Fat-suppressed Sequences Research Articles

Intramammary edema of invasive breast cancers on MRI T2-weighted fat suppression sequence: Correlation with molecular subtypes and clinical-pathologic prognostic factors

ObjectiveTo investigate the associations between different patterns of intramammary edema on preoperative 3.0 T magnetic resonance imaging (MRI) T2-weighted fat suppression sequence and invasive breast cancer molecular subtypes and clinical-pathologic prognostic factors. MethodsBetween May 2014 and December 2020, 191 patients with invasive breast cancer who had undergone preoperative MRI and mastectomy or breast-conserving surgery were retrospectively enrolled. The relationships between different patterns of intramammary edema and invasive breast cancer molecular subtypes and clinical-pathologic features were evaluated using the Student's t-test or Mann–Whitney U test and the χ2 test or Fisher's exact test. ResultsPatients with luminal B (HER2 positive), HER2-enriched and triple negative breast cancers respectively had different patterns of intramammary edema (P < 0.001). There was a significant association between intramammary edema and clinical-pathologic factors, including larger tumor size, higher Ki-67 index, lymph node metastasis and lymphovascular invasion (all P < 0.001). ConclusionsIntramammary edema may provide added values of predicting molecular subtypes and clinical-pathologic prognosis, enhancing the ability to individualize the treatment of patients with invasive breast cancer.

Do Patients Really Have Pain with Quadriceps Fat Pad Edema?

To determine the appropriate MRI criteria for the radiological diagnosis of significant quadriceps fat pad edema, to investigate the relationship between these criteria and anterior knee pain, and to evaluate possible structural and positional factors in the etiology. In this retrospective case-control study, individuals with and without quadriceps fat pad edema in the knee MRIs taken between May 2016 and December 2018 were determined as the case and control groups, respectively, in a ratio of 1:1. The MRI criteria for significant quadriceps fat pad edema were set as 10mm and above the anterior-posterior diameter of the quadriceps fat pad, posterior convexity, and an increased signal in the fat-suppressed proton density sequence. The groups were compared for anterior knee pain, pain characteristics, working positions (sitting and standing), and MRI findings of structural factors. P < 0.05 was considered statistically significant. A total of 108 individuals were evaluated. Anterior knee pain was more common in the case group (49/54, p < 0.001) and was highly correlated with signs of quadriceps fat pad edema (R = -0,657). Frequent pain at night (18/54, p = 0.013), increased pain when walking upstairs (40/54, p = 0.003), knees are flexed (43/54, p < 0.001), and decreased pain when knees are extended (42/54, p < 0.001) were significantly high in the case group. No significant differences were observed in working position and structural factors. Quadriceps fat pad edema is significantly associated with anterior knee pain and certain specific pain characteristics.

What morphological MRI features enable differentiation of low-grade from high-grade soft tissue sarcoma?

Objective:To assess the diagnostic performance of morphological MRI features separately and in combination for distinguishing low- from high-grade soft tissue sarcoma (STS).Methods and materials:We retrospectively analysed pre-treatment MRI examinations with T1, T2 with and without fat suppression (FS) and contrast-enhanced T1 obtained in 64 patients with STS categorized histologically as low (n = 21) versus high grade (n = 43). Two musculoskeletal radiologists blinded to histology evaluated MRI features. Diagnostic performance was calculated for each reader and for MRI features showing significant association with histology (p < 0.05). Logistic regression analysis was performed to develop a diagnostic model to identify high-grade STS.Results:Among all evaluated MRI features, only six features had adequate interobserver reproducibility (kappa>0.5). Multivariate logistic regression analysis revealed a significant association with tumour grade for lesion heterogeneity on FS images, intratumoural enhancement≥51% of tumour volume and peritumoural enhancement for both readers (p < 0.05). For both readers, the presence of each of the three features yielded odds ratios for high grade versus low grade from 4.4 to 9.1 (p < 0.05). The sum of the positive features for each reader independent of reader expertise yielded areas under the curve (AUCs) > 0.8. The presence of ≥2 positive features indicated a high risk for high-grade sarcoma, whereas ≤1 positive feature indicated a low-to-moderate riskConclusion:A diagnostic MRI score based on tumour heterogeneity, intratumoural and peritumoural enhancement enables identification of lesions that are likely to be high-grade as opposed to low-grade STS.Advances in knowledge:Tumour heterogeneity in Fat Suppression sequence, intratumoural and peritumoural enhancement is identified as signs of high-grade sarcoma.

