Diagnostic Magnetic Resonance Imaging Research Articles

Assessing MRI Sensitivity and Specificity for Detecting Occult Nipple-Areolar Complex Malignancy in Nipple-Sparing Mastectomy Candidates: A Systematic Review and Meta-Analysis

Background: Approximately 8% of breast cancers originate within the central ducts near the nipple-areolar complex(NAC), which revealed higher rates of occult involvement than previously thought. Precise preoperative imaging to assess NAC and subjacent tumor involvement has become critical to identify candidates for nipple-sparing mastectomy(NSM) while ensuring oncological safety. The aim of our study is to determine whether MRI could be used for the detection of subtle neoplastic infiltration. Method: Electronic databases including PubMed, Scopus, Web of Science, and EMBASE were systematically searched to identify all relevant studies on diagnostic performance of Magnetic Resonance Imaging(MRI) in malignant extension to the nipple published before 2024. The keywords include MRI, NAC, breast cancer, NSM. True Positive(TP), True Negative(TN), False Positive(FP), False Negative(FN) were extracted for analysis. Finally, 5 articles were selected for our meta-analysis. STATA version 15 was used to analysis data. Result: Our meta-analysis showed a pooled sensitivity of 89%(95% CI: 81%-94%)with low heterogeneity(I2 = 17.51%), and a pooled specificity of 89% (95% CI: 71%-96%), with significant heterogeneity(I2 = 95.87%). The pooled positive diagnostic likelihood ratio(pDLR) was 7.81(95% CI: 2.82-21.61, I2 = 92.66%), and the negative diagnostic likelihood ratio(nDLR) was 0.12(95% CI: 0.07-0.22, I2 = 11.94%). Conclusion: Diagnostic MRI characteristics such as NAC enhancement, non-mass enhancement(NME) type, mass size (greater than 20 mm), and tumor-to-nipple distance(TND) were assocaited with the presence of NAC involement. Because of high diagnostic accuracy, MRI imaging can be used as a helpful tool for NAC diagnosis.

A Comprehensive Review of Couvelaire Uterus: Diagnosis, and Management

Couvelaire uterus, also known as uteroplacental apoplexy or Couvelaire syndrome, is a rare and serious complication of pregnancy characterized by the extravasation of blood into the myometrium and the formation of a hematoma between the myometrium and the placenta. This review aims to provide a comprehensive overview of the pathophysiology, clinical manifestations, diagnosis, and management of Couvelaire uterus. We discuss the etiology and risk factors associated with the condition, as well as its potential complications and outcomes. Additionally, we outline the various diagnostic modalities available, including ultrasound and magnetic resonance imaging, and describe the current management strategies, which often involve close monitoring and, in severe cases, surgical intervention. By highlighting the key aspects of Couvelaire uterus, this review seeks to enhance clinicians' understanding of this rare condition and improve patient outcomes.

Diagnostic magnetic resonance imaging characteristics of congenital mesoblastic nephroma: a retrospective multi-center International Society of Pediatric Oncology-Renal Tumor Study Group (SIOP-RTSG) radiology panel study

BackgroundCongenital mesoblastic nephroma is the most common solid renal tumor in neonates. Therefore, patients <3 months of age are advised to undergo upfront nephrectomy, whereas invasive procedures at diagnosis in patients ≥3 months of age are discouraged by the International Society of Pediatric Oncology-Renal Tumor Study Group (SIOP-RTSG). Nevertheless, discriminating congenital mesoblastic nephroma, especially from the more common Wilms tumor, solely based on imaging remains difficult. Recently, magnetic resonance imaging (MRI) has become the preferred modality. Studies focusing on MRI characteristics of congenital mesoblastic nephroma are limited.ObjectiveThis study aims to identify diagnostic MRI characteristics of congenital mesoblastic nephroma in the largest series of patients to date.Materials and methodsIn this retrospective multicenter study, five SIOP-RTSG national review radiologists identified 52 diagnostic MRIs of histologically proven congenital mesoblastic nephromas. MRI was performed following SIOP-RTSG protocols, while radiologists assessed their national cases using a validated case report form.ResultsPatients (24/52 classic, 11/52 cellular, and 15/52 mixed type congenital mesoblastic nephroma, 2/52 unknown) had a median age of 1 month (range 1 day–3 months). Classic type congenital mesoblastic nephroma appeared homogeneous with a lack of hemorrhage, necrosis and/or cysts, showing a concentric ring sign in 14 (58.3%) patients. Cellular and mixed type congenital mesoblastic nephroma appeared more heterogeneous and were larger (311.6 and 174.2 cm3, respectively, versus 41.0 cm3 for the classic type (P<0.001)). All cases were predominantly T2-weighted isointense and T1-weighted hypointense, and mean overall apparent diffusion coefficient values ranged from 1.05–1.10×10−3 mm2/s.ConclusionThis retrospective international collaborative study showed classic type congenital mesoblastic nephroma predominantly presented as a homogeneous T2-weighted isointense mass with a typical concentric ring sign, whereas the cellular type appeared more heterogeneous. Future studies may use identified MRI characteristic of congenital mesoblastic nephroma for validation and for exploring the discriminative non-invasive value of MRI, especially from Wilms tumor.Graphical

