Follow-up Magnetic Resonance Imaging Study Research Articles

Validation of Efficacy and Safety of TachoSil ® Tissue Sealant for Vessel Transposition in Microvascular Decompression.

Use of TachoSil ® as the transposition material of microvascular decompression (MVD) for hemifacial spasm (HFS) and trigeminal neuralgia (TN) is easy and safe to perform, but the efficacy and safety of this technique are unknown. This study attempted to validate the efficacy and safety of TachoSil ® as a transposition material of MVD. A retrospective study of the surgical results and complications of 63 patients (35 HFS and 28 TN) treated by the TachoSil ® technique between January 2011 and December 2021 was conducted. The efficacy of the treatment was evaluated by Kaplan-Meier survival analysis. Magnetic resonance imaging follow-up study was performed to detect any adverse events including a mass formation. The rate of complete disappearance of HFS was 91.4% at 1 year and estimated to be 85.7% after a 10-year follow-up. The rate of no pain without medication for TN was 85.4% at 1 year and estimated to be 69.0% after a 9-year follow-up. These surgical results are comparable with those previously reported. Flaking of TachoSil ® releasing the offending artery was only recognized in one case (1.6%). Therefore, TachoSil ® can be considered as an effective transposition material for MVD. TachoSil ® did not increase the rate of acute and subacute adverse events such as inflammation and delayed facial palsy. Magnetic resonance imaging follow-up identified no abnormalities including mass that suggested granuloma formation. The efficacy of the TachoSil ® technique for HFS and TN and the reliability of TachoSil ® as an adhesive material in MVD were verified. No adverse events associated with TachoSil ® use in MVD were found. We conclude that the TachoSil ® technique has relatively long efficacy and safety for MVD.

Longitudinal changes in pelvic organ support among primiparas with postpartum pelvic organ prolapse: A follow-up magnetic resonance imaging study.

To quantify morphological changes of pelvic floor in primiparas with postpartum pelvic organ prolapse (POP) during the early postpartum period. A total of 309 primiparas underwent pelvic floor magnetic resonance imaging (MRI) at 6 weeks postpartum. Those primiparas diagnosed with postpartum POP by MRI criterion were followed up at 3 and 6months postpartum. Normal primiparas were enrolled in the control group. The puborectal hiatus line, muscular pelvic floor relaxation line, levator hiatus area, iliococcygeus angle, levator plate angle, uterus-pubococcygeal line, and bladder-pubococcygeal line were assessed on MRI. Longitudinal changes in pelvic floor measurements between the two groups were compared by repeated-measures analysis of variance. Compared with the control group, enlarged puborectal hiatus line, levator hiatus area, and RICA and decreased uterus-pubococcygeal line were observed at rest in the POP group (all P< 0.05). All of the pelvic floor measurements were significantly different in the POP group compared with the control group at the maximum Valsalva maneuver (all P< 0.05). All of the pelvic floor measurements showed no significant change over time in both the POP and control groups (all P> 0.05). Postpartum POP accompanied by poor pelvic floor support will persist in the early postpartum period.

Quantification of strain analysis and late gadolinium enhancement in coronary chronic total occlusion: a cardiovascular magnetic resonance imaging follow-up study.

The present study aimed to investigate the benefits of percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs) by using cardiac magnetic resonance imaging (CMR) feature tracking. Fifty-five CTOs with successful CTO-PCI underwent CMR at baseline and 12 months. Feature tracking was applied to measure left ventricle strain index in CTOs with decreased and preserved left ventricular ejection fraction (LVEF). CTOs were also divided into two groups according to the infarct size of 10% or combined with multi-vessel disease. We also measured these parameters in 40 healthy subjects. Three quarters of CTOs showed preserved ejection fraction and no enlargement of left ventricle at baseline, but the global strains were lower than the controls (all P<0.01). In the entire CTO population, left ventricular ejection fraction did not show significant improvement in the 1-year follow-up (59.8%±11.3% vs. 62.0%±8.6%, P=0.08). However, global strains improved over time, and peak global radial strain and circumferential strain showed significant treatment effect of CTO-PCI in the entire CTO population (31.1%±9.9% vs. 34.3%±8.7%, P<0.01; -17.9±3.6 vs. -19.2±3.1, P<0.01), and the subgroup with decreased LVEF, infarct size less than 10%, or multi-vessel disease, but not with the 1-vessel disease. In the LAD and LCX CTO territory, radial and circumferential strain showed treatment effect of CTO-PCI on the recovery of strain parameters (P<0.01 for both). In the RCA CTO territory, circumferential and longitudinal strain showed treatment effect of CTO-PCI on the recovery of strain parameters (P<0.05 for both). In this single center study, global radial strain and circumferential strain showed treatment effect of successful CTO-PCI at 1-year follow-up in CTOs with the decreased LVEF, infarct size less than 10%, or multi-vessel disease, and the regional strain also showed a similar trend. However, the benefit of CTO-PCI on the strain recovery was not shown in patients with 1-vessel disease. Therefore, whether patients with CTO benefit from PCI still needs further verification.