Magnetic resonance imaging and shear wave elastography comparison in the evaluation of breast lesions

This study aims to compare the Magnetic Resonance Imaging (MRI) and Shear Wave Elastography (SWE) data and investigate their contribution to diagnosis when both are individually used and combined. This study included the consent of 46 diagnostic biopsy patients after their breast MRI examination was performed. Mass appearance patients in the sonographic evaluation were SWE examined before the biopsy. In MR examination, lesion localization, size, contrast curves, contrast enhancement features, intensity in the fat-suppressed T2A sequence, Emean value in SWE examination, and histopathological results were examined. Individual and combined use of MRI and SWE findings were evaluated with histopathological results. The diagnosis consistency was compared according to the histopathological results of the malignant-benign defined lesions. Higher sensitivity in MRI; higher specificity and accuracy in SWE were acquired when both methods were compared. The accuracy of MRI improved when MRI use is combined with SWE. The combined use of SWE with MRI increases the diagnostic accuracy in breast lesion characterization. We observed that lesions showing a type 3 enhancement curve and iso-hypointense on the T2W sequence in breast MRI could be predicted to show a stiff elasticity pattern on SWE due to higher elastography values.

NON-CHONDRAL MULTI-TISSUE PATHOLOGY AS ASSESSED BY MRI INCREASES RATES OF QUANTITATIVE MRI-DEFINED CARTILAGE THICKNESS LOSS OVER 24 MONTHS: THE APPROACH STUDY

NON-CHONDRAL MULTI-TISSUE PATHOLOGY AS ASSESSED BY MRI INCREASES RATES OF QUANTITATIVE MRI-DEFINED CARTILAGE THICKNESS LOSS OVER 24 MONTHS: THE APPROACH STUDY

Magnetic Resonance Imaging Data Features to Evaluate the Efficacy of Compound Skin Graft for Diabetic Foot.

This study aimed to analyze the role of magnetic resonance imaging (MRI) data characteristics based on the deep learning algorithm in evaluating the treatment of diabetic foot (DF) with composite skin graft. In this study, 78 patients with DF were randomly rolled into the experimental group (composite skin graft) and control group (autologous skin graft) with 39 patients in each group. MRI scans were performed before and after treatment to compare the changes of experimental observation indicators such as healing time, recurrence rate, and scar score. The results showed that T1-weighted imaging (T1WI) of the scanning sequence was considerably increased in the experimental group after treatment. The signal intensity of fat-suppressed T2-weighted imaging (T2WI) and fat-suppressed T1WI enhancement sequences was considerably decreased (P < 0.05). In addition, compared with the control group, the recurrence rate, healing time, and scar score in the experimental group were considerably decreased (P < 0.05). The accuracy, specificity, and sensitivity of MRI imaging information in evaluating the therapeutic effect of DF patients were 85.2%, 89.75%, and 86.47%, respectively. According to the specificity and sensitivity, the subject operating characteristic curve was drawn, and the area under the curve was determined to be 0.838. In summary, MRI image data characteristics based on the deep learning algorithm can provide auxiliary reference information for the efficacy evaluation of compound skin transplantation for DF.

PREVALENCE OF POTENTIAL MRI-BASED EXCLUSIONARY FINDINGS IN OSTEOARTHRITIS CLINICAL TRIALS: DATA FROM THE OSTEOARTHRITIS INITIATIVE (OAI)

PREVALENCE OF POTENTIAL MRI-BASED EXCLUSIONARY FINDINGS IN OSTEOARTHRITIS CLINICAL TRIALS: DATA FROM THE OSTEOARTHRITIS INITIATIVE (OAI)

PREVALCENCE OF MR‐DECTED CARTILAGE DAMAGE IN KNEES WITH KELLGREN-LAWRENCE 2 & 3 OSTEOARTHRITIS AND IMPLICATIONS FOR CLINICAL TRIALS

