Full Magnetic Resonance Imaging Research Articles

Abstract PO3-07-11: Concordance between abbreviated and complete magnetic resonance protocols for screening woman at moderate and high risk for breast cancer

Abstract Introduction: Patients at high risk for developing breast cancer are potential beneficiaries of personalized screening strategies. Breast magnetic resonance imaging (MRI) has shown high sensitivity, but its broader use remains constrained by issues such as high cost and long examination time. The abbreviated magnetic resonance protocol is presented as an alternative to overcome these challenges. Our primary outcome was to evaluate the concordance of the final report between full and abbreviated protocols. Secondary outcomes included the acquisition and reading time of images from the abbreviated protocol. Methods: A cross-sectional study was conducted on asymptomatic women at moderate and high risk for breast cancer who underwent the full MRI screening protocol in private health institutions in the city of Belo Horizonte, Brazil. The abbreviated protocol was derived from the full protocol by the computer through selection of specific sequences. Each image was independently blind read, and assigned a category from the Breast Imaging - Reporting and Data System (BI-RADS) by at least two examiners. The results were then compared using the Cohen's kappa and Intraclass Correlation Coefficients. Results: The study included 170 women, and a concordance rate of 96,9% was found for the reported BI-RADS category between protocols in this population. A 21-minute reduction was observed in examination time for the abbreviated protocol. Conclusion: The significant concordance between protocols indicates that despite the reduction in acquisition time, number of acquired images, and method's complexity, the abbreviated MRI protocol meets most screening demands. It is, therefore, a viable alternative for cost reduction and improving patients tolerability for the studied population. Table 1. Clinical characteristics of the study population Absolute and percentage data about age, personal risk for breast cancer, family history, and previous genetic testing in the study population. Table 2. Concordance analysis between abbreviated and complete MRI protocols based on the ACR-BIRADS classification - Coen Kappa and Intraclass Correlation Coefficient The Kappa value of 0.9687 (95% CI 0.9426 - 0.9949, p < 0.01) indicates almost perfect concordance between the two protocols. The intraclass correlation coefficient of 0.982 (95% CI 0.97 - 0.987, p < 0.01), also indicates excellent concordance using the two-way random effect models criteria. Citation Format: Mariana Mitraud Ottoni Guedes, Agnaldo Lopes da Silva Filho, Thais Paiva Moraes, Adriene Moraes Campos, Ivie Braga de Paula, Felipe Marcondes de Oliveira Coelho, Barbara Silveira Santana, Bertha Andrade Coelho, Maria Fernanda Sperotto Valadares Gontijo, Leticia Martins De Araujo Campos Linhares, Anna Dias Salvador, Waldeir José de Almeida Junior, José Tadeu Campos de Avelar. Concordance between abbreviated and complete magnetic resonance protocols for screening woman at moderate and high risk for breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-11.

Ultrasonography, computed tomography and magnetic resonance imaging of the dromedary camel distal limbs

BackgroundLameness associated with the distal limb region in dromedary camels is quiet prevalent. The diagnosis of lameness relies on a comprehensive orthopedic examination conjugated with an appropriate imaging modality to achieve a decisive diagnosis. Using of modern imaging tools provoked a significant breakthrough in the diagnosis of lameness. Ultrasonography (US) is widely established in dromedaries, whereas computed tomography (CT) and magnetic resonance imaging (MRI) are gaining popularity. CT provides a considerably higher bone detail than any other imaging modality. US and MRI continue to be the best options for soft tissue imaging. A truthful assessment of the clinical US, CT and MRI images dictates a comprehensive familiarity with the standard US, CT and MRI tissue deviations. Accordingly, our purposes were to present a full MRI protocol for investigating the dromedary camel distal limbs as well as comparing and illustrating the merits of using MRI, CT and US for evaluation of the front and hind distal limbs in 10 healthy lameness free dromedary camel cadavers. The limbs were scanned via a high-field 1.5 Tesla MRI magnet and a multi-detector CT scanner then subjected to a systematic US examination in both longitudinal and transverse planes. The obtained MRI, CT and US images were evaluated, correlated and compared.ResultsCT and MRI eliminated the structural superimposition in the dromedary camel distal limbs and afforded assessment of minute ligamentous and tendentious structures that were inaccessible by US including the axial collateral ligaments, ligaments supporting the proximal sesamoid bones and the palmar/plantar aspects of the inter-phalangeal joints. US and MRI were appreciated for the assessment of the articular cartilage that was not visible on the plain CT images.ConclusionsCT and MRI accurately identified and characterized bones and soft tissues constituting the dromedary camel distal limbs. US was appreciated for assessment of soft tissues, articular cartilage and bone contours. CT and MRI may be considered when US results are inconclusive or to evaluate the unreachable parts of the camel distal limbs. Images presented in this study could be used as a reference standard for evaluating dromedary camel distal limb diseases.

