MRI Evaluation Research Articles

E073 The use of magnetic resonance imaging to assess disease activity in axial spondyloarthritis- data from a tertiary rheumatology centre

Abstract Background/Aims The role of MRI of the spine and sacroiliac joints to aid the diagnosis of axial spondyloarthritis (axSpA) is now well established. However, its utility in disease monitoring, in particular assessment of treatment non-response is unclear with limited and conflicting data on the relationship between inflammatory changes suggestive of disease activity on MRI and outcome measures such as ASDAS-CRP and BASDAI. Although the most recent ASAS/EULAR guidelines recommend against routine use of MRI in the assessment of treatment response in axSpA, this is a pragmatic approach often undertaken in NHS clinics with substantial cost implications. We aimed to explore the current use of MRI to assess disease activity in axSpA in a large tertiary centre, in particular its utility in exploring treatment non-response and its impact on treatment switching decision. Methods As part of a service evaluation audit, MRIs performed under the “inflammatory back pain protocol” at Leeds Teaching Hospitals Trust between December 2021 and May 2023 were identified from radiology request data. Patients with axial spondyloarthritis (nr-axSpA, r-axSpA or axial psoriatic spondyloarthritis [axPsA]), were identified. Demographic data, baseline MRI findings, current medications, repeat MRI findings for ongoing axial symptoms, outcome measures and inflammatory markers were extracted from the clinical notes. Data on MRI findings consistent with inflammatory or structural changes related to axSpA or alternative findings, were extracted from the radiologist’s report. Results Overall, 111 patients had an MRI to assess disease activity, 93 had axSpA (49 r-axSpA, 44 nr-axSpA) and 18 axPsA. Patients were predominantly male (58.5%) and HLA-B27 positive (65.8%), 25.2% and 27.9% current smokers and ex-smokers respectively. A history of psoriasis was documented in 25.2% and peripheral arthritis in 42.3%. Baseline MRI was available on 76 patients (68.9%), of which 61 (80.3%) had spinal or sacroiliac inflammation as per the radiologist report. In total, 79 patients were on bDMARD therapy, with TNFi the commonest class (n = 59, 52.7%). Repeat MRI demonstrated active inflammation in the spine or sacroiliac joints in 58.6% (n = 65) as per the radiologist report. Patients with active inflammation in the repeat scan were more likely to have their bDMARD switched or treatment escalated (54% vs 36%). Other important findings included spinal stenosis (n = 4), disc disease (n = 15), vertebral fractures (n = 2) and potential malignancy (n = 1). Conclusion In our practice, MRI is of utility in the monitoring and assessment of non-response in axSpA in two-thirds of cases, aiding treatment decision making by leading to a switch of bDMARD in half of patients and excluding alternative pathologies, such as vertebral fractures and disc disease which may also affect components of disease activity scores. Further research exploring association of MR findings with clinical outcomes, including economic evaluation of routine MRI to assess disease activity in axSpA is warranted. Disclosure J. Weddell: None. R. Shah: None. P. Robinson: None. A. Barr: None. C. Vandevelde: None. J. Freeston: None. D. McGonagle: None. H. Marzo-Ortega: None.

The predictive value of MRI scores for neurodevelopmental outcome in infants with neonatal encephalopathy.

MRI scoring systems are utilized to quantify brain injury and predict outcome in infants with neonatal encephalopathy (NE). Our aim was to evaluate the predictive accuracy of total scores, white matter (WM) and grey matter (GM) subscores of Barkovich and Weeke scoring systems for neurodevelopmental outcome at 2 years of age in infants receiving therapeutic hypothermia for NE. Data of 162 infants were analyzed in this retrospective cohort study. DeLong tests were used to compare areas under the curve of corresponding items of the two scoring systems. LASSO logistic regression was carried out to evaluate the association between MRI scores and adverse composite (death or severe disabilities), motor and cognitive outcomes (Bayley developmental index <70). Weeke scores predicted each outcome measure with greater accuracy than the corresponding items of Barkovich system (DeLong tests p < 0.03). Total scores, GM and cerebellum involvement were associated with increased odds for adverse outcomes, in contrast to WM injury, after adjustment to 5' Apgar score, first postnatal lactate and aEEG normalization within 48 h. A more detailed scoring system had better predictive value for adverse outcome. GM injury graded on both scoring systems was an independent predictor of each outcome measure. A more detailed MRI scoring system had a better predictive value for motor, cognitive and composite outcomes. While hypoxic-ischemic brain injuries in the deep grey matter and cerebellum were predictive of adverse outcome, white matter injury including cortical involvement was not associated with any of the outcome measures at 2 years of age. Structured MRI evaluation based on validated scores may aid future clinical research, as well as inform parents and caregivers to optimize care beyond the neonatal period.

