Conventional Magnetic Resonance Research Articles

Optimizing Clinical Cardiac MRI Workflow through Single Breath-Hold Compressed Sensing Cine: An Evaluation of Feasibility and Efficiency

Background: Although compressed sensing (CS) accelerated cine holds immense potential to replace conventional cardiovascular magnetic resonance (CMR) cine, how to use CS-based cine appropriately during clinical CMR examinations still needs exploring. Methods: A total of 104 patients (46.5 ± 17.1 years) participated in this prospective study. For each participant, a balanced steady state free precession (bSSFP) cine was acquired as a reference, followed by two CS accelerated cine sequences with identical parameters before and after contrast injection. Lastly, a CS accelerated cine sequence with an increased flip angle was obtained. We subsequently compared scanning time, image quality, and biventricular function parameters between these sequences. Results: All CS cine sequences demonstrated significantly shorter acquisition times compared to bSSFPref cine (p < 0.001). The bSSFPref cine showed higher left ventricular ejection fraction (LVEF) than all CS cine sequences (all p < 0.001), but no significant differences in LVEF were observed among the three CS cine sequences. Additionally, CS cine sequences displayed superior global image quality (p < 0.05) and fewer artifacts than bSSFPref cine (p < 0.005). Unenhanced CS cine and enhanced CS cine with increased flip angle showed higher global image quality than other cine sequences (p < 0.005). Conclusion: Single breath-hold CS cine delivers precise biventricular function parameters and offers a range of benefits including shorter scan time, better global image quality, and diminished motion artifacts. This innovative approach holds great promise in replacing conventional bSSFP cine and optimizing the CMR examination workflow.

The Relationship between Types of Os Trigonum and Findings of Conventional Ankle Magnetic Resonance Imaging: A Study Based on Three-Dimensional Magnetic Resonance Imaging

The Relationship between Types of Os Trigonum and Findings of Conventional Ankle Magnetic Resonance Imaging: A Study Based on Three-Dimensional Magnetic Resonance Imaging

Characterization of bone marrow lesions in axial spondyloarthritis using quantitative T1 mapping MRI.

Conventional magnetic resonance imaging (MRI) uses T1-weighted and short-tau inversion recovery (STIR) sequences to characterize bone marrow in axial spondyloarthritis. However, quantification is restricted to estimating the extent of lesions because signal intensities are highly variable both within individuals and across patients and MRI scanners. This study evaluates the performance of quantitative T1 mapping for distinguishing different types of bone marrow lesions of the sacroiliac joints. In this prospective study, 62 patients underwent computed tomography (CT) and MRI of the sacroiliac joints including T1, STIR, and T1 mapping. Bone marrow lesions were characterized by three readers and assigned to one of four groups: sclerosis, osteitis, fat lesions, and mixed marrow lesions. Relaxation times on T1 maps were compared using generalized estimating equations and receiver operating characteristics (ROC) analysis. A total of 119 lesions were selected (sclerosis: 38, osteitis: 27, fat lesions: 40; mixed lesions: 14). T1 maps showed highly significant differences between the lesions with the lowest values for sclerosis (1516±220 ms), followed by osteitis (1909±75 ms), and fat lesions (2391±200 ms); p<0.001. T1 mapping differentiated lesions with areas under the ROC curve of 99% (sclerosis vs. osteitis) and 100% (other comparisons). T1 mapping allows accurate characterization of sclerosis, osteitis, and fat lesions at the sacroiliac joint but only for homogeneous, non-mixed lesions. Thus, further sequence development is needed before implementation in clinical routine.

Field-of-view optimized and constrained undistorted single shot intravoxel incoherent motion diffusion-weighted imaging of the cervix during the menstrual cycle: A prospective study

