Contraindications For Magnetic Resonance Imaging Research Articles

Strategies for Identifying and Recruiting Women at High Risk for Breast Cancer for Research Outside of Clinical Settings: Observational Study.

Research is needed to understand and address barriers to risk management for women at high (≥20% lifetime) risk for breast cancer, but recruiting this population for research studies is challenging. This paper compares a variety of recruitment strategies used for a cross-sectional, observational study of high-risk women. Eligible participants were assigned female at birth, aged 25-85 years, English-speaking, living in the United States, and at high risk for breast cancer as defined by the American College of Radiology. Individuals were excluded if they had a personal history of breast cancer, prior bilateral mastectomy, medical contraindications for magnetic resonance imaging, or were not up-to-date on screening mammography per American College of Radiology guidelines. Participants were recruited from August 2020 to January 2021 using the following mechanisms: targeted Facebook advertisements, Twitter posts, ResearchMatch (a web-based research recruitment database), community partner promotions, paper flyers, and community outreach events. Interested individuals were directed to a secure website with eligibility screening questions. Participants self-reported method of recruitment during the eligibility screening. For each recruitment strategy, we calculated the rate of eligible respondents and completed surveys, costs per eligible participant, and participant demographics. We received 1566 unique responses to the eligibility screener. Participants most often reported recruitment via Facebook advertisements (724/1566, 46%) and ResearchMatch (646/1566, 41%). Community partner promotions resulted in the highest proportion of eligible respondents (24/46, 52%), while ResearchMatch had the lowest proportion of eligible respondents (73/646, 11%). Word of mouth was the most cost-effective recruitment strategy (US $4.66 per completed survey response) and paper flyers were the least cost-effective (US $1448.13 per completed survey response). The demographic characteristics of eligible respondents varied by recruitment strategy: Twitter posts and community outreach events resulted in the highest proportion of Hispanic or Latina women (1/4, 25% and 2/6, 33%, respectively), and community partner promotions resulted in the highest proportion of non-Hispanic Black women (4/24, 17%). Although recruitment strategies varied in their yield of study participants, results overall support the feasibility of identifying and recruiting women at high risk for breast cancer outside of clinical settings. Researchers must balance the associated costs and participant yield of various recruitment strategies in planning future studies focused on high-risk women.

A Study of High-Resolution Ultrasound and Magnetic Resonance Imaging Findings in Shoulder Joint Pain at a Tertiary Care Hospital in Central India.

Objective This study aims to investigate the diagnostic efficacy of high-resolution ultrasound (USG) and magnetic resonance imaging (MRI) in patients with shoulder joint pain at a tertiary care hospital in Central India. Methods This cross-sectional study was conducted at Acharya Vinoba Bhave Rural Hospital from 2021 to 2024. The study population consisted of patients with shoulder pain, without fractures, who were evaluated using USG and MRI. Participants with infective arthritis, rheumatoid arthritis, previous shoulder surgery, or contraindications for MRI were excluded. Data were recorded and analyzed using Microsoft Excel (Microsoft Corporation, Redmond, Washington) and R 4.2.0 software (The R Foundation, Vienna, Austria). Sensitivity, specificity, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of USG and MRI. Results A total of 80 patients were included, with 49 (61%) males and 31 (39%) females. The MRI findings showed supraspinatus partial tears in 44 (55%) cases, complete tears in 10 (12.5%), and various other shoulder pathologies. USG detected supraspinatus partial tears in 16 (19.5%) and complete tears in seven (8.8%). Kappa statistics indicated moderate to high agreement between USG and MRI for several pathologies, with near-perfect agreement for complete tears. Conclusion High-resolution USG is a valuable tool for the initial assessment of shoulder joint pain, providing reliable diagnostic information with high agreement levels with MRI for complete tears and certain shoulder conditions. MRI remains indispensable for comprehensive evaluation, particularly for partial tears and complex pathologies.

Minimal dose CT for left ventricular ejection fraction and combination with chest-abdomen-pelvis CT

ObjectivesThis prospective study tested the diagnostic accuracy, and absolute agreement with MRI of a low-dose CT protocol for left ventricular ejection fraction (LVEF) measurement. Furthermore we assessed its potential for combining it with Chest-Abdomen-Pelvis CT (CAP-CT) for a one-stop examination. Materials & methodsEighty-two patients underwent helical low-dose CT. Cardiac magnetic resonance imaging (MRI) was the reference standard. In fifty patients, CAP-CT was performed concurrently, using a modified injection protocol. In these, LVEF was measured with radioisotope cardiography (MUGA). Patients >18 years, without contrast media or MRI contraindications, were included. Bias was measured with Bland-Altman analysis, classification accuracy with Receiver Operating Characteristics, and inter-reader agreement with Intra-Class Correlation Coefficient (ICC). Correlation was examined using Pearson's correlation coefficients. CAP image quality was compared to previous scans with visual grading characteristics. ResultsThe mean CT dose-length-product (DLP) was 51.8 mGycm, for an estimated effective dose of 1.4 mSv, compared to 5.7 mSv for MUGA. CT LVEF bias was between 2 % and 10 %, overestimating end-diastolic volume. When corrected for bias, sensitivity and specificity of 100 and 98.5 % for classifying reduced LVEF (50 % MRI value) was achieved. ICC for MUGA was significantly lower than MRI and CT. Distinction of renal medulla and cortex was reduced in the CAP scan, but proportion of diagnostic scans was not significantly different from standard protocol. ConclusionWhen corrected for inter-modality bias, CT classifies patients with reduced LVEF with high accuracy at a quarter of MUGA dose and can be combined with CAP-CT without loss of diagnostic quality.