Imaging features of perinephric myxoid pseudotumors of fat.

Retrospectively evaluate multimodality imaging features of perinephric myxoid pseudotumor of fat (PMPTF). Institutional cases of PMPTF with CT, MRI and/or ultrasound evaluation from 1/1/2020 to 9/1/2023 were retrospectively reviewed. Patient demographics and clinical history were reviewed, and imaging features recorded. 14 patients with pathologically-proven PMPTF were identified (11M, 3 F; mean age 66.7 ± 17.0years; range 40-87years). Three patients (18%) had bilateral lesions; a total of 17 PMPTFs were reviewed. 15/17 (88%) were biopsy-proven; two cases were diagnosed by imaging only in patients with a contralateral biopsy-proven PMPTF. All evaluable specimens were negative for MDM2 amplification. 11/17 (65%) occurred in patients with renal disease, including 4/17 (24%) in patients with renal transplant. 100% (17/17) had CT, 11/17 (65%) MRI, and 6/17 (35%) ultrasound. The mean largest lesion dimension was 10.9 ± 4.6cm (range 4.3-17.0cm). Of cases involving native kidneys, 7/13 (54%) presented as multifocal perinephric masses and 5/13 (38%) as a solitary perinephric mass. All four transplant cases presented as infiltrative-appearing masses involving the renal sinus with lesser perinephric involvement. 14/17 (82%) lesions contained macroscopic fat on CT and MRI and 3/17 (18%) showed no macroscopic fat, all involving renal transplants. All cases with MRI demonstrated T2 hyperintensity with signal dropout on opposed-phase imaging. 11/13 (85%) PMPTF showed no or equivocal CT enhancement. Enhancement was better seen on MRI in all cases evaluated by both CT and MRI. Of the six PMPTFs imaged by ultrasound, four (67%) were heterogeneously hypoechoic and two (33%) had mixed regions of hypo-, iso- and hyperechogenicity relative to adjacent renal parenchyma. PMPTF is a rare, benign, and underrecognized lesion that may mimic malignancy, particularly retroperitoneal well-differentiated liposarcoma. The imaging features of this unusual pseudosarcoma differ in native and transplanted kidneys. Improved awareness of this entity will facilitate appropriate patient management and avoid unnecessary intervention.

Cardiac MRI evaluation of aortic biophysical properties in paediatric Turner syndrome.

Aortopathy in Turner syndrome is associated with aortic dilation, and the risk of dissection is increased when the aortic size index is ≥ 2-2.5 cm/m2. We evaluated the aortic biophysical properties in paediatric Turner syndrome using cardiac MRI to determine their relationship to aortic size index. Turner syndrome patients underwent cardiac MRI to evaluate ventricular function, aortic dimensions, and biophysical properties (aortic stiffness index, compliance, distensibility, pulse wave velocity, and aortic and left ventricular elastance). Spearman correlation examined correlations between these properties and aortic size index. Data was compared to 10 controls. Of 25 Turner syndrome patients, median age 14.7 years (interquartile range: 11.0-16.8), height z score -2.7 (interquartile range: -2.92 - -1.54), 24% had a bicuspid aortic valve. Turner syndrome had increased diastolic blood pressure (p < 0.001) and decreased left ventricular end-diastolic (p < 0.001) and end-systolic (p = 0.002) volumes compared to controls. Median aortic size index was 1.81 cm/m2 (interquartile range: 1.45-2.1) and 7 had an aortic size index > 2 cm/m2. Aortic and left ventricular elastance were greater in Turner syndrome compared to controls (both p < 0.001). Increased aortic size index correlated with increased aortic elastance (r = 0.5, p = 0.01) and left ventricular elastance (r = 0.59, p = 0.002) but not aortic compliance. Higher ascending aortic areas were associated with increased aortic compliance (r = 0.44, p = 0.03) and left ventricular elastance (r = 0.49, p = 0.01). Paediatric Turner syndrome with similar aortic size index to controls showed MRI evidence of abnormal aortic biophysical properties. These findings point to an underlying aortopathy and provide additional parameters that may aid in determining risk factors for aortic dissection.

