and cone-beam computed tomography (CBCT) examinations at the same time were included in the study. We used 3D medical models based on CBCT data as the gold standard. The SPECT results were compared with the model data, and the sensitivity and specificity were calculated. To further describe the condylar growth activity, statistical analysis was performed, and the P value was set at 0.05., Results: The sample was composed of 75 patients. The sensitivity of SPECT was 55.3%, the specificity was 48.6%, and the area under the receiver operating characteristic curve was 0.53. There was no significant difference in sex between patients with and without active growth., Conclusion: The sensitivity and specificity of SPECT are poor, and SPECT alone is not suitable for evaluating the active stage of condylar growth. 3D medical modeling has good prospects for application in the diagnosis of condylar hyperplasia., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

This research was to explore the application value of three-dimensional computed tomography (CT) based on artificial intelligent algorithm in analyzing the characteristics of skin lesions in children with psoriasis. In this study, 15 children with psoriasis were selected as the observation group, and 15 children with other skin diseases were selected as the control group. The CT images were optimized, and the feature selection was carried out based on artificial intelligent algorithm. Firstly, the results were compared with the results of simple skin three-dimensional CT to determine the effectiveness. Then, the two groups of three-dimensional skin CT image features of skin psoriasis-like hyperplasia, Munro microabscess, dermal papillary vascular dilation, and squamous epithelium based on intelligent algorithms were compared. After comparison, the detection rate of psoriasis-like hyperplasia, Munro microabscess, dermal papillary vascular dilation, and squamous epithelium in the observation group was higher than that in the control group, with significant difference and statistical significance ( P < 0.05). In addition, the sensitivity of psoriasis-like hyperplasia, Munro microabscess, dermal papilla vascular dilatation, and squamous epithelium in children with psoriasis was 80.0%, 86.7%, 80.0%, and 93.3%, respectively. The specificity of psoriasis-like hyperplasia, Munro microabscess, dermal papilla vascular dilatation, and squamous epithelium in children with psoriasis was 86.7%, 93.3%, 60.0%, and 73.3%, respectively. The results showed that Munro microabscess and psoriasis-like hyperplasia had high sensitivity and specificity in all diagnostic items, which could be used as important features of skin lesion sites in the diagnosis of psoriasis in children. The research provides a basis for the clinical diagnosis of psoriasis in children, which is worthy of clinical promotion., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Lina Wang et al.)

Abstract: The current research aimed to retrospectively investigate the trends of the growth of condylar hyperplasia with serial planar scintigraphs.Patients of unilateral condylar hyperplasia with at least one follow-up planar scintigraph were retrospectively included in the study. Patients' age, gender at the initial scan, durations of following scans, and ratios between condylar activities were recorded.The study retrospectively included 111 patients of unilateral condylar hyperplasia. Patients were divided into 3 groups (progressive, relatively stable, regressive) according to ratio variation between initial and last scans. There were 23 (21%) patients fell into the progressive group, 40 (36%) patients into the relatively stable group, and 48 (43%) patients into the regressive group. More female patients were in the progressive group than those in the other groups (P < .01). There were no significant differences among the 3 groups in terms of age or durations of follow-up (P > .05). There were no strong relations between ratio differences and ages. However, a weak relation seems to exist in the regressive group with r = -0.240, (P = .10).Our investigation showed that more than a half of patients with condylar hyperplasia remain constantly or progressively active growth in patients in the follow-up scans. Roughly less than a half of patients showed regressive trends toward normal growth. Patients' age seemly does not play a role in the growth trend pattern, although there are no optimum follow-up periods, regularly follow-up scans are needed to determine the growth status of condylar hyperplasia., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Parathyroid lesions exhibiting a water clear cell morphology are exceedingly rare manifestations in primary hyperparathyroidism (PHPT), and the phenomenon has been reported both for uniglandular (water clear cell adenoma; WCCA) and multiglandular disease (water clear cell hyperplasia; WCCH). In all, only 24 previous descriptions of WCCA exist in the literature. Herein, we present seven cases with water clear cell morphology (6 WCCAs and 1 case of WCCH) in an institutional series of approximately 4000 parathyroid lesions spanning 29 years in a tertiary centre setting. Major histological attributes and clinical parameters associated with this morphological subtype were reviewed, and a literature search was conducted. WCCA and WCHH exhibited an institutional prevalence of 0.15% and 0.025%, respectively. All cases displayed histological hallmarks of water clear cell morphology, with cells exhibiting abundant cytoplasm filled with vacuoles. Atypical findings or unequivocal evidence of invasive behaviour were not observed. The gender distribution was 6:1 (F:M), patients were generally symptomatic with mild hypercalcaemia, and the median age at surgery was 53 years (range 38-78). The preoperative localisation was inconclusive in four of seven, and neck exploration of all four glands was undertaken in five cases. The excised WCCAs exhibited an average weight of 1215 mg, markedly higher than conventional adenomas, and all patients were cured of PHPT following parathyroidectomy. Interestingly, previous reports mirror our observations that these lesions often are large, in relation to their sizes biochemically fairly indolent, and indecisively localised using scintigraphy, providing correlations of possible clinical value when pre-operatively assessing these rare lesions., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aim: The present study was undertaken to investigate the occurrence of incidental findings (IFs) in the temporomandibular joint region in cone-beam computed tomography (CBCT) scans., Materials and Methods: A total of 1,850 randomly selected scans were examined for IFs in the temporomandibular joint (TMJ) area. IFs of flattening of condyle, condylar hyperplasia, condylar hypoplasia, osteophyte, osteoarthritis, bifid condyle, subchondral pseudocyst, subchondral sclerosis, and soft tissue calcification were evaluated. Data analysis was done using SPSS version 21.0., Results: A prevalence of 59.89% of IFs was noted in the present study. Flattening of the condyle was the most reported IF found in 369 (35.6%). Soft tissue calcifications were found in 294 (28.3%) and cysts in 143 (13.8%). When gender-wise distribution of TMJ IFs was evaluated, highly significant differences were noted between the gender for flattening of condyle, hyperplasia, and osteophytes at p <0.001., Conclusion: Dentists must critically evaluate CBCT images for evidence of IFs, so as to ensure comprehensive treatment package and early diagnosis of any disorders., Clinical Significance: CBCT in the recent times is widely used in dentistry for diagnostic purposes. It not only reveals a valuable diagnostic information of the intended site but also the region surrounding it. Findings obtained in the region beyond the intended site are described as IFs, which becomes important in determining an appropriate therapeutic plan. The study was conducted to evaluate the occurrence of IFs in the temporomandibular joint region.