Diagnostic validity of abbreviated breast MRI in the diagnosis of breast cancer: a comparative study to the full breast MRI protocol using BI-RADS.

This work aimed to determine the diagnostic performance of the magnetic resonance imaging (MRI) breast abbreviated protocol (AP) in diagnosing malignant breast lesions using BI-RADS compared with the diagnostic accuracy of the full diagnostic protocol (FDP). A prospective single-centre study was conducted. A total of 125 female patients with suspicious breast masses underwent MRI with the AP and the FDP. The images of AP and FDP were independently interpreted by 2 radiologists with 10 years of experience in breast imaging, and any disagreement was resolved with a third one. Using the histopathological examination as a reference test, the diagnostic effectiveness of both FDP and AP in breast cancer screening was calculated. ROC curve was utilised to estimate the optimal BI-RADS cut-off for prediction of malignancy. The difference in image interpretation time between both protocols was estimated using the Mann-Whitney test. Moreover, the inter-test agreement between both protocols was assessed using Cohen's κ test. The study included 83 malignant and 42 benign lesions. AP indicated a specificity, sensitivity, and accuracy of 90.5%, 96.4%, and 94.4%, while the FDP showed a specificity, sensitivity, and accuracy of 92.9%, 100%, and 97.6%, respectively. BI-RADS 3 category was the best cut-off for prediction of malignancy. There was a significant difference between both protocols concerning the interpretation time (p < 0.001). There was excellent agreement between both protocols, with a κ of 0.915. Breast MRI AP may be employed instead of FDP to identify breast cancer with similar diagnostic performance. Moreover, it reduces the interpretation time and the scan cost.

Development of an MRI-Based Prediction Model for Anti-TNF Treatment Failure in Perianal Crohn’s Disease: A Multicenter Study

Clinical and radiologic variables associated with perianal fistula (PAF) outcomes are poorly understood. We developed prediction models for anti-tumor necrosis factor (TNF) treatment failure in patients with Crohn's disease-related PAF. In a multicenter retrospective study between 2005 and 2022 we included biologic-naive adults (>17 years) who initiated their first anti-TNF therapy for PAF after pelvic magnetic resonance imaging (MRI). Pretreatment MRI studies were prospectively reread centrally by blinded radiologists. We developed and internally validated a prediction model based on clinical and radiologic parameters to predict the likelihood of anti-TNF treatment failure, clinically, at 6 months. We compared our model and a simplified version of MRI parameters alone with existing imaging-based PAF activity indices (MAGNIFI-CD and modified Van Assche MRI scores) by De Long statistical test. We included 221 patients: 32 ± 14 years, 60% males, 76% complex fistulas; 68% treated with infliximab and 32% treated with adalimumab. Treatment failure occurred in 102 (46%) patients. Our prediction model included age at PAF diagnosis, time to initiate anti-TNF treatment, and smoking and 8 MRI characteristics (supra/extrasphincteric anatomy, fistula length >4.3 cm, primary tracts >1, secondary tracts >1, external openings >1, tract hyperintensity on T1-weighted imaging, horseshoe anatomy, and collections >1.3 cm). Our full and simplified MRI models had fair discriminatory capacity for anti-TNF treatment failure (concordance statistic, 0.67 and 0.65, respectively) and outperformed MAGNIFI-CD (P= .002 and < .0005) and modified Van Assche MRI scores (P < .0001 and < .0001), respectively. Our risk prediction models consisting of clinical and/or radiologic variables accurately predict treatment failure in patients with PAF.

Energy Expenditure, Body Composition, and Skeletal Muscle Oxidative Capacity in Patients with Myotonic Dystrophy Type 1.

