Magnetic Resonance Imaging Criteria Research Articles

Are there reliable multiparametric MRI criteria for differential diagnosis between intracranial meningiomas and solitary intracranial dural metastases?

Intracranial meningiomas are the most common tumors of the central nervous system (CNS). Meningiomas account for up to 36% of all brain tumors. The incidence of metastatic brain lesions has not been determined. Up to 30% of adult patients with cancer of one localization or another suffer from a secondary tumor lesion of the brain. The vast majority of meningiomas have meningeal localization; >90% are solitary. The incidence of intracranial dural metastases (IDM) is 8-9% of cases, while in 10% of cases, the brain is the only localization, and in 50% of cases the metastases are solitary. Typically, the task of distinguishing between meningioma and dural metastasis does not involve difficulties. Periodically, there is a situation when the differential diagnosis between these tumors is ambiguous, since meningiomas and solitary IDM may have similar characteristics, in particular, a cavity-less solid structure, limited diffusion of water molecules, the presence of extensive peritumoral edema, and an identical contrast pattern. The present study included 100 patients with newly diagnosed tumors of the CNS, who subsequently underwent examination and neurosurgical treatment at the Federal Center for Neurosurgery with histological verification between May 2019 and October 2022. Depending on the histological conclusion, two study groups of patients were distinguished: The first group consisted of patients diagnosed with intracranial meningiomas (n=50) and the second group of patients were diagnosed with IDM (n=50). The study was performed using a magnetic resonance imaging (MRI) General Electric Discovery W750 3T before and after contrast enhancement. The diagnostic value of this study was estimated using Receiver Operating Characteristic curve and area under the curve analysis. Based on the results of the study, it was found that the use of multiparametric MRI (mpMRI) in the differential diagnosis of intracranial meningiomas and IDM was limited by the similarity of the values of the measured diffusion coefficient. The assumption, previously put forward in the literature, regarding the presence of a statistically significant difference in the apparent diffusion coefficient values, which make it possible to differentiate tumors, was not confirmed. When analyzing perfusion data, IDM showed higher cerebral blood flow (CBF) values compared with intracranial meningiomas (P≤0.001). A threshold value of the CBF index was revealed, which was 217.9 ml/100 g/min, above which it is possible to predict IDM with a sensitivity and specificity of 80.0 and 86.0%, respectively. Diffusion-weighted images are not reliable criteria for differentiating intracranial meningiomas from IDM and should not influence the diagnosis suggested by imaging. The technique for assessing the perfusion of a meningeal lesion makes it possible to predict metastases with a sensitivity and specificity close to 80-90% and deserves attention when making a diagnosis. In the future, in order to reduce the number of false negative and false positive results, mpMRI would require additional criteria to be included in the protocol. Since IDM differs from intracranial meningiomas in the severity of neoangiogenesis and, accordingly, in greater vascular permeability, the technique for assessing vascular permeability (wash-in parameter with dynamic contrast enhancement) may serve as a refining criterion for distinguishing between dural lesions.

Mutant Isocitrate Dehydrogenase 1 Expression Enhances Response of Gliomas to the Histone Deacetylase Inhibitor Belinostat.

Histone deacetylase inhibitors (HDACis) are drugs that target the epigenetic state of cells by modifying the compaction of chromatin through effects on histone acetylation. Gliomas often harbor a mutation of isocitrate dehydrogenase (IDH) 1 or 2 that leads to changes in their epigenetic state presenting a hypermethylator phenotype. We postulated that glioma cells with IDH mutation, due to the presence of epigenetic changes, will show increased sensitivity to HDACis. This hypothesis was tested by expressing mutant IDH1 with a point alteration-converting arginine 132 to histidine-within glioma cell lines that contain wild-type IDH1. Glioma cells engineered to express mutant IDH1 produced D-2-hydroxyglutarate as expected. When assessed for response to the pan-HDACi drug belinostat, mutant IDH1-expressing glioma cells were subjected to more potent inhibition of growth than the corresponding control cells. Increased sensitivity to belinostat correlated with the increased induction of apoptosis. Finally, a phase I trial assessing the addition of belinostat to standard-of-care therapy for newly diagnosed glioblastoma patients included one patient with a mutant IDH1 tumor. This mutant IDH1 tumor appeared to display greater sensitivity to the addition of belinostat than the other cases with wild-type IDH tumors based on both standard magnetic resonance imaging (MRI) and advanced spectroscopic MRI criteria. These data together suggest that IDH mutation status within gliomas may serve as a biomarker of response to HDACis.