Diagnostic algorithms for acute ankle injury imaging

Ankle trauma is the most prevalent low extremity injury among urgent referral patients. Up to 85% of acute ankle traumas lead to an isolated ligament injury, with up to 50% of these patients would have chronic pain syndrome in the future, related to inaccurate diagnosis and resulting inappropriate treatment strategy and rehabilitation term.
 We analyzed publications on the state-of-the-art aspects of radiation diagnostics of acute ankle injury available from PubMed/MEDLINE databases and in the Russian Index of Scientific Citation (Elibrary.ru) for the last ten years; some earlier essential publications on certain aspects were also considered.
 Up to now, there have been no unified guidelines on the radiation diagnosis of ankle injury depending on the trauma type, mechanism, and severity. The Ottawa ankle rules (1994) are the basic guidelines for selection of the patients with acute trauma who should be offered X-rays. Primary X-ray would allow for the choice of the treatment strategy or further diagnostic assessment of the patient. Computed tomography is done for multi-fragment intra-articular fractures and for the control after their reposition. Computed tomography is used in patients with severe pain syndrome and other absolute and relative contraindications for magnetic resonance imaging. The latter allows for the imaging of all injured structures within a single assessment procedure and by such to make the diagnosis of ligament and tendon ruptures, to visualize osteochondral injuries, hidden and stress fractures and many other acute ankle injuries. Ultrasound assessment can considerably add to clinical understanding of the patient during acute trauma, if magnetic resonance imaging is contraindicated.
 Based on the analysis performed, we propose the algorithms for diagnostic assessment in various clinical situations.

Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in the Detection of Choledocholith, taking Post-Operative findings as the Gold Standard

Objective: To assess the diagnostic accuracy of Magnetic resonance cholangiopancreatography (MRCP) in the detection of Choledocholith, taking post-operative findings as the gold standard.
 Study Design: Cross-sectional validation study
 Place and Duration of Study: Combined Military Hospital, Kharian Pakistan, from Jan 2020 to Jan 2021.
 Methodology: Patients presenting with sonographic evidence of choledocholithiasis without any contraindications for magnetic resonance imaging were subjected to MRCP after informed consent. The patients who underwent surgery were followed up, and their per-operative findings were compared with the radiological findings of MRCP. 
 Results: A total of 87 patients were included in the study. The mean age of patients was 37.04±10.49 years (range of 22-65 years). The sensitivity for MRCP was 95%, specificity was 73.33%, positive predictive value (PPV) was 93.44%, and negative predictive value was 78.57%. The diagnostic accuracy for MRCP was found to be 90.66%.
 Conclusion: The study shows that magnetic resonance cholangio-pancreatography is an effective imaging modality in diagnosing choledocholithiasis.

8798 Pressure-Induced Fibroid Ischemia: First-in-Human Experience with a Novel Device for Laparoscopic Treatment of Symptomatic Fibroids