Myotonic dystrophy type 1 (DM1) patients are at risk for metabolic abnormalities and commonly experience overweight and obesity. Possibly, weight issues result from lowered resting energy expenditure (EE) and impaired muscle oxidative metabolism. This study aims to assess EE, body composition, and muscle oxidative capacity in patients with DM1 compared to age-, sex- and BMI-matched controls. A prospective case control study was conducted including 15 DM1 patients and 15 matched controls. Participants underwent state-of-the-art methodologies including 24 h whole room calorimetry, doubly labeled water and accelerometer analysis under 15-days of free-living conditions, muscle biopsy, full body magnetic resonance imaging (MRI), dual-energy x-ray absorptiometry (DEXA), computed tomography (CT) upper leg, and cardiopulmonary exercise testing. Fat ratio determined by full body MRI was significantly higher in DM1 patients (56 [49-62] %) compared to healthy controls (44 [37-52] % ; p = 0.027). Resting EE did not differ between groups (1948 [1742-2146] vs (2001 [1853-2425>] kcal/24 h, respectively; p = 0.466). In contrast, total EE was 23% lower in DM1 patients (2162 [1794-2494] vs 2814 [2424-3310] kcal/24 h; p = 0.027). Also, DM1 patients had 63% less steps (3090 [2263-5063] vs 8283 [6855-11485] steps/24 h; p = 0.003) and a significantly lower VO2 peak (22 [17-24] vs 33 [26-39] mL/min/kg; p = 0.003) compared to the healthy controls. Muscle biopsy citrate synthase activity did not differ between groups (15.4 [13.3-20.0] vs 20.1 [16.6-25.8] μM/g/min, respectively; p = 0.449). Resting EE does not differ between DM1 patients and healthy, matched controls when assessed under standardized circumstances. However, under free living conditions, total EE is substantially reduced in DM1 patients due to a lower physical activity level. The sedentary lifestyle of DM1 patients seems responsible for the undesirable changes in body composition and aerobic capacity.

Abbreviated magnetic resonance imaging protocols in oncology: improving accessibility in precise diagnostics.

Cancer, as the second leading cause of death in the world, is one of the major public health concerns today. Accurate diagnosis and prompt initiation of adequate treatment are of key importance for prognosis. Abbreviated magnetic resonance protocols (AMRI) are promising techniques based on magnetic resonance imaging (MRI) protocols that shorten acquisition time without significant loss of examination quality. Faster protocols that focus on detection of suspicious lesions with most precise sequences, can contribute to comparable diagnostic performance of a full MRI protocol. The purpose of this article was to review the current application of AMRI protocols in several oncological diseases.

Predicting the grade of meningiomas by clinical-radiological features: A comparison of precontrast and postcontrast MRI.

Postcontrast magnetic resonance imaging (MRI) is important for the differentiation between low-grade (WHO I) and high-grade (WHO II/III) meningiomas. However, nephrogenic systemic fibrosis and cerebral gadolinium deposition are major concerns for postcontrast MRI. This study aimed to develop and validate an accessible risk-scoring model for this differential diagnosis using the clinical characteristics and radiological features of precontrast MRI. From January 2019 to October 2021, a total of 231 meningioma patients (development cohort n = 137, low grade/high grade, 85/52; external validation cohort n = 94, low-grade/high-grade, 60/34) were retrospectively included. Fourteen types of demographic and radiological characteristics were evaluated by logistic regression analyses in the development cohort. The selected characteristics were applied to develop two distinguishing models using nomograms, based on full MRI and precontrast MRI. Their distinguishing performances were validated and compared using the external validation cohort. One demographic characteristic (male), three precontrast MRI features (intratumoral cystic changes, lobulated and irregular shape, and peritumoral edema), and one postcontrast MRI feature (absence of a dural tail sign) were independent predictive factors for high-grade meningiomas. The area under the receiver operating characteristic (ROC) curve (AUC) values of the two distinguishing models (precontrast-postcontrast nomogram vs. precontrast nomogram) in the development cohort were 0.919 and 0.898 and in the validation cohort were 0.922 and 0.878. DeLong's test showed no statistical difference between the AUC values of the two distinguishing models (p = 0.101). An accessible risk-scoring model based on the demographic characteristics and radiological features of precontrast MRI is sufficient to distinguish between low-grade and high-grade meningiomas, with a performance equal to that of a full MRI, based on radiological features.