A Pilot Study of Simulation-Free Hippocampal-Avoidance Whole Brain Radiation Therapy Using Diagnostic MRI-Based and Online Adaptive Planning

We aimed to demonstrate the clinical feasibility and safety of simulation-free hippocampal avoidance whole brain radiation therapy (HA-WBRT) in a pilot study (National Clinical Trial 05096286). Ten HA-WBRT candidates were enrolled for treatment on a commercially available computed tomography (CT)-guided linear accelerator with online adaptive capabilities. Planning structures were contoured on patient-specific diagnostic magnetic resonance imaging (MRI), which were registered to a CT of similar head shape, obtained from an atlas-based database (AB-CT). These patient-specific diagnostic MRI and AB-CT data sets were used for preplan calculation, using NRG-CC001 constraints. At first fraction, AB-CTs were used as primary data sets and deformed to patient-specific cone beam CTs (CBCT) to give patient-matched density information. Brain, ventricle, and brain stem contours were matched through rigid translation and rotation to the corresponding anatomy on CBCT. Lens, optic nerve, and brain contours were manually edited based on CBCT visualization. Preplans were then reoptimized through online adaptation to create final, simulation-free plans, which were used if they met all objectives. Workflow tasks were timed. In addition, patients underwent CT-simulation to create immobilization devices and for prospective dosimetric comparison of simulation-free and simulation-based plans. Median time from MRI importation to completion of "preplan" was 1 weekday (range, 1-4). Median on-table workflow duration was 41 minutes (range, 34-70). NRG-CC001 constraints were achieved by 90% of the simulation-free plans. One patient's simulation-free plan failed a planning target volume coverage objective (89% instead of 90% coverage); this was deemed acceptable for first-fraction delivery, with an offline replan used for subsequent fractions. Both simulation-free and simulation CT-based plans otherwise met constraints, without clinically meaningful differences. Simulation-free HA-WBRT using online adaptive radiation therapy is feasible, safe, and results in dosimetrically comparable treatment plans to simulation CT-based workflows while providing convenience and time savings for patients.

Radiology Reports Do Not Accurately Portray the Severity of Cervical Neural Foraminal Stenosis.

Retrospective study. (1) To compare cervical magnetic resonance imaging (MRI) radiology reports to a validated grading system for cervical foraminal stenosis (FS) and (2) to evaluate whether the severity of cervical neural FS on MRI correlates to motor weakness or patient-reported outcomes. Radiology reports of cervical spine MRI are often reviewed to assess the degree of neural FS. However, research looking at the association between these reports and objective MRI findings, as well as clinical symptoms, is lacking. We retrospectively identified all adult patients undergoing primary 1 or 2-level anterior cervical discectomy and fusion at a single academic center for an indication of cervical radiculopathy. Preoperative MRI was assessed for neural FS severity using the grading system described by Kim and colleagues for each level of fusion, as well as adjacent levels. Neural FS severity was recorded from diagnostic radiologist MRI reports. Motor weakness was defined as an examination grade <4/5 on the final preoperative encounter. Regression analysis was conducted to evaluate whether the degree of FS by either classification was related to patient-reported outcome measure severity. A total of 283 patients were included in the study, and 998 total levels were assessed. There were significant differences between the MRI grading system and the assessment by radio-logists ( P < 0.001). In levels with moderate stenosis, 28.9% were classified as having no stenosis by radiology. In levels with severe stenosis, 29.7% were classified as having mild-moderate stenosis or less. Motor weakness was found similarly often in levels of moderate or severe stenosis (6.9% and 9.2%, respectively). On regression analysis, no associations were found between baseline patient-reported outcome measures and stenosis severity assessed by radiologists or MRI grading systems. Radiology reports on the severity of cervical neural FS are not consistent with a validated MRI grading system. These radiology reports underestimated the severity of neural foraminal compression and may be inappropriate when used for clinical decision-making. Level III.