Many potential disease-modifying osteoarthritis drugs (DMOADs) have been investigated, but to date no DMOADs that slow or stop disease progression have been approved by the Food and Drug Administration (FDA) or the European Medicines Agency (EMA). A potential reason for the lack of demonstrated efficacy may be reliance on radiographs for defining structural inclusion and exclusion criteria for clinical trials, such as use of joint space width and Kellgren-Lawrence (KL) grade as surrogates for cartilage damage. To estimate the distribution of cartilage damage seen on knee MRI in a sample of knees with radiographic KL 2 and 3 OA that would potentially qualify for a DMOAD trial. We selected knees from the Osteoarthritis Initiative (OAI) that met common structural inclusion criteria for DMOAD trial enrollment at OAI baseline: knees with radiographs centrally graded as KL 2 or 3 and medial minimum joint space width (mJSW) ≥ 1.5mm. A musculoskeletal radiologist with 10 years of experience in semi-quantitative MRI assessment scored knee cartilage damage in the medial and lateral tibiofemoral and patellofemoral compartments using WORMS (Whole-Organ Magnetic Resonance Imaging Score). Coronal intermediate weighted (IW) TSE and sagittal fat-suppressed IW TSE sequences on 3T MRI were used. The WORMS cartilage scores, which are based on both the extent and depth of cartilage damage, were collapsed into 4 categories: no cartilage damage (WORMS 0 and 1), focal partial or full-thickness (PT/FT) cartilage damage (WORMS 2 and 2.5), diffuse partial thickness (PT) cartilage damage (WORMS 3 and 4), and diffuse full-thickness (FT) cartilage damage (WORMS 5 and 6). We estimated the prevalence of each category of cartilage damage in KL2 and KL3 knees; 95% confidence intervals (CI) accounted for clustering at the participant-level since some participants contributed two knees to the analysis. We identified 2,372 participants contributing 3,446 knees with radiographic OA (KL 2 and 3) and medial mJSW ≥ 1.5mm. There were 2,318 KL2 knees and 1,128 KL3 knees. We found no cartilage damage in any compartments in 9.8% (95%CI: 8.5, 11.1) of KL2 knees and 2.0% (95%CI: 1.1, 2.9) of KL3 knees. Cartilage damage was absent in the medial tibiofemoral compartment in 52.4% (95%CI: 50.1, 54.6) of KL2 knees, and 14.4% (95%CI: 12.2, 16.6) of KL3 knees, versus 61% (95%CI: 58.8, 63.2) of KL2 knees and 53.6% (95%CI: 50.4, 56.7) of KL3 knees in the lateral compartment. When medial and lateral compartments were combined, cartilage damage was absent in 34.8% (95%CI: 32.7, 36.9) of the KL2 knees, and 4.3% (95%CI: 3.0, 5.5) of the KL3 knees. Diffuse FT cartilage lesions in the medial compartment were found in 6.1% (95%CI: 5.0, 7.1) of KL2 knees and 42.5% (95%CI: 39.4, 45.6) of KL3 knees. MRI screening prior to clinical trial enrollment may identify a substantial percentage of knees with normal cartilage, as well as knees with diffuse FT cartilage lesions that may not be responsive to DMOADs, depending on the mode of action of a given pharmacological compound. AG has received consultancies fees from Pfizer, Novartis, AstraZeneca, Merck Serono, Regeneron and TissueGene and is shareholder of Boston Imaging Core Lab (BICL), LLC a company providing image assessment services. FWR is shareholder of BICL, LLC and has received consultancies fees from Calibr–California Institute of Biomedical Research and Grünenthal, GmbH. DH receives publication royalties from Wolters-Kluwer. CKK has received consultancy fees from Thuasne, Regeneron, Novartis, Kolon Tissue Gene, Taiwan Liposome, Amzell AZ, LG Chem, Express Scripts, and has received grants from Lilly, Pfizer GSK, Cumberland CORRESPONDENCE ADDRESS: mjarraya@mgh.harvard.edu .

Preoperative Templating of Bone-Patellar Tendon-Bone Graft for Anterior Cruciate Ligament Reconstruction: A Morphometry-Based Graft Harvest Method.

Knowledge of anatomy and morphometry of the patella and patellar tendon is crucial for the selection of bone-patellar tendon-bone (BTB) graft for anterior cruciate ligament reconstruction. Graft tunnel mismatch in BTB graft especially in patients with patella alta or baja can result in compromised fixation for the bone-to-bone healing. This complication can be avoided by proper templating of graft using parameters measured from magnetic resonance imaging (MRI). The study aimed to derive morphometric data from MRI and predict the suitability of BTB graft preoperatively. MRI of 1,002 knees was chosen from database after applying the eligibility criteria, which included individuals in the age group of 18-50 years (both sexes) with the intact patella and patellar tendon. Individuals with pathologies of the knee joint and associated structures such as patellar fracture/dislocations, fractures of the distal femur and proximal tibia, and avulsion of the quadriceps tendon or patellar tendon were excluded. For analysis, 1.5 Tesla, proton density, and fat-suppressed sequences of sagittal and axial sections of T2-weighted MRI images were used. Mean age of the 1,002 patients was 35.45 years and there were 290 women and 712 men. Respective measurements were as follows: patella length, width, and thickness, 40.3 mm, 40.2 mm, and 18.6 mm, respectively; patellar tendon length, width, and insertional thickness, 45.2 mm, 27.2 mm, and 5.7 mm, respectively; Insall-Salvati ratio, 1.13; overall graft length, 90.2 mm; and effective tendon length, 26.1 mm. A simple MRI analysis can give us valuable inputs on BTB graft morphometry. The values can also help us with the near-perfect graft harvest. The intraoperative complication of graft tunnel mismatch can be avoided by predicting the overall graft length, effective tendon length, tibial tunnel length, and patellar position using the measured parameters on MRI.