MRI findings correlate with difficult dissection during proximal hamstring repair and with postoperative sciatica.

This study examines the correlation between MRI findings and difficult dissection during proximal primary hamstring repair and postoperative sciatica. A total of 32 cases of surgically repaired hamstring tendon tears that underwent preoperative and postoperative MRI were divided into sciatica (n = 12) and control (n = 20) groups based on the presence or absence of postoperative sciatica. Cases were scored by two blinded musculoskeletal radiologists for imaging features associated with difficult surgical dissection and the development of subsequent sciatica. Intra- and interrater agreements, as well as correlation of MRI findings with symptoms (odds ratio, OR), were calculated. On preoperative MRI, diffuse hamstring muscle edema pattern suggestive of active denervation (OR 9.4-13.6), and greater sciatic perineural scar circumference (OR 1.9-2) and length (OR 1.2-1.3) were significantly correlated with both difficult dissection and postoperative sciatica. Preoperatively, a greater number of tendons torn (OR 3.3), greater tear cross-sectional area (CSA, OR 1.03), and increased nerve T2-weighted signal (OR 3.2) and greater perineural scar thickness (OR 1.7) were also associated with difficult dissection, but not postoperative sciatica. On postoperative MRI, hamstring denervation, sciatic nerve tethering to the hamstring tendon, and development of perineural scar and greater perineural scar extent were all significantly correlated with postoperative sciatica. Preoperative hamstring MRI demonstrates findings predictive of difficult sciatic nerve dissection; careful MRI evaluation of the nerve and for the presence and extent of perineural scar is important for preoperative planning. Preoperative and postoperative MRI both depict findings that correlate with postoperative sciatica.

Do MRI Results Represent Functional Outcomes Following Arthroscopic Repair of an Isolated Meniscus Tear in Young Patients?-A Prospective Comparative Cohort Study.

The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in young patients. A total of 35 patients under 18 years old who underwent isolated meniscus repair were included. The Pedi-IKDC score, Lysholm score, and Tegner activity index (TAS) were compared between the groups formed according to the Stroller and Crues three-grade classification of postoperative MRI-based evaluations. Grade 3 MRI views were classified as unhealed, grade 2 as partially healed, and grade 1 as fully healed within the repaired meniscus, whereas grade 3 cases were considered unsuccessful due to MRI evaluation. MRI assessment revealed 4 cases of grade 1 (11.4%), 14 cases of grade 2 (40.8%), and 17 cases of grade 3 (48.0%) lesions. Pedi-IKDC and TAS scores were significantly higher among MRI grade 2 patients than among MRI grade 3 patients (p < 0.05). Weak negative correlations between MRI grades and all functional scales were found (p < 0.05). ROC analysis showed that Pedi-IKDC and TAS scores could correctly classify 77% and 71% of MRI grade 3 patients, respectively. The optimal cut-off values to detect grade 3 patients were 88.74 for the Pedi-IKDC score and 4.5 for the TAS score. To conclude, established functional score cut-off values may help identify unhealed meniscus repair patients.

Evaluation of multi-parameter MRI in preoperative staging of endometrial carcinoma

BackgroundEndometrial carcinoma (EC) is a prevalent gynecological malignancy, necessitating accurate preoperative staging for effective treatment planning. This study explores the application value of multi-parameter MRI in diagnosing and staging endometrial cancer. MethodsSeventy-six patients diagnosed with endometrial cancer underwent 3.0 T pelvic MRI within two weeks before surgery. Imaging data were analyzed based on FIGO clinical staging criteria. The study assessed the sensitivity, specificity, positive predictive value, and negative predictive value of MRI for each stage. ResultsPostoperative pathology confirmed 71 cases of endometrial adenocarcinoma, 3 serous adenocarcinoma, and 2 clear cell carcinomas. MRI staging showed a high consistency (Kappa value = 0.786) with postoperative pathology. The overall accuracy of MRI diagnosis was 86.8%. Sensitivity and specificity varied for each stage: IA (91.3%, 96.2%), IB (88.6%, 93.8%), II (97.4%, 89.2%), and III (84.2%, 100%). ConclusionWhile there was a slight misdiagnosis rate, the overall accuracy of preoperative MRI for endometrial cancer was high, aiding in precise diagnosis and clinical staging. MRI effectively identified myometrial infiltration, cervical involvement, paracentral extension, and lymph node metastasis. Further research with larger sample sizes is recommended for enhanced reliability.