Study Objective Assessment of feasibility of use of a novel fibroid treatment device intended to cause fibroid infarction by increasing intra-tumoral pressure. Design Prospective, single-arm, single-center. Follow up duration – 12 months post-procedure. Setting Subjects in dorsal lithotomy position; arms secured at the sides, shoulder pads in Trendelenburg position during laparoscopy. Surgeon on the subject's left, assistant on the subject's right; facing subject's legs. Laparoscopic tower at the midline of subject's legs. Patients or Participants Sixteen 30–50-year–old pre-menopausal black women indicated for hysterectomy with 2-6–cm type-2-, 3-, 4-, 5-, 6-, or 2-5-fibroids. Main exclusion criteria: prior myomectomy or surgical or minimally-invasive fibroid treatment, known/suspected pregnancy, pregnancy intent, prior pelvic surgery, ongoing anticoagulant therapy, life-threatening condition, contraindication for magnetic resonance imaging with gadolinium contrast. Eleven subjects completed the follow-up. Interventions The novel Empress fibroid treatment system comprises two handheld devices (OrbiTal, OrbiTight), a titanium ring, and a size-0 absorbable suture. OrbiTal was inserted into the abdominal cavity and a suture was passed around a fibroid. OrbiTight carrying the titanium ring was inserted thereafter, the suture was threaded through the ring, tightened, crimped, and left on the uterus outer surface. Multiple sutures could be placed. Measurements and Main Results Uterine and fibroid characteristics were calculated from fat-suppressed T1-weighted coronal, sagittal, and transverse planes on gadolinium-enhanced magnetic resonance images 1 day and 1,3, 6, and 12 months after the procedure. At 3 months, fibroid volume decreased by 36.3% (P=.002) and continued to decrease until the 12-month follow-up (60.4%; P=.008). There were no failed procedures. Improvement was observed at 3 months post-procedure in the Health-Related Quality of Life total, Energy/Mood, Control, and Sexual Function domains of the Uterine Fibroid Symptom and Quality of Life questionnaire. Serious adverse events, unanticipated risks were not reported. Conclusion Initial assessment of the device supports feasibility of the approach for fibroid treatment, does not reveal safety concerns. Assessment of feasibility of use of a novel fibroid treatment device intended to cause fibroid infarction by increasing intra-tumoral pressure. Prospective, single-arm, single-center. Follow up duration – 12 months post-procedure. Subjects in dorsal lithotomy position; arms secured at the sides, shoulder pads in Trendelenburg position during laparoscopy. Surgeon on the subject's left, assistant on the subject's right; facing subject's legs. Laparoscopic tower at the midline of subject's legs. Sixteen 30–50-year–old pre-menopausal black women indicated for hysterectomy with 2-6–cm type-2-, 3-, 4-, 5-, 6-, or 2-5-fibroids. Main exclusion criteria: prior myomectomy or surgical or minimally-invasive fibroid treatment, known/suspected pregnancy, pregnancy intent, prior pelvic surgery, ongoing anticoagulant therapy, life-threatening condition, contraindication for magnetic resonance imaging with gadolinium contrast. Eleven subjects completed the follow-up. The novel Empress fibroid treatment system comprises two handheld devices (OrbiTal, OrbiTight), a titanium ring, and a size-0 absorbable suture. OrbiTal was inserted into the abdominal cavity and a suture was passed around a fibroid. OrbiTight carrying the titanium ring was inserted thereafter, the suture was threaded through the ring, tightened, crimped, and left on the uterus outer surface. Multiple sutures could be placed. Uterine and fibroid characteristics were calculated from fat-suppressed T1-weighted coronal, sagittal, and transverse planes on gadolinium-enhanced magnetic resonance images 1 day and 1,3, 6, and 12 months after the procedure. At 3 months, fibroid volume decreased by 36.3% (P=.002) and continued to decrease until the 12-month follow-up (60.4%; P=.008). There were no failed procedures. Improvement was observed at 3 months post-procedure in the Health-Related Quality of Life total, Energy/Mood, Control, and Sexual Function domains of the Uterine Fibroid Symptom and Quality of Life questionnaire. Serious adverse events, unanticipated risks were not reported. Initial assessment of the device supports feasibility of the approach for fibroid treatment, does not reveal safety concerns.

An algorithm for pacing and cardioverting electronic devices undergoing magnetic resonance imaging: The PACED-MRI protocol

ObjectiveCardiac implantable electronic devices (CIEDs) have traditionally been a contraindication for magnetic resonance imaging (MRI). However, there is an increasing amount of literature to suggest that MRI can be safely performed in select patients with pacemakers and implantable cardioverter defibrillators by following a standardized protocol. We created an institutional protocol, made accessible as an online form, that is primarily technologist-driven and does not require direct electrophysiologist supervision. The purpose of this study was to evaluate the PACEDMRI protocol for screening and completing MRI in patients with MR conditional CIEDs. Subjects and methodsAfter the implementation of our standardized PACED-MRI protocol, patients with MR conditional CIEDs who were referred for MRI were included in the study. On the day of the MRI, the device company representative utilized our protocol accessed through PACEDMRI.com. If all parameters and criteria within the protocol were met, the examination proceeded. The device representative programed the CIED to the appropriate mode for MRI as instructed by the PACED-MRI protocol. CIED interrogation was performed immediately before and after MRI. The on-call electrophysiology nurse practitioner was notified only if the protocol instructed the team to not proceed with MRI. CIED programming changes, malfunctions, and intraprocedural events were documented. Additionally, any adverse outcomes were recorded including peri-MRI symptom onset, arrhythmia, and death. ResultsOne hundred thirty-eight MRI examinations were performed on patients with MR conditional CIEDs (100 pacemakers: 38 implantable cardiac defibrillators). There was no incidence of symptom onset requiring early termination of the MRI, death, or arrhythmic events during or after MRI. No significant changes in lead parameters, including sensing amplitudes, lead thresholds, or lead impedances were noted on post-MRI device interrogation. Out of the 138 completed MRIs, the on-call electrophysiology provider was notified on one, non-urgent occasion. ConclusionThe implementation of the standardized, technologists-driven PACED-MRI protocol allowed for a multidisciplinary approach to MRI for patients with MR conditional CIEDs.This study demonstrates that the PACED-MRI protocol can be used for patients with MR conditional CIEDs undergoing MRI without the need for direct electrophysiologist supervision.

