Journal of the Belgian Society of Radiology最新文献

Teaching point: Spectral tomography offers valuable complementary diagnostic tools in the setting of cerebral fat macroembolism, a rare condition often presenting with nonspecific clinical symptoms.

Key message: Patients with polysplenia syndrome can develop pulmonary hypertension and heart failure due to underlying congenital heart disease, underscoring the need for early recognition and intervention to prevent further progression of the condition.

Objectives: This study aims to assess the performances of T1‑weighted (T1W) and T2‑weighted (T2W) Dixon sequences as replacements for the standard magnetic resonance imaging (MRI) protocol for diagnosing active and chronic sacroiliitis. Materials/Methods: This single‑centre, prospective study included 107 patients who underwent 3 Tesla MRIs. The patients with inflammatory low‑back pain (aged 18-50 years) were included. The exclusion criteria included pregnancy, pelvic infection/malignancy history, pelvic metal implants or foreign body artefacts. The imaging protocol comprised standard T1W and T2W fat‑saturated (T2W‑FS) sequences and T1W-T2W Dixon sequences. Active sacroiliitis signs were assessed by comparing T2W‑FS images with T2W Dixon water‑only (WO) images. Chronic sacroiliitis signs were evaluated by comparing the standard T1W sequence with T1W-T2W Dixon fat‑only (FO), in‑phase (IP) and out‑of‑phase (OP) images. The quantitative analysis involved calculating signal‑to‑noise ratios (SNRs) and contrast‑to‑noise ratios (CNRs) for bone marrow edema (BME) and periarticular fat deposition (PFD). Descriptive statistics, correlation, diagnostic performance tests and interobserver reliability tests were performed in the qualitative analysis. Results: There were no statistically significant differences in BME detection between the T2W‑FS and T2W Dixon‑WO images. T2W Dixon exhibited significantly greater SNRs-CNRs than did the standard protocol for BME and periarticular fat deposition assessments. T1W-T2W Dixon imaging demonstrated sufficiently high diagnostic performance for detecting erosions, periarticular fat deposition and ankylosis compared with the standard protocol. Conclusions: The T2W Dixon sequence has the potential to replace the standard protocol, which would reduce acquisition time. However, we do not recommend the use of the T1W Dixon sequence in routine practice, since standard T1W images provide similar or superior results to T1W Dixon images.

Rhabdomyosarcoma is the most common soft tissue sarcoma in children but is less frequent in adults, with the head and neck region as primary site. Magnetic resonance imaging (MRI) is the preferred diagnostic imaging tool, though its imaging characteristics are relatively non‑specific and overlap with other soft tissue sarcomas. The prognosis of rhabdomyosarcoma depends on the primary tumour site and size, with parameningeal head and neck localisations having a less favourable prognosis due to the higher risk of spread. Therefore, further imaging including brain and spinal MRI is recommended. Teaching point: The prognosis of rhabdomyosarcoma depends on the primary tumour site and size, with parameningeal head and neck localisations having a less favourable prognosis due to the higher risk of spread.

Teaching point: Accessory extraocular muscles are rare intraorbital congenital structures that can cause diplopia and restrictive strabismus.

Synovial haemangioma is a rare benign entity, most common in children and adolescents. These tumours can extensively infiltrate joint structures and periarticular soft tissues, making management challenging. Magnetic resonance imaging (MRI) has a key role in diagnosis and therapeutic planning. The authors report the case of a 17‑year‑old male with multiple synovial haemangiomas, highlighting the complexity of management and the essential role of MRI in assessment and treatment. Teaching point: Synovial haemangiomas may lead to bone remodelling, periarticular soft‑tissue infiltration and, ultimately, limb deformities and early‑onset osteoarthritis. Magnetic resonance imaging (MRI) is crucial for diagnosis as well as for guiding therapeutic planning.

Ewing Sarcoma Breakpoint Region 1 and POZ/BTB And AT Hook Containing Zinc Finger 1 (EWSR1::PATZ1) gene fusion central nervous system (CNS) tumors are increasingly recognized as a potential distinct entity, with only limited reported cases. The imaging characteristics of these tumors have not been well established. In this study, we provide a detailed radiological description of a case in a 24‑year‑old man and conduct a literature review to identify common imaging features. A total of seven cases, including our own, were evaluated. Histopathological diagnoses included two ependymomas, an infantile glioblastoma, an astroblastoma, a ganglioglioma, and two gliomas not otherwise specified. Common imaging patterns included avid contrast enhancement, intratumoral cysts, intraventricular location or extension leading to hydrocephalus, and sharp delineation. Additional frequently observed features included calcifications and hemorrhagic foci. In conclusion, although the histopathological appearance of EWSR1::PATZ1 gene fusion CNS tumors is diverse, there are consistent imaging features. Recognition of these features can be valuable in the diagnostic process, as radiologists can be the first to suggest the diagnosis.

We report the case of a 4‑year‑old child who experienced rapid neurological decline following opioid administration during anesthesia for an interventional procedure to treat a vein of Galen aneurysm. Cerebral magnetic resonance imaging (MRI) revealed marked cytotoxic edema in both cerebellar hemispheres and the brainstem, indicative of opioid‑induced neurotoxicity. A follow‑up MRI, performed 2 weeks later, showed profound cerebellar and brainstem atrophy and showed reduction in mass effect due to cytotoxic edema. Teaching point: Pediatric opioid‑use‑associated neurotoxicity with cerebellar edema (POUNCE) syndrome is a rare condition, characterized by cerebellar edema as a hallmark feature, which can be identified on MRI in pediatric patients following opioid use.

Teaching point: Extradigital glomus tumor should be considered in the differential diagnosis of a highly vascular solid lesion that is painful on palpation.