Availability Of Magnetic Resonance Imaging Research Articles

Radiologically isolated syndrome: from biological bases to practical management.

Technological advances and greater availability of magnetic resonance imaging have prompted an increment on incidental and unexpected findings within the central nervous system. The concept of radiologically isolated syndrome characterizes a group of subjects with images suggestive of demyelinating disease in the absence of a clinical episode compatible with multiple sclerosis. Since the description of this entity, many questions have arisen; some have received responses but others remain unanswered. A panel of experts met with the objective of performing a critical review of the currently available evidence. Definition, prevalence, biological bases, published evidence, and implications on patient management were reviewed. Thirty to 50% of subjects with radiologically isolated syndrome will progress to multiple sclerosis in 5 years. Male sex, age < 37 years old, and spinal lesions increase the risk. These subjects should be evaluated by a multiple sclerosis specialist, carefully excluding alternative diagnosis. An initial evaluation should include a brain and complete spine magnetic resonance, visual evoked potentials, and identification of oligoclonal bands in cerebrospinal fluid. Disease-modifying therapies could be considered when oligoclonal bands or radiological progression is present. At present time, radiologically isolated syndrome cannot be considered a part of the multiple sclerosis spectrum. However, a proportion of patients may evolve to multiple sclerosis, meaning it represents much more than just a radiological finding.

Chiari I malformation in patients with RASopathies.

Chiari I malformation (CIM) is a common pediatric neurologic anomaly which could be associated with a variety of genetic disorders. However, it is not always clear whether the observed associations between CIM and RASopathies are real or random. The knowledge of the real association could provide useful guidance to clinicians. Furthermore, it could help to better understand the still unknown genetic etiology of CIM. We reviewed the current knowledge of CIM and RASopathies in the paper. Here, we describe one patient with CIM and Noonan syndrome and three patients with CIM and neurofibromatosis type 1. Three of the four patients underwent standard surgical therapy of Chiari decompression and had a straightforward recovery without further complications from surgery. In RASopathy, imaging of the nervous system may be necessary. With the increase in availability of magnetic resonance imaging, we believe that there will be a growing body of evidence to suggest that CIM is more commonly seen in RASopathy. Future studies should attempt to elucidate the pathogenic mechanism responsible for CIM mediated by the RAS/MAPK signaling pathway.

A seemingly usual case of paraplegia with MRI diagnosis of meningioma: An unexpected course of events leading to inflammatory necrotizing myelopathy

Necrotizing myelopathy is a rare but potentially devastating disease and an important cause of paralysis. Its diagnosis can be challenging inspite of availability of magnetic resonance imaging (MRI) and laboratory investigations. The differential diagnoses of this condition are tuberculosis, Foix–Alajouanine syndrome, transverse myelitis, and spinal tumors. The purpose of this case report was to document the pathological findings of this entity and highlight the misleading tendency of postoperative thick fibrous scar tissue, which may complicate the MRI picture of necrotizing myelopathy and it may masquerade as an intradural meningioma. The spinal cord biopsy is the only way to confirm the diagnosis in suspected cases based on the gradual subacute progression of clinical symptoms and MRI findings of rim-like rather than solid enhancement.

Talar Osteonecrosis after Subchondroplasty for Acute Lateral Ligament Injuries: A Small Case Series

