Magnetic Resonance Imaging Abnormalities Research Articles

Admission and follow-up cardiac magnetic resonance imaging findings in BNT162b2 Vaccine-Related myocarditis in adolescents

Background There is limited data on the pattern and severity of myocardial injury in patients with COVID-19 vaccination associated myocarditis. Objective We aimed to define the myocardial damage occurring after BNT162b2 vaccination, raise awareness about adverse reactions developing after vaccination, and determine the patterns and scope of Cardiac magnetic resonance imaging (MRI) findings. Patients/Methods A total of 9 patients diagnosed with vaccine-associated myopericarditis were followed up. Results The mean age of the patient at diagnosis was 15.3 ± 1.0 (range: 14–17) years, and all patients were male. Seven patients presented with myocarditis symptoms after their second vaccine dose, one patient presented with pericarditis symptoms after his first dose, and the other patient presented with myocarditis symptoms after his booster dose. The median time at presenting to the hospital was 3 (range: 2–22) days. Seven (77.7%) patients had abnormal electrocardiography (ECG) findings, and the most prevalent finding was diffuse ST-segment elevation. Initial cardiac MRI results were abnormal in all patients, where 8 (88.8%) patients had late gadolinium enhancement, and 5 (55.5%) had myocardial edoema. Three patients showed local left ventricular wall-motion abnormalities. In their follow-up MRIs 3–6 months later, myocardial edoema was present in 2 (28.5%) patients, while late gadolinium enhancement was present in all patients (7/7, 100%, 2 patients did not have control MRI time). Hypokinetic segments were still present in one of the 3 patients. No negative cardiac events were observed in the short-term follow-up of any patient. Conclusion Further follow-up evaluation and larger multicenter studies are needed to determine the clinical significance of persistent cardiac MRI abnormalities.

Efficacy, Retention Rate, and Influencing Factors of Ketogenic Diet Therapy in Children with Refractory Epilepsy: A Retrospective Study.

This study aimed to evaluate the efficacy and retention rate of a ketogenic diet (KD) and assess factors that influence the efficacy of KD therapy in children with refractory epilepsy (RE). We retrospectively studied the efficacy and retention rate of 56 RE children who accepted KD therapy from January 2013 to December 2019. Patients who had a ≥50% reduction in seizure frequency were defined as responders. The retention rate was calculated as the proportion of children who continued KD/the total number of children who were followed up at the time of enrollment. We also analyzed the effects of different factors (such as gender, KD initial age, KD duration, the type of epilepsy syndrome, and others) on the efficacy of the KD. (1) The efficacy rates for the KD at 3, 6, 12, and 18 months were 51.8, 53.6, 39.2, and 23.2%, respectively. (2) The retention rates for the KD at 3, 6, 12 and 18 months were 100, 69.6, 41.1, and 23.2%, respectively. (3) There was no correlation between efficacy and gender, epilepsy onset age, the type of epilepsy syndrome, electroencephalogram improvement, or the number of antiseizure medications, while cranial magnetic resonance imaging (MRI) abnormalities, KD duration, and KD initial age affected its efficacy at 3 months. (1) KD therapy for refractory childhood epilepsy was effective and produced a high retention rate. (2) MRI abnormalities and the initial age and duration of KD influenced its short-term efficacy in RE children.

Magnetic resonance imaging evaluation of single axillary lymph node metastasis in breast cancer: Emphasis on the location of lymph nodes

To evaluate the frequency and location of abnormal lymph nodes (LNs) in breast cancer patients with a single axillary lymph node (ALN) metastasis on breast magnetic resonance imaging (MRI). We retrospectively reviewed the MRI findings of 219 consecutive patients with breast cancer with single ALN metastasis who were surgically confirmed at our institution between January 2018 and December 2018. The morphological features and locations of the abnormal LN on MRI were analyzed. Pathology reports were reviewed to evaluate the size of the metastases and whether they were sentinel LNs (SLNs). Of the 219 patients with a single ALN metastasis, 56 (25.6%) showed abnormal MRI findings. Of these, 54 (96.4%) had either the lowest or second-lowest LN in the level I axilla. In 184 (91.5%) of 201 patients who underwent SLN biopsy, the metastatic LN were SLN. Macrometastases were found more frequently in cases with abnormal LNs than in those with normal-looking LNs (P = .004). The most frequent morphological feature of metastatic ALNs was a diffuse cortical thickening of 3 to 5 mm (37.5%). Although MRI findings of single ALN metastasis in breast cancer patients are none or minimal, abnormalities are observed in the lowest or second-lowest LN in the lower axilla when present, suggesting the location of the SLNs.

