Diagnostic Accuracy Of Magnetic Resonance Imaging Research Articles

Diagnostic Accuracy of MRI in Detecting Orbital Masses Keeping Histopathology as Gold Standard

Background: Orbital masses, encompassing a spectrum of benign and malignant lesions, pose significant diagnostic and therapeutic challenges. Magnetic resonance imaging (MRI) has been pivotal in the non-invasive evaluation of these lesions, owing to its superior soft tissue contrast and detailed anatomical resolution. The correlation between MRI findings and histopathological diagnosis remains crucial for accurate clinical decision-making. Objective: The study aimed to evaluate the diagnostic accuracy of MRI in identifying orbital masses, with a focus on differentiating between benign and malignant lesions, using histopathology as the gold standard. Methods: A prospective cross-sectional study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi, from January to December 2023. A total of 145 patients scheduled for surgery or biopsy, presenting with clinical symptoms indicative of orbital masses, were enrolled using a non-probability sequential sampling method. MRI evaluations were performed using a 1.5 Tesla machine. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of MRI in detecting orbital masses were calculated, comparing MRI findings with histopathological results. Results: Of the 145 patients, 55.2% were female, and 44.8% were male, with an age range predominantly between 18-30 years (87.6%). MRI identified 77.2% of cases as malignant and 22.8% as benign, whereas histopathology diagnosed 83.4% as malignant and 16.6% as benign. The diagnostic accuracy of MRI for benign masses showed a sensitivity of 81.82%, specificity of 96.43%, PPV of 87.10%, NPV of 94.74%, and an overall diagnostic accuracy of 93.10%. For malignant masses, MRI demonstrated a sensitivity of 90.16%, specificity of 86.90%, PPV of 83.33%, NPV of 92.41%, and a diagnostic accuracy of 88.28%. Conclusion: MRI exhibits a high diagnostic accuracy in identifying orbital masses, with excellent sensitivity and specificity. It proves to be a reliable diagnostic tool in differentiating between benign and malignant orbital lesions, supporting its integral role in the preoperative assessment and clinical management of patients with suspected orbital masses. Keywords: Orbital Masses, Magnetic Resonance Imaging, Diagnostic Accuracy, Histopathology, Benign Lesions, Malignant Lesions, MRI Sensitivity, MRI Specificity

Accuracy of MRI in predicting deep myometrial invasion in endometrial cancer and the influence of leiomyoma, adenomyosis and the microcystic elongated and fragmented tumour pattern.

The most common form of endometrial cancer is Type 1 endometrioid adenocarcinoma. Depth of myometrial invasion is the most important prognostic factor correlating with overall patient survival. The objective was to investigate how accurate magnetic resonance imaging (MRI) is in predicting the depth of myometrial invasion in preoperative assessment, and the influence of leiomyoma and/or adenomyosis, or microcystic, elongated and fragmented (MELF) pattern of invasion on MRI diagnostic performance. Retrospective audit of 235 endometrial cancer patients from the regional Gynaecology Oncology multidisciplinary meeting at Auckland City Hospital, between January 2020 and January 2021. Radiologist assigned stage was compared to histopathology. Presence of leiomyoma, adenomyosis andMELF pattern evaluated followed by analysis under a Biostatistician's supervision. Overall MRI diagnostic accuracy for depth of myometrial invasion was 86%. For deep myometrial invasion, MRI had a sensitivity of 72% and specificity 91%. Out of the misreported 32/235 cases, 16 demonstrated fibroids and/or adenomyosis leading to a sensitivity of 57% and specificity 93% for deep invasion, compared with 94% and 74% respectively in the population without, demonstrating statistical significance. Thirty seven cases with MELF pattern of invasion showed a sensitivity of 81% and specificity 80% for deep invasion, compared with 63% and 92% respectively in the group without, demonstrating no statistical significance. MRI assessment of the depth of myometrial invasion in endometrial cancer has high accuracy. In the presence of background uterine fibroids/adenomyosis, pre-operative MRI accuracy of evaluating deep invasion shows a statistically significant reduction.

Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results

Magnetic resonance imaging (MRI) and potential MRI-guided biopsy enable enhanced identification of clinically significant prostate cancer. Despite proven efficacy, MRI and potential MRI-guided biopsy remain costly, and there is limited evidence regarding the cost-effectiveness of this approach in general and for different prostate-specific antigen (PSA) strata. To examine the cost-effectiveness of integrating annual MRI and potential MRI-guided biopsy as part of clinical decision-making for men after being screened for prostate cancer compared with standard biopsy. Using a decision analytic Markov cohort model, an economic evaluation was conducted projecting outcomes over 10 years for a hypothetical cohort of 65-year-old men in the US with 4 different PSA strata (<2.5 ng/mL, 2.5-4.0 ng/mL, 4.1-10.0 ng/mL, >10 ng/mL) identified by screening through Monte Carlo microsimulation with 10 000 trials. Model inputs for probabilities, costs in 2020 US dollars, and quality-adjusted life-years (QALYs) were from the literature and expert consultation. The model was specifically designed to reflect the US health care system, adopting a federal payer perspective (ie, Medicare). Magnetic resonance imaging with potential MRI-guided biopsy and standard biopsy. Incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $100 000 per QALY was estimated. One-way and probabilistic sensitivity analyses were performed. For the 3 PSA strata of 2.5 ng/mL or greater, the MRI and potential MRI-guided biopsy strategy was cost-effective compared with standard biopsy (PSA 2.5-4.0 ng/mL: base-case ICER, $21 131/QALY; PSA 4.1-10.0 ng/mL: base-case ICER, $12 336/QALY; PSA >10.0 ng/mL: base-case ICER, $6000/QALY). Results varied depending on the diagnostic accuracy of MRI and potential MRI-guided biopsy. Results of probabilistic sensitivity analyses showed that the MRI and potential MRI-guided biopsy strategy was cost-effective at the willingness-to-pay threshold of $100 000 per QALY in a range between 76% and 81% of simulations for each of the 3 PSA strata of 2.5 ng/mL or more. This economic evaluation of a hypothetical cohort suggests that an annual MRI and potential MRI-guided biopsy was a cost-effective option from a US federal payer perspective compared with standard biopsy for newly eligible male Medicare beneficiaries with a serum PSA level of 2.5 ng/mL or more.

Stronger Magnets, No Improvements in Accuracy: Comparing Efficacy of 3-T Magnetic Resonance Imaging (MRI) vs 1.5-T MRI in Detecting Associated Lesions in Patients with Lateral Ankle Instability

Category: Ankle Arthritis Introduction/Purpose: Patients with lateral ankle instability often have other associated pathologies, including osteochondral lesions of the talus (OLT), peroneus brevis tears, and intra-articular loose bodies. If left untreated, these pathologies can lead to worsening instability, significant ankle pain, and progressive osteoarthritis. Arthroscopy has historically been the gold standard for diagnosing and treating these abnormalities, while magnetic resonance imaging (MRI) can be useful in preoperative evaluation and planning. Our group’s previous research evaluated a subset of the current sample, focusing on MRI diagnostic accuracy of OLTs, demonstrating that 3-T outperformed 1.5-T. Using a larger sample size, the purpose of this study is to assess the efficacy of 3-T MRI and 1.5-T MRI in diagnosing additional pathologies in patients undergoing Broström Gould procedure for lateral ankle instability. Methods: Following institutional review board approval, a database was obtained for all patients at a single institution who underwent a Broström Gould procedure with a concurrent diagnostic arthroscopy of the tibiotalar joint between 1/1/2014- 6/30/2022. Additionally, patients required a pre-operative ankle MRI for inclusion in the study. Patients who did not undergo a preoperative MRI, diagnostic arthroscopy, and Broström Gould procedure were excluded from the study. Additionally, patients with pre-operative MRIs in which the field strength could not be determined were also excluded from analysis. Patient charts were reviewed to determine the field strength of the preoperative MRIs, the efficacy of 3-T and 1.5-T MRIs in correctly identifying the presence or absence of OLTs, peroneus brevis tears, loose bodies, os trigonum, medial malleolus fractures, lateral malleolus fractures, and posterior impingement lesions. Intraoperative diagnostic arthroscopy findings were utilized as a reference standard. Results: One hundred twelve patients met our inclusion criteria of undergoing preoperative MRI with identifiable field strength, Broström Gould procedure, and diagnostic arthroscopy of the tibiotalar joint. The average age was 35.73 ± 21.01 years; 65 (58.0%) patients were female. Fifty-six (50.0%) patients had a preoperative 3-T MRI and 56 patients had a preoperative 1.5-T MRI. There were no differences observed regarding demographic data between groups. Fifty-one OLTs, 12 peroneus brevis tears, 14 loose bodies, two os trigonum, two medial malleolus fractures, two lateral malleolus fractures, and one posterior impingement lesion were identified in our sample (Figure 1A). Three tesla MRI test characteristics did not significantly differ from the test characteristics of 1.5-T MRI (Figures 1B, 1C). Conclusion: The sensitivity, specificity, and overall diagnostic accuracy of 3-T MRI compared against 1.5-T MRI did not significantly differ regarding each imaging modalities’ efficacy in identifying OLTs, peroneus brevis tears, loose bodies, os trigonum, medial and lateral malleolus fractures, and posterior impingement lesions. These findings demonstrate no significant improvement in the diagnostic accuracy of 3-T MRI over 1.5-T MRI in identifying pathologies associated with lateral ankle instability. While many lesions were correctly identified by both modalities, patients will continue to benefit from undergoing intraoperative arthroscopy to determine the most accurate diagnosis regarding their ankle instability.

Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: A systematic review and meta-analysis.

Differential diagnosis between uterine leiomyomas and sarcomas is challenging. Magnetic resonance imaging (MRI) represents the second-line diagnostic method after ultrasound for the assessment of uterine masses. To assess the accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas. A systematic review and meta-analysis was performed searching five electronic databases from their inception to June 2023. All peer-reviewed observational or randomized clinical trials that reported an unbiased postoperative histologic diagnosis of uterine leiomyoma or uterine sarcoma, which also comprehended a preoperative MRI evaluation of the uterine mass. Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and area under the curve on summary receiver operating characteristic of MRI in differentiating uterine leiomyomas and sarcomas were calculated as individual and pooled estimates, with 95% confidence intervals (CI). Eight studies with 2495 women (2253 with uterine leiomyomas and 179 with uterine sarcomas), were included. MRI showed pooled sensitivity of 0.90 (95% CI 0.84-0.94), specificity of 0.96 (95% CI 0.96-0.97), positive likelihood ratio of 13.55 (95% CI 6.20-29.61), negative likelihood ratio of 0.08 (95% CI 0.02-0.32), diagnostic odds ratio of 175.13 (95% CI 46.53-659.09), and area under the curve of 0.9759. MRI has a high diagnostic accuracy in the differential diagnosis between uterine leiomyomas and sarcomas.

MRI in Evaluation of Rectal Cancer pre- and post-Chemo-Radiation Treatment.

Rectal cancer is associated with a high risk of metastases and local recurrence; local recurrence rates after surgical treatment being up to 32%. An accurate local staging at the time of initial diagnosis is therefore very important. Magnetic Resonance Imaging (MRI) is already established as an accurate tool for the preoperative staging of rectal cancer and has resulted in marked improvements in staging accuracy.&#x0D; Material and Methods: This study used MRI in comparing the morphologic features of rectal cancer before and after 8 weeks of chemo-radiation treatment (CRT) and to correlate the post treatment MRI appearances with the histological findings in resected tumors. 45 patients with histo-pathologically proven rectal adenocarcinoma received standardized 8 weeks chemo-radiation therapy and subjected to MRI before and after treatment for clinical staging. A correlation between pathological response and MRI findings was done.&#x0D; Results: The MRI diagnostic accuracy to diagnose T2 is 74.2% with relatively low specificity (64.7%). The diagnostic accuracy of MRI in evaluation of stage T3 and T4, the MRI sensitivity was 96.2% however of low specificity 26.3%. The diagnostic accuracy was 66.7%. Additionally, in evaluation of T2 stage, the sensitivity of MRI was very low 27.3% and specificity relatively high 94.7%. Diagnostic accuracy was 70%.&#x0D; Post RCT, based on downstaging after CRT, the sensitivity of MRI to show no tumor was very low 0% with diagnostic accuracy 88.9%. However, to evaluate stage T2, the sensitivity was 84.6% with low specificity 66.7% and the diagnostic accuracy was 74.2%.&#x0D; Conclusion: MRI had an accuracy average of 81.6% in T stage and 68.9% in N stage in re-staging rectal tumors after CRT. Over-staging results of majority of the inaccuracy. The statistical agreement between post-CRT MRI and the pathologic staging involving T and N stages was not satisfactory. In view of the above, Post CRT, restaging rectal cancer remains a challenge.

MRI's Diagnostic Reliability in Cervical Cancer Screening Detecting Cancer using Magnetic Resonance Imaging is a Reliable Method (MRI) A Single Center Study

Aim: to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) for cervical cancer detection in patients with cervix carcinoma who had received a clinical diagnosis. Study Design: A Single Center Study Place and duration Department of Radiology Qazi hussain ahmad medical complex Nowshera from january 2018 to December 2019. Methods: In all, 75 individuals between the ages of 31 and 62 with clinically suspected cervical cancer were recruited in this research. After obtaining written agreement, extensive patient demographic information was gathered, including their age, place of residence, socioeconomic status, co-morbidities, and clinical presentation. An MRI of the pelvis was performed on each patient to find the malignancy. Histopathology was used as the standard. Results: Patients' ages ranged from 31 to 41 years for 15 (21%) patients, 42 to 52 years for 26 (34%) patients, 53 to 63 years for 21 (28%) patients, and beyond 61 years for 13 (18%) patients. The most prevalent symptom, post-menopausal bleeding, was seen in 32 (42%) patients, followed by atypical vaginal bleeding in 25 (34%) patients, foul-smelling watery discharge in 18 (24%) patients, and pelvic discomfort in 15 (21%) patients. By MRI, 53 patients (71%) had positive results, while 22 patients (29%) had negative findings. By histological examination, 56 patients (75%) had positive findings, while 19 patients (24%) had negative. The diagnostic accuracy of MRI was 90%, 87, 96, 74%, and 87%, respectively. Sensitivity, specificity, PPV, and NPV were also high. Conclusion: For cervical cancer diagnosis, magnetic resonance imaging is a beneficial diagnostic technique. Keywords: Cervical Carcinoma, Accuracy, Magnetic Resonance Imaging

MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience

BackgroundAnastomotic leakage (AL) is one of the most serious postoperative complications after colorectal anastomosis. This study aims to evaluate the feasibility and diagnostic accuracy of magnetic resonance imaging (MRI) in the early detection of AL in patients with clinically suspected AL after rectal anterior resection.MethodsThis was a prospective study including patients who underwent anterior resection and postoperative MRI examination. AL was diagnosed by comprehensive indictors, which were mainly confirmed by clinical signs, symptoms, and retrograde contrast enema (RCE) radiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosing AL with MRI were calculated.ResultsIn total, 347 patients received anterior resection for rectal cancer, and 28 patients were suspected to have AL. Finally, 23 patients were included and received MRI examination. The median time interval from surgery to MRI was 10 days (3–21 days). The median distance from anastomosis to anal verge was 4.0 cm (2.0–10 cm), and 11 patients underwent diverted ileostomy. Eighteen patients had an anastomotic leak, including one patient who had a pelvic abscess and five patients who had no evidence of AL in the MRI examination. The overall sensitivity and specificity were 94.4% (95% CI 70.6% to 99.7%) and 80% (95% CI 29.8% to 98.9%), respectively. The PPV was 0.94 (95% CI 0.71 to 0.99) and the NPV was 0.80 (95% CI 0.29 to 0.99). For patients who had anastomosis less than 5 cm, the diagnostic accuracy of MRI was 93.7% (15/16). T2-weighted imaging with fat suppression can effectively reveal the leak track.ConclusionsThe accuracy of plain MRI examination in diagnosing AL was favorable for patients with a suspected AL. T2-weighted imaging with fat suppression was the best imaging modality to diagnose AL. A multicenter prospective study with more samples is needed to further determine the safety and feasibility of MRI in the diagnosis of AL.

MRI of odontogenic maxillofacial infections: diagnostic accuracy and reliability

ObjectivesTo determine the diagnostic accuracy of emergency magnetic resonance imaging (MRI) in odontogenic maxillofacial infections, the clinical and surgical significance of MRI findings, and whether MRI can identify the tooth responsible for the infection.MethodsA retrospective cohort study reviewed 106 emergency neck MRI scans of patients with neck infections of odontogenic origin. The diagnostic accuracy of MRI in identifying abscesses was studied relative to surgical findings. Correlations were analyzed between various MRI findings and clinical results and outcomes, such as the surgical approach (intraoral vs. extraoral). The ability of MRI findings to predict the causative tooth was assessed in a blinded multi-reader setting.ResultsOf the 106 patients with odontogenic infections, 77 (73%) had one or more abscesses. Imaging showed a sensitivity, specificity, and accuracy of 0.95, 0.84, and 0.92, respectively, for MRI diagnosis of an odontogenic abscess. Among the imaging findings, mediastinal edema was the strongest predictor of extraoral surgery. MRI showed bone marrow edema in the majority of patients, and multi-reader assessment showed good reliability. MRI was also able to predict the causative tooth accurately.ConclusionsEmergency neck MRI can accurately detect odontogenic abscesses and reliably point to the causative tooth. These results can increase the utility and reliance on emergency MRI in clinical decision-making.

Diagnostic accuracy of MRI in mesorectal fascial involvement

Introduction: Evaluation of mesorectal fascial involvement in rectal cancer is of prime importance in decision making regarding treatment options.&#x0D; Objective: To determine diagnostic accuracy of Magnetic Resonance Imaging (MRI) in detection of mesorectal fascia involvement in rectal carcinoma patients using histopathology as gold standard.&#x0D; Materials &amp; Methods: A comparative study was performed in the Radiology department of Kuwait Teaching Hospital, Peshawar, from January 1, 2021, till December 31, 2021, on 155 patients of rectal carcinoma who had their MRI done for rectal cancer on 0.3T MR Machine. Surgical findings like mesorectal fascial involvement by the tumor, presence/absence of pelvic lymph nodes within 5mm of mesorectal fascia, and staging of the tumor were included as variables. Specimens were sent in formalin to a histopathologist, and findings were considered for comparison. Data were analyzed using SPSS version 23.&#x0D; Results: Out of 155 patients, 82 patients showed mesorectal fascial involvement whereas 73 patients were Circumferential Resection Margin (CRM) negative. Out of these 7 patients were falsely labeled as CRM positive on MRI, whereas 9 patients were falsely labeled as CRM negative on MRI. Positive predictive value was 91%, with negative predictive value of 88%. Diagnostic accuracy was 89.6%. Sensitivity was 89% whereas specificity was 90.4%.&#x0D; Conclusion: MRI has high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of mesorectal fascial involvement in case of rectal carcinoma taking 5mm as cut off value.

