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Xiao ST, Zhang HQ, Wang YX. Isolated neural arch tuberculosis with tuberculomas: case report. Skeletal Radiol 2024; 53:1417-1421. [PMID: 37712982 DOI: 10.1007/s00256-023-04450-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/12/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
We reported a case of atypical spinal tuberculosis on the posterior elements of lumbar spine in a 52-year-old female. It was easy to be misdiagnosed as spinal tumor due to its imaging characteristics. We performed puncture biopsy to initially consider tuberculosis, and then the patient was accepted surgical treatment. The intraoperative removed specimen was sent to pathological examination, microbial culture, Xpert MTB/RIF and metagenomic next-generation sequencing (mNGS) and then the diagnosis of neural arch tuberculosis was confirmed. After operation, the patient obtained stable effect by anti-tuberculosis drug treatment. In a word, the uncommon case had an important reference significance for the diagnosis of atypical spine tuberculosis and differentiation from spinal tumors. It is critical to make right preliminary diagnosis by appropriate examination as it determined the next diagnosis and treatment in special and rare clinical cases.
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Affiliation(s)
- Shun-Tian Xiao
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China
| | - Hong-Qi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China
| | - Yu-Xiang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China.
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China.
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Trivedi R, Trivedi P, Gupta R. Multisegment Extradural Tuberculoma Masquerading as a Spinal Tumor. Cureus 2022; 14:e24707. [PMID: 35663718 PMCID: PMC9162441 DOI: 10.7759/cureus.24707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/29/2022] Open
Abstract
We report a case of a man who presented with features of spinal cord compression, and imaging showed an L3-S2 space-occupying lesion that mimicked a spinal tumor. The patient underwent L3 to S2 laminectomy and a fibrous, thick sheet-like, poorly vascular lesion was observed macroscopically. The histopathological examination of the lesion showed caseous necrosis and epithelioid giant cells. This raised suspicion of tuberculosis and which was later confirmed on a polymerase chain reaction. The present case illustrates that tuberculosis is a disease that should not be ignored, particularly considering its ability to resemble other types of mass lesions.
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Verma M, Sood S, Singh B, Thakur M, Sharma S. Dynamic contrast-enhanced magnetic resonance perfusion volumetrics can differentiate tuberculosis of the spine and vertebral malignancy. Acta Radiol 2021; 63:1504-1512. [PMID: 34806421 DOI: 10.1177/02841851211043838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is considerable overlap in radiologic features of tubercular and malignant spinal lesions on conventional magnetic resonance imaging (MRI). PURPOSE To evaluate the role of dynamic contrast-enhanced (DCE) MRI perfusion parameters in differentiating vertebral malignancy from spinal tuberculosis. MATERIAL AND METHODS This was a prospective study and we enrolled consecutive patients presenting with a clinical/radiologic evidence of vertebral lesions. DCE-MRI of the spine was performed using 3D volume interpolated breath-hold examination (VIBE) sequence after intravenously injecting 0.1 mmol/kg body weight of gadopentetate dimeglumine. We used Tofts model to calculate DCE parameters that included Ktrans (transfer constant), kep (rate constant), ve (fractional volume of extracellular extravascular space), and iAUC (initial area under the curve). We compared the mean value of each perfusion parameter by type of lesion (tubercular/malignant) at 0.05 significance level and performed receiver operating characteristic curve analysis. RESULTS We could confirm histologic/cytologic diagnosis in 35 of the 45 patients recruited. Of these, 19 were tubercular and 16 were malignant lesions. The mean (± standard deviation) of kep (min-1) was significantly higher (2.89 ± 3.3) in malignant compared to tubercular lesions (0.81 ± 0.19), whereas ve was significantly lower in malignant (0.27 ± 0.13 mL/g) compared to benign lesions (0.47 ± 0.12 mL/g) at 0.05 significance level. kep cutoff of ≥1.17 min-1 had a sensitivity of 93.8% and specificity of 100% with a diagnostic accuracy of 94.4% in detecting malignant disease. CONCLUSION High kep is the single best predictor of malignant vertebral lesions. We recommend kep cutoff value of ≥1.17 min-1 that has high diagnostic accuracy in identifying malignant lesions.
