Iacopo Carbone

Preoperative differentiation between pathological T3 (pT3) disease, representing locally advanced tumor confined to the larynx, and pathological T4 (pT4) disease, characterized by extension through the laryngeal cartilage and/or beyond the larynx, remains challenging in laryngeal squamous cell carcinoma (LSCC). This single-center retrospective study investigated the association between primary-tumor apparent diffusion coefficient (ADC) and pathological T stage and explored whether ADC could complement MRI-based morphological T classification. Twenty-eight patients with surgically confirmed, moderately differentiated LSCC were included (13 pT3 and 15 pT4). Mean ADC values were compared using the Mann–Whitney U test, and discrimination of pT4 disease was evaluated using receiver operating characteristic (ROC) analysis. Leave-one-out cross-validation was performed for internal validation of the ADC threshold and exploratory combined MRI–ADC rule. Mean ADC was significantly lower in pT4 than in pT3 tumors (760 ± 209 versus 1150 ± 188 × 10⁻⁶ mm²/s; p < 0.001). ADC achieved an area under the ROC curve of 0.913 (95% confidence interval, 0.769–1.000). The apparent combined MRI–ADC rule yielded a sensitivity of 93.3%, specificity of 100%, and overall accuracy of 96.4%. Under leave-one-out cross-validation, the corresponding estimates were 93.3%, 92.3%, and 92.9%, respectively. No statistically significant association between primary-tumor ADC and pathological nodal status was detected. Primary-tumor ADC was associated with pathological T stage and showed potential complementary value to morphological MRI; however, the threshold and combined rule remain hypothesis-generating and require independent external validation.

Background: Isolated hypoglossal nerve palsy is a rare neurological condition with a broad differential diagnosis. Although neoplastic disorders are the most common cause, internal carotid artery dissection (ICAD) is an uncommon but clinically important and potentially reversible vascular etiology that is frequently underrecognized. This systematic review synthesized the available evidence regarding the clinical presentation, imaging findings, pathophysiological mechanisms, treatment, and outcomes of isolated hypoglossal nerve palsy associated with ICAD through a standardized patient-level descriptive analysis. Methods: This systematic review was conducted according to the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261364863). PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to April 2026. Manual reference screening and forward citation tracking were also performed. Studies reporting original, patient-level data on isolated hypoglossal nerve palsy associated with ICAD were eligible. Clinical, imaging, treatment, and outcome data were extracted and synthesized descriptively. In hybrid publications combining original case reporting with a narrative literature review, only eligible, original patient data were included in the quantitative synthesis, whereas the narrative review components were used for citation tracking and contextual comparison. Results: A total of 26 standalone primary publications were included, comprising 23 case reports and 3 case series. Two additional hybrid publications each contributed one eligible patient. One hybrid publication contained an original case-report component, whereas the other reported two original cases and was therefore considered to contain a case-series component, although only one of its patients fulfilled the eligibility criteria. Overall, the 28 publications contributed 32 eligible patients to the patient-level quantitative synthesis. The narrative review components of the two hybrid publications were used solely for citation tracking and contextual comparison. Patients were predominantly male (28/32, 87.5%), with a median age of 47 years. Tongue deviation (28/28, 100%) and tongue weakness (30/30, 100%) were the hallmark clinical features, followed by dysarthria (26/26, 100%) and dysphagia (18/22, 81.8%). All patients presented with isolated hypoglossal nerve palsy at presentation, without Horner syndrome or additional lower cranial nerve involvement. MRI was the most frequently reported imaging modality (29/32, 90.6%), whereas CTA was commonly used to characterize luminal abnormalities. Intramural hematoma (25/26, 96.2%), luminal stenosis (23/26, 88.5%), and external arterial enlargement (22/24, 91.7%) were the most consistent neuroradiological findings. Conservative medical management predominated (31/32, 96.9%). The available evidence was more consistent with a compressive mechanism related to subadventitial arterial wall expansion, although an ischaemic contribution involving the vasa nervorum could not be excluded. A favourable clinical outcome (complete recovery or marked improvement) was observed in 21/30 patients (70.0%). Overall, improvement of any degree, including partial recovery, was documented in 25/30 evaluable patients (83.3%). Outcome data should be interpreted cautiously because they derive predominantly from individual case reports. Conclusions: This systematic review provides an updated standardized synthesis of the available case-level evidence on isolated hypoglossal nerve palsy associated with ICAD. CTA and MRI/MRA provide complementary diagnostic information and may facilitate timely diagnosis when interpreted according to the clinical context. The available evidence identifies recurrent clinico-radiological patterns that may assist clinicians in recognizing this uncommon presentation while highlighting the need for prospective multicentre studies to better inform future diagnostic and therapeutic strategies.

We describe a case of an asymptomatic 70-year-old female patient on whom a carotid ultrasound examination was performed that showed intima–media thickening and a 4 mm long carotid web with a 50% web-to-bulb ratio. Spectral Doppler waveform demonstrated a turbulent flow pattern and a peak systolic velocity increase of 100% (velocity ratio = 2) when compared with the common carotid artery. Therefore, the patient seemed to be at risk of stroke, and antiaggregant treatment was suggested.

