Fast Spin-echo Magnetic Resonance Research Articles

Comparative physiological, morphological, histological, and AQP2 immunohistochemical analysis of the Arabian camels (Camelus dromedarius) and oxen kidney: Effects of adaptation to arid environments

Compared to other mammals, Arabian camels are ideal models for exploring the structural adaptations that enable camels to survive in arid environments. Thus, this study aimed to explore how evolutionary adaptation to arid conditions modifies the characteristics of the kidneys in Arabian camels (Camelus dromedarius) compared to oxen. Urine samples were physically and chemically analyzed. Harvested kidneys were subjected to topographical and fast spin echo magnetic resonance (FSE-MR) imaging. Histology, histomorphometry, and Aquaporin-2 (AQP2) expression by immunohistochemistry were also performed. Here, in dromedaries, sodium and potassium values in the urine were much higher (p=0.001, for both), whereas chloride was much lower (p=0.004) than the values of oxen. Compared with oxen, the level of the hormone aldosterone in serum was significantly lower (p=0.002), whereas creatinine and urea were significantly higher (p=0.005 and p=0.001, respectively). Uric acid in dromedaries and oxen did not differ significantly (p=0.349). Like sodium levels (p=0.001) in dromedary serum, chloride was also much higher (p=0.002) than in oxen. The average value of potassium was much lower (p=0.009) than that of oxen. Morphologically, anatomical and FSE MRI studies revealed that minor and major calyces were not found in dromedary kidneys. The renal pelvis was not found in oxen, and the major calyx was directly connected to the ureter. The dromedary kidney contained a wider medullary portion as well as increased diameters for renal corpuscles (RCs), proximal convoluted tubules (PCTs), and collecting tubules (CTs, p<0.05) compared with the oxen. We also noted that AQP2 was significantly expressed in dromedary nephron components, except for RCs, compared with oxen as shown by immunohistochemistry. Overall, these data strongly suggest that the dromedary has a greater ability to adapt to harsh desert conditions in terms of producing highly concentrated urine than oxen.

Denoising of three-dimensional fast spin echo magnetic resonance images of knee joints using spatial-variant noise-relevant residual learning of convolution neural network

PurposeTwo-dimensional (2D) fast spin echo (FSE) techniques play a central role in the clinical magnetic resonance imaging (MRI) of knee joints. Moreover, three-dimensional (3D) FSE provides high-isotropic-resolution magnetic resonance (MR) images of knee joints, but it has a reduced signal-to-noise ratio compared to 2D FSE. Deep-learning denoising methods are a promising approach for denoising MR images, but they are often trained using synthetic noise due to challenges in obtaining true noise distributions for MR images. In this study, inherent true noise information from two number of excitations (2-NEX) acquisition was used to develop a deep-learning model based on residual learning of convolutional neural network (CNN), and this model was used to suppress the noise in 3D FSE MR images of knee joints. MethodsA deep learning-based denoising method was developed. The proposed CNN used two-step residual learning over parallel transporting and residual blocks and was designed to comprehensively learn real noise features from 2-NEX training data. ResultsThe results of an ablation study validated the network design. The new method achieved improved denoising performance of 3D FSE knee MR images compared with current state-of-the-art methods, based on the peak signal-to-noise ratio and structural similarity index measure. The improved image quality after denoising using the new method was verified by radiological evaluation. ConclusionA deep CNN using the inherent spatial-varying noise information in 2-NEX acquisitions was developed. This method showed promise for clinical MRI assessments of the knee, and has potential applications for the assessment of other anatomical structures.

Evaluation of lymph nodes in oral squamous cell carcinoma by diffusion-weighted magnetic resonance imaging, apparent diffusion coefficient mapping, and fast-spin echo magnetic resonance imaging

Objectives: To evaluate cervical lymph nodes in OSCC with fast spin echo MRI. ii) To evaluate cervical lymph nodes in OSCC with Diffusion Weighted MRI & estimate its ADC value. iii) To compare the findings of cervical lymph nodes in OSCC with diffusion-weighted MRI, ADC mapping and fast spin echo MRI with histopathology. Methods: The study was conducted on 25 histopathologically proven OSCC patients. Enlarged cervical lymph nodes were assessed by Fast spin echo MRI and diffusion weighted MRI. Cervical lymph nodal status in OSCC regarding whether it is benign or malignant was evaluated by diffusion-weighted MRI, ADC mapping and Fast Spin Echo MRI characteristics. These values were compared on post operative histopathology for lymph nodal metastasis. Results: By fast spin echo MRI: Number of true-positive was 05 (4.23%). Number of false-positive was 05(4.23%). Sensitivity was 32.25%. Specificity was 95.10%. Accuracy was 50% positive predictive value (PPV) was 50%. Negative predictive value (NPV) was 86.44%. By DWI MRI: Number of true-positive was 12 (10.16%). Number of false-positive was 12 (10.16%). Sensitivity was 75%. Specificity was 88.24%. Accuracy was 96.69%. PPV was 50%. NPV was 86.44%. Conclusions: DW imaging performed with ADC values showed higher accuracy than fast spin-echo MRI and can provide added value in cervical nodal metastases in OSCC.