Liver Acquisition with Volume Acceleration versus T2 fat suppressed MRI sequences in the evaluation of perianal fistula

Back groundPerianal fistula is an abnormal communication between the anal canal and the outer perineal skin. It is a disease of young adults, being more common in males.MRI is a noninvasive, well-tolerated imaging modality with high resolution of the soft tissues. It is considered the imaging modality of choice for the initial evaluation and follow-up of perianal fistulas as it is more tolerated and less embarrassing for the patient than other imaging techniques.ObjectivesTo compare MR sequences fat-suppressed (FS) T2-weighted imaging and Liver Acquisition with Volume Acceleration (LAVA) for better visualization and assessment of the perianal fistulas and sphincters.Patients and methodsThis was a retrospective study done in the period between January 2018 and January 2020 on 100 patients. The patients' age ranged from 15 to 67 years, with a mean age of 35.45 ± 12.35 years. All patients had previously undergone MRI pelvis with intravenous contrast. We considered the operative results as the reference standard.ResultsThis study included 36 (36.0%) females and 64 (64.0%) males. LAVA sequence was better than T2 FS MRI sequence for the detection of the internal opening of the fistulous tract as well as secondary fistulous tracts with perfect interobserver agreement (P < 0.001). Both LAVA and T2 FS MRI sequences have the same significance for the detection of the abscesses, horseshoe, and supralevator extension of the fistula, with perfect interobserver agreement between both observers and between them and surgery.ConclusionAdding LAVA sequence to the protocol of MRI in the evaluation of perianal fistula helps to give better details as compared with T2 FS sequence as regarding the internal opening and the secondary tracts of the fistulous tract, but they have the same results regarding the sensitivity to detect abscesses, horseshoe, and supralevator extension of the perianal fistula.

Evaluation of a single-breath-hold radial turbo-spin-echo sequence for T2 mapping of the liver at 3T

ObjectivesT2 mapping of the liver is a potential diagnostic tool, but conventional techniques are difficult to perform in clinical practice due to long scan time. We aimed to evaluate the accuracy of a prototype radial turbo-spin-echo (rTSE) sequence, optimized for multi-slice T2 mapping in the abdomen during one breath-hold at 3 T.MethodsA multi-sample (fat: 0–35%) agarose phantom doped with MnCl2 and 80 subjects (73 patients undergoing abdomen MR examination and 7 healthy volunteers) were investigated. A radial turbo-spin-echo (rTSE) sequence with and without fat suppression, a Cartesian turbo-spin-echo (Cart-TSE) sequence, and a single-voxel multi-echo STEAM spectroscopy (HISTO) were performed in phantom, and fat-suppressed rTSE and HISTO sequences were performed in in vivo measurements. Two approaches were used to sample T2 values: manually selected circular ROIs and whole liver analysis with Gaussian mixture models (GMM).ResultsThe rTSE-T2s values exhibited a strong correlation with Cart-TSE-T2s (R2 = 0.988) and with HISTO-T2s of water (R2 = 0.972) in phantom with an offset between rTSE and Cart-TSE maps (mean difference = 3.17 ± 1.18 ms). The application of fat suppression decreased T2 values, and the effect was directly proportional to the amount of fat. Measurements in patients yielded a linear relationship between rTSE- and HISTO-T2s (R2 = 0.546 and R2 = 0.580 for ROI and GMM, respectively).ConclusionThe fat-suppressed rTSE sequence allows for fast and accurate determination of T2 values of the liver, and appears to be suitable for further large cohort studies.Key Points•Radial turbo-spin-echo T2 mapping performs comparably to Cartesian TSE-T2 mapping, but an offset in values is observed in phantom measurements.•Fat-suppressed radial turbo-spin-echo T2 mapping is consistent with T2 of water as assessed by MRS in phantom measurements.•Fat-suppressed radial turbo-spin-echo sequence allows fast T2 mapping of the liver in a single breath-hold and is correlated with MRS-based T2 of water.

