Magnetic Resonance Imaging in Primary Sclerosing Cholangitis

Primary sclerosing cholangitis (PSC) is a chronic liver disease in which there are inflammation and scarring of the bile ducts leading to fibrosis, destruction and narrowing of the bile ducts, resulting in cholestasis. In the long run, PSC can cause liver cirrhosis and failure. In clinical practice, the diagnosis of PSC is generally based on blood tests and imaging studies (currently preferably magnetic resonance cholangiopancreatography). To make a diagnosis of PSC it is necessary to exclude secondary causes of sclerosing cholangitis. The most common MRI features of PSC concerning bile ducts are: bile duct dilatation, beading, extrahepatic bile duct stenosis, wall enhancement and thickening. The most common MRI features of PSC concerning hepatic parenchyma are: rounded shape of the liver caused by hypertrophy of caudate lobe and left liver lobe, atrophy of the right lobe, enlargement of portal and/or portacaval lymph nodes, peripheral parenchymal inflammation, wedge-shaped confluent fibrosis, heterogeneity of the liver parenchyma, periportal oedema, cirrhosis with indirect signs of portal hypertension such as splenomegaly, ascites and collateral vasculature.

The role of multiparametric magnetic resonance in bladder cancer management

Multiparametric magnetic resonance imaging with VI-RADS is a newly discussed method of diagnosing bladder cancer. There are more studies suggesting implementation of mpMRI with VI-RADS to the modern scheme of treating bladder cancer. It requires much more observation and trials to give a final recommendations. The aim of the summary is to present VI-RADS scale and possibilities that appear with the method. Many studies, that were made by departments of urology or radiology, showed promising results. Background: estimation of bladder cancer depends on proper tumor staging, grading and assessment of its biological potential. It is provided by a multimodal approach using clinical, histopathological and radiological methods. Development of MRI provides the best imaging technique for locoregional staging in several other tumors. Lately it was adjusted in BCa preoperative evaluation leading to significant improvement in differentiating patients with NMIBCs and MIBCs. Objective: this article aims to approximate the fundamentals of MRI in BCa and to provide an overview of the available data on the role of VI-RADS score in the diagnostic pathway of bladder cancer.

A non-cardiac applications of T1-mapping

T1-mapping has proven to be a valuable tool in cardiac imaging. While mainly used in cardiac MRI, it is investigated for usage and application of T1-mapping to imaging of other organs and systems, including abdominal imaging, musculoskeletal imaging or neuroradiology, resulting in potential new prospects for medical imaging. T1-mapping provides numerical data on an inherent, physical property of imaged tissue – enabling quantitative and comparative assessment of tissue characterization f.ex. fibrosis, amyloid contents, fatty transformation, myelinization or contrast enhancement as well as lesion characterization. Reports of application of T1-mapping in assessment of liver, kidney or pancreas fibrosis create perspectives of reducing the number of invasive diagnostic procedures, such as biopsies, as well as monitoring treatment response or disease progression. Furthermore T1-mapping can potentially replace MR elastography in assessment of liver fibrosis or used in thyroid fibrosis to define degree of destruction in AIT or other thyroid diseases. In neuroradiology T1-mapping is promising in the spine imaging, enabling better characterization of spinal cord lesions also has a potential to evaluate effectiveness of conservative or operative treatment. There are also successful reports of employing T1-mapping in orbital imaging, such as in predicting steroid resistant diplopia in Graves’ disease or in evaluation of diabetic cataracts. In musculoskeletal imaging, T1-relaxation could be a possible biomarker of bone quality that could play a role in osteoporotic fracture risk assessment. In conclusion, T1-mapping shows promise as a quantitative method complementary to standard MR imaging beyond cardiac MRI, and needs further research and validation efforts to establish its place in standard diagnostic protocols.

Abnormal shadow on chest radiograph: a supra – or infradiaphragmatic finding?

Incidental findings on chest X-ray of oncological patients need further evaluation in contrast-enhanced computed tomography (CT). We report two cases of abnormal shadows, detected on radiograph, in patients with breast cancer: the first one projected under the left hemidiaphragm and the second one obscuring the right hemidiaphragm. Both patients were asymptomatic, subjected to a surgery and to a CT. The first scan revealed a 15 mm diameter nodule in left lung with smooth margins and central calcifications. Whereas, the second exam showed a subcapsular, ring, calcified lesion in the liver. In both cases, CT was essential for staging and therapeutic choice.

The role of Interventional Radiology in primary and metastatic liver disease – a short review of primary methods and therapy approaches

Primary and metastatic liver tumors are an increasing global health burden. As of 2020 colorectal cancer (CRC), which often presents with hepatic metastasis in the course of the disease was a second leading cause of cancer-related mortality worldwide. This was followed by hepatic cell carcinoma (HCC). Besides systemic therapies and surgical methods, which are not always applicable, many locoregional approaches were developed and are being increasingly implemented in the field of interventional radiology (IR) – both as primary and bridging procedures. The purpose of this article is to outline and briefly discuss these primary approaches used in IR in liver neoplastic disease.