Target volumes comparison between postoperative simulation magnetic resonance imaging and preoperative diagnostic magnetic resonance imaging for prone breast radiotherapy after breast-conserving surgery.

This study investigated the differences in target volumes between preoperative magnetic resonance imaging (MRIpre) and postoperative MRI (MRIpost) for breast radiotherapy after breast-conserving surgery (BCS) using deformable image registration (DIR). Seventeen eligible patients who underwent whole-breast irradiation in the prone position after BCS were enrolled. On MRIpre, the gross tumor volume (GTV) was delineated as GTVpre, which was then expanded by 10 mm to represent the preoperative lumpectomy cavity (LC), denoted as LCpre. The LC was expanded to the clinical target volume (CTV) and planning target volume (PTV) on the MRIpre and MRIpost, denoted as CTVpre, CTVpost, PTVpre, and PTVpost, respectively. The MIM software system was used to register the MRIpre and MRIpost using DIR. Differences were evaluated regarding target volume, distance between the centers of mass (dCOM), conformity index (CI), and degree of inclusion (DI). The relationship between CILC /CIPTV and the clinical factors was also assessed. Significant differences were observed in LC and PTV volumes between MRIpre and MRIpost (p < 0.0001). LCpre was 0.85 cm3 larger than LCpost, while PTVpre was 29.38 cm3 smaller than PTVpost. The dCOM between LCpre and LCpost was 1.371 cm, while that between PTVpre and PTVpost reduced to 1.348 cm. There were statistically significant increases in CI and DI for LCpost-LCpre and PTVpost-PTVpre (CI = 0.221, 0.470; DI = 0.472, 0.635). No obvious linear correlations (p > 0.05) were found between CI and GTV, primary tumor volume-to-breast volume ratio, distance from the primary tumor to the nipple and chest wall, and body mass index. Despite using DIR technology, the spatial correspondence of target volumes between MRIpre and MRIpost was suboptimal. Therefore, relying solely on preoperative diagnostic MRI with DIR for postoperative LC delineation is not recommended.

Growth speed of large brain metastases between diagnostic and radiosurgical planning MRI and predictors of rapid tumor growth

PurposeWe aimed to assess volumetric changes of large brain metastases (≥ 2 cm) between their diagnosis and planning for treatment with fractionated stereotactic radiation surgery (fSRS). Predictors of rapid tumor growth were also analyzed.Materials and methodsOne hundred nine patients harboring 126 large brain metastases were retrospectively evaluated. Tumor characteristics were evaluated on diagnostic magnetic resonance imaging (dMRI) and MRI performed when planning fSRS (pMRI). Average tumor growth rate and percentage growth rate were calculated. Predictors of rapid growth (percentage growth rate > 5%) were determined using multivariate logistic regression.ResultsBoth tumor diameter and volume were significantly larger on pMRI than on dMRI (P < 0.001). Median tumor percentage growth rate was 2.6% (range, − 10.8–43.3%). Eighty-eight tumors (70%) were slow-growing (percentage growth rate < 5%) and 38 (30%) grew rapidly (percentage growth rate ≥ 5%). Major peritumoral edema and no steroids were predictors of rapid tumor growth.ConclusionLarge brain metastases can grow considerably between the time of diagnosis and the time of fSRS treatment planning. We recommend the time between dMRI and fSRS treatment initiation be as short as possible.

Quantitative MRI-based radiomics analysis identifies blood flow feature associated to overall survival for rectal cancer patients.

Radiomics objectively quantifies image information through numerical metrics known as features. In this study, we investigated the stability of magnetic resonance imaging (MRI)-based radiomics features in rectal cancer using both anatomical MRI and quantitative MRI (qMRI), when different methods to define the tumor volume were used. Second, we evaluated the prognostic value of stable features associated to 5-year progression-free survival (PFS) and overall survival (OS). On a 1.5T MRI scanner, 81 patients underwent diagnostic MRI, an extended diffusion-weighted sequence with calculation of the apparent diffusion coefficient (ADC) and a multiecho dynamic contrast sequence generating both dynamic contrast-enhanced and dynamic susceptibility contrast (DSC) MR, allowing quantification of Ktrans, blood flow (BF) and area under the DSC curve (AUC). Radiomic features were extracted from T2w images and from ADC, Ktrans, BF and AUC maps. Tumor volumes were defined with three methods; machine learning, deep learning and manual delineations. The interclass correlation coefficient (ICC) assessed the stability of features. Internal validation was performed on 1000 bootstrap resamples in terms of discrimination, calibration and decisional benefit. For each combination of image and volume definition, 94 features were extracted. Features from qMRI contained higher prognostic potential than features from anatomical MRI. When stable features (> 90% ICC) were compared with clinical parameters, qMRI features demonstrated the best prognostic potential. A feature extracted from the DSC MRI parameter BF was associated with both PFS (p = 0.004) and OS (p = 0.004). In summary, stable qMRI-based radiomics features was identified, in particular, a feature based on BF from DSC MRI was associated with both PFS and OS.

