Excellent Inter-reader Reliability Research Articles

Response evaluation criteria in PSMA PET/CT (RECIP 1.0) in metastatic castration-resistant prostate cancer.

45 Background: Response Evaluation Criteria in Prostate-Specific Membrane Antigen (PSMA) PET/CT (RECIP 1.0) initially integrated software-based quantitative assessment of PSMA-positive total tumor volume (PSMA-VOL). Clinical implementation of such software is not expected soon, limiting the use of RECIP in practice. This study aimed to assess the agreement of RECIP determined using tumor segmentation software (quantitative RECIP) with RECIP determined by qualitative reads by nuclear medicine physicians (visual RECIP) for response evaluation in metastatic castration-resistant prostate cancer. Methods: This multicenter retrospective study at three academic centers included patients who received lutetium-177 (177Lu) PSMA treatment between December 2014 and July 2019. PSMA PET/CT images at baseline and 12 weeks were assessed qualitatively by five nuclear medicine physicians for changes in PSMA-VOL and for new lesions. Quantitative changes in PSMA-VOL were also measured using tumor segmentation software. The status of new lesions was combined with qualitative changes in PSMA-VOL to determine visual RECIP and with quantitative changes in PSMA-VOL to determine quantitative RECIP. The primary outcomes were the agreement between visual and quantitative RECIP and the interreader reliability of visual RECIP according to the Fleiss κ. The secondary outcome was the association of visual RECIP with overall survival according to Cox regression. Results: A total of 124 patients (median age, 73 years [IQR, 67–76 years]) were included. Forty (32%) and 84 (68%) patients had quantitative RECIP progressive disease (PD) and non-PD, respectively. Agreement between visual versus quantitative RECIP was excellent (κ=0.89; 118 of 124 patients [95%]). Agreement among readers in classifying visual RECIP PD versus non-PD was excellent (κ=0.81; 103 of 124 patients [83%]). RECIP-PD was associated with significantly shorter overall survival compared with RECIP-nonPD (hazard ratio, 2.6 [95%CI: 1.7, 3.8]; P <.001). Conclusions: Qualitatively assessed RECIP demonstrated excellent agreement with quantitative RECIP and excellent interreader reliability, and can be readily implemented in clinical practice for response evaluation in patients with metastatic castration-resistant prostate cancer undergoing 177Lu-PSMA therapy and possible other systemic therapies.

Three-dimensional Volumetric Visceral and Subcutaneous Fat Analysis on Opportunistic Computed Tomography Imaging of Patients With Greater Trochanteric Pain Syndrome Compared With Those With Predominant Osteoarthritis: A Case-Control Study.

This study aimed to address the gap in knowledge assessing the impact of visceral and subcutaneous body fat on 3-dimensional computed tomography imaging in patients with greater trochanteric pain syndrome (GTPS) in comparison with those primarily diagnosed with osteoarthritis (OA). We evaluated adult patients with a confirmed diagnosis of GTPS from our institutional hip-preservation clinic spanning 2011 to 2022. Selection criteria included their initial clinic visit for hip pain and a concurrent pelvis computed tomography scan. These patients were age- and sex-matched to mild-moderate OA patients selected randomly from the database. Visceral and subcutaneous fat areas were measured volumetrically from the sacroiliac joint to the lesser trochanter using an independent software. Interreader reliability was also calculated. A total of 93 patients met the study criteria, of which 37 belonged to the GTPS group and 56 belonged to the OA group. Both groups were sex and race matched. Average age in GTPS and OA groups was 59.3 years and 56 years, respectively. For GTPS group, average body mass index was 28.9 kg/m 2 , and for the OA group, average body mass index was 29.9 kg/m 2 , with no significant difference ( P > 0.05). Two-sample t test showed no significant differences in the visceral fat, subcutaneous fat, or the visceral fat to total fat volume ratio between the GTPS and OA groups. There was excellent interreader reliability. Our results indicate that there is no significant difference in fat distribution and volumes among GTPS and OA patients. This suggests that being overweight or obese may not be directly linked or contribute to the onset of GTPS. Other factors, such as gluteal tendinopathy, bursitis, or iliotibial band syndrome, might be responsible and need further investigation.