Longitudinal changes in medial meniscus extrusion and clinical outcomes following pullout repair for medial meniscus posterior root tears: a 3-year evaluation

PurposeWe aimed to evaluate the longitudinal changes in medial meniscus extrusion (MME) and clinical scores at multiple time points up to 3 years after pullout repair for medial meniscus posterior root tears (MMPRTs).MethodsThis retrospective case series study included 64 patients who underwent pullout repair for MMPRTs and four MRI evaluations (preoperatively and at 3 months, 1 year, and 3 years postoperatively). MME was measured during the same time points. Clinical scores were assessed four times: preoperatively and at 1, 2, and 3 years postoperatively. Additionally, a multivariate analysis was performed on the change in MME (ΔMME) from the preoperative measurement point to 3 years postoperatively.ResultsThe ΔMME per month from the preoperative measurement point to 3 months postoperatively, from 3 months to 1 year postoperatively, and from 1 to 3 years postoperatively were 0.30, 0.05, and 0.01 mm/month, respectively. All clinical scores significantly improved 3 years postoperatively (p < 0.001). In a multiple regression analysis for ΔMME from the preoperative measurement point to 3 years postoperatively, sex significantly affected the outcome (p = 0.039).ConclusionFollowing pullout repair for MMPRTs with well-aligned lower extremities, although MME progression could not be entirely prevented, the rate of progression decreased over time, and clinical scores improved. In particular, MME progressed markedly during the first 3 months postoperatively. Additionally, sex had a significant influence on MME progression, suggesting that males may be able to expand the indications of pullout repair for MMPRTs.

MRI-Based Cell Tracking of OATP-Expressing Cell Transplants by Pre-Labeling with Gd-EOB-DTPA.

A critical step in cell-based therapies is determining the exact position of transplanted cells immediately post-transplant. Here, we devised a method to detect cell transplants immediately post-transplant, using a clinical gadolinium-based contrast agent. These cells were detected as hyperintense signals using a clinically familiar T1-weighted MRI protocol. HEK293 cells were stably transduced to express human OATP1B3, a hepatic organic anion transporting polypeptide that transports Gd-EOB-DTPA into cells that express the transporters, the intracellular accumulation of which cells causes signal enhancement on T1-weighted MRI. Cells were pre-labeled prior to injection in media containing Gd-EOB-DTPA for MRI evaluation and indocyanine green for cryofluorescence tomography validation. Labeled cells were injected into chicken hearts, in vitro, after which MRI and cryofluorescence tomography were performed in sequence. OATP1B3-expressing cells had substantially reduced T1 following labeling with Gd-EOB-DTPA in culture. Following their implantation into chicken heart, these cells were robustly identified in T1-weighted MRI, with image-derived injection volumes of cells commensurate with intended injection volumes. Cryofluorescence tomography showed that the areas of signal enhancement in MRI overlapped with areas of indocyanine green signal, indicating that MRI signal enhancement was due to the transplanted cells. OATP1B3-expressing cells can be pre-labeled with Gd-EOB-DTPA prior to injection into tissue, affording the use of clinically familiar T1-weighted MRI to robustly detect cell transplants immediately after transplant. This procedure is easily generalizable and has potential advantages over the use of iron oxide based cell labeling agents and imaging procedures.

Validity of an ultrasonographic joint-specific scoring system in juvenile idiopathic arthritis: a cross-sectional study comparing ultrasound findings of synovitis with whole-body magnetic resonance imaging and clinical assessment

ObjectiveTo assess the validity of an ultrasonographic scoring system in juvenile idiopathic arthritis (JIA) by comparing ultrasound detected synovitis with whole-body MRI and clinical assessment of disease activity.MethodsIn a cross-sectional...

