The value of magnetic resonance imaging in forensic investigation: a mapping review.

Purpose To compare the diagnostic performance of a short dual-pulse sequence magnetic resonance (MR) imaging protocol versus a standard six-pulse sequence multiparametric MR imaging protocol for detection of clinically significant prostate cancer. Materials and Methods This HIPAA-compliant study was approved by the regional ethics committee. Between July 2013 and March 2015, 63 patients from a prospectively accrued study population who underwent MR imaging of the prostate including transverse T1-weighted; transverse, coronal, and sagittal T2-weighted; diffusion-weighted; and dynamic contrast material-enhanced MR imaging with a 3-T imager at a single institution were included in this retrospective study. The short MR imaging protocol image set consisted of transverse T2-weighted and diffusion-weighted images only. The standard MR imaging protocol image set contained images from all six pulse sequences. Three expert readers from different institutions assessed the likelihood of prostate cancer on a five-point scale. Diagnostic performance on a quadrant basis was assessed by using areas under the receiver operating characteristic curves, and differences were evaluated by using 83.8% confidence intervals. Intra- and interreader agreement was assessed by using the intraclass correlation coefficient. Transperineal template saturation biopsy served as the standard of reference. Results At histopathologic evaluation, 84 of 252 (33%) quadrants were positive for cancer in 38 of 63 (60%) men. There was no significant difference in detection of tumors larger than or equal to 0.5 mL for any of the readers of the short MR imaging protocol, with areas under the curve in the range of 0.74-0.81 (83.8% confidence interval [CI]: 0.64, 0.89), and for readers of the standard MR imaging protocol, areas under the curve were 0.71-0.77 (83.8% CI: 0.62, 0.86). Ranges for sensitivity were 0.76-0.95 (95% CI: 0.53, 0.99) and 0.76-0.86 (95% CI: 0.53, 0.97) and those for specificity were 0.84-0.90 (95% CI: 0.79, 0.94) and 0.82-0.90 (95% CI: 0.77, 0.94) for the short and standard MR protocols, respectively. Ranges for interreader agreement were 0.48-0.60 (83.8% CI: 0.41, 0.66) and 0.49-0.63 (83.8% CI: 0.42, 0.68) for the short and standard MR imaging protocols. Conclusion For the detection of clinically significant prostate cancer, no difference was found in the diagnostic performance of the short MR imaging protocol consisting of only transverse T2-weighted and diffusion-weighted imaging pulse sequences compared with that of a standard multiparametric MR imaging protocol. © RSNA, 2017 Online supplemental material is available for this article.

We aimed to evaluate the efficacy of a breath-hold superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging protocol for the detection of focal hepatic lesions, in comparison with a non-breath-hold SPIO-enhanced imaging protocol and computed tomography during arterioportography (CTAP) plus CT during hepatic arteriography (CTHA). Findings of SPIO-enhanced MR imaging and CTAP/CTHA for 24 hepatic metastases in 17 patients and 29 HCCs in 21 patients were analyzed. All patients underwent breath-hold SPIO-enhanced MR imaging (1.5 tesla), breath-hold plus non-breath-hold SPIO-enhanced MR imaging, and CTAP plus CTHA prior to partial hepatectomy or laparoscopic ablation therapy. Histopathology for lesion characterization and intraoperative ultrasound for lesion detection were available for all patient. Breath-hold SPIO-enhanced MR imaging consisted of T2-weighted single-short fast spin echo (FSE), T2-weighted (T2W) FSE, T2*-weighted gradient echo (GRE), and T1-weighted GRE. For the non-breath-hold imaging protocol, respiratory-triggered, fat-suppressed T2W-FSE was added to the breath-hold MR imaging protocol. Double phase CTAP plus CTHA was performed on an angio-CT system. To compare the three imaging protocols, three radiologists performed blind film reading, and all data, on a hepatic segment-to-segment basis, were entered for alternative free-response receiver-operating characteristic (AFROC) analysis. ROC analysis showed that there was no significant difference in the area under the AFROC curve (A1) value for metastases and HCCs among the three protocols; the breath-hold SPIO-enhanced MR imaging protocol, non-breath-hold MR imaging protocol, and CTAP plus CTHA. The breath-hold SPIO-enhanced MR imaging protocol showed a sensitivity, specificity, and accuracy equivalent to the non-breath-hold MR imaging protocol and CTAP plus CTHA. As a preoperative test, SPIO-enhanced MR imaging could have the potential to replace CTAP plus CTHA in a certain clinical setting.