Clinical and imaging findings in enteropathic spondyloarthritis with special emphasize in diagnostic delay: a cross-sectional study.

Enteropathic spondyloarthritides (eSpAs) are chronic inflammatory joint diseases associated with inflammatory bowel disease (IBD). Limited data are available on the prevalence since arthritis in IBD patients may be underestimated because medications may hide disease activity with a possible diagnostic delay. We aimed to evaluate diagnostic delay in eSpA and explore associated demographic, clinical, and radiographic characteristics. Single-centre cross-sectional study conducted on consecutive out-patients referred to the combined Gi-Rhe clinic (November 2018-October 2019). We analysed eSpA patients for diagnostic delay, disease activity, inflammatory markers, conventional radiography (CR) and magnetic resonance images (MRI) of sacroiliac joints/spine. A total of 190 eSpA patients [118 peripheral SpA, 72 axial (Ax) SpA including 44 non-radiographic (nr)-axSpA] were enrolled. axSpA patients had a higher prevalence of men sex, HLA-B27 positivity, uveitis and pancolitis compared with peripheral eSpA. Median diagnostic delay in eSpA was 48 months (IQR 6-77) with no difference between axial and peripheral patients. Radiographic-axial SpA (r-axSpA) patients displayed a higher diagnostic delay compared with nr-axSpA (median/IQR 36/17-129 versus 31/10-57 months, p = 0.03) and were older, with longer disease duration, low education status and high rate of employment than patients with nr-axSpA. r-axSpA patients with sclerosis, syndesmophytes and bridge at CR had higher diagnostic delay than those without lesions. Men showed higher prevalence of spine damage lesions than women as sclerosis, squaring, syndesmophytes and bridges. Longer disease duration was detected in patients with radiographic damage as bridge and sacroiliitis grade 3. On MRI, sacroiliac bone oedema was associated with reduced diagnostic delay, whereas bone erosions were associated with higher diagnostic delay compared with that in patients without these lesions. Patients with psoriasis displayed a higher diagnostic delay compared to those without skin involvement. Diagnostic delay was higher in r-axSpA compared with nr-axSpA despite the same treatment. Demographic, clinical features and radiological lesions were associated with diagnostic delay.

Does waiting for surgery matter? How time from diagnostic MRI to resection affects outcomes in newly diagnosed glioblastoma.

Maximal safe resection is the standard of care for patients presenting with lesions concerning for glioblastoma (GBM) on magnetic resonance imaging (MRI). Currently, there is no consensus on surgical urgency for patients with an excellent performance status, which complicates patient counseling and may increase patient anxiety. This study aims to assess the impact of time to surgery (TTS) on clinical and survival outcomes in patients with GBM. This is a retrospective study of 145 consecutive patients with newly diagnosed IDH-wild-type GBM who underwent initial resection at the University of California, San Francisco, between 2014 and 2016. Patients were grouped according to the time from diagnostic MRI to surgery (i.e., TTS): ≤ 7, > 7-21, and > 21 days. Contrast-enhancing tumor volumes (CETVs) were measured using software. Initial CETV (CETV1) and preoperative CETV (CETV2) were used to evaluate tumor growth represented as percent change (ΔCETV) and specific growth rate (SPGR; % growth/day). Overall survival (OS) and progression-free survival (PFS) were measured from the date of resection and were analyzed using the Kaplan-Meier method and Cox regression analyses. Of the 145 patients (median TTS 10 days), 56 (39%), 53 (37%), and 36 (25%) underwent surgery ≤ 7, > 7-21, and > 21 days from initial imaging, respectively. Median OS and PFS among the study cohort were 15.5 and 10.3 months, respectively, and did not differ among the TTS groups (p = 0.81 and 0.17, respectively). Median CETV1 was 35.9, 15.7, and 10.2 cm3 across the TTS groups, respectively (p < 0.001). Preoperative biopsy and presenting to an outside hospital emergency department were associated with an average 12.79-day increase and 9.09-day decrease in TTS, respectively. Distance from the treating facility (median 57.19 miles) did not affect TTS. In the growth cohort, TTS was associated with an average 2.21% increase in ΔCETV per day; however, there was no effect of TTS on SPGR, Karnofsky Performance Status (KPS), postoperative deficits, survival, discharge location, or hospital length of stay. Subgroup analyses did not identify any high-risk groups for which a shorter TTS may be beneficial. An increased TTS for patients with imaging concerning for GBM did not impact clinical outcomes, and while there was a significant association with ΔCETV, SPGR remained unaffected. However, SPGR was associated with a worse preoperative KPS, which highlights the importance of tumor growth speed over TTS. Therefore, while it is ill advised to wait an unnecessarily long time after initial imaging studies, these patients do not require urgent/emergency surgery and can seek tertiary care opinions and/or arrange for additional preoperative support/resources. Future studies are needed to explore subgroups for whom TTS may impact clinical outcomes.