ObjectiveTo provide insight into the biological characteristics of the healthy cervix by defining intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) parameters across the menstrual cycle. MethodsForty-three females of reproductive age (18–45 years old) were included in this prospective study. Conventional magnetic resonance imaging (MRI) and IVIM-DWI scans were performed at multiple time-points across the menstrual cycle: T1 (menses), T2 (follicular phase), T3 (luteal phase). Intra- and interobserver repeatability of the IVIM-DWI values were evaluated with intraclass correlation coefficients (ICC), and D* was excluded from the analyses due to poor repeatability. Differences in each IVIM-DWI parameter among T1, T2, and T3 were explored. Subjects were stratified by age and parity for subgroup analyses (younger [18 - < 30 years] vs. older [≥30–45 years]; parity 0 vs. parity 1 and 2). Correlations between subject age and IVIM-DWI parameters were assessed. The overlap for each IVIM-DWI parameter among T1, T2, and T3 was evaluated. ResultsADC and D values of the cervix were significantly lower at T3 compared with T1 (p = 0.02 and 0.03) or T2 (p < 0.01 and < 0.01). In younger subjects (n = 26), ADC and D values were significantly lower at T3 compared with T1 (p < 0.01 and p = 0.02) or T2 (p = 0.03 and p = 0.04). In older subjects (n = 17), ADC values were significantly higher at T2 compared with T1 (p = 0.01) or T3 (p = 0.01). There were significant differences in ADC values at T1 in subgroup analyses stratified by age and parity (both p < 0.01). There was a moderate correlation between age and ADC values at T1. Overlap for IVIM-DWI parameters across the menstrual cycle was >50%. ConclusionADC and D values of the heathy cervix differed across the menstrual cycle. Age and parity may influence the ADC value.

Cortical atrophy in early-stage patients with anti-NMDA receptor encephalitis: a machine-learning MRI study with various feature extraction.

Conventional brain magnetic resonance imaging (MRI) of anti-N-methyl-D-aspartate-receptor encephalitis (NMDARE) is non-specific, thus showing little differential diagnostic value, especially for MRI-negative patients. To characterize patterns of structural alterations and facilitate the diagnosis of MRI-negative NMDARE patients, we build two support vector machine models (NMDARE versus healthy controls [HC] model and NMDARE versus viral encephalitis [VE] model) based on radiomics features extracted from brain MRI. A total of 109 MRI-negative NMDARE patients in the acute phase, 108 HCs and 84 acute MRI-negative VE cases were included for training. Another 29 NMDARE patients, 28 HCs and 26 VE cases were included for validation. Eighty features discriminated NMDARE patients from HCs, with area under the receiver operating characteristic curve (AUC) of 0.963 in validation set. NMDARE patients presented with significantly lower thickness, area, and volume and higher mean curvature than HCs. Potential atrophy predominately presented in the frontal lobe (cumulative weight = 4.3725, contribution rate of 29.86%), and temporal lobe (cumulative weight = 2.573, contribution rate of 17.57%). The NMDARE versus VE model achieved certain diagnostic power, with AUC of 0.879 in validation set. Our research shows potential atrophy across the entire cerebral cortex in acute NMDARE patients, and MRI machine learning model has a potential to facilitate the diagnosis MRI-negative NMDARE.

Differences in Brain Atrophy Pattern between People with Multiple Sclerosis and Systemic Diseases with Central Nervous System Involvement Based on Two-Dimensional Linear Measures.

Conventional brain magnetic resonance imaging (MRI) in systemic diseases with central nervous system involvement (SDCNS) may imitate MRI findings of multiple sclerosis (MS). In order to better describe the MRI characteristics of these conditions, in our study we assessed brain volume parameters in MS (n = 58) and SDCNS (n = 41) patients using two-dimensional linear measurements (2DLMs): bicaudate ratio (BCR), corpus callosum index (CCI) and width of third ventricle (W3V). In SDCNS patients, all 2DLMs were affected by age (CCI p = 0.005, BCR p < 0.001, W3V p < 0.001, respectively), whereas in MS patients only BCR and W3V were (p = 0.001 and p = 0.015, respectively). Contrary to SDCNS, in the MS cohort BCR and W3V were associated with T1 lesion volume (T1LV) (p = 0.020, p = 0.009, respectively) and T2 lesion volume (T2LV) (p = 0.015, p = 0.009, respectively). CCI was associated with T1LV in the MS cohort only (p = 0.015). Moreover, BCR was significantly higher in the SDCNS group (p = 0.01) and CCI was significantly lower in MS patients (p = 0.01). The best predictive model to distinguish MS and SDCNS encompassed gender, BCR and T2LV as the explanatory variables (sensitivity 0.91; specificity 0.68; AUC 0.86). Implementation of 2DLMs in the brain MRI analysis of MS and SDCNS patients allowed for the identification of diverse patterns of local brain atrophy in these clinical conditions.

