Chirag Kamal Ahuja

Background: Giant cell tumour of bone (GCTB) is a locally aggressive primary bone neoplasm that predominantly involves the epiphyseal‐metaphyseal regions of long bones. Involvement of the mobile spine is uncommon, with cervical vertebral localization being particularly rare. Preoperative diagnosis at this site can be challenging because of overlapping clinical, radiologic and morphologic features with other giant cell‐rich lesions. Case: A 60‐year‐old woman presented with progressive neck pain, upper‐limb paresthesias and a posterior cervical swelling. Imaging revealed an expansile osteolytic lesion involving the C2–C4 vertebrae, with cortical destruction and soft tissue extension. CT‐guided fine‐needle aspiration cytology (FNAC) revealed highly cellular smears composed of bland mononuclear stromal cells intimately admixed with numerous uniformly distributed osteoclast‐type multinucleated giant cells. The striking similarity between the nuclei of the giant cells and mononuclear stromal cells provided an important diagnostic clue. In the absence of significant cytologic atypia, atypical mitoses, malignant osteoid or necrosis, a cytologic diagnosis of GCTB was rendered. Subsequent histopathologic examination of the resection specimen confirmed the diagnosis. Conclusion: GCTB should be considered in the differential diagnosis of giant cell‐rich osteolytic vertebral lesions, despite its rarity at this site. Recognition of characteristic cytomorphologic features, particularly the uniform distribution of osteoclast‐type giant cells and their nuclear similarity to mononuclear stromal cells, together with clinicoradiologic correlation, can enable accurate preoperative diagnosis on image‐guided FNAC.

Enteroviral infections range from self-limiting illnesses to severe neurological disorders. A thorough review of published literature reveals few studies highlighting the neuroimaging findings of such cases; however, none have been published from the Indian subcontinent. The present study analyzes the varied imaging and clinical spectrum of microbiologically proven cases of encephalomyelitis due to enterovirus in a tertiary care institute in northern India. This prospective study was conducted at a tertiary care institute in north India, and included 23 cases that presented with variable neurological symptoms of central nervous system infection and were found to have enterovirus, confirmed using reverse transcriptase-polymerase chain reaction. All these patients had undergone a brain magnetic resonance imaging (MRI). MRI spine was done depending on the symptoms of the patients. Imaging analysis was done by two experienced neuroradiologists. Fever was the most common presenting symptom, followed by altered sensorium and seizures. In neuroimaging, we found ganglio-capsular (13 cases, 56%), brain stem (7, 30%), cerebral hemisphere (6, 26%), and spinal cord (3, 13.04%) involvement. Basal ganglia and brainstem involvement was a common pattern seen in our cases, unlike the previously reported pattern of predominant posterior fossa structure involvement. As the pattern and site of both the spinal cord and the brain differ from previously published literature, further analysis would be needed to confirm the cause of such findings. This study has been approved by the institutional ethics committee. All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent has been taken from parents/legal guardians of the participants of the study. ^# These authors contributed equally. Article published online: 05 February 2026 © 2026. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

Background and objective Infantile Vitamin B12 deficiency commonly called Infantile tremor syndrome (ITS) is a neurocutaneous disorder primarily affecting exclusively breastfed infants of vegetarian mothers. Few reports of structural neuroimaging in this condition highlight cerebral and corpus callosal atrophy, while microstructural brain changes remain underexplored. This study investigates brain microstructural changes in Infantile Vitamin B12 deficiency using diffusion tensor imaging (DTI) and their correlation with neurodevelopmental outcomes following B12 supplementation. Methods Thirty children with Infantile vitamin B12 deficiency underwent clinical, neurodevelopmental, and DTI assessments at baseline and post-B12 treatment (3 months or later). MRI scans were analysed for fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) using both region-of-interest (ROI) and voxel-based approaches. Correlations between DTI metrics and developmental scores were evaluated. Results Vitamin B12 supplementation significantly improved serum B12, hemoglobin, neurodevelopmental scores and normalized homocysteine levels. DTI revealed increased FA and reduced MD, RD, and AD, indicating remyelination and axonal recovery. Corpus callosum, corona radiata, and internal capsule showed maximal improvement, aligning with recovery remyelination. Grey matter areas, including the thalamus and pre-central gyrus, also demonstrated recovery. Developmental scores positively correlated with DTI metrics, particularly in regions associated with language and motor function. Conclusion Infantile vitamin B12 deficiency is characterized by global brain microstructural abnormalities that improve significantly with B12 therapy. DTI metrics correlate with neurodevelopmental recovery, underscoring the role of B12 in brain myelination.