Changes in Cerebral Gray and White Matter in Patients with Pantothenate Kinase-Associated Neurodegeneration: A Long-Term Magnetic Resonance Imaging Follow-Up Study.

ObjectiveTo determine the volume changes in gray and white matter during a long-term follow-up in patients suffering from pantothenate kinase-associated neurodegeneration (PKAN).MethodsMagnetic resonance imaging was repeated in 13 patients and 14 age-matched controls after a mean interval of more than 7 years. T1-weighted sequences were evaluated by fully automated atlas-based volumetry, compared between groups and correlated with disease progression.ResultsThe patients did not show generalized cerebral atrophy but did show a significantly faster volume reduction in the globus pallidus during follow-up (between -0.96% and -1.02% per year, p < 0.05 adjusted for false discovery rate) than controls, which was significantly related to the progression in their dystonia scores (p = 0.032).ConclusionThe volume loss in the globus pallidus over time—together with the accumulation of iron known as the “tiger’s eye”—supports the pathophysiologic concept of this nucleus as a center of inhibition and its severe malfunction in PKAN.

Pregnancy-related sacroiliac joint findings in females with low back pain: a four-year magnetic resonance imaging follow-up study.

Pregnancy-related pain may be associated with sacroiliac joint (SIJ) changes, detectable by magnetic resonance imaging (MRI). To analyze the prevalence and course of SIJ MRI and clinical findings in women referred with low back pain and relate these to pregnancy. A retrospective follow-up study from a longitudinally collected cohort comprising 328 women. Women reporting debut of pain in relation to a pregnancy (PP group) tended to have a higher baseline prevalence of all investigated MRI findings, cumulated positive SIJ tests, and a potential fulfilment of the spondyloarthritis diagnosis compared to remainders. The prevalence of subchondral bone marrow edema (BME), any SIJ MRI finding, and potential fulfilment of the spondyloarthritis diagnosis were significantly higher in the PP group compared to women who had not been pregnant. In the total study group, the prevalence of ≥1 MRI finding increased over the four-year study period from 34% to 47% (P<0.001), driven by increasing prevalence of BME (25% to 32%; P=0.008) and fatty marrow deposition (FMD) (20% to 25%; P=0.020). In addition, the BME volume score increased. Over time, the PP group had persisting high prevalence of buttock pain and total MRI findings and their FMD volume score increased, but there were no between-group differences in MRI variables at follow-up. Overall, the prevalence of MRI findings increased over time. Although the PP group had different clinical and SIJ MRI characteristics cross-sectional at baseline compared to remainders, longitudinal analyses revealed that these diminished over time.