Practical RECIP: Visual assessment of response evaluation criteria In PSMA-PET 1.0

To evaluate the accuracy of Response Evaluation Criteria In PSMA-Imaging (RECIP) 1.0 determined by visual reads of nuclear medicine physicians for response evaluation using PSMA-PET/CT in men with mCRPC treated with 177Lu-PSMA radioligand therapy. In total, 124 patients were included in this multicenter retrospective study. All patients received 177Lu-PSMA and underwent PSMA-PET/CT scans at baseline (bPET) and at 12 weeks (iPET). Five nuclear medicine specialists individually interpreted each pair of PSMA-PET/CT scans for responses in PSMA-positive total tumor volume (PSMA-VOL) assessed visually and for occurrence of new lesions. Responses in PSMA-VOL were also assessed quantitatively using semi-automatic segmentation software. Occurrence of new lesions was combined: 1) with visual responses in PSMA-VOL to determine visual RECIP; and 2) with quantitative responses in PSMA-VOL to determine quantitative RECIP. RECIP response classes were dichotomized for differentiation of clinically relevant progressive (PD) vs. non-progressive disease (nPD): RECIP-PD vs. RECIP-nPD. Primary outcome measure was the inter-reader reliability of visual RECIP and agreement between visual vs. quantitative RECIP (by Cohen's κ coefficient). Secondary outcome measure was the prognostic value of visual RECIP (by Cox regression) for overall survival (OS). Based on readers’ majority rule, 41/124 (33%) and 83/124 (67%) patients had visual RECIP-PD and RECIP-nPD, respectively. Agreement among readers in classifying visual RECIP-PD vs. RECIP-nPD was observed in 103 (83%) patients (excellent agreement: κ = 0.81). Agreement between visual vs. quantitative RECIP was observed in 118 (95%) patients (excellent agreement: κ = 0.89). OS was significantly shorter in men with visual RECIP-PD vs. RECIP-nPD (HR 2.55; 95%CI, 1.71–3.81; P < 0.001). The median OS was 8.4 months (95%CI, 7.0–9.8) for patients with RECIP-PD and 16.1 months (95%CI, 13.6–18.5) for patients with RECIP-nPD. Visual RECIP demonstrated excellent inter-reader reliability and excellent agreement with quantitative RECIP calculated using semi-automatic segmentation software. Visual RECIP was prognostic for overall survival of men undergoing 177Lu-PSMA radioligand therapy. RECIP 1.0 evaluated visually by nuclear medicine physicians can be used in practice and clinical trials for response evaluation using PSMA-PET/CT in men with mCRPC.

Low-dose CT hounsfield units: a reliable methodology for assessing vertebral bone density in radiographic axial spondyloarthritis

ObjectiveStudying vertebral bone loss in radiographic axial spondyloarthritis (r-axSpA) has been challenging due to ectopic bone formation. We cross-sectionally analysed low-dose CT (ldCT) trabecular bone density Hounsfield units (HU) measurements...

Tiny golden angle stack-of-stars (tygaSoS) free-breathing functional lung imaging

PurposeMRI of the lung parenchyma is still challenging due to cardiac and respiratory motion, and the low proton density and short T2*. Clinical feasible MRI methods for functional lung assessment are of great interest. It was the objective of this study to evaluate the potential of combining the ultra-short echo-time stack-of-stars approach with tiny golden angle (tyGASoS) profile ordering for self-gated free-breathing lung imaging. MethodsFree-breathing tyGASoS data were acquired in 10 healthy volunteers (3 smoker (S), 7 non-smoker (NS)). Images in different respiratory phases were reconstructed applying an image-based self-gating technique. Resulting image quality and sharpness, and parenchyma visibility were qualitatively scored by three blinded independent reader, and the signal-to-noise ratio (SNR), proton fraction (fP) and fractional ventilation (FV) quantified. ResultThe imaging protocol was well tolerated by all volunteers. Image quality was sufficient for subsequent quantitative analysis in all cases with good to excellent inter-reader reliability. Between expiration (EX) and inspiration (IN) significant differences (p < 0.001) were observed in SNR (EX: 3.73 ± 0.89, IN: 3.14 ± 0.74) and fP (EX: 0.27 ± 0.09, IN: 0.25 ± 0.08). A significant (p < 0.05) higher fP (EX/IN: 0.22 ± 0.07/0.21 ± 0.07 (NS), 0.33 ± 0.07/0.30 ± 0.06 (S)) was observed in the smoker group. No significant FV differences resulted between S and NS. ConclusionThe study proves the feasibility of free-breathing tyGASoS for multiphase lung imaging. Changes in fP may indicate an initial response in the smoker group and as such proves the sensitivity of the proposed technique. A major limitation in FV quantification rises from the large inter-subject variability of breathing patterns and amplitudes, requiring further consideration.