545: OPTIC NERVE SHEATH DIAMETER AS A PREDICTOR OF BRAIN SWELLING IN PEDIATRIC CEREBRAL MALARIA

Introduction: Cerebral malaria (CM) is an important cause of death in children in low-and-middle income countries (LMICs) with a case fatality rate of >15%. Brain swelling on magnetic resonance imaging (MRI) is associated with morbidity and mortality in CM; however, this modality is expensive and unavailable in many LMICs. Optic nerve sheath diameter (ONSD) measurement is an inexpensive, non-invasive method of detecting increased ICP in other neurocritical illnesses. We hypothesized that increased ONSD would correlate with brain swelling on MRI and would be higher in survivors with neurological sequelae and non-survivors. Methods: We performed a retrospective chart review of 207 children aged 0-12 years in Blantyre, Malawi from 2013-22 with CM as defined by the World Health Organization. Brain swelling on admission MRI was characterized by brain volume scores (BVS) assigned by two blinded pediatric neuroradiologists; severe swelling was defined as 7-8, mild-to-moderate as 4-6, normal as 3. Admission ONSD measurement was taken via portable ultrasound (GE Logiq e); normal was defined as < 4.5 mm. Favorable outcome in survivors was defined as a grossly normal neurological exam on discharge. Data were compared using Kruskall-Wallis and Pearson’s correlation tests utilizing Stata (College Station, TX). Results: Median age of the cohort was 50 months (IQR 40); 49% (n=102) were female. 73% (n=152) had a favorable outcome, 12% (n=25) an unfavorable outcome, and 14% (n=30) died. Twenty-nine (14%) had a normal BVS, 134 (65%) had mild-to-moderate swelling, and 44 (21%) had severe swelling. ONSD was elevated in 86% (n=178) of patients overall; when compared by BVS group, it was elevated in 79% (n=23) of normal, 87% (n=117) of mild-to-moderate, and 86% (n=38) of severe. There was a weakly positive correlation between BVS and ONSD (r=0.14, p=0.05). Median ONSD was not significantly different when compared by discharge outcome (p=0.11) or when compared by BVS (p=0.18). Conclusions: ONSD was not a reliable tool to identify increased brain swelling as detected on MRI in children with CM. This may be due to heterogenous mechanisms leading to abnormal MRI findings. Future studies to identify an alternative method of early identification of children with CM that are high risk for morbidity and mortality are urgently needed.

Follow-up study of neuropsychological scores of infant patients with cobalamin C defects and influencing factors of cerebral magnetic resonance imaging characteristics.

The purpose of this study was to investigate whether baseline cerebral magnetic resonance imaging (MRI) characteristics could predict therapeutic responsiveness in patients with cobalamin C (cblC) defects. The cerebral MRI results of 40 patients with cblC defects were evaluated by a neuroradiologist. Neuropsychological scores and imaging data were collected. Neuropsychological tests were performed before and after standardized treatment. Thirty-eight patients initially underwent neuropsychological testing [developmental quotient (DQ)]. CblC defects with cerebellar atrophy, corpus callosum thinning and ventricular dilation had significantly lower DQs than those without (P < 0.05). Through a multivariate linear stepwise regression equation after univariate analysis, ventricular dilation was the most valuable predictor of lower DQs. Thirty-six patients (94.7%) underwent follow-up neuropsychological testing. The pre- and post-treatment DQ values were not significantly different (Z = -1.611, P = 0.107). The post-treatment DQ classification (normal, moderately low, or extremely low) showed nearly no change compared to the pretreatment DQ classification (k = 0.790, P < 0.001). Ventricular dilation, cerebral atrophy and corpus callosum thinning are the main MRI abnormalities of cblC defects, and these manifestations are significantly correlated with delayed development in children. MRI findings can be considered an important tool for determining the severity of cblC defects.

