Can multicontrast ultrafast brain MRI assist residents to triage intracranial emergencies with structured reporting?

OBJECTIVE. The long scan time of brain MRI is a major drawback that limits its clinical use for evaluating pediatric patients who are inherently prone to motion and frequently require sedatives. This study investigated the clinical feasibility of a 1-minute ultrafast brain MRI protocol in pediatric patients by assessing its image quality in comparison with that of routine brain MRI. MATERIALS AND METHODS. Twenty-three patients were enrolled who underwent 1-minute ultrafast MRI and routine brain MRI protocols including five essential sequences (T1-weighted imaging, T2-weighted imaging, DWI, FLAIR, and T2*-weighted imaging). Total scan time for the same image contrast levels was 1 minute 11 seconds for ultrafast MRI versus 9 minutes 51 seconds for routine brain MRI. Two readers independently reviewed all images from the two MRI protocols and graded the image quality on a 4-point Likert scale. The Wilcoxon signed rank test was used to compare the readers' ratings; interobserver agreement between the readers was also assessed. RESULTS. Although the mean scores of overall image quality and anatomic delineation in ultrafast brain MR images were significantly lower than those in routine brain MR images, ultrafast brain MRI showed sufficient overall image quality and anatomic delineation with more than 2 points on the 4-point scale. CONCLUSION. The 1-minute ultrafast brain MRI protocol showed at least sufficient image quality compared with routine brain MRI. Therefore, 1-minute ultrafast brain MRI can be a viable first-line neuroimaging study for pediatric patients because of its shorter scan time, absence of radiation hazard, and reduced sedation requirements.

Ultrafast brain MRI is required for uncooperative patients and time-critical diseases such as stroke because it reduces scan times and motion artifacts. This study investigated the clinical feasibility of a 1-min ultrafast brain MRI protocol for detecting intracranial abnormalities in restless and uncooperative patients. We retrospectively reviewed the records of 25 patients who underwent a 1-min ultrafast MRI protocol using T1-weighted image, T2-weighted image, echo-planar fluid-attenuated inversion recovery, diffusion-weighted image, and T2*-weighted image between March 2017 and May 2017. Simple methods were applied for ultrafast MRI protocol to reduce scan time as follows: parallel imaging techniques, multiband technique on diffusion sequence, and echo-planar fluid-attenuated inversion recovery. The images were compared with the routine brain MRI protocol using synthetic MRI, and quality was assessed by two independent readers. The Wilcoxon signed-rank test was used to compare the readers' ratings of the routine MRI protocol and ultrafast MRI protocol images. Using a four-point assessment scale, overall image quality and anatomical delineation of ultrafast brain MRI images were lower than those of routine brain MRI images. However, the ultrafast protocol demonstrated sufficient overall image quality and anatomical delineation with an assessment rating greater than two points. The ultrafast protocol had fewer artifacts than the routine protocol using synthetic MRI. Although the overall image quality and anatomical delineation of the 1-min ultrafast MRI were inferior to those of the routine brain MRI protocol, the ultrafast protocol showed at least sufficient image quality. Therefore, this protocol may be an option in specific clinical situations involving non-cooperative, restless, or pediatric patients, or patients with time-critical disease such as stroke. Further study is required to validate our findings.

A 3-Minute Ultrafast MRI and MRA Protocol for Screening of Acute Ischemic Stroke.

Evaluation of shunted hydrocephalus is the most common indication for ultrafast brain MRI. Radiation-/sedation-free imaging capabilities make this protocol more desirable over CT and standard brain MRI. We hypothesized that ultrafast brain MRI can be used for selected indications beyond shunted hydrocephalus without adverse outcomes. Ultrafast brain MRI was performed with axial, sagittal, and coronal HASTE. The radiology information system was used to identify pediatric patients (0-18 years of age) who underwent ultrafast brain MRI between March 2014 and May 2016. A retrospective chart review was completed to identify indications other than shunted hydrocephalus, such as ventriculomegaly, macrocephaly, or intracranial cyst. All ultrafast brain MRIs were evaluated by a certified neuroradiologist and a neurosurgeon. Ultrafast brain MRI was deemed of sufficient diagnostic value for these indications if no further standard brain MRI was required for the study indication or if additional imaging was performed for an alternate indication. The radiology information system identified 800 patients who had undergone an ultrafast brain MRI during the study period. One hundred twenty-two of these patients had ventriculomegaly, macrocephaly, or intracranial cyst as the study indication. Twenty-one of the 122 patients were excluded due to insufficient follow-up. Of the remaining 101 patients, only 5 had a standard brain MRI for the same indication, with no additional clinically significant information identified on those studies. These results suggest that ultrafast brain MRI is sufficient to evaluate ventriculomegaly, macrocephaly, or intracranial cyst. Ultrafast brain MRI is radiation- and sedation-free; therefore, we recommend its use as the primary screening neuroimaging study for these indications.