Cortical matrix remodeling as a hallmark of relapsing–remitting neuroinflammation in MR elastography and quantitative MRI

Multiple sclerosis (MS) is a chronic neuroinflammatory disease that involves both white and gray matter. Although gray matter damage is a major contributor to disability in MS patients, conventional clinical magnetic resonance imaging (MRI) fails to accurately detect gray matter pathology and establish a clear correlation with clinical symptoms. Using magnetic resonance elastography (MRE), we previously reported global brain softening in MS and experimental autoimmune encephalomyelitis (EAE). However, it needs to be established if changes of the spatiotemporal patterns of brain tissue mechanics constitute a marker of neuroinflammation. Here, we use advanced multifrequency MRE with tomoelastography postprocessing to investigate longitudinal and regional inflammation-induced tissue changes in EAE and in a small group of MS patients. Surprisingly, we found reversible softening in synchrony with the EAE disease course predominantly in the cortex of the mouse brain. This cortical softening was associated neither with a shift of tissue water compartments as quantified by T2-mapping and diffusion-weighted MRI, nor with leukocyte infiltration as seen by histopathology. Instead, cortical softening correlated with transient structural remodeling of perineuronal nets (PNNs), which involved abnormal chondroitin sulfate expression and microgliosis. These mechanisms also appear to be critical in humans with MS, where tomoelastography for the first time demonstrated marked cortical softening. Taken together, our study shows that neuroinflammation (i) critically affects the integrity of PNNs in cortical brain tissue, in a reversible process that correlates with disease disability in EAE, (ii) reduces the mechanical integrity of brain tissue rather than leading to water accumulation, and (iii) shows similar spatial patterns in humans and mice. These results raise the prospect of leveraging MRE and quantitative MRI for MS staging and monitoring treatment in affected patients.

Expression of concern: Comparing the predictive value of quantitative magnetic resonance imaging parametric response mapping and conventional perfusion magnetic resonance imaging for clinical outcomes in patients with chronic ischemic stroke.

Expression of concern: Comparing the predictive value of quantitative magnetic resonance imaging parametric response mapping and conventional perfusion magnetic resonance imaging for clinical outcomes in patients with chronic ischemic stroke.

The Value of Amide Proton Transfer MRI in the Diagnosis of Malignant and Benign Urinary Bladder Lesions: Comparison With Diffusion-Weighted Imaging.

Conventional magnetic resonance imaging (MRI) has certain limitations in distinguishing between malignant and benign urinary bladder (UB) lesions. Amide proton transfer (APT) imaging may provide more diagnostic information than diffusion-weighted imaging (DWI) to distinguish between malignant and benign UB. To investigate the potential of APT imaging in the diagnosis of malignant and benign UB lesions and to compare its diagnostic efficacy with that of conventional DWI. Prospective. Eighty patients with UB lesions. A 3.0 T/turbo spin echo (TSE) T1-weighted and T2-weighted imaging, single-shot echo planar DWI, and three-dimensional TSE APT imaging. Patients underwent radical cystectomy or transurethral resection of the bladder lesions within 2 weeks after CT urography and MRI examination. APT signal intensity in UB lesions was quantified by the asymmetric magnetization transfer ratio (MTRasym). MTRasym and apparent diffusion coefficient (ADC) values were measured and compared between malignant and benign UB lesions. Kolmogorov-Smirnov test, Student's t test or Mann-Whitney U test, Spearman rank correlation coefficient, area under the receiver operating characteristic (ROC) curve (AUC), Delong test, and intraclass correlation coefficient (ICC). The significance threshold was set at P < 0.05. Thirty-two patients had pathologically confirmed benign UB lesions, including 2 bladder leiomyomas, 1 submucosal amyloidosis, 1 inflammatory myofibroblastic tumor, and 28 inflammatory lesions, and 48 patients had pathologically confirmed urothelial carcinoma. Urothelial carcinomas showed significantly higher MTRasym values (1.53% [0.74%] vs. 0.85% [0.23%]) and significantly lower ADC values (1.24 ± 0.34 × 10-3 mm2/s vs. 1.43 ± 0.22 × 10-3 mm2/s) than benign UB lesions. The MTRasym value (AUC = 0.928) was significantly better in differentiating urothelial carcinoma from benign UB lesions than the ADC value (AUC = 0.722). APT imaging may have value in discriminating malignant from benign UB lesions and has better diagnostic performance than DWI. 3 TECHNICAL EFFICACY: Stage 2.

