Multiple Myeloma Involving Left Hemicranium

Multiple myeloma (MM) is a malignant neoplasm of bone marrow affecting plasma cells. It is commonly seen as multiple punched-out lesions in the skull bone as a characteristic feature. Its presentation as hemicranial involvement with intracranial extension is rare. A 46-year-old male presented with left side scalp swelling, prominent over parietal region. X-ray showed multiple punched out lesions involving left hemicranium. CT and MRI brain showed intracranial extension of lesion without brain parenchyma invasion. He was treated with biopsy of lesion followed by chemotherapy.

Primary Pericardial Synovial Sarcoma: A Case Report and Literature Review

We report a case of a 52-year-old woman who was referred to our institution with a superior vena cava syndrome and was investigated through echocardiography, CT and MRI revealing a well-defined, encapsulated pericardial mass. The pathology, correlated with the immunohistochemical analysis, concluded it was an extremely rare primary pericardial synovial sarcoma. The patient underwent surgery and chemotherapy with a 16-month disease-free survival and passed away after a contralateral aggressive relapse. Moreover, we discuss the role of each imaging modality together with their pericardial synovial sarcoma reported features.

The Fusion of MRI and CT in the Planning of Brachytherapy for Cancer of the Uterine Cervix

Introduction: tumors of the uterine cervix are among the most common carcinomas in women. Intracervical brachytherapy is an indispensable part of curative treatment. Although the tumor is significantly more recognizable in MRI than in CT, the practical application of MRI in brachytherapy planning is still difficult. The present study examines the technical possibilities of merging CT and MRI. Materials and Methods: the treatment files and imaging of all 53 patients who had been irradiated by image-guided adaptive brachytherapy (IGABT) between January 2019 and August 2021 at the Department of Radiotherapy of the Hannover Medical School were evaluated, retrospectively. Patients were treated first with an external beam radiotherapy (EBRT) combined with simultaneous chemotherapy. After an average of 4.2 weeks, the preparation for IGABT began. The clinical target volume (CTV) for brachytherapy was contoured first in an MRI acquired before starting EBRT (MRI 1) and once more in a second MRI just before starting IGABT (MRI 2). Then, after inserting the intravaginal applicator, a CT-scan was acquired, and the CTV was contoured in the CT. Finally, the recordings of MRI 1, MRI 2, and the CT were merged, and the congruence of CTVs was quantitatively evaluated. Results: the CTV delineated in MRI 2 was, on average, 28% smaller than that in MRI 1 after an average applied radiation dose of 42 Gy. The CTV delineated in the CT covered an average of no more than 80.8% of the CTV delineated in MRI 2. The congruence of CTVs was not superior in patients with a smit sleeve in the cervical channel, with a 3D-volumetric MRI or with a contrast-enhanced sequence for MRI. Conclusion: the anatomical shape and position of the uterus is significantly changed by introducing a vaginal applicator. Despite the superior delimitability of the tumor in MRI, brachytherapy cannot be reliably planned by the image fusion of an MRI without a vaginal applicator.

Development and validation of radiologic scores for guiding individualized induction chemotherapy in T3N1M0 nasopharyngeal carcinoma