MRI changes and clinical characteristics in temporomandibular joints with displacement of the articular disk without reduction – a cross-sectional observational study

ABSTRACT Objectives This study examined changes in magnetic resonance imaging (MRI) of temporomandibular joints (TMJ) with anterior displacement disk without reduction (DDwoR) and its correlation to clinical symptoms. Methods 190 individuals with DDwoR were evaluated according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and MRI. Pain’s chronicity/intensity and limited mouth opening (locking) were correlated with: TMJ degeneration (MRI T1), effusion (T2), disc’s shape and position (proton density). Results In 103 TMJ with DDwoR, hemiconvex shape (41.6%), sclerosis (45.6%) and mild effusion (47.6%) were the most prevalent findings. There was not association (p > .05) between: different DDwoR positions with pain’s intensity/chronicity; effusion with locking. Disk deformation was associated with degeneration (p = .034) and pain’s intensity (p = .006). Locking was associated with degeneration (p = .05). Conclusions Condylar osteodegeneration is often related to DDwoR. Locking by DDwoR is associated with severe levels of chronic pain and articular disk deformation.

Surgical and transcatheter pulmonary valve replacement in patients with repaired tetralogy of Fallot: cardiac magnetic resonance imaging characteristics and morphology of right ventricular outflow tract.

Pulmonary valve replacement is recommended in patients with repaired tetralogy of Fallot based on cardiac magnetic resonance imaging (MRI) criteria. This procedure is performed by surgical or transcatheter approaches. We aimed to investigate the differences in preprocedural MRI characteristics (volume, function, strain) and morphology of the right ventricular outflow tract and branch pulmonary arteries in patients for whom surgical or transcatheter pulmonary valve replacementwas planned. Cardiac MRI of 166 patients with tetralogy of Fallot were analyzed. Of these, 36 patients for whompulmonary valve replacement was plannedwere included. Magnetic resonance imaging characteristics, right ventricular outflow tract morphology, branch pulmonary artery flow distribution and diameter were compared between surgical and transcatheter groups. Spearman correlation and Kruskal-Wallis tests were performed. Circumferential and radial MRI strain for the right ventricle were lower in thesurgical group (P=0.045and P=0.046, respectively). The diameter of the left pulmonary artery was significantly lower (P=0.021) and branch pulmonary artery flow and diameter ratio were higher (P=0.044and P = 0.002, respectively) in the transcatheter group. There was a significant correlation between right ventricular outflow tract morphology and right ventricular end-diastolic volume indexand global circumferential and radial MRI strain (P=0.046, P=0.046and P= 0.049, respectively). Preprocedural MRI strain, right-to-left pulmonary artery flow, diameter ratio and morphological features of the right ventricular outflow tract were significantly different betweenthe two groups. A transcatheter approach may be recommended for patients with branch pulmonary artery stenosis, since both pulmonary valve replacement and branch pulmonary artery stenting can be performed in the same session.

Longitudinal changes in pelvic organ support among primiparas with postpartum pelvic organ prolapse: A follow-up magnetic resonance imaging study.