Category:Ankle; Sports; TraumaIntroduction/Purpose:Non-operative treatment is regarded as the standard of care for the management of acute, uncomplicated lateral ankle sprains. As diagnostic and treatment options evolve, there is intermittently renewed interest in early surgical treatment of these acute injuries. Wider availability of magnetic resonance imaging (MRI) has made advanced imaging of acute ankle sprains more commonplace. One entity commonly seen on MRI is the ‘bone marrow lesion’ (BML). Recently, a procedure termed ‘Subchondroplasty’ (Zimmer, Warsaw, Indiana) has been developed to address chronic bone marrow lesions that have failed conservative management. We present a series of five cases referred from outside institutions in which patients developed rapid osteonecrosis of their tali after undergoing acute lateral ligament reconstruction with talar Subchondroplasty.Methods:We retrospectively evaluated the charts and available imaging of five patients who had developed osteonecrosis after undergoing a Subchondroplasty procedure in the setting of acute lateral ligament injury at outside institutions. Outside radiology reports, x-rays and magnetic resonance images, clinic notes, and operative reports were collected and analyzed. Patient demographics, comorbidities, and secondary interventions (after the index procedure) were recorded.Results:Average patient age was 23 (range 16-31). All patients were healthy. The patients were taken care of by different outside providers. All patients had pre-operative MRI demonstrating ATFL signal changes and bony edema within the talus in a distribution expected after ankle sprain. All patients were taken to the OR within 4 weeks of injury. Three underwent isolated talar Subchondroplasty; two underwent Subchondroplasty and an open Broström procedure. Within 6 months, radiographs and MRI in all patients demonstrated diffuse sclerosis of the tali, and diffuse talar hyperintensity on MRI scans, consistent with osteonecrosis. Two patients additionally had talar fragmentation and collapse. Currently, one patient has subsequently undergone total ankle replacement, two have had arthroscopy with bone marrow stimulation, and two are considering arthrodesis.Conclusion:We present 5 cases from outside institutions in which patients with acute ankle sprains and associated acute talar bone marrow lesions developed osteonecrosis after Subchondroplasty with or without lateral ligament repair. Although Subchondroplasty was likely not well-indicated in these acute cases, it raises a question of whether Subchondroplasty may be harmful to the talar blood supply. There is currently a lack of evidence to support Subchondroplasty for use in the foot and ankle. Practitioners should exercise caution when performing Subchondroplasy for the talus.

Clinical presentation and management of acromegaly in elderly patients

Background and aimAcromegaly is a rare disease with a peak of incidence in early adulthood. However, enhanced awareness of this disease, combined with wide availability of magnetic resonance imaging (MRI), has increased the diagnosis of forms with mild presentation, especially in elderly patients. Moreover, due to increased life expectancy and proactive individualized treatment, patients with early-onset acromegaly are today aging. The aim of our study was to describe our cohort of elderly patients with acromegaly.Materials and methodsThis is a cross-sectional retrospective study of 96 outpatients. Clinical, endocrine, treatment, and follow-up data were collected using the electronic database of the University Hospital of Padova, Italy.ResultsWe diagnosed acromegaly in 13 patients, aged ≥65 years, presenting with relatively small adenomas and low IGF-1 secretion. Among them, 11 patients were initially treated with medical therapy and half normalized hormonal levels after 6 months without undergoing neurosurgery (TNS). Remission was achieved after TNS in three out of four patients (primary TNS in two); ten patients presented controlled acromegaly at the last visit. Acromegaly-related comorbidities (colon polyps, thyroid cancer, adrenal incidentaloma, hypertension, and bone disease) were more prevalent in patients who had an early diagnosis (31 patients, characterized by a longer follow-up of 24 years) than in those diagnosed aged ≥65 years (5 years of follow-up).ConclusionsElderly acromegalic patients are not uncommon. Primary medical therapy is a reasonable option and is effectively used, while the rate of surgical success is not reduced. A careful cost-benefit balance is suggested. Disease-specific comorbidities are more prevalent in acromegalic patients with a longer follow-up rather than in those diagnosed aged ≥65 years.

Nuclear Medicine for the Orthopedic Foot and Ankle Surgeon.