Background/Objectives: Penile fractures are a rare urological emergency, defined as the traumatic rupture of the tunica albuginea. They are classically diagnosed on clinical grounds, requiring urgent operative repair, most commonly by penile degloving. Magnetic resonance imaging (MRI) has emerged as a promising tool in the management of penile fractures. Often recommended in the setting of equivocal clinical diagnoses, MRI can help diagnose, as well as localise, the site of injury. Furthermore, it also holds potential in differentiating penile fractures from mimicking conditions, thereby possibly preventing unnecessary surgical procedures. This study is aimed at evaluating the diagnostic accuracy of MRI for penile fractures. Furthermore, it seeks to explore MRI’s effectiveness in guiding the surgical approach through precise localisation of the injury site. Methods: The PubMed, Embase, and Cochrane databases were searched from January 1995 to December 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a total of 246 cases from 32 studies were identified. Results: Pooled results for MRI use in penile fracture diagnosis resulted in a positive predictive value of 97.8%, a negative predictive value of 87.0%, a sensitivity of 98.6%, and a specificity of 80%. MRI can accurately guide localised incisions, due to its ability to accurately identify the exact site of injury, with no additional reported complications or conversions to degloving. Considerable heterogeneity was observed within MRI parameters and protocols used in the studies identified. Conclusions: This review suggests that MRI is an accurate imaging modality for penile fractures and should be considered as a first-line investigation for equivocal cases. Its application may refine clinical management by avoiding unnecessary surgeries in cases mimicking penile fractures and improve pre-operative planning through precise injury localisation. This study is limited by heterogeneity in MRI protocols and the small sample sizes and retrospective nature of many included studies. The future standardisation of MRI protocols could enhance its utility and reliability in the clinical setting. Additionally, further research is needed to evaluate the long-term outcomes following the repair of small fractures detected on MRI and following MRI-guided localised incisions during surgical repair. Level of Evidence: 2.

Postmortem cytology: Alive and well in the practice of autopsy and forensic pathology.

A systematic review of quality of thyroid-specific health-related quality-of-life instruments recommends ThyPRO for patients with benign thyroid diseases

Kinetic Analysis of Lesions Identified on a Rapid Abridged Multiphase (RAMP) Breast MRI Protocol

Given the limited capacity and suboptimal sensitivity of ultrasonography (US), gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) demonstrates good diagnostic performance for hepatocellular carcinoma (HCC). Some researchers have proposed that the abbreviated MRI (AMRI) protocols have potential as a surveillance tool. However, few studies have compared multiple AMRI protocols with complete Gd-EOB-DTPA contrast-enhanced MRI for HCC surveillance. We aimed to explore and compare the diagnostic performance of 3 AMRI protocols as HCC surveillance in high-risk patients. This multi-center, retrospective, blinded reader study conducted in China consecutively enrolled 339 patients with hepatitis and/or cirrhosis who underwent complete Gd-EOB-DTPA contrast-enhanced MRI for HCC surveillance from 2020 to 2023. We extracted 3 additional AMRI protocols: noncontrast-AMRI [NC-AMRI: T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)]; dynamic-AMRI (Dyn-AMRI: early and late arterial phases, portal venous phase, and DWI); and hepatobiliary phase-AMRI (HBP-AMRI: T2WI, DWI, and HBP). Then, 2 independent radiologists assessed the AMRI and complete Gd-EOB-DTPA contrast-enhanced MRI protocols. Patients were classified as HCC positive/HCC negative based on the reference standard. Agreement was assessed using Kappa statistics. The acquisition time differences of the 4 MRI protocols were analyzed by analysis of variance (ANOVA). Per-lesion HCC diagnostic performances were compared by Cochran's Q test. Receiver operating characteristic (ROC) curves for the 3 AMRI protocols were evaluated, and the area under the ROC curve (AUROC) was calculated and compared by DeLong's test. A total of 353 lesions were detected in the 339 included patients, and 21/339 patients were diagnosed with HCC (prevalence, 6.2%). The inter-observer agreement was good for all 4 MRI protocols (k>0.75). Acquisition times differed significantly (P<0.001), from the shortest to the longest: NC-AMRI (263.44±5.05s) < HBP-AMRI (269.18±4.93 s) < Dyn-AMRI (307.71±4.93 s) < complete Gd-EOB-DTPA contrast-enhanced MRI (582.03±3.59s). The sensitivity (Cochran's Q=14.667, P=0.002) and specificity (Cochran's Q=59.682, P<0.001) of 4 MRI protocols were statistically significant. HBP-AMRI showed the highest sensitivity (84.00%), whereas Dyn-AMRI exhibited the highest specificity (99.39%) among 3 AMRI protocols. The per-lesion positive predictive value (PPV) for the NC-AMRI, Dyn-AMRI, and HBP-AMRI was 41.66%, 88.89%, and 47.72%, the corresponding negative predictive value (NPV) was 96.21%, 97.31%, and 98.70%, and the number needed to diagnose (NND) for the NC-AMRI, Dyn-AMRI, HBP-AMRI, and complete Gd-EOB-DTPA contrast-enhanced MRI was: 1.865, 1.577, 1.234, and 1.569, respectively. DeLong's test showed the AUROC value of either Dyn-AMRI or HBP-AMRI was significantly higher than that of NC-AMRI (Z=2.330, P=0.019; Z=2.680, P=0.007, respectively), but no significant difference between HBP-AMRI and Dyn-AMRI (Z=1.643, P=0.100). AMRI protocols can be implemented in clinical practice as a patient-centered and tailored regimen for HCC surveillance in China. NC-AMRI might become an optional tool due to its minimal scanning time, lower cost, and exemption from contrast agents. Dyn-AMRI, achieving the highest specificity, is a reliable surveillance strategy. HBP-AMRI as a favorable alternative showed a high sensitivity and NPV while maintaining considerable specificity and NND.