Clinical value of magnetic resonance spectroscopy in assessment of early curing impact of concurrent chemoradiotherapy after high-grade glioma surgery

Background/Aim. High-grade glioma (HGG) is an interstitial cell-derived primary tumor of the nervous system. The current guidelines for the diagnosis and treatment of glioma recommend the maximum safe range of tumor resection for treatment methods. Adjuvant concurrent chemoradiotherapy is recommended after surgery, followed by six cycles of single-drug chemotherapy, temozolomide. Evaluation of the early efficacy of concurrent chemoradiotherapy after HGG surgery, especially for patients with a high risk of recurrence, is a crucial step in enhancing the treatment efficiency for patients diagnosed with HGG. In this study, we investigated the clinical utility of magnetic resonance (MR) spectroscopy (MRS) in assessing the early curing impact of concurrent chemoradiotherapy following HGG surgery. Methods. A total of 50 patients with incomplete resection or suspected residual postoperative HGG, treated in the radiotherapy department of our hospital between January 2016 and June 2021, were selected for routine concurrent chemoradiotherapy. Conventional MR imaging and MRS were performed one week prior to treatment and one month after treatment to assess changes in specific brain metabolites. All 50 patients were followed up for 6 to 12 months. Based on the follow-up results, the patients were divided into two groups: the tumor recurrence group and the tumor suppression group. One month after the end of the treatment, the differences in levels of brain metabolites between the two groups were analyzed using MRS. Results. The levels of N-acetylaspartate (NAA) and creatine (Cr) increased after radiotherapy, while choline (Cho) peak value, and Cho/Cr, NAA/Cr, and Cho/NAA ratios decreased compared to pre-treatment levels. There were statistically significant differences in the NAA peak value, and Cho/Cr, and Cho/NAA ratios in the tumor enhancement area before and after treatment (p &lt; 0.05). There were also statistically significant differences in Cho/Cr ratio in the peritumoral edema area before and after treatment (p &lt; 0.05). Conclusion. After concurrent chemoradiotherapy, MRS can be used to detect early metabolic changes in the tumor enhancement and peritumoral edema areas of HGG.

EVALUATION OF THE OPTIC NERVE IN MIGRAINE PATIENTS BY MAGNETIC RESONANCE IMAGING HISTOGRAM ANALYSIS

Background: Migraine is a chronic, paroxysmal neurovascular primary headache disease seen in approximately 15% of the world. In many studies on migraine, changes in the gray and white matter at the microvascular level have been detected. 90% of patients with aura have visual auras. Histogram analysis is an artificial intelligence application that can detect microscopic pathology in tissues before visual pathology. Objective: Histogram analysis was utilized in our investigation to ascertain whether or not the optic nerve, which is ordinarily visible on magnetic resonance images, was impacted. Methods: 120 adult migraine patients and 120 control group were involved. MRI was performed on a Philips 1.5 Tesla Ingenia device. For histogram analysis, optic nerve region of interest (ROI) measurement was performed in the coronal planes from the edges of the intraorbital segment, whose borders can be clearly distinguished, by using the manual drawing tool for both eyes. The data were analyzed through the MatLab program. Results: The average age of individuals diagnosed with migraine was 37.04 ± 9.57 years, whereas the control group had an average age of 37.8 ± 10.8 years. Between the two groups, 27 distinct parameters computed via histogram analysis were compared. In the control and migraine groups, no statistically significant distinction was observed between the right and left eyes. In contrast to the migraine and control groups, the Mean Local Standard Deviation of the Matrix was found to be The histogram's 5th, 10th, 25th, and 75th percentiles, the average squared, the root sum of squared, the size percent M, the most frequently used value, the median, and the average are all quantified using the root sum of squares. The number of pixels is also indicated. It was determined that ROI values were statistically significant (p0.05). Conclusion: In migraine patients, alterations in the optic nerve, which are typically discernible on conventional magnetic resonance images, may be identified via histogram analysis.

