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PURPOSE: In pediatric medicine, precise estimation of bone age is essential for skeletal maturity evaluation, growth disorder diagnosis, and therapeutic intervention planning. Conventional techniques for determining bone age depend on radiologists' subjective judgments, which may lead to non-negligible differences in the estimated bone age. This study proposes a deep learning-based model utilizing a fully connected convolutional neural network(CNN) to predict bone age from left-hand radiographs. METHODS: The data set used in this study, consisting of 473 patients, was retrospectively retrieved from the PACS (Picture Achieving and Communication System) of a single institution. We developed a fully connected CNN consisting of four convolutional blocks, three fully connected layers, and a single neuron as output. The model was trained and validated on 80% of the data using the mean-squared error as a cost function to minimize the difference between the predicted and reference bone age values through the Adam optimization algorithm. Data augmentation was applied to the training and validation sets yielded in doubling the data samples. The performance of the trained model was evaluated on a test data set (20%) using various metrics including, the mean absolute error (MAE), median absolute error (MedAE), root-mean-squared error (RMSE), and mean absolute percentage error (MAPE). The code of the developed model for predicting the bone age in this study is available publicly on GitHub at https://github.com/afiosman/deep-learning-based-bone-age-estimation . RESULTS: Experimental results demonstrate the sound capabilities of our model in predicting the bone age on the left-hand radiographs as in the majority of the cases, the predicted bone ages and reference bone ages are nearly close to each other with a calculated MAE of 2.3 [1.9, 2.7; 0.95 confidence level] years, MedAE of 2.1 years, RMAE of 3.0 [1.5, 4.5; 0.95 confidence level] years, and MAPE of 0.29 (29%) on the test data set. CONCLUSION: These findings highlight the usability of estimating the bone age from left-hand radiographs, helping radiologists to verify their own results considering the margin of error on the model. The performance of our proposed model could be improved with additional refining and validation.

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In vascular neurosurgery, dural arteriovenous fistulas (DAVFs) are a difficult, challenging condition whose natural history and therapy are still debated. This case report presented a 30-year-old male patient who experienced intermittent headaches for two months, along with gradual weakness in all four limbs, resulting in quadriplegia. Magnetic resonance imaging (MRI), computed tomography (CT), and digital subtraction angiography (DSA) played a significant role in the diagnosis of the patient, in which the final diagnosis was vascular myelopathy due to Dural arteriovenous fistula (DAVF). A successful embolization procedure of arteriovenous fistula using balloon-assisted liquid embolic agents, through branches of the right occipital artery was performed, resulting in complete obliteration of the fistula. In order to improve the neurovascular symptoms that had previously been reported, the patient was effectively undergoing rehabilitation, with notable progress.

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Vein of Galen malformation (VGM) is a rare congenital, uncommon intracerebral vascular anomaly rarely complicated with the development of brain abscess as secondary to primary infection or after endovascular treatment. We report a very rare finding of a vein of Galen aneurysm associated with a large brain abscess at the time of diagnosis. A 12-year-old boy with a high-grade fever, severe headache, and recurrent episodes of convulsions came into the radiology department of Kassala Advanced Diagnostic Center. On a Siemens 16-slice scanner, brain non-contrast enhanced computed tomography (NECT) and contrast enhanced CT (CECT) was used to determine the source of the acute headache and convulsions which revealed a right frontal peripherally enhancing cystic lesion measuring 5.7 × 4.7 × 5.3 cm2 surrounded by massive vasogenic edema causing mass effect with midline shift to the left side by 1.5 cm suggestive of brain abscess. There is evidence of another avidly enhancing lesion seen within the third ventricle continuous with a straight sinus surrounded by extensive vascular loops consistent with an aneurysm of the vein of Galen, it was causing compression of the cerebral aqueduct with upstream mild hydrocephalus with dilated both lateral ventricles. Late presentation, diagnosis, and treatment also lead to an increase in the morbidities and mortalities of such case conditions. Urgent intervention should be considered for better outcomes.