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Affiliation(s)
- Mansi Verma
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
| | - Shikha Sood
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
| | - Balraj Singh
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, India
| | - Manoj Thakur
- Department of Orthopaedics, Indira Gandhi Medical College, Shimla, India
| | - Sudershan Sharma
- Department of Pathology, Indira Gandhi Medical College, Shimla, India
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Cao S, Gao X, Bai G, Xin B, Wang T, Cao J, Lv K, Zhu C, Ni X, Zou W, Zhou Y, Xiao J, Liu T. Development and Validation of a Scoring System for Differential Diagnosis of Tuberculosis and Metastatic Tumor in the Spine. Infect Drug Resist 2021; 14:407-413. [PMID: 33574681 PMCID: PMC7871883 DOI: 10.2147/idr.s298316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose Spinal tuberculosis (TB) and metastatic tumor (MT) are common diseases with similar manifestations. Although pathological evaluation is the gold standard to confirm diagnosis, performing biopsies in all patients is not feasible. This study is aimed to create a scoring system to facilitate the differential diagnosis of spinal TB and MT before invasive procedures. Methods Altogether, 447 patients with spinal TB (n=198) and MT (n=249) were retrospectively analyzed. Patients were randomly assigned at 2:1 ratio to a training cohort and a validation cohort. Clinical, laboratory, and radiological diagnostic factors were identified by χ2 and multiple logistic regression analyses. The scoring system was then established based on the identified independent diagnostic factors scored by regression coefficient β value, with the cut-off value being determined by ROC curve. The sensitivity and specificity of the system was calculated by comparing the predicted diagnosis with their actual pathological diagnosis. Results This scoring system was composed of 5 items: pain worsens at night (0 or 2 points), CRP value (0 or 3 points), tumor marker values (0 or 2 points), skip lesions (0 or 3 points), and intervertebral space destruction (0 or 3 points). Patients scoring higher than 7.5 could be diagnosed as spinal TB, otherwise, MT. According to the internal validation, the sensitivity and specificity of the system were 87.9% and 91.6%, respectively. Conclusion This study established and validated a scoring system which could be used to differentiate spinal TB from MT, thus helping clinicians in quick and accurate differential diagnosis.
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Affiliation(s)
- Shuang Cao
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.,Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Xin Gao
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Guangjian Bai
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Baoquan Xin
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Tao Wang
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiashi Cao
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Kai Lv
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Chengzhang Zhu
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Xiangzhi Ni
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Weiwei Zou
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yejin Zhou
- Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Jianru Xiao
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Tielong Liu
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
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Clinical-Morphological Aspects in Spinal Tuberculosis. CURRENT HEALTH SCIENCES JOURNAL 2019; 44:250-260. [PMID: 30647945 PMCID: PMC6311224 DOI: 10.12865/chsj.44.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/21/2018] [Indexed: 11/28/2022]
Abstract
Osteoarticular tuberculosis (OATB) Aim: The authors made a clinical morphological assessment of tissue samples from
patients admitted in Surgical Departments of the Emergency County Hospital of Craiova, Romania, between 1990 and 2015,
proved as presenting tuberculous lesions of the spine in the Department of Pathology of the same Hospital. Materials
and Methods: The studied material consisted of bone, joint and sometimes muscle tissue fragments resulted from
biopsies or surgical excisions from 7 cases coming out of 54 patients investigated in the above-mentioned period of
time, where the established histological diagnosis was tuberculosis (TB). For diagnostic confirmation, Ziehl-Neelsen
staining has been used as a rule but, in some cases, immunohistochemistry was also used. Results: TB lesions have
prevailed in men and around the age of 50 years. Thoracic segment of the spine was the most involved. Epithelioid
and giant Langhans cells dominated the inflammatory cellular population. Necrosis was always present, usually in
its classical acidophilic form. Fibrosis was almost always absent. On the whole, the granulomatous reaction was in
almost half of the cases hyporeactive and disorganized. Conclusions: The clinical morphological profile of our
series is fitting with data described in the literature. Because of its life threatening potential, spinal TB
should be investigated thoroughly especially in its morphological features in order to obtain as quickly as possible
an etiological diagnosis.