To quantify morphological changes of pelvic floor in primiparas with postpartum pelvic organ prolapse (POP) during the early postpartum period. A total of 309 primiparas underwent pelvic floor magnetic resonance imaging (MRI) at 6 weeks postpartum. Those primiparas diagnosed with postpartum POP by MRI criterion were followed up at 3 and 6months postpartum. Normal primiparas were enrolled in the control group. The puborectal hiatus line, muscular pelvic floor relaxation line, levator hiatus area, iliococcygeus angle, levator plate angle, uterus-pubococcygeal line, and bladder-pubococcygeal line were assessed on MRI. Longitudinal changes in pelvic floor measurements between the two groups were compared by repeated-measures analysis of variance. Compared with the control group, enlarged puborectal hiatus line, levator hiatus area, and RICA and decreased uterus-pubococcygeal line were observed at rest in the POP group (all P< 0.05). All of the pelvic floor measurements were significantly different in the POP group compared with the control group at the maximum Valsalva maneuver (all P< 0.05). All of the pelvic floor measurements showed no significant change over time in both the POP and control groups (all P> 0.05). Postpartum POP accompanied by poor pelvic floor support will persist in the early postpartum period.

Magnetic resonance imaging presentation of diffuse and focal adenomyosis before and after pregnancy

Research questionIs there a change in magnetic resonance imaging (MRI) criteria of diffuse and focal phenotypes of adenomyosis before and after pregnancy? DesignA retrospective, monocentric, observational study in a single academic tertiary referral centre for endometriosis diagnosis and management. Women were followed for symptomatic adenomyosis, and without a prior history of surgery who give birth after 24+0 weeks. For each patient, pelvic MRI pre- and post-pregnancy was performed by two experienced radiologists with the same image acquisition protocol. Diffuse and focal adenomyosis MRI presentation were analysed before and after pregnancy. ResultsBetween January 2010 and September 2020, of the 139 patients analysed, 96 (69.1%) had adenomyosis at MRI distributed as follow: 22 (15.8%) presented diffuse adenomyosis, 55 (39.6%) focal adenomyosis and 19 (13.7%) both phenotypes. The frequency of isolated diffuse adenomyosis on MRI was significantly lower before versus after pregnancy (n = 22 [15.8%] versus n = 41 [29.5%], P = 0.01). The frequency of isolated focal adenomyosis was significantly higher before pregnancy than after pregnancy (n = 55 [39.6%] versus n = 34 [24.5%], P = 0.01). The mean volume of all focal adenomyosis lesions on MRI decreased significantly after pregnancy, from 6.7 ± 2.5 mm3 to 6.4 ± 2.3 mm3, P = 0.01. ConclusionThe current data indicate that, based on MRI, there is an increase in diffuse adenomyosis and a decrease in focal adenomyosis after pregnancy.

Role of Diffusion-Weighted Magnetic Resonance Imaging for Characterization of Mediastinal Lymphadenopathy.

To assess the diagnostic performance of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the characterization of mediastinal lymph nodes and compare them with morphological parameters. A total of 43 untreated patients with mediastinal lymphadenopathy underwent DW and T2 weighted MRI followed by pathological examination in the period from January 2015 to June 2016. The presence of diffusion restriction, apparent diffusion coefficient (ADC) value, short axis dimensions (SAD), and T2 heterogeneous signal intensity of the lymph nodes were evaluated using receiver operating characteristic curve (ROC) and forward step-wise multivariate logistic regression analysis. The ADC of malignant lymphadenopathy was significantly lower (0.873 ± 0.109 × 10-3 mm2/s) than that of benign lymphadenopathy (1.663 ± 0.311 × 10-3 mm2/s) (p = 0.001). When an ADC of 1.0955 × 10-3 mm2/s was used as a threshold value for differentiating malignant from benign nodes, the best results were obtained with a sensitivity of 94%, a specificity of 96%, and an area under the curve (AUC) of 0.996. A model combining the other three MRI criteria showed less sensitivity (88.9%) and specificity (92%) compared to the ADC-only model. The ADC was the strongest independent predictor of malignancy. The addition of other parameters failed to show any increase in sensitivity and specificity.

Clinical-Radiological Mismatch in Multiple Sclerosis Patients during Acute Relapse: Discrepancy between Clinical Symptoms and Active, Topographically Fitting MRI Lesions.