Nuclear medicine has been widely applied as a diagnostic tool for orthopedic foot and ankle pathology. Although its indications have diminished with improvements in and the availability of magnetic resonance imaging, nuclear medicine still has a significant and valuable role. The present article offers a comprehensive and current review of the most common nuclear imaging modalities for the orthopedic foot and ankle surgeon. Methods discussed include bone scintigraphy, gallium citrate scintigraphy, labeled-leukocyte scintigraphy, and single-photon emission computed tomography (SPECT). We review the indications and utility of these techniques as they pertain to specific foot and ankle conditions, including osteomyelitis, stress fractures, talar osteochondral lesions, complex regional pain syndrome, oncology, plantar fasciitis, and the painful total ankle arthroplasty. We conclude with a discussion of our approach to nuclear medicine with illustrative cases. Level of Evidence: Level V, expert opinion.

Axial spondyloarthritis - A challenging inflammatory rheumatic disease

Axial spondyloarthritis (ax-SpA) belongs to the most common inflammatory rheumatic diseases. The disease can be subdivided into non-radiographic ax-SpA and radiographic SpA or ankylosing spondylitis. The broad availability of magnetic resonance imaging has enabled us to diagnose this disease earlier. However, the fact that chronic back pain represents one of the most common symptoms and also in a healthy population is a remarkable pitfall for the diagnosis of ax-SpA. Aside from imaging, laboratory parameters, especially HLA-B27 as well as parameters of inflammation in conjunction with the medical history and the clinical examination are required to perform the diagnosis, which still can be challenging. Regarding therapy, biologics and especially tumour necrosis factor blockers have widely broadened our capabilities to treat this disease for patients who are not adequately responding to non-steroidal anti-rheumatic drugs. Interleukin-17 blockade represents a newer option, and Janus Kinase inhibition has shown some promising results in clinical trials. However, despite all efforts that have been achieved in ax-SpA, still the period between the onset of symptoms and diagnosis remains too long and must be further shortened.

Radiologically isolated syndrome: prognosis and predictors of conversion to multiple sclerosis

Increased sensitivity and availability of magnetic resonance imaging (MRI) in neurological routine practice led to the fact that more and more experts began to encounter changes typical for multiple sclerosis (MS) according to MRI in the absence of anamnestic and clinical indications of damage to the central nervous system (CNS). This nosological form has been defined as a radiologically isolated syndrome (RIS). More and more RIS cases convert to MS (up to 30% in the first 5 years after RIS diagnosis). At the moment, there are no biological markers that allow combining RIS and MS into one pathological process and early treatment with disease-modifying drugs (DMT). Prospective studies are actively being conducted to identify demographic, clinical, neuroimaging and biochemical conversion predictors. The identification of the molecular biological RIS features, combining these changes with MS, is an urgent scientific task and will allow timely initiation of therapy of the pathological process already at the subclinical stage.

Update on diagnostics and microsurgical treatment of vestibular schwannoma

Vestibular schwannomas are primary benign tumors of the cerebellopontine angle originating either from the superior or the inferior vestibular nerve. Hearing deterioration is the leading symptom, which is why the widespread name for this tumor is acoustic neuroma. Due to the widespread availability of magnetic resonance imaging (MRI), the diagnosis of vestibular schwannoma is frequently made in an early stage of the disease. In these cases await and scan policy is recommended. If the tumor grows, the therapeutic options are stereotactic radiotherapy or microsurgical tumor operation. Young patient age, functional hearing ability, persistent dizziness, cystic tumor consistence and large space-occupying tumor size are in favor of surgery via the retrosigmoid, transmeatal approach. In experienced hands excellent results in terms of functional preservation of the facial nerve and the cochlear nerve and radical tumor resection can be obtained.

Significance and Indications of Surgery for Asymptomatic Nonfunctioning Pituitary Adenomas

The availability of magnetic resonance imaging (MRI) has led to an increase in the detection of pituitary incidentaloma (PI). However, there are no robust data on surgical treatment of PI on which to base therapeutic recommendations. This study was performed to investigate the significance of surgery for asymptomatic nonfunctioning pituitary adenoma (NFPA) among PIs. A total of 180 patients that underwent tumor resection of pituitary adenoma via the transsphenoidal approach between 2005 and 2017 were reviewed. Thirty-three consecutive patients with subjectively asymptomatic NFPA were included in this study. Our surgical indications for asymptomatic NFPAs were categorized as follows: macroadenoma with optic chiasma compression (group A, n= 14), solid tumor ≥2 cm in size (group B, n= 7), and tumor growth on follow-up MRI (group C, n= 12). The clinical outcomes were analyzed accordingly. Seven patients (50%) in group A showed subjective improvement of visual function after tumor resection even though they had no complaints preoperatively. On the other hand, no changes occurred in any cases in group B or group C. Although there were no critical complications in this series, the incidence of nonnegligible nasal complications was relatively high (24.2%) and may decrease the patient's quality of life. Surgery should be recommended for asymptomatic NFPA with optic chiasma compression to improve visual outcome. On the other hand, immediate intervention for other asymptomatic NFPA to reduce the likelihood of the appearance of tumor-related symptoms remains questionable considering its invasiveness to the nose.

Medullar Kock without Pott: 13 cases observed at the university hospital center of Conakry, Guinea

Background: The diagnostic certainty of medullar tuberculosis (TB) without Pott disease is difficult to establish in a tropical environment with the large group of infectious, parasitic, and systemic myelopathies, despite the increasing availability of magnetic resonance imaging (MRI) data and improvement of biological exploration platforms. Methods: We retrospectively analyzed the files of 186 patients hospitalized in the Department of Neurology and Neurosurgery of the University Hospital Center of Conakry, Guinea, between 2008 and 2016 for the management of non-compressive and compressive myelopathy. Biological evidence of TB infection was demonstrated for 13 (6.9%) patients. Results: Infectious clinical picture prior to the development of neurological signs was reported in 11 patients (84.6%). The neurological signs were summed up by the existence of a sensitivo-motor semiology of progressive evolution (100% of cases) with sphincter disorders in 11 patients (84.6%) and a medullary compression symptomatology with a lesion and under lesion syndrome from the outset in 4 patients (30.8%). Medullary MRI revealed an extensive intramedullary hypersignal in 9 patients with non-compressive myelopathy and in 4 cases, the lesions appeared in T1 hypersignal and T2 isosignal were localized. Lumbar puncture (LP) revealed lymphocytic pleocytosis, hypoglucorrhage (0.3 to 0.5 g/l), and leukocytosis. Conclusion: This study reveals a classic clinical, biological, neuroradiological, and evolutionary profile of compressive and non-compressive myelopathies. These results are important for the therapeutic and evolutionary discussion of TB myelopathies for good management.

РОЛЬ УЛЬТРАЗВУКОВОГО ИССЛЕДОВАНИЯ В КОМПЛЕКСНОЙ ДИАГНОСТИКЕ ШЕЙНОЙ РАДИКУЛОПАТИИ (ОБЗОР ЛИТЕРАТУРЫ)

Изучено современное состояние вопроса диагностики шейной радикулопатии – широко распространенного заболевания, имеющего тенденцию к хронизации, потере трудоспособности и инвалидизации. Традиционные методы лучевой визуализации шейного отдела позвоночника – рентгенография, рентгеновская компьютерная и магнитно-резонансная томография – наряду с достоинствами имеют ряд недостатков: рентгенологическая визуализация не предоставляет информации о состоянии мягких тканей и связана с лучевой нагрузкой, доступность магнитно-резонансной томографии ограничена, что делает актуальной проблему поиска альтернативных методов диагностики.Достоинством ультразвукового исследования является доступность, быстрота, полипозиционность, отсутствие лучевой нагрузки, возможность многократного выполнения. Однако в диагностике шейной радикулопатии его возможности еще не до конца раскрыты, в научной литературе имеются лишь единичные упоминания о возможностях метода, а в повседневной клинической практике он в указанных целях не используется. Имеющиеся в литературе данные об исследовании других отделов позвоночника и периферических нервов, а также единичные сообщения об ультразвуковых исследованиях вертебральных и мягкотканных структур шейного отдела позволяют прогнозировать высокую эффективность ультразвуковой визуализации в диагностике шейной радикулопатии и перспективность дальнейших исследований данной проблемы.

Leksell Stereotactic Radiosurgery for Cavernous Malformations.

Cavernous malformations (CM) represent a distinct subgroup of brain vascular malformations that are characterized by small sinusoidal vascular channels with hyaline degeneration and old blood pigments. Because of the increasing availability of magnetic resonance imaging (MRI) they are detected much more frequently in the present era. CM may be solitary or found in the context of a familial variant that results in an increasing number of CM developing as the patient ages. Because of the variable risk of subacute bleeding, their management options have been controversial. The annual risk of an incidentally detected CM bleeding is <0.5% each year. Leksell radiosurgery is used for a subgroup of patients who have repeatedly bled. In general, CM best considered for stereotactic radiosurgery are deep seated and do not pre-sent to a pial or ependymal surface where microsurgical corridors for removal are feasible. When radiosurgery is used for patients at high risk for both re-bleeding as well as microsurgical resection, the risk of bleeding can be reduced from as high as 33% each year to <0.5% each year after a 2-year latency interval. The target lies within the hemosiderin rim detected during the MRI that is part of planning. Marginal doses are significantly less than those used for angiographically visible arteriovenous malformations.

Chapter 6 - EEG source localization

Since the discovery of electroencephalography (EEG), when it was hoped that EEG would offer "a window into the brain," researchers and clinicians have attempted to localize the neuronal activity in the brain that generates the scalp potentials measured noninvasively with EEG. Early explorations in the 1950s using electric field theory to infer the location and orientation of the current dipole in the brain from the scalp potential distribution triggered considerable efforts to quantitatively deduce these sources. Initially, dipole fitting, or dipole localization, was the method of choice and many studies used this approach in experimental and clinical studies with remarkable success. Later on, new methods were proposed that attempted to overcome the problem of having to fix the number of sources a priori; these methods are known as distributed source imaging techniques. The introduction and increasing availability of magnetic resonance imaging, allowing detailed realistic anatomy of the brain and head to be incorporated in source localization methods, has drastically increased the precision of such approaches. Today, source localization of EEG (and magnetoencephalography, or MEG) has reached a level of consistency and precision that allows these methods to be placed in the family of brain imaging techniques. The particular advantage that they have over other imaging methods is their high temporal resolution, which allows the origin of activity to be distinguished from its propagation and information flow in large-scale brain networks to be examined. This chapter gives an overview of these methods and illustrates them with several examples, thereby focusing on EEG source imaging in epilepsy and presurgical planning, as clinical applications with remarkable maturation.

Morphogenesis of Canine Chiari Malformation and Secondary Syringomyelia: Disorders of Cerebrospinal Fluid Circulation.

Chiari-like Malformation (CM) and secondary syringomyelia (SM), as well as their analogous human conditions, is a complex developmental condition associated with pain and accompanying welfare concerns. CM/SM is diagnosed ever more frequently, thanks in part to the increased availability of magnetic resonance imaging in veterinary medicine. Research over the last two decades has focused primarily on its pathophysiology relating to overcrowding of the cranial caudal fossa. More recent characterizations of CM/SM include brachycephaly with osseous reduction and neural parenchymal displacement involving the entire brain and craniocervical junction to include rostral flattening, olfactory bulb rotation, increased height of the cranium, reduced cranial base with spheno-occipital synchondrosis angulation, reduced supraoccipital and interparietal crest and rostral displacement of the axis and atlas with increased odontoid angulation. The most shared manifestation of CM is the development of fluid-filled pockets (syrinx, syringes) in the spinal cord that can be readily quantified. Dogs with symptomatic CM without SM have a reduced basioccipital bone, compensatory increased cranial fossa height with displaced parenchyma whereby the cerebellum is invaginated beneath the occipital lobes but without compromising cerebrospinal fluid channels enough to cause SM. Thus, broadly defined, CM might be described as any distortion of the skull and craniocervical junction which compromises the neural parenchyma and cerebrospinal fluid circulation causing pain and/or SM. The etiology of CM is multifactorial, potentially including genetically-influenced, breed-specific abnormalities in both skeletal and neural components. Since causation between specific morphologic changes and SM or clinical signs is unproven, CM might be more appropriately considered as a brachycephalic obstructive CSF channel syndrome (BOCCS) rather than a single malformation. Understanding the normal development of the brain, skull and craniocervical junction is fundamental to identifying deviations which predispose to CM/SM. Here we review its anatomical, embryological, bio-mechanical, and genetic underpinnings to update the profession's understanding of this condition and meaningfully inform future research to diminish its welfare impact.

Bacterial meningitis in neonates and infants - the sonographic picture.

Bacterial meningitis is a major diagnostic and therapeutic problem among children and neonates, with severe, rapidly progressing course and potentially life-threatening complications. Early antibacterial treatment is essential for the patient’s favorable prognosis. Cerebral imaging plays an important role in the diagnostic process alongside physical examination and laboratory tests. Magnetic resonance imaging is the gold standard for diagnosing bacterial meningitis. Because of limited availability of magnetic resonance imaging, cranial ultrasound is the first imaging procedure to be performed (if the anterior fontanelle is preserved providing an adequate acoustic window). The safety and reliability of ultrasound examination, possibility to perform the examination at bedside without the need for sedation make cranial ultrasound a useful tool both for preliminary diagnostic investigation and for the monitoring of both treatment and long-term complications. Sonographic findings in patients with bacterial meningitis and possible complications are diverse. Changes can be seen on the surface of the brain, in the extra-axial space, in the ventricular system and in brain tissue. In some cases they can also be visible in the lumbosacral segment of the spinal cord. This paper presents ultrasound characteristics of lesions associated with bacterial meningitis in neonates and infants, based on the authors’ own material and data from the available literature.

Temporal Galc deletion reveals a critical vulnerable period in the pathogenesis of Krabbe leukodystrophy

The availability of magnetic resonance imaging (MRI) has led to an increase in the detection of pituitary incidentaloma (PI). However, there are no robust data on surgical treatment of PI on which to base therapeutic recommendations. This study was performed to investigate the significance of surgery for asymptomatic nonfunctioning pituitary adenoma (NFPA) among PIs.A total of 180 patients that underwent tumor resection of pituitary adenoma via the transsphenoidal approach between 2005 and 2017 were reviewed. Thirty-three consecutive patients with subjectively asymptomatic NFPA were included in this study. Our surgical indications for asymptomatic NFPAs were categorized as follows: macroadenoma with optic chiasma compression (group A, n = 14), solid tumor ≥2 cm in size (group B, n = 7), and tumor growth on follow-up MRI (group C, n = 12). The clinical outcomes were analyzed accordingly.Seven patients (50%) in group A showed subjective improvement of visual function after tumor resection even though they had no complaints preoperatively. On the other hand, no changes occurred in any cases in group B or group C. Although there were no critical complications in this series, the incidence of nonnegligible nasal complications was relatively high (24.2%) and may decrease the patient's quality of life.Surgery should be recommended for asymptomatic NFPA with optic chiasma compression to improve visual outcome. On the other hand, immediate intervention for other asymptomatic NFPA to reduce the likelihood of the appearance of tumor-related symptoms remains questionable considering its invasiveness to the nose.

Imaging biomarkers in Alzheimer's disease: added value in the clinical setting.

Over the last 20 years the availability of magnetic resonance imaging and positron-emission tomography technologies as well as of cerebrospinal fluid biomarkers has allowed research and clinical approach to Alzheimer's disease (AD) to move towards the earliest manifestations of the disease. This new approach resulted in an increasing knowledge about in-vivo biological and neuropathological processes of each phase of the AD-related damage from preclinical, to mild cognitive impairment, and finally to dementia due to AD. The present narrative review deals with the available data as well as with the unsolved issued related to the incorporation of AD biomarkers into the clinical practice. Ongoing research efforts aiming to better define and implement the use of imaging AD biomarkers in clinical practice according to a patient-centered approach and sustainability for clinical-care systems are also discussed.

Hippocampal subfields at ultra high field MRI: An overview of segmentation and measurement methods

ABSTRACTThe hippocampus is one of the most interesting and studied brain regions because of its involvement in memory functions and its vulnerability in pathological conditions, such as neurodegenerative processes. In the recent years, the increasing availability of Magnetic Resonance Imaging (MRI) scanners that operate at ultra‐high field (UHF), that is, with static magnetic field strength ≥7T, has opened new research perspectives. Compared to conventional high‐field scanners, these systems can provide new contrasts, increased signal‐to‐noise ratio and higher spatial resolution, thus they may improve the visualization of very small structures of the brain, such as the hippocampal subfields. Studying the morphometry of the hippocampus is crucial in neuroimaging research because changes in volume and thickness of hippocampal subregions may be relevant in the early assessment of pathological cognitive decline and Alzheimer's Disease (AD). The present review provides an overview of the manual, semi‐automated and fully automated methods that allow the assessment of hippocampal subfield morphometry at UHF MRI, focusing on the different hippocampal segmentation produced. © 2017 The Authors Hippocampus Published by Wiley Periodicals, Inc.

Early toxicity in a prospective phase I/II trial of MRI-assisted focal boost integrated with HDR monotherapy for low- and intermediate-risk prostate cancer.

120 Background: There is growing evidence for the use of High Dose Rate (HDR) brachytherapy as monotherapy for the treatment of low and intermediate risk prostate cancer patients. With the increasing availability of magnetic resonance imaging (MRI) there is an opportunity to further escalate dose to the dominant intraprostatic lesion (DIL). We report acute toxicity of this prospective phase I/II trial. Methods: Eligible patients had low- and intermediate risk prostate cancer, IPSS &lt; 16, were medically eligible for HDR brachytherapy treatment and had an identified DIL on multiparametric MRI (mpMRI) prior to brachytherapy treatment. Patients were treated with 19 Gy delivered in one fraction to the whole prostate. A 0-5mm expansion was applied to the DIL to define the PTV DIL, with a DIL PTV D90 to receive &gt; 23Gy based on previous experience. Toxicity was assessed using CTCAE v.4.0 at baseline, 6 weeks 3, 6, 9 and 12 months post brachytherapy. Results: A total of 34 patients have undergone HDR monotherapy treatment with an integrated DIL boost with a median follow up of 6 months. The median age was 67 years (range 46-80). At presentation, median PSA was 6.1 ng/mL (range 2.5-16.4). Three, 26, and 6 patients had low, low intermediate and high intermediate risk disease. Baseline characteristics were PIRAD 5 (n = 21) and PIRAD 4 (n = 13), median prostate volume was 38 cc (range 18-54). The median DIL volume was 2.8 cc (range 1.14-7.8). The median DIL D90 was 27 Gy (range 19-35.8). No patients experienced acute or late grade 2+ GI toxicity. The percentage of acute grade 2 GU toxicity were as follows; retention 62%, frequency 18%, urinary tract pain 6%. One patient had acute clot retention requiring catheterization x1 day and has been catheter-free since. Late grade 2 GU toxicity (alpha blockers) was reported in 6/16 patients at 6 months. Conclusions: The use of mpMRI to define and further escalate dose to the DIL using HDR monotherapy is feasible with minimal acute toxicities. Further long term follow up is required to determine the efficacy of treatment, and impact on quality of life and late toxicities. Clinical trial information: NCT02623933.