<h3>BACKGROUND AND PURPOSE:</h3> Evaluation of shunted hydrocephalus is the most common indication for ultrafast brain MRI. Radiation-/sedation-free imaging capabilities make this protocol more desirable over CT and standard brain MRI. We hypothesized that ultrafast brain MRI can be used for selected indications beyond shunted hydrocephalus without adverse outcomes. <h3>MATERIALS AND METHODS:</h3> Ultrafast brain MRI was performed with axial, sagittal, and coronal HASTE. The radiology information system was used to identify pediatric patients (0–18 years of age) who underwent ultrafast brain MRI between March 2014 and May 2016. A retrospective chart review was completed to identify indications other than shunted hydrocephalus, such as ventriculomegaly, macrocephaly, or intracranial cyst. All ultrafast brain MRIs were evaluated by a certified neuroradiologist and a neurosurgeon. Ultrafast brain MRI was deemed of sufficient diagnostic value for these indications if no further standard brain MRI was required for the study indication or if additional imaging was performed for an alternate indication. <h3>RESULTS:</h3> The radiology information system identified 800 patients who had undergone an ultrafast brain MRI during the study period. One hundred twenty-two of these patients had ventriculomegaly, macrocephaly, or intracranial cyst as the study indication. Twenty-one of the 122 patients were excluded due to insufficient follow-up. Of the remaining 101 patients, only 5 had a standard brain MRI for the same indication, with no additional clinically significant information identified on those studies. <h3>CONCLUSIONS:</h3> These results suggest that ultrafast brain MRI is sufficient to evaluate ventriculomegaly, macrocephaly, or intracranial cyst. Ultrafast brain MRI is radiation- and sedation-free; therefore, we recommend its use as the primary screening neuroimaging study for these indications.

Ultra-fast biparametric MRI in prostate cancer assessment: Diagnostic performance and image quality compared to conventional multiparametric MRI.

Herein we share our preliminary experience with an ultrafast brain MRI technique for use in the ED consisting of axial T1-weighted (40s), axial T2-weighted (62s), axial diffusion-weighted (80s), axial FLAIR (96s), axial T2* (6s), and axial susceptibility-weighted (108s) imaging for a total scan time of 6min and 53s. Utilization of this ultrafast technique yields an efficient assessment of the brain, decreases ED length of stay and inpatient observation admissions, and may obviate the need for vascular imaging with either CTA or MRA in the ED.

Ultrafast Brain MRI Protocol at 1.5 T Using Deep Learning and Multi-shot EPI

Correction of cerebrospinal fluid levels and brain growth demonstrated by serial fetal magnetic resonance imaging following