Can Qualitative Cervical Tractography Predict Clinical Findings as Effectively as It Aids Surgical Planning Today?

To investigate cervical spinal tractography (CST) and diffusion tensor imaging findings in patients with intramedullary cervical spinal cord (CSC) tumors and to evaluate the association between qualitative diffusion tensor tractography (DTT) findings and neurological examination findings (NEF). Neuroradiology case records were retrospectively evaluated to identify patients with intramedullary CSC tumors who underwent cervical spinal DTT. Conventional magnetic resonance imaging (MRI) and DTT were performed using a 3.0-T MRI system. Demographic data, CST and clinical findings, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were recorded. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were calculated. This study enrolled 31 patients (16 women and 15 men) with a mean age of 35.2 ± 15.6 years (range: 1-70 years). The mean FA and ADC were 0.34 ± 0.45 and 1.88 ± 0.89, respectively. Physical examination revealed hemihypesthesia (19.3%), hemiparesis (16.1%), and quadriparesis (3.2%). Completely normal neurological findings were observed in 61.3% of the patients. DTT revealed deviation (n=15), deformation (n=11), and interruption (n=5) of the fibers. No significant relationship was observed between NEF and DTT findings (p=0.127). The sensitivity, specificity, PPV, and NPV of DTT for CSC tracts were 100%, 0%, 38.7%, and 0%, respectively. Although qualitative DTT of the CSC might be useful for planning and preservation of the fiber tracts during intramedullary tumor surgery, it did not exhibit significant association with clinical findings in this study. Qualitative DTT of CSC in patients with intramedullary tumors may not correlate well with NEF.

The Value of 3D SPACE MRI in Differentiating between Sequestrated Lumbar Disc Herniation and Tumors: Two Cases and Literature.

Intervertebral disc herniation, defined as the protrusion or extrusion of the disc mass outside the disc space, is common and easy to diagnose on conventional Magnetic Resonance imaging (MRI) or Computed Tomography (CT) scans. However, the sequestrated disc fragments are challenging to detect, and intervertebral disc mass displacement into the dural sac, which can lead to serious neurological problems such as Cauda equina syndrome (CES). The sequestrated disc fragments do not have specific clinical or radiological characteristics that can differentiate an atypical disc mass from a tumor, making the diagnosis difficult preoperatively. Herein, we describe the use of Sampling Perfection with Application Optimized Contrast using different flip angle Evolution in Magnetic Resonance Imaging (3D SPACE MRI) in the diagnosis of the intervertebral disc fragment that mimicked a tumor. In this study, we report two cases of sequestered lumbar disc herniation. The first case was a 37-year-old patient with a 2-year history of intermittent left lower limb pain that aggravates with exercise and is relieved at rest, while the second case was a 42-year-old patient with a history of 40 days of numbness and pain in the left lower limb. 3D SPACE MRI is a beneficial diagnostic imaging tool for discriminating between disc mass that mimics a tumor and a tumor before surgery. If the disc fragment mimicking a tumor can be identified before the operation, open surgical treatment won't be necessary for all patients.

Assessing brain microstructural changes in chronic kidney disease: a diffusion imaging study using multiple models.

