Massive spinal epidural infantile hemangioma, image findings, and treatment: a case report and review of literature

Spinal involvement of infantile hemangiomas is rare with the predilection to involve the epidural space. A proper diagnosis might be challenging due to the atypical location and variable/inconsistent use of the International Society for the Study of Vascular Anomalies (ISSVA) classification by radiologists, pathologists, and clinicians. A proper diagnosis of epidural infantile hemangioma is key due to the different aggressiveness of the treatment options with inconstant literature regarding the best available treatment. Herein, we present a case of a massive epidural infantile hemangioma successfully treated with only beta-blocker. We discuss the clinical, MRI, CT, ultrasound, and histological features of this lesion as we review the literature with the objective of addressing some of the confusion surrounding the subject.

Imaging findings of the injured in the massive Beirut blast

PURPOSE

(1) Describe imaging utilization and findings within two weeks of the 2020 Beirut blast according to the mechanism of injury, (2) determine the appropriate imaging modality per organ/system, and (3) describe changes in the workflow of a radiology department to deal with massive crises.

MATERIALS AND METHODS

Two hundred sixty patients presented to the largest emergency department in Beirut and underwent imaging within 2 weeks of the blast. In this retrospective study, patients were divided into early (1) and late (2) imaging groups. Patients' demographic, outcome, type and time of imaging studies, body parts imaged, and mechanism and types of injuries were documented.

RESULTS

Two hundred five patients in group 1 underwent 502 and 55 patients in group 2 underwent 145 imaging studies. Tertiary blast injuries from direct impact and falling objects were the most common type of injuries followed by secondary (shrapnel) injuries. Both types of injuries affected mostly the head and neck and upper extremities. Plain radiographs were adequate for the extremities and CT for the head and neck. A regularly updated and practiced emergency plan is essential to mobilize staff and equipment and efficiently deliver radiology services during crises.

CONCLUSION

Because the powerful Beirut blast occurred at the port located in the periphery of the city, most injuries seen on imaging were of the upper extremities and head and neck caused by the severe blast wind or penetrating shrapnel and resulted from people using their arms to protect their heads and bodies from direct impact and falling objects.

Additional occult cancers identified on staging breast MRI: imaging appearances and pathologic characteristics

INTRODUCTION

Breast magnetic resonance imaging (MRI) is increasingly being used for staging of patients with breast cancer due to its high sensitivity in detecting additional cancers (ACs). However, the clinical impact of diagnosing and treating these cancers remains unclear.

METHODS

A retrospective study was undertaken of patients with newly diagnosed breast cancer who underwent staging MRI at The American University of Beirut Medical Centre (AUBMC) between 2012 and 2020. Pathology reports and breast MRI examinations were reviewed. Eighteen breast cancer patients with 19 pathology-proven index cancers (ICs) and 19 pathology-proven MRI-detected ACs were included. Chi-square and Fisher's exact tests for categorical variables and Wilcoxon signed rank test for numerical variables were used to compare ICs to ACs.

RESULTS

The ICs consisted of four ductal carcinoma in situ (DCIS), 13 invasive ductal carcinomas (IDC), of which five with associated DCIS, and two invasive lobular carcinomas, (ILC) of which one with associated DCIS. ACs comprised 12 DCIS, five IDC, two with associated DCIS and two ILC, one with associated DCIS. Interval cancers were more frequently invasive whereas ACs were more frequently in situ (P = 0.021). ACs were more frequently nuclear grade 2 (P = 0.009). There was no statistically significant difference between ICs and ACs in lesion type (P = 0.062), shape (P = 0.073), initial enhancement (P = 1), delayed enhancement (P = 0.732), hormonal receptor profile (P = 0.68) and Ki67 (P = 0.388). Among ACs, ten (53%) were larger than 10 mm of which five (26%) were invasive cancers, and five (26%) were larger than the ICs.

CONCLUSIONS

ACs detected by breast MRI were more likely to be in situ and to show a nuclear grade 2. Although not reaching statistical significance, some ACs tend to be clinically significant by their type, size or nuclear grade. The impact on clinical management remains to be determined.

Potential hotspots of amphibian roadkill risk in Spain

We test a forecasting strategy to identify potential hotspots of amphibian roadkill, combining the spatial distribution of amphibians, their relative risk of collision with vehicles and data on road density in Spain. We extracted a large dataset from studies reporting road casualties of 39 European amphibian species and then estimated the 'relative roadkill risk' of species as the frequency of occurrence of casualties for each amphibian and standardized by the range of distribution of the species in Europe. Using a map with the spatial distribution of Spanish amphibians at a spatial resolution of 10 × 10 Km squares, we estimated the 'cumulative relative risk of roadkill' for each amphibian assemblage as the sum of risk estimates previously calculated for each species. We also calculated the total length of roads in each square (road density). Finally, combining all layers of information, we elaborated a forecasting map highlighting the potential amphibian roadkill risk across Spain. Our findings are relevant to suggest areas that should be focused on at more detailed spatial scales. Additionally, we found that the frequency of roadkill was unrelated to the evolutionary distinctiveness score and conservation status of amphibian species, while was positively correlated with their distribution range.