Relapses in multiple sclerosis (MS) patients are usually defined as subacute clinical symptoms that last for at least 24 h. To validate a clinical relapse on magnetic resonance imaging (MRI), an anatomically fitting lesion with gadolinium enhancement in the central nervous system (CNS) would be mandatory. The aim of this study was to validate clinical relapses in regard to the concomitant detection of active, anatomically fitting MRI lesions. We performed a retrospective analysis of 199 MS patients with acute relapse who had received an MRI scan before the initiation of methylprednisolone (MPS) therapy. Clinical data and MRIs were systematically reanalyzed by correlating clinical symptoms with their anatomical representation in the CNS. Patients were then categorized into subgroups with a clinical-radiological match (group 1) or clinical-radiological mismatch (group 2) between symptoms and active, topographically fitting lesions and further analyzed in regard to clinical characteristics. In 43% of our patients, we observed a clinical-radiological mismatch (group 2). Further analysis of patient characteristics showed that these patients were significantly older at the time of relapse. MS patients in group 2 also showed a significantly longer disease duration and significantly more previous relapses when compared to group 1. Comparing symptom clusters, the appearance of motor dysfunction during the current relapse was significantly more frequent in group 2 than in group 1. The overall dose of MPS treatment was significantly lower in group 2 than in group 1 with a similar treatment response in both groups. The substantial clinical-radiological mismatch during acute relapse in our study could be explained by several factors, including a psychosomatic component or disturbance of network connectivity. Alternatively, secondary progression or a diffuse neuro-inflammatory process might cause clinical symptoms, especially in older patients with a longer disease duration. As a consequence, treatment of clinical relapses and the definition of breakthrough disease should be reconsidered in regard to combined clinical and MRI criteria and/or additional biomarkers. Further studies are necessary to address the contribution of diffuse neuro-inflammation to the clinical presentation of symptoms.

Modern Possibilities of Liver Diffusion-Weighted Magnetic Resonance Images in the Diagnosis of Alcoholic Liver Disease

Objective: to evaluate the current possibilities of diffusion-weighted imaging (DWI) in liver magnetic resonance imaging (MRI) for the diagnosis of alcoholic liver disease (ALD).Material and methods. The examined patients were at the inpatient and outpatient stages of observation in the gastroenterology department on the basis of the Clinical Hospital No. 1 (Smolensk) and received treatment for diffuse liver diseases of alcoholic etiology. The study included 128 patients: 76 (59%) males and 52 (41%) females, mean age 42.3 ± 4.7 years. Patients were monitored from 2019 to 2022. All of them underwent abdominal organs ultrasound with liver clinical elastography and liver MRI with DWI; in 34 cases liver multi-slice computed tomography was performed.Results. When comparing the results of a qualitative assessment of liver DWI MRI with the CAGE (Cut, Annoyed, Guilty, Eye-opener) test data and the results of patients and relatives survey about the use of alcoholic beverages, a high correlation was established between the diffusion restriction in the liver during MRI and impaired withdrawal regimen (r = 0.901). The diagnostic and prognostic significance of the developed criteria for liver DWI MRI in patients with ALD at admission was assessed: for qualitative assessment AUROC 0.827 (95% CI 0.792–0.873), for quantitative assessment AUROC 0.949 (95% CI 0.912–0.981); in dynamic observation: for qualitative assessment AUROC 0.958 (95% CI 0.925–0.984), for quantitative assessment AUROC 0.947 (95% CI 0.947–0.981).Conclusion. The obtained quantitative indicators of liver DWI MRI make it possible to predict the clinical form of ALD: apparent diffusion coefficient for steatosis is 2.66 ± 0.9 × 10–3 mm2/s, for steatohepatitis – 2.14 ± 0.5 × 10–3 mm2/s, for hepatitis – 1.75 ± 0.6 × 10–3 mm2/s, for cirrhosis – 1.15 ± 0.6 × 10–3 mm2/s (AUROC 0.948; 95% CI 0.922–0.983). Qualitative parameters of liver DWI MRI (there is/is not a diffusion restriction) predict violations of the withdrawal regimen in patients with ALD in all its clinical forms (AUROC 0.931; 95% CI 0.822–0.979).

Gadoxetic acid-enhanced MRI-derived functional liver imaging score (FLIS) and spleen diameter predict outcomes in ACLD.