Neurological and Neuroradiological Manifestations in Neonates Born to Mothers With Coronavirus Disease 2019

BackgroundTo investigate the complications that occurred in neonates born to mothers with coronavirus disease 2019 (COVID-19), focusing on neurological and neuroradiological findings, and to compare differences associated with the presence of maternal symptoms. MethodsNinety neonates from 88 mothers diagnosed with coronavirus disease 2019 (COVID-19) during pregnancy were retrospectively reviewed. Neonates were divided into two groups: symptomatic (Sym-M-N, n = 34) and asymptomatic mothers (Asym-M-N, n = 56). The results of neurological physical examinations were compared between the groups. Data on electroencephalography, brain ultrasound, and magnetic resonance imaging abnormalities were collected for neonates with neurological abnormalities. ResultsNeurological abnormalities at birth were found in nine neonates (Sym-M-N, seven of 34, 20.6%). Decreased tone was the most common physical abnormality (n = 7). Preterm and very preterm birth (P < 0.01), very low birth weight (P < 0.01), or at least one neurological abnormality on physical examination (P = 0.049) was more frequent in Sym-M-N neonates. All infants with abnormalities on physical examination showed neuroradiological abnormalities. The most common neuroradiological abnormalities were intracranial hemorrhage (n = 5; germinal matrix, n = 2; parenchymal, n = 2; intraventricular, n = 1) and hypoxic brain injury (n = 3). ConclusionsNeonates born to mothers with symptomatic COVID-19 showed an increased incidence of neurological abnormalities. Most of the mothers (96.4%) were unvaccinated before the COVID-19 diagnosis. Our results highlight the importance of neurological and neuroradiological management in infants born to mothers with COVID-19 and the prevention of maternal COVID-19 infection.

Experience of diagnosis and managements for patients with primary progressive freezing of gait

ObjectiveThe goal of this research was to evaluate the clinical characteristics of patients with primary progressive freezing of gait (PPFOG). Patients and methodsThis retrospective study enrolled 8 PPFOG patients and 10 age-matched Parkinson's disease with freezing of gait (PDFOG) patients. All patients underwent structured forms to document clinical manifestations and neuropsychological evaluations. ResultPPFOG patients demonstrated later onset age than PDFOG patients (70.00 ± 9.97 years versus 53.30 ± 5.40 years, respectively; P < 0.05). Besides FOG (100%), the most prevalent concomitant symptoms of PPFOG patients were falling (n = 6, 75%), and fatigue (n = 5, 62.5%). More PPFOG patients had cerebrovascular risk factors and mild brain magnetic resonance imaging (MRI) abnormalities, which were constant with the manifestations of “cerebral small vessel disease” (P = 0.0001). ConclusionAccording to this study, the majority of PPFOG patients were linked with cerebrovascular disease risk factors and mild brain MRI abnormalities. More research on larger populations is needed to better understand the potential mechanisms underlying the link between PPFOG and cerebral small vessel disease.

Natural History of SURF1 Deficiency: A Retrospective Chart Review

BackgroundThis retrospective chart review evaluated the clinical characteristics of SURF1-related neurological disease spectrum to better characterize the phenotypes. MethodsPatient demographics, magnetic resonance imaging abnormalities, neurological events, motor abnormalities, and gastrointestinal and respiratory assistance were evaluated in 27 patients with genetically diagnosed SURF1 deficiency. ResultsThe mean (S.D.) age of symptom onset collected from 13 patients was 19.7 (11.8) months. Mean (S.D.) age of diagnosis collected from 24 patients was 44.0 (45.1) months. The most common symptoms were gross motor delay (14 of 14), fine motor delay (10 of 11), verbal delay (9 of 10), and intellectual and learning disability (14 of 19). Neurological symptoms included ataxia (14 of 15), other abnormal movements (8 of 9), hypotonia (9 of 11), and dystonia (6 of 9). Three of nine reporting patients (33.3%) had a history of seizure, and 84.6% (11 of 13) had a history of regression/loss of acquired skills. Extraneurological clinical features included pulmonary complications (10 of 11) and feeding difficulties (13 of 13); cardiac complications were noted in three patients. Brainstem is frequently involved with the medulla and midbrain being the most common sites. As of July 2021, three patients were deceased. ConclusionsThe most common clinical symptoms were motor delay, verbal delay, intellectual and learning disability, dysphagia, feeding difficulties, and reflux. Neurological presentations include ataxia, hypotonia, visual/ocular abnormalities, dystonia, and imaging abnormalities include basal ganglia and brainstem lesions. Although heterogeneous, SURF1 deficiency should be considered with these clinical and imaging presentations and may support earlier identification.

Aberrant gray matter structure in neurosyphilis without conventional MRI abnormality: a pilot study with voxel and surface-based morphology.