Multiparametric Quantitative MRI Evaluation of Changes in Brain Myelin Content after the First Course of Chemotherapy

Objective. Quantitative assessment of changes in brain myelin content after the first course of chemotherapyMaterials and Methods. T1 and T2 maps as well as myelin water fraction (MWF) and macromolecular proton fraction (MPF) maps, reflecting myelin content, were acquired in 6 patients (mean age — 13.7 ± 2.4 years) before and after the first course of chemotherapy. The study was carried out using on 3T MRI scanner. Statistical data processing was carried out using the GraphPad Prism.Results. MPF and T2 values showed an increase in the thalamus and white matter of the occipital lobes of the brain, while MWF values showed an increase in the cerebellum and a decline in the white matter of the frontal lobes. Significant changes were not found for T1 values.Discussion. According to MWF the structures of the brain which are primarily affected by treatment with toxic drugs — the white matter of the frontal lobes and the cerebellum, were revealed. MWF values decreasing in the white matter of the frontal lobes may indicate the process of demyelination in this area, while increased MWF values in the cerebellum could be caused either by remyelination processes or by incomplete cleansing of myelin residues accumulation by macrophages at the site of degeneration. Conclusion. The results obtained demonstrated high potential of MWF values serve as early changes biomarker of neurotoxicity after the chemotherapy treatment. Along with this, the MPF index, which is more sensitive to cerebral edema, may be a predictor of demyelination.

Perivascular spaces and where to find them - MR imaging and evaluation methods.

Perivascular spaces (synonym: Virchow-Robin spaces) were first described over 150 years ago. They are defined as the fluid-filled spaces surrounding the small penetrating cerebral vessels. They gained growing scientific interest especially with the postulation of the so-called glymphatic system and their possible role in neurodegenerative and neuroinflammatory diseases. PubMed was used for a systematic search with a focus on literature regarding MRI imaging and evaluation methods of perivascular spaces. Studies on human in-vivo imaging were included with a focus on studies involving healthy populations. No time frame was set. The nomenclature in the literature is very heterogeneous with terms like "large", "dilated", "enlarged" perivascular spaces whereas borders and definitions often remain unclear. This work generally talks about perivascular spaces. This review article discusses the morphologic MRI characteristics in different sequences. With the continual improvement of image quality, more and tinier structures can be depicted in detail. Visual analysis and semi or fully automated segmentation methods are briefly discussed. If they are looked for, perivascular spaces are apparent in basically every cranial MRI examination. Their physiologic or pathologic value is still under debate. · Perivascular spaces can be seen in basically every cranial MRI examination.. · Primarily T2-weighend sequences are used for visual analysis. Additional sequences are helpful for distinction from their differential diagnoses.. · There are promising approaches for the semi or fully automated segmentation of perivascular spaces with the possibility to collect more quantitative parameters.. · Seehafer S, Larsen N, Aludin S et al. Perivascular spaces andwhere to find them - MRI imaging and evaluation methods. Fortschr Röntgenstr 2024; 196: 1029 - 1036.

Quantitative MRI Evaluation of Ferritin Overexpression in Non-Small-Cell Lung Cancer.

Cancer cells frequently present elevated intracellular iron levels, which are thought to facilitate an enhanced proliferative capacity. Targeting iron metabolism within cancer cells presents an avenue to enhance therapeutic responses, necessitating the use of non-invasive models to modulate iron manipulation to predict responses. Moreover, the ubiquitous nature of iron necessitates the development of unique, non-invasive markers of metabolic disruptions to develop more personalized approaches and enhance the clinical utility of these approaches. Ferritin, an iron storage enzyme that is often upregulated as a response to iron accumulation, plays a central role in iron metabolism and has been frequently associated with unfavorable clinical outcomes in cancer. Herein, we demonstrate the successful utility, validation, and functionality of a doxycycline-inducible ferritin heavy chain (FtH) overexpression model in H1299T non-small-cell lung cancer (NSCLC) cells. Treatment with doxycycline increased the protein expression of FtH with a corresponding decrease in labile iron in vitro and in vivo, as determined by calcein-AM staining and EPR, respectively. Moreover, a subsequent increase in TfR expression was observed. Furthermore, T2* MR mapping effectively detected FtH expression in our in vivo model. These results demonstrate that T2* relaxation times can be used to monitor changes in FtH expression in tumors with bidirectional correlations depending on the model system. Overall, this study describes the development of an FtH overexpression NSCLC model and its correlation with T2* mapping for potential use in patients to interrogate iron metabolic alterations and predict clinical outcomes.

