Journal of the Belgian Society of Radiology最新文献

Paediatric cervical spine trauma, though rare, is difficult to detect as the injuries are often soft-tissue injuries and thus not visible using conventional radiography. A 6-and-a-half-year-old child presented with neck pain following a fall. A thorough radiological workup over several days demonstrated soft-tissue injuries, undetected by initial cervical X-rays, requiring MRI to definitively prove. The patient recovered with conservative treatment. Teaching Point: Paediatric cervical spine injuries often present with soft tissue injuries, which can missed on X-rays and require further imaging to detect.

Introduction: Microhemorrhages have not been described in mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes syndrome (MELAS) on magnetic resonance imaging (MRI). Main symptoms and/or important findings: A MELAS-patient had a rapid succession of 3 stroke-like episodes with dysphasia, visual field deficits and paresis of the right arm. MRI showed a lesion with corticosubcortical vasogenic edema without reduced diffusion, conforming to a stroke-like MELAS-lesion. Microhemorrhages within MELAS-lesions were detected on MRI. The main diagnoses, therapeutic interventions, and outcomes: Microhemorrhages are an atypical imaging finding in MELAS. The patient was treated with L-arginine.

Conclusion: Microhemorrhages can present on MRI in (sub)acute MELAS lesions and may reflect mitochondrial microangiopathy.

Teaching Point: Dural sinus stenosis are a rare cause of increased intracranial pressure and can be treated in some cases by stenting.

Objectives: The aim of this study was to evaluate the residual value of Conventional Radiography in children with arthralgia clinically suspected of Juvenile Idiopathic Arthritis (JIA).

Materials and methods: Three hundred seventy-two patients aged 1-18 years suspected of JIA were retrospectively reviewed. All patients had foot and ankle plain films performed in standard two projections: ankle in antero-posterior and lateral, and foot in antero-posterior and oblique. The cohort was divided into two groups: patients with confirmed JIA and non-JIA control group of children with foot and ankle arthralgia without diagnosis of inflammatory connective tissue disease. Radiographic findings in both groups were compared.

Results: In 40% of JIA and 70% of non-JIA patients radiographs were normal. All radiographic findings were significantly more common in JIA than in non-JIA group (p = 0.000). Soft tissue swelling was the most frequent abnormality found in JIA patients (31, 51%) and only in 2.41% of non-JIA patients (p = 0.000). Osteoporosis and joint space narrowing were also significantly more common in JIA group (p = 0.000). The majority of imaging findings in non-JIA group were non-inflammatory abnormalities.

Conclusion: Conventional radiography is an important tool in differential diagnosis of arthralgia of unknown etiology, as soft tissue swelling, osteoporosis and joint space narrowing are significantly more common in JIA patients as compared with patients without the diagnosis of inflammatory connective tissue disease. However, in case of high clinical suspicion of JIA and normal radiography, we recommend subsequent ultrasound (US) and/or MRI to allow early treatment.

Teaching Point: Nasal and nasopharyngeal Rosai-Dorfman disease is a rare cause of nasal obstruction.

Spinal teratomas are rare spinal tumors. Most of these present in children. We present the imaging findings of a spinal teratoma that was not symptomatic until adulthood. Teaching point: Congenital spinal tumors may occasionally present for the first time in adulthood, and radiologists need to be familiar with the imaging findings.

Objectives: To determine the performance of virtual monoenergetic images (VMIs) of the portal venous phase (PVP) compared with the pancreatic-phase image for pancreatic ductal adenocarcinoma (PDAC) evaluation.

Materials and methods: This retrospective study enrolled 64 patients with PDAC who underwent pancreatic CT with dual-layer spectral CT between February 2018 and January 2020. A polychromatic pancreatic-phase image and VMIs at 40 (VMI₄₀), 55 (VMI₅₅), and 70 keV (VMI₇₀) of the PVP were generated. The tumor-to-pancreas contrast-to-noise ratio (CNR), attenuation difference, peripancreatic vascular signal-to-noise ratio (SNR), and CNR were compared among the four images. Subjective image analysis was performed for tumor conspicuity, heterogeneity, size, and arterial invasion.

Results: VMI₄₀ and VMI₅₅ demonstrated higher tumor-to-pancreas CNR, attenuation difference, and higher peripancreatic vascular CNR and SNR than the pancreatic-phase image and VMI₇₀ (p < .001). On subjective analysis, VMI₅₅ showed the best tumor conspicuity. Moreover, the inter-reader agreement for arterial invasion in VMIs from the PVP was not inferior to that in the pancreatic-phase image.

Conclusion: For evaluating PDAC, the VMI₅₅ of the PVP was superior to the pancreatic-phase image in terms of tumor conspicuity and peripancreatic vascular enhancement. Therefore, the VMI₅₅ of the PVP could be an alternative to the pancreatic-phase scan in patients suspicious of PDAC.

Teaching Point: When a renal angiomyolipoma (AML) is incidentally detected on imaging, the venous system should be assessed for intravascular fat component.

A 27-year-old woman was confirmed to have extraabdominal desmoid-type fibromatosis. Desmoid-type fibromatosis is a very rare connective tissue neoplasm with the extraabdominal type even more rare. It is most commonly found in proximal structures such as shoulders, neck, chest, and extremities. There are few case reports for desmoid-type fibromatosis located in paraspinal soft tissue. We report a case of desmoid-type fibromatosis mimicking a myxofibrosarcoma. Teaching Point: Even if there are suggestive findings for malignant soft tissue tumor on radiologic evaluation, histological confirmation is necessary before surgical treatment.

Teaching Point: Iatrogenic overdrainage of cerebrospinal fluid may cause intracranial hypotension with secondary engorgement of the epidural venous plexus, resulting in potentially reversible compression radiculopathy or myelopathy.