Objective: Venous hypertension associated with a primitive basal vein of Rosenthal (BVR) has been noted as the most likely cause of idiopathic subarachnoid hemorrhage (iSAH). Other types of venous drainage variations have been scarcely studied but may further explain the cases not associated with a BVR anomaly. Our aim was to investigate if dural venous sinus (DVS) anomalies are related with iSAH., Methods: A total of 76 patients diagnosed with iSAH were identified from a prospectively maintained database and their angiographic findings compared with 76 patients diagnosed with aneurysmal subarachnoid hemorrhage., Results: On top of the BVR variations, our data showed a higher prevalence of transverse sinus hypoplasia (47.4% vs. 28.9%; P = 0.019), superior petrosal sinus hypoplasia (32.9% vs. 13.2%; P = 0.003), and clival plexus hyperplasia (65.8% vs. 43.4%; P = 0.005) in patients with iSAH. Analyzing by total number of angiograms, the iSAH group showed also a higher prevalence of inferior petrosal sinus hyperplasia (36.2% vs. 25%; P = 0.003). Of the patients with iSAH without a primitive BVR, 84% harbored ≥1 perimesencephalic DVS variation and the overall number of venous drainage variations was significantly higher in patients with iSAH., Conclusions: In addition to the well-documented BVR anomalies, there seems to be a significant relationship of other DVS variations in patients with iSAH. Transverse sinus hypoplasia, superior petrosal sinus hypoplasia, inferior petrosal sinus hyperplasia, and clival plexus hyperplasia were significantly more frequent in patients with iSAH. The presence of ≥3 of those variations would increase the suspicion of a nonaneurysmatic subarachnoid hemorrhage and could help avoid a second angiogram., (Copyright © 2021 Elsevier Inc. All rights reserved.)

MRI features are presented in a multicenter retrospective series of five patients with a unilateral masslike lesion seen in the genitourinary diaphragm at MRI performed for known or suspected prostate cancer. In all cases, the lesion appeared as an encapsulated 1.3 to 3.0 cm mass of heterogeneous low or intermediate T2 signal intensity in the genitourinary diaphragm, and targeted biopsy demonstrated benign Cowper's gland tissue. This entity is a potential imaging pitfall that could result in a diagnosis of an exophytic nodule of benign prostatic hyperplasia or local spread of prostate cancer. We present these cases to facilitate correct identification of Cowper's gland hyperplasia as an occasional finding at MRI of the prostate., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: The objectives of this study were to evaluate postsurgical condylar remodeling using a radiographical interpretation, quantify condylar volumetric asymmetry, and assess soft tissue symmetry after simultaneous unilateral high condylectomy and bimaxillary osteotomies., Methods: Sixteen patients diagnosed with unilateral condylar hyperplasia underwent unilateral high condylectomy and orthognathic surgery to correct skeletal and facial asymmetries. Cone-beam computed tomography scans were acquired before and 1-year after surgery. A radiographic consensus was evaluated for signs of reparative or degenerative changes. The condyles were mirrored and registered for assessment of volumetric and morphologic asymmetry. Soft tissue symmetry was evaluated by measurement of the distance of soft tissue pogonion from the skeletal midsagittal plane., Results: Patients who undergo unilateral high condylectomy and orthognathic surgery present radiographic signs suggestive of degenerative changes, including sclerosis, osteophytes, flattening, and erosion in both the surgical and nonsurgical condyles (P ≤0.01). There was an average volumetric improvement of 531.9 ± 662.3 mm 3 1-year postsurgery (P = 0.006). Soft tissue symmetry improved in all patients, with an average improvement of 65.8% (4.0 mm ± 2.6 mm, P ≤ 0.01). There was no correlation between the change in condylar volumetric asymmetry and the stability of the soft tissue correction., Conclusions: High condylectomy for the correction of a skeletal asymmetry in patients with condylar hyperplasia successfully reduces the volumetric asymmetry between the condyles. Postsurgical dysmorphic remodeling and degenerative changes were noted in both the surgical and nonsurgical condyles. Despite remarkable changes and remaining joint asymmetry, the soft tissue correction is stable 1-year postsurgery., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)