Cartiform Implantation for focal cartilage defects in the knee: A 2-year clinical and magnetic resonance imaging follow-up study

The purpose of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes in patients who underwent cryopreserved viable osteochondral allograft (CVOCA) implantation for focal cartilage defects in the knee at a minimum of 2-years postoperatively. This is a retrospective follow-up study of twelve patients who underwent CVOCA implantation from 2013 to 2015 by a single surgeon for a International Cartilage Repair Society (ICRS) grade 3 or 4 chondral defect. Patient-reported outcome (PRO) measurements and MRI were obtained 2-years postoperatively. Collected PRO measures included: International Knee Documentation Committee (IKDC) form; Visual Analog Scale (VAS) pain score; Veterans RAND 12-Item Health Survey (VR-12); Knee Injury and Osteoarthritis Outcome Score (KOOS); and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Patients completed a standard return to work and sports/recreation survey. A blinded, fellowship-trained musculoskeletal radiologist independently evaluated each MRI to determine the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Mean follow-up was 2.1 years (2.0–2.3). There were 6 women and 6 men with a mean age of 46.2 ± 11.9 years. Mean PRO scores were: IKDC 72.6 ± 17.4; VAS 2.9 ± 2.8; WOMAC 84.2 ± 15.1; KOOS- Pain 83.8 ± 18.5, Symptoms 77.6 ± 16.0, ADL 88.0 ± 16.9, Sports/Rec 67.7 ± 33.3, QOL 54.8 ± 24.2; and VR-12 PCS 45.0 ± 8.5 and MCS 51.1 ± 9.5. The mean MOCART score was 59.5 ± 12.9. To our knowledge, this is the largest study to report clinical and MRI outcomes of CVOCA implantation in the knee. With positive functional outcomes and lack of failures at 2-year follow-up, CVOCA is a promising treatment option for focal chondral defects in the knee. Study designRetrospective case series, Level of evidence 4.

Acute exercise, memory, and neural activation in young adults

Acute exercise benefits memory, and the temporal placement of exercise relative to exposure can affect the magnitude of benefits observed. Although the temporal placement appears to be important, there is a limited understanding as to how cognitive benefits in response to acute exercise are achieved. Hence, we conducted a two-part study including a behavioral study and a follow-up functional magnetic resonance imaging (fMRI) study to advance our understanding of the potential role of the effects of exercise on memory and neural activation. For Study One, we assessed the effect of acute exercise on memory in young adults. Participants were randomized to exercise before exposure for 20 min (before only, BO), after exposure for 20 min (After Only, AO), before and after exposure for 10 min at each time (before and after, BA), or to receive no exercise (No-exercise Control, NC). Similar to previous findings, any exercise prior to exposure (BO, BA) benefited some aspects of memory performance. Interestingly, the more consistent and larger benefits were seen with a shorter duration of exercise both before and after exposure (BA). Study Two replicated the methods of Study One comparing the BA condition (which had the most robust benefits) to the NC condition while collecting fMRI data during the memory task. Analyses assessed condition differences of activation during encoding and recall. There were no condition differences during memory encoding, however there was a condition effect on activation in occipito-temporal regions during the memory recall trials. Consistent with previous research, exercise appears to benefit memory with some exercise prior to exposure being important for the benefits achieved. Further, exercise affects neural activation and the results appear complementary to the behavior findings. Future research should use a within-subjects design to control for heterogeneity in behavior and neural activation.

Gray Matter Changes in the Insular Cortex During the Course of the Schizophrenia Spectrum.

Progressive gray matter reductions in the insular cortex have been reported in the early phases of schizophrenia (Sz); however, the trajectory of these reductions during the course of the illness currently remains unclear. Furthermore, it has not yet been established whether patients with schizotypal (SzTypal) features exhibit progressive changes in the insular cortex. This follow-up magnetic resonance imaging study examined volume changes in the short and long insular cortices (mean inter-scan interval = 2.6 years) of 23 first-episode (FE) and 17 chronic patients with Sz, 14 with SzTypal disorder, and 21 healthy controls. Baseline comparisons revealed smaller insular cortex volumes bilaterally in Sz patients (particularly in the chronic group) than in SzTypal patients and healthy controls. FESz patients showed significantly larger gray matter reductions in the insular cortex over time (left: −3.4%/year; right: −2.9%/year) than those in healthy controls (−0.1%/year for both hemispheres) without the effect of subregion or antipsychotic medication, whereas chronic Sz (left: −1.5%/year; right: −1.6%/year) and SzTypal (left: 0.5%/year; right: −0.6%/year) patients did not. Active atrophy of the right insular cortex during FE correlated with fewer improvements in positive symptoms in the Sz groups, while mild atrophy of the left insular cortex during the chronic phase was associated with the severity of negative symptoms in the follow-up period. The present results support dynamic volumetric changes in the insular cortex being specific to overt Sz among the spectrum disorders examined and their degree and role in symptomatology appear to differ across the illness stages.

