The importance of the perivascular space (PVS) as one of the imaging markers of cerebral small vessel disease (CSVD) has been widely appreciated by the neuroradiologists. The PVS surrounds the small blood vessels in the brain and has a signal consistent with the cerebrospinal fluid (CSF) on MR. In a variety of physio-pathological statuses, the PVS may expand. The discovery of the cerebral glymphatic system has provided a revolutionary perspective to elucidate its pathophysiological mechanisms. Research on the function and pathogenesis of this system has become a prevalent topic among neuroradiologists. It is now believed that this system carries out the similar functions as the lymphatic system in other parts of the body and plays an important role in the removal of metabolic waste and the maintenance of homeostatic fluid circulation in the brain. In this article, we will briefly describe the composition of the cerebral glymphatic system, the influencing factors, the MR manifestations of the PVS and the related imaging technological advances. The aim of this research is to provide a reference for future clinical studies of the PVS and glymphatic system.
Background: Pulmonary actinomycosis is a rare bacterial disorder often misdiagnosed as other pulmonary diseases because of a lack of specific characteristics and radiographic findings. Aspergillus nodules, a common fungal infection and form of chronic pulmonary aspergillosis, have imaging findings that overlap with those of pulmonary actinomycosis. This study reviews patients’ clinical and imaging data, to differentiate pulmonary actinomycosis from Aspergillus nodules. Methods: This retrospective study included 17 patients with pulmonary actinomycosis and 25 patients with Aspergillus nodules diagnosed histopathologically in a tertiary Chinese hospital between June 2014 and January 2022. Data on age, sex, lesion types/locations, and CT findings were analyzed. Results: No significant differences were found in age (mean age 58.2 ± 7.7 vs. 57.2 ± 11.9; p = 0.76), but statistically significant differences were found in sex (men 13 vs. women 10; p = 0.02), between groups. Common symptoms between groups included cough, hemoptysis, sputum production, fever, and chest pain, which showed no significant between-group differences (p = 0.09, p = 0.28, p = 0.10, p = 1, p = 0.41, respectively). Visual evaluation revealed that pulmonary actinomycosis lesions were more likely than pulmonary aspergillosis to appear mass-like (p < 0.001), with bulky volume (p = 0.002), ill-defined margins (p = 0.045), and interlobular septal thickening (p = 0.008). Pleural changes and mediastinal or hilar lymphadenopathy were more common in pulmonary actinomycosis than in Aspergillus nodules (p = 0.037, p = 0.010, respectively), whereas cavitation, an air-crescent sign, and bronchiectasis were more common in pulmonary aspergillosis (p = 0.027, p < 0.001, p = 0.016, respectively). Conclusion: Distinguishing between pulmonary actinomycosis and Aspergillus nodules on the basis of clinical manifestations alone is difficult, although distinctive CT findings may differentiate the two diseases.
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