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Meningioangiomatosis: MR imaging and pathological correlation in two cases.

Meningioangiomatosis is a rare, benign neoplastic disorder involving the cortex and leptomeninges. The pathological findings are characterised by proliferation of meningothelial cells and leptomeningeal vessels and calcifications within the mass. We experienced two cases of pathologically confirmed meningioangiomatosis, one as a solitary cortical mass with calcification and the other as a cortical lesion manifested as extensive intracranial haemorrhage. On MRI, the first case showed an isointense cortical mass in the left frontal lobe and homogeneous enhancement on the contrast-enhanced study. The second case showed a target-like lesion with a peripheral dark signal rim on T2-weighted images accompanied by extensive haemorrhage in the adjacent frontal lobe and lateral ventricles.

Child↗

MR imaging analysis of heterogeneous leiomyomas of the uterus.

Thirty-six leiomyomas from the same number of patients that were heterogeneous on MR imaging were evaluated for analyzing their MR patterns and for differentiating each type of secondary changes by means of MR imaging-pathologic correlation. The tumors with a mean diameter of 9 cm could be classified into 4 patterns depending on the morphological appearance of signal intensity: speckled (n = 14); nodular (n = 11); cystic (n = 9); or indeterminate (n = 2). Speckled pattern was associated with a mild degree of hyaline or myxoid degeneration or focal necrosis. Nodular pattern was caused by necrosis or cellular leiomyoma, and cystic pattern was related to severe hyaline or myxoid degeneration or necrosis. Each type of secondary changes within leiomyomas showed distinctive MR findings, if they were severely involved. However, use of an additional contrast-enhanced study was necessary in some instances for further clarification. MR imaging has a potential in distinguishing each type of secondary changes that occur in leiomyomas. Various degenerative changes occur in approximately 65% of uterine leiomyomas, and are caused mainly by alteration in the blood supply originating from rapid growth, pregnancy, mechanical accident, and postmenopausal atrophy. These changes include hyaline, mucoid, or myxoid degeneration, calcification, cystic changes, necrosis (red degeneration), and fatty metamorphosis. It is well known that the presence of degenerative changes within leiomyomas can be predicted on MR imaging by a heterogeneous signal intensity on T2-weighted images, although clear distinction of each type of degeneration can not be made by this modality. Recently, cellular leiomyoma, one of the variants of leiomyomas, was also reported to cause heterogeneous signal intensity. However, because various other uterine tumors can also have similar signal intensity on MR imaging, further evaluation for the heterogeneous leiomyomas appears to be necessary. The purpose of our study was to analyze the patterns of heterogeneous leiomyomas and to differentiate each type of secondary changes by means of MR imaging-pathologic correlation.

Adult↗

GE-IA-NAM: gene-environment interaction analysis via imaging-assisted neural additive model.

MOTIVATION: Gene-environment (G-E) interaction analysis is crucial in cancer research, offering insights into how genetic and environmental factors jointly influence cancer outcomes. Most existing G-E interaction methods are regression-based, which may lack flexibility to capture complex data patterns. Recent advances have investigated deep neural network-based G-E models. However, these methods may be more vulnerable to information deficiency due to challenges such as limited sample size and high dimensionality. Apart from genetic and environmental data, pathological images have emerged as a widely accessible and informative resource for cancer modeling, presenting its potential to enhance G-E modeling. RESULTS: We propose the pathological imaging-assisted neural additive model for G-E analysis (GE-IA-NAM). The flexible and interpretable additive network architecture is adopted to account for individualized effects associated with genetic factors, environmental factors, and their interactions. To improve G-E modeling, an assisted-learning strategy is investigated, which adopts a joint analysis to integrate information from pathological images. Simulations and the analysis of lung and skin cancer datasets from The Cancer Genome Atlas demonstrate the competitive performance of the proposed method. AVAILABILITY AND IMPLEMENTATION: Python code implementing the proposed method is available at https://github.com/Mr-maoge/NAM-IA-GE. The data that support the findings in this article are openly available in TCGA (The Cancer Genome Atlas) at https://portal.gdc.cancer.gov/.

Gene-Environment Interaction↗

Pneumoconiosis: comparison of imaging and pathologic findings.