INNV-05. CO-OCCURRENCES OF A HIGH-GRADE GLIOMA WITH CAVERNOUS MALFORMATIONS AND PATHOGENIC VARIANTS IN PDCD10 AND SMARCA4

Abstract INTRODUCTION The co-occurrence of multiple disease processes can make for more challenging diagnoses. Here we report an unusual case of a patient found to have an IDH1-mutant high-grade glioma along with multiple cerebral cavernous malformations and pathogenic germline variants in PDCD10 and SMARCA4. Case Description: A 17-year-old female presented with left arm paresthesia and weakness along with persistent headaches within the frontal and occipital regions that progressed in intensity to include nausea and emesis. A fast sequence magnetic resonance imaging (MRI) of her head was obtained that revealed the presence of multiple bilateral cystic lesions suspicious for cavernomas with the most notable lesion in the right parietal lobe. Ophthalmology consultation revealed grade III papilledema bilaterally. A full brain MRI with and without contrast was obtained and demonstrated a right anterior parietal lobe lesion with associated mass effect, as well as multiple bilateral supratentorial and left cerebellar cavernous malformations. The patient underwent tumor debulking of her dominant lesion. Pathology revealed an IDH1 mutant diffuse astrocytoma, WHO grade 3. Germline genetic testing was pursued which revealed a PDCD10 pathogenic variant consistent with familial cerebral cavernous malformation syndrome and a likely pathogenic variant in SMARCA4. Treatment of her high-grade-glioma included radiation therapy followed by maintenance oral temozolomide. DISCUSSION This case illustrates the unusual co-occurrences of a high-grade glioma with familial cavernous malformation syndrome and germline pathogenic variants in PDCD10 and SMARCA4. Our patient continues to do well clinically, but because of her now significant risk of developing ovarian cancer she has elected to undergo a prophylactic bilateral salpingo-oophorectomy. Recognition of abnormal genetic results is critical in the setting of multiple disease processes and can play a crucial role in the on-going care for a patient.

The Diagnostic Accuracy of Magnetic Resonance Imaging (MRI) For Detection of Spinal Tuberculosis (TB)

Background: Diagnosis of spinal tuberculosis is a major challenge. It is usually made using a blend of, laboratory , imaging investigations, clinical and none of these are 100% confirmatory. The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) for detection of spinal tuberculosis (TB)&#x0D; Methodology: This cross-sectional study was conducted in the department of Radiology, Lahore General Hospital, on 150 patients, with suspicion of spinal TB from January,2020 to August,2020. Patients having Backache for &gt;6 months, loss of appetite, loss of weight &gt;10% in previous one month, raised ESR &gt;15 mm/hour, and positive sputum results for AFB were included. The patients underwent full spinal MRI scan. MRI was done using 1.5 Tesla MR for diagnosis of spinal TB. The diagnosis of spinal TB was then confirmed on histopathologic reporting.&#x0D; Results:Mean age of study participants was 47.83±9.65 years. There was male predominance with 93 (62.0%) males and 57 (38.0%) female patients. The mean duration of spinal TB symptoms was 11.52±3.12 months. On accuracy of MRI, there were 83 (55.3%) true positive cases, 10 (6.67%) false positive, 08 (5.33%) false negative and 49 (32.67%) true negative. The sensitivity of MRI was 91.2%, specificity 83.1%, positive predictive value (PPV) 89.2% and negative predictive value (NPV) 86.0%.&#x0D; Conclusion: Sensitivity of MRI was 91.2% and specificity 83.1%.MRI is an ideal non-invasive imaging modality for the diagnosis of spinal TB.&#x0D; Keywords: Magnetic resonance imaging, Spinal, Tuberculosis.

HGG-19. Co-occurrences of a high-grade glioma with cavernous malformations and pathogenic variants inPDCD10 andSMARCA4

INTRODUCTION: The co-occurrence of multiple disease processes can make for more challenging diagnoses. Here we report an unusual case of a patient found to have an IDH1-mutant high-grade glioma along with multiple cerebral cavernous malformations and pathogenic germline variants in PDCD10 and SMARCA4. CASE DESCRIPTION: A 17-year-old female presented with left arm paresthesia and weakness along with persistent headaches within the frontal and occipital regions that progressed in intensity to include nausea and emesis. A fast sequence magnetic resonance imaging (MRI) of her head was obtained that revealed the presence of multiple bilateral cystic lesions suspicious for cavernomas, with the most notable lesion in the right parietal lobe. Ophthalmology consultation revealed grade III papilledema bilaterally. A full brain MRI with and without contrast was obtained and demonstrated a right anterior parietal lobe lesion with associated mass effect, as well as multiple bilateral supratentorial and left cerebellar cavernous malformations. The patient underwent tumor debulking of her dominant lesion. Pathology revealed an IDH1-mutant diffuse astrocytoma, WHO grade III. Tumor genetic testing was done and identified a SMARCA4 and two TP53 variants. Germline genetic testing was then pursued which revealed a PDCD10 pathogenic variant consistent with familial cerebral cavernous malformation syndrome and a likely pathogenic variant in SMARCA4. Treatment of her high-grade-glioma included radiation therapy followed by maintenance oral temozolomide. DISCUSSION: This case illustrates the unusual co-occurrences of a high-grade glioma with familial cavernous malformation syndrome and germline pathogenic variants in PDCD10 and SMARCA4. Our patient continues to do well clinically, but because of her risk of developing small cell carcinoma of the ovary she has elected to undergo a prophylactic bilateral salpingo-oophorectomy. Recognition of abnormal genetic results is critical in the setting of multiple disease processes and can play a crucial role in the on-going care for a patient.