Baseline anthropometric indices predict change in vertebral size in early adulthood - A 10-year follow-up MRI study.

The vertebral cross-sectional area (CSA) has an independent effect on vertebral strength. Recent evidence has shown that vertebral dimensions significantly increase in the third decade of life, and that lifestyle factors such as body size and composition are clearly associated with vertebral CSA. This study aimed to test the hypothesis that general anthropometric traits (stature, total body mass, lean body mass, fat mass, body mass index, waist circumference), each objectively measured at baseline, predict the change in vertebral CSA over the subsequent decade. A representative sample of young Northern Finnish adults was used (n=371) with repeated magnetic resonance imaging (MRI) scans from ~20 and ~30years (baseline and follow-up, respectively). Vertebral CSA was measured from the MRI scans with high reliability and low measurement error. The statistical analysis was performed using linear regression models adjusted for sex and exact length of MRI interval. According to the regression models, in descending order of effect size, lean body mass (standardized beta coefficient 0.243 [95% confidence interval 0.065-0.420]), total body mass (0.158 [0.043-0.273]), body mass index (0.125 [0.026-0.224]), waist circumference (0.119 [0.010-0.228]), and fat mass (0.104 [0.004-0.205]) were positively and significantly associated with CSA gain over the follow-up, whereas stature (0.079 [-0.066-0.224]) was not associated with CSA change. The results of this study suggest that anthropometric indices may be used for estimating subsequent change in vertebral size. In particular, greater lean body mass seems to be beneficial for vertebral size and thus potentially also for vertebral strength. Future studies should aim to replicate these associations in a dataset with longitudinal anthropometric trajectories and identify the potential common factors that influence both anthropometric traits and vertebral CSA gain.

T25. THE RELATIONSHIP BETWEEN AGE AT FIRST-EPISODE AND LONGITUDINAL CORTICAL CHANGES IN FIRST-EPISODE PSYCHOSIS: A TWO-YEAR LONGITUDINAL STUDY IN AN ADOLESCENT AND ADULT-ONSET COHORT

BackgroundIn a unique deeply phenotyped longitudinal dataset consisting of first-episode psychosis (FEP) patients with a wide age at FEP onset (15 to 35 years) and healthy controls, we aimed to determine whether cortical abnormalities are already present at FEP, whether they progress further over the first two years of the illness, and, if so, whether change patterns are associated with age at first episode.MethodsMulticenter (four-site) two-year follow-up case-control brain magnetic resonance imaging study; 74 patients with a FEP of less than 12 months’ duration, and 64 healthy controls (matched for age, sex, parental socioeconomic status and handedness) were scanned twice (median time between baseline and follow-up scan 24 months, range [16 – 32]). We computed percentage changes (PC) over follow-up in thickness/area/volume for frontal, temporal, parietal and occipital lobes. We included diagnosis (patient vs. control), age at baseline scan, sex, TBV and site as potential confounders. We conducted post-hoc comparisons for young (≤19y) and adult (>19y) diagnostic pairs (FEP vs healthy controls).ResultsA significant age-by-diagnosis interaction was only found for temporal lobe cortical thickness (CT)-PC (d = -.54, p = .002). Within this lobe, the largest effects for the age x diagnosis interaction were found in the middle (d = -.43, p = .01) and inferior (d = - .48, p = .007) temporal gyrus CT-PC. The younger the patient group, the greater temporal thinning relative to their age-matched control group. The most extreme patient vs. control PC difference (i.e. the largest effect size) was found at an age cut-off of 19 years (d=0.9, p= .01).DiscussionIn individuals with psychosis, the two-year cortical changes that follow the FEP are dependent of age at first episode, with those with an earlier onset showing more severe cortical thinning in the temporal lobe.