To compare three magnetic resonance imaging (MRI) protocols containing diffusion-weighted imaging with background suppression (DWIBS) and one traditional protocol for detecting extrahepatic colorectal cancer metastases. Thirty patients with extrahepatic colorectal cancer metastases were scanned in three stations from the skull base to the upper thighs using a 1.5T MRI system with six different MRI sequences; transverse and coronal T2 -weighted (T2 W) turbo spin-echo (TSE), coronal short tau inversion recovery (STIR), 3D T1 W TSE, DWIBS, and a contrast-enhanced T1 W 3D gradient echo (GRE) sequence. The six sequences were used to build four hypothetical MRI interpretive sets which were read by two readers in consensus, blinded to prior imaging. Lesions were categorized into 13 anatomic regions. Fluorodeoxyglucose / positron emission tomography / computed tomography (FDG-PET/CT) read with full access to prior imaging and clinical records was used as the reference standard. Sensitivity, specificity, and false discovery rate (FDR) were calculated as appropriate and receiver operating characteristic (ROC) curves were constructed. In all, 177 malignant lesions were detected by FDG-PET/CT and distributed in 92 out of 390 scanned anatomic regions. The sensitivity was statistically higher in two out of three sets incorporating DWIBS on a per-lesion basis (66.7%, 63.3%, and 66.7% vs. 57.6%) (P = 0.01, P = 0.11, and P = 0.01, respectively) and in all sets incorporating DWIBS on a per-region basis (75.0%, 75.0%, and 77.2 vs. 66.3%) (P = 0.04, P = 0.04, and P = 0.01, respectively). There was no difference in specificity, FDR, or AUCROC . There was no difference between sets containing DWIBS irrespective of the use of a contrast-enhanced sequence. MRI sets containing DWIBS had superior sensitivity. This sensitivity was retained when omitting a contrast-enhanced sequence. 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1619-1630.

To determine whether a three-dimensional isotropic resolution fast spin-echo sequence (FSE-Cube) has similar diagnostic performance as a routine magnetic resonance (MR) imaging protocol for evaluating the cartilage, ligaments, menisci, and osseous structures of the knee joint in symptomatic patients at 3.0 T. This prospective, HIPAA-compliant, institutional review board-approved study was performed with a waiver of informed consent. FSE-Cube was added to the routine 3.0-T MR imaging protocol performed in 100 symptomatic patients (54 male patients with a median age of 32 years and 46 female patients with a median age of 33 years) who subsequently underwent arthroscopic knee surgery. All MR imaging studies were independently reviewed twice by two musculoskeletal radiologists. During the first review, the routine MR imaging protocol was used to detect cartilage lesions, ligament tears, meniscal tears, and bone marrow edema lesions. During the second review, FSE-Cube with multiplanar reformations was used to detect these joint abnormalities. With arthroscopic results as the reference standard, the sensitivity and specificity of FSE-Cube and the routine MR imaging protocol in the detection of cartilage lesions, anterior cruciate ligament tears, and meniscal tears were calculated. Permutation tests were used to compare sensitivity and specificity values. FSE-Cube had significantly higher sensitivity (P = .039) but significantly lower specificity (P = .003) than the routine MR imaging protocol for detecting cartilage lesions. There were no significant differences (P = .183-.999) in sensitivity and specificity between FSE-Cube and the routine MR imaging protocol in the detection of anterior cruciate ligament tears, medial meniscal tears, or lateral meniscal tears. FSE-Cube depicted 96.2% of medial collateral ligament tears, 100% of lateral collateral ligament tears, and 85.3% of bone marrow edema lesions identified on images obtained with the routine MR imaging protocol. FSE-Cube has similar diagnostic performance as a routine MR imaging protocol for detecting cartilage lesions, cruciate ligament tears, collateral ligament tears, meniscal tears, and bone marrow edema lesions within the knee joint at 3.0 T.