Breast MRI: Simplifying Protocol and BI-RADS Categories

BackgroundBreast magnetic resonance imaging (MRI) is a useful imaging method, and studies have proven abbreviated protocols may reduce its time and costs with comparable accuracy. To assess the agreement of the abbreviated and full MRI protocols for breast cancer. Patients and MethodsThis retrospective cross-sectional study included consecutive women who underwent breast MRI from June 2019 to May 2020. Breast MRIs were performed in 2 hospitals, and 3 board-certified radiologists conducted its evaluations. The abbreviated breast MRI was assessed in the following order: MIP; subtraction; and T1W pre- and post-contrast. Findings were categorized according Breast Imaging - Reporting and Data System (BI-RADS 5th edition). The groups were named simplified BI-RADS and were adapted from BI-RADS 5-point scoring system. ResultsFour hundred and nineteen women (838 BI-RADS), with mean age of 49.5 ± 12.3 years were evaluated. A very good agreement was found between the protocols for total population (weighted kappa: 0.95; P <.001) and for MRI indication subgroups (weighted kappa: 0.86-1.00; P <.001). A high accuracy was also observed comparing abbreviated breast MRI compared to a full diagnostic MRI (97.6%). ConclusionAbbreviated breast MRI has demonstrated performance comparable to full diagnostic MRI protocols for breast cancer screening and diagnostic. In addition, the present study proposes the use of the simplified BI-RADS as a new classification, in order to assist physicians in clinical management.

A Fully Automated Analytic System for Measuring Endolymphatic Hydrops Ratios in Patients With Ménière Disease via Magnetic Resonance Imaging: Deep Learning Model Development Study.

BackgroundRecently, the analysis of endolymphatic hydropses (EHs) via inner ear magnetic resonance imaging (MRI) for patients with Ménière disease has been attempted in various studies. In addition, artificial intelligence has rapidly been incorporated into the medical field. In our previous studies, an automated algorithm for EH analysis was developed by using a convolutional neural network. However, several limitations existed, and further studies were conducted to compensate for these limitations.ObjectiveThe aim of this study is to develop a fully automated analytic system for measuring EH ratios that enhances EH analysis accuracy and clinical usability when studying Ménière disease via MRI.MethodsWe proposed the 3into3Inception and 3intoUNet networks. Their network architectures were based on those of the Inception-v3 and U-Net networks, respectively. The developed networks were trained for inner ear segmentation by using the magnetic resonance images of 124 people and were embedded in a new, automated EH analysis system—inner-ear hydrops estimation via artificial intelligence (INHEARIT)-version 2 (INHEARIT-v2). After fivefold cross-validation, an additional test was performed by using 60 new, unseen magnetic resonance images to evaluate the performance of our system. The INHEARIT-v2 system has a new function that automatically selects representative images from a full MRI stack.ResultsThe average segmentation performance of the fivefold cross-validation was measured via the intersection of union method, resulting in performance values of 0.743 (SD 0.030) for the 3into3Inception network and 0.811 (SD 0.032) for the 3intoUNet network. The representative magnetic resonance slices (ie, from a data set of unseen magnetic resonance images) that were automatically selected by the INHEARIT-v2 system only differed from a maximum of 2 expert-selected slices. After comparing the ratios calculated by experienced physicians and those calculated by the INHEARIT-v2 system, we found that the average intraclass correlation coefficient for all cases was 0.941; the average intraclass correlation coefficient of the vestibules was 0.968, and that of the cochleae was 0.914. The time required for the fully automated system to accurately analyze EH ratios based on a patient's MRI stack was approximately 3.5 seconds.ConclusionsIn this study, a fully automated full-stack magnetic resonance analysis system for measuring EH ratios was developed (named INHEARIT-v2), and the results showed that there was a high correlation between the expert-calculated EH ratio values and those calculated by the INHEARIT-v2 system. The system is an upgraded version of the INHEARIT system; it has higher segmentation performance and automatically selects representative images from an MRI stack. The new model can help clinicians by providing objective analysis results and reducing the workload for interpreting magnetic resonance images.