To explore the effectiveness of diffusion quantitative parameters derived from advanced diffusion models in detecting brain microstructural changes in patients with chronic kidney disease (CKD). The study comprised 44 CKD patients (eGFR<59 mL/min/1.73 m2) and 35 age-and sex-matched healthy controls. All patients underwent diffusion spectrum imaging (DSI) and conventional magnetic resonance imaging. Reconstructed to obtain diffusion MRI models, including diffusion tensor imaging (DTI), neurite orientation dispersion and density imaging (NODDI) and Mean Apparent Propagator (MAP)-MRI, were processed to obtain multi-parameter maps. The Tract-Based Spatial Statistics (TBSS) analysis was utilized for detecting microstructural differences and Pearson correlation analysis assessed the relationship between renal metabolism markers and diffusion parameters in the brain regions of CKD patients. Receiver operating characteristic (ROC) curve analysis assessed the diagnostic performance of diffusion models, with AUC comparisons made using DeLong's method. Significant differences were noted in DTI, NODDI, and MAP-MRI parameters between CKD patients and controls (p < 0.05). DTI indicated a decrease in Fractional Anisotropy(FA) and an increase in Mean and Radial Diffusivity (MD and RD) in CKD patients. NODDI indicated decreased Intracellular and increased Extracellular Volume Fractions (ICVF and ECVF). MAP-MRI identified extensive microstructural changes, with elevated Mean Squared Displacement (MSD) and Q-space Inverse Variance (QIV) values, and reduced Non-Gaussianity (NG), Axial Non-Gaussianity (NGAx), Radial Non-Gaussianity (NGRad), Return-to-Origin Probability (RTOP), Return-to-Axis Probability (RTAP), and Return-to-Plane Probability (RTPP). There was a moderate correlation between serum uric acid (SUA) and diffusion parameters in six brain regions (p < 0.05). ROC analysis showed the AUC values of DTI_FA ranged from 0.70 to 0.793. MAP_NGAx in the Retrolenticular part of the internal capsule R reported a high AUC value of 0.843 (p < 0.05), which was not significantly different from other diffusion parameters (p > 0.05). The advanced diffusion models (DTI, NODDI, and MAP-MRI) are promising for detecting brain microstructural changes in CKD patients, offering significant insights into CKD-affected brain areas.

COMPARISON OF SELECTED CLASSIFICATION METHODS BASED ON MACHINE LEARNING AS A DIAGNOSTIC TOOL FOR KNEE JOINT CARTILAGE DAMAGE BASED ON GENERATED VIBROACOUSTIC PROCESSES

Osteoarthritis is one of the most common cause of disability among elderly. It can affect every joint in human body, however, it is most prevalent in hip, knee, and hand joints. Early diagnosis of cartilage lesions is essential for fast and accurate treatment, which can prolong joint function. Available diagnostic methods include conventional X-ray, ultrasound and magnetic resonance imaging. However, those diagnostic modalities are not suitable for screening purposes. Vibroarthrography is proposed in literature as a screening method for cartilage lesions. However, exact method of signal acquisition as well as classification method is still not well established in literature. In this study, 84 patients were assessed, of whom 40 were in the control group and 44 in the study group. Cartilage status in the study group was evaluated during surgical treatment. Multilayer perceptron - MLP, radial basis function - RBF, support vector method - SVM and naive classifier – NBC were introduced in this study as classification protocols. Highest accuracy (0.893) was found when MLP was introduced, also RBF classification showed high sensitivity (0.822) and specificity (0.821). On the other hand, NBC showed lowest diagnostic accuracy reaching 0.702. In conclusion vibroarthrography presents a promising diagnostic modality for cartilage evaluation in clinical setting with the use of MLP and RBF classification methods.

Exploring the utility of EUS in Budd-Chiari syndrome: a multicenter multiobserver prospective cohort study

Background and aimsThe diagnosis of Budd-Chiari syndrome (BCS) is essentially radiological and is needed to plan appropriate therapy. We therefore conducted this proof of concept study to assess the utility of EUS in assessing anatomy of BCS. MethodsA prospective multi-centre observational study including 50 consecutive patients with a diagnosis of BCS were enrolled. All patients underwent a detailed EUS examination by three independent endosonographers, blinded to the anatomical details of BCS and others’ findings. This was compared to each other and to conventional angiography (where available) or Magnetic resonance venography (MRV). Outcomes assessed include inter observer agreement, sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy in diagnosing pathological lesions of BCS. ResultsFifty BCS patients (Mean age 34 years ; range 13-65 years) underwent EUS. Results showed good agreement among endosonographers for diagnosing right hepatic vein (RHV) (kappa=0.716) and left hepatic vein (LHV) lesions (kappa=0.722), moderate agreement for middle hepatic vein (MHV) lesions (kappa=0.660) and very good agreement for inferior vena cava (IVC) lesions (kappa=0.823). EUS demonstrated high sensitivity, positive predictive value, low inter-observer variability, and overall diagnostic accuracy for BCS lesions. ConclusionsIn conclusion, EUS is a safe and accurate diagnostic tool for BCS. It can provide accurate mapping of hepatic veins, intrahepatic collaterals, and the IVC.