Progression of parenchymal and ductal findings in patients with chronic pancreatitis: A 4-year follow-up MRI study

PurposeKnowledge of the underlying mechanisms behind progression of chronic pancreatitis (CP) is needed to identify targets for new mechanism-based treatments. There is an urgent need for imaging biomarkers that can detect early morphological and functional pancreatic damage in order to initiate intervention and reduce the progression of CP at an early stage. The aim of our study was to assess and explore the potential role of structural magnetic resonance imaging (MRI) biomarkers for characterisation of disease progression in a CP patient cohort over a 4-year period. MethodsThis longitudinal MRI study included twenty-five patients with definitive CP. Assessments of morphological imaging parameters at baseline and after 4 years included pancreatic gland volume, apparent diffusion coefficient (ADC) values, fat signal fraction (FSF) and main pancreatic duct (MPD) diameter. Patients were classified according to the modified Cambridge classification. ResultsCP patients developed significantly reduced pancreatic gland volume, which decreased from mean 50.3 ± 19.6 ml at baseline to 43.5 ± 20.8 ml at follow-up (P < 0.001), decreased ADC values, meaning a higher degree of fibrosis (P < 0.001), increased FSF, meaning more fat infiltration (P < 0.001) and higher Cambridge classification scores (P = 0.033). The MPD diameter in the pancreatic head, body and tail did not change significantly over time (all P > 0.05). Only few, but no clear and systematic, associations were found between the progressions of the individual MRI measures. ConclusionsMorphological progression in patients with established CP seems to be primarily parenchymal-related. The different parenchymal changes were mostly unrelated and probably reflect diverse pathophysiological processes.

Ten-year Longitudinal Follow-up MRI Study of Age-related Changes in Thoracic Intervertebral Discs in Asymptomatic Subjects.

Prospective longitudinal study. The aim of this study was to evaluate long-term degenerative changes in intervertebral discs in the thoracic spine in healthy asymptomatic subjects. Longitudinal magnetic resonance imaging (MRI) studies of intervertebral disc degeneration have been reported for the cervical and lumbar but not the thoracic spine. In this longitudinal study (average follow-up 10.0 ± 0.6 years), we assessed degenerative changes in the thoracic spine of 103 volunteers (58 men) of 223 healthy volunteers in the initial MRI study of the thoracic spine (follow-up rate 46.2%). The mean age at the initial study was 45.0 ± 11.5 years (24-77 years). Initial and follow-up thoracic-spine MRIs were graded for the following 4 factors of degenerative changes: decrease in signal intensity of intervertebral disc (DSI), posterior disc protrusion (PDP), anterior compression of dura and spinal cord (AC), and disc-space narrowing (DSN) from T1-2 to T12-L1. We assessed associations between changes in MRI grade and demographical factors such as age, sex, body mass index, smoking habits, sports activities, and disc degeneration in the cervical spine. MRIs revealed that 63.1% of the subjects had degenerative changes in the thoracic intervertebral discs that had progressed at least one grade during the follow-up period. DSI progressed in 44.7% of subjects, PDP in 21.4%, and AC in 18.4% during the 10-year period. No DSN progression was seen. DSI was frequently observed in the upper thoracic spine (T1-2 to T4-5). Disc degeneration was relatively scarce in the lower thoracic spine (T9-10 to T12-L1). PDP was frequently observed in the middle thoracic spine (T5-6 toT8-9). We found significant associations between DSI and cervical-spine degeneration (P = .004) and between AC and smoking (P = .04). Progressive thoracic disc degeneration, observed in 63.1% of subjects; was significantly associated with smoking and with cervical-spine degeneration. 2.

Prediction of Recurrence in Parasagittal and Parafalcine Meningiomas: Added Value of Diffusion-Weighted Magnetic Resonance Imaging