An eye tracking based virtual reality system for use inside magnetic resonance imaging systems

Patients undergoing Magnetic Resonance Imaging (MRI) often experience anxiety and sometimes distress prior to and during scanning. Here a full MRI compatible virtual reality (VR) system is described and tested with the aim of creating a radically different experience. Potential benefits could accrue from the strong sense of immersion that can be created with VR, which could create sense experiences designed to avoid the perception of being enclosed and could also provide new modes of diversion and interaction that could make even lengthy MRI examinations much less challenging. Most current VR systems rely on head mounted displays combined with head motion tracking to achieve and maintain a visceral sense of a tangible virtual world, but this technology and approach encourages physical motion, which would be unacceptable and could be physically incompatible for MRI. The proposed VR system uses gaze tracking to control and interact with a virtual world. MRI compatible cameras are used to allow real time eye tracking and robust gaze tracking is achieved through an adaptive calibration strategy in which each successive VR interaction initiated by the subject updates the gaze estimation model. A dedicated VR framework has been developed including a rich virtual world and gaze-controlled game content. To aid in achieving immersive experiences physical sensations, including noise, vibration and proprioception associated with patient table movements, have been made congruent with the presented virtual scene. A live video link allows subject-carer interaction, projecting a supportive presence into the virtual world.

Ultra-High b-Value Diffusion-Weighted Imaging-Based Abbreviated Protocols for Breast Cancer Detection.

Contrast-enhanced (CE) magnetic resonance imaging (MRI) is the most effective imaging modality for breast cancer detection. A contrast agent-free examination technique would be desirable for breast MRI screening. The purpose of this study was to evaluate the capability to detect and characterize suspicious breast lesions with an abbreviated, non-contrast-enhanced MRI protocol featuring ultra-high b-value diffusion-weighted imaging (DWI) compared with CE images. The institutional review board-approved prospective study included 127 female subjects with different clinical indications for breast MRI. Magnetic resonance imaging examinations included DWI sequences with b-values of 1500 s/mm2 (b1500) and 2500 s/mm2 (b2500), native T1- and T2-weighted images, and CE sequences at 1.5 T and 3 T scanners. Two reading rounds were performed, including either the b1500 or the b2500 DWI in consecutive assessment steps: (A) maximum intensity projections (MIPs) of DWI, (B) DWI and apparent diffusion coefficient maps, (C) as (B) but with additional native T1- and T2-weighted images, and (D) as (C) but with additional CE images (full-length protocol). Two readers independently determined the presence of a suspicious lesion. Histological confirmation was obtained for conspicuous lesions, whereas the full MRI data set was obtained for inconspicuous and clearly benign lesions. Statistical analysis included calculation of diagnostic accuracy and interrater agreement via the intraclass correlation coefficient. The cohort comprised 116 cases with BI-RADS 1 findings and 138 cases with BI-RADS ≥2 findings, including 38 histologically confirmed malignancies. For (A), breasts without pathological findings could be recognized with high diagnostic accuracy (negative predictive value, ≥97.0%; sensitivity, ≥92.1% for both readers), but with a limited specificity (≥58.3%; positive predictive value, ≥28.6%). Within the native readings, approach (C) with b2500 performed best (negative predictive value, 99.5%; sensitivity, 97.4%; specificity, 88.4%). The intraclass correlation coefficient was between 0.683 (MIP b1500) and 0.996 (full protocol). A native abbreviated breast MRI protocol with advanced high b-value DWI might allow nearly equivalent diagnostic accuracy as CE breast MRI and seems to be well suited for lesion detection purposes.