Objectives We aimed to develop and validate radiologic scores from [18F]FDG PET/CT and MRI to guide individualized induction chemotherapy (IC) for patients with T3N1M0 nasopharyngeal carcinoma (NPC). Methods A total of 542 T3N1M0 patients who underwent pretreatment [18F]FDG PET/CT and MRI were enrolled in the training cohort. A total of 174 patients underwent biopsy of one or more cervical lymph nodes. Failure-free survival (FFS) was the primary endpoint. The radiologic score, which was calculated according to the number of risk factors from the multivariate model, was used for risk stratification. The survival difference of patients undergoing concurrent chemoradiotherapy (CCRT) with or without IC was then compared in risk-stratified subgroups. Another cohort from our prospective clinical trial (N = 353, NCT03003182) was applied for validation. Results The sensitivity of [18F]FDG PET/CT was better than that of MRI (97.7% vs. 87.1%, p < 0.001) for diagnosing histologically proven metastatic cervical lymph nodes. Radiologic lymph node characteristics were independent risk factors for FFS (all p < 0.05). High-risk patients (n = 329) stratified by radiologic score benefited from IC (5-year FFS: IC + CCRT 83.5% vs. CCRT 70.5%; p = 0.0044), while low-risk patients (n = 213) did not. These results were verified again in the validation cohort. Conclusions T3N1M0 patients were accurately staged by both [18F]FDG PET/CT and MRI. The radiologic score can correctly identify high-risk patients who can gain additional survival benefit from IC and it can be used to guide individualized treatment of T3N1M0 NPC. Key Points • [18F]FDG PET/CT was more accurate than MRI in diagnosing histologically proven cervical lymph nodes. • Radiologic lymph node characteristics were reliable independent risk factors for FFS in T3N1M0 nasopharyngeal carcinoma patients. • High-risk patients identified by the radiologic score based on [18F]FDG PET/CT and MRI could benefit from the addition of induction chemotherapy.

Imaging Evaluation of Thymoma and Thymic Carcinoma

Imaging is integral in the management of patients with thymoma and thymic carcinoma. At initial diagnosis and staging, imaging provides the clinical extent of local invasion as well as distant metastases to stratify patients for therapy and to determine prognosis. Following various modalities of therapy, imaging serves to assess treatment response and detect recurrent disease. While imaging findings overlap, a variety of CT, MRI, and PET/CT characteristics can help differentiate thymoma and thymic carcinoma, with new CT and MRI techniques currently under evaluation showing potential.

Can Whole-body MRI Replace CT in Management of Metastatic Testicular Cancer? A Prospective, Non-inferiority Study.

Purpose Concerns of imaging-related radiation in young patients with high survival rates have increased the use of magnetic resonance imaging (MRI) in testicular cancer (TC) stage I. However, computed tomography (CT) is still preferred for metastatic TC. The purpose of this study was to compare whole-body MRI incl. diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) with contrast-enhanced, thoracoabdominal CT in metastatic TC.Methods A prospective, non-inferiority study of 84 consecutive patients (median age 33 years) with newly diagnosed metastatic TC (February 2018 - January 2021). Exclusion criteria were age <18 years, claustrophobia and MRI contraindications. Patients had both MRI and CT before and after treatment. Anonymised images were reviewed by experienced radiologists.Lesion malignancy was evaluated on a Likert scale (1 benign – 4 malignant). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated on patient and lesion level. For non-inferiority testing, the difference in sensitivity between CT and MRI was calculated. The level of significance was set at 5%. ROC curves and interobserver agreement were calculated.Results On patient level, MRI had 98% sensitivity and 75% specificity compared to CT. On lesion level within each modality, MRI had 99% sensitivity and 78% specificity, whereas CT had 98% sensitivity and 88% specificity. MRI sensitivity was non-inferior to CT (difference 0.57% (95% CI -1.4-2.5%)). The interobserver agreement was substantial between CT and MRI. Conclusion MRI with DWIBS was non-inferior to contrast-enhanced CT in detecting metastatic TC disease. Trial registration www.clinicaltrials.gov NCT03436901, finished July 1st 2021.

Primary Hepatoid Adenocarcinoma of Gallbladder With MB21D2/GALNT12/ARID2 Mutations: A Case Report