Parasagittal and parafalcine (PSPF) meningiomas recur more frequently than other intracranial meningiomas owing to the difficulty in achieving gross total resection. The present study investigated the preoperative magnetic resonance imaging (MRI) features for the prediction of progression/recurrence (P/R) in benign PSPF meningiomas with an emphasis on the apparent diffusion coefficient (ADC) values. We retrospectively investigated the preoperative MRI features for the prediction of P/R in benign (World Health Organization grade I) PSPF meningiomas. Only patients who had undergone preoperative and postoperative MRI follow-up studies for ≥1 year were included. From October 2006 to December 2015, 48 patients with a diagnosis of benign PSPF meningioma were included (median follow-up period, 42.5 months). Of these 48 patients, 12 (25%) developed P/R (median time to P/R, 23 months). PSPF meningiomas in male patients, subtotal resection, large tumor diameter, high diffusion-weighted imaging signal, and lower ADC values or ratios were significantly associated with P/R (P < 0.05). The cutoff points of the ADC value and ADC ratio for the prediction of P/R were 0.83× 10-3 mm2/second and 0.99, with an area under the curve of 0.82 and 0.83, respectively (P= 0.001). On multivariate Cox proportional hazards analysis, male sex and low ADC values (<0.83× 10-3 mm2/second) were high-risk factors for P/R, with a hazard ratio of 12.37 and 30.2, respectively (P < 0.05). Kaplan-Meier analysis showed that lower ADC values and ratios predicted for significantly shorter progression-free survival (P < 0.05). The preoperative ADC values and ratios for the prediction of P/R offer additional valuable information for the treatment planning for PSPF meningiomas.

Twenty-year Longitudinal Follow-up MRI Study of Asymptomatic Volunteers: The Impact of Cervical Alignment on Disk Degeneration.

A 20-year longitudinal study. To evaluate the long-term effect of sagittal alignment of the cervical spine on intervertebral disk degeneration in healthy asymptomatic subjects. This study continues a previous 10-year longitudinal study to determine whether sagittal alignment affects disk degeneration during normal aging. We assessed 90 healthy subjects (30 men and 60 women) from among 497 volunteers who underwent magnetic resonance imaging (MRI) and plain radiographs of the cervical spine between 1994 and 1996 (follow-up rate 18.1%). The mean age at the initial study was 35.5±13.4 years (11-65 y). We compared initial MRIs and follow-up MRIs, conducted at an average of 21.6 years after the initial study, for (1) decreased signal intensity of the intervertebral disks, (2) posterior disk protrusion, and (3) disk-space narrowing from C2-3 to C7-T1. Subjects were grouped by age at follow-up (under 40 vs. 40 y and older) and by a lordotic or nonlordotic cervical sagittal alignment at baseline. We assessed neck pain, stiff shoulders, and upper-arm numbness at follow-up, and examined associations between clinical symptoms and MRI parameters. Progressive changes during the 20-year period included a decrease in disk signal intensity (84.4% of subjects), posterior disk protrusion (86.7%), and disk-space narrowing (17.8%). No significant association was observed between sagittal alignment and decreased disk signal intensity, posterior disk protrusion, or disk-space narrowing. Among subjects over the age of 40, progressive degenerative changes at C7-T1 were significantly more frequent in nonlordotic subjects (90.9%) compared with those with cervical lordosis (54.2%, P=0.032). The prevalence of clinical symptoms was similar in lordotic and nonlordotic subjects at follow-up. Nonlordotic cervical alignment was related to the progression of disk degeneration at C7-T1 but not other levels. Cervical alignment did not affect the development of clinical symptoms in healthy subjects. Level III.

Long-chain polyunsaturated fatty acid supplementation in the first year of life affects brain function, structure, and metabolism at age nine years.

The present study sought to determine whether supplementation of long-chain polyunsaturated fatty acids (LCPUFA) during the first year of life influenced brain function, structure, and metabolism at 9years of age. Newborns were randomly assigned to consume formula containing either no LCPUFA (control) or formula with 0.64% of total fatty acids as arachidonic acid (ARA; 20:4n6) and variable amounts of docosahexaenoic acid (DHA; 22:6n3) (0.32%, 0.64%, or 0.96% of total fatty acids) from birth to 12months. At age 9years (±0.6), 42 children enrolled in a follow-up multimodal magnetic resonance imaging (MRI) study including functional (fMRI, Flanker task), resting state (rsMRI), anatomic, and proton magnetic resonance spectroscopy (1 H MRS). fMRI analysis using the Flanker task found that trials requiring greater inhibition elicited greater brain activation in LCPUFA-supplemented children in anterior cingulate cortex (ACC) and parietal regions. rsMRI analysis showed that children in the 0.64% group exhibited greater connectivity between prefrontal and parietal regions compared to all other groups. In addition, voxel-based analysis (VBM) revealed that the 0.32% and 0.64% groups had greater white matter volume in ACC and parietal regions compared to controls and the 0.96% group. Finally, 1 H MRS data analysis identified that N-acetylaspartate (NAA) and myo-inositol (mI) were higher in LCPUFA groups compared to the control group. LCPUFA supplementation during infancy has lasting effects on brain structure, function, and neurochemical concentrations in regions associated with attention (parietal) and inhibition (ACC), as well as neurochemicals associated with neuronal integrity (NAA) and brain cell signaling (mI).