Functional liver imaging score (FLIS) - derived from gadoxetic acid-enhanced MRI - correlates with liver function and independently predicts liver-related mortality in patients with chronic liver disease (CLD), while splenic craniocaudal diameter (SCCD) is a marker of portal hypertension. The aim of this study was to investigate the accuracy of a combination of FLIS and SCCD for predicting hepatic decompensation, acute-on-chronic liver failure (ACLF), and mortality in patients with advanced CLD (ACLD). We included 397 patients with CLD who underwent gadoxetic acid-enhanced liver MRI. The FLIS was calculated by summing the points (0-2) of 3 hepatobiliary-phase features: hepatic enhancement, biliary excretion, and portal vein signal intensity. Patients were stratified into 3 groups according to liver fibrosis severity and presence/history of hepatic decompensation: non-ACLD, compensated ACLD (cACLD), and decompensated ACLD (dACLD). SCCD showed excellent intra- and inter-reader agreement. Importantly, SCCD was an independent risk factor for hepatic decompensation in patients with cACLD (per cm; adjusted hazard ratio [aHR] 1.13; 95% CI 1.04-1.23; p= 0.004). Patients with cACLD and a FLIS of 0-3 points and/or a SCCD of >13cm were at increased risk of hepatic decompensation (aHR 3.07; 95% CI 1.43-6.59; p= 0.004). In patients with dACLD, a FLIS of 0-3 was independently associated with an increased risk of ACLF (aHR 2.81; 95% CI 1.16-6.84; p= 0.02), even after adjusting for other prognostic factors. Finally, a FLIS and SCCD-based algorithm was independently predictive of transplant-free mortality and stratified the probability of transplant-free survival (TFS) in ACLD (p <0.001): FLIS 4-6 and SCCD ≤13cm (5-year TFS of 84%) vs. FLIS 4-6 and SCCD >13cm (5-year TFS of 70%) vs. FLIS 0-3 (5-year TFS of 24%). The FLIS and SCCD are simple imaging markers that provide complementary information for risk stratification in patients with compensated and decompensated ACLD. Magnetic resonance imaging (MRI) can be used to assess the state of the liver. Previously the functional liver imaging score, which is based on MRI criteria, was developed as a measure of liver function and to predict the risk of liver-related complications or death. By combining this score with a measurement of spleen diameter, also using MRI, we generated an algorithm that could predict the risk of adverse liver-related outcomes in patients with advanced chronic liver disease.

Role of magnetic resonance imaging in predicting long-term outcomes of cervical cancer treatment

Objective . To study the value of a mathematical model of lymph node (LN) metastasis according to magnetic resonance imaging (MRI) data in cervical cancer (CC) in a comparative aspect with the traditional MRI criterion of LN metastasis (the size on the short axis being ≥ 1.0 cm) for assessing the prognosis of the disease. Materials and methods . To assess the CC prognosis, the indices of one-year, five-year cancer-specific survival (CSS) rates of 100 patients were analyzed in a comparative aspect: if metastatic lymph nodes (MLNs) are detected according to MRI data based on the use of the mathematical model for the MLN diagnosis and the traditional MRI criterion. Results . The comparison of five-year CSS indices for groups of patients with a favorable prognosis (N0) using the traditional criterion and the mathematical model has revealed a statistically significant difference (р &lt; 0.001). Conclusion . The developed mathematical model of LN metastasis according to MRI data makes it possible to predict the unfavorable development of CC, as well as serves as a guide for individual therapy.