A Rare Case Report of an Isolated Avulsion Fracture of Gerdy's Tubercle

We report a case of en bloc avulsion fracture of tibial tuberosity and Gerdy's tubercle. A 40 -year-old male suffered from an acute pain in his left knee after a motorcycle accident. Simple radiographs showed an avulsion of the tibial tuberosity. Confirmed by CT scans. MRI evaluation revealed no intra-articular associated pathology. Open reduction and internal fixation with 1 screws were performed under antero-lateral approach to expose the Gerdy's tubercle with ITB. At 2 months postoperative, he could walk and complained of no difficulty in activities on daily living with full range-of-motion of the knee. We believe that the injury was caused by violent contraction of the tensor fascia lata or gluteus maximus. Preoperative planning including the determination of the extent of fracture and recognition of concomitant injury is a prerequisite for appropriate treatment.

Quantitative fetal MRI with diffusion tensor imaging in cases with 'short' corpus callosum.

It has been suggested previously that the presence of Probst bundles (PB) in cases with a short corpus callosum (SCC) on diffusion tensor imaging (DTI) may help to differentiate between corpus callosal (CC) dysplasia and a variant of normal CC development. The objectives of this study were to compare DTI parameters between cases of SCC vs normal CC and between cases of SCC with PB (SCC-PB+) vs SCC without PB (SCC-PB-). This was a retrospective study of patients referred to the Necker Hospital in Paris, France, for magnetic resonance imaging (MRI) evaluation of an apparently isolated SCC detected by sonography between November 2016 and December 2022 (IRB: 00011928). MRI was performed using a 1.5-Tesla Signa system. T2-weighted axial and sagittal sequences of the fetal brain were used to measure the length and thickness of the CC. 16-direction DTI axial brain sequences were performed to identify the presence of PB and to generate quantitative imaging parameters (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) of the entire CC, genu, body and splenium. Cases in which other associated brain abnormalities were detected on MRI were excluded. Cases were matched for fetal gender and gestational age with controls in a 1:3 ratio. Control cases were normal fetuses included in the LUMIERE on the FETUS trial (NCT04142606) that underwent the same DTI evaluation of the brain. Comparisons between SCC and normal CC cases, and between SCC-PB+ and SCC-PB- cases were performed using ANOVA and adjusted for potential confounders using ANCOVA. Twenty-two SCC cases were included and compared with 66 fetuses with a normal CC. In 10/22 (45.5%) cases of SCC, PB were identified. As expected, dimensions of the CC were significantly smaller in SCC compared with normal CC cases (all P < 0.01). In SCC-PB+ vs SCC-PB- cases, FA values were significantly lower in the entire CC (median, 0.21 (range, 0.19-0.24) vs 0.24 (range, 0.22-0.28); P < 0.01), genu (median, 0.21 (range, 0.15-0.29) vs 0.24 (range, 0.17-0.29); P = 0.04), body (median, 0.21 (range, 0.18-0.23) vs 0.23 (range, 0.21-0.27); P = 0.04) and splenium (median, 0.22 (range, 0.16-0.30) vs 0.25 (range, 0.20-0.29); P = 0.03). ADC values were significantly higher in the entire CC, genu and body in SCC-PB+ vs SCC-PB- cases (all P < 0.05). In SCC-PB+ cases, all FA values were significantly lower, and ADC values in the CC body were significantly higher compared with normal CC cases (all P < 0.05). In SCC-PB- cases, there was no significant difference in FA and ADC compared with normal CC cases (all P > 0.05). Fetal DTI evaluation of the CC showed that FA values were significantly lower and ADC values tended to be significantly higher in SCC-PB+ compared with normal CC cases. This may highlight alterations of the white matter microstructure in SCC-PB+. In contrast, isolated SCC-PB- did not demonstrate significant changes in DTI parameters, strengthening the possibility that this is a normal CC variant. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Medial Pterygoid Abscess Masquerading as a Temporomandibular Joint Disorder: A Case Report.