Diagnostic Value and Application of Prenatal MRI and Ultrasound in Fetal Cleft Lip and Palate.

Objective The purpose was to explore the diagnostic value and application of prenatal magnetic resonance imaging (MRI) and ultrasound (US) in fetal cleft lip and palate. Methods From January 2018 to December 2019, 39 pregnant women without normal fetal maxillofacial structure or with fetal maxillofacial deformity under US examination in our hospital were selected as the study subjects. Not knowing the clinical data of the pregnant women, MRI and US physicians performed diagnostic analysis on the MRI or US images of all the study subjects and analyzed the results of prenatal MRI and US diagnosis and postpartum follow-up to compare the diagnostic efficacy and confidence of MRI and US. Results The follow-up found that there were 20 cases of cleft lip, 15 cases of cheilopalatognathus, 3 cases of cleft palate, and 1 case of unilateral cleft lip with alveolar cleft, with a total of 39 cases having cleft lip and palate deformity. MRI and US had the same efficacy in the diagnosis of cleft lip. As for cleft palates, the diagnostic accuracy of MRI (94.87%) was significantly better than that of US (48.72%, P < 0.001). The diagnostic confidence of fetal cleft lip and palate by MRI (89.73%) was significantly better than that of US (43.59%, P < 0.001). The AUC of US (0.597) was significantly less than that of MRI (0.940), indicating that the diagnostic accuracy of US was not as good as that of MRI (P < 0.05). The sensitivity and 1 − specificity of MRI were significantly higher than those of US. Conclusion MRI is more accurate than US in the diagnosis of fetal cleft lip and palate, and MRI can be the preferred method for prenatal detection of cleft lip and palate, thus providing more accurate opinions and information for perinatal pregnant women.

Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: a systematic review and meta-analysis

ObjectivesAccurate prenatal diagnosis of placenta accrete spectrum disorder (PAS) remains a challenge, and the reported diagnostic value of ultrasonography (US) and magnetic resonance imaging (MRI) varies widely. This study aims to systematically evaluate the diagnostic accuracy of US as compared with MRI in the detection of PAS within the identical patient population.MethodsMedline, EMBASE, Google scholar and Cochrane library were searched. Pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic (SROC) curve were calculated. Subgroup analysis was also performed to elucidate the heterogeneity of results.ResultsA total of 18 articles comprising 861 pregnancies were included in the study. The overall diagnostic accuracy of US for identification of PAS was as follows: sensitivity [0.90 (0.86–0.93)], specificity [0.83 (0.79–0.86)], DOR [39.5 (19.6–79.7)]. The overall diagnostic accuracy of MRI for identification of PAS was as follows: sensitivity [0.89 (0.85-0.92)], specificity [0.87 (0.83–0.89)], DOR [37.4 (17.0–82.3)]. The pooled sensitivity (p = 0.808) and specificity (p = 0.413) between US and MRI are not significantly different. SROC analysis revealed that there was no statistical difference (p = 0.552) in US and MRI for the overall predictive accuracy of PAS. Furthermore, in the subgroup analysis of between retrospective and prospective studies, between earlier and most recent studies, there was no statistical difference (p > 0.05) in diagnostic accuracy of US and MRI for the detection of PAS.ConclusionsBoth ultrasonography (US) and magnetic resonance imaging (MRI) showed comparable accuracy in the prenatal diagnosis of placenta accrete spectrum disorder (PAS). Routine employment of MRI with relatively high expense in the prenatal identification of PAS should not be recommended.

Deep Learning Algorithm-Based MRI Image in the Diagnosis of Diabetic Macular Edema.

This study investigates the value of magnetic resonance imaging (MRI) based on a deep learning algorithm in the diagnosis of diabetic macular edema (DME) patients. A total of 96 patients with DME were randomly divided into the experimental group (N = 48) and the control group (N = 48). A deep learning 3D convolutional neural network (3D-CNN) algorithm for MRI images of patients with DME was designed. The application value of this algorithm was comprehensively evaluated by MRI image segmentation Dice value, sensitivity, specificity, and other indicators and diagnostic accuracy. The results showed that the quality of MRI images processed by the 3D-CNN algorithm based on deep learning was significantly improved, and the Dice value, sensitivity, and specificity index data were significantly better than those of the traditional CNN algorithm (P < 0.05). In addition, the diagnostic accuracy of MRI images processed by this algorithm was 93.78 ± 5.32%, which was significantly better than the diagnostic accuracy of 64.25 ± 10.24% of traditional MRI images in the control group (P < 0.05). In summary, the 3D-CNN algorithm based on deep learning can significantly improve the accuracy and sensitivity of MRI image recognition and segmentation in patients with DME, can significantly improve the diagnostic accuracy of MRI in patients with DME, and has a good clinical application value.