Adhesive capsulitis; evaluation of a recently introduced MRI criterion

Introduction: Adhesive capsulitis is a common disorder, defined as the painful limitation of glenohumeral range of motion due to capsular hyperplasia and fibrosis. Magnetic resonance imaging (MRI) – as the gold standard of shoulder imaging- plays a critical role in diagnosis of adhesive capsulitis, in the early stages. The anterior predominance of pathologic and arthroscopic abnormalities suggest that the thickness of anterior joint capsule may be a more reliable diagnostic criterion on MRI; however, to our knowledge, only one study has evaluated the significance of this parameter up to now, the results of which, may be subject to substantial bias, due to small sample size. Objectives: To evaluate the anterior capsule of glenohumeral joint, in terms of thickness and signal intensity, and also to conduct a comparison between adhesive capsulitis subjects and control individuals. Materials and Methods: This is a case-control study. Cases were all patients with the final diagnosis of adhesive capsulitis, based on history, physical examination and imaging. Controls were all patients who underwent shoulder MRI, because of another reason. Anterior capsular thickness, and other qualitative and quantitative criteria were evaluated on the MRIs, by two musculoskeletal radiologists, with three and 10 years experience respectively. Results: All of the evaluated criteria showed significant difference, between cases and controls. Considering the cut-off point equal to 1.3 mm, "anterior capsular thickness" had 86.7% sensitivity, 96.7% specificity, 96.3% positive and 87.9% negative predictive values respectively, which posed an acceptable position among MRI criteria of adhesive capsulitis. Of note, was the near perfect inter-observer agreement of this criterion between the two radiologists, implicating its practicality. Conclusion: The anterior capsule signal and thickness are valuable criteria for diagnosis of adhesive capsulitis on MRI. Future studies with large sample volumes, clinical sub-categorization of the patients and multivariate analysis are recommended to more accurately define its role in MRI-based diagnosis of adhesive capsulitis.

Promoting the use of the PRECISE score for prostate MRI during active surveillance: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship

ObjectivesThe PRECISE criteria for serial multiparametric magnetic resonance imaging (MRI) of the prostate during active surveillance recommend the use of a dedicated scoring system (PRECISE score) to assess the likelihood of clinically significant radiological change. This pilot study assesses the effect of an interactive teaching course on prostate MRI during active surveillance in assessing radiological change in serial imaging.MethodsEleven radiology fellows and registrars with different experience in prostate MRI reading participated in a dedicated teaching course where they initially evaluated radiological change (based on their previous training in prostate MRI reading) independently in fifteen patients on active surveillance (baseline and follow-up scan), and then attended a lecture on the PRECISE score. The initial scans were reviewed for teaching purposes and afterwards the participants re-assessed the degree of radiological change in a new set of images (from fifteen different patients) applying the PRECISE score. Receiver operating characteristic analysis was performed. Confirmatory biopsies and PRECISE scores given in consensus by two radiologists (involved in the original draft of the PRECISE score) were the reference standard.ResultsThere was a significant improvement in the average area under the curve (AUC) for the assessment of radiological change from baseline (AUC: 0.60 [Confidence Intervals: 0.51–0.69] to post-teaching (AUC: 0.77 [0.70–0.84]). This was an improvement of 0.17 [0.016–0.28] (p = 0.004).ConclusionsA dedicated teaching course on the use of the PRECISE score improves the accuracy in the assessment of radiological change in serial MRI of the prostate.

Oligoclonal bands, age 11–17 years, occipital lesion, and female sex differentiate pediatric multiple sclerosis from acute disseminated encephalomyelitis: A nationwide cohort study

BackgroundOur aim was to propose criteria to distinguish multiple sclerosis (MS) from acute disseminated encephalomyelitis (ADEM) at onset based on age at onset, sex, cerebrospinl fluid (CSF)-specific oligoclonal bands, and MRI. MethodsA neuroradiologist undertook retrospective evaluation of the baseline magnetic resonance imaging (MRI) in a nationwide cohort of children with medical record-validated MS (n = 67) and monophasic ADEM (n = 46). Children with ADEM had at least 5 years of follow-up for relapse. We used forward stepwise conditional logistic regression to develop our criteria based on age at onset, sex, CSF-specific oligoclonal bands, and MRI. We undertook sensitivity analyses using children with ADEM including encephalopathy and polyfocal neurological deficits and in those with onset between 11 and 17 years of age. We estimated accuracy statistics from our criteria and all previously proposed MRI criteria to distinguish MS and ADEM. ResultsThe best performing criteria to differentiate MS from ADEM were scoring at least three points in the following categories: presence of CSF-specific oligoclonal bands (2 points), occipital lesion (1 point), age 11–17 years (1 point), female sex (1 point). These criteria gave highly reliable discrimination with sensitivity of 95% (95% CI=89%–100%), specificity of 100% (95% CI=100%–100%), and area under the curve of 98% (95% CI=95%–100%). The best performing MRI criteria had area under the curve of 84% (95% CI=78%–91%). Previously proposed MRI criteria had the following areas under the curve: Callen (75%), KIDMUS (82%), and McDonald 2017 criteria (68%). ConclusionCombining sex, age at onset, CSF-specific oligoclonal bands, and MRI gives highly reliable differentiation between pediatric MS and monophasic ADEM at onset.