Nomogram based on clinical and brain computed tomography characteristics for predicting more than 5 cerebral microbleeds in the hypertensive population.

BackgroundCerebral microbleeds (CMBs) are common in the hypertensive population and can only be detected with magnetic resonance imaging (MRI). The anticoagulation and thrombolytic regimens for patients with >5 CMBs are different from those for patients with ≤ 5 CMBs. However, MRI is not suitable for evaluating CMBs in patients with MRI contraindications or acute ischemic stroke urgently requiring thrombolysis. We aimed to develop and validate a nomogram combining clinical and brain computed tomography (CT) characteristics for predicting >5 CMBs in a hypertensive population.Materials and methodsIn total, 160 hypertensive patients from 2016 to 2020 who were confirmed by MRI to have >5 (77 patients) and ≤ 5 CMBs (83) were retrospectively analyzed as the training cohort. Sixty-four hypertensive patients from January 2021 to February 2022 were included in the validation cohort. Multivariate logistic regression was used to evaluate >5 CMBs. A combined nomogram was constructed based on the results, while clinical and CT models were established according to the corresponding characteristics. Receiver operating characteristic (ROC) and calibration curves and decision curve analysis (DCA) were used to verify the models.ResultsIn the multivariable analysis, the duration of hypertension, level of homocysteine, the number of lacunar infarcts (LIs), and leukoaraiosis (LA) score were included as factors associated with >5 CMBs. The clinical model consisted of the duration of hypertension and level of homocysteine, while the CT model consisted of the number of LIs and LA. The combined model consisted of the duration of hypertension, level of homocysteine, LI, and LA. The combined model achieved an area under the curve (AUC) of 0.915 (95% confidence interval [CI]: 0.860–0.953) with the training cohort and 0.887 (95% CI: 0.783–0.953) with the validation cohort, which were higher than those of the clinical model [training cohort: AUC, 0.797 (95% CI: 0.726, 0.857); validation cohort: AUC, 0.812 (95% CI: 0.695, 0.899)] and CT model [training cohort: AUC, 0.884 (95% CI: 0.824, 0.929); validation cohort: AUC, 0.868 (95% CI: 0.760, 0.940)]. DCA showed that the clinical value of the combined model was superior to that of the clinical model and CT model.ConclusionA combined model based on clinical and CT characteristics showed good diagnostic performance for predicting >5 CMBs in hypertensive patients.

Prevalence and Vascular Distribution of Multiterritorial Atherosclerosis Among Community-Dwelling Adults in Southeast China

Data are limited on the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in community populations. To investigate the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in older, community-dwelling populations in China. This cross-sectional study was based on the baseline survey from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study, a population-based prospective cohort study that enrolled community-dwelling adults aged 50 to 75 years based on cluster sampling from 6 villages and 4 living communities of Lishui city in southeast China. Data were collected from May 2017 to September 2019 and analyzed from September to November 2021. Atherosclerotic plaque and stenosis at baseline were assessed in multiple vascular territories. Brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries; computed tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries; and ankle-brachial index for peripheral arteries were performed at baseline survey. The extent of atherosclerosis was assessed according to the number of these 8 vascular sites affected, and polyvascular lesions were defined as at least 2 affected sites. A total of 3433 of 4202 invited individuals consented to participate in the study. After excluding 366 participants with contraindications for MRI or CTA scanning, with life expectancies of 4 years of fewer, or with mental disease, a total of 3067 community-dwelling adults were enrolled. The mean (SD) age was 61.2 (6.7) years; 1640 (53.5%) were women, and 74 (2.4%) had prevalent ASCVD. Most participants (2870 [93.6%]) had atherosclerotic plaques in at least 1 vascular territory. Atherosclerotic plaques were mostly detected in the aorta (2419 [79.6%]) and iliofemoral arteries (2312 [75.8%]), followed by subclavian (1500 [49.8%]), coronary (1366 [44.9%]), extracranial (1110 [36.4%]), renal (873 [28.7%]), and intracranial (542 [17.7%]) arteries. A substantial proportion of participants (1180 [38.5%]) had arterial stenosis of 50% or greater, predominantly affecting the coronary (542 [17.8%]) and iliofemoral (527 [17.3%]) arteries. Polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories, and polyvascular stenosis was observed in 412 patients (13.4%). In this study, atherosclerotic plaque was highly prevalent in the older community population in China, and a substantial proportion of individuals reach stenosis of 50% or greater.