Clinical Significance of Preoperative CT and MR Imaging Findings in the Prediction of Postoperative Recurrence of Spinal Giant Cell Tumor of Bone.

ObjectivesTo explore the predictive value of preoperative imaging in patients with spinal giant cell tumor of bone (GCTB) for postoperative recurrence and risk stratification.MethodsClinical data for 62 cases of spinal GCTB diagnosed and treated at our hospital from 2008 to 2018 were identified. All patients were followed up for more than 2 years according to the clinical guidelines after surgery. Medical history data including baseline demographic and clinical characteristics, computed tomography (CT) and magnetic resonance imaging (MRI) findings of recurrent and non‐recurrent patients were compared. Two musculoskeletal radiologists read the images and were blinded to the clinical data. The imaging features associated with postoperative recurrence were analyzed by multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff value of the largest lesion diameter predicting recurrence after surgery.ResultsAccording to whether the disease recurred within the follow‐up period, patients were divided into the recurrence group and the non‐recurrence group. Of 62 patients (29 males and 33 females), 17 had recurrence and 45 did not. The recurrence rate was 27.4%. The mean follow‐up time was 73.66 (± 32.92) months. The three major treatments were total en bloc spondylectomy (n = 26), intralesional spondylectomy (n = 20), and curettage(n = 16). A total of 16 CT and MRI features were analyzed. A univariate analysis showed no significant difference in age, sex, treatment, multi‐vertebral body involvement, location, boundary, expansile mass, residual bone crest, paravertebral soft tissue mass, CT value, and MRI signal on T1‐weighted imaging (WI), T2‐WI, and T2‐WI fat suppression (FS) sequences (P > 0.05). The largest lesion diameter [(4.68 ± 1.79) vs (5.92 ± 2.17) cm, t = 2.287, P = 0.026] and the vertebral compression fracture (51% vs 82%, χ 2 = 5.005, P = 0.025) were significantly different between the non‐recurrence and recurrence groups. Logistic regression analysis showed that both largest lesion diameter (odds ratio [OR], 1.584; 95% confidence interval [CI], 1.108–2.264; P = 0.012) and compression fracture (OR, 8.073; 95%CI, 1.481–11.003; P = 0.016) were independent predictors of postoperative recurrence. When we set the cutoff value for the largest lesion diameter at 4.2 cm, the sensitivity and specificity for distinguishing the recurrence and non‐recurrence of GCTB were 94.1% and 42.2%, respectively, and the area under the curve (AUC) was 0.671. The combined model achieved a sensitivity, specificity and accuracy of 47.1%, 97.8% and 83.9%, respectively.ConclusionsIn spinal GCTB, maximum lesion diameter and the vertebral compression fracture are associated with tumor recurrence after surgery, which may provide helpful information for planning personalized treatment.

Definitions, pathogenesis, and pharmacological options for bone marrow lesions: an updated review

The term “Bone Marrow Lesions” (BMLs) identifies a pathological state characterized by a structural degeneration of the osteochondral unit (OCU) and by an alteration of the biochemical balance existing between articular cartilage and subchondral bone. These lesions, if they do not resolve spontaneously and if not adequately treated, can give rise to chronic degenerative diseases such as osteoarthritis and, in the most serious cases, evolve into stress fractures. The technique considered to be the gold standard for the detection of BMLs is Magnetic Resonance Imaging (MRI), to which BMLs appear as an area of ill-defined hyperintensity (high signal) in subchondral bone in fat-suppressed T2-weighted sequences, and hypointense areas (low signal) in T1-weighted sequences. There are several pharmacological intervention strategies for the treatment of BMLs, primarily the administration of bisphosphonates, but in recent years Iloprost treatment is also proving to be an effective therapeutic strategy. The aim of this review is to provide further evidence on the sequence of clinical-biological events leading to the appearance of these lesions, and on the current treatment strategies with the best outcome, in order to shed light on the importance of conducting further research in this field, since BMLs are part of a pathological picture characterised by numerous variables.