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Qiao P, Zhao P, Gao Y, Bai Y, Niu G. Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis. Chin J Cancer Res 2018; 30:425-431. [PMID: 30210222 PMCID: PMC6129564 DOI: 10.21147/j.issn.1000-9604.2018.04.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis were quantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess the value of DCE-MRI in the differential diagnosis of these diseases. Methods Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor (30 cases of each) received conventional MRI and DCE-MRI examination. The volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and plasma volume fraction (Vp) of the diseased vertebral bodies were measured on the perfusion parameter map, and the differences in these parameters between the patients were compared.
Results For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis, respectively, the Ktrans values (median ± quartile pitch) were 0.989±0.014, 0.720±0.011 and 0.317±0.005 min–1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min–1; the Ve values were 0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; the corresponding H values were 50.25 (for Ktrans), 52.47 (for Kep), 48.33 (for Ve) and 46.56 (for Vp), and all differences were statistically significant (two-sided P<0.05).
Conclusions The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis.
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Affiliation(s)
- Pengfei Qiao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Pengfei Zhao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yang Gao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yuzhen Bai
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Guangming Niu
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
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Lang N, Yuan H, Yu HJ, Su MY. Diagnosis of Spinal Lesions Using Heuristic and Pharmacokinetic Parameters Measured by Dynamic Contrast-Enhanced MRI. Acad Radiol 2017; 24:867-875. [PMID: 28162875 DOI: 10.1016/j.acra.2016.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/17/2016] [Accepted: 12/17/2016] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiation of four spinal lesions by using heuristic and pharmacokinetic parameters analyzed from DCE signal intensity time course. MATERIALS AND METHODS DCE-MRI of 62 subjects with confirmed myeloma (n = 9), metastatic cancer (n = 22), lymphoma (n = 7), and inflammatory tuberculosis (TB) (n = 24) in the spine were analyzed retrospectively. The region of interest was placed on strongly enhanced tissues. The DCE time course was categorized as the "wash-out," "plateau," or "persistent enhancement" pattern. The maximum enhancement, steepest wash-in enhancement, and wash-out slope using the signal intensity at 67 seconds after contrast injection as reference were measured. The Tofts 2-compartmental pharmacokinetic model was applied to obtain Ktrans and kep. Pearson correlation between heuristic and pharmacokinetic parameters was evaluated, and receiver operating characteristic curve analysis was performed for pairwise group differentiation. RESULTS The mean wash-out slope was -22% ± 10% for myeloma, 1% ± 0.4% for metastatic cancer, 3% ± 3% for lymphoma, and 7% ± 10% for TB, and it could significantly distinguish myeloma from metastasis (area under the curve [AUC] = 0.884), lymphoma (AUC = 1.0), and TB (AUC = 1.0) with P = .001, and distinguish metastasis from TB (AUC = 0.741) with P = .005. The kep and wash-out slope were highly correlated (r = 0.92), and they showed a similar diagnostic performance. The Ktrans was significantly correlated with the maximum enhancement (r = 0.71) and the steepest wash-in enhancement (r = 0.85), but they had inferior diagnostic performance compared to the wash-out slope. CONCLUSIONS DCE-MRI may provide additional diagnostic information, and a simple wash-out slope had the best diagnostic performance. The heuristic and pharmacokinetic parameters were highly correlated.