Improving pre-operative MRI diagnosis of peroneal tendon tears with a new objective sign and assessing the value of peroneus brevis fatty atrophy

Objectives: We aimed to compare the diagnostic performance of an objective set of magnetic resonance imaging (MRI) criteria named the cleft sign with traditional reads for pre-operative diagnosis of peroneal tendon tears. We also investigated the relationship between peroneus brevis tendon tears and muscle quality. Material and Methods: Two blinded readers retrospectively and independently evaluated pre-operative ankle MRI studies of 38 patients who had undergone peroneal tendon surgery for peroneal tendon tears, peroneus brevis muscle quality, and the cleft sign. MRI examinations from 38 control subjects were also reviewed for peroneus brevis muscle quality. The diagnostic performances of MRI for peroneal tendon tears with and without application of the cleft sign were analyzed. The correlation between peroneus brevis fatty atrophy and tendon tears was also examined. Results: In patients without prior peroneal surgery, the sensitivity and specificity of MRI for peroneus brevis tendon tears were 60%/89% and 80%/78% for readers 1 and 2, respectively. Application of the cleft sign significantly increased sensitivity in reader 1 to 95%, with a non-significant increase in accuracy in both readers. The interobserver reliability for the cleft sign was moderate for peroneus brevis (κ = 0.57). No significant difference in peroneus brevis muscle quality was present between subjects with and without peroneus brevis tendon tears and between surgical and control patients. Conclusion: In patients without prior peroneal tendon surgery, the cleft sign can significantly improve reader diagnostic sensitivity for peroneus brevis tears. The muscle quality of the peroneus brevis has limited value in MRI diagnosis of peroneal tendon tears.

MRI and Adenomyosis: What Can Radiologists Evaluate?

Uterine adenomyosis is a common benign condition defined by the presence of heterotopic endometrial glands and stroma within the myometrium. Adenomyosis is often related to infertility and other adverse pregnancy outcomes. Modern imaging techniques allow the non-invasive diagnosis of adenomyosis and, in this framework, Magnetic Resonance Imaging (MRI) has assumed a central role due to its high diagnostic accuracy in the detection of adenomyosis. Currently, there is still a lack of international consensus on adenomyosis diagnostic criteria and classification, despite the fact that an agreed reporting system would promote treatment outcomes and research. This review aims to emphasize the important contribution of MRI to the diagnosis of adenomyosis and to highlight how, thanks to the great tissue differentiation provided by MRI, it is possible to identify the main direct (cystic component) and indirect (junctional zone features) signs of adenomyosis and to distinguish its various subtypes according to different MRI-based classifications. We also explored the main MRI criteria to identify the most common pitfalls and differential diagnoses of adenomyosis, whose features should be considered to avoid misdiagnosis.

Magnetic resonance imaging criteria at onset to differentiate pediatric multiple sclerosis from acute disseminated encephalomyelitis: A nationwide cohort study (S26.001)

Magnetic resonance imaging criteria at onset to differentiate pediatric multiple sclerosis from acute disseminated encephalomyelitis: A nationwide cohort study (S26.001)

Diagnosis and Pathogenesis of Sarcopenia in Chronic Liver Disease Using Liver Magnetic Resonance Imaging.