EVI and NDVI as proxies for multifaceted avian diversity in urban areas

Most ecological studies use remote sensing to analyze broad-scale biodiversity patterns, focusing mainly on taxonomic diversity in natural landscapes. One of the most important effects of high levels of urbanization is species loss (i.e., biotic homogenization). Therefore, cost-effective and more efficient methods to monitor biological communities' distribution are essential. This study explores whether the Enhanced Vegetation Index (EVI) and the Normalized Difference Vegetation Index (NDVI) can predict multifaceted avian diversity, urban tolerance, and specialization in urban landscapes. We sampled bird communities among 15 European cities and extracted Landsat 30-meter resolution EVI and NDVI values of the pixels within a 50-m buffer of bird sample points using Google Earth Engine (32-day Landsat 8 Collection Tier 1). Mixed models were used to find the best associations of EVI and NDVI, predicting multiple avian diversity facets: Taxonomic diversity, functional diversity, phylogenetic diversity, specialization levels, and urban tolerance. A total of 113 bird species across 15 cities from 10 different European countries were detected. EVI mean was the best predictor for foraging substrate specialization. NDVI mean was the best predictor for most avian diversity facets: taxonomic diversity, functional richness and evenness, phylogenetic diversity, phylogenetic species variability, community evolutionary distinctiveness, urban tolerance, diet foraging behavior, and habitat richness specialists. Finally, EVI and NDVI standard deviation were not the best predictors for any avian diversity facets studied. Our findings expand previous knowledge about EVI and NDVI as surrogates of avian diversity at a continental scale. Considering the European Commission's proposal for a Nature Restoration Law calling for expanding green urban space areas by 2050, we propose NDVI as a proxy of multiple facets of avian diversity to efficiently monitor bird community responses to land use changes in the cities.

Spatial Overlap and Habitat Selection of Corvid Species in European Cities

Understanding habitat and spatial overlap in sympatric species of urban areas would aid in predicting species and community modifications in response to global change. Habitat overlap has been widely investigated for specialist species but neglected for generalists living in urban settings. Many corvid species are generalists and are adapted to urban areas. This work aimed to determine the urban habitat requirements and spatial overlap of five corvid species in sixteen European cities during the breeding season. All five studied corvid species had high overlap in their habitat selection while still having particular tendencies. We found three species, the Carrion/Hooded Crow, Rook, and Eurasian Magpie, selected open habitats. The Western Jackdaw avoided areas with bare soil cover, and the Eurasian Jay chose more forested areas. The species with similar habitat selection also had congruent spatial distributions. Our results indicate that although the corvids had some tendencies regarding habitat selection, as generalists, they still tolerated a wide range of urban habitats, which resulted in high overlap in their habitat niches and spatial distributions.

Flight initiation distance and refuge in urban birds

Risk-taking in birds is often measured as the flight initiation distance (FID), the distance at which individuals take flight when approached by a potential predator (typically a human). The ecological factors that affect avian FID have received great attention over the past decades and meta-analyses and comparative analyses have shown that FID is correlated with body mass, flock size, starting distance of the approaching human, density of potential predators, as well as varying along rural to urban gradients. However, surprisingly, only few studies (mainly on reptiles and mammals) have explored effects of different types of refugia and their availability on animal escape decisions. We used Bayesian regression models (controlling for the phylogenetic relatedness of bird species) to explore changes in escape behaviour recorded in European cities in relationship to the birds' distance to the nearest refuge and distance fled to the refuge. In our analyses, we also included information on the type of refuge, built-up and vegetation cover, starting distance, flock size, urbanization level, and type of urban habitat. We found that birds preferred tree refuges over artificial and bush refuges. Birds escaped earlier if the distance to the nearest refuge of any type was longer and if birds fled longer distances to the refuge. FID was shorter when birds used bushes as refugia or landed on the ground after flushing compared to using artificial refugia. Similarly, the distance fled to a refuge was shortest when using bushes, and increased when escaping to artificial substrates and trees. Birds were more timid in suburban than core areas of cities, cemeteries than parks, and in areas with higher bush cover but lower cover of built-up areas and trees. Our findings provide novel information regarding the importance of refuge proximity and type as factors affecting the escape behaviour of urban birds.