Triple-negative breast cancer (TNBC) is a highly proliferative breast cancer subtype. We aimed to identify TNBC among invasive cancers presenting as masses using maximum slope (MS) and time to enhancement (TTE) measured on ultrafast (UF) DCE-MRI, ADC measured on DWI, and rim enhancement on UF DCE-MRI and early-phase DCE-MRI. This retrospective single-center study, between December 2015 and May 2020, included patients with breast cancer presenting as masses. Early-phase DCE-MRI was performed immediately after UF DCE-MRI. Interrater agreements were evaluated using the intraclass correlation coefficient (ICC) and Cohen's kappa. Univariate and multivariate logistic regression analyses of the MRI parameters, lesion size, and patient age were performed to predict TNBC and create a prediction model. The programmed death-ligand 1 (PD-L1) expression statuses of the patients with TNBCs were also evaluated. In total, 187 women (mean age, 58years ± 12.9 [standard deviation]) with 191 lesions (33 TNBCs) were evaluated. The ICC for MS, TTE, ADC, and lesion size were 0.95, 0.97, 0.83, and 0.99, respectively. The kappa values of rim enhancements on UF and early-phase DCE-MRI were 0.88 and 0.84, respectively. MS on UF DCE-MRI and rim enhancement on early-phase DCE-MRI remained significant parameters after multivariate analyses. The prediction model created using these significant parameters yielded an area under the curve of 0.74 (95% CI, 0.65, 0.84). The PD-L1-expressing TNBCs tended to have higher rim enhancement rates than the non-PD-L1-expressing TNBCs. A multiparametric model using UF and early-phase DCE-MRI parameters may be a potential imaging biomarker to identify TNBCs. Prediction of TNBC or non-TNBC at an early point of diagnosis is crucial for appropriate management. This study offers the potential of UF and early-phase DCE-MRI to offer a solution to this clinical issue. • It is crucial to predict TNBC at an early clinical period. • Parameters on UF DCE-MRI and early-phase conventional DCE-MRI help in predicting TNBC. • Prediction of TNBC by MRI may be useful in determining appropriate clinical management.

Ultrafast MR imaging strategies are useful in the assessment of neurological morphology as well as function. Reflecting inevitable trade-offs between spatial resolution and data acquisition speed, ultrafast MRI is, however, limited in its ability to explore morphology. Obvious indications include the fast examination of a restless patient with half k-space sampling, which can serve as a screening procedure. Fetal brain imaging might be considered another, more original application of ultrafast brain imaging. Limitations of the ultrafast MRI assessment of cerebral morphology become apparent, however, when detection of multiple sclerosis plaques is considered. In the spine, ultrafast imaging permits the evaluation of dynamic motion processes.

BACKGROUND. Isotropic 3D T1-weighted imaging has long acquisition times, potentially leading to motion artifact and altered brain volume measurements. Acquisition times may be greatly shortened using an isotropic ultrafast 3D echo-planar imaging (EPI) T1-weighted sequence. OBJECTIVE. The purpose of this article was to compare automated brain volume measurements between conventional 3D T1-weighted imaging and ultrafast 3D EPI T1-weighted imaging. METHODS. This retrospective study included 36 patients (25 women, 11 men; mean age, 68.4 years) with memory impairment who underwent 3-T brain MRI. Examinations included both conventional 3D T1-weighted imaging using inversion recovery gradient-recalled echo sequence (section thickness, 1.0 mm; acquisition time, 3 minutes 4 seconds) and, in patients exhibiting motion, an isotropic ultrafast 3D EPI T1-weighted sequence (section thickness, 1.2 mm; acquisition time, 30 seconds). The 36-patient sample excluded five patients in whom severe motion artifact rendered the conventional sequence of insufficient quality for volume measurements. Automated brain volumetry was performed using NeuroQuant (version 3.0, CorTechs Laboratories) and FreeSurfer (version 7.1.1, Harvard University) software. Volume measurements were compared between sequences for nine regions in each hemisphere. RESULTS. Volumes showed substantial to almost perfect agreement between the two sequences for most regions bilaterally. However, most regions showed significant mean differences between sequences, and Bland-Altman analyses showed consistent systematic biases and wide limits of agreement (LOA). For example, for the left hemisphere using NeuroQuant, volume was significantly greater for the ultrafast sequence in four regions and significantly greater for the conventional sequence in three regions, whereas standardized effect size between sequences was moderate for four regions and large for one region. Using NeuroQuant, mean bias (ultrafast minus conventional) and 95% LOA were greatest in cortical gray matter bilaterally (-50.61 cm3 [-56.27 cm3, -44.94 cm3] for the left hemisphere; -50.02 cm3 [-54.88 cm3, -45.16 cm3] for the right hemisphere). The variation between the two sequences was observed in subset analyses of 16 patients with and 20 patients without Alzheimer disease. CONCLUSION. Brain volume measurements show significant differences and systematic biases between the conventional and ultrafast sequences. CLINICAL IMPACT. In patients in whom severe motion artifact precludes use of the conventional sequence, the ultrafast sequence may be useful to enable brain volume-try. However, the current conventional 3D T1-weighted sequence remains preferred in patients who can tolerate the standard examination.