Development and reliability of a novel ultrasonographic joint-specific scoring system for synovitis with reference atlas for patients with juvenile idiopathic arthritis

ObjectiveTo develop an ultrasonographic image acquisition protocol and a joint-specific scoring system for synovitis with reference atlas in patients with juvenile idiopathic arthritis (JIA) and to assess the reliability of...

Accelerating acquisition of readout-segmented echo planar imaging with a simultaneous multi-slice (SMS) technique for diagnosing breast lesions.

To investigate the feasibility and effectiveness of SMS rs-EPI for evaluating breast lesions. This prospective study was approved by IRB. Ninety-six patients had 102 histopathologically verified lesions (80 malignant and 22 benign) that were evaluated. Conventional rs-EPI and SMS rs-EPI data were acquired on a 3T scanner. Mean kurtosis (MK), mean diffusion (MD), and apparent diffusion coefficient (ADC) values were quantitatively calculated for each lesion on both sequences. Images were qualitatively and quantitatively analyzed with respect to image sharpness, geometric distortion, lesion conspicuity, anatomic structure, overall image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Student's t test, Pearson correlation, receiver operating characteristic curve, Wilcoxon rank sum test, and paired-sample t tests were used for statistical analysis. Compared to conventional rs-EPI, the acquisition time of SMS rs-EPI was markedly reduced (2:17 min vs 4:27 min). Pearson's correlations showed excellent linear relationships for each parameter between conventional rs-EPI and SMS rs-EPI (MK, r = 0.908; MD, r = 0.938; and ADC, r = 0.975; p < 0.01 for all). Furthermore, SMS rs-EPI had similar diagnostic performance compared with conventional rs-EPI. SMS rs-EPI had comparable visual image quality as conventional rs-EPI, with excellent inter-reader reliability (ICC = 0.851-0.940). No differences existed between conventional rs-EPI and SMS rs-EPI for either SNR or CNR (p > 0.05). Applying the SMS technique can significantly reduce the acquisition time and produce similar diagnostic accuracy while generating comparable image quality as the conventional rs-EPI. • SMS rs-EPI reduces scan time from 4:27 min to 2:17 min compared with conventional rs-EPI. • SMS rs-EPI has a comparable diagnostic performance to conventional rs-EPI in the differentiation between malignant and benign breast lesions. • SMS rs-EPI demonstrates comparable image quality to conventional rs-EPI with shorter scan time.

Subclinical sacroiliitis detected by abdominopelvic computed tomography in Korean patients with Crohn's disease.