A 2-year follow-up MRI study for the evaluation of an age estimation method based on knee bone development.

Age estimation is an actual topic in the area of forensic medicine with a special focus on the age limits of 16 and 18 years. Current research on this topic relies on retrospective data of inhomogeneous populations relating to sex, age range, and socioeconomic status. In this work, we present a 2-year follow-up study for the evaluation of an age estimation method on a prospective magnetic resonance imaging (MRI) knee data collective of a homogeneous population. The study includes 40 male subjects from northern Germany aged 14 to 21 years. Three MRI examinations were evenly acquired within 2 years for each subject. As a first evaluation, a three-stage system was used to assess the ossification status of the knee (I:"open", II:"partially ossified", III:"fully ossified"). Three raters assessed the growth plate of the distal femur, proximal tibia, and proximal fibula based on central 2D slices. A good inter-rater agreement was attained (κ = 0.84). All subjects younger than 18 years were rated as stage I and had a cumulative knee score (SKJ) ≤ 5. Based on the follow-up datasets, new parameters quantifying the intra-individual ossification process were calculated. The results of this follow-up analysis show a different start, end, and speed of each growth plate's maturation as well as an ossification peak for individuals at the age of 16. The generated MRI database provides new insights into the ossification process over time and serves as a basis for further evaluations of age estimation methods.

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot - a review of patient charts.

ABSTRACT Background: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. Study design: Retrospective observational study, chart review Material and methods: Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment. Only cases without concomitant infection or skin ulcer were chosen, in whom both was documented, onset of symptomatic foot swelling and patient compliance with cast treatment. Results: From 1994 to 2017, 45 consecutive cases in 37 patients were retrieved, with 95 MRI follow-up studies (1–6 per case, average interval between studies 13 weeks). Decreasing EESC was documented in 66/95 (69%) follow-up studies. However, 29/95 (31%) studies revealed temporarily increasing, migrating or stagnating EESC. Conclusion: EESC on MRI disappear in response to prolonged offloading and immobilizing treatment; however, physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images. Conventional MRI is useful for surveillance of active-stage Charcot foot recovery.

One-Year Serial Follow-up Magnetic Resonance Imaging Study of RigidFix for Femoral Fixation in Anterior Cruciate Ligament Reconstruction.

PurposeTo assess graft slippage at the site of femoral fixation by follow-up magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) reconstruction with a four-strand autogenous hamstring tendon using RigidFix (DePuy Mitek).Materials and MethodsTwenty-one subjects diagnosed with ACL rupture underwent ACL reconstruction using hamstring autograft with the transtibial technique. RigidFix was used for femoral fixation and Intrafix and washer screw were used for tibial fixation. Follow-up MRIs were taken immediately after surgery and at 1, 3, 6, and 12 months after surgery. Slippage of the graft and breakage of the RigidFix cross-pin were assessed. Side-to-side difference (SSD) on stress radiographs was measured to assess residual laxity.ResultsMean slippage of the graft was 0.21±0.31 mm at one year after surgery. Cross-pin breakage was noted in two subjects: in one subject, immediately after surgery and in the other subject, at 6 months after surgery. Mean SSD was 1.32±1.07 mm at the last follow-up. The correlation coefficient between graft slippage and SSD was 0.131 (p=0.571).ConclusionsRigidFix is a stable fixation device for hamstring autograft with minimally statistically significant but clinically insignificant graft slippage. Cross-pin breakage did not affect the clinical outcomes. Careful preparation of the graft is needed for performing the technique correctly.