Pneumoconiosis may be classified as either fibrotic or nonfibrotic, according to the presence or absence of fibrosis. Silicosis, coal worker pneumoconiosis, asbestosis, berylliosis, and talcosis are examples of fibrotic pneumoconiosis. Siderosis, stannosis, and baritosis are nonfibrotic forms of pneumoconiosis that result from inhalation of iron oxide, tin oxide, and barium sulfate particles, respectively. In an individual who has a history of exposure to silica or coal dust, a finding of nodular or reticulonodular lesions at chest radiography or small nodules with a perilymphatic distribution at thin-section computed tomography (CT), with or without eggshell calcifications, is suggestive of silicosis or coal worker pneumoconiosis. Magnetic resonance imaging is helpful for distinguishing between progressive massive fibrosis and lung cancer. CT and histopathologic findings in asbestosis are similar to those in idiopathic pulmonary fibrosis, but the presence of asbestos bodies in histopathologic specimens is specific for the diagnosis of asbestosis. Giant cell interstitial pneumonia due to exposure to hard metals is classified as a fibrotic form of pneumoconiosis and appears on CT images as mixed ground-glass opacities and reticulation. Berylliosis simulates pulmonary sarcoidosis on CT images. CT findings in talcosis include small centrilobular and subpleural nodules or heterogeneous conglomerate masses that contain foci of high attenuation indicating talc deposition. Siderosis is nonfibrotic and is indicated by a CT finding of poorly defined centrilobular nodules or ground-glass opacities.

Aged↗

Imaging corneal pathology in a transgenic mouse model using nonlinear microscopy.

A transgenic mouse model with a Clim [co-factor of LIM (a combination of first letters of Lin-11 (C. elegans), ISL1 (rat), and Mec-3 (C. elegans) gene names) domain proteins] gene partially blocked in the epithelial compartment of its tissues is used to establish the sensitivity of intrinsic reflectance nonlinear optical microscopy (NLOM) to stromal and cellular perturbations in the cornea. Our results indicate dysplasia in the squamous epithelium, irregular collagen arrays in the stroma, and a compromised posterior endothelium in the corneas of these mice. As suggested by biochemical data, the collagen alterations are likely due to collagen III synthesis and deposition during healing and remodeling of transgenic mice corneal stromas. All of the topographic features seen in NLOM images of normal and aberrant corneas are confirmed by coregistration with histological sections. In this work, we also use ratiometric redox fluorometry based on two-photon excited cellular fluorescence from reduced nicotinamide adenine dinucleotide (NAD)(P)H and oxidized flavin adenine dinucleotide (FAD) to study mitochondrial energy metabolism. Employing this method, we detect higher metabolic activity in the endothelial layer of cornea compared to an epithelial layer located further away from the metabolites. The combination of two-photon excited fluorescence (TPF) with second harmonic generation (SHG) signals allows imaging to aid in understanding the relationship between alternation of specific genes and structural changes in cells and extracellular matrix.

Animals↗

Magnetic resonance imaging in pathologically proven Hallervorden-Spatz disease.

We present an 11-year-old girl in whom high field strength MRI performed 2 1/2 years and 6 months before her death showed prominent hypointensity in the globus pallidus and substantia nigra consistent with iron deposition. This finding suggested Hallervorden-Spatz disease, which was confirmed at autopsy.

Basal Ganglia Diseases↗

Computed tomography, magnetic resonance imaging, and pathologic observations of the effects of intrathecal metrizamide and iohexol on the canine central nervous system.

A two-group crossover design experiment was used in eight dogs to compare the effects of intrathecally injected (0.25 mL/kg, 180 mg I/mL) metrizamide and iohexol. Additional acute observations were made in four of the dogs following a high dose (0.45 mL/kg of 300 mg I/mL) of each agent. In computed tomographic observations, there was progressive passage of each contrast medium across the interface between the cerebrospinal fluid and the brain, and statistically identical levels of each contrast medium were present in the cerebral gyri. There was a similar passage of contrast medium across the interface between the cerebrospinal fluid and the spinal cord. The rate of passage of each agent into the brain parenchyma suggested their active transport rather than a simple diffusion. In both T2-weighted magnetic resonance imaging and histopathologic studies, there was no evidence of cerebral edema following either high or low doses of each agent. In T1-weighted images made following the intravenous injection of gadolinium-DTPA (0.1 mmol/kg), the blood-brain barrier was intact.

Animals↗

[CT-guided percutaneous needle biopsy for diagnosis of atypical pulmonary tuberculosis: analysis of clinical, imaging and pathological data in 15 cases].

OBJECTIVE: To explore the clinical value of CT-guided percutaneous needle biopsy (PCNB) for diagnosis of atypical pulmonary tuberculosis. METHODS: The data from 15 patients undergoing diagnostic PCNB for pulmonary tuberculosis were retrospectively analyzed. Prior to PCNB, definitive diagnosis failed to be obtained from other examinations including sputum smear in 10 cases, fiberoptic bronchoscopy in 12, chest X-ray in 13, CT scan in 15, and position emission tomography (PET) with CT examination in 1 case. RESULTS: Sputum smears and fiberoptic bronchoscopy both failed to produce positive results and pulmonary and/or mediastinal lesions were shown by chest X-ray, CT, and PET-CT. Pulmonary tuberculosis were diagnosed in the 15 cases by histopathological examination following PCNB, and pneumothorax in relation to PCNB occurred in 3 cases and hemoptysis in 1 case. CONCLUSION: PCNB provides a safe and accurate means for diagnosis of pulmonary tuberculosis when imaging and other diagnostic modalities fail to result.