Background/AimsSacroiliitis is a frequent extraintestinal manifestation of inflammatory bowel diseases (IBDs). This study aimed to assess the prevalence of sacroiliitis using a validated screening tool based on abdominopelvic computed tomography (APCT) in Korean patients with Crohn’s disease (CD) and examine potential associations between clinical characteristics and sacroiliitis.MethodsOne hundred five patients with CD undergoing APCT for any indication at an IBD clinic were matched 1:1 for age and sex with 105 controls without underlying chronic illnesses. Using a validated APCT screening tool that defines sacroiliitis as either ankylosis or a total erosion score (TES) ≥ 3, all computed tomography scans were assessed by two independent, blinded radiologists. We compared the prevalence of sacroiliitis between CD patients and controls and clinical characteristics between CD patients with and without sacroiliitis.ResultsThe prevalence of sacroiliitis was significantly higher in CD patients than in controls (13.3% vs. 4.8%, p = 0.030). All subjects with sacroiliitis had a TES ≥ 3, but no ankylosis. The assessment of sacroiliitis in APCT showed excellent interreader reliability (Cohen’s kappa = 0.933 for presence of sacroiliitis). Sacroiliitis in CD patients was bilateral and asymptomatic. There were no significant associations between sacroiliitis and any demographic data or clinical characteristics in these patients.ConclusionsThe prevalence of APCT-detected sacroiliitis in CD patients was higher than that in controls, but the condition was asymptomatic. The clinical significance of asymptomatic sacroiliitis in Korean CD patients remains unclear.

The role of MRI-derived depth of invasion in staging oral tongue squamous cell carcinoma: inter-reader and radiological-pathological agreement.

Background The 8th edition of tumor, node, metastasis (TNM) classification incorporates depth of invasion evaluation in the staging of oral cavity squamous cell carcinoma, since it is a predictor of nodal metastasis and an independent prognostic factor. Although the histopathological definition of depth of invasion is clear, an accurate method for its radiological assessment has not yet been validated. Purpose To investigate the role of MRI-derived depth of invasion evaluation in staging oral tongue squamous cell carcinoma and to assess the inter-reader agreement and the radiological–pathological correlation. Material and Methods We retrospectively reviewed 43 patients with oral tongue squamous cell carcinoma who underwent preoperative MRI. The MRI-derived depth of invasion was measured by two radiologists, each with a different degree of experience in head and neck imaging. The pathological depth of invasion was recorded from histopathological reports. The inter-reader and the radiological–histopathological correlations for the depth of invasion were evaluated with Bland–Altman plots, the intraclass correlation coefficients (ICC), and the paired samples test; agreements for T staging were assessed using the Kappa coefficient. Results Inter-reader reliability was excellent for the MRI-derived depth of invasion (ICC = 0.91), very good between MRI-derived depth of invasion and pathological depth of invasion (ICC = 0.89 for the experienced reader, 0.86 for the inexperienced reader). Both readers reached a good agreement regarding T staging (kappa value = 0.70). Furthermore, the agreement between radiological and pathological T staging was good (kappa value = 0.74 for the experienced reader, 0.60 for the inexperienced reader). Conclusion MRI-derived depth of invasion should be measured in the pretreatment assessment of oral tongue squamous cell carcinoma as it has an excellent inter-reader reliability and nearly excellent radiological–pathological correlation.

Regional muscle changes in adult dysfunctional hip conditions of femoroacetabular impingement and hip dysplasia.

To analyze regional muscle CT density and bulk in femoroacetabular impingement (FAI) and hip dysplasia (HD) versus controls. Patients who obtained perioperative CT imaging for FAI and HD before surgery were retrospectively studied. Asymptomatic controls included for comparison. Two readers independently evaluated regional hip muscle [iliopsoas (IP), rectus femoris (RF), gluteus minimus (Gm), and medius (GM)] density, muscle area, and muscle circumference. Inter-observer reliability calculated using intra-class correlation coefficient (ICC). A consecutive series of 25 FAI patients, 16 HD patients, and 38 controls were recruited in the study. FAI patients had significantly greater Gm and GM circumferences as well as greater RF and IP areas on the normal side compared to the asymptomatic control group (p values 0.004, 0.032, 0.033, and 0.028, respectively). In addition, Gm and RF circumferences and RF area were significantly larger (p values 0.029, 0.036, and 0.014, respectively) in FAI patients on the affected side compared to the control group. HD patients had significantly smaller Gm and GM circumferences on the affected side than normal side measurements in FAI group (p values 0.043 and 0.003, respectively). Normal side GM circumference was also smaller in HD patients than normal side FAI hips (p value 0.02). There was no significant difference between the measurements on normal and abnormal sides in each disease group. No significant difference was found between measurements of HD compared to controls (p > 0.05). No muscle density differences were seen among different groups. There was moderate to excellent inter-reader reliability for all measurements except Gm muscle density. Muscle analysis was able to quantify differences among patients with FAI, HD, and asymptomatic controls. These changes could indicate either a muscle imbalance contributing to the pathology or disuse atrophy, which may have implications for specific muscle-strengthening therapies and rehabilitation procedures in such patients.