Bilateral spontaneous pneumothorax in a non-intubated COVID-19 patient

Spontaneous bilateral pneumothorax is a rare condition occurring only in 1,3% of cases of spontaneous pneumothorax. Although spontaneous pneumothorax is recognized complication of COVID it is usually associated with severe cases of COVID pneumonia with massive lung involvement and a high level of inflammatory cytokines – so called "inflammatory storm". Large percentage of this patients requires life support with mechanical ventilation and pneumothorax is usually accompanied with pneumomediastinum. Nevertheless occurrence of spontaneous pneumothorax in non-intubated patients is very low. Therefore the presented case is exceptional in two ways – spontaneous pneumothorax occurred in non-intubated patient and is presented bilaterally. Early diagnosis of spontaneous bilateral pneumothorax can pose a diagnostic dilemma as it mimics progression of lung involvement in the course of COVID, pulmonary embolism or myocardial infarction. In our case apart from COVID pneumonia, patient had typical clinical presentation of myocardial infarction and known coronary artery disease, which initially mislead clinicians toward diagnosis of myocardial infarction (MI). However after exclusion of MI, chest radiograph was requested which revealed bilateral pneumothorax. The exact mechanism of pneumothorax development in non-intubated patients is not clear. Lung inflammation in COVID causes formation of pneumatocele, which can predispose to spontaneous pneumothorax. It is important to note that our patient developed pneumothorax without evident pneumatocele, underlying lung condition or history of trauma. This case shows that bilateral pneumothorax in COVID-19 can develop also in patients with only mild clinical course of COVID pneumonia. Early diagnosis and proper management is essential and can prevent life-threatening complications.

Cerebral amyloid angiopathy-related inflammation (CAA-ri) in a patient positive for SARS-CoV-2 – radiological findings and differential diagnosis

84-year old female with confirmed, asymptomatic SARS-CoV-2 infection was admitted to Neurology Department after sudden onset of left-sided hemiparesis and impaired consciousness. Imaging played a key role in diagnostic process, in course of which the diagnosis of cerebral amyloid angiopathy-related inflammation (CAA-ri) was made. According to latest research, SARS-CoV-2 infection is considered to cause various neurological complications. To my best knowledge this is the first case of CAA-ri and SARS-CoV-2 coexistence to be reported.

Abdominal and pelvic imaging findings in COVID-19

Pulmonary imaging findings of Coronavirus disease 2019 (COVID-19) has been widely described, but recently few studies have been published about abdominal and pelvic radiological presentation. The aim of this study was to provide an overview of abdominal imaging findings in patients with COVID-19. After investigation of recent published literature we came to conclusion that most common findings are associated with gastrointestinal abnormalities with mural thickening of part of gastrointestinal tract being the most common, followed by vascular and less frequently described solid organ and gallbladder abnormalities. It is important to be familiar with abdominal COVID-19 manifestations, since they’re often implicated with the development of poor clinical outcomes.

Chest CT findings in COVID-19

RT-PCR is the gold standard in the diagnosis of COVID-19 infections, due to its high specificity. However, there are clinical situations in which chest CT may prove vital, for example in patients with high clinical and epidemiologic suspicion towards COVID-19 before positive RT-PCR conversion or in detecting complications. Researchers have developed scales that, based on the findings in chest CT, help predict the severity of the disease. There are three main pathologic patterns of lung injury that correlate with the duration of COVID-19 symptoms. Epithelial pattern with diffuse alveolar damage and desquamation/reactive hyperplasia of pneumocytes; vascular pattern with capillary congestion and (micro)thrombi and fibrotic pattern with interstitial fibrous changes. The epithelial pattern and vascular pattern appear early, even before the symptoms of the disease, whereas the fibrous pattern appears approximately three weeks after the onset of the disease. Typical findings on chest CT in COVID-19 infection are: GGO, consolidation, GGO mixed with consolidation, interlobular septal thickening, air bronchogram sign, crazy paving, bronchial wall thickening and vascular enlargement. Findings that may suggest a different etiology include multiple nodules, tree-in-bud opacities, bronchiectasis, pleural and pericardial effusion, extensive consolidations.

Methylphenidate-induced psychosis in a young antipsychotic-naïve female patient

Methylphenidate (MPD) is commonly prescribed for patients with Attention Deficit/Hyperactivity Disorder (ADHD). Although used off-label, MPD forms part of complex and multifactorial treatment regimen for narcolepsy and hypersomnia, together with including behavioural interventions. The drug is sometimes also prescribed off-label to subjects with other mental illness or somatic condition to improve intellectual outcome, ease fatigue or enhance the ability to concentrate. Common side effects include headache, insomnia, decreased appetite and hypertension. Concurrently, clinicians should be aware of relatively rare but potentially threatening adverse effects including agitation and psychotic symptoms. Several case reports regarding MPD-induced psychosis have been published, but most of them regard children or teenagers (1) and much less is known about drug-induced psychosis in adults (2). In this article, we present a case report of MPD-induced psychosis in a 31-year-old, antipsychotic-naïve patient. Careful evaluation including clinical examination, medical and family history and possible early signs of psychosis is recommended each time before MPD treatment will be initiated.