Adolescent↗

Imaging and pathology in pediatric neurological disorders.

Radiologic and pathologic findings correlate well in many pediatric neurologic disorders. However, there are some exceptions. Radiologic techniques are unable to visualize or identify pathologic changes in some diseases (e.g. status marmoratus and subdural fluid collection), whereas pathologic examination fails to clarify the histologic substrate of radiologic abnormalities in other conditions (e.g. Fukuyama-type congenital muscular dystrophy and neurofibromatosis type 1). Although studies to solve these issues have met with practical difficulties, important progress has recently been made on some disorders such as Fukuyama-type congenital muscular dystrophy and acute necrotizing encephalopathy.

Central Nervous System Diseases↗

Assessment of multiple sclerosis lesions with spherical harmonics: comparison of MR imaging and pathologic findings.

Spherical harmonics (SH) were used to approximate the volume and three-dimensional geometry of multiple sclerosis (MS) lesions in deceased patients. The institutional ethical committee does not require its approval for studies involving pathologic specimens. Pathologic findings were used as the reference standard. In addition, lesion volume was measured with cylindrical approximation (CA). Volumetric comparisons of biases were based on summary statistics, Spearman correlation, Wilcoxon test, and two-way analysis of variance. Shape comparison metrics included mean distance and Dice similarity coefficient (DSC). Eight of 11 lesions had smaller biases with SH method (P < .001). Median biases with SH and CA did not differ significantly, as compared with pathologic findings (r = 1.00 vs 0.99, respectively). Variances of the biases were significantly smaller for SH (P = .04). Ranges of normalized distance and DSC were 0.1%-2.5% and 75%-96%, respectively. Mean DSC was significantly higher than 70% (P < .001). SH method provided unbiased lesion volume and added geometric information that may enable a better understanding of the pathogenesis and lesion evolution over time.

Brain↗

Locally advanced breast cancer treated with primary chemotherapy: comparison between magnetic resonance imaging and pathologic evaluation of residual disease.

AIMS AND BACKGROUND: We evaluated the response of locally advanced breast cancer to induction chemotherapy using MRI techniques. The size and vitality of any residual pathologic tissue was quantified by means of morphologic and dynamic analysis. A curve derived from the dynamic parameters shows the uptake intensity with respect to the time elapsed since administration, which is related to vascularization and therefore indirectly reflects the angiogenesis of malignant tissue. METHODS AND STUDY DESIGN: A group of 30 patients were examined with MRI for staging purposes before undergoing treatment and subsequently to assess the response to treatment. Alterations in size and dynamic parameters were closely monitored. RESULTS: The overall accuracy was 90%, the sensitivity 96%, the specificity 75%, the positive predictive value 92.5% and the negative predictive value 66%. Interestingly, analysis of the dynamic curves made it possible to obtain additional information regarding the angiogenetic activity of the residual tumor. CONCLUSIONS: Evaluation of the response to treatment by means of conventional imaging and clinical examination can be particularly difficult because of the fibrosis induced by cytotoxic drugs or the small volume of residual disease. The additional information supplied by MRI could therefore allow a more conservative surgical approach in selected cases of optimal response to treatment, as well as a much more accurate follow-up. Furthermore, the variation in dynamic parameters according to the vitality of residual disease could in the future become a useful tool for monitoring the effectiveness of anti-angiogenetic drugs.

Antineoplastic Combined Chemotherapy Protocols↗

MR and TL-210 spect imaging with pathologic correlation for the assessment of CNS lymphoma vs. toxoplasmosis in AIDS patients.

PURPOSE: Analyze the value of TL-201 (Tl) brain single-photon emission computed tomography (SPECT), to differentiate CNS lymphoma from toxoplasmosis in AIDS patients. MATERIAL AND METHODS: Twenty-four AIDS patients with MR enhancing lesion(s), underwent a brain Tl SPECT. Final diagnosis was established by pathology and clinical/MR follow-up. RESULTS: Nine patients had CNS tumor, 9 toxoplasmosis and 6 other non-tumorous lesions. The sensitivity of T1 to diagnose CNS tumor was 77% and the specificity 93%. Two false negative studies correspond to tumors with significant necrosis. CONCLUSIONS: T1 proved useful for differentiating brain neoplasm from toxoplasmosis. Tumors with significant necrosis, did not show the expected increase in T1 uptake. Determination of T1 uptake ratios help detect tumor with faint tracer uptake.