A patient presenting with a history of restricted mouth opening and deflection of the mandible after a prolonged dental procedure raises a suspicion of temporomandibular joint disorder (TMD) due to its estimated high prevalence of 29%. Muscle relaxants and routine active physiotherapy established normal range of movement and pain reduction was achieved through TENS therapy and analgesics. However, the non-subsidence of deflection prompted an initial suspicion of TMD which was overturned by MRI. The MRI evaluation revealed left side medial pterygoid abscess. It is imperative to understand that despite strong history and relevant clinical features, for the definitive diagnosis radiographic evaluation is highly contributory. Misdiagnosing TMD due to its similar presentation can have significant implications for the patient's well-being and quality of life. The clinical features of medial pterygoid abscess including restricted mouth opening and pain can be similar to that of TMD. These abscesses are most commonly caused by odontogenic infections but can also occur as a result of septic inferior alveolar nerve block techniques. Limited literature reports of pterygoid space abscess have been described, but intramuscular and medial pterygoid abscess is an absolute rarity. Causal relationship to septic inferior alveolar nerve block further makes this case report an interesting read.

The Prognostic Role of Volumetric MRI Evaluation in the Surgical Treatment of Glioblastoma

Background: Glioblastoma is the most common primary brain neoplasm in adults, with a poor prognosis despite a constant effort to improve patient survival. Some neuroradiological volumetric parameters seem to play a predictive role in overall survival (OS) and progression-free survival (PFS). The aim of this study was to analyze the impact of the volumetric areas of contrast-enhancing tumors and perineoplastic edema on the survival of patients treated for glioblastoma. Methods: A series of 87 patients who underwent surgery was retrospectively analyzed; OS and PFS were considered the end points of the study. For each patient, a multidisciplinary revision was conducted in collaboration with the Neuroradiology and Neuro-Oncology Board. Manual and semiautomatic measurements were adopted to perform the radiological evaluation, and the following quantitative parameters were retrospectively analyzed: contrast enhancement preoperative tumor volume (CE-PTV), contrast enhancement postoperative tumor volume (CE-RTV), edema/infiltration preoperative volume (T2/FLAIR-PV), edema/infiltration postoperative volume (T2/FLAIR-RV), necrosis volume inside the tumor (NV), and total tumor volume including necrosis (TV). Results: The median OS value was 9 months, and the median PFS value was 4 months; the mean values were 12.3 and 6.9 months, respectively. Multivariate analysis showed that the OS-related factors were adjuvant chemoradiotherapy (p &lt; 0.0001), CE-PTV &lt; 15 cm3 (p = 0.03), surgical resection &gt; 95% (p = 0.004), and the presence of a “pseudocapsulated” radiological morphology (p = 0.04). Conclusions: Maximal safe resection is one of the most relevant predictive factors for patient survival. Semiautomatic preoperative MRI evaluation could play a key role in prognostically categorizing these tumors.

Effectiveness of Magnetic Resonance Imaging/Ultrasound-guided Target Biopsy in Detecting Clinically Significant Prostate Cancer.

To evaluate the effectiveness of magnetic resonance imaging/ultrasound (MRI-US)-guided fusion biopsy in the detection of clinically significant prostate cancer (CSPC) and analyze the clinical features of patients highly suspected of having prostate cancer (PCa) but shown to be negative in target biopsies (TB) among patients with prostate imaging reporting and data system (PI-RADS) 4 or 5 lesions on multiparametric MRI (mpMRI) evaluations. We retrospectively evaluated all patients who underwent MRI/transrectal ultrasound (TRUS)-guided fusion biopsies at our institution between April 2018 and April 2022. All patients with at least one PI-RADS 3 or higher lesion and prostate-specific antigen (PSA) ≤20 ng/ml were enrolled in our study and subjected to TB in the region of interest (ROI). CSPC was defined as grade group (GG) ≥2 (equivalent to a Gleason score of 3+4). The detection rates of CSPC were higher in patients who underwent systematic biopsy (SB) and TB (54%; 177/328) than in those who underwent SB alone (39%; 128/328). Significant differences were noted in the detection of CSPC depending on age, prostate volume, PI-RADS score, PSA density (PSAD), number of biopsies obtained, lesion location, and ROI. MRI/TRUS-guided fusion prostate biopsy increased the detection rate of CSPC. PCa was less likely to be detected in patients with a low PSAD, large prostate volume and no family history among those with PI-RADS 4 or 5 lesions and should be considered in such patients and addressed by performing additional SB for improving CSPC detection rate.