Background/Objectives: A systematic review was conducted to compile all the evidence on the impact of ADRB1 and ADRB2 genetic variants on the response to β-blockers, used for the management of cardiovascular diseases. Methods: After searching in PubMed, PharmGKB, and the Cochrane Central Register of Controlled Trials including terms related to these drugs, genes, and pathologies, 1182 articles were retrieved, 29 of which met the inclusion criteria. A β-adrenoreceptor (ADRB) blockade qualitative variable was inferred for all the associations between genetic variants and clinical phenotypes. Results: The relationship between ADRB1 rs1801253 (G>C) C allele and higher receptor blockade showed a moderate overall level of evidence, reaching a high level on its relationship with higher reduction in the systolic (SBP) and diastolic blood pressure and heart rate (HR). The relationship between ADRB1 rs1801252 (A>G) G allele and lower receptor blockade reached an overall high level of evidence, considering its impact on the reduction in the SBP, HR, left ventricular end-diastolic diameter, and incidence of major cardiovascular events. The relationship between ADRB2 rs1042714 (G>C) C allele and lower receptor blockade reached a moderate overall level of evidence due to its impact on HR, pulmonary wedge pressure, and left ventricular ejection fraction response. The ADRB2 rs1042713 (G>A) A allele was associated with higher receptor blockade and higher HR reduction with a low level of evidence. Conclusions: The genotyping of both ADRB1 variants may be clinically useful; further investigation is required on the relevance of both ADRB2 variants. Further research is warranted to determine the clinical usefulness of ADRB preemptive genotyping.

Background: Adductor avulsions are complex injuries often involving multiple structures, as indicated by several magnetic resonance imaging (MRI) studies. However, no studies have compared MRI assessments using a dedicated groin protocol with surgical findings. Hypothesis: It was hypothesized that MRI assessments using a dedicated groin protocol would correlate closely with surgical findings, applicable to both experienced and novice users of the pyramidalis–anterior pubic ligament–adductor longus complex (PLAC) classification. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study analyzed 161 athletes who underwent MRI using a dedicated groin protocol, followed by surgical repair of the PLAC. Two musculoskeletal radiologists—1 experienced (rater A) and 1 inexperienced (rater B) in the use of the PLAC classification—independently assessed the MRI scans twice, 6 weeks apart, using a structured 3-step protocol to evaluate (1) adductor longus fibrocartilage (intact, partially avulsed, or completely avulsed), (2) pyramidalis separation from adductor longus (intact, partially separated, or completely separated), and (3) pectineus status (intact or partially avulsed). Agreement between MRI and surgical findings was evaluated using a PLAC injury classification (types 1-5), with intra- and interobserver reliability measured by Cohen kappa. Results: Among the 161 athletes, 93 played soccer, of whom 69 were professional. All athletes exhibited complete fibrocartilage avulsion, with 83 athletes (52%) showing adductor longus separation from the pyramidalis. Isolated adductor longus avulsions (PLAC type 1) were observed in only 36 athletes (22%). The interobserver kappa score between MRI assessments and surgical findings was 0.942 for rater A and 0.858 for rater B. Intraobserver ratings were 0.967 for rater A and 0.875 for rater B. Both inter- and intraobserver scores indicated almost perfect agreement. In combination, these statistical findings support the validity, reliability, and applicability of the MRI protocol using the PLAC classification system for 2 users with varying levels of experience. Conclusion: Adductor avulsions were rarely isolated, typically involving multiple muscles. The PLAC classification effectively captured the complexity of these injuries. When used in conjunction with a dedicated MRI protocol, the PLAC classification demonstrated almost perfect agreement and concordance with surgical findings. Together, the PLAC classification and MRI protocol offered a more comprehensive and accurate representation of patients’ clinical and radiological features and provided valuable guidance for surgical planning.