AIDS-Related Opportunistic Infections↗

Failure of autotransplantation of the spleen in dogs: an anatomic, radionuclide imaging, and pathologic study.

Although splenic autotransplantation is successful in mice and rats, with regeneration occurring in any location, no extensive study had been performed on dogs. We transplanted the spleen into subcutaneous and intraperitoneal locations on 40 dogs. Four to six months later, splenic scanning and reexploration was carried out. Spleens were removed, weighed, and microscopic sections were made. Months later, no uptake was present on scanning, weight was less than 6% of original weight, and little identifiable splenic tissue was present on microscopic sections. When 15 small sections were transplanted to the omentum in a "necklace" fashion, good uptake and preservation were seen after six months. The small amount of spleen transplanted by this method, however, makes this an unsatisfactory option. We conclude, therefore that our large-animal experiments do not provide a basis on which to recommend autotransplantation of the spleen in humans. Preservation of splenic tissue by splenorrhaphy is still the treatment of choice.

Animals↗

Delayed radiation myelopathy: serial MR-imaging and pathology.

Clinical data, MR-scans, time-dose fractionation schemes and neuropathologic findings of two cases of delayed radiation myelopathy (DRM), are presented. Both patients, a 72-year-old diabetic woman with cervical lymphnode metastasis from a squamous cell carcinoma and a 46-year-old woman with tonsillar carcinoma, developed paraparesis followed by quadriplegia, at 7 and at 10 months following radiation. The spinal cord received 46 and 49 Gy. (Fraction dose 2.25 Gy and 2.0 Gy, 4 times/week). Serial MR-scans showed spinal cord enlargement and focally increased signal intensity (T1-gd). The second patient survived and stabilized following therapy with coumarins. The first patient died 13 months after radiotherapy. At autopsy necrosis, local calcium deposits, lipid macrophages and swollen astrocytes were observed in the white matter. There was slight hyalinosis of the intramedullary vessel walls. We conclude that serial MRI may be helpful to distinguish DRM from other causes of spinal cord injury. DRM may occur at a total dose less than 50 Gy. Additional risk factors (diabetes, hypertension), and fraction doses above 2 Gy contribute to the development of DRM.

Aged↗

Pleomorphic xanthoastrocytoma: clinical, imaging and pathological features of four cases.

Four cases of pleomorphic xanthoastrocytoma (PXA) were collected from among 688 glioma patients who underwent operation at the Institute of Neurosurgery, University of Naples "Federico II" between January 1973 and December 1994. Three were females and one male, ranging in age from 10 months to 65 years. Three tumors were superficial in location, appearing as a meningo-cerebral mass in the temporo-parietal region. In one case, the tumor was situated deep within the brain (capsulo-thalamic region), without contact with leptomeninges. Three patients had experienced epileptic seizures, whereas one patient presented with an ictal episode. Tumor excision was grossly total in two cases, and subtotal in the remaining two. In three cases, histological examination demonstrated a "typical" PXA; conversely one tumor (subtotal excised) was an "atypical" PXA. The two patients with incomplete surgical resection were postoperatively treated with fractionated brain radiation therapy. Of the two patients who had grossly total removals, one showed tumor recurrence 6 years after surgery, and underwent operation (the recurrent neoplasm did not exhibit malignant transformation); the second patient was free of tumor at 14 months following craniotomy. Of the two patients who had undergone subtotal removals, one died because of massive regrowth of the lesion 22 months after surgery, whereas the second patient was asymptomatic at 1 year follow up.

Adolescent↗

Computed tomography and magnetic resonance imaging of pathologic conditions of the middle ear.

Computed tomography (CT) is an excellent technique for demonstrating even small abnormalities of the thin and complex bony structures of the middle ear. For this reason, it is the modality of choice in the study of conductive hearing loss (CHL). However, not every patient complaining of CHL requires a CT study. In fact, established indications encompass complex conditions, such as the complications of acute and chronic otomastoiditis, the postoperative ear in chronic otomastoiditis or in the localization of prosthetic devices, and the assessment of congenital or vascular anomalies. Particularly, the precise extent of bone erosion associated with cholesteatoma is correctly demonstrated by high resolution CT. Conversely, although fistulization through the tegmen tympani or the posterior wall of temporal bone is usually detectable by CT, the actual involvement of meninges and veins are better assessed by magnetic resonance (MR). MR is also indicated when complicated inflammatory lesions are suspected to extend into the inner ear or towards the sigmoid sinus or jugular vein. Neoplasms arising from or extending into the middle ear require the use of both techniques as their combined data provide essential information. Most important data for surgical planning concern the destruction of thin bony structures and the relationships of the lesion with the dura and surrounding vessels. DSA and interventional vascular techniques maintain an essential role in the presurgical work-up and embolization of paragangliomas extended into the middle ear.

Cholesteatoma↗