A survey of non-sedate practices when acquiring pediatric magnetic resonance imaging examinations.

Improving access to magnetic resonance imaging (MRI) in childhood can be facilitated by making it faster and cheaper and reducing need for sedation or general anesthesia (GA) to mitigate motion. Some children achieve diagnostic quality MRI without GA through the use of non- practices fostering their cooperation and/or alleviating anxiety. Employed before and during MRI, these variably educate, distract, and/or desensitize patients to this environment. To assess current utilization of non-sedate practices in pediatric MRI, including variations in practice and outcomes. A survey-based study was conducted with 1372 surveys emailed to the Society for Pediatric Radiology members in February 2021, inviting one response per institution. Responses from 50 unique institutions in nine countries revealed 49/50 (98%) sites used ≥ 1 non-sedate practice, 48/50 (96%) sites in infants < 6months, and 11/50 (22%) for children aged 6months to 3years. Non-sedate practices per site averaged 4.5 (range 0-10), feed and swaddle used at 47/49 (96%) sites, and child life specialists at 35/49 (71%). Average success rates were moderate (> 50-75%) across all sites and high (> 75-100%) for 20% of sites, varying with specific techniques. Commonest barriers to use were scheduling conflicts and limited knowledge. Non-sedate practice utilization in pediatric MRI was near-universal but widely variable across sites, ages, and locales, with room for broader adoption. Although on average non-sedate practice success rates were similar, the range in use and outcomes suggest a need for standardized implementation guidelines, including patient selection and outcome metrics, to optimize utilization and inform educational initiatives.

Volume of the normal prostate gland in polish boys, aged 1–17 years: Based on transabdominal ultrasound – Prospective study

Until now, there are no established norms for prostate size in children. Prostate volume during development has been analyzed in small study groups. In diagnostic imaging, transabdominal ultrasound and magnetic resonance imaging are used. To establish prostate volume norms for individuals aged 1-17 years using transabdominal ultrasound. Between 2021 and 2023, transabdominal prostate ultrasound was performed on 482 Caucasian boys, aged 1-17 years, who were patients of the urology clinic. Normative data were based on results of 345 boys with normal lower urinary tract, urethral and penile structures. Patients with abnormal external genitalia, Prune Belly Syndrome, Myelomeningocele, chromosomal disorders, or prostate abnormalities found in ultrasound were excluded from the study. Patient eligibility was determined based on medical records and physical examinations. During ultrasound, height, anterior-posterior dimension, and width of prostate were assessed. Prostate volume was calculated using the ellipsoid formula VH x L(AP) x W x 0.523. Measurements were correlated with age, weight, and height. Results were analyzed using descriptive statistics, statistical significance tests for means, and correlation methods. After estimating preliminary results, taking into account the development periods, patients were divided into age groups: 1-4 years (n=70), 5-10 years (n=124), 11-12 years (n=43), 13-15 years (n=65), and 16-17 years (n=43). The table and nomogram shows prostate volumes based on age. Prostate size remains stable up to the age of 8. We noticed a transitional phase at the age of 8-11 years. A significant increase in volume occurs over 11 years of age. There was a statistically significant relationship between prostate size, age, height, and weight. Established norms can serve as a reference for prostate analysis in patients with defects of the genitourinary system. An interesting analysis would be a prostate size assessment in relation to stage of development on Tanner scale. Transabdominal ultrasound, being a non-invasive, painless, and readily accessible examination, allows assessment of prostate size even in boys aged 1 year old. A statistically significant relationship was found between prostate size, weight, and height. Norms for prostate size in boys were established according to age.