BackgroundPrimary hepatoid adenocarcinoma of the gallbladder is a relatively rare type of extrahepatic adenocarcinoma. The genetic changes involved in this type of adenocarcinoma were unexplained so far. We reported a rare case of primary hepatoid adenocarcinoma of gallbladder with Mab-21 domain containing 2 (MB21D2), polypeptide N-acetylgalactosaminyltransferase 12 (GALNT12), and AT-rich interaction domain 2 (ARID2) mutations, which was confirmed after surgical resection pathologically.Case SummaryA 69-year-old female with distention of hypogastrium and constipation received enema treatment, but ineffectively. No abnormalities were found on relevant physical examination. Then, the CT and MRI demonstrated a 3.3–4-cm soft tissue mass shadow in the neck of the gallbladder. The primary lesions consisted of two components: high-grade intraepithelial neoplasia of glands and hepatoid glands microscopically after laparoscope cholecystectomy. Immunohistochemical staining showed the sameness and difference of the two areas. Furthermore, tumor mutational burden (TMB) shows that the MB21D2, GALNT12, and ARID2 genes were mutated.ConclusionThis is the first report of primary hepatoid adenocarcinoma of the gallbladder with MB21D2, GALNT12, and ARID2 mutations. This will provide a theoretical basis for genetic changes in rare tumors.

A Comparative Study of Diagnostic Performance of CT and MRI for Abdominal Staging of Paediatric Renal Tumours-A Report from Tertiary Care Centre Hospital

Objective: To compare the diagnostic performance of CT and MRI for local staging of pediatric renal tumours. Materials and Methods: The study population was derived from our hospital Medical College Kolkata and Hospital. Baseline abdominal imaging performed with both CT and MRI.A retrospective review was done with 50 renal tumour cases selected and planned for nephrectomy over a study period of one year from October 2020 to November 2021. Each case was evaluated for capsular penetration, lymph node metastasis, tumour thrombus, preoperative tumour rupture, and synchronous contralateral lesions. The surgical and pathological findings were the reference gold standard. Results: The sensitivity of CT and MRI for detecting capsular penetration was 70% and 60%, respectively (P=0.73), while specificity was 84.3% and 84% (P=1.0). The sensitivity of CT and MRI for detecting lymph node metastasis was 80% and 53% (P=0.22), and specificity was 88% and 92% (P=1.0). Synchronous contralateral lesions were identified by CT in 5/12 cases and by MRI in 8/12 cases. Conclusion: CT and MRI have similar diagnostic performance for detection of lymph node metastasis and capsular penetration. MRI was more accurate in detecting contralateral synchronous lesions; how-ever these were observed in a very a smaller number of cases. Hence either modality can be used for initial loco–regional staging of paediatric renal tumours

Analysis of Discrete Wavelet Transforms Variants for the Fusion of CT and MRI Images

Background: Medical image fusion methods are applied to a wide assortment of medical fields, for example, computer-assisted diagnosis, telemedicine, radiation treatment, preoperative planning, and so forth. Computed Tomography (CT) is utilized to scan the bone structure, while Magnetic Resonance Imaging (MRI) is utilized to examine the soft tissues of the cerebrum. The fusion of the images obtained from the two modalities helps radiologists diagnose the abnormalities in the brain and localize the position of the abnormality concerning the bone. Methods: Multimodal medical image fusion procedure contributes to the decrease of information vulnerability and improves the clinical diagnosis exactness. The motive is to protect salient features from multiple source images to produce an upgraded fused image. The CT-MRI image fusion study made it conceivable to analyze the two modalities straightforwardly. Several states of the art techniques are available for the fusion of CT & MRI images. The discrete wavelet transform (DWT) is one of the widely used transformation techniques for the fusion of images. However, the efficacy of utilization of the variants of wavelet filters for the decomposition of the images, which may improve the image fusion quality, has not been studied in detail. Therefore the objective of this study is to assess the utility of wavelet families for the fusion of CT and MRI images. In this paper investigation on the efficacy of 8 wavelet families (120 family members) on the visual quality of the fused CT & MRI image has been performed. Further, to strengthen the quality of the fused image, two quantitative performance evaluation parameters, namely classical and gradient information, have been calculated. Results: Experimental results demonstrate that amongst the 120 wavelet family members (8 wavelet families), db1, rbio1.1, and Haar wavelets have outperformed other wavelet family members in both qualitative and quantitative analysis. Conclusion: Quantitative and qualitative analysis shows that the fused image may help radiologists diagnose the abnormalities in the brain and localize the position of the abnormality concerning the bone more easily. For further improvement in the fused results, methods based on deep learning may be tested in the future.