Magnetic Resonance Imaging or Computed Tomography for Suspected Acute Stroke: Association of Admission Image Modality with Acute Recanalization Therapies, Workflow Metrics, and Outcomes.

ObjectiveTo examine rates of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), door‐to‐needle (DTN) time, door‐to‐puncture (DTP) time, and functional outcome between patients with admission magnetic resonance imaging (MRI) versus computed tomography (CT).MethodsAn observational cohort study of consecutive patients using a target trial design within the nationwide Swiss‐Stroke‐Registry from January 2014 to August 2020 was carried out. Exclusion criteria included MRI contraindications, transferred patients, and unstable or frail patients. Multilevel mixed‐effects logistic regression with multiple imputation was used to calculate adjusted odds ratios with 95% confidence intervals for IVT, MT, DTN, DTP, and good functional outcome (mRS 0–2) at 90 days.ResultsOf the 11,049 patients included (mean [SD] age, 71 [15] years; 4,811 [44%] women; 69% ischemic stroke, 16% transient ischemic attack, 8% stroke mimics, 6% intracranial hemorrhage), 3,741 (34%) received MRI and 7,308 (66%) CT. Patients undergoing MRI had lower National Institutes of Health Stroke Scale (median [interquartile range] 2 [0–6] vs 4 [1–11]), and presented later after symptom onset (150 vs 123 min, p < 0.001). Admission MRI was associated with: lower adjusted odds of IVT (aOR 0.83, 0.73–0.96), but not with MT (aOR 1.11, 0.93–1.34); longer adjusted DTN (+22 min [13–30]), but not with longer DTP times; and higher adjusted odds of favorable outcome (aOR 1.54, 1.30–1.81).InterpretationWe found an association of MRI with lower rates of IVT and a significant delay in DTN, but not in DTP and rates of MT. Given the delays in workflow metrics, prospective trials are required to show that tissue‐based benefits of baseline MRI compensate for the temporal benefits of CT. ANN NEUROL 2022;92:184–194

Plasma Neurofilament Light Chain Levels Are Elevated in Children and Young Adults With Wolfram Syndrome.

Wolfram syndrome is a rare disease caused by pathogenic variants in the WFS1 gene with progressive neurodegeneration. As an easily accessible biomarker of progression of neurodegeneration has not yet been found, accurate tracking of the neurodegenerative process over time requires assessment by costly and time-consuming clinical measures and brain magnetic resonance imaging (MRI). A blood-based measure of neurodegeneration, neurofilament light chain (NfL), is relatively inexpensive and can be repeatedly measured at remote sites, standardized, and measured in individuals with MRI contraindications. To determine whether NfL levels may be of use in disease monitoring and reflect disease activity in Wolfram syndrome, plasma NfL levels were compared between children and young adults with Wolfram syndrome (n = 38) and controls composed of their siblings and parents (n = 35) and related to clinical severity and selected brain region volumes within the Wolfram group. NfL levels were higher in the Wolfram group [median (interquartile range) NfL = 11.3 (7.8–13.9) pg/mL] relative to controls [5.6 (4.5–7.4) pg/mL]. Within the Wolfram group, higher NfL levels related to worse visual acuity, color vision and smell identification, smaller brainstem and thalamic volumes, and faster annual rate of decrease in thalamic volume over time. Our findings suggest that plasma NfL levels can be a powerful tool to non-invasively assess underlying neurodegenerative processes in children, adolescents and young adults with Wolfram syndrome.

Diagnostic Validity of Magnetic Resonance Imaging for the Detection of Ependymoma among Bangladeshi Children

Background: Detection of ependymoma is very essential for the management of the patients.&#x0D; Objective: The purpose of the present study was to validate as well as to find out the Magnetic Resonance Imaging (MRI) findings of ependymoma among paediatric patients.&#x0D; Methodology: This cross-sectional study was carried out from January 2010 to June 2011 for a period of one year and six months in the Department of Radiology &amp; Imaging at Dhaka Medical College, Dhaka, Bangladesh. Pediatric Patients having clinically suspected brain tumours of ependymoma variant who were undergone MRI of brain were included in this study. The pediatric patients clinically suspected for brain tumor in posterior cranial fossa region with the suspicion of ependymoma having no contraindication for MRI was underwent MRI examination. The postoperative resected tissues were examined histopathological in the respective department. All the clinical profiles and demographic data were collected.&#x0D; Result: This study included 33 patients with clinical features compatible with posterior fossa tumors. Out of all cases 4 cases were diagnosed as ependymoma in MRI and confirmed by histopathological evaluation. Out of 4 histologicaly proved cases, all cases were in ventricle. However, 2 cases were hypointense and 2 cases were isointense in TIWI and 3 cases were hyperintense in T2WI .3 cases are solid and 1 case was mixed. All cases had irregular margin and mass effect. All cases also had peri-lesional oedema. Marked enhancement was present in 3 cases. The sensitivity of MRI for the detection of ependymoma was 75.0% (95% CI 19.41% to 99.37%). However, the specificity of MRI was very high which was 96.5% (95% CI 82.24% to 99.91%). The positive predictive values and negative predictive value of MRI were 75.0% (95% CI 28.73% to 95.71%) and 96.5% (95% CI 83.66% to 99.35%) respectively. The accuracy was 93.9% (95% CI 79.77% to 99.26%).&#x0D; Conclusion: In conclusion accuracy of MRI for the detection of ependymoma is very high.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 147-151

