Background and Purpose Postradiation treatment necrosis is one of the most serious late sequelae and appears within 6 months. The magnetic resonance spectroscopy imaging (MRSI) has been used for the detection of brain tumors. The study aimed to determine the radiological accuracy and efficacy in distinguishing recurrent brain tumor from radiation‐induced necrosis by identifying pseudoprogression. Methods The research was performed in accordance with the preferred reporting items for systematic review and meta‐analysis guidelines. International electronic databases including 15 English sources were investigated. A total of 4281 papers with 2159 citations from 15 databases from 2011 to 2021 met the search strategies of magnetic resonance (MR) spectroscopy in recurrent brain tumors and postradiation necrosis. Results Nine studies were enrolled in the meta‐analysis with a total of 354 patients (203 male and 151 female) whose average age ranged from 4 to 74 years. Anbarloui et al., Elias et al., Nemattalla et al., Smith et al., Zeng et al., and Weybright et al. showed strong evidence of heterogeneity regarding choline/N‐acetylaspartate (Cho/NAA) ratio in the evaluation of the nine studies. Elias et al., Nemattalla et al., Bobek‐Billewicz et al., and Smith et al. showed a high heterogeneity in Cho/creatine (Cr) ratio. Elias et al., Nemattalla et al., Smith et al., and Weybright et al. revealed high heterogeneity in NAA/Cr ratio estimates. Conclusion MR spectroscopy is effective in distinguishing recurrent brain tumors from necrosis. Our meta‐analysis revealed that Cho/NAA, Cho/Cr, and NAA/Cr ratios were significantly better predictor of detected recurrent tumor. Therefore, the MRSI is an informative tool in the distinction of tumor recurrence versus necrosis.

Teaching Point: Spontaneous rupture of the anterior tibial tendon at the ankle joint may mimic a tumor.

Teaching Point: Calcified intervertebral disc herniation in children is rare, and spontaneous resolution is the rule.

Background: Fabry disease occurs due to mutations in the α-galactosidase A (GLA) gene present in the X-chromosome, which results in α-galactosidase A (α-GAL A) enzyme deficiency, leading to the intracellular accumulation of glycosphingolipids like globotriaosylceramide (Gb3). It involves multiorgan dysfunction, particularly affecting kidneys, heart, and central and peripheral nervous system. We intended to evaluate the prevalence of Fabry disease in various regions of Iraq along with the clinical manifestations. Methods: This cross-sectional multi-center study was conducted in Iraq with 1148 patients with variable presentations from January 2018 to June 2022. The demography, patient medical and family history were recorded. Routine clinical investigations were performed along with some specific assessments. Lysosomal α-GAL A enzyme activity was determined using the dried blood spot test followed by tandem mass spectrometry, where values between 200–2000 pmol/spot*20 h were considered normal. Any patient with α-GAL A activity <100 pmol/spot*20h was sent for genetic testing for confirmation of the diagnosis. Statistical analysis of data involved Pearson’s chi-squared test. Results: In total, 17 patients had Fabry disease, with a 16:1 male:female ratio. The disorder was predominant in the 10–30-year age group. Renal dysfunction was the dominant clinical manifestation (82.3%), followed by peripheral neuropathy (35.3%), angiokeratoma (29.4%), corneal verticillate (23.5%), and left ventricular hypertrophy (17.6%). The prevalence of Fabry disease was highest in north Iraq, followed by middle and south regions. Conclusions: A prompt and timely diagnosis of Fabry disease is the cornerstone for preventing complications, especially renal and cardiac involvement.