The underlying mechanism of neurosyphilis was not fully understood. To assess gray matter (GM) microstructure in patients with early-stage neurosyphilis without overt conventional magnetic resonance imaging (MRI) abnormality using voxel-based morphometry (VBM) and surface-based morphometry (SBM) analyses. Three-dimensional high-resolution T1-weighted imaging data from 19 individuals with neurosyphilis and 19 healthy controls were analyzed. A battery of neuropsychological tests was performed before each MRI examination. The differences of GM volume and cerebral cortical morphological data between the two groups were compared. The correlations between MRI metrics and neuropsychology/laboratory tests in the patient group were investigated. Regional decreased GM volumes in patients with neurosyphilis were found in the left frontal cortices (Rolandic operculum, middle frontal, and precentral) and bilateral temporal/occipital cortices (bilateral middle temporal, left lingual, and right middle occipital) (P < 0.05, FDR correction). SBM analysis showed significant cortical thickness reduction in the right medial orbitofrontal lobe, and reduced gyrification index in the left insula in patients with neurosyphilis (P < 0.05, FDR correction). Additionally, in the patient group, the GM volume in the middle frontal gyrus, the cortical thickness of right medial orbitofrontal lobe, and the gyrification index in the left insula were negatively correlated to the number connection test-A scores. The gyrification index was also negatively correlated to cerebrospinal fluid white blood cell count. Early-stage neurosyphilis without conventional MRI abnormality presented regional GM volume reduction and cortical morphological changes, which might be related to cognitive impairment and intra-cranial infection. VBM and SBM analyses might be useful for understanding the underlying neural trait of neurosyphilis.

Bone Marrow Lesions and Magnetic Resonance Imaging-Detected Structural Abnormalities in Patients With Midfoot Pain and Osteoarthritis: A Cross-Sectional Study.

To compare magnetic resonance imaging (MRI)-detected structural abnormalities in patients with symptomatic midfoot osteoarthritis (OA), patients with persistent midfoot pain, and asymptomatic controls, and to explore the association between MRI features, pain, and foot-related disability. One hundred seven adults consisting of 50 patients with symptomatic and radiographically confirmed midfoot OA, 22 adults with persistent midfoot pain but absence of radiographic OA, and 35 asymptomatic adults underwent 3T MRI of the midfoot and clinical assessment. MRIs were read for the presence and severity of abnormalities (bone marrow lesions [BMLs], subchondral cysts, osteophytes, joint space narrowing [JSN], effusion-synovitis, tenosynovitis, and enthesopathy) using the Foot Osteoarthritis MRI Score. Pain and foot-related disability were assessed with the Manchester Foot Pain and Disability Index. The severity sum score of BMLs in the midfoot was greater in patients with midfoot pain and no signs of OA on radiography compared to controls (P=0.007), with a pattern of involvement in the cuneiform-metatarsal joints similar to that in patients with midfoot OA. In univariable models, BMLs (ρ=0.307), JSN (ρ=0.423), and subchondral cysts (ρ=0.302) were positively associated with pain (P < 0.01). In multivariable models, MRI abnormalities were not associated with pain and disability when adjusted for covariates. In individuals with persistent midfoot pain but no signs of OA on radiography, MRI findings suggested an underrecognized prevalence of OA, particularly in the second and third cuneiform-metatarsal joints, where BML patterns were consistent with previously recognized sites of elevated mechanical loading. Joint abnormalities were not strongly associated with pain or foot-related disability.

Efficacy and Safety of Adding Kami Guibi‐tang to Acetylcholinesterase Inhibitor for Cognitive Function in Mild Alzheimer’s Disease: A Pilot, Randomized, Double‐blind, Placebo‐controlled Trial

AbstractBackgroundThe main treatments for mild AD have been acetylcholinesterase inhibitors(AChEI). However, no current drugs can fundamentally treat AD or reverse advanced cognitive decline. This clinical study was conducted to explore the efficacy and safety of adding Kami Guibi‐tang(KGT) to AChEI for cognitive function in elderly patients with mild AD.MethodThis study was designed as the pilot for a larger randomized, double‐blind, placebo‐controlled study. Elderly participants aged 55 to 90 years diagnosed with mild AD. Subjects were randomized to receive either KGT or placebo for 24 weeks, in addition to their regular AChEI. The primary study outcome was treatment efficacy as assessed by the relative amount of change over the study period in total scores on the Dementia version of the Seoul Neuropsychologic Screening Battery(SNSB‐D). Changes in SNSB sub‐scores such as the Korean Mini‐Mental State Exam(K‐MMSE) and in scores on the Korean version of Quality of Life‐Alzheimer’s Disease(KQoL‐AD), and the Caregiver‐Administered Neuropsychiatric Inventory(CGA‐NPI) were assessed as secondary outcomes. We also monitored patient safety parameters including adverse events and abnormalities in blood tests, electrocardiogram, and brain magnetic resonance imaging tests.Result7 participants in the KGT group and 7 participants in the placebo group completed the 24‐week trial. There were no significant changes in SNSB‐D total/subindex scores, KQoL‐AD or CGA‐NPI scores for either group, and no significant differences were observed between the two groups. K‐MMSE scores were decreased significantly within each group, but were not significantly different between groups. No adverse events related to KGT were reported. In addition, we compared / analyzed the results of a previous pilot study conducted on amnestic mild cognitive impairment(aMCI) with the same protocol as this study. The aMCI group showed a significant improvement in the total SNSB‐D score(especially in the memory domain) and K‐MMSE and Korean Instrumental Activities of Daily Living scores compared with the mild AD group.ConclusionAdding KGT to AChEI did not significantly improve cognitive function in SNSB compared to placebo. Although KGT did not show cognitive improvement in the patients with mild AD in this study, we suggest that KGT would have a positive effect on the patients with early stages of cognitive impairment such as aMCI.

Rotator Cuff Tear Progression at 2-year Follow-up in Manual Wheelchair Users with Spinal Cord Injury

<h3>Research Objectives</h3> To investigate rotator cuff tear progression in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals. <h3>Design</h3> Longitudinal cohort study, 2-year follow-up. <h3>Setting</h3> Outpatient clinic at a tertiary medical center. <h3>Participants</h3> Thirty-three adult MWC users with SCI (26 men) with an average age (SD) of 42 (12) years and 33 age/sex-matched able-bodied individuals participated in this study. Median time since injury (interquartile ratio) for the SCI participants was 7 (19) years. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons (dominant side) including partial tears (low, intermediate, and high grade) and full tears at baseline and 2-year follow-up visits were graded by a board-certified musculoskeletal radiologist. Presence of shoulder pain was collected. <h3>Results</h3> Fifty-two percent of the MWC users reported shoulder pain at baseline which was significantly higher than able-bodied cohort (10%, P=0.004). The prevalence of any tendon tears across the rotator cuff in MWC users was 61% and 67% at baseline and year 2 visits, respectively, and for able-bodied participants was 45%, and 52%. The MWC users experienced a significant (P=0.001) rotator cuff tear progression from baseline to year 2 (15 participants with worsening score and 2 with improving score). MRI findings did not change significantly for the able-bodied cohort. The MWC user cohort had 3 times (relative risk; 95% CI: 1.23 to 7.30, P = 0.007) higher risk of experiencing rotator cuff tear progression over 2 years in comparison to the able-bodied cohort. <h3>Conclusions</h3> The findings of this study indicate the significantly accelerated rate of rotator cuff degeneration in MWC users with SCI in comparison to able-bodied individuals. <h3>Author(s) Disclosures</h3> National Institutes of Health Funding (grant no. R01 HD84423).

Evaluating brain white matter hyperintensity, IQ scores, and plasma neurofilament light chain concentration in early-treated patients with infantile-onset Pompe disease

The study aimed to describe central nervous system (CNS) progression in patients with infantile-onset Pompe disease (IOPD) and explore the potential clinical impact and predictors. Patients with IOPD treated with enzyme replacement therapy were longitudinally followed with brain magnetic resonance imaging (MRI) and evaluation for IQ scores from 2004 to 2021. Investigation of CNS involvement focused on white matter (WM) abnormalities and was quantified using a scoring system for metachromatic leukodystrophy. MRI scores were correlated with plasma neurofilament light chain (NfL) concentration and IQ scores. A total of 19 patients who started enzyme replacement therapy at a mean age of 26 days were analyzed; the median age at last examination was 12.1 (range= 1.7-19) years. MRI abnormalities were found in all patients, from supratentorial central WM to U-fibers, then to infratentorial WM, and eventually to gray matter. MRI scores progressed (n= 16) at variable rates (range= 0.8-2.7/y) and were positively correlated with age (n= 16) and negatively correlated with IQ scores (n= 8). Plasma NfL concentration was positively correlated with MRI scores (r2= 0.8569; P < .001; n= 13). Our results suggest that the progression of CNS involvement in IOPD may be associated with neuroaxonal injury and decreased IQ scores. NfL could serve as a biomarker for CNS involvement in IOPD.

Biallelic PRMT7 pathogenic variants are associated with a recognizable syndromic neurodevelopmental disorder with short stature, obesity, and craniofacial and digital abnormalities

Protein arginine methyltransferase 7 (PRMT7) is a member of a family of enzymes that catalyzes the methylation of arginine residues on several protein substrates. Biallelic pathogenic PRMT7 variants have previously been associated with a syndromic neurodevelopmental disorder characterized by short stature, brachydactyly, intellectual developmental disability, and seizures. To our knowledge, no comprehensive study describes the detailed clinical characteristics of this syndrome. Thus, we aim to delineate the phenotypic spectrum of PRMT7-related disorder. We assembled a cohort of 51 affected individuals from 39 different families, gathering clinical information from 36 newly described affected individuals and reviewing data of 15 individuals from the literature. The main clinical characteristics of the PRMT7-related syndrome are short stature, mild to severe developmental delay/intellectual disability, hypotonia, brachydactyly, and distinct facial morphology, including bifrontal narrowing, prominent supraorbital ridges, sparse eyebrows, short nose with full/broad nasal tip, thin upper lip, full and everted lower lip, and a prominent or squared-off jaw. Additional variable findings include seizures, obesity, nonspecific magnetic resonance imaging abnormalities, eye abnormalities (i.e., strabismus or nystagmus), and hearing loss. This study further delineates and expands the molecular, phenotypic spectrum and natural history of PRMT7-related syndrome characterized by a neurodevelopmental disorder with skeletal, growth, and endocrine abnormalities.

The Association of Tissue Change and Treatment Success During High-intensity Focused Ultrasound Focal Therapy for Prostate Cancer

BackgroundTissue preservation strategies have been increasingly used for the management of localized prostate cancer. Focal ablation using ultrasound-guided high-intensity focused ultrasound (HIFU) has demonstrated promising short and medium-term oncological outcomes. Advancements in HIFU therapy such as the introduction of tissue change monitoring (TCM) aim to further improve treatment efficacy. ObjectiveTo evaluate the association between intraoperative TCM during HIFU focal therapy for localized prostate cancer and oncological outcomes 12 mo afterward. Design, setting, and participantsSeventy consecutive men at a single institution with prostate cancer were prospectively enrolled. Men with prior treatment, metastases, or pelvic radiation were excluded to obtain a final cohort of 55 men. InterventionAll men underwent HIFU focal therapy followed by magnetic resonance (MR)-fusion biopsy 12 mo later. Tissue change was quantified intraoperatively by measuring the backscatter of ultrasound waves during ablation. Outcome measurements and statistical analysisGleason grade group (GG) ≥2 cancer on postablation biopsy was the primary outcome. Secondary outcomes included GG ≥1 cancer, Prostate Imaging Reporting and Data System (PI-RADS) scores ≥3, and evidence of tissue destruction on post-treatment magnetic resonance imaging (MRI). A Student's t - test analysis was performed to evaluate the mean TCM scores and efficacy of ablation measured by histopathology. Multivariate logistic regression was also performed to identify the odds of residual cancer for each unit increase in the TCM score. Results and limitationsA lower mean TCM score within the region of the tumor (0.70 vs 0.97, p = 0.02) was associated with the presence of persistent GG ≥2 cancer after HIFU treatment. Adjusting for initial prostate-specific antigen, PI-RADS score, Gleason GG, positive cores, and age, each incremental increase of TCM was associated with an 89% reduction in the odds (odds ratio: 0.11, confidence interval: 0.01–0.97) of having residual GG ≥2 cancer on postablation biopsy. Men with higher mean TCM scores (0.99 vs 0.72, p = 0.02) at the time of treatment were less likely to have abnormal MRI (PI-RADS ≥3) at 12 mo postoperatively. Cases with high TCM scores also had greater tissue destruction measured on MRI and fewer visible lesions on postablation MRI. ConclusionsTissue change measured using TCM values during focal HIFU of the prostate was associated with histopathology and radiological outcomes 12 mo after the procedure. Patient summaryIn this report, we looked at how well ultrasound changes of the prostate during focal high-intensity focused ultrasound (HIFU) therapy for the treatment of prostate cancer predict patient outcomes. We found that greater tissue change measured by the HIFU device was associated with less residual cancer at 1 yr. This tool should be used to ensure optimal ablation of the cancer and may improve focal therapy outcomes in the future.

Clinical characteristics and associated factors of pediatric acute disseminated encephalomyelitis patients with MOG antibodies: a retrospective study in Hangzhou, China

BackgroundTo explore the clinical characteristics and related factors of children with acute disseminated encephalomyelitis (ADEM) with positive anti-myelin oligodendrocyte glycoprotein (MOG) antibody.MethodsA retrospective study was conducted and enrolled pediatric ADEM patients who underwent serum MOG antibody detection from May 2017 to August 2020. The patients were divided into two groups: MOG- immunoglobulin G (IgG) positive (n = 35) and MOG-IgG negative (n = 50). We analyzed the clinical characteristics of MOG-IgG-positive ADEM pediatric patients and conducted a comparative analysis between the two groups.ResultsThirty-five patients (21 males and 14 females) in the MOG-IgG-positive group with encephalopathy, multifocal neurological symptoms, and typical magnetic resonance imaging (MRI) abnormalities were enrolled. They usually had a favorable outcome, while some suffered from relapse. Compared to the MOG-IgG-negative group, MOG-IgG-positive ADEM patients had a longer disease duration (median: 10 vs. 6 days), more meningeal involvement (31.4% vs. 8%) and frontal lobe involvement (82.8% vs. 68%), higher relapse rates (14.3% vs. 2%), lower serum tumor necrosis factor (1–12.4 pg/ml, median 1.7 vs. 1–34 pg/ml, median 2.2) and interferon-gamma (1–9.4 pg/ml, median 1.3 vs. 1–64 pg/ml, median 3) (P < 0.05, respectively). Multivariate logistic regression analysis showed that the longer disease duration, meningeal involvement and frontal lobe involvement were the correlated factors of patients with ADEM with MOG antibody (P < 0.05).ConclusionsOur findings provide clinical evidence that MOG-IgG positivity is associated with longer disease duration, meningeal involvement, and frontal lobe involvement.

Characteristics of prostate biopsy in patients under the dutasteride treatment.

We performed a retrospective study to clarify the characteristics of prostate biopsies in patients treated with dutasteride, a benign prostate hyperplasia treatment drug that inhibits 5α-reductase. We studied the digital clinical data of 677 patients, including 96 cases treated with dutasteride, with suspected localized prostate cancer. All patients underwent transrectal ultrasonography-guided prostate biopsy between 2014 and 2017 in our department. A propensity score matching analysis was performed based on prostate-specific antigen (PSA) (calculated as double the PSA value for the dutasteride group) and age. Ninety-six patients in each of the dutasteride and control groups were assessed and their characteristics were compared. The characteristics of the patients in the dutasteride and control groups were well balanced by matching. There were fewer prostate cancer-positive patients in the dutasteride group. When comparing only the prostate cancer-positive patients in each group, there were significantly more cases of high-grade cancers and abnormal magnetic resonance imaging (MRI) findings in the dutasteride group. In the dutasteride group, abnormal MRI findings and advanced age were significant predictors of high grade cancer. This study shows the characteristics of prostate biopsies in patients treated with dutasteride and indicates that patients on dutasteride with advanced age and abnormal MRI findings should undergo prostate biopsy.

A Retrospective Analysis of the Neurological Evaluation of Cases With Neonatal Hypoglycemia.

Introduction Hypoglycemia is a common treatable metabolic disorder in the neonatal period. It can cause several neurological problems if untreated. In this study, the neurological outcomes of cases with hypoglycemia in the neonatal period were examined retrospectively, and the study aimed to determine risk factors and prognostic factors. Methods In this retrospective study, cases were followed in the pediatric neurology outpatient clinic between 2019 and 2022, and patients with a history of hypoglycemia in the neonatal period were enrolled and analyzed retrospectively. The laboratory studies and clinical findings of the cases were obtained from follow-up records from the pediatric neurology outpatient clinic retrospectively. Physical examination findings, hypoglycemia levels, and symptoms of hypoglycemia, if any, were obtained retrospectively from the discharge files of the patients. Results A total of 70 cases were included in the study. Twenty-eight were girls and 42 were boys. Forty of the cases were preterm. The number of asymptomatic cases was 38, and the number of symptomatic cases was 32. There was no significant difference in regardto the mean lowest serum glucose levels between symptomatic and asymptomatic cases. Thirty-three of the patients had neurological problems such as neuromotor developmental delay, cortical blindness, and epilepsy. Abnormal magnetic resonance imaging (MRI) findings were detected in 30 of the symptomatic cases and eight of the asymptomatic cases. The rate of neurological sequelae in asymptomatic cases was found to be significantly lower than in symptomatic cases. Conclusions Patients who have a symptomatic hypoglycemic period, maternal gestational problems, and abnormal MRIcarry a high risk for neurological sequelae, and these findings indicate poor prognosis.