Biobank innovations for chronic cerebrovascular disease with Alzheimer's disease study (BICWALZS)

AbstractBackgroundBiobank Innovations for chronic Cerebrovascular disease With ALZheimer’s disease Study (BICWALZS) aimed to recruit 650 individuals, aged from 40 to 90 years, to investigate how chronic cerebrovascular contribute to the brain changes or brain pathologies related to the Alzheimer’s disease (AD) process.MethodAll participants received comprehensive clinical and neuropsychological evaluations, multi‐modal brain imaging, including magnetic resonance imaging (MRI), magnetic resonance angiography, Flutemetamol positron emission tomography (PET), blood and genetic marker analyses at baseline, and a subset of participants underwent actigraphy monitoring and fibroblast sampling. Participants are to be followed annually with brief clinical assessments, and some subjects with amyloid or subcortical ischemia are evaluated biannually with the full assessment, including neuropsychological, MRI and laboratory tests.ResultsIn total, 543 individuals had volunteered for this study. Among them, 345 individuals with mild cognitive impairment (MCI), 44 individuals with subcortical vascular dementia(SVaD) and 154 individuals with AD dementia (ADD)–were enrolled at baseline.ConclusionThe BICWALZS cohort is a prospective, longitudinal cohort study that recruited participants with a wide age range and a wide distribution of cognitive status (MCI, SVaD and ADD) and it has several strengths in its design and methodologies. Details of the recruitment, study methodology, and baseline sample characteristics are described in this paper.

Fetal Magnetic Resonance Imaging (MRI) in Holoprosencephaly and Associations With Clinical Outcome: Implications for Fetal Counseling.

Holoprosencephaly is the most common malformation of forebrain development and includes a wide spectrum of severity. The objective of this retrospective study was to evaluate fetal magnetic resonance imaging (MRI) associations with outcome. Of the 63 cases identified on antenatal ultrasonography, 28 cases were confirmed on fetal MRI. There were 17 live births; 9 patients died within the first month of life. There were 7 survivors. The vast majority were nonambulatory and required feeding support; none required respiratory support. We found that presence and number of non-holoprosencephaly-associated malformations was also associated with survival. Of 5 patients with 3 or more systemic anomalies, 4 died regardless of holoprosencephaly subtype and 1 was lost to follow-up. Patients with suspected holoprosencephaly on ultrasonography should have full body fetal MRI and echocardiogram to better evaluate systemic anomalies. Counseling should involve pediatric palliative care services to prepare families in caring for babies with limited life span.

A meta-analysis comparing the diagnostic performance of abbreviated MRI and a full diagnostic protocol in breast cancer

To undertake a meta-analysis of the diagnostic performance of abbreviated (ABB) magnetic resonance imaging (MRI) and full diagnostic protocol MRI (FDP-MRI) in breast cancer. This meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The PubMed and EMBASE databases were searched through August 2019 for studies comparing the diagnostic performance of ABB-MRI and FDP-MRI in the breast. Studies were reviewed by two authors independently according to eligibility and exclusion criteria and split into two subgroups (screening population studies and studies using cohorts enriched with known cancers) to avoid bias. Quality assessment and bias for diagnostic accuracy was determined with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The diagnostic accuracy for each subgroup was pooled using a bivariate random effects model and summary receiver operating characteristic (sROC) curves produced. Sensitivities and specificities were compared using a paired t-test. Five screening (62/2,588 cancers/patients) and eight enriched cohort (540/1,432 cancers/patients) studies were included in the meta-analysis. QUADAS-2 assessment showed a low risk of bias in most studies. The pooled sensitivity/specificity/area under the receiver operating characteristic curve (AUC) for screening studies was 0.90/0.92/0.94 for ABB-MRI and 0.92/0.95/0.97 for FDP-MRI. The pooled sensitivity/specificity/AUC for enriched cohort studies was 0.93/0.83/0.94 for ABB-MRI and 0.93/0.84/0.95 for FDP-MRI. There was no significant difference in sensitivity or specificity using ABB-MRI or FDP-MRI (p=0.18 and 0.27, p=0.18 and 0.93, respectively). The diagnostic performances of the ABB-MRI and FDP-MRI protocols used in either screening or enriched cohorts were comparable. There was a large variation in patient population, study methodology, and abbreviated protocols reported.