Artificial intelligence in radial diagnostics of breast cancer

Breast cancer (BC) ranks second in prevalence among all malignant tumors and is the most frequent cancer in women. This literature review details the introduction of artificial intelligence (AI) systems based on ultra-precise neural networks into clinical practice. This direction in diagnostic medicine is very promising, and in many ways can improve the existing and firmly entered into everyday practice methods of breast imaging. Such methods include mammography, ultrasound (USG) and magnetic resonance imaging (MRI). Mammography screening is an advanced tool for early detection of breast cancer, which has reduced the mortality rate from the disease by 30% in the last thirty years. Nevertheless, the method has potential drawbacks, including false positives and false negatives due to the phenomenon of tissue summation on a two-dimensional image, as well as the increased density of anatomical structures of the breast. Artificial intelligence systems are designed to improve and simplify this imaging method, reducing the time required for image interpretation. At present, these digital systems for their implementation in practice are not yet sufficiently studied, there are many errors and flaws in the interpretation of mammograms. The next widely used method of breast visualization is ultrasound. This method is able to detect neoplasms hidden by mammography in women with anatomically dense breast tissue structure, which makes it particularly useful in cancer diagnosis in women of reproductive age. However, ultrasound also has its disadvantages, among which stand out the operator-dependence of the method. Currently, the artificial intelligence system S-detect (2018, Samsung Medison) is actively used, which is able to interpret the image, automatically reading information in real time, thus increasing the effectiveness of ultrasound. The program has already demonstrated high sensitivity, specificity and accuracy (95.8%, 93.8%, 89.6%, respectively) in detecting benign and malignant breast masses in the trial phases from 2019. To date, there are no approved guidelines for the use of artificial intelligence programs in ultrasound diagnostics, with further research and evidence of the utility of such synergy required. Artificial intelligence programs combined with MRI diagnostics have also demonstrated increased efficiency and sensitivity of the method. However, false positives and false negatives (including missed pathology) have also been reported in this combination.&#x0D; A literature review of PubMed and Google Scholar article databases was performed. The focus was on full-text articles.

Autoimmune pancreatitis versus pancreatic cancer

Autoimmune pancreatitis (AIP) is classified as a distinct form of pancreatitis according to the guidelines. It is characterized by imaging morphologic and histologic features and is associated with extrapancreatic manifestations in type1 IgG4-associated disease. Symptoms and findings almost always improve with administration of steroids. Differentiation from pancreatic ductal adenocarcinoma is required, particularly in the presence of AIP with focal parenchymal involvement. If AIP is suspected, abdominal ultrasound and/or endosonography, computed tomography (CT), and preferably magnetic resonance imaging (MRI) are indicated. A distinction is made between parenchymal and ductal changes that specifically indicate the presence of AIP. The diagnosis of autoimmune pancreatitis should be made based on the International Consensus Criteria (ICDC), in which the five main features (imaging, serology, histology, other organ involvement, response to steroid medication) are assessed. In type1 AIP, typical imaging changes are sufficient to establish the diagnosis even with negative histology, whereas for type2 AIP, histologic evidence is required. Imaging changes help in the differential diagnosis from pancreatic cancer. The following article addresses and evaluates crucial imaging diagnostic CT and MRI criteria for correct classification of findings, description of results, and differentiation of autoimmune pancreatitis from pancreatic cancer.

Association of Emergency Department Evaluation With Public Insurance Use and Treatment Delays for ACL Injury.

Utilization of an emergency department (ED) visit for anterior cruciate ligament (ACL) injury is associated with high cost and diagnostic unreliability. Patients initially evaluated at an ED for an ACL injury would be more likely to be from a lower income quartile, use public insurance, and experience a delay in treatment. Cohort study; Level of evidence, 3. Patients in the Rhode Island All Payers Claims Database who underwent ACL reconstruction (ACLR) between 2012 and 2021 were identified using the Current Procedure Terminology (CPT) code 29888. Patients were stratified into 2 cohorts based on CPT codes for ED or in-office services within 1 year of ACLR. A chi-square analysis was used to test for differences between cohorts in patient and surgical characteristics. Multivariable linear and logistic regression were used to determine how ED evaluation affected timing and outcome variables. While adjusting for patient and operative characteristics, patients in the ED cohort were more likely to have Medicaid (29% vs 12.5%; P < .001) and be in the lowest income quartile (44.6% vs 32.1%; P < .001). ED visit and Medicaid status were associated with increased time to (1) diagnostic magnetic resonance imaging, adding 7.97 days on average (95% CI, 4.14-11.79 days; P < .001) and 8.40 days (95% CI, 3.44-13.37 days; P = .001), respectively; and (2) surgery, adding 20.30 days (95% CI, 14.10-26.49 days; P < .001) and 12.88 days (95% CI, 5.15-20.60 days; P = .001), respectively. Patients >40 years who were evaluated in the ED were 2.5 times more likely to require subsequent ACLR (odds ratio, 2.50 [95% CI, 1.01-6.21]; P = .049). In this study, patients who visited the ED within 1 year before ACLR were more likely to have a lower income, public insurance, increased time to diagnostic imaging, and increased time to surgery, as well as decreased postoperative physical therapy use and increased subsequent ACLR rates in the 40-49 years age-group.