BackgroundLiver magnetic resonance imaging (MRI) is rarely used to evaluate sarcopenia. This study sought to develop new diagnostic criteria for MRI in Asians and investigate the relationship between adipopenia and sarcopenia using MRI proton density fat fraction (PDFF), which is correlated with body fat mass.MethodologyThis study included 512 patients with chronic liver disease (CLD) who underwent magnetic resonance elastography (MRE). The following parameters were assessed: paraspinal muscle area/height index (PSMI) measured at the level of the superior mesenteric artery and PDFF. The cutoff PSMI and PDFF values for the diagnosis of sarcopenia and adipopenia, respectively, were determined using receiver operating characteristic analysis of Asians with low body mass index.ResultsAmong patients with CLD, the prevalence rates of sarcopenia and adipopenia were 25% and 17%, respectively. We found that sarcopenia increased from stage 3 fibrosis and was inversely correlated with steatosis grade. Multivariate analysis found that MRI-PDFF was associated with sarcopenia. The Kaplan-Meier method in cirrhosis (n = 122) showed that the non-sarcopenia, sarcopenia, and sarcopenia/adipopenia groups had three-year survival rates of 97%, 55% (p < 0.01), and 23%, respectively. The Cox proportional hazards model identified the Child-Pugh score and sarcopenia/adipopenia as independent prognostic factors.ConclusionsThe new diagnostic criteria for sarcopenia confirmed that the prognosis of cirrhosis can be stratified. Furthermore, sarcopenia with adipopenia was shown to be a phenotype of severe sarcopenia in cirrhosis, and screening for sarcopenia should include cases in the precirrhotic stage.

Towards imaging criteria that best differentiate MS from NMOSD and MOGAD: Large multi-ethnic population and different clinical scenarios

BackgroundThe “1/3″ brain magnetic resonance imaging (MRI) criteria including 1) a lesion adjacent to the lateral ventricle and in the inferior temporal lobe, or 2) a juxtacortical lesion, or 3) a Dawson finger-type lesion were shown to distinguish multiple sclerosis (MS) from antibody-mediated conditions. In this large multicentre study, we aimed to assess how the criteria perform 1) in different onset phenotypes, 2) distinct ethnic groups, 3) when the absence of myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD)-typical fluffy infratentorial (FIT) lesions and longitudinally extensive transverse myelitis (LETM) lesions are added as features (“2/4″ and 3/5″ criteria, respectively). Methods577 patients with MS (n = 332), aquaporin-4 antibody (AQP4-Ab) neuromyelitis optica spectrum disorder (NMOSD) (n = 196) and MOGAD (n = 49) were recruited from 6 international centres (Buenos Aires, Sao Paolo, Maracaibo, Goyang, Oxford and Milan). Imaging scans were obtained at disease onset or relapse. ResultsAdding the absence of FIT lesions increased the specificity of the “1/3″ criteria vs. AQP4-Ab NMOSD from 84.7% to 87.2% and vs. MOGAD from 85.7% to 93.9% without compromising their sensitivity (86%). In particular, for those presenting with brain/brainstem attacks “2/4″ had significantly higher specificity than “1/3″ (85% vs. 80% against AQP4-Ab NMOSD, 88.9% vs. 72.2% against MOGAD). Positive predictive values of the “1/3″ criteria for MS were lowest for Asian patients (84.8 vs. 99.1% for White) but were significantly increased by adding further criteria (94.1% for “3/5″). ConclusionThe “1/3″ criteria perform well in discriminating MS from NMOSD and MOGAD regardless of ethnic background and clinical scenario. Adding the absence of FIT lesions increases the specificity in those presenting with brain/brainstem symptoms.

Safety of Tattoos, Permanent Make-Up, and Medical Implants in Population-Based 3T Magnetic Resonance Brain Imaging: The Rhineland Study.

Excluding persons from magnetic resonance imaging (MRI) research studies based on their medical history or because they have tattoos, can create bias and compromise the validity and generalizability of study results. In the population-based Rhineland Study, we limited exclusion criteria for MRI and allowed participants with passive medical implants, tattoos or permanent make-up to undergo MRI. Thereby, we could include 16.6% more people than would have been possible based on common recommendations. We observed no adverse events or artifacts. This supports that most passive medical implants, tattoos and permanent make-up are MRI suitable and can be scanned in research settings.