Intratumor hemodynamics using contrast-enhanced MRI in intra-arterial chemotherapy for head and neck cancer

The objectives of the study were to estimate the perfusion of tumors by drugs used in intra-arterial chemotherapy for head and neck cancer with magnetic resonance imaging and to establish the factors involved in determining the optimal dose. Contrast agent was administered intra-arterially into either the lingual or maxillary artery in 43 patients. Triple-phase continuous fast spin echo magnetic resonance imaging was performed. Changes in blood water longitudinal relaxation rate (⊿R1) were measured in relation to imaging phase, type of artery, measurement site, and tumor size. ⊿R1 was significantly higher at the tumor margin than at the center for both arteries, except in the first phase for the lingual artery. ⊿R1 was greatest in the third phase for the lingual artery and in the second phase for the maxillary artery. For both arteries, as the tumor size increased, there was a significant decrease in ⊿R1 at the center of the tumor compared with the margin. The factors associated with ⊿R1 were imaging phase, type of artery, measurement site, and tumor size. When determining a drug's optimal dose, the type of artery and tumor size must be taken into consideration.

Tumor grade estımatıon of clear cell and papıllary renal cell carcınomas usıng contrast-enhanced MDCT and FSE T2 weıghted MR ımagıng: radıology-pathology correlatıon.

Discrimination of low grade (grade 1-2) renal tumors from high grade (grade 3-4) ones carries crucial importance in terms of the management of these patients and also in the decision-making of appropriate treatment strategies. Our aim was to investigate whether contrast-enhanced multidetector computed tomography (MDCT) and T2 weighted fast spin echo (FSE) magnetic resonance imaging (MRI) could play a specific role in the discrimination of low grade versus high grade tumors in clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) patients. In this study, we retrospectively evaluated 66 RCC patients based on histopathologic findings who had underwent either partial or total nephrectomies. Our cohort consisted of 52 ccRCC and 14 pRCC patients, of whom 50 were male (%76) and 16 were female (%24). Among the 52 ccRCC patients, 18 had both cortico-medullary phase contrast-enhanced CT and MRI, 15 had only cortico-medullary phase CT and 19 had only MRI examination. In the pRCC group, 8 patients had both cortico-medullary phase contrast-enhanced CT and MRI, 3 had only cortico-medullary phase CT and 3 had only MRI. We both calculated mean tumor attenuation values on cortico-medullary phase MDCT images as HU (hounsfield unit) and also tumor mean signal intensity values on FSE T2 weighted MR images, using both region of interest and whole lesion measurements including normal renal cortex. The obtained values were compared with the grading results of the ccRCC and pRCC tumors according to the WHO/International Society of Urological Pathology grading system. A significant positive correlation was found between the mean attenuation values of both tumor subtypes on cortico-medullary phase contrast-enhanced CT and their grades (p < 0.001). High grade tumors exhibited higher mean attenuation values (74.3 ± 22.3 HU) than the low grade tumors (55.2 ± 23.7 HU) in both subtypes. However, a statistically significant correlation was not found between the mean signal intensity values of the two tumor subtypes on FSE T2 weighted MR images and their grades (p > 0.05). Low grade tumors had a mean signal intensity value of 408.9 ± 44.6, while high grade tumors showed a value of 382.1 ± 44.2. The analysis of the ccRCC group patients, yielded a statistically significant correlation between the mean signal intensity values on T2 weighted images and tumor grading (p < 0.001). Low grade (grade 1-2) ccRCC patients exhibited higher mean signal intensity values (475.7 ± 51.3), as compared to those of high grade (grade 3-4) (418.5 ± 45.7) tumors. On the other hand, analysis of the pRCC group patients revealed that there was a significant correlation between the mean attenuation values of tumors on cortico-medullary phase contrast-enhanced CT and their grades (p < 0.001). High grade papillary subtype tumors (54.2 ± 25.2) showed higher mean attenuation values than the low grade (35.5 ± 18.8) ones. Contrast-enhanced MDCT and T2 weighted FSE MRI can play a considerable role in the discrimination of low grade versus high grade tumors of both subtype RCC patients. Thus, these non-invasive evaluation techniques may have positive impact on the determination of the management and treatment strategies of these patients.

Detection of multiple sclerosis lesions in the cervical cord: which of the MAGNIMS 'mandatory' non-gadolinium enhanced sagittal sequences is optimal at 3T?