Correlation between Diagnostic Magnetic Resonance Imaging Criteria and Cerebrospinal Fluid Pressure in Pediatric Idiopathic Intracranial Hypertension

Purpose: Idiopathic intracranial hypertension (IIH) is a clinical syndrome that mimics brain tumors with increased intracranial pressure. The present study is designed to investigate the diagnostic criteria of magnetic resonance imaging (MRI) and the severity of cerebrospinal fluid (CSF) pressure to understand the relationship and frequency of these criteria with the level of CSF pressure.Methods: The present cross-sectional study was conducted on children diagnosed with IIH between the years 2011 and 2020, who were admitted to the pediatric neurology department of Ghaem Hospital, Mashhad, Iran. Clinical manifestations and imaging findings of the patients were recorded through a checklist. Results: Forty-nine patients were included in the study; 27 (55.1%) were male, and 22 (44.9%) were female. The average CSF pressure was 40.64±20.63 cmH&lt;sub&gt;2&lt;/sub&gt;O. The mean diameter distension of the perioptic subarachnoid space was 6.02±1.21 mm. Six (10.8%) patients had unilateral transverse sinus stenosis with an average CSF pressure of 20.47±36.80 cmH&lt;sub&gt;2&lt;/sub&gt;O and 11 (21.4%) patients had bilateral transverse sinus stenosis with an average pressure of 48.22±21.04 cmH&lt;sub&gt;2&lt;/sub&gt;O. In 22 (44.89%) patients, flattening of the posterior globe with the CSF pressure of 48.80±17.94 cmH&lt;sub&gt;2&lt;/sub&gt;O was reported. Twenty-four (49%) patients had optic nerve tortuosity, with an average CSF pressure of 46.52±20.33 cmH&lt;sub&gt;2&lt;/sub&gt;O. Among the diagnostic criteria, the pressure had a significant relationship with the flattening of the posterior globe (&lt;i&gt;P&lt;/i&gt;&lt;0.022).Conclusion: Since MRI is a non-invasive method for examining IIH, the findings of this study may aid in diagnosing and monitoring these patients.

Case Series: Multiple Soft Tissue Lesions Demonstrated by Sonography and MRI Correlation

Varied diagnostic imaging techniques may often be used in tandem, to enhance and complement each other, when an initial imaging diagnosis appears equivocal. Diagnostic medical sonography and magnetic resonance imaging (MRI) are imaging techniques that often complement each another. Sonography is an excellent diagnostic technique to determine the consistency of a soft tissue mass (e.g., solid vs cystic), and its relationship to adjacent structures, size, and shape. Sonography is especially useful for evaluating palpable lumps and allows sonographers to perform targeted examinations around the area of interest. In addition, color and pulsed-wave Doppler enable further characterization of a lesion’s presence or lack of vascularity. Sonography can also guide core-needle biopsy of superficial lesions. However, sonography is less reliable for deep masses in large anatomical regions. The American College of Radiology recommends MRI for deeper lesions of this type. Magnetic resonance imaging is also recommended for soft tissue masses suspected to be localized to the peripheral nervous system.

Comparative Assessment of Echocardiography and Magnetic Resonance Imaging in the Evaluation of Structural Cardiopathies in Adults: A Comprehensive Analysis

Cardiovascular diseases, specifically structural cardiopathies, continue to pose a significant burden on global healthcare systems. The accurate assessment of these conditions in adults demands precise and reliable imaging modalities. This article presents a comprehensive exploration of the role of two prominent diagnostic tools, echocardiography and magnetic resonance imaging (MRI), in the evaluation of structural cardiopathies in the adult population. We scrutinize the clinical utility, advantages, limitations, and diagnostic accuracy of both imaging techniques, shedding light on their respective roles in the clinical decision-making process. Furthermore, we delve into recent advancements and emerging trends in echocardiography and MRI, highlighting the potential synergistic use of these modalities to optimize the diagnostic and therapeutic approach to structural cardiopathies in adults. The findings from this review will contribute to enhancing clinical practice and patient outcomes in the management of these intricate cardiovascular conditions.