Magnetic resonance imaging (MRI) is commonly used for analyzing white matter abnormalities in the human brain. Integrating machine learning into MRI analysis can enhance diagnostic processes. However, the application of such techniques for white matter analysis in clinical practice is often limited when MRI data are multi-scanner (i.e., heterogeneous), particularly in scenarios with limited data, as seen in rare diseases. Therefore, it is crucial to develop methods that are highly independent of the MRI scanner and acquisition protocol. This study introduces HeteroMRI, a deep learning method for classifying MRIs based on white matter abnormalities. Most importantly, HeteroMRI mitigates the effects of data heterogeneity on classification performance. Herein, HeteroMRI is employed to detect brain MRIs with white matter abnormalities. This method utilizes intensity clustering of the white matter tissue to reduce the effects of the heterogeneity of MRIs. MRI data from 11 public datasets with 40 MRI protocols are included. By using 200 MRIs for training the model, the binary classifier achieves an average accuracy of 93% ± 4%. Furthermore, the method is evaluated in limited data scenarios, simulating conditions of rare diseases. By reducing the data by 64% and 75%, the model's accuracy has a 4% and 12% decrease, respectively. The presented method opens new avenues for white matter abnormality-related classification of heterogeneous MRI data without additional machine learning methods to reduce MRI heterogeneity. This classification approach demonstrates a high degree of independence from the MRI scanner and protocol, while also proving to be relatively generalizable to unseen MRI protocols.

To localize the cortical motor hand area with functional magnetic resonance (MR) imaging before and after MR imaging--guided laser-induced interstitial thermotherapy of tumors in the precentral brain region to control energy delivery and to improve safety. Functional MR images were obtained in eight patients (five men, three women; aged 27-63 years) while they flexed their fingers. MR imaging--guided laser-induced interstitial thermotherapy was terminated when there was less than 8-12 mm between the border of the laser-induced lesion and the motor hand area anterior aspect. Seven patients had a statistically significant localized change in signal intensity in the central region of the contralateral hemisphere. This area was a spotlike circumscribed focus in three patients and scattered over a larger zone in four patients. Persistent deficits did not occur after thermotherapy in any patient. In three patients, onset of reversible perifocal edema in the motor hand area coincided with the development of hemiparesis, which completely resolved. No patient had activity within the tumor on functional MR images. Functional MR imaging findings can be used to prevent neurologic damage during MR imaging--guided laser-induced interstitial thermotherapy.

To determine the potential of mesoporphyrin- and gadopentetate dimeglumine-enhanced and functional magnetic resonance (MR) imaging in the assessment of the acute effect of nicorandil on ischemic injury of the myocardium. Spin-echo MR imaging was used to monitor changes in myocardial contrast and function in reperfused myocardial injury. Inversion-recovery echo-planar MR imaging was used to depict the injured region. Myocardial injury in rats was produced by using 30 minutes of coronary occlusion followed by 24 hours reperfusion. Nicorandil (n = 9) was infused during occlusion and early reperfusion. Control animals (n = 11) received no therapy. At 24 hours, after administration of mesoporphyrin and gadopentetate dimeglumine and histochemical staining, the function and size of the injured region of the left ventricle (LV) were determined. A t test was used to compare data between groups of animals, whereas regression and Bland-Altman analyses were used to determine correlation and agreement between MR imaging and histomorphometry, respectively. Treated animals showed reduced infarction size as compared with the control group from 25.6% +/- 7.9 (SD) to 7.9% +/- 6.8 of LV myocardial area (P < .001), as defined with mesoporphyrin-enhanced MR imaging; while the size of the rim increased from 10.8% +/- 10.0 to 16.1% +/- 14.4 (P < .05). The diastolic-midventricular cavity area was smaller in treated animals (15.2 mm(2) +/- 4.3) compared with the control group (28.5 mm(2) +/- 7.9; P < .001). At functional MR imaging, nicorandil improved systolic reduction in LV cavity area (57.5% +/- 17.3) compared with the control group (38.0% +/- 16.0; P < .05) and preserved regional LV wall thickening at the site of injury (12.2% +/- 11.1 in treated group vs 0.3% +/- 8.6 in the control group; P < .05). Contrast material-enhanced MR imaging has the potential to demonstrate reduction in size of ischemically injured myocardium, whereas functional MR imaging demonstrated the recovery of LV function 24 hours after nicorandil therapy.

Protocolised MRI as an adjunct to CT in the diagnosis of femoral neck fracture in high energy ipsilateral femoral shaft fractures – A break-even analysis