MRI outcomes in patients with acute-onset vertigo in the emergency department – A prospective study

Acute colorectal emergencies, including bowel obstruction, perforation, and ischemia, require rapid surgical intervention and are associated with significant morbidity and mortality. While robotic surgery has demonstrated clear benefits in elective colorectal procedures, its application in emergency scenarios remains limited and under-investigated. This systematic review and meta-analysis aim to assess the safety and effectiveness of robotic surgery compared to conventional laparoscopic and open approaches in the management of acute colorectal emergencies. We performed a comprehensive literature search across Cochrane, PubMed, Embase, and Scopus databases from inception through December 2024, following PRISMA guidelines. Eligible studies included randomized controlled trials (RCTs), cohort studies, and case-control studies comparing robotic surgery with traditional techniques in acute colorectal emergencies. Primary outcomes were operative time, conversion to open surgery, and complication rates. Secondary outcomes included mortality, reoperation rates, and hospital length of stay. A random-effects model was applied to account for study heterogeneity. Fifteen studies encompassing 2,340 patients (1,170 robotic, 1,170 conventional) were included. Robotic procedures were associated with longer operative times (mean difference [MD] 48.7min; 95% CI 32.1-65.3; p < 0.001), but demonstrated significantly lower conversion rates to open surgery (odds ratio [OR] 0.42; 95% CI 0.26-0.68; p = 0.001) and reduced overall complication rates (OR 0.61; 95% CI 0.45-0.83; p = 0.002). No significant differences were found for mortality (OR 0.91; 95% CI 0.58-1.42; p = 0.67), reoperation rates (OR 0.78; 95% CI 0.51-1.19; p = 0.25), or length of hospital stay (MD -0.3 days; 95% CI -0.9 to 0.3; p = 0.31). Robotic surgery in acute colorectal emergencies appears to reduce conversion and complication rates compared to conventional approaches, despite increased operative times. These findings support the potential role of robotic techniques in emergency settings. Further high-quality RCTs are needed to validate long-term outcomes and cost-effectiveness.

A 52-year-old woman presented to the clinic with headaches that began with a sore neck and progressed to the occipital region over a 4-week period. There were no associated symptoms of nausea, photophobia, or phonophobia. The patient felt relief upon lying down and the pain would begin again upon sitting or standing. The symptoms were initially constant but then started to subside to an intermittent basis. However, the pain then involved her whole head with occasional unilateral tinnitus. Over-the-counter non-steroidal anti-inflammatory drugs did not relieve her pain. The patient had a history of infrequent migraines without aura that were very different from these symptoms. Neurologic and physical exam were normal including no tenderness to palpation of the head or cervical spine. Magnetic resonance imaging (MRI) of the brain performed with and without contrast demonstrated diffuse pachymeningeal enhancement (Fig. 1, long white arrow), low-lying cerebellar tonsils (Fig. 1, short white arrow), and an enlarged pituitary gland (Fig. 1, black arrow) shown here on T1 sequence with contrast. Subsequently, she underwent cisternography and was found to have an opening pressure of 7-cm H2O, though the computerized tomography (CT) of the sinuses revealed no evidence of a cerebrospinal fluid leak. MRI of the cervical and thoracic spine revealed fluid in the epidural spaces of C1-2 and T1-9 levels (2, 3, respectively). A CT myelography demonstrated fluid but no identifiable source of the leak. After an epidural “blood patch” was performed on the patient in the upper lumbar region, there was immediate symptom relief. Comment: Spontaneous intracranial hypotension (SIH) is a well-known entity that is often misdiagnosed, particularly in the emergency setting.1 A good history will reveal the typical postural changes of symptoms associated with low cerebrospinal fluid pressure. While MRI of the brain usually shows diffuse pachymeningitis and low-sitting cerebellar tonsils, the enlargement of the pituitary can be quite concerning and physicians will want to rule out adenoma. However, this phenomenon has been described in SIH after viewing MRIs prior to and after treatment, in that the pituitary returns to normal size within a short amount of time.2