Magnetic Resonance Imaging Lesions Research Articles

Evaluation of Cognitive Impairment in Refractory Temporal Lobe Epilepsy Patients Concerning Structural Brain Lesions

Introduction: Temporal lobe epilepsy (TLE) is the most prevalent form of drug-resistant epilepsy with concurrent cognitive impairment. Prevention, earlier diagnosis, and personalized management of cognitive deficits in TLE require more understanding of underlying structural and functional brain Ialterations. No study has evaluated the performance of TLE patients in different cognitive domains based on their structural brain lesions. Methods: In this study, 69 refractory TLE patients underwent magnetic resonance imaging (MRI) epilepsy protocol and several neuropsychological tests, consisting of the Wechsler adult intelligence scale-revised, Rey-Osterrieth complex figure test, verbal fluency test, digit span test, spatial span test, Wechsler memory scale-III, design fluency test, Rey visual design learning test, auditory-verbal learning test, and trail making test. MRI findings were classified into the following groups: Focal cortical dysplasia, gliosis, atrophy, mesial temporal sclerosis (MTS), tumor, vascular malformation, and other lesions or normal. Results of neuropsychological tests were compared between MRI groups using a generalized linear model with gamma distribution and log link. Results: Patients with MTS showed better performance in general intellectual functioning, working memory, attentional span, and auditory-verbal learning compared to patients with non-MTS MRI lesions. Atrophy and focal cortical dysplasia had the largest differences from MTS. Conclusion: Cognitive performance of refractory TLE patients varies concerning structural brain alterations. Further neuroimaging studies of TLE lead to prevention and more accurate management of cognitive decline in clinical settings.

Olfactory dysfunction in patients with Wilson's Disease.

Many neurodegenerative disorders are associated with olfactory dysfunction (OD), but little is known about OD in Wilson's Disease (WD). We evaluated olfactory function in patients with WD. OD was examined in 68 patients with WD and 70 sex- and age-matched healthy controls using subjective testing with 'Sniffin Sticks'. Threshold discrimination identification (TDI) score and its three components (odour detection threshold, discrimination, and identification) were assessed. Compared to controls, patients with WD had a significantly weaker sense of smell in terms of TDI (p < 0.01), odour discrimination (p < 0.01), and identification (p < 0.01), but not in terms of odour detection threshold (p = 0.27). Patients with predominantly neurological symptoms were characterised by greater OD by TDI (p < 0.01), odour detection threshold (p = 0.01), and discrimination (p = 0.03). The presence of pathological lesions (p = 0.04) in brain magnetic resonance imaging and generalised brain atrophy (p = 0.02) predisposed to worse TDI. In the WD group, weak inverse correlations between age and TDI score (r = -0.27), odour detection threshold (r = -0.3), and discrimination (r = -0.3) were found. Male gender was a risk factor for abnormal TDI in both WD and controls (both p = 0.02). Patients with WD, particularly older individuals, more frequently had OD than healthy volunteers. Predominantly neurological symptoms, and the presence of typical brain MRI changes, predisposed patients with WD to smell disorders.

Clinical features of patients with MOG-IgG associated disorders and analysis of the relationship between fibrinogen-to-albumin ratio and the severity at disease onset.

The study aimed to investigate the differences in clinical features between pediatric and adult patients with first-episode MOG-IgG associated disorders (MOGAD) and evaluate the relationship between the fibrinogen-to-albumin ratio (FAR) and the severity of neurological deficits at disease onset. We retrospectively collected and analyzed biochemical test results, imaging characteristics, clinical manifestations, expanded disability status scale (EDSS) score, and FAR. The Spearman correlation analysis and logistic regression models were used to examine the association between FAR and severity. Receiver operating characteristic (ROC) curve analysis was to analyze the predictive ability of FAR for the severity of neurological deficits. Fever (50.0%), headache (36.1%), and blurred vision (27.8%) were the most common clinical manifestations in the pediatric group (<18 years old). However, in the adult group (≥18 years old), the most common symptoms were blurred vision (45.7%), paralysis (37.0%), and paresthesia (32.6%). Fever was more common in the pediatric group, while paresthesia was more common in the adult patients, with all differences statistically significant (P < 0.05). The most frequent clinical phenotype in the pediatric group was acute disseminated encephalomyelitis (ADEM; 41.7%), whereas optic neuritis (ON; 32.6%) and transverse myelitis (TM; 26.1%) were more common in the adult group. The differences in clinical phenotype between the two groups were statistically significant (P < 0.05). In both pediatric and adult patients, cortical/subcortical and brainstem lesions were the most common lesions on cranial magnetic resonance imaging (MRI), whereas, for spinal MRI, cervical and thoracic spinal cord lesions were the most commonly observed. According to binary logistic regression analysis, FAR was an independent risk factor for the severity of neurological deficits (odds ratio = 1.717; 95% confidence interval = 1.191-2.477; P = 0.004). FAR (r = 0.359, P = 0.001) was positively correlated with the initial EDSS score. The area under the ROC curve was 0.749. The current study found age-dependent phenotypes in MOGAD patients as ADEM was more commonly observed in patients < 18 years old, while ON and TM were more frequently found in patients ≥18 years old. A high FAR level was an independent indicator for more severe neurological deficits at disease onset in patients with a first episode of MOGAD.

Optical coherence tomography in patients with Wilson's disease.

Morphological changes of retina in patients with Wilson's disease (WD) can be found by optical coherence tomography (OCT), and such changes had significant differences between neurological forms (NWD) and hepatic forms (HWD) of WD. The aim of this study was to evaluate the relationship between morphological parameters of retina and brain magnetic resonance imaging (MRI) lesions, course of disease, type of disease, and sexuality in WD. A total of 46 WD patients and 40 health controls (HC) were recruited in this study. A total of 42 WD patients were divided into different groups according to clinical manifestations, course of disease, sexuality, and brain MRI lesions. We employed the Global Assessment Scale to assess neurological severity of WD patients. All WD patients and HC underwent retinal OCT to assess the thickness of inner limiting membrane (ILM) layer to retinal pigment epithelium layer and inner retina layer (ILM to inner plexiform layer, ILM-IPL). Compared to HWD, NWD had thinner superior parafovea zone (108.07±6.89 vs. 114.40±5.54μm, p<.01), temporal parafovea zone (97.17±6.65 vs. 103.60±4.53μm, p<.01), inferior parafovea zone (108.114±7.65 vs. 114.93±5.84μm, p<.01), and nasal parafovea zone (105.53±8.01 vs. 112.10±5.44 μm, p<.01) in inner retina layer. Course of disease influenced the retina thickness. Male patients had thinner inner retina layer compared to female patients. Our results demonstrated that WD had thinner inner retina layer compared to HC, and NWD had thinner inner retina layer compared to HWD. We speculated the thickness of inner retina layer may be a potential useful biomarker for NWD.

Common errors, pitfalls, and management of complications of prostate biopsy : The most common diagnostic and procedural challenges of transrