Accuracy Of MRI In Detection Research Articles

Diagnostic accuracy of MRI for detection of occult instability of type I anterior to posterior pelvic injuries

Type I Young and Burgess anterior posterior compression (APC) pelvic injuries have been classically managed non operatively due to theoretical integrity of sacroiliac joint ligaments (SIJL), though examination under anesthesia (EUA) has been proven occult mechanical instability in up to 50% of these injuries. We sought to determine the diagnostic accuracy of magnetic resonance (MRI) for detection of occult instability on APC-I injuries when compared to EUA.Methods: Diagnostic test study of prospectively recruited patients admitted with APC-I pelvic injuries between 2015 and 2022. All patients consented to participate in this study were subjected to MRI and EUA. The evaluators of each of these tests were blinded. On MRI evaluation, SIJL were considered compromised when unilateral injury to anterior SIJL was visualized in three or more consecutive images or in bilateral injuries, when injury to the anterior SIJL in two or more consecutive images on each side was observed. Positive EUA was considered a symphyseal diastasis over 25 mm on stress fluoroscopy. Demographic data was collected as recruited and sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. Confidence interval was set at 95%. EUA was considered the gold standard in statistical analysis.Results: A total of 32 patients mean aged 36 (24–61) years were included. Mean symphyseal diastasis at admission was 17.58 (11 - 25) mm. The median time from injury to EUA was 5 (0–21) days. Positive EUA was observed on 20 patients and 25 patients presented compromised SIJL. MRI presented a sensitivity of 95% (75.13% - 99.87%), specificity of 50% (21.09% - 78.91%), positive-predictive value of 73% (60.61% to 82.93%), negative-predictive value of 87% (48.66% - 98.08%).Conclusion: Injury to SIJL on MRI presented an accuracy of 77% (58.29% - 89.64%) for the detection of occult pelvic instability on EUA.

Diagnostic Accuracy of MRI for Detection of Meningitis in Infants.

To determine the accuracy of MR imaging for diagnosis of meningitis in infants. Retrospective review of infants less than 1 year of age who underwent a brain MR imaging for meningitis from 2010-2018. Gold standard for diagnosis of bacterial meningitis was a positive bacterial CSF culture or a positive blood culture with an elevated CSF WBC count, and diagnosis of viral meningitis was a positive CSF PCR result and elevated CSF WBC count. Sensitivity, specificity, PPV, NPV, and accuracy for MR imaging diagnosis of meningitis were calculated. Two hundred nine infants with mean age 80 days (range 0-347 days) were included. There were 178 true positives with the most common pathogens being: Group B Streptococcus (58), E. coli (50), Streptococcus pneumoniae (21), H. influenzae (4); Herpes simplex virus 1 or 2 (18); Enterovirus (4); and other (23). There were 31 true negatives. Range of sensitivity, specificity, PPV, NPV, and accuracy of MR imaging for detection of meningitis was 67.4-83.5%, 92.3-95.7%, 95.0-98.6%, 33.3-76.5%, and 71.3-86.5% respectively. MR imaging sensitivity decreased after 10 days from time of presentation while specificity remained stable. Among individual MR imaging findings, leptomeningeal enhancement was the most sensitive finding, while cerebritis, infarction, ventriculitis, abscess, and intraventricular purulent material were the most specific findings. MR imaging of the brain demonstrates high specificity and moderate sensitivity for diagnosis among infants presenting with signs and symptoms of meningitis. The results reflect current standard of care for imaging of infants with meningitis however a selection bias for imaging of more severe meningitis may affect these results.

Evaluation of the diagnostic accuracy of MRI in detection of knee cartilage lesions using Receiver Operating Characteristic curves

Medical treatment, and especially surgical procedures, is carefully planned and executed based on various diagnostic methods. Physical examination provides preliminary information about the patient’s health; however, when orthopaedic surgery is concerned, more accurate radiological evaluation is necessary. MRI is perceived as a state-of-the-art radiological modality. In this study, we have evaluated MRI efficiency in detecting chondral lesions in the knee joint requiring surgical treatment. The evaluation of selected diagnostic methods used in the assessment of joint cartilage damage was carried out based on statistical indicators and ROC (Receiver Operating Characteristic) curves. The indicators were determined using Statistica and Matlab software. 95. patients underwent knee arthroscopy subsequently after performing MRI for various intraarticular lesions. Chondral lesions estimated with the use of the ICRS scale were divided into two groups, one requiring surgical treatment ICRS grade 3-4, and selected for conservative treatment ICRS grade 0-2. Results were evaluated with the use of ROC curves. MFC was the most common lesion site, where chondral lesions requiring surgical intervention were found in nearly 50% of patients. LTC was affected only in 9 patients, which was the rarest location for chondral lesions. The diagnostic efficiency for each anatomical location was evaluated. The highest diagnostic accuracy was found on MFC followed by LTC. The lowest diagnostic accuracy was found for PFJ. The AUC ranged from 0.8438 for MFC to 0.55 for PFJ. LFC and MTC showed similar accuracy with AUC respectively 0.6419 and 0. 6623. To sum up, MRI is a gold standard for cartilage evaluation, however, its accuracy differs among various anatomical locations, therefore requires a thorough assessment prior to surgical planning.

Diagnostic accuracy of Multiparametric MRI in detection of prostate cancer compared with histopathology obtained by MRI directed TRUS guided cognitive fusion biopsy are T2WI, DWI and DCE enough for Indian scenario

Background: The incidence of prostatic carcinoma is increasing worldwide. With its high resolution, ability to provide excellent tissue characterization and multiplanar imaging capabilities, multi-parametric magnetic resonance imaging (mpMRI) plays a crucial role in detection, local staging and follow-up of carcinoma prostate. It also helps guide targeted biopsies in initial biopsy negative patient. Objectives: Study diagnostic accuracy of mp-MRI and primarily that of the three MR sequences T2, DWI and DCE in detection of prostatic cancer by correlating them with histopathology and thus whether it is feasible for a short MRI of 3 sequences to be used on a large scale in Indian scenario. Materials and Methods: A prospective study was done at a tertiary care hospital between April 2017 to November 2018 in which 50 patients who presented with suspicion of prostate cancer were referred to radiology department for evaluation using MRI. MRIexamination was done using 3T Siemens Magnetom Verio. Followed by this MRI directed TRUS guided cognitive fusion biopsy was done from the prostate. Samples were sent for histopathology. Results: Out of 50 cases studied, 24 cases (48%) were found to be malignant and 26 cases (52 %) were benign on histopathology. In our study, combined T2 + DWI + DCE gave sensitivity of 95.83 %, specificity of 57.69%, positive predictive value of 68.21 % and negative predictive value of 93.75%. Conclusion: Multiparametric MRI using T2, DWI and DCE has a high diagnostic accuracy for evaluation of prostatic cancer.

Can Preoperative Ultrasonography and MRI Replace Sentinel Lymph Node Biopsy in Management of Axilla in Early Breast Cancer-a Prospective Study from a Tertiary Cancer Center.

Although SLNB is a less invasive procedure in detecting axillary lymph node metastases(ALNM) in early breast cancer; still, it carries some complications like lymphedema and in addition, performing SLNB requires surgical skills, technical knowledge, presence of facility like preoperative sentinel lymphoscintigraphy, and availability of hand-held gamma probe for intraoperative assessment. We calculated the relative diagnostic strength of preoperative axillary USG and MRI and compared with of SLNB for detection of ALNM in early breast cancer and assessed whether MRI and USG could accurately predict axillary LN status, potentially replacing SLNB. We evaluated 40 cases of clinically node-negative early breast cancer with preoperative axillary USG and MRI and subsequently subjected to SLNB. The sensitivity, specificity, PPV, NPV, and accuracy of axillary USG were 62.5%, 96.88%, 88.33%, 91.18%, and 90% respectively (p value < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of MRI in detection of ALNM were 75%, 93.75%, 75%, 93.75%, and 90% (p value < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of combined USG and MRI in detection of ALNM were 87.5%,90.63%, 70%, 96.67%, and 90% respectively (p value < 0.001), which are comparable to previous study series. The diagnostic performance of combined approach of axillary USG and MRI is promising, as the NPV of combined USG and MRI is approaching the NPV of the SLNB in detecting ALNM. Based on above findings, if axillary LNs are found nonsuspicious in preoperative axillary USG and MRI, further axillary dissection may be avoided, and if found suspicious, then ALND may be directly proceeded avoiding SLNB in between.

A study to evaluate the accuracy of MRI in comparison to knee arthroscopy in diagnosing cruciate ligament tear and meniscal tears in organized sports and physical exercise related knee injuries in armed forces personnel

Background: Knee injuries related to organised sports and physical training related activities are a major component of injuries sustained by armed forces personnel. Knee instability caused by meniscal and ligamentous injuries cause varying degree of disabilities to the trained soldier and have a serious implication on the battle preparedness of the armed forces. MRI of the knee being a non-invasive modality is being increasingly used in pre and post op evaluation of patients in such cases.Methods: A prospective observational study comprising of 161 patients of knee injuries sustained due to sports and physical training related activities was carried out. MRI and arthroscopic examination of the knee was done, and various statistical tests were performed to evaluate the accuracy of MRI in comparison to arthroscopy.Results: ACL tears were seen in 122 patients (75.5%), PCL tears were seen in 67 patients (41.6%), while medial and lateral meniscus tears were noted in 93 (57.7%) and 50 (31%) patients respectively. The sensitivity and specificity of MRI in detecting ACL tear, PCL tear and medial meniscus injury ranged from 84% - 90.5% and for lateral meniscus it was 72.92% to 86.73 %. The accuracy of MRI in detecting the tear of ACL, PCL and menisci ranged from 82.61% to 89.97%.Conclusions: The accuracy of MRI in detection of meniscal and ACL tears is very high. Pre-operative MRI in conjunction with adequate history and physical examination can help the clinician to make an accurate diagnosis and can help reduce unnecessary arthrosopic surgeries.

Diagnostic Accuracy of MRI for Detection of Papillary Renal Cell Carcinoma: A Systematic Review and Meta-Analysis.

The objective of our study was to perform a systematic review and meta-analysis of the diagnostic performance of MRI in differentiation of papillary renal cell carcinoma (RCC) from other renal masses. We performed searches of three electronic databases for studies that used MRI techniques to differentiate papillary RCC from other renal lesions. Methodologic quality was assessed, and diagnostic test accuracy was summarized using bivariate random-effects modeling or with construction of a summary ROC (SROC) curve. Thirteen studies involving 275 papillary RCC lesions and 758 other renal masses met the inclusion criteria. Resulting summary estimates for the performance of MRI to differentiate papillary RCC from other renal lesions were a sensitivity of 79.6% (95% CI, 62.3-90.2%) and specificity of 88.1% (95% CI, 80.1-93.1%). In subgroup analysis, quantitative pooling of seven studies using enhancement in the corticomedullary phase resulted in a sensitivity of 85.6% (95% CI, 67.8-94.4%), specificity of 91.7% (95% CI, 76.0-97.5%), and area under the SROC curve of 0.894. Four studies used tumor appearance on T2-weighted imaging to detect papillary RCC, and results showed a pooled sensitivity of 89.9% (95% CI, 73.0-96.7%) and specificity of 84.9% (95% CI, 69.0-93.4%). Three studies used signal loss on T1-weighted in-phase imaging to detect papillary RCC but marked heterogeneity precluded pooling. Meta-analysis supports moderate sensitivity and excellent specificity of quantitative enhancement in the corticomedullary phase for differentiating papillary RCC from other tumors. The accuracy of combining enhancement and T2 signal-intensity characteristics merits further evaluation as a potential aid for management decisions.

Role of MRI in Diagnosis of Rotator Cuff Tears

Background: A rotator cuff tear is a tear of one or more of the tendons of the four rotator cuff muscles of the shoulder. The rotator cuff is a group of muscles that play an important role in function of the glenohumeral joint. Value of the clinical examination of a shoulder is often uncommonly exhibited; therefore, imaging modalities have valuable implications in the management of rotator cuff pathologies. Aim: the purpose of this study is to assess the diagnostic accuracy of MRI in diagnosis of rotator cuff tears. Materials and Methods: we examined 20 consecutive cases of shoulder arthroscopy, who had undergone preoperative investigation in the form of MRI. Comparing the accuracy of MRI for detection of full-thickness rotator cuff tears, using the operative findings as the ‘gold standard’ was used. All the patients presented to Radiology Department referred from Orthopedic Outpatient Clinic, El-Demerdash University Hospital and Nassir Institution, from January 2017 to October 2017. Results: 16(80%) were males, 4(20%) were females, with age range from (27y) to (57y) (mean range 42y) complaining of symptoms and signs of shoulder pain which go more with RCT the overall accuracy of MRI in diagnosis of RCT, was 99%, while sensitivity and specificity was 99%,98.8) respectively, with P value less than 0.05. Conclusion: MRI is an accurate diagnostic imaging method for RCT specially for the FTT, and considered to be best cost-effective, non-invasive imaging method for screening of rotator cuff tears. In patients who underwent surgery, MRI yielded comparably high sensitivity for detecting full-thickness RCT.

MRI of placenta percreta: differentiation from other entities of placental adhesive disorder.

To retrospectively review the MRI findings of placenta percreta and identify those helpful for differentiation from non-placenta percreta. The MRI images of 21 patients with a preliminary diagnosis of placental adhesive disorder scanned between 2005 and 2014 were evaluated. Radiologists blinded to the final diagnosis evaluated six previously described MRI findings of placenta adhesive disorder. The sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predictive value (PPV) of MRI for the diagnosis of placenta percreta were also calculated. The study included 12 cases of placenta percreta and 9 cases of non-placenta percreta. Invasion of placental tissue outside the uterus was found only in placenta percreta (p=0.045; sensitivity 41.7%; specificity 100%). All placenta percreta cases also had a moderate to marked degree of heterogeneous placental signal intensity (p=0.063; sensitivity 100%; specificity 33.3%). The size of the dark bands on T2-weighted imaging, and the presence of disorganized intra-placental vessels, showed no statistically significant difference between placenta percreta and non-placenta percreta. The sensitivity, specificity, NPV, PPV, and accuracy of MRI for detection of placenta percreta were 91.7, 44, 80, 68, and 71.4%, respectively. MRI is recommended for the evaluation of placenta percreta, with the most specific signs including the invasion of placental tissue outside the uterus on B-FFE sequences, and consideration of the degree of placental signal heterogeneity. The size of the T2 dark band alone, or bizarre disorganized intra-placental vessels, did not correlate with the severity of invasion.

219 Diagnostic accuracy of multiparametric MRI in detection of clinically significant prostate cancer

219 Diagnostic accuracy of multiparametric MRI in detection of clinically significant prostate cancer

Grading of Active Inflammation with MR Enterography: Comparison to Widely Used Clinical Indices

Purpose: To compare the results of MR enterography to clinical indicators of disease activity and quality of life in patients with Crohn's disease. Methods: This study was approved by our hospital IRB. 37 consecutive patients undergoing outpatient MR enterography (MRe) examinations completed both the Harvey-Bradshaw Index (HBI) and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) on the day of the MRe exam. An inflammatory score was generated from each MR examination based upon the following findings: wall thickness, mucosal hyperenhancement, elevated T2 signal within or adjacent to the wall, mesenteric engorgement, local adenopathy and abscess formation. Regression analysis was performed to assess for correlation between the questionnaires and the MR enterography score. Results: There was no statistically significant correlation between the clinical indices and the MR enterography scores. Comparison of the HBI to the MR enterography score yielded p = 0.6 and comparison of SIBDQ to MR enterography score yielded p = 0.4. The results of the clinical indices did strongly correlate with each other (p < 0.05, r-square = 0.48). This is consistent with other studies that have shown endoscopic assessment of disease does not correlate with clinical indices such as Crohn's Disease Activity Index and Inflammatory bowel disease questionnaire. Conclusion: MR enterography does not correlate with widely used clinical markers of disease activity in patients with Crohn's disease. Given the recent evidence of the accuracy of MRI for detection of inflammation; we conclude that clinical indices, while useful for assessing symptomatology, are no substitute for imaging and endoscopic assessment to detect active inflammation. The clinical indices are subjective and therefore may be affected by subjective symptoms from processes other than IBD such as irritable bowel syndrome, depression, etc.