Magnetic resonance imaging findings in pediatric neck infections—a comparison with adult patients

BackgroundDifferences in the functioning of the immune system and the anatomical proportions of the neck between children and adults lead to different manifestations of deep neck infections. Magnetic resonance imaging (MRI) may serve as an alternative to computed tomography (CT) as the primary imaging modality.ObjectiveTo study characteristic MRI findings and the diagnostic accuracy of MRI in pediatric deep neck infections.Materials and methodsWe retrospectively studied a cohort of pediatric patients who underwent a neck 3-tesla MRI study over a five-year period. Inclusion criteria were: 1) emergency MRI findings indicating an infection, 2) infection as the final clinical diagnosis, 3) diagnostic image quality verified by the radiologist reading the study and 4) age under 18 years. Patient record data, including surgery reports, were compared with the MRI findings.ResultsData of 45 children were included and analysed. Compared to adults, children had a higher incidence of retropharyngeal infection and lymphadenitis, and a lower incidence of peritonsillar/parapharyngeal infection. MRI showed evidence of an abscess in 34 children. Of these 34 patients, 24 underwent surgery, which confirmed an abscess in 21 but no abscess in three patients. In addition, three patients underwent surgery without MRI evidence of abscess, and an abscess was found in one of these cases. The measures of diagnostic accuracy among the children were sensitivity 0.96, specificity 0.77, positive predictive value 0.89, negative predictive value 0.91 and accuracy 0.89. Compared with adults, children had lower C-reactive protein, but a similar proportion of them had an abscess, and abscess size and rate of surgery were similar.ConclusionDespite the differences in the infection foci, emergency MRI in children had equal diagnostic accuracy to that in adults.

The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations.

Background:Early diagnosis is important in patients with Lisfranc joint injury to avoid subsequent complications. As the ligaments in the Lisfranc joint are relatively small and course obliquely, isotropic 3-dimensional (3D) magnetic resonance imaging (MRI) can be beneficial to evaluate ligament injury. The purpose of this study was to investigate the diagnostic accuracy of MRI, including isotropic 3D MRI for acute injury of the Lisfranc joint, especially of the interosseous C1-M2 ligament (Lisfranc ligament), the dorsal C1-M2 ligament (dorsal ligament), and the interosseous C1-C2 ligament, compared with direct operative observations.Methods:This retrospective review identified 27 patients who had undergone MR examination for acute Lisfranc joint injury followed by surgery. We reviewed the operative reports that described the Lisfranc, dorsal, and interosseous C1-C2 ligaments. All patients underwent an MRI, including a 2D oblique plane image parallel to the Lisfranc ligament and an isotropic 3D MRI. An image analysis of the integrity of the 3 ligaments and other associated injuries was performed. The diagnostic accuracy of MRI was analyzed using operative findings as a reference standard.Results:Lisfranc and dorsal ligament injuries were identified on MRI in all patients. MRI depicted disruption of the interosseous C1-C2 ligament in 12 patients. MRI diagnostic accuracy for detection of Lisfranc, dorsal, and interosseous C1-C2 ligaments was 100% (95% CI 0.82-1.0), 74% (95% CI 0.54-0.89), and 70% (95% CI 0.50-0.86), respectively.Conclusion:MRI with oblique planes parallel to the Lisfranc ligament and isotropic 3D MRI was reliable for detecting Lisfranc ligament injury, whereas MRI findings of the dorsal and interosseous C1-C2 ligaments were less consistent with operative observations.Level of Evidence:Level IV, case series.

Superiority of magnetic resonance imaging in small renal mass diagnosis where image reports mismatches between computed tomography and magnetic resonance imaging.