Target Volumes Comparison between Postoperative Simulation MRI and Preoperative Diagnostic MRI for Prone Breast Radiotherapy after Breast-Conserving Surgery

To investigate the correlation and difference between target volumes determined by postoperative prone positioning magnetic resonance imaging (MRI) and preoperative prone diagnostic MRI for breast radiotherapy after breast-conserving surgery (BCS) based on deformable image registration (DIR). A total of 17 patients undergoing prone whole breast-irradiation after BCS were enrolled, all these patients were undergoing preoperative and postoperative prone MRI scans. The gross tumor volume (GTV) was delineated on the preoperative MRI images, then expanding 10 mm to simulate the preoperative lumpectomy cavity (LC). The LC were expended to clinical target volume (CTV), and planning target volume (PTV) on preoperative and postoperative MRI sequences, respectively. Preoperative and postoperative MRI was registered based on DIR by a commercially available software system. The target volume, the distance between the centers of mass (dCOM), conformity index (CI), degree of inclusion (DI) were compared to explore the target volume variation for pre- and post-surgery delineation. And evaluated the relationship between CILC/CIPTV and clinical factors. The volume of GTVpre was 3.05cm3(range, 1-23.63cm3). The median volume of LCpre were 26.84 cm3 (range, 11.75-102.28 cm3). 0.85cm3 smaller than the LCpre, the LCpost were 25.99 cm3 (range, 5.98-41.95) (P = 0.04). The dCOM, CI, and DI between LCpre and LCpost were 1.371cm (range, 0.533-5.447), 0.221 (range, 0.041-0.516), and 0.472 (range, 0.108-0.804). There was no significant statistically difference between PTVpre and PTVpost (120.73cm3 vs 131.67cm3, p = 0.723). Compared with LC, the CI and DI between PTVpre and PTVpost were increased to 0.446 (range, 0.233-0.700), 0.636 (range, 0.362-0.834), respectively. Meanwhile, the dCOM was reduced to 1.239cm (range, 0.413-3.642). There was no obvious linear correlation between the CI with the GTV volume, the ratio of the primary tumor volume to the breast volume, the distance from the primary tumor to the nipple and chest wall, and the Body Mass Index (BMI), respectively. For prone breast irradiation, even based on DIR, the spatial correspondence of the target volumes between preoperative and postoperative MRI images were still poor. Therefore, it is not reasonable to delineate postoperative LC refer to preoperative diagnostic MRI based on DIR. Preoperative MRI also cannot provide individualized guidance for LC delineation according to tailored patient.

Magnetic resonance spectroscopy (MRS) of multifidus muscle metabolites in chronic low back pain (CLBP).

The purpose of the study was to investigate several potential imaging biomarkers of CLBP that may be useful for diagnosis and treatment efficacy evaluation. Proton magnetic resonance spectroscopy (1H-MRS) was used to detect the content and ratio of creatine (Cr), choline (Cho), and lipid (Lip) in the multifidus muscle (Mm) in patients with CLBP and to test for relationships between these metabolites and pain severity and duration. Sixty patients with CLBP (experimental group) and sixty-nine asymptomatic volunteers (control group) underwent routine diagnostic magnetic resonance imaging of the lumbar spine. 1H-MRS was acquired with single-voxel MR spectroscopy. The MRS region of interest for measuring Cho, Cr, and Lip concentrations was determined at the L4/5 multifidus muscle (Mm), bilaterally. The contents and ratios of Cr, Cho, and Lip in bilateral and ipsilateral-to-pain (or matched control side) Mm were obtained, and the integral ratios of different metabolites obtained by using Cr as an internal reference were statistically analyzed. There were no significant within-group differences in the contents and ratios of Lip, Cr, Cho, Lip/Cr, and Cho/Cr between the left and right Mm of the healthy control group (p > 0.05) or the CLBP group (p > 0.05). The CLBP group showed a much higher Lip and Lip/Cr ratio in the bilateral Mm compared to the healthy control group (p < 0.05) but there were no between-group differences in Cr, Cho, or the Cho/Cr ratio (p > 0.05). The severity of CLBP was correlated with Lip (p < 0.05). Using 1H-MRS, we demonstrated higher Lip and Lip/Cr ratios in the Mm of patients with CLBP, compared to asymptomatic controls. Mm Lip was correlated with CLBP intensity. An increase in Lip in the Mm may be a characteristic finding in CLBP and may offer a useful prognostic marker for guiding rehabilitation strategies.