Development of cystic malacia after high-dose cranial irradiation of pediatric CNS tumors in long-term follow-up.

The purpose of this study is to investigate the incidence of cystic malacia in long-term survivors of pediatric brain tumors treated with high-dose cranial irradiation. Between 1997 and 2015, we treated 41 pediatric patients (26 males, 15 females; age ranging from 3.3 to 15.7years, median 9-year-old) of pediatric brain tumors [17 medulloblastomas, 7 primitive neuroectodermal tumors (PNET), 3 pineoblastomas, 6 non-germinomatous germ cell tumors (NGGCT), 8 gliomas (including 4 ependymomas, 1 anaplastic astrocytoma, 1 oligodendroglioma, 1 pilocytic astrocytoma, 1 astroblastoma)] with high-dose craniospinal irradiation. Follow-up ranged from 14.0 to 189.2months (median 86.0months, mean 81.5months), the irradiation dose to the whole neural axis ranged from 18 to 41.4Gy, and the total local dose from 43.2 to 60.4Gy. All patients underwent follow-up magnetic resonance imaging (MRI) studies at least once a year. Diagnosis of cystic malacia was based solely on MRI findings. Of the 41 patients, 31 were censored during their follow-up due to recurrence of the primary disease (n=5), detection of secondary leukemia after development of cystic malacia (n=1), or the absence of cystic malacia on the last follow-up MRI study (n=25). We also evaluated the development of post-irradiation cavernous angioma and white matter changes. Following irradiation treatment, 11 patients developed 19 cystic malacia during a median course of 30.8months (range 14.9 to 59.3months). The site of predilection for cystic malacia was white matter around trigone of lateral ventricles with an incidence of 47.4% (9 of 19 lesions, 7 in 11 patients). Patients with supratentorial tumors developed cystic malacia statistically earlier than the patients with infratentorial tumors (P=0.0178, log-rank test). Among the same patient group, incidence of post-irradiation cavernous angioma increased progressively, while the incidence of post-irradiation cystic malacia did not increase after 5years. White matter degeneration developed earlier than cystic malacia or cavernous angioma, and these three clinical entities developed mutually exclusive of each other. We attribute the higher incidence of post-irradiation cystic malacia, in our long-term follow-up study, to the cranial irradiation for pediatric brain tumors, particularly supratentorial brain tumors, and recommend a regular, long-term follow-up of brain tumor patients treated with cranial irradiation.

Uterine fibroid embolization with acrylamido polyvinyl microspheres: prospective 12-month clinical and MRI follow-up study.

Background Uterine fibroid embolization (UFE) is an effective minimally invasive treatment aimed to obtain complete fibroid infarction. Purpose To evaluate the degree of fibroid infarction after embolization with acrylamido polyvinyl alcohol microspheres (Bead Block). Material and Methods This prospective study included 26 pre-menopausal women in the period October 2013 to January 2015. UFE with the use of Bead Block microspheres 700-900 µm was obtained until flow stasis was achieved. Contrast-enhanced magnetic resonance imaging (MRI) was used to define residual contrast enhancement in the total fibroid burden and enhancement >10% was defined as insufficient embolization. The dominant fibroid volume and total uterine volume changes were assessed. Clinical outcome was analyzed using the quality of life questionnaire (UFS-QOL). Results Twenty-four of the 26 patients (92%) had a technically successful UFE with complete flow-stop in both uterine arteries. Twenty-two of the 26 patients (85%) completed 3 months of MRI control and 20 patients (77%) completed 12 months of MRI control. There were 16 of 22 patients (73%) with complete fibroid burden infarction and/or without residual contrast enhancement of the fibroids of more than 10% at 3 months of control. Six of 22 patients (27%) had insufficient fibroid burden infarction with residual contrast enhancement of more than 10%. Twenty-two and 18 of 26 patients completed the 3-month and 12-month questionnaire, respectively. UFS-QOL analyses showed that 91% of the patients had significant clinical improvement. Conclusion Sixteen of the 22 patients had complete fibroid burden infarction using Bead Block microspheres (700-900 µm); however, unacceptably high insufficient fibroid burden infarction in almost one-fourth of the patients were recorded.