Diagnostic value of SPECT/CT bone imaging in fresh osteoporotic vertebral compression fractures.

To investigate the diagnostic value of single photon emission computed tomography/computed tomography (SPECT/CT) bone imaging in fresh osteoporotic vertebral compression fractures. The imaging data of 30 patients with osteoporosis (10 males and 20 females; aged 50~93 years) who received SPECT/CT bone imaging and spinal magnetic resonance imaging (MRI) in our hospital from June 2018 to June 2021 were analyzed retrospectively. Single photon emission tomography/CT bone imaging and spinal MRI were analyzed by two experienced specialists. Kappa consistency test and pairing were used for the diagnostic results of the two groups χ2 test (McNemar test) for statistical analysis. Fifty one vertebral fractures were detected in 30 patients, including 41 fresh vertebral fractures and 10 old vertebral fractures by SPECT/CT bone imaging; MRI revealed 40 fresh vertebral fractures and 11 old vertebral fractures. Single photon emission tomography/CT bone imaging and spinal MRI had good consistency in the diagnosis of fresh osteoporotic vertebral compression fractures (Kappa=0.820, P<0.001), and there was no significant difference between the two imaging methods in the diagnosis of osteoporotic vertebral fractures (P=1.000). The value of SPECT/CT in the localization and characterization of osteoporotic fresh vertebral compression fractures is similar to that of MRI. At the same time, SPECT/CT can also find some bone lesions that cannot be displayed by conventional MRI. Especially when patients have MRI contraindications, SPECT/CT bone imaging can be used as the preferred imaging method.

Multiparametric ultrasound of prostate: role in prostate cancer diagnosis.

Recent advances in ultrasonography (US) technology established modalities, such as Doppler-US, HistoScanning, contrast-enhanced ultrasonography (CEUS), elastography, and micro-ultrasound. The early results of these US modalities have been promising, although there are limitations including the need for specialized equipment, inconsistent results, lack of standardizations, and external validation. In this review, we identified studies evaluating multiparametric ultrasonography (mpUS), the combination of multiple US modalities, for prostate cancer (PCa) diagnosis. In the past 5 years, a growing number of studies have shown that use of mpUS resulted in high PCa and clinically significant prostate cancer (CSPCa) detection performance using radical prostatectomy histology as the reference standard. Recent studies have demonstrated the role mpUS in improving detection of CSPCa and guidance for prostate biopsy and therapy. Furthermore, some aspects including lower costs, real-time imaging, applicability for some patients who have contraindication for magnetic resonance imaging (MRI) and availability in the office setting are clear advantages of mpUS. Interobserver agreement of mpUS was overall low; however, this limitation can be improved using standardized and objective evaluation systems such as the machine learning model. Whether mpUS outperforms MRI is unclear. Multicenter randomized controlled trials directly comparing mpUS and multiparametric MRI are warranted.

A systematic review of the use of magnetic resonance imaging in non-conditional pacemakers and implantable defibrillators

Abstract Background Cardiac implantable electronic devices (CIEDs) were long considered a contraindication for magnetic resonance imaging (MRI). Modern devices are now MRI conditional, but still the majority of CIEDs in the population are legacy devices and are classified as unsafe for MRI. There is growing consensus that MRI is also safe in these patients. Purpose The purpose of this study was to perform an up to date systematic review of the evidence evaluating the use of MRI in patients with non-conditional CIEDs. Methods Searches of the PubMed, CINAHL and Embase databases were performed. Studies that assessed the rate of adverse outcomes after MRI in patients with non-conditional CIEDs were included. Studies were excluded if they did not disclose the conditionality of patients CIEDs. Case reports or case series were not included. Results 36 cohort studies were identified. No patient in these studies died during or immediately after MRI. Symptom associated with either torque or heating occurred in &amp;lt;1% of patients. Electrical resets occurred 1–2% of patients. There were no cases of non-conditional lead or generator failure. Inappropriate pacing occurred in &amp;lt;1% of patients. No ICD shocks occurred during MRI. Changes in CIED parameters occurred in 1–4% of patients. Conclusions This systematic review highlights the relative safety of the use of MRI in patients with non-conditional CIEDs. Demonstrated be the fact that no deaths or device shocks have been suffered as a consequence of MRI in any of these studies, and the extremely low incidence of device or lead related complications. Still strict selection and monitoring protocol should be used when imaging these patients. Funding Acknowledgement Type of funding sources: None.

