Polysplenia syndrome is classified as one of the situs ambiguous or heterotaxy syndromes and is classically termed left isomerism or bilateral left-sidedness. However, polysplenia is a controversial and complex entity with no fixed pathognomonic features but rather a broad spectrum of abnormalities. In many published case series, polysplenia was neither associated with viscero-atrial heterotaxy nor with duplication of left-sided structures. The relationship between polysplenia and viscero-atrial situs is not clear. Several recent case reports describe the association of polysplenia with situs inversus totalis or with pancreatic; venous and other anomalies or with several types of malignancy. This article provides the reader with a review of the literature as well as our own experience aiming at better understanding of the polysplenia syndrome, its relationship with viscero-atrial situs and the spectrum of associated extra-cardiac anomalies.

Background: Conventional brain MRI cannot always distinguish between different white matter lesions. Susceptibility weighted imaging (SWI) can detect a sign called central vein sign which is suggested to discriminate between multiple sclerosis and other white matter lesions thus increasing the accuracy of MRI in MS diagnosis. This study aimed to evaluate the role of MR susceptibility weighted imaging in differentiating MS from CSVD lesions. Results: The central vein sign (CVS) was found to have a premium diagnostic performance in diagnosis of MS with sensitivity 83.3%, specificity 70%, positive predictive value 80.6%, and negative predictive value 73.7%. When CVS positive lesions load was ≥ 44.24%, the specificity of CVS in diagnosing MS raised to 100%. Conclusion: Detection of the CVS on SWI can reliably discriminate between MS and CSVD.

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Background: Early detection of locally recurrent breast carcinoma has been shown to significantly improve longterm survival. Surgery and radiation therapy made treated breast prone to several modifications. This can complicate the interpretation of ultrasound and mammographic images, especially when local recurrence is suspected. The aim of this work is to assess the role of unenhanced MRI (T1WI, T2WI, STIR, and DWI) in differentiating recurrent breast cancer from benign post-operative lesions. Results: The presence of fat SI within the lesions had 100% sensitivity, 90.9% specificity, 94.1% PPV, 100% NPV, and 96.2% accuracy in differentiating fat necrosis from recurrent breast carcinoma. A cutoff ADC value of 1 × 10-3 mm 2 / s for observer one had 80% sensitivity, 90.9% specificity, and 88.9% accuracy in diagnosis of recurrent breast carcinoma. For observer two, a cutoff ADC value of 1.25 × 10-3 mm2/s had sensitivity of 80%, specificity of 88.6%, and diagnostic accuracy of 87.03% in differentiating recurrent breast carcinoma from benign post-operative changes. Unenhanced MRI had 81.8% sensitivity, 97.7% specificity, 90% PPV, 95.5% NPV, and 94.5% accuracy in the diagnosis of recurrent breast carcinoma. Conclusion: Unenhanced MRI including T1WI, T2WI, STIR, DWI, and ADC map had high sensitivity, specificity, and diagnostic accuracy in diagnosis of recurrent breast carcinoma and differentiating it from benign post-operative changes.

Background Prostate cancer (PCa) is considered to be the commonest cancer among males. Early and precise diagnosis of PCa is essential for adequate treatment. Multiparametric MR imaging (mpMRI) is actually the most precise imaging technique used for early diagnosis of PCa. The aim of this work was to assess the diagnostic capability of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) of PI-RADS V2.1 in detection of prostate cancer (PCa). This prospective study was carried on 60 male patients with high PSA. bpMRI and mpMRI were performed for all patients using a 3-T MRI scanner. The diagnostic performance of bpMRI of PI-RADS V2.1 was compared to that of mpMRI of PI-RADS V 2.1. The diagnosis of Pca was confirmed by transrectal ultrasound-guided biopsy and the results of open prostatectomy specimens. Results When considering PI-RADS categories 1, 2, and 3 as benign and categories 4 and 5 as malignant, mpMRI had higher sensitivity and diagnostic accuracy when compared with bpMRI (sensitivity was 88.6% for mpMRI versus 60% for bpMRI and diagnostic accuracy was 91.7% for mpMRI versus 75% for bpMRI). When considering PI-RADS categories 1 and 2 as benign and PI-RADS categories 3.4 and 5 as malignant, the sensitivity and diagnostic accuracy of bpMRI and mpMRI were comparable (sensitivity was 94.3% for both bpMRI and mpMRI and diagnostic accuracy was 86.7% for both bpMRI and mpMRI). Conclusion Considering PI-RADS scores 4 and 5 as malignant, mpMRI had higher sensitivity and diagnostic accuracy when compared with bpMRI; however, when considering PI-RADS scores 3, 4, and 5 as malignant, both bpMRI and mpMRI had similar diagnostic accuracy.

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Background Patients with suspected brain lesions are usually evaluated by means of intravenous contrast materials. These lesions may demonstrate enhancement through different mechanisms. At most institutions, CE-T1WI is the preferred sequence. FLAIR is a sort of inversion recovery pulse sequence with a long TR, TE and T1 and hence effectually nulls signals from CSF. The long T1 causes mild T effect and this result in lesion enhancement on post-contrast study. Therefore, lesions demonstrating enhancement on CE-T1WI will also demonstrate enhancement on CE-FLAIR images. The purpose of this work was to assess the role of CE-FLAIR versus CE-T1WI in evaluation of different intraparenchymal brain lesions. Results Comparing CE-T1WI to CE-FLAIR in various brain pathologies, both observers found higher sensitivity and specificity for lesion to background contrast ratio on CE-FLAIR comparing to CE-T1WI. Observer 1 found that lesion to background contrast ratio on CE-FLAIR had sensitivity of 71.4%, specificity of 66.7% and AUC of 0.661 versus 63.3% sensitivity, 58.3% specificity and 0.634 AUC for CE-T1WI. Observer 2 found that lesion to background contrast ratio on CE-FLAIR had sensitivity of 77.6%, specificity of 66.7% and AUC of 0.719 versus 61.2% sensitivity, 50% specificity and 0.628 AUC for CE-T1WI. Conclusion On comparing CE-FLAIR to CE-T1WI, CE-FLAIR display better lesion detection and enhancement also better soft tissue contrast resolution.