The magnetic resonance imaging in multiple sclerosis consensus guidelines currently mandate three sagittal non-contrast enhanced sequences of T2-weighted fast spin echo, proton density-weighted fast spin echo and short tau inversion recovery; however, these particular three sequences have not previously been compared at 3T. This study compared T2-weighted fast spin echo, proton density-weighted fast spin echo, short tau inversion recovery as well as the double inversion recovery sequence for the sagittal detection of multiple sclerosis lesions in the cervical spinal cord at 3T. Nineteen multiple sclerosis patients underwent magnetic resonance imaging with 3T sagittal T2-weighted fast spin echo, proton density-weighted fast spin echo, short tau inversion recovery and double inversion recovery between November 2012 and April 2013. Two neuroradiologists independently reviewed the images, and the number of lesions detected on each sequence was recorded. Lesion conspicuity was quantitatively assessed with the lesion-to-cord-contrast ratio and lesion contrast-to-noise ratio. The Wilcoxon signed rank test was performed for statistical analysis. Proton density-weighted fast spin echo and short tau inversion recovery detected 32% more lesions compared to T2-weighted fast spin echo, and 37% more lesions compared to double inversion recovery. The lesion-to-cord-contrast ratio was highest in short tau inversion recovery, while the lesion contrast-to-noise ratio was highest for proton density-weighted fast spin echo. This study provides the necessary evidentiary support at 3T for the magnetic resonance imaging in multiple sclerosis spinal magnetic resonance imaging protocol consensus guidelines. At 3T sagittal proton density-weighted fast spin echo and short tau inversion recovery sequences allowed improved detection of cervical spinal cord multiple sclerosis lesions, compared to T2-weighted fast spin echo and three-dimensional double inversion recovery magnetic resonance imaging. Utilising T2-weighted fast spin echo alone at 3T is insufficient for lesion detection.

Comparison of cortico-medullary phase contrast-enhanced MDCT and T2-weighted MR imaging in the histological subtype differentiation of renal cell carcinoma: radiology-pathology correlation.

PurposeRenal cell carcinoma (RCC) subtype differentiation is of crucial importance in the management and prognosis of these patients. In this study, we investigated the usefulness of unenhanced and cortico-medullary phase contrast-enhanced multidetector-row computed tomography (MDCT) and T2-weighted fast spin-echo (FSE) magnetic resonance imaging (MRI) modalities in the discrimination of the 3 main subtype RCC patients in correlation with their histopathological findings.Material and methodsA total of 80 pathologically proven RCC patients who had undergone either partial or total nephrectomy were retrospectively investigated in this study. Their histological subtypes were 54 clear cell renal cell carcinoma (ccRCC), 15 papillary renal cell carcinoma (pRCC), and 11 chromophobe renal cell carcinoma (cRCC), based on pathological evaluation. There were 62 male (77.5%) and 18 female (22.5%) patients. Among the 54 ccRCC patients, 29 patients had both non-contrast and cortico-medullary phase CT, 1 had only non-contrast CT, 5 only had cortico-medullary phase CT, and 38 had MRI examination. In the pRCC group, 10 patients had both non-contrast and cortico-medullary phase CT, 1 had only non-contrast CT, 1 had only cortico-medullary phase CT, and 12 had MRI. Finally, in the remaining 11 cRCC patients, 9 had both non-contrast and cortico-medullary phase CT, and only 5 had MRI. We calculated both tumour attenuation values as HU (Hounsfield units) on unenhanced and cortico-medullary phase MDCT images and also tumour mean signal intensity values on FSE T2-weighted MRI images by using the region of interest (ROI) including normal renal cortex measurements. Besides quantitative evaluation, we also performed qualitative visual assessment of tumours on contrast-enhanced MDCT and FSE T2-weighted MRI.ResultsThere was no statistically significant difference among the attenuation values of the 3 tumour subtypes on pre-contrast CT images. ccRCC demonstrated a prominent degree of contrast enhancement compared to the chromophobe and papillary ones on cortico-medullary phase MDCT. We found no statistically significant difference between chromophobe and papillary subtypes, although chromophobe tumours showed slightly higher attenuation values compared to papillary ones. ccRCCs usually demonstrated a heterogenous contrast enhancement on cortico-medullary phase CT images, while the papillary subtype usually had a homogenous appearance on visual assessment. On FSE T2-weighted MR images, the signal intensity values of ccRCC patients were found to be significantly higher than both chromophobe and papillary subtypes. Although cRCC patients had a prominently lower T2 signal intensity than clear cell subtype, there was no statistically significant signal intensity difference between chromophobe and papillary subtypes. Regarding visual assessment, papillary subtype tumours showed a mostly homogenous appearance on T2-weighted images and a statistically significant difference was present. On the other hand, there was no significant difference of visual assessment of the clear cell and chromophobe subtypes.ConclusionsThe measurement of the attenuation values on cortico-medullary phase MDCT and the mean signal intensity values on FSE T2-weighted MRI can provide useful information in the differentiation of RCC main subtypes. Also, visual assessment of tumours on both modalities can contribute to this issue by providing additional imaging properties.

Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement.

The relationship between morphological characteristics of the hip capsule and patient symptoms in the setting of femoroacetabular impingement (FAI) is undefined. In this study, patients with symptomatic FAI prospectively underwent 3T magnetic resonance (MR) imaging of the affected hip and completed the hip disability and osteoarthritis outcome score (HOOS) to determine the correlation between hip capsule anatomy and patient symptoms. Anterior hip capsule volume, posterior capsule volume, anterior-posterior capsule volume ratio, and proximal-distal volume ratio in the anterior capsule were quantified and measured using axial-oblique intermediate-weighted 3D fast spin echo MR images. A total of 35 patients (35 hips) were included for analysis (mean age: 30.6 years; mean body mass index [BMI]: 24.9 kg/m2 ; 57% male). The mean alpha angle was 62.2° ± 4.7°, the mean anterior hip capsule volume was 1705.1 ± 450.3 mm3 , the mean posterior hip capsule volume was 1284.8 ± 268.5 mm3 , the mean anterior to posterior capsule volume ratio was 1.1 ± 0.39, and the mean proximal to distal volume ratio of the anterior capsule was 0.65 ± 0.28. There was no correlation between age, gender, or BMI, and any hip capsule characteristics. Worse scores on the HOOS pain scale were correlated with increased anterior to posterior volume ratio (r = -.38; 95% confidence interval: -0.06 to -0.63). In conclusion, hip capsule morphology correlates with patient symptoms in the setting of FAI as increased anterior capsular volume, relative to posterior capsular volume, is associated with greater patient pain.

Associations of serum citrate levels with knee structural changes and cartilage enzymes in patients with knee osteoarthritis.

The aim of this study was to investigate cross-sectional associations between serum levels of citrate and knee structural changes and cartilage enzymes in patients with knee osteoarthritis (OA). A total of 137 subjects with symptomatic knee OA (mean age 55.0years, range 34-74, 84% female) were included. Knee radiography was used to assess knee osteophytes, joint space narrowing (JSN) and radiographic OA assessed by Kellgren-Lawrence (K-L) grading system. T2-weighted fat-suppressed fast spin echo magnetic resonance imaging (MRI) was used to determine knee cartilage defects, bone marrow lesions (BMLs) and infrapatellar fat pad (IPFP) signal intensity alternations. Colorimetric fluorescence was used to measure the serum levels of citrate. Enzyme-linked immunosorbent assay was used to measure the serum cartilage enzymes including matrix metalloproteinase (MMP)-3 and MMP-13. After adjustment for potential confounders (age, sex, body mass index), serum citrate was negatively associated with knee osteophytes at the femoral site, cartilage defects at medial femoral site, total cartilage defects, and total BMLs (odds ratio [OR] 0.17-0.30, all P<.05). Meanwhile, serum citrate was negatively associated with IPFP signal intensity alteration (OR 0.30, P=.05) in multivariable analyses. Serum citrate was significantly and negatively associated with MMP-13 (β -3106.37, P<.05) after adjustment for potential confounders. However, citrate was not significantly associated with MMP-3 in patients with knee OA. Serum citrate was negatively associated with knee structural changes including femoral osteophytes, cartilage defects, and BMLs and also serum MMP-13 in patients with knee OA, suggesting that low serum citrate may be a potential indicator for advanced knee OA.

Validation of contrast enhanced cine steady-state free precession and T2-weighted CMR for assessment of ischemic myocardial area-at-risk in the presence of reperfusion injury.

The purpose of the study was to validate by histopathology, contrast enhanced cine steady-state free precession and T2-weighted CMR for the assessment of ischemic myocardial area-at-risk (AAR) in the presence of microvascular obstruction (MVO). Eleven anesthetized pigs underwent CMR 7 to 10 days post infarction. The area-at-risk was measured from T2-weighted fast spin echo (T2-STIR) and contrast-enhanced steady-state free precession magnetic resonance imaging (CE-SSFP) images using semi-automated algorithms based on a priori knowledge of perfusion territory. Also, late gadolinium enhancement (LGE) was performed to measure final infarct size (FIS). Histopathological comparison with Evans blue dye to define AAR and triphenyltetrazolium chloride to define FIS served as the reference. All infarcts demonstrated MVO on LGE images. Bland-Altman analysis showed no significant bias in AAR or myocardial salvage between T2-STIR and CE-SSFP or between CMR and histopathology. The mean differences ± 2SD from Bland-Altman analysis were: AAR: Evans Blue vs. T2-STIR [0.7%; +13.5%; -12.1%]; AAR: Evans Blue vs. CE-SSFP [0.1%; +13.8%; -13.7%]; AAR: T2-STIR vs. CE-SSFP [0.7%; +6.2%; -4.9%]; Salvage: Evans Blue-TTC vs. T2-STIR-LGE [0.8%; +11.1%; -9.6%]; Salvage: Evans Blue-TTC vs. CE-SSFP-LGE [0.1%; +9.9%; -9.6%]; Salvage: CE-SSFP-LGE vs. T2-STIR-LGE [0.7%; +6.2%; -4.9%]. Both T2-STIR and CE-SSFP sequences allow for unbiased quantification of AAR in the presence of ischemia/reperfusion injury when analysed by semi-automated algorithms. These experimental data, which was validated by histopathology, supports the use of CMR for the assessment of myocardial salvage during the subacute phase.

Diagnostic Accuracy of Noncontrast MR Angiography Protocols at 3T for the Detection and Characterization of Lower Extremity Peripheral Arterial Disease

PurposeTo compare the diagnostic accuracy of established non–gadolinium (Gd)-enhanced magnetic resonance (MR) angiography protocols with Gd-enhanced MR angiography at 3T for evaluating lower extremity peripheral arterial disease (PAD). Materials and MethodsFrom February 2014 to 2015, 20 patients with PAD and intermittent claudication (16 men; age range, 51–76 y; Fontaine stage II) underwent 3-station (abdominopelvic, thigh, and calf) non-Gd MR angiography and bolus-chase Gd MR angiography protocols performed at 3T (Siemens Tim Trio), including quiescent-interval single-shot (QISS) MR angiography for all 3 stations and a combination of quadruple inversion recovery (QIR) MR angiography for the abdominopelvic station and electrocardiogram-gated fast spin echo (ECG-FSE) MR angiography for the extremities. Two radiologists independently evaluated vessel segments for vascular stenosis, diagnosis confidence, graft presence, and Trans-Atlantic Inter-Society Consensus (TASC) II classification for each station. Diagnostic accuracies and κ agreement were assessed. ResultsOf 573 vascular segments imaged, 16.9% (97/573, 19/20 patients) demonstrated hemodynamically significant abnormalities. Reader confidence was sufficient for diagnosis in 98% of segments with Gd MR angiography, 93% with QIR/ECG-FSE, and 95% with QISS. Overall reader confidence was higher with QISS than QIR/ECG-FSE within all 3 stations combined (P < .05). With low-confidence segments treated as misdiagnosis, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and κ agreement for all 3 stations combined were 81.4/87.2/57.0/95.8/86.2%/0.578 for QIR/ECG-FSE and 75.0/90.6/61.6/94.7/88.0%/0.597 for QISS. Using TASC II criteria to assess severity, QISS and QIR/ECG-FSE had no statistical difference in agreement with Gd MR angiography. ConclusionsQISS and QIR/ECG-FSE MR angiography protocols demonstrate comparable diagnostic accuracies with high specificity. Either protocol provides an alternative to Gd MR angiography at 3T for patients with PAD.

Patellar tendon enthesis abnormalities and their association with knee pain and structural abnormalities in older adults

Purpose: The patellar tendon works together with the quadriceps tendon to enable knee flexion. Its attachment site (enthesis) is at risk of micro damage and degeneration. Recent studies suggest that enthesis abnormalities are associated with development of osteoarthritis through the synovio-entheseal complex. However, no studies have assessed the presence of patellar enthesis abnormalities in older adults and its association with osteoarthritis outcomes. Therefore, we aimed to describe associations between presence of patellar tendon enthesis (PTE) abnormalities visible on magnetic resonance (MR) images at baseline and knee pain, physical function limitations, and osteoarthritic structural abnormalities both cross-sectionally and longitudinally over 10.7 years. Methods: Patellar tendon enthesis abnormalities, defined as presence of abnormal bone signal and/or bone erosion were measured on T2-weighted fat suppressed fast spin echo MR images at baseline in 961 community-dwelling older adults. Knee pain and physical function limitation score were assessed using WOMAC at baseline and 10.7 years. Tibial, femoral, and patella bone marrow lesions (BMLs), cartilage volume and cartilage defects were assessed at baseline and 10.7 years, tibial bone area at baseline and 2.7 years, and infrapatellar fat pad area at baseline using validated methods. Associations were assessed using hurdle, log binomial, linear, and mixed models, after adjusting for confounders. Results: 20% of participants had bone signal and/or erosion at PTE. Cross-sectionally, presence of PTE abnormalities were associated with greater intensity of pain while going up and down stairs (β = 0.22 (95% CI; 0.03, 0.41)), greater risk of having a femoral (RR = 1.46 (1.22, 1.90)) BML, greater lateral tibial bone area (β = 25.95 (1.00, 50.91)), smaller infrapatellar fat pad area (β = −0.26 (−0.46, −0.05)), and a worse tibial cartilage defect score (RR = 1.70 (1.16, 2.47), after adjustment for age, sex, BMI, and structural confounders. Longitudinally, presence of PTE abnormalities at baseline predicted an increased risk of deleterious changes in tibial BML size (RR = 1.52 (1.12, 2.05)) only over 10.7 years but not pain or other structural changes. Conclusions: Patellar tendon enthesis abnormalities are common in the elderly. The presence of cross-sectional but not longitudinal associations suggests they commonly co-exist with other knee structural abnormalities. This suggests they may not be a major player in symptom development or structural changes with the exception of tibial BMLs.

Associations between systemic bone mineral density, knee cartilage defects and bone marrow lesions in patients with knee osteoarthritis.

The relationship between bone mineral density (BMD) and osteoarthritis (OA) remains controversial. This study aimed to explore the cross-sectional associations between BMD at the total body, hip and spine and joint structural abnormalities including cartilage defects and bone marrow lesions (BMLs) in patients with knee OA. One hundred and eight-five subjects with symptomatic knee OA were included in this study. T2-weighted fast spin echo magnetic resonance imaging was used to assess knee cartilage defects and BMLs. Total body, hip and spine BMD were measured using dual-energy X-ray absorptiometry. After adjustment for potential confounders, total hip BMD was negatively associated with medial tibial cartilage defects, lateral femoral cartilage defects, medial tibial BMLs and lateral tibial BMLs. Spine and total body BMD were negatively associated with lateral femoral cartilage defects, but not with BMLs. We concluded that BMD particularly at the hip was negatively associated with knee cartilage defects and BMLs.

Congenital Unilateral Fallopian Tube and Renal Agenesis in a Patient with Primary Infertility

A 35-year-old nulligravid normo-ovulatory woman presented for the evaluation of primary infertility. Hysterosalpingography revealed normal filling (Fig. 1A) and intraperitoneal spillage of radiographic contrast through the right fallopian tube (Fig. 1B). No fill or spillage of contrast was noted through the left fallopian tube. A diagnostic hysteroscopy confirmed the presence of the right ostium (Fig. 2A); the left ostium was visually absent (Fig. 2B). Magnetic resonance imaging was subsequently performed, which showed blunting of the endometrium within the left cornua at the level of the uterotubal junction. There was no evidence of a kidney in the left renal fossa or within the pelvis (Fig. 2C). These findings indicated the congenital absence of the left fallopian tube and kidney. The patient underwent ovulation induction with intrauterine insemination and conceived in her second cycle. Fig. 2(A) Diagnostic hysteroscopy confirming the presence of the right ostium (white arrow). (B) Hysteroscopy indicating the absence of the left ostium (white X). (C) Single-shot fast spin echo magnetic resonance imaging confirming the presence of the right kidney (dotted white circle) in a coronal section. The same section shows an absent left kidney (white X). View Large Image Figure Viewer Download Hi-res image

Diagnostic performance of wrist magnetic resonance (MR) arthrography: comparison of three-dimensional isotropic T1 weighted fast spin-echo MR arthrography and two-dimensional MR arthrography.

To compare the diagnostic performance of direct wrist MR arthrography (D-MRA) with two-dimensional (2D) T1 weighted fast spin-echo (FSE) and three-dimensional (3D) isotropic T1 weighted FSE sequences for detecting triangular fibrocartilage (TFC) central perforations and scapholunate ligament (SLL) and lunotriquetral ligament (LTL) tears. 26 patients who had undergone pre-operative wrist D-MRA with 2D and 3D isotropic T1 weighted FSE sequences and subsequent arthroscopic surgeries were included. Each MRI sequence was independently evaluated and scored by two readers retrospectively for the presence of TFC central perforations and SLL and LTL tears. Arthroscopic findings were used as the reference standard. Diagnostic performance was evaluated by using the area under the receiver operating characteristic curve. The sensitivity, specificity and accuracy of both sequences for diagnosing the injuries were calculated. Arthroscopic surgery revealed 21 TFC central perforations, 7 SLL tears and 3 LTL tears. The area under the receiver operating characteristic curve value of 2D and 3D for central perforations in TFC and tears in SLL and LTL was identical or similar (0.667-0.947). The sensitivity, specificity and accuracy of both sequences for diagnosing the injury of each structure were not significantly different (TFC, 90.5/80/88.5% for both readers/sequences; SLL, 100/89.5/92.3% for both readers' 2D and Reader A's 3D, and 85.7/89.5/88.5% for Reader B's 3D; LTL, 66.7/100/96.2% for both readers' 2D and 33.3/100/92.3% for both readers' 3D). Interobserver agreements were substantial to excellent. In wrist D-MRA, the diagnostic performances of 3D isotropic and 2D T1 weighted FSE sequences are comparable for TFC central perforations and SLL and LTL tears. Advances in knowledge: The diagnostic performance of 3D isotropic T1 weighted FSE D-MRA and that of 2D T1 weighted FSE D-MRA were not significantly different in the diagnosis of central perforations in the TFC and tears in the SLL and LTL. 3D isotropic T1 weighted FSE D-MRA has potential for substituting 2D imaging.

Cross-sectional and longitudinal associations between serum inflammatory cytokines and knee bone marrow lesions in patients with knee osteoarthritis.

To describe cross-sectional and longitudinal associations between serum levels of interleukin (IL) - 6, IL-17A, IL-17F, IL-23 and knee bone marrow lesions (BMLs) in patients with knee osteoarthritis (OA). Patients (n=192) with symptomatic knee OA (mean 63 years, range 50-79, female 53%) were assessed at baseline and after 24 months. At each time point, serum IL-6, IL-17A, IL-17F and IL-23 were measured using Bio-Plex® Multiplex Immunoassays with Luminex xMAP technology. Knee BMLs were scored using the modified whole organ MRI score (WORMS) from T2 weighted fat-suppressed fast spin echo magnetic resonance imaging (MRI). Multivariable linear regression and log binominal regression were used to determine the associations between cytokines and BMLs. Baseline IL-6 (quarters) were significantly associated with total knee BMLs (P<0.01 for the trend) as well as associated with an increase in BML score (P=0.05 for the trend), after adjustment for confounders. Baseline IL-17F and IL-23 (highest quarters vs others) was associated with an increase in BML score in females (P=0.04 for IL-17F; P=0.01 for IL-23), but not in males, in multivariable analyses. In contrast, IL-17A was not significantly associated with BMLs in either females or males. IL-6 is associated with increased knee BMLs in both females and males with OA. Serum IL-17F and IL-23 predicted increased knee BML scores in females only, suggesting that inflammation is involved in BML pathogenesis in knee OA, especially in women. ClinicalTrials.gov identifier: NCT01176344; Australian New Zealand Clinical Trials Registry: ACTRN12610000495022.

Confidence in Assessment of Lumbar Spondylolysis Using Three-Dimensional Volumetric T2-Weighted MRI Compared With Limited Field of View, Decreased-Dose CT.

Background:Limited z-axis–coverage computed tomography (CT) to evaluate for pediatric lumbar spondylolysis, altering the technique such that the dose to the patient is comparable or lower than radiographs, is currently used at our institution. The objective of the study was to determine whether volumetric 3-dimensional fast spin echo magnetic resonance imaging (3D MRI) can provide equal or greater diagnostic accuracy compared with limited CT in the diagnosis of pediatric lumbar spondylolysis without ionizing radiation.Hypothesis:Volumetric 3D MRI can provide equal or greater diagnostic accuracy compared with low-dose CT for pediatric lumbar spondylolysis without ionizing radiation.Study Design:Clinical review.Level of Evidence:Level 2.Methods:Three pediatric neuroradiologists evaluated 2-dimensional (2D) MRI, 2D + 3D MRI, and limited CT examinations in 42 pediatric patients who obtained imaging for low back pain and suspected spondylolysis. As there is no gold standard for the diagnosis of spondylolysis besides surgery, interobserver agreement and degree of confidence were compared to determine which modality is preferable.Results:Decreased-dose CT provided a greater level of agreement than 2D MRI and 2D + 3D MRI. The kappa for rater agreement with 2D MRI, 2D + 3D MRI, and CT was 0.19, 0.32, and 1.0, respectively. All raters agreed in 31%, 40%, and 100% of cases with 2D MRI, 2D + 3D MRI, and CT. Lack of confidence was significantly lower with CT (0%) than with 2D MRI (30%) and 2D + 3D MRI (25%).Conclusion:For diagnosing spondylolysis, radiologist agreement and confidence trended toward improvement with the addition of a volumetric 3D MRI sequence to standard 2D MRI sequences compared with 2D MRI alone; however, agreement and confidence remain significantly greater using decreased-dose CT when compared with either MRI acquisition.Clinical Relevance:Decreased-dose CT of the lumbar spine remains the optimal examination to confirm a high suspicion of spondylolysis, with dose essentially equivalent to radiographs. If clinical symptoms are not classic for spondylolysis, 2D MRI is still very good at detecting spondylolysis while remaining sensitive for detection of alternative diagnoses such as disc abnormalities and pars stress reaction. The data suggest that standard 2D MRI sequences should not be entirely replaced by a volumetric T2-weighted 3D sequence (despite promising features of rapid acquisition time, increased spatial resolution, and reconstruction capability).

Can Signal Abnormalities Detected with MR Imaging in Knee Articular Cartilage Be Used to Predict Development of Morphologic Cartilage Defects? 48-Month Data from the Osteoarthritis Initiative.

Purpose To determine the incidence with which morphologic articular cartilage defects develop over 48 months in cartilage with signal abnormalities at baseline magnetic resonance (MR) imaging in comparison with the incidence in articular cartilage without signal abnormalities at baseline. Materials and Methods The institutional review boards of all participating centers approved this HIPAA-compliant study. Right knees of 90 subjects from the Osteoarthritis Initiative (mean age, 55 years ± 8 [standard deviation]; 51% women) with cartilage signal abnormalities but without morphologic cartilage defects at 3.0-T MR imaging and without radiographic osteoarthritis (Kellgren-Lawrence score, 0-1) were frequency matched for age, sex, Kellgren-Lawrence score, and body mass index with right knees in 90 subjects without any signal abnormalities or morphologic defects in the articular cartilage (mean age, 54 years ± 5; 51% women). Individual signal abnormalities (n = 126) on intermediate-weighted fast spin-echo MR images were categorized into four subgrades: subgrade A, hypointense; subgrade B, inhomogeneous; subgrade C, hyperintense; and subgrade D, hyperintense with swelling. The development of morphologic articular cartilage defects (Whole-Organ MR Imaging Score ≥2) at 48 months was analyzed on a compartment level and was compared between groups by using generalized estimating equation logistic regression models. Results Cartilage signal abnormalities were more frequent in the patellofemoral joint than in the tibiofemoral joint (59.5% vs 39.5%). Subgrade A was seen more frequently than were subgrades C and D (36% vs 22%). Incidence of morphologic cartilage defects at 48 months was 57% in cartilage with baseline signal abnormalities, while only 4% of compartments without baseline signal abnormalities developed morphologic defects at 48 months (all compartments combined and each compartment separately, P < .01). The development of morphologic defects was not significantly more likely in any of the subgrades (P = .98) and was significantly associated with progression of bone marrow abnormalities (P = .002). Conclusion Knee cartilage signal abnormalities detected with MR imaging are precursors of morphologic defects with osteoarthritis and may serve as imaging biomarkers with which to assess risk for cartilage degeneration. (©) RSNA, 2016.

Are 3D FSE MRI sequences of the knee at 1.5 T effective in the detection of meniscal and ligament tears? How useful are they?

Radiol Bras. 2016 Mar/Abr;49(2):V–VI The use of fast spin-echo (FSE) magnetic resonance imaging (MRI) sequences is the most versatile way of evaluating the musculoskeletal system. Anisotropic, two-dimensional (2D) sequences have greater resolution in the acquisition plane whereas the voxel resolution in isotropic three-dimensional (3D) volumetric sequences is the same in all planes with no loss of spatial resolution and with no distortion. Initially, 3D gradient-echo sequences which had acceptable acquisition time and high resolution but inadequate tissue contrast were the standard for evaluating the musculoskeletal system. As of 2007, technological advances led to more consistent use of 3D FSE sequences in such evaluations, because 3D FSE sequences provide greater tissue contrast for clinical application in the knee than do 3D gradient-echo sequences. Imaging studies of the knee structures can require the use of oblique planes with special orientation. That is the case of anterior cruciate ligament evaluation, a common situation on the daily practice. In 2007, Rajeswaran et al. highlighted the value of using oblique planes to evaluate the popliteofibular ligament, which plays a role in instability related to lesions of the posterolateral corner structures of the knee. Evaluations of the articular cartilage of the knee can also benefit from the use of 3D isotropic volumetric sequences due to its capacity to reformat in different planes and its greater spatial resolution which improves the characterization of cartilagineous lesions. This last characteristic has a particular application in the femoral trochlea. The articular cartilage evaluation in this area, using axial planes with the usual angulation, has certain limitations. The sagittal plane is called in order to complement this evaluation, although it can be less precise due to partial volume effects. Para-axial slices, perpendicular to the articular surface of the trochlea, can better define injury in this area. Regarding the detection of ligament and meniscal injuries, the performance of volumetric sequences is similar to that of 2D sequences, although the quality of 3D images is considered inferior to that of 2D images. Although some authors question the real value of 3D FSE sequences for the diagnosis of meniscal and cartilaginous lesions in

Three-dimensional isotropic fast spin-echo MR lymphangiography of T1-weighted and intermediate-weighted pulse sequences in patients with lymphoedema

To evaluate the feasibility of magnetic resonance (MR) lymphangiography acquired using three-dimensional (3D) isotropic T1-weighted fast spin-echo (FSE) and 3D isotropic intermediate-weighted FSE sequences, as the new method of MR lymphangiography, and to compare the results of these two methods in patients with lymphoedema. Thirty-three extremities of 27 patients with primary or secondary lymphoedema and who had undergone radionuclide lymphoscintigraphy and MR lymphangiography with 3D isotropic T1-weighted FSE and 3D isotropic intermediate-weighted FSE were included in the study. The results of both imaging techniques were independently reviewed by two readers in consensus who rated the lymphatic drainage pattern, the quality of the depiction of lymphatic vessels and lymph nodes, and the level of lymph vessel enhancement. The assessment scores of each imaging sequence were compared using the Wilcoxon signed-rank test. The results were expressed as means with standard deviations. More lymphatic vessels were visualised on T1-weighted FSE than on intermediate-weighted FSE (p<0.001). As more lymphatic vessels were detected on T1-weighted FSE, the per-extremity grade of the lymphatic drainage pattern was higher (p=0.046) and the visible levels of lymph-vessel enhancement were also significantly higher (p=0.004) on the T1-weighted FSE sequence, whereas the conspicuity of lymph nodes was superior on intermediate-weighted FSE (p=0.004). MR lymphangiography using the 3D FSE pulse sequence is a feasible and noticeable new technique of MR lymphangiography. Between the two applicable protocols used, T1-weighted FSE provided better information regarding lymphatic vessels and their drainage, whereas intermediate-weighted FSE has the advantage of depicting lymph nodes in lymphoedematous extremities.