Objectives: To set age-specific normal reference values for brainstem, cerebellar vermis, and peduncles measurements and characterize values’ variations according to gender, age, and age by gender interaction. Methods: 565 normal brain magnetic resonance examinations with normal anatomy and signal intensity of the supra- and infratentorial structures were categorized into six age groups (infant, child, adolescent, young adult, middle-age adult, and old aged adults). Patients with congenital malformations, gross pathology of the supra- or infratentorial brain, brain volume loss, developmental delay, metabolic disorders, and neuropsychological disorders (n = 2.839) were excluded. On midsagittal T 1 weighted and axial T 2 weighted images specific linear diameters and ratios of the brainstem, cerebellar vermis, and peduncles were attained. Two observers assessed a random sample of 100 subjects to evaluate the inter- and intraobserver reproducibility. Intraclass correlation coefficients, means ± standard deviation, one and two-way analysis of variance tests were used in the statistical analysis. Results: Good to excellent inter- and intraobserver measurements’ reproducibility were observed, except for the transverse diameter of the midbrain, the anteroposterior diameter of the medulla oblongata at the pontomedullary and cervicomedullary junctions, cerebellar vermis anteroposterior diameter, and thickness of the superior cerebellar peduncle. Age-specific mean values of the investigated measurements were established. A significant gender-related variation was recorded in the anteroposterior diameter of the basis pontis (p = 0.044), the anteroposterior diameter of the medulla oblongata at the cervicomedullary junction (p = 0.044), and cerebellar vermis height (p = 0.018). A significant age-related change was detected in all measurements except the tectal ratio. Age by gender interaction had a statistically significant effect on the tectal ratio, inferior, and middle cerebellar peduncles’ thickness (p = 0.001, 0.022, and 0.028, respectively). Conclusion: This study provides age-specific normal mean values for various linear dimensions and ratios of the posterior fossa structures with documentation of measurements’ variability according to gender, age, and their interaction. Advances in knowledge: It provides a valuable reference in the clinical practice for easier differentiation between physiological and pathological conditions of the posterior fossa structures especially various neurodegenerative diseases and congenital anomalies.

Gliomas are a type of brain tumor that requires accurate monitoring for progression following surgery. The Brain Tumor Reporting and Data System (BT-RADS) has emerged as a potential tool for improving diagnostic accuracy and reducing the need for repeated operations. This prospective multicenter study aimed to evaluate the diagnostic accuracy and reliability of BT-RADS in predicting tumor progression (TP) in postoperative glioma patients and evaluate its acceptance in clinical practice. The study enrolled patients with a history of partial or complete resection of high-grade glioma. All patients underwent two consecutive follow-up brain MRI examinations. Five neuroradiologists independently evaluated the MRI examinations using the BT-RADS. The diagnostic accuracy of the BT-RADS for predicting TP was calculated using histopathology after reoperation and clinical and imaging follow-up as reference standards. Reliability based on inter-reader agreement (IRA) was assessed using kappa statistics. Reader acceptance was evaluated using a short survey. The final analysis included 73 patients (male, 67.1%; female, 32.9%; mean age, 43.2 ± 12.9 years; age range, 31–67 years); 47.9% showed TP, and 52.1% showed no TP. According to readers, TP was observed in 25–41.7% of BT-3a, 61.5–88.9% of BT-3b, 75–90.9% of BT-3c, and 91.7–100% of BT-RADS-4. Considering >BT-RADS-3a as a cutoff value for TP, the sensitivity, specificity, and accuracy of the BT-RADS were 68.6–85.7%, 84.2–92.1%, and 78.1–86.3%, respectively, according to the reader. The overall IRA was good (κ = 0.75) for the final BT-RADS classification and very good for detecting new lesions (κ = 0.89). The readers completely agreed with the statement “the application of the BT-RADS should be encouraged” (score = 25). The BT-RADS has good diagnostic accuracy and reliability for predicting TP in postoperative glioma patients. However, BT-RADS 3 needs further improvements to increase its diagnostic accuracy.

Background: Breast asymmetry is a common mammographic finding which encompasses a diversity of possibilities. It may be the only sign for underlying malignancy. Contrast enhanced mammography (CEM) can reveal the asymmetry underlying angiogenesis, allowing for proper diagnosis, clinical management, reducing the number of unnecessary biopsies and increasing the rate of cancer detection. At this study we aimed to assess the performance of contrast enhanced mammography in the evaluation of different types of mammographic asymmetry. Methods: This is a prospective study approved by our institutional review board. The study included 36 consecutive females whose mammograms revealed any type of mammographic asymmetry. After obtaining patients’ informed consents, contrast enhanced mammography (CEM) examination was performed. Low energy and combined images were analyzed using the newly published contrast enhanced mammography (CEM) attachment to ACR BI-RADS® Mammography 2013 in 2022 followed by BIRADS categorization. Ultrasound was performed for all cases to verify the BIRADS category. Final diagnosis established by Ultrasound and follow-ups for benign lesions. Malignant and suspicious lesions on CEM or ultrasound were biopsied.Results: The performance of CEM in the detection of malignant breast lesions underlying breast asymmetry in correlation to final diagnosis was as follows: sensitivity was 94.44% with 83.33 % specificity and 88.89% accuracy. Conclusion: CEM is reliable for unravelling breast asymmetry underlying pathology. Analysis of low energy and combined images aids in the characterization of underlying asymmetry, directing proper clinical management and increasing cancer detection rates.Keywords: Asymmetry; Contrast enhanced mammography; CEM