Proximal radius fractures in children: evaluation of associated elbow fractures

Additional fractures occur in association with proximal radius fractures, but the extent of these secondary injuries has not been systematically assessed. To ascertain the frequency and nature of additional fractures associated with proximal radius injuries in a large pediatric cohort. Radiographs meeting search criteria for proximal radius fracture during a 5-year period were reviewed. Fracture characteristics and the coexistence of additional elbow fractures were recorded and analyzed. The retrospective review was compared with initial interpretation and a blinded review by two pediatric musculoskeletal radiologists. Four hundred ninety-four proximal radius fractures were included. The radial neck was the most common fracture site (89%). Neck fractures occurred in younger patients (mean: 7.3years) than head fractures (mean: 13.3years) (P<0.001). Additional elbow fractures occurred in 39%, most commonly at the olecranon (22%). Additional fractures occurred in younger patients (mean: 7.2years) than isolated proximal radius fractures (mean: 8.5years) (P<0.001). Elbow joint effusion and complete or displaced radius fractures were each associated with additional elbow fractures (P<0.001). When compared with initial interpretation, 25% of additional fractures were not identified on initial radiographs, of which 44% were occult retrospectively. Fracture identification demonstrated excellent inter-reader reliability (interclass correlation coefficient [ICC]: 0.88, 0.94), but joint effusion interobserver agreement was only fair (ICC: 0.52, 0.41). Proximal radius fractures in children often occur in association with other elbow fractures, most commonly involving the olecranon. Enhanced awareness of these fracture patterns, especially in the setting of joint effusion or complete and displaced radius fractures, may improve detection to guide appropriate management.

Sesamoid malalignment in hallux valgus: Radiographic and MRI measurements and their correlation with internal derangement findings of the first metatarsophalangeal joint.

Sesamoid displacement (SD) and rotation are important components in the preoperative assessment of hallux valgus (HV). To date, Interreader reliability (IRR) of SD on X-rays and MRI, correlations with hallux valgus angle (HVA), and qualitative changes of the hallux-sesamoid complex (HSC) on MRI have not been studied. The aim of this study was to correlate sesamoid malalignment with HV severity and findings of internal joint derangement. Two readers analyzed a series of 56 consecutive patients who had X-rays and MRI performed on the same foot within 3 months of each other. Multiple measures of SD on X-rays and MRI and the sesamoid rotation angle (SRA) on MRI were assessed and correlated with HVA and various qualitative features at the HSC including cartilage, plantar plate, and collateral ligament abnormalities. We found excellent IRR (ICC = 0.79 - 0.99) for SRA on MR, but poor IRR for lateral sesamoid displacement (LDS) and tibial sesamoid position (TSP) scales on both modalities. Good IRR was also seen for morphologic abnormalities of HSC. The absolute value of the SRA on MR positively correlated with HVA ( p < 0.0001). LDS and TSP on both modalities lacked a significant correlation with HVA ( p > 0.05). No correlation was found between any measure of SD or rotation with HSC morphologic changes ( p > 0.05). Among different measures of sesamoid malalignment, sesamoid rotation angle measured on MRI can be used to judge the severity of HV; however, it does not correlate with qualitative morphologic abnormalities of the HSC. The MRI measurement of SRA is a better indicator of sesamoid displacement relative to the HSC than standard AP radiographic measures of non-rotational sesamoid displacement; however, it should not be used to predict qualitative morphologic abnormalities of the HSC.

Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading.