Clinical value of conventional magnetic resonance imaging combined with diffusion-weighted imaging in predicting pelvic lymph node metastasis of cervical cancer.

In cervical cancer (CC), the involvement of pelvis lymph nodes is a crucial factor for patients' outcome. We aimed to investigate the value of conventional magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) in predicting CC pelvic lymph node metastasis (PLNM). This retrospective study included CC patients who received surgical treatments. Surgical pathology results served as the gold standard for investigating the diagnostic performance of conventional MRI combined with DWI. We analyzed the association between tumor ADC and PLNM, as well as other pathological factors. The areas under the receiver operating characteristic curves (AUCs) for ADC in assessing PLNM and pathological factors were evaluated, and optimal cut-off points were obtained. A total of 261 CC patients were analyzed. PLNM patients had significantly lower tumor ADC (0.829 ± 0.144×10-3mm2/s vs. 1.064 ± 0.345×10-3mm2/s, p<0.0001), than non-PLNM CC. The agreement between conventional MRI combined with DWI and pathological results on PLNM diagnosis was substantial (Kappa=0.7031, p<0.0001), with 76% sensitivity, 94.31% specificity, and 90.8% accuracy. The AUC of tumor ADC was 0.703, and the optimal cut-off was 0.95×10-3 mm2/s. In multivariate analysis model 1, tumor ADC<0.95×10-3mm2/s was significantly associated with PLNM (OR, 2.83; 95%CI, 1.08-7.43; p= 0.0346) after adjusting for age and pathological risk factors. In multivariate analysis model 2, tumor ADC<0.95×10-3mm2/s (OR, 4.00; 95%CI, 1.61-9.89; p=0.0027), age<35 years old (OR, 2.93; 95%CI, 1.04-8.30; p=0.0428), increased tumor diameter on MRI (OR, 2.17; 95%CI, 1.18-3.99; p=0.0128), vaginal vault involvement on MRI (OR, 2; 95%CI, 1.002-3.99; p=0.0494) were independent predictors for PLNM. Tumor ADC<0.95×10-3mm2/s was significantly associated with higher risk of tumor diameter ≥4cm (OR, 2.60; 95%CI, 1.43-4.73; p=0.0017), muscular layer infiltration >1/2 (OR, 5.46; 95%CI, 3.19-9.34; p<0.0001), vaginal vault involvement (OR, 2.25; 95%CI, 1.28-3.96; p=0.0051), and lymphovascular space involvement (OR, 3.81; 95%CI, 2.19-6.63; p<0.0001). Conventional MRI combined with DWI had a good diagnostic performance in detecting PLNM. The tumor ADC value in PLNM patients was significantly lower than that in non-PLNM patients. Tumor ADC <0.95×10-3mm2/s, age <35 years old, increased tumor diameter on MRI, vaginal vault involvement on MRI were independent predictors for PLNM.

Neurodevelopmental Outcome and Neuroimaging of Very Low Birth Weight Infants from an Italian NICU Adopting the Family-Centered Care Model.

Improvements in perinatal care have substantially decreased mortality rates among preterm infants, yet their neurodevelopmental outcomes and quality of life persist as a pertinent public health concern. Family-centered care has emerged as a holistic philosophy that promotes effective alliances among patients, families, and healthcare providers to improve the quality of care. This longitudinal prospective study aims to evaluate the neurodevelopmental outcomes and brain MRI findings in a cohort of preterm newborns admitted to a neonatal intensive care unit (NICU) adopting a family-centered care model. Very low birth weight (VLBW) infants admitted to the NICU of Modena between 2015 and 2020 were enrolled. Infants who underwent conventional brain magnetic resonance imaging (MRI) at term-equivalent age were included. Neurodevelopmental follow-up was performed until the age of 24 months by a multidisciplinary team using the Amiel-Tison neurological assessment and the Griffiths Mental Developmental Scales (GMDS-R). Neurodevelopmental outcomes were classified as major sequelae (cerebral palsy, DQ ≤ 70, severe sensory impairment), minor sequelae (minor neurological signs such as clumsiness or DQ between 71 and 85), and normal outcomes (no neurological signs and DQ > 85). Risk factors for severe outcomes were assessed. In total, 49 of the 356 infants (13.8%) died before hospital discharge, and 2 were excluded because of congenital disorders. Of the remaining 305 infants, 222 (72.8%) completed the 24 month follow-up and were included in the study. Neurodevelopmental outcomes were classified as normal (n = 173, 77.9%), minor (n = 34, 15.3%), and major sequelae (n = 15, 6.8%). Among 221 infants undergoing brain MRI, 76 (34.4%) had major lesions (intraventricular hemorrhage, hemorrhagic parenchymal infarction, periventricular leukomalacia, and large cerebellar hemorrhage). In the multivariate regression model, the retinopathy of prematurity (OR 1.8; p value 0.016) and periventricular-intraventricular hemorrhage (OR 5.6; p value < 0.004) were associated with major sequelae. We reported low rates of severe neurodevelopmental outcomes in VLBW infants born in an Italian NICU with FCC. Identifying the risk factors for severe outcomes can assist in tailoring and optimizing early interventions on an individual basis, both within the NICU and after discharge.