"WHAT AN IMPOSTER!" LIPOMATOUS HYPERTROPHY OF THE ATRIAL SEPTUM: A DIAGNOSTIC CHALLENGE IN CARDIAC IMAGING

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Lipomatous hypertrophy of the atrial septum (LHAS) is a rare, non-neoplastic fatty infiltration of the inter-atrial septum that spares the fossa ovalis. It is best differentiated from other cardiac tumors with transesophageal echocardiogram (TEE) and cardiac computed tomographic (CT) or magnetic resonance (MR) imaging. CASE PRESENTATION: A 52-year-old woman with diabetes, hypertension and a chronic tobacco smoker, presented with complaints of shortness of breath. An electrocardiogram showed non-specific ST-T wave changes. A TTE revealed an ejection fraction of 60% and a well-encapsulated mass in the right atrium; the differential diagnosis of the mass included entities such as atrial myxoma. Further evaluation with a TEE demonstrated a large, sessile, immobile mass in the right atrium with a characteristic dumbbell shaped thickening of the atrial septum, thus raising the possibility of lipomatous hypertrophy of the atrial septum (LHAS). Cardiac MRI confirmed the distinctive hour-glass shaped mass in the intra-atrial septum, with characteristic sparing of the fossa ovalis. There was no contrast enhancement and lacked signal on fat suppression sequences confirming benign LHAS. DISCUSSION: LHAS is a rare, non-neoplastic abnormality of the heart. Unlike other cardiac tumors such as myxomas and papillary fibroelastomas which require surgical intervention, LHAS is a benign finding. It is thought to be an infiltration of brown adipose tissue into the myocytes of the interatrial septum. Most cases remain clinically silent and are detected incidentally during echocardiography, surgery or autopsy. Echocardiography, where a TEE is more sensitive than a TTE, and cardiac MRIs demonstrate a characteristic dumbbell or hour-glass shaped appearance. Tailored MRI sequences with lack of gadolinium enhancement and fat suppression imaging, differentiate it from other intracardiac neoplasms, including myxomas. Moreover, positron emission tomography (PET) scans will show high fluorodeoxyglucose (FDG) uptake by the brown adipose tissue that may further aid in diagnosis. Rare complications of LHAS include SVC syndrome, sick-sinus syndrome and other life-threatening arrhythmias that may warrant surgical intervention. CONCLUSIONS: LHAS is an uncommon cardiac anomaly. The utility of TEE and cardiac MRI, in this case, aids in defining the benign nature of LHAS. REFERENCE #1: Nadra I. Lipomatous hypertrophy of the ineratrial septum; a commonly misdiagnosed mass often leading to unnecessary cardiac surgery. Heart. 2004;90(12):66. REFERENCE #2: Heyer C, Kagel T, Lemburg S, Bauer T, Nicolas V. Lipomatous hypertrophy of the interatrial septum. Chest. 2003;124(6):2068–2073. doi: 10.1378/chest.124.6.2068. DISCLOSURES: No relevant relationships by Adhiraj Bhattacharya, source=Web Response No relevant relationships by Rizwan Khan, source=Web Response No relevant relationships by Michael Maysky, source=Web Response

Intraindividual Comparison between the Contrast-Enhanced Golden-Angle Radial Sparse Parallel Sequence and the Conventional Fat-Suppressed Contrast-Enhanced T1-Weighted Spin-Echo Sequence for Head and Neck MRI.

The golden-angle radial sparse parallel-volumetric interpolated breath-hold (GRASP-VIBE) sequence is a recently introduced imaging technique with high resolution. This study compared the image quality between conventional fat-suppressed T1-weighted TSE and GRASP-VIBE after gadolinium enhancement in the head and neck region. Data from 65 patients with clinical indications for head and neck MR imaging between September 2020 and January 2021 were retrospectively reviewed. Two radiologists assessed the overall image quality, overall artifacts, and image conspicuities in the oropharynx, hypopharynx, and cervical lymph nodes according to 5-point scores (best score: 5). Interobserver agreement was assessed using weighted κ statistics. The SNR and contrast-to-noise ratio were calculated and compared between the 2 sequences using a paired Wilcoxon signed rank test. The analysis included 52 patients (mean age, 60 [SD, 14 ] years; male, 71.2% [37/52]) who were mostly diagnosed with head and neck malignancies (94.3% [50/52]). κ statistics ranged from slight agreement in cervical lymph node conspicuity (κ = 0.18) to substantial agreement in oropharyngeal mucosal conspicuity (κ = 0.80) (κ range, 0.18-0.80). Moreover, GRASP-VIBE demonstrated significantly higher mean scores in overall image quality (4.68 [SD, 0.41] versus 3.66 [SD, 0.73]), artifacts (4.47 [SD, 0.48] versus 3.58 [SD, 0.71]), oropharyngeal mucosal conspicuity (4.85 [SD, 0.41] versus 4.11 [SD, 0.79]), hypopharyngeal mucosal conspicuity (4.84 [SD, 0.34] versus 3.58 [SD, 0.81]), and cervical lymph node conspicuity (4.79 [SD, 0.32] versus 4.08 [SD, 0.64]) than fat-suppressed T1-weighted TSE (all, P < .001). Furthermore, GRASP-VIBE demonstrated a higher SNR (22.8 [SD, 11.5] versus 11.3 [SD, 5.6], P < .001) and contrast-to-noise ratio (4.7 [SD, 5.4] versus 2.3 [SD, 2.7], P = .059) than fat-suppressed T1-weighted TSE. GRASP-VIBE provided better image quality with fewer artifacts than conventional fat-suppressed T1-weighted TSE for the head and neck regions.

Reliability and Convergent Construct Validity of Quantitative Ultrasound for Synovitis, Meniscal Extrusion, and Osteophyte in Knee Osteoarthritis With MRI.

To determine: 1) inter-rater reliability of quantitative measurements of ultrasound-detected synovitis, meniscal extrusion, and osteophytes; and 2) construct (convergent) validity via correlations and absolute agreements between ultrasound- and gold-standard magnetic resonance imaging (MRI)-outcomes in knee osteoarthritis. Dynamic ultrasound images for supra-patellar synovitis, meniscal extrusion, and osteophytes were acquired and quantified by a physician operator, musculoskeletal ultrasonographer, and medical student independently. On the same day, 3T MRI images were acquired. Effusion-synovitis, meniscal extrusion, and osteophytes were quantified on sagittal or coronal proton-density-weighted fat-suppressed noncontrast TSE sequences, respectively. Intra-class correlation coefficients (ICCs), Pearson's correlations (r), and Bland-Altman plots were used to analyze inter-rater reliability, and correlations, and agreements between the two imaging modalities. Eighty-nine participants [48 females (53.9%)] with mean (standard deviation) age of 61.5 ± 6.9 years were included. The inter-rater reliability was excellent for osteophytes (ICC range=0.90-0.96), meniscal extrusion (ICC range=0.90-0.93), and synovitis (ICC range=0.86-0.88). The correlations between ultrasound pathologies and their MRI counterparts were very strong (ICC range=0.85-0.98) except for lateral meniscal extrusion [0.66 (95% CI, 0.52-0.76)]. Bland-Altman plots showed 0.01, 0.05, 0.10, 0.53, and 0.60 mm larger size in ultrasound medial tibial and medial femoral osteophytes, medial meniscal extrusions, synovitis, and lateral meniscal extrusions with 95% limits of agreements [±0.39, ±0.44, ±0.85, ±0.70, and ±0.90 (SDs)] than MRI measures, respectively. The lines of equality were within 95% CI of the mean differences (bias) only for medial osteophytes and medial meniscal extrusion. The quantitative assessment of synovitis, meniscal extrusion, and osteophytes generally showed excellent inter-rater reliability and strong correlations with MRI-based measurements. Absolute agreement was strong for medial tibiofemoral pathologies.

Novel quantitative digital image analysis methodology for assessment of inflammatory changes in MRI data in a post-hoc analysis of data acquired from a phase IIb study of baricitinib in patients with active rheumatoid arthritis

PurposeTo evaluate a novel quantitative methodology to assess inflammatory changes in magnetic resonance imaging (MRI) data from patients with rheumatoid arthritis (RA) and the impact of image quality on imaging outcomes compared to the RA Magnetic Resonance Imaging Score (RAMRIS). MethodsThree-dimensional, T1-weighted, fat-suppressed MRI sequences of the hand/wrist before and after intravenous Gadolinium contrast from patients with RA in a placebo-controlled clinical trial (NCT01185353) were re-evaluated post hoc. The methodology was integrated into proprietary software (DYNAMIKA®) and assessed inflammation through pixelated measurements of the contrast-enhancing (inflammatory) volume. A semi-automatic approach outlined contrast-enhancing synovial tissue in the wrist and second to fifth metacarpophalangeal joints with a rough region of interest (ROI); quantitative imaging biomarkers were generated by means of quantitative total volume of inflammation and quantitative degree of inflammation relative to the signal in a 1 cm in diameter ROI in the center of the thenar or lumbrical muscle for internal reference. The time from Gadolinium injection to finalization of the post-contrast images was calculated from the images’ Digital Imaging and Communications in Medicine header. An experienced reader graded image quality as poor, acceptable, or good. ResultsResults from this quantitative methodology, especially when excluding images with poor quality scores (14–32%), provided a more pronounced and monotonically increasing dose-response than the original RAMRIS results on synovitis and osteitis. ConclusionsThis computer-aided quantitative scoring method provided continuous measures of inflammatory changes relative to muscle and may be more sensitive and interpretable concerning dose/response separation between RA treatment groups.

