Radiation necrosis in the brain commonly occurs in three distinct clinical scenarios, namely, radiation therapy for head and neck malignancy or intracranial extraaxial tumor, stereotactic radiation therapy (including radiosurgery) for brain metastasis, and radiation therapy for primary brain tumors. Knowledge of the radiation treatment plan, amount of brain tissue included in the radiation port, type of radiation, location of the primary malignancy, and amount of time elapsed since radiation therapy is extremely important in determining whether the imaging abnormality represents radiation necrosis or recurrent tumor. Conventional magnetic resonance (MR) imaging findings of these two entities overlap considerably, and even at histopathologic analysis, tumor mixed with radiation necrosis is a common finding. Advanced imaging modalities such as diffusion tensor imaging and perfusion MR imaging (with calculation of certain specific parameters such as apparent diffusion coefficient ratios, relative peak height, and percentage of signal recovery), MR spectroscopy, and positron emission tomography can be useful in differentiating between recurrent tumor and radiation necrosis. In everyday practice, the visual assessment of diffusion-weighted and perfusion images may also be helpful by favoring one diagnosis over the other, with restricted diffusion and an elevated relative cerebral blood volume being seen much more frequently in recurrent tumor than in radiation necrosis.
Radiopaque jaw lesions are frequently encountered at radiography and computed tomography, but they are usually underevaluated or underdescribed in radiology reports. A systematic approach to the evaluation of radiopaque jaw lesions is necessary to diagnose the lesion or at least provide a meaningful differential diagnosis. To evaluate a radiopaque jaw lesion, the first, most important step is to categorize the lesion according to its attenuation, its relationship to the teeth, and its location with respect to the tooth. These basic observations are essential to the evaluation of any type of jaw lesion. Once these observations have been made, it is easy to create a proper differential diagnosis. The presence of important characteristics, such as margination, a perilesional halo, bone expansion, and growth pattern, as well as whether the lesion is sclerotic, has ground-glass attenuation, or is mixed lytic and sclerotic, further narrows the differential diagnosis. It is important to note that some radiopaque jaw lesions may be entirely lucent early in their evolution. Awareness of the demographic distribution of these lesions and their associated clinical features, as well as the radiologic approach, is important to explore the "terra incognita" of radiopaque jaw lesions.
Spinal cord imaging findings in COVID-19 are evolving with the increasing frequency of neurological symptoms among COVID-19 patients. Several mechanisms are postulatedto be the cause of central nervous system affection including direct virusneuroinvasive potential, post infectious secondary immunogenic hyperreaction, hypercoagulability, sepsis and possible vasculitis as well as systemic and metabolic complications associated with critical illness. Only a few case reports of spinal cord imaging findings are described in COVID-19, which include transverse myelitis, acute disseminated encephalomyelitis (ADEM) and post infectious Guillain Barre’ syndrome. We are describing a case of myelitis which, to the best of our knowledge, is the first reported case of myelitis in COVID-19.
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