English

BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging method of demonstration of hepatic, cholangio- and pancreatic-systems and their duct system and depends on heavy T2-weighted (T2-W) images. The present study was undertaken to study and evaluate patients with clinical suspicion of the biliary tract, gall bladder and pancreatic pathology, with conventional magnetic resonance imaging (MRI) and MRCP and to assess the pitfalls in MRCP for the evaluation of the biliary tract, gall bladder, and pancreas. METHODS The study included sixty patients with clinical signs and symptoms of obstructive jaundice referred for MRCP to the Department of Radiodiagnosis at Katuri Medical College and Hospital and patients who were referred to the department with clinical suspicion of pancreas, gallbladder and biliary tract disease. Pregnant patients, claustrophobic patients and patients with MRI contraindications such as cardiac pacemakers, aneurysm clips and metallic implants were excluded from the study. RESULTS Most of the patients in our study were of 30 - 70 years age group. Of the sixty cases included in our study, 58 % were males and 42 % were females. In most of the patients, in our study, benign pathology was observed which included cholelithiasis and choledocholithiasis and acute pancreatitis being next common. Case of choledochal cyst were also encountered. Most of common bile duct strictures were of benign aetiology. Of the malignant pathology detected, cholangiocarcinoma followed by periampullary carcinoma and gallbladder carcinoma were commonly encountered. CONCLUSIONS Magnetic resonance pancreatic cholangiography is an imaging modality for evaluation of pancreaticobiliary disorders. MRCP detected the exact location and cause of biliary tract obstruction and aetiology was well demonstrated. Pure cholesterol stones are difficult to detect on CT because they are iso attenuating or slightly hypoattenuating to bile. Sub centimetric calculi are well demonstrated by MRCP. Malignant strictures and benign strictures are well demonstrated. MRCP being non-invasive and radiation hazard free with inherent high resolution with multiplanar imaging capability could be considered as gold standard in imaging of few gall bladder and biliary system disorders. KEYWORDS Magnetic Resonance Cholangiopancreatography, Cholelithiasis, Pancreatitis, Periampullary Carcinoma, Gall Bladder Carcinoma, Cholangiocarcinoma

Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices With Abandoned Leads

Magnetic resonance imaging (MRI) is the modality of choice for many conditions. Conditional devices and novel protocols for imaging patients with legacy cardiac implantable electronic devices (CIEDs) have increased access to MRI in patients with devices. However, the presence of abandoned leads remains an absolute contraindication. To assess if the performance of an MRI in the presence of an abandoned CIED lead is safe and whether there are deleterious effects on concomitant active CIED leads. This cohort study included consecutive CIED recipients undergoing 1.5-T MRI with at least 1 abandoned lead between January 2013 and June 2020. MRI scans were performed at the Hospital of the University of Pennsylvania. No patients were excluded. CIEDs were reprogrammed based on patient-specific pacing needs. Electrocardiography telemetry and pulse oximetry were monitored continuously, and live contact with the patient throughout the scan via visual and voice contact was performed if possible. After completion of the MRI, CIED evaluation was repeated and programming returned to baseline or to a clinically appropriate setting. Variation in pre- and post-MRI capture threshold of 50% or more, ventricular sensing 40% or more, and lead impedance 30% or more, as well as clinical sequelae such as pain and sustained tachyarrhythmia were considered significant. Long-term follow-up lead-related data were analyzed if available. A total of 139 consecutive patients (110 men [79%]) with a mean (SD) age of 65.6 (13.4) years underwent 200 MRIs of various anatomic regions including the thorax. Repeat examinations were common with a maximum of 16 examinations for 1 patient. There was a total of 243 abandoned leads with a mean (SD) of 1.22 (0.45) per patient. The mean (SD) number of active leads was 2.04 (0.78) and 64 patients (46%) were pacemaker dependent. A transmit-receive radiofrequency coil was used in 41 patients (20.5%), all undergoing MRI of the brain. There were no abnormal vital signs or sustained tachyarrhythmias. No changes in battery voltage, power-on reset events, or changes of pacing rate were noted. CIED parameter changes including decreased right atrial sensing in 4 patients and decreased left ventricular R-wave amplitude in 1 patient were transiently noted. One patient with an abandoned subcutaneous array experienced sternal heating that subsided on premature cessation of the study. The risk of MRI in patients with abandoned CIED leads was low in this large observational study, including patients who underwent examination of the thorax. The growing aggregate of data questions the absolute contraindication for MRI in patients with abandoned CIED leads.