To analyze malignancy of computed tomography (CT) and magnetic resonance imaging (MRI) results in the same renal mass. We retrospectively reviewed 1,216 patients who underwent partial nephrectomy from January 2017 to December 2021 in our institute. Patients who had both CT and MRI reports prior to surgery were included. We compared the diagnostic accuracy between the CT and the MRI. The patients were divided into two groups according to the consistency of reports: the 'Consistent group' and the 'Inconsistent group'. The Inconsistent group was further divided into two subgroups. Group 1 is the case that showed benign findings on CT but malignancy on MRI. Group 2 is the cases of malignancy on CT but benign on MRI. 410 patients were identified. Benign lesion was identified in 68 cases (16.6%). The sensitivity, specificity and diagnostic accuracy of MRI was 91.2%, 36.8%, and 82.2% respectively, whereas that of CT was 84.8%, 41.2%, and 77.6% respectively. Consistent group were 335 cases (81.7%) and inconsistent group were 75 cases (18.3%). The mean mass size was significantly smaller in the inconsistent group compared to the consistent group (consistent group vs. inconsistent group: 2.31±0.84 cm vs.1.84±0.75 cm, p<0.001). Also, the Group 1 had higher odds of malignancy compared to Group 2 in the renal mass size 2-4 cm (odds ratio, 5.62 [1.02-30.90]). Smaller mass size affects the discrepancy of CT and MRI reports. In addition, MRI showed better diagnostic performance in mismatch cases in the small renal masses.

Accuracy of MRI Pelvis in the Diagnosis of Ovarian Endometrioma: Using Histopathology as Gold Standard.

BackgroundEndometriosis is defined as the ectopic presence of endometrial mucosa at locations other than the uterine cavity. It results in significant morbidity and is a leading cause of infertility as well. Magnetic resonance imaging (MRI) is establishing its role in the diagnosis of endometriosis and its complications. The objective of this study was to assess the accuracy of MRI in the diagnosis of ovarian endometriosis using histopathology as the gold standard.Materials and methodsAll patients presenting with clinical complaints and suspicion of endometriosis, undergoing MRI followed by surgical resection and confirmation by histopathology, were included in the study. Data were analyzed on a predefined proforma and parameters of accuracy were calculated.Results A total of 170 patients were included in this study, having a mean age of 36.8 years with a standard deviation of 10.4 years. The mean parity for included subjects was 2.25, with a standard deviation of 1.3. Overall, the sensitivity of MRI was 86.7% and the specificity was 81.9%. The positive predictive value (PPV) of MRI was 83.3%, while the negative predictive value (NPV) was 81.9%. Overall, the diagnostic accuracy of MRI was 84.7%.ConclusionThe accuracy of MRI in the diagnosis of endometriosis was found to be acceptable and comparable to most of the worldwide published literature. The routine use of MRI for diagnosis and preoperative planning is justified by the results of this study.

The diagnostic value of chest CT and MRI for lymph node metastasis of thoracic esophageal cancer

Objective To compare the clinical value of chest CT and Magnetic Resonance Imaging (MRI) in the diagnosis of lymph node metastasis of thoracic esophageal cancer. Methods A retrospective analysis of 90 patients with thoracic esophageal cancer lymph node metastasis diagnosed and treated in our hospital from July 2015 to June 2019. All patients underwent chest CT and MRI scans after admission, and the lesion tissue samples were taken for pathological examination after surgery. Physical examination, with pathological diagnosis results as the gold standard, analyze the sensitivity and specificity of chest CT and MRI. Results The sensitivity, specificity, positive predictive value, and negative predictive value of MRI scan was 88.73%, 94.74%, 98.44%, and 69.23%, respectively, which were higher than 69.01%, 52.63%, 84.48%, and 31.25% of the chest CT scan. In the distribution of lymph node metastasis, the middle of the thorax was the largest, and the proportions of the upper, middle, and lower thoraxes were 26.67%, 60.00%, and 13.33%, respectively. The uppermost mediastinal and paratracheal lymph nodes had the largest metastases in the upper thorax, the paratracheal and subcarinal lymph nodes in the middle thoracic segment had the most metastasis, and the next to the cardia and left gastric artery lymph nodes in the lower thorax had the largest metastases. The accuracy of MRI diagnosis is higher than that of chest CT. Conclusion Both chest CT and MRI can diagnose lymph node metastasis of thoracic esophageal cancer. The diagnostic value of MRI in diagnosing lymph node metastasis of thoracic esophageal cancer is better than chest CT. The diagnostic accuracy of MRI in each part of the lymph node is higher than that of chest CT, which can show the lymph nodes more clearly in transfer situation. 摘要： 目的 比较胸部计算机断层扫描 (computer tomography, CT) 和磁共振成像 (magnetic resonance imaging, MRI) 判断胸段食管癌淋巴结转移的临床价值。 方法 回顾性分析2015年7月一2019年6月在我院诊治的胸段食管癌淋 巴结转移患者90例, 所有患者在入院后均采用胸部CT和MRI平扫及增强扫描, 并在手术后对病灶组织标本进行病 理学检测, 以病理诊断结果为金标准, 分析胸部CT和MRI灵敏度和特异度。 结果 MRI扫描, 灵敏度为88.73%, 特 异度为94.74%, 阳性预测值为98.44%, 阴性预测值为69.23%, 高于胸部CT扫描的69.01%、52.63%、84.48%、31.25%。淋巴结转移分布中, 胸中段最多, 胸上段、胸中段、胸下段所占比例分别为26.67%、60.00%、13.33%, 胸上段中 最上纵隔和气管旁淋巴结转移最多, 胸中段气管旁、隆突下淋巴结转移最多, 胸下段贲门旁、胃左动脉旁淋巴结转移最 多, MRI诊断准确率高于胸部CT。 结论 胸部CT、MRI均能够诊断出胸段食管癌淋巴结转移, MRI诊断胸段食管癌 淋巴结转移的诊断价值优于胸部CT, MRI在胸段淋巴结各部位的诊断准确率高于胸部CT, 能够更清晰显示淋巴结的 转移情况。