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Affiliation(s)
- Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Hon J Yu
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine Hall 164, Irvine, CA 92697-5020
| | - Min-Ying Su
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine Hall 164, Irvine, CA 92697-5020.
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Lang N, Su MY, Yu HJ, Yuan H. Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:1729-37. [PMID: 25749725 DOI: 10.1007/s00586-015-3851-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/17/2015] [Accepted: 02/26/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the differences between imaging features of spinal tuberculosis (TB) and metastatic cancer measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The presentation of TB on convention MRI may not show the typical TB signs, and they may be mis-diagnosed as malignant diseases. DCE-MRI may provide additional information to help making differential diagnosis. MATERIALS AND METHODS DCE-MRI was performed in 24 TB and 22 metastatic cancer patients. The DCE kinetic pattern was determined as "wash-out", "plateau" or "persistent enhancement". The characteristic DCE parameters were calculated from the signal intensity time course. The two-compartmental pharmacokinetic model was used to obtain K (trans), which is the parameter associated with the delivery of MR contrast agents into the lesion, and k ep, which is the parameter associated with the distribution and clearance of contrast agents from the lesion. RESULTS Of the 24 TB, one case showed the wash-out kinetic pattern, 12 cases showed the plateau pattern, and 11 cases showed the persistent enhancement pattern. Of the 22 metastatic cancers, 12 cases showed wash-out, 7 cases showed plateau, and 3 cases showed persistent enhancement patterns. Compared to the metastatic cancer group, the TB group had a lower k ep (0.27 ± 0.15 vs. 0.49 ± 0.23 min(-1), P < 0.001). The ROC analysis showed that the area under the curve was 0.780 for k ep. CONCLUSIONS DCE-MRI may provide additional information for differentiation between spinal TB and metastasis, when their manifestations on conventional imaging were similar.
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Affiliation(s)
- Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China,
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Momjian R, George M. Atypical imaging features of tuberculous spondylitis: case report with literature review. J Radiol Case Rep 2014; 8:1-14. [PMID: 25926906 PMCID: PMC4394978 DOI: 10.3941/jrcr.v8i11.2309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Spinal tuberculosis in its typical form that shows destruction of two adjacent vertebral bodies and opposing end plates, destruction of the intervening intervertebral disc and a paravertebral or psoas abscess, is easily recognized and readily treated. Atypical tuberculous spondylitis without the above mentioned imaging features, although seen infrequently, has been well documented. We present, in this report, a case of atypical tuberculous spondylitis showing involvement of contiguous lower dorsal vertebral bodies and posterior elements with paravertebral and epidural abscess but with preserved intervertebral discs. The patient presented in advanced stage with progressive severe neurological symptoms due to spinal cord compression. Non-enhanced magnetic resonance imaging led to misdiagnosis of the lesion as a neoplastic process. It was followed by contrast enhanced computed tomography of the chest and abdomen that raised the possibility of an infectious process and, post-operatively, histopathological examination of the operative specimen confirmed tuberculosis. This case indicates the difficulty in differentiating atypical spinal tuberculosis from other diseases causing spinal cord compression. The different forms of atypical tuberculous spondylitis reported in the literature are reviewed. The role of the radiologist in tuberculous spondylitis is not only to recognize the imaging characteristics of the disease by best imaging modality, which is contrast enhanced magnetic resonance imaging, but also to be alert to the more atypical presentations to ensure early diagnosis and prompt treatment to prevent complications. However, when neither clinical examination nor magnetic resonance imaging findings are reliable in differentiating spinal infection from one another and from neoplasm, adequate biopsy, either imaging guided or surgical biopsy is essential for early diagnosis.
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Affiliation(s)
- Rita Momjian
- Department of Radiology, Khoula Hospital, Muscat, Sultanate of Oman
| | - Mina George
- Department of Histopathology, Khoula Hospital, Muscat, Sultanate of Oman
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