Patients with Bilateral ACL Reconstruction (ACLR) have 3x the Rate of Posterior Tibial Slope Greater than 12-Degrees Compared to Unilateral ACLR: MRI and Radiographic Evaluation

Objectives: Increased posterior tibial slope (PTS) is a risk factor for primary anterior cruciate ligament (ACL) tear and graft failure, but PTS has not been well-defined in those who have experienced bilateral ACL injuries. We aimed to compare PTS angles, as well as the rate of elevated PTS (&gt;12° on lateral radiograph; &gt;7° on MRI), between patients who underwent bilateral ACL reconstruction (ACLR) vs unilateral ACLR. A secondary purpose was to examine whether these associations remained consistent on both plain radiographs and MRIs. Methods: We retrospectively identified patients who underwent primary ACLR at our institution from the years 2012 to 2020. Patients with non-simultaneous bilateral ACLR (n=53) were propensity matched to those with unilateral ACLR (n=53) by age, sex, and BMI. Exclusion criteria were: rotated lateral radiographs, inadequate quality MRI, concomitant ligament injury or fracture. Unilateral ACLRs with less than 5-year follow-up were further excluded. Three blinded readers measured PTS on lateral radiographs, while medial (MPTS) and lateral PTS (LPTS) were measured on MRI. Bivariate regression was performed to determine correlation between radiograph and MRI measurements. Results: A final cohort of 106 patients was analyzed (mean age: 27.4 ± 10.5 years, 49.1% male, BMI: 25.5 ± 4.3). PTS in the bilateral ACLR cohort was significantly greater than the unilateral ACLR cohort on radiographs (11.26° vs 10.13°, p=0.044) and LPTS (7.32° vs 6.08°, p=0.012), but not MPTS (4.55° vs 4.17°, p=0.467). The percentage of bilateral patients with radiograph PTS &gt;12° was 41.0%, compared to 13.2% in unilateral cohort (p=0.012). The bilateral cohort had a significantly greater rate of LPTS &gt;7° compared to unilateral patients (53.8% vs 32.1%, p=0.016), but not MPTS (p=0.467). On MRI, LPTS (5.93° ± 3.20°) was significantly greater than MPTS (5.12° ± 2.78°, p&lt;0.001). There was weak correlation between MPTS-radiograph ( R=0.24, p=0.02) and LPTS-radiograph was not significantly correlated ( R=0.03, p=0.810). Conclusions: Patients who underwent bilateral ACLR had significantly greater PTS on radiographs and LPTS on MRI compared to those with unilateral ACLR. The rate of PTS &gt;12° was 3.1x greater among bilateral ACLR compared to unilateral ACLR. PTS measurements on radiographs demonstrated weak-to-negligible correlation with MRI measurements, suggesting future normative PTS values should be reported specific to the imaging modality.

Evaluation of Brain MRI Findings in Patients Referred with Seizures

Introduction: Seizures are one of the common and warning signs of brain diseases, which doctors often use CT-scan or MRI for diagnose. The present study was conducted with the aim of evaluation of brain MRI of the patients referred with seizures in order to determine their brain lesions and involvement.&#x0D; Methods: The study was carried out using a retrospective cross-sectional descriptive method. All the patients with seizures referred for MRI to the Radiology Department of Shahid Sadoughi Hospital in Yazd City, Iran during 2016-2020 were examined. By referring to the archives of the radiology department, the records and MRI of the patients referred with seizures were extracted. Then, the data were extracted from the Hospital Information System and the patients' files; after that they were analyzed with SPSS version 16.&#x0D; Results: The present study was conducted on 105 patients with seizures for brain MRI. 48.6% (51 people) of patients were male and 51.4% (54 people) were female. The average age of the patients was 34.17 ± 10.50 years. MRI was normal in 59% of the patients. 16.2% Non-Specific, 6.7% Mass and 4.8% evidence of Encephalomalacia were also reported. The most lesions with 10.5% were related to left frontal lobe and 2.9% were related to right frontal lobe. 99% of seizures were unspecified convulsion and 1% were postprocedural disorder of nervous system. There was no significant relationship between the gender of the patients and their diagnosis (P&gt;0.471).&#x0D; Conclusion: Wide abnormalities such as mass, edema, encephalomalacia and demyelination are observed in the MRI of the patients with seizures and are often located in the frontal lobe. In general, seizures can cause transient and reversible brain abnormalities in MRI.