Pelvic effusion in patients with ovarian thecoma-fibroma associated with the tumor size and plaste CA-125 level: A retrospective magnetic resonance imaging study

PurposeTo survey the occurrence rate of ascites in patients with thecoma-fibroma and its potential correlation with tumor MR imaging characteristics. MethodsA total of 40 patients with surgically proven thecoma-fibroma were enrolled in this retrospective study. We determined the tumor size, the components (solid or cystic) and their signal intensity features. Second, we identified ascites according to the fat-suppressed sagittal T2-weighted imaging sequence and divided all cases into two groups (with or without ascites). Furthermore, we explored the correlations of ascites with tumor size, tumor solidity, pathological types, patient's postmenopausal status and serum CA-125 levels by using the χ2 test. Results(1) Among the 40 cases, 15 tumors were fibromas, 15 thecomas, and 10 fibrothecomas. Nine patients (26.47%) had elevated CA-125 levels (>35.0 U/ml). (2) Thirty-one patients had ascites (77.50%), 29 of which had a small amount of ascites. Nine cases had no ascites (22.50%). (3) MRI showed a solid mass in 22 cases (55.0%), cystic mass in five cases (12.5%) and mixed solid-cystic mass in 13 cases (32.5%). The χ2 test revealed that the incidence of ascites was significantly correlated with tumor size, tumor solidity and serum CA-125 levels (P < 0.05), but not with menopause and pathological type (P > 0.05). ConclusionOur data revealed that the incidence of ascites was 77.50% and was mainly correlated with tumor size and elevated CA-125 levels. These findings have potential value for improving the diagnosis and differential diagnosis of thecoma-fibroma.

Forensic age estimation based on magnetic resonance imaging of the proximal humeral epiphysis in Chinese living individuals.

Forensic age estimation in living individuals is mainly based on radiological features, but direct radiography and computed tomography lead to a rise in ethical concerns due to radiation exposure. Thus, the contribution of magnetic resonance imaging (MRI) to age estimation of living individuals is a subject of ongoing research. In the current study, MRIs of shoulder were retrospectively collected from a modern Chinese Han population and data from 835 individuals (599 males and 236 females) in the age group 12 to 30years were obtained. A staging technique based on (Schmidt et al. Int J Legal Med 121(4):321-324, 2007) and (Kellinghaus et al. Int J Legal Med 124(4):321-325, 2010) was used and all images were evaluated with T1-wieghted turbo spin echo (T1-TSE) sequence and T2-weighed fat suppression (T2-FS) sequence. One-sided images were assessed because data from both sides were considered coincidental, as no significant differences were found (P > 0.05). Two MRI sequences were evaluated separately and subsequently compared. Regression models and supportive vector classification (SVC) models were established accordingly. The intraobserver and interobserver agreement levels were good. Compared with T1-TSE sequence, the R2 values of T2-FS sequence were generally higher, while the mean absolute deviation (MAD) values were slightly lower. For T2-FS sequence, the MAD value was 1.49years in males and 2.19years in females. With two MRI sequences incorporated, the SVC model obtained with 85.7% correctly classified minors and 96.2% correctly classified adults in males, while 83.3% and 98.0% respectively in females. In conclusion, T2-FS sequence may slightly outperform the T1-TSE sequence in shoulder MRI analysis for age estimation, while shoulder MRIs could be a reliable prediction indicator for the 18-year threshold and two MRI sequences incorporated are encouraged.

MR Neurography of Peripheral Nerve Injury in the Presence of Orthopedic Hardware: Technical Considerations.

As the frequency of orthopedic procedures performed each year in the United States continues to increase, evaluation of peripheral nerve injury (PNI) in the presence of pre-existing metallic hardware is in higher demand. Advances in metal artifact reduction techniques have substantially improved the capability to reduce the susceptibility effect at MRI, but few reports have documented the use of MR neurography in the evaluation of peripheral nerves in the presence of orthopedic hardware. This report delineates the challenges of MR neurography around metal given the high spatial resolution often required to adequately depict small peripheral nerves. It offers practical tips, including strategies for prescan assessment and protocol optimization, including use of more conventional two-dimensional proton density and T2-weighted fat-suppressed sequences and specialized three-dimensional techniques, such as reversed free-induction steady-state precession and multispectral imaging, which enable vascular suppression and metal artifact reduction, respectively. Finally, this article emphasizes the importance of real-time monitoring by radiologists to optimize the diagnostic yield of MR neurography in the presence of orthopedic hardware. © RSNA, 2021.