To evaluate proven soft tissue musculoskeletal malignancies blinded to their Fédération Nationale des Centres de Lutte Contre le Cancer histologic grades to identify the predictive values of conventional MR findings and best fit region of interest (ROI) apparent diffusion coefficient (ADC) measurements. Fifty-one consecutive patients with different histologic grades were evaluated by four readers (R1-4) of different experience levels. Quantitatively, the maximum longitudinal size, tumor to muscle signal intensity ratios, and ADC measurements and, qualitatively, the spatial location of the tumor, its signal alterations, heterogeneity, intralesional hemorrhage or fat, and types of enhancement were assessed. Intraclass correlation, weighted kappa, ANOVA, and Fisher exact tests were used. There were 22/51 (43%) men (mean age ± SD = 52 ± 16years) and 29/51 (57%) women (mean age ± SD = 54± 17years), with the majority of tumors 38/51 (75%) in the lower extremities. Histologic grades were I in 8/51 (16%), II in 17/51 (33%), and III in 26/51 (51%), respectively. The longitudinal dimensions were different among three grades (p = 0.0015), largest with grade I. More central enhancements and deep locations were seen in grade III tumors (p = 0.0191, 0.0246). The ADC mean was significantly lower in grade III than in grade I or II (p < 0.0001 and p = 0.04). The ADC min was significantly lower in grade III than in grade I (p = 0.02). Good to excellent agreements were seen for T1/T2 tumor/muscle ratios, longitudinal dimension, and ADC (ICC = 0.60-0.98). Longitudinal tumor dimension, central enhancement, and ADC values differentiate histology grades in musculoskeletal soft tissue malignancy with good to excellent inter-reader reliability. • The longitudinal tumor dimension of grade III malignancy is smaller than that of grade I (p < 0.0001), and higher-grade tumors are located deeper (p = 0.0246). • The ADC mean is significantly lower in grade III than in grade I or grade II (p < 0.0001 and p = 0.04). • The ADC minimum is significantly lower in grade III than in grade I (p = 0.02).

Quantitative PET/CT in clinical practice: assessing the agreement of PET tumor indices using different clinical reading platforms.

The aim of this study was to determine whether various fluorine-18-fluorodeoxyglucose PET/CT-derived parameters used in oncology vary significantly depending on the interpretation software systems used in clinical practice for multiple human solid tumors. A total of 120 fluorine-18-fluorodeoxyglucose PET/CT studies carried out in patients with pancreatic, lung, colorectal, and head and neck cancers were evaluated retrospectively on two different vendor software platforms including Mirada and MIMVista. Regions of interest were placed on the liver to determine the liver mean standardized uptake value at lean body mass (SUL) and on each tumor to determine the SULmax, SULpeak. Total lesion glycolysis (TLG) and metabolic tumor volume (MTV) were determined using fixed thresholds of 50% of SULmax and SULpeak. Inter-reader, intersystem intraclass correlations, systematic bias, and variability reflected by the 95% limits of agreement, and precision were determined. There was excellent inter-reader reliability between the readers and the two software systems, with intraclass correlations more than 0.9 for all PET metrics, with P values less than 0.0001. The bias and SD on Bland-Altman analysis between the two software platforms for tumor SULmax, SULpeak, Max50MTV, and Peak50MTV, respectively, for Reader 1 were -1.52±2.24, 0.80±3.67, -0.80±13.01, and -4.49±20.6. For Reader 2, the biases were -1.62±1.95, 0.18±3.60, -0.27±4.64, and -3.13±8.30. The precision between the two systems was better for SULmax and SULpeak, with less variance observed, than for volume-based metrics such as Max50MTV and Peak50MTV or TLG. Excellent correlation has been found between two tested software reading platforms for all PET-derived metrics in a dual-reader analysis. Overall, the SULmax and SULpeak values had less bias and better precision compared with the MTV and TLG.

Hallux Valgus Evaluation on MRI: Can Measurements Validated on Radiographs Be Used?