Transfusion-dependent beta-thalassemia (TDT) is frequently associated with endocrine dysfunction secondary to hemosiderosis involving multiple organs. This study aimed to evaluate long-term endocrine dysfunction, neuroradiological manifestations, and biochemical markers of iron overload in adult TDT subjects, alongside analyzing associations between pituitary siderosis and endocrine deficits. A cross-sectional study was conducted on 63 adult TDT subjects treated at a tertiary care center in North India. Patient history, clinical examination, biochemical evaluation, and neuroimaging findings were recorded. Hormonal assessments included insulin-like growth factor-1 (IGF-1), growth hormone (GH), thyroid function, cortisol, adrenocorticotropic hormone, sex steroids, and gonadotropins. Dynamic hormone testing was conducted to assess GH status (n = 44) and adrenal reserve (n = 45). Iron deposition in the brain, liver, and heart was assessed radiologically using MRI. Sixty-three subjects (43 males), median age 27 years (IQR: 22–30), were analyzed. Most (59/63) had thalassemia major (TM); the remainder had thalassemia intermedia (TI). Endocrine deficits included low IGF-1 (75.8%), low DHEAS (73%), hypocortisolism (64.5%), hypogonadism (58%), growth hormone deficiency on provocation test (56%), and central hypothyroidism (24%). MRI revealed pituitary siderosis in 76.6%, hepatic siderosis in 53.4%, and cardiac siderosis in 38.2%. Calvarial thickening and diploic space widening in 81% each were common findings. No significant association was observed between pituitary siderosis, pituitary height, and endocrine deficits. Most TDT subjects experience hypothalamo-pituitary dysfunction despite chelation therapy, emphasizing the need for close monitoring. While MRI is valuable for assessing systemic hemosiderosis, its utility in predicting endocrine dysfunction is limited.

A novel heterozygous STAT3 variant (p.Phe710Ser) was identified in an adolescent with hyper IgE syndrome and an intracranial aneurysm. Successful nonsurgical coil occlusion underscores the importance of vascular screening and the feasibility of interventional radiology in HIES.

Background Primary autoimmune hypothalamitis is an exceptionally rare inflammatory condition of the hypothalamus. Its etiology, clinical presentation, and management are not well established, with significant overlap and distinctions from hypophysitis. Material and methods This study presents management and outcomes of patients with autoimmune hypothalamitis managed at a tertiary care centre. A literature review was also performed analyzing clinico-demographic, biochemical, radiological, and therapeutic characteristics. Results There were 4 cases of autoimmune hypothalamitis out of 2200 sellar-suprasellar lesions managed over the past decade at our centre. Case 1 presented with arginine vasopressin (AVP) deficiency and adipsia, showing partial radiological response to glucocorticoids. Case 2 presented with neuropsychiatric features, with limited improvement on therapy. Case 3 had panhypopituitarism with stable disease on imaging, while Case 4 had AVP deficiency and hypogonadism with no significant radiological or hormonal recovery post therapy. Literature review (n = 34) of all cases showed female predominance (88%), but minimal association with pregnancy (6%). Polyuria-polydipsia was the most common presentation (81%), followed by memory disturbances and/or confusion (35%). Secondary hypogonadism was most common (88%) hormone deficiency followed by hypocortisolism (85%) and AVP deficiency (82%). T2 hyperintensity was the most common feature (95%) on MRI. Glucocorticoids enabled partial radiological response in most cases (82%), with hormonal recovery being less common (18%). Adjunctive medical therapy was required in 54.1% cases (most commonly azathioprine). Surgery was primarily used for biopsy and adjunctive radiotherapy in 3 cases. FDG-PET demonstrated utility in diagnosis, systemic involvement and follow-up. Conclusion Autoimmune hypothalamitis remains a challenging diagnosis due to its rarity and overlapping features with other sellar pathologies. Histopathological evaluation or circulating antibodies can point towards the diagnosis. FDG-PET can be valuable in diagnosis and follow-up. Glucocorticoids are the mainstay of treatment, with partial radiological response commonly observed.