The YOUth cohort study: MRI protocol and test-retest reliability in adults

The YOUth cohort study is a unique longitudinal study on brain development in the general population. As part of the YOUth study, 2000 children will be included at 8, 9 or 10 years of age and planned to return every three years during adolescence. Magnetic resonance imaging (MRI) brain scans are collected, including structural T1-weighted imaging, diffusion-weighted imaging (DWI), resting-state functional MRI and task-based functional MRI. Here, we provide a comprehensive report of the MR acquisition in YOUth Child & Adolescent including the test-retest reliability of brain measures derived from each type of scan. To measure test-retest reliability, 17 adults were scanned twice with a week between sessions using the full YOUth MRI protocol. Intraclass correlation coefficients were calculated to quantify reliability. Global brain measures derived from structural T1-weighted and DWI scans were reliable. Resting-state functional connectivity was moderately reliable, as well as functional brain measures for both the inhibition task (stop versus go) and the emotion task (face versus house). Our results complement previous studies by presenting reliability results of regional brain measures collected with different MRI modalities. YOUth facilitates data sharing and aims for reliable and high-quality data. Here we show that using the state-of-the art YOUth MRI protocol brain measures can be estimated reliably.

External Fixation Devices Within the Magnetic Resonance Imaging Bore: A Safety and Radiologic Analysis.

To (1) report the thermal changes encountered at the pin/skin interface in a cadaver with a knee-spanning external fixator inside the magnetic resonance imaging (MRI) bore and (2) report on the quality of the MRI sequences collected. Three commonly used external fixation systems were placed on cadaveric lower extremities to simulate knee external fixation. Fiber optic thermal probes were placed at the pin/skin interface of a femoral and tibial pin. A control probe was embedded in the soft tissues of the thigh. Full knee MRI scans were performed using a 1.5-Tesla magnet. Real-time thermal data were collected. A clinically significant increase in temperature compared with the control was defined as 2°C. Two blinded radiologists evaluated the images for image quality and overall diagnostic utility using a standardized 5-point grading scale. There were statistically significant differences in the temperature changes between the femoral/tibial pin sites and the control probe sites during each phase of the MRI scan. However, there was only one clinically significant difference in temperature change during a single sequence of one MRI scan of one of the external fixator devices. Overall image quality was graded as a 4 for each image set with 100% interobserver agreement (k = 1.0). Despite significant differences in temperature changes between the pin sites and controls over multiple MRI sequences in commonly used external fixator devices, the differences in temperature change are likely not clinically relevant. Overall image quality and interpretability of the images were excellent.

Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department

BackgroundRapid magnetic resonance imaging (MRI) protocols may be effective in the emergency department (ED) to evaluate nontraumatic neurologic complaints. We evaluate neuroimaging (rapid MRI [rMRI]), head computerized tomography [HCT], and full MRI) use following widespread implementation of rMRI protocols in a pediatric emergency department (ED).MethodsWe conducted a retrospective study in a tertiary care pediatric ED of encounters with neuroimaging during two 9-month periods: one prior to (control period) and one after generalized availability of 4 rMRI protocols (rMRI period). The primary outcome was differences in neuroimaging rates between the two periods. Secondary outcomes included ED process measures, unsuccessful imaging, and undetected pathology, with full MRI within 14 days as the reference standard.ResultsThere were 1052 encounters with neuroimaging during the control and 1308 during the rMRI periods. Differences in neuroimaging between periods were 27.7% for rMRI (95% CI, 24.4, 31.0), − 21.5% for HCT (95% CI, − 25.5, − 17.5), and − 6.2% for full MRI (95% CI, − 9.3, − 3.1%.) Time to imaging (182 [IQR 138–255] versus 86 [IQR 52–137] minutes) as well as ED length of stay (396 [IQR 304–484] versus 257 [IQR 196–334] minutes) was longer for rMRI versus HCT (p < 0.01). Between the control and rMRI periods, there were differences in types of neuroimaging performed for patients with altered mental status, headache, seizure, shunt dysfunction, stroke, syncope, trauma, vomiting, infection, and other neurologic complaints (p < 0.05). rMRI studies were unsuccessful in 3.6% of studies versus 0.0% of HCTs (p < 0.01). The 22 unsuccessful rMRI studies were unsuccessful due to artifacts from dental hardware (n = 2) and patient motion (n = 20). None of the rMRI studies with full MRI follow-up imaging had undetected pathology; the false negative rate for the HCT exams was as high as 25%.ConclusionsAfter routine ED use of 4 rMRI protocols, there was a more than 20% decrease in HCT use without missed diagnoses. Time to neuroimaging and length of stay were longer for rMRI than HCT, with higher rates of unsuccessful imaging. Despite these limitations, rMRI may be an alternative to HCT for nontraumatic complaints in the ED.