Clinical practice in radiology and pathology requires professional expertise and many years of training to visually evaluate and interpret abnormal phenotypic features in medical images and tissue sections to generate diagnoses that guide patient management and treatment. Recent advances in digital image analysis methods and machine learning have led to significant interest in extracting additional information from medical and digital whole‐slide images in radiology and pathology, respectively. This has led to significant interest and research in radiomics and pathomics to correlate phenotypic features of disease with image analytics in order to identify image‐based biomarkers. The expanding role of big data in radiology and pathology parallels the development and role of immunohistochemistry (IHC) in the daily practice of pathology. IHC methods were initially developed to provide additional information to help classify tumors and then transformed into an indispensable tool to guide treatment in many types of cancer. IHC markers are used in daily practice to identify specific types of cells and highlight their distributions in tissues in order to distinguish benign from neoplastic cells, determine tumor origin, subclassify neoplasms, and support and confirm diagnoses. In this regard, radiomics, pathomics, and IHC methods are very similar since they enable the extraction of image‐based features to characterize various properties of diseases. Due to the dramatic advancements in recent radiomics research, we provide a brief overview of the role of established and emerging IHC biomarkers in various tumor types that have been correlated with radiologic biomarkers to improve diagnostic accuracy, predict prognosis, guide patient management, and select treatment strategies. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2020;51:341–354.
To emphasize the utility of contrast enhanced MRI for identifying the extent of disease in herpes zoster ophthalmicus with intracranial extension to help determine proper management. We present a rare case of herpes zoster ophthalmicus (HZ/HZO) with intracranial extension and MRI demonstration of involvement of the trigeminal nerve, the trigeminal nucleus, and the spinal trigeminal nucleus and tract. Herpes zoster is caused by reactivation of varicella zoster virus. Herpes zoster ophthalmicus with involvement of the ophthalmic division of the trigeminal nerve has been estimated to account for 10-20% of the cases (Yawn et al. in Mayo Clin Proc 88:562-570, 2013). While postherpetic neuralgia is the most common complication, HZ/HZO can rarely manifest in a more sinister manner resulting in multi-dermatomal involvement, disseminated disease, cranial arteritis (Walker in Radiology 107:109-110, 1973), cranial nerve paresis (O.d in Clinical Eye and Vision Care 11:75-80, 1999), hemiplegia (Cavaletti in The Italian Journal of Neurological Sciences 11:297-300, 1990), ocular/dysfunction (Kocaoğlu in Türk Oftalmoloji Dergisi 48:42-46, 2018), and intracranial extension (Chen in BMC Infectious Diseases 17:213, 2017; Yawn in Mayo Clin Proc. 88:562-570, 2013). Contrast enhanced MRI (CE-MRI) can be of great benefit to elucidate the extent of disease and intracranial involvement for institution of more aggressive management to prevent further complications.
Heterotopic ossification (HO) typically presents in the hip, knee, and elbow joints in the setting of trauma or postsurgical intervention. Less commonly, it may occur secondary to neurologic dysfunction or underlying genetic conditions, but idiopathic HO is rare. Most cases of HO are managed nonoperatively with surgical resection remaining a controversy due to high recurrence rates. We describe a case of idiopathic HO of the shoulder that occurred in the absence of trauma, neurologic dysfunction, or underlying genetic disorder that was treated with surgical excision. Heterotopic ossification (HO) is the formation of ectopic bone within the soft tissues. 1 HO can be classified into three broad categories based on etiology: traumatic HO from fractures, dislocations, orthopaedic surgeries, and burns; neurogenic HO from spinal cord damage or head injury; and genetic HO from conditions, such as progressive fibrodysplasia ossificans or progressive osseous heteroplasia. 2 Traumatic HO comprises up to 90% of cases, most commonly a complication of arthroplasty or bone fracture, with a higher predisposition for men. 3 Although it can occur anywhere in the body, HO typically affects areas most susceptible to trauma, such as the elbow, thigh, pelvis, and shoulder. 4 When symptomatic, HO can present with pain, decreased range of motion, and in severe cases, bony ankylosis. 2 The diagnosis is made with radiographic imaging, including radiographs, CT, and MRI. Several classification systems have been used to grade the severity of HO, but the Brooker Classification System used for HO at the hip 5 and the Hastings and Graham System for HO at the elbow 6 are two of the most commonly used.A definitive diagnosis of HO can be made by histopathologic evaluation of a tissue sample. HO is often defined pathologically by the type of tissue in which it occurs, such as myositis ossificans involving skeletal muscle. The histopathologic features of the lesion typically evolve over time, with early lesions being composed of cellular fibrovascular tissue with small amounts of bone matrix. More mature lesions have prominent bone formation with a zonal architecture, a hallmark of HO. It is important to differentiate HO from a neoplastic process, such as soft-tissue sarcoma or osteosarcoma. Microscopically, in more mature lesions, trabeculae of woven bone with osteoblastic rimming accompanied by more mature lamellar bone is more
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