Here, we describe a case of an asymptomatic 73-year-old female patient who suffered from type A acute aortic dissection with epiaortic arteries involvement and underwent surgical operation 9 years ago. A follow-up color Doppler ultrasound revealed a right vertebral artery intermittent flow reversal due to innominate artery dissection. To our knowledge, no previous studies have reported this intermittent flow reversal; therefore, supra-aortic trunks should be considered among the possible causes of vertebral artery flow reversal.

Here, we describe the case of an asymptomatic 70-year-old male patient who performed a contrast-enhanced computed tomography examination for prostate cancer staging, and an exceptional finding was reported. Specifically, a probable and never before reported minimal V aortic arch remnant with a thin intima–media band that joins together the anterior and posterior aortic walls.

Purpose: The accuracy of multiparametric magnetic resonance imaging (mpMRI) heavily relies on image quality, as evidenced by the evolution of the prostate imaging quality (PI-QUAL) scoring system for the evaluation of clinically significant prostate cancer (csPC). This study aims to evaluate the impact of PI-QUAL scores in detecting csPC within PI-RADS 4 and 5 lesions. Methods: We retrospectively selected from our database all mpMRI performed from January 2019 to March 2022. Inclusion criteria were as follows: (1) mpMRI acquired in our institution according to the technical requirements from the PI-RADS (v2.1) guidelines; (2) single lesion scored as PI-RADS (v2.1) 4 or 5; (3) MRI-TBx performed in our institution; (4) complete histology report; and (5) complete clinical record. Results: A total of 257 male patients, mean age 70.42 ± 7.6 years, with a single PI-RADS 4 or 5 lesion undergoing MRI-targeted biopsy, were retrospectively studied. Of these, 61.5% were PI-RADS 4, and 38.5% were PI-RADS 5, with 84% confirming neoplastic cells. In high-quality image lesions (PI-QUAL ≥ 4), all PI-RADS 5 lesions were accurately identified as positive at the final histological examination (100% of CDR). For PI-RADS 4 lesions, 37 (23%) were negative, resulting in a cancer detection rate of 77% (95% CI: 67.51–84.83). Conclusions: The accuracy of mpMRI, independently of the PI-RADS score, progressively decreased according to the decreasing PI-QUAL score. These findings emphasize the crucial role of the PI-QUAL scoring system in evaluating PI-RADS 4 and 5 lesions, influencing mpMRI accuracy.

Purpose: To evaluate using quantitative analysis on chest CT images a possible lung volume reduction in Long COVID patients who complain mild respiratory symptoms, with chest CT negative for inflammatory findings. Materials and Methods: CT images of patients from 18 to 40 years old who underwent chest CT scan at our institution were analyzed retrospectively, using AwServer Thoracic VCAR software for a quantitative study. Exclusion criteria were inflammatory findings at CT, previous lung surgery, lung cancer, and breath artifacts that invalidate the quality of images. Patients were divided into two groups: in the first one (“post-COVID”) were patients who had previous SARS-CoV-2 infection, confirmed by an RT-PCR, who underwent chest CT from 3 to 6 months after their negativization for long COVID symptoms; in the control group (“non-COVID”), were enrolled patients who underwent a chest CT scan from January 2018 to December 2019, before the spread of COVID in Italy. Results: Our final population included 154 TC, 77 post-COVID patients (mean age 33 ± 6) and 77 non-COVID patients (mean age 33 ± 4.9). Non statistical significative differences were obtained between groups in terms of age, sex, and other characteristics that affect total lung capacity such as obesity, thoracic malformations, and smoking habit. Mean values of the total lung volume (TV), right-lung volume (RV), and left-lung volume (LV) in the post-COVID group compared with non-COVID group were, respectively: 5.25 ± 0.25 L vs. 5.72 ± 0.26 L (p = 0.01); 2.76 ± 0.14 L vs. 3 ± 0.14 L (p = 0.01); 2.48 ± 0.12 L vs. 2.72 ± 0.12 L (p = 0.01). Conclusion: In patients with symptoms suggesting Long COVID and negative chest CT macroscopic findings, quantitative volume analysis demonstrated a mean value of reduction in lung volume of 10% compared to patients of the same age who never had COVID. A chest CT negative for inflammatory findings may induce clinicians to attribute Long COVID mild respiratory symptoms to anxiety, especially in young patients. Our study brings us beyond appearances and beyond the classic radiological signs, introducing a quantitative evaluation of lung volumes in these patients. It is hard to establish to what extent this finding may contribute to Long COVID symptoms, but this is another step to gain a wider knowledge of the potential long-term effects caused by this new virus.

Peri-gastric appendagitis followed associated with gastro-hepatic ligament/lesser omentum hemorrhagic infarction has not been well investigated yet. With an accurate radiological diagnosis of peri-gastric appendagitis, even in case of hemorrhagic infarction, the patient can receive supportive measures for the self-limited pain and can forgo surgery, endoscopy, and further invasive testing.