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We describe a case report of a 13 year-old a gymnastic athlete who was diagnosed with an olecranon stress fracture associated with mild medial epicondyle apophysitis, Following a brief review of the literature on this case, the researchers call attention to the significance of and imaging assessment especially MR in determining the correct diagnosis and identifying concomitant injuries. MRI findings concluded firstly a marked bone marrow edema seen at the posterior medial aspect of the olecranon with linear low signal traversing the olecranon related to a stress fracture. Secondly, subchondral linear low signal and bone marrow edema at the radial head related to another stress fracture/reaction injury. Thirdly, bone marrow edema at the medial apophysis with overlying soft tissue edema suggestive for medial epicondylitis.

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BACKGROUND: Magnetic resonance imaging (MRI) exams may cause patients to feel anxious before or during the scan, which affects the scanning outcome and leads to motion artifacts. Adequate preparation can effectively alleviate patients' anxiety before the scan. We aimed to assess the effect of different preparation methods on MRI-induced anxiety: We conducted a prospective randomized study on MRI patients between March and May 2022. We divided 30 patients into two groups: the control group, which received routine preparation (RP), and the experimental group, which received video preparation (VP). We used the State-Trait Anxiety Inventory (STAI) to measure anxiety levels before and after the interventions. We assessed patients' self-satisfaction after the scan: After preparation, VP (STAI mean = 10.7500) and RP (STAI mean = 12.7857), we observed a significant association between the pre- and post-STAI results in VP (p = 0.025). The effects of both methods in decreasing anxiety were more significant for first-timers (p = 0.009 in RP/0.014 in VP). We noted high satisfaction levels for both forms of preparation. The VP technique was superior in reducing patient anxiety, especially in first-time MRI patients. Hence, VP techniques can be used in different clinical settings to reduce anxiety and facilitate patients' understanding of the instructions given.

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Persistent Mullerian Duct Syndrome (PMDS) is a type of pseudohermaphroditism that occurs in males. It is an autosomal recessive type of familial disease that is commonly associated with a history of consanguinity. We have documented this case of a 22-year-old adult male who came with acute right iliac pain; after an ultrasound scan and hormone investigations, he was diagnosed with polycystic ovarian syndrome (PCOS).

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Importance: Antibodies to myelin oligodendrocyte glycoprotein IgG (MOG-IgG) are increasingly detected in patients with non-multiple sclerosis-related demyelination, some of whom manifest a neuromyelitis optica (NMO) phenotype. Cortical involvement, encephalopathy, and seizures are rare in aquaporin 4 antibody (AQP4-IgG)-related NMO in the white European population. However, the authors encountered several patients with seizures associated with MOG-IgG disease. Objective: To compare incidence of seizures and encephalitis-like presentation, or both between AQP4-IgG-positive and MOG-IgG-positive patients. Design, Setting, and Participants: Retrospective case series of all patients who were seropositive for MOG-IgG (n = 34) and the last 100 patients with AQP4-IgG disease (NMO spectrum disorder) seen in the NMO service between January 2013 and December 2016, and analysis was completed January 4, 2017. All patients were seen in a tertiary neurological center, The Walton Centre NHS Foundation Trust in Liverpool, England. Main Outcomes and Measures: The difference in seizure frequency between the AQP4-IgG-positive and MOG-IgG-positive patient groups was determined. Results: Thirty-four patients with MOG-IgG disease (20 female) with a median age at analysis of 30.5 years (interquartile range [IQR], 15-69 years), and 100 AQP4-IgG-positive patients (86 female) with a median age at analysis of 54 years (IQR, 12-91 years) were studied. Most patients were of white race. Five of the 34 patients with MOG-IgG (14.7%) had seizures compared with 1 patient with AQP4-IgG (2-sided P < .008, Fisher test). On magnetic resonance imaging, all 5 MOG-IgG-positive patients had inflammatory cortical brain lesions associated with the seizures. In 3 of the 5 MOG-IgG-positive patients, seizures occurred as part of the index event. Four of the 5 presented with encephalopathy and seizures, and disease relapsed in all 5 patients. Four of these patients were receiving immunosuppressant medication at last follow-up, and 3 continued to take antiepileptic medication. In contrast, the only AQP4-IgG-positive patient with seizures had a diagnosis of complex partial epilepsy preceding the onset of NMO by several years and experienced no encephalitic illness; her magnetic resonance imaging results demonstrated no cortical, subcortical, or basal ganglia involvement. Conclusions and Relevance: Patients with MOG-IgG-associated disease were more likely to have seizures and encephalitis-like presentation than patients with AQP4-IgG-associated disease.

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