Can diffusion and T2 star-weighted magnetic resonance imaging aid in the diagnosis of ectopic endometrium?

BackgroundEndometriosis is a common gynecologic disorder characterized by the implantation of the endometrial tissue ectopically outside the endometrial cavity. It affects about 10% of females at the childbearing period and is estimated to be present up to 20–50% in women complaining of infertility. While laparoscopy is considered the mainstay for diagnosis, magnetic resonance imaging (MRI) is recognized as a useful tool for definitive diagnosis, pre-surgical planning, and determining whether the patient will require multi-specialty involvement. The aim of this study is to evaluate the performance of MRI with the addition of diffusion-weighted imaging (DWI) and T2 star (T2*) to conventional MRI, for the accurate assessment of ectopic endometrium.ResultsEndometriotic lesions that showed diffusion restriction on DWI were 80.7%, and 96.1% of the endometriotic lesions had signal voids on the T2*W sequence, whereas only 65.4% of the lesions had typical signal intensities on T1WI and T2WI. Diagnostic performance of the MRI examination was improved by the use of the diffusion sequence and better improved by the T2* sequence, compared to the conventional MR protocol sensitivity (SE) = 96.12% and specificity (SP) = 85.7% in T2*-weighted images, SE = 80.7% and SP = 71.4% in DWI, and SE = 65.4% and SP = 71.4% in conventional MRI. P value for conventional MRI was 0.1, which is of no statistical significance (p < 0.05). P value for DWI was 0.016, which is statistically significant (p < 0.05). P value for T2*WI was 0.001, which is more statistically significant (p < 0.05) and could be adequately correlated with laparoscopy.ConclusionDWI and T2* significantly increase MRI diagnostic accuracy by allowing the detection of the hemorrhagic character of the endometriotic lesions. Studies with a large sample size are needed to confirm that they can replace invasive laparoscopy for the diagnosis of endometriosis.

Abstract PS3-30: Peri-operative diagnostic accuracy of magnetic resonance imaging and ultrasonography in breast cancer: A meta-analysis

Abstract Background: Accurate determination of the extent of tumor is essential when a breast-conserving therapy (BCT) is considered. Due to its high sensitivity, breast magnetic resonance imaging (MRI) is increasingly used for the accurate diagnosis and surgical planning of breast cancers. However, a recent meta-analysis showed that peri-operative evaluation with MRI leads to higher mastectomy rates in patients that could have potentially underwent BCT. Objective: The aim of this study is to compare the pre-operative diagnostic accuracy of MRI to ultrasonography (US) in breast cancer. Methods: We identified eligible studies that examined peri-operative tumor size using MRI and US and compared it to its pathological counterpart. Databases of PubMed, Embase and Google Scholar were reviewed. To keep the study homogenous, only studies evaluating invasive ductal carcinoma were included and studies evaluating ductal carcinoma in-situ and lobular ductal carcinoma were excluded. An accurate tumor estimation by MRI or US was defined as within 10 mm from the pathological tumor size. An overestimation was defined as imaging tumor size more than 10 mm larger than its pathological counterpart. Odds ratios (ORs) were calculated using a random-effects model with 2-sided p-value of 0.05 set as the significance level. Results: Twenty-five studies with 3,562 patients were included in the final analysis. MRI was 1.6-fold more accurate than US in preoperative diagnostic evaluation of breast cancer (OR 1.65; 95% confidence interval (CI) 1.24-2.18, p-value &amp;lt;0.00001). However, MRI was 20 folds more likely to overestimate the tumor size compared to US (OR 20.25; 95% CI 9.46-43.33; p-value &amp;lt;0.0001). Conclusion: MRI remains the most accurate modality for the diagnosis of breast cancer. However, it is highly likely to overestimate tumor size and can result in unnecessary mastectomies. US is a reasonable diagnostic option for most patients with breast cancer. Citation Format: Jason A Mouabbi, Zeyad Sako, Ahmed Abdalla, Tarik Hadid, Mothaffar F Rimawi. Peri-operative diagnostic accuracy of magnetic resonance imaging and ultrasonography in breast cancer: A meta-analysis [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-30.