Hallux valgus (HV) is a common deformity of the great toe affecting >23% of adults in the United States. The severity of the deformity is traditionally analyzed using radiographs to determine measurements such as the HV and intermetatarsal angles. We sought to determine the relationship between the radiographic and magnetic resonance imaging (MRI) measurements because this is not yet known. Two of us analyzed a series of 56 consecutive patients who had had radiographs and MRI performed on the same foot between April 27, 2015 and March 9, 2016 and who satisfied all other inclusion and exclusion criteria (age 18 to 100 years, no history of recent foot trauma, and no metal hardware in the foot). We found excellent interreader reliability (intraclass correlation 0.89 to 0.96) and intermodality agreement (intraclass correlation 0.83 to 0.91). The HV angle measured 15.0° ± 8.8° on the MRI scans and 13.8° ± 8.7° on the radiographs (mean difference −1.15° ± 3.89°), and the intermetatarsal angle was 9.0° ± 3.1° on the MRI scans and 8.8° ± 2.9° on the radiographs (mean difference −0.22° ± 2.10°). The HV measurements were reliable on both radiographs and MRI for the range of values tested. Small intermodality statistically significant differences in HV angle measurements were found; however, these might not be enough to be clinically significant.

Accuracy of apparent diffusion coefficient in differentiating pancreatic neuroendocrine tumour from intrapancreatic accessory spleen.

To evaluate and compare the accuracy of absolute apparent diffusion coefficient (ADC) and normalised ADC (lesion-to-spleen ADC ratio) in differentiating pancreatic neuroendocrine tumour (NET) from intrapancreatic accessory spleen (IPAS). Study included 62 patients with the diagnosis of pancreatic NET (n=51) or IPAS (n=11). Two independent reviewers measured ADC on all lesions and spleen. Receiver operating characteristics (ROC) analysis to differentiate NET from IPAS was performed and compared for absolute and normalised ADC. Inter-reader reliability for the two methods was assessed. Pancreatic NET had significantly higher absolute ADC (1.431x10-3 vs 0.967x10-3 mm2/s; P<0.0001) and normalised ADC (1.59 vs 1.09; P<0.0001) compared to IPAS. An ADC value of ≥1.206x10-3 mm2/s was 70.6% sensitive and 90.9% specific for the diagnosis of NET vs. IPAS. Lesion to spleen ADC ratio of ≥1.25 was 80.4% sensitive, and 81.8% specific while ratio of ≥1.29 was 74.5% sensitive and 100% specific in the differentiation. The area under the curve (AUCs) for two methods were similar (88.2% vs. 88.8%; P=0.899). Both methods demonstrated excellent inter-reader reliability with ICCs for absolute ADC and ADC ratio being 0.957 and 0.927, respectively. Both absolute and normalised ADC allow clinically relevant differentiation of pancreatic NET and IPAS. • Imaging overlaps between IPASs and pancreatic-NETs lead to unnecessary procedures including pancreatectomy. • Uniquely low ADC of spleen allows differentiating IPASs from pancreatic NETs. • Both absolute-ADC and normalised-ADC (lesion-to-spleen ADC-ratio) demonstrate high accuracy in differentiating IPASs from NETs. • Both methods demonstrate excellent inter-reader reliability.

Traumatic Shoulder Dislocation Among Adolescents: Hill-Sachs Lesion Volume and Recurrent Instability.

Accurate assessment of Hill-Sachs lesions (HSLs) and their relationship to the glenoid track is essential to optimizing management following traumatic shoulder dislocation. The purpose of this study was to measure the size of HSLs by a novel method with magnetic resonance (MR) arthrography and to investigate the relationship between lesion size and instability history in adolescents (below 19 y of age) with a history of traumatic dislocation. All shoulder MR arthrograms queried to identify HSLs over a 4-year period were retrospectively reviewed and independently evaluated by 2 blinded musculoskeletal radiologists. HSLs were evaluated on axial T1-weighted fat-saturated images. For each consecutive image slice in which the HSL was identified, a freehand region of interest was constructed along the compression fracture cavity. Region of interest sum was multiplied by image slice thickness (and gap between slices if present) to generate a total HSL volume (mm). Subject chart review was then performed to acquire demographic data, including shoulder dislocation history. A total of 30 patients met inclusion criteria and included 22 boys (mean age, 16.3 y) and 8 girls (mean age, 16.4 y). Four patients had a history of 1 traumatic dislocation, 12 had a history of 2, and 14 had a history of ≥3. The average size of the HSL for all patients was 3.8 mm (range, 0.52 to 11 mm). There was no significant difference in HSL volume between the 21 skeletally immature (3.7 mm) and 9 skeletally mature (4.2 mm) patients (P=0.67). Patients with a history of 1, 2, or 3+ dislocations had an average HSL volume of 1.3, 3.7, and 4.7 mm, respectively. The measurement method revealed excellent interreader reliability (P=0.00). There was a statistically significant difference between dislocation history group mean HSL volumes (P=0.019), as well as a statistically significant difference between the number of dislocations and lesion volume (P=0.011). HSLs can be effectively measured in adolescent patients using MR arthrography and patients with larger HSLs have more recurrent instability episodes, potentially meriting greater and earlier attention to the defect. Prognostic/diagnostic study level IV.

Limited, Fast Magnetic Resonance Imaging as an Alternative for Preoperative Evaluation of Pectus Excavatum

The purpose of this study was to determine the reliability, feasibility, and image quality of a limited, fast magnetic resonance imaging (MRI) protocol for preoperative evaluation of pectus excavatum in a pediatric population referred for presurgical imaging. A total of 47 patients, median age 14 years, referred for preoperative imaging of pectus excavatum, underwent axial balanced steady-state free precession MRI of the chest, with a limited patient charge. Two pediatric radiologists independently conducted a blinded retrospective study. The Haller and asymmetry indices were calculated at the level of greatest anterior-posterior chest narrowing. In addition, right heart compression and image quality were subjectively assessed, and scan duration was determined. Intraclass correlation coefficient reliability was between 0.85 and 0.98, indicating almost perfect agreement for quantitative measurements. Subjective evaluation of right heart compression and image quality showed moderate interreader agreement. Image quality was graded as good or excellent by both readers for all studies. No difference in the Haller index was observed between modalities in 3 patients on both computed tomographic scan and MRI (P = 0.2697). The median scan duration was 8 minutes. Limited MRI is a reliable and cost-effective alternative for preoperative assessment of pectus excavatum. It is fast, free of ionizing radiation, and there is excellent interreader reliability for measurements of chest wall deformity.

A modification of the Omeract RA MRI score for erosions for use with an extremity MRI system with reduced field of view

Objectives:To develop and test the reliability of a modified version of the OMERACT rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for erosions using extremity MRI (eMRI) with reduced field of...

Validation of the Spondyloarthritis Research Consortium of Canada magnetic resonance imaging spinal inflammation index: Is it necessary to score the entire spine?

The Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) spinal inflammation index has been developed to objectively measure inflammation in ankylosing spondylitis (AS) and to assess change in response to therapeutic intervention. Scoring of the entire spine limits feasibility and a scoring method that records inflammation in only the more severely affected spinal segments may improve feasibility without sacrificing performance. MRI films of 68 patients with AS were assessed in random order by 2 blinded readers. Interreader reliability was assessed by intraclass correlation coefficient. Pre- and posttreatment MRI films of 29 patients randomized to placebo or anti-tumor necrosis factor alpha (anti-TNFalpha) therapy were read by readers blinded to chronology, and responsiveness was assessed by effect size and standardized response mean. The performance of scores based on 6, 8, 10, and all 23 spinal discovertebral units (DVU) was compared. The median number of affected spinal levels per patient was 6.0 and 62% of all affected levels were included when analysis was limited to only the 6 most severely affected levels per patient. Comparison of DVU scores that were limited to only the more severely affected DVU (6-, 8-, 10-DVU score) with scores for all 23 spinal DVU showed excellent interreader reliability for status and change scores (Spearman's correlation >0.90) as well as similar construct validity. Responsiveness to anti-TNFalpha therapy was greater when the more limited scoring methods were used and was greatest with the 6-DVU score. The SPARCC MRI spinal inflammation index performs better when analysis is limited to a maximum of 6 most severely affected levels compared with assessment of the entire spine. This should improve its feasibility in clinical trials and research.