MR imaging biomarkers for evaluation of adhesive capsulitis of the shoulder. Additive value of anterior capsule abnormality as a reliable criterion for diagnosis of adhesive capsulitis: a cross sectional analytic study

BackgroundAdhesive capsulitis of the shoulder is a pain syndrome of progressive nature, associated with reduced active and passive range of motion of the gleno-humeral joint. Previous studies suggested an underlying synovial inflammatory process, followed by capsular hypertrophy and reactive fibrosis. The aim of our study was to investigate the influence of anterior shoulder joint capsule abnormal thickening and abnormal signal intensity on MRI, as important imaging biomarkers, for the diagnosis of as adhesive capsulitis.ResultsThis cross sectional analytic study involved 28 patients with adhesive capsulitis ((17 males, 11 females, age range:23–65 years, mean age: 45.61 years ± 11.95) and 28 controls (14 males, 14 females; age range, 39 to 61 years; mean age 52.82 years ± 6.45;). The patients and the controls were reviewed by two radiologists with experience of more than 10 years, blinded to each other's results. Adhesive capsulitis was diagnosed based on clinical criteria of significant restricted passive motion of shoulder joint. The thickness and abnormal signal intensity of anterior glenohumeral joint capsule were evaluated at its thickest portion, positioned underneath the subscapularis muscle. Additionally, the formerly known MR characteristics of adhesive capsulitis, involving the thickness of humeral and glenoid portions of axillary recess, maximal thickness of axillary capsule, and thickness of coracohumeral ligament, were assessed. The estimation of abnormal hyperintensity of humeral and glenoid capsule in axillary recess, subcoracoid fat triangle obliteration and abnormal hyperintensity were also included in our study. All magnetic resonance imaging (MRI) quantitative values showed significant difference between adhesive capsulitis group and control group. Regarding qualitative values, only abnormal high signal intensity of the anterior portion of joint capsule, of the axillary portion of joint capsule and of glenoid portion of axillary capsule showed statisticaly significant difference between cases and controls. In receiver operating characteristic (ROC) curve study, the anterior capsule thickness revealed a high diagnostic value with an area under the curve (AUC) of 1.0. An anterior capsule thickness cut off value of at 2.45 mm showed a very high diagnostic performance, revealing a sensitivity of and specificity of 100%.ConclusionsThe anterior glenohumeral joint capsule abnormal thickening, and abnormal hyperintensity have a high diagnostic performance, in addition to the previously known abnormal MRI findings, in the evaluation of adhesive capsulitis.

Brain magnetic resonance imaging predictors in anti-N-methyl-D-aspartate receptor encephalitis.

Brain magnetic resonance imaging (MRI) findings in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis are nonspecific and rarely have obvious associations with clinical characteristics and outcomes. This study aimed to comprehensively describe the MRI features of patients with NMDAR encephalitis, examine their associations with clinical characteristics, and evaluate their predictive power for disease recurrence and prognosis. We retrospectively extracted the clinical data and brain MRI findings of 144 patients with NMDAR encephalitis. Patients underwent a 2-year follow-up to assess disease outcomes. We evaluated the associations of brain MRI findings at the onset with clinical characteristics, recurrence, and prognosis. Initial MRI showed typical abnormalities in 65 patients (45.1%); of these, 34 (29.3%) developed recurrence and 10 (9.4%) had poor prognosis (mRS ≥3). Binary logistic regression analyses revealed that insula abnormalities were associated with acute seizure (odds ratio [OR]=3.048, 95% confidence interval [CI]: 1.026-9.060) and white matter lesions were associated with cognitive impairment (OR=2.730, 95% CI: 1.096-6.799). Risk factors for a poor 2-year prognosis included a higher number of brain MRI abnormalities (OR=1.573, 95% CI: 1.129-2.192) and intensive care unit (ICU) admissions (OR=15.312, 95% CI: 1.684-139.198). The risk factors for 2-year recurrence included abnormalities of the thalamus (HR=3.780, 95% CI: 1.642-8.699). Brain MRI features of patients with NMDAR encephalitis were associated with clinical manifestations, prognosis, and recurrence. Higher numbers of MRI abnormalities and ICU admissions were predictive of poor prognosis. Abnormalities of the thalamus constituted a recurrence-related risk factor.