Novel inductively coupled ear-bars (ICEs) to enhance restored fMRI signal from susceptibility compensation in rats.

Functional magnetic resonance imaging faces inherent challenges when applied to deep-brain areas in rodents, e.g. entorhinal cortex, due to the signal loss near the ear cavities induced by susceptibility artifacts and reduced sensitivity induced by the long distance from the surface array coil. Given the pivotal roles of deep brain regions in various diseases, optimized imaging techniques are needed. To mitigate susceptibility-induced signal losses, we introduced baby cream into the middle ear. To enhance the detection sensitivity of deep brain regions, we implemented inductively coupled ear-bars, resulting in approximately a 2-fold increase in sensitivity in entorhinal cortex. Notably, the inductively coupled ear-bar can be seamlessly integrated as an add-on device, without necessitating modifications to the scanner interface. To underscore the versatility of inductively coupled ear-bars, we conducted echo-planner imaging-based task functional magnetic resonance imaging in rats modeling Alzheimer's disease. As a proof of concept, we also demonstrated resting-state-functional magnetic resonance imaging connectivity maps originating from the left entorhinal cortex-a central hub for memory and navigation networks-to amygdala hippocampal area, Insular Cortex, Prelimbic Systems, Cingulate Cortex, Secondary Visual Cortex, and Motor Cortex. This work demonstrates an optimized procedure for acquiring large-scale networks emanating from a previously challenging seed region by conventional magnetic resonance imaging detectors, thereby facilitating improved observation of functional magnetic resonance imaging outcomes.

Can conventional magnetic resonance imaging at presentation predict chemoresistance in osteosarcoma?

Histological tumour necrosis is the current indicator for the response of osteosarcoma after neoadjuvant chemotherapy. Chemoresistant tumours require close monitoring and adjustment of treatment. Characteristics of tumours on baseline MRI may be able to predict response to chemotherapy. The aim is to identify which baseline MRI findings can help predict chemoresistant osteosarcoma. Baseline MRI before giving neoadjuvant chemotherapy of 95 patients during 2008-2021 was reviewed by 2 musculoskeletal radiologists. Histological necrosis from surgical specimens was the reference standard. MRIs were reviewed for tumour characteristics (tumour volume, maximum axial diameter, central necrosis, haemorrhage, fluid-fluid level), peritumoural bone and soft tissue oedema, and other parameters including intra-articular extension, epiphyseal involvement, neurovascular involvement, pathologic fracture, and skip metastasis. The cut-off thresholds were generated by receiver operating characteristic curves which then tested for diagnostic accuracy. Two-third of patients were chemoresistance (histological necrosis <90%). Tumour volume >150 mL, maximum axial diameter >7.0 cm, area of necrosis >50%, presence of intra-articular extension, and peritumoural soft tissue oedema >6.5 cm significantly predicted chemoresistance, particularly when found in combination. Tumour volume >150 mL and maximum axial diameter >7.0 cm could be used as an independent predictor (multivariable analysis, P-value = .025, .045). Findings on baseline MRI could help predicting chemoresistant osteosarcoma with tumour size being the strongest predictor. Osteosarcomas with large size, large cross-sectional diameter, large area of necrosis, presence of intra-articular extension, and extensive peritumoural soft tissue oedema were most likely to have a poor response to neoadjuvant chemotherapy.