Spondylodiscitis and epidural abscesses

Klinisches/methodisches ProblemDie Spondylodiszitis ist eine Entzündung der intervertebralen Bandscheibe, die beim Erwachsenen aufgrund der Vaskularisation in der Regel mit einer Spondylitis der angrenzenden Wirbelkörper einhergeht und klinisch häufig nur unspezifische Symptome wie Rücken- oder Nackenschmerzen zeigt. Sie kann erregerassoziiert von verschiedenen Pathogenen, v. a. Bakterien, verursacht werden. Dabei können ein oder mehrere Bewegungssegmente betroffen sein. Die Infektion kann epidurale Abszedierungen verursachen und sich auch auf umliegende Kompartimente ausbreiten. Die Radiologie, und hier insbesondere die Magnetresonanztomographie (MRT), spielt eine wichtige Rolle bei der Primärdiagnostik und im Rahmen von Verlaufsbeurteilungen zur Überprüfung des Therapieansprechens. Die Therapie beruht auf konservativen (Antibiotika) und invasiven Ansätzen, einschließlich einer Operation. Die interventionelle Punktion und Drainage ist v. a. in frühen Stadien der Abszessbildung eine vielversprechende Alternative.Radiologische StandardverfahrenMagnetresonanztomographie (MRT), Computertomographie (CT), nuklearmedizinische Verfahren, konventionelles Röntgen.LeistungsfähigkeitDie MRT hat den höchsten Stellenwert. CT und nuklearmedizinische Verfahren können ergänzend und im Fall bestehender Kontraindikationen zur MRT eingesetzt werden.SchlussfolgerungBei adäquater Diagnostik und Therapie hat die Spondylodiszitis eine gute Prognose. Neben der gezielten bzw. kalkulierten medikamentösen Therapie steht beim epiduralen Abszess die invasive Therapie im Vordergrund. Die interventionell-radiologische Punktion und Drainage (auch zur Keimidentifikation für die gezielte Antibiotikatherapie) können frühzeitig eine schonende Alternative zur chirurgischen Sanierung darstellen.

MRI monitoring of macaque monkeys in neuroscience: Case studies, resource and normative data comparisons

Information from Magnetic Resonance Imaging (MRI) is useful for diagnosis and treatment management of human neurological patients. MRI monitoring might also prove useful for non-human animals involved in neuroscience research provided that MRI is available and feasible and that there are no MRI contra-indications precluding scanning. However, MRI monitoring is not established in macaques and a resource is urgently needed that could grow with scientific community contributions. Here we show the utility and potential benefits of MRI-based monitoring in a few diverse cases with macaque monkeys. We also establish a PRIMatE MRI Monitoring (PRIME-MRM) resource within the PRIMatE Data Exchange (PRIME-DE) and quantitatively compare the cases to normative information drawn from MRI data from typical macaques in PRIME-DE. In the cases, the monkeys presented with no or mild/moderate clinical signs, were well otherwise and MRI scanning did not present a significant increase in welfare impact. Therefore, they were identified as suitable candidates for clinical investigation, MRI-based monitoring and treatment. For each case, we show MRI quantification of internal controls in relation to treatment steps and comparisons with normative data in typical monkeys drawn from PRIME-DE. We found that MRI assists in precise and early diagnosis of cerebral events and can be useful for visualising, treating and quantifying treatment response. The scientific community could now grow the PRIME-MRM resource with other cases and larger samples to further assess and increase the evidence base on the benefits of MRI monitoring of primates, complementing the animals’ clinical monitoring and treatment regime.

The effectiveness of contrast-enhanced spectral mammography and magnetic resonance imaging in dense breasts.

PurposeBreast cancer is the most common cause of death from neoplastic disease in women. Among all breast anatomy types, glandular type is the most problematic concerning evaluation. While digital mammography still remains the basic diagnostic tool, one must be aware of its limitations in dense breasts. Although magnetic resonance imaging (MRI) has greatly improved sensitivity, its specificity is low. Moreover, there are contraindications for MRI for some patients, so a substitute has been searched for. This study was performed to check if contrast-enhanced spectral mammography (CESM) can be a viable option for patients with dense breasts.Material and methodsThe study involved 121 patients with abnormalities detected on base-line diagnostic imaging (ultrasound or mammography). The patients had subsequent examinations, both CESM and MRI performed within a maximum 2-month time interval. The sensitivity and specificity of both methods in the whole group as well as in specific breast structure types were measured and compared.ResultsContrast enhancement was visible in all 121 cases on MRI, while on CESM lack of enhancement was noted in 13 cases. All of those 13 lesions turned out to be benign. There were 40 (33%) benign and 81 (69%) malignant tumours. The analysed group included 53 (44%) glandular type breast patients, 39 (32%) mixed type, and 29 (23%) fatty type. Although MRI proved to be slightly more effective in dense breasts, both methods showed similar results in the whole study group.ConclusionCESM can be used with confidence in patients with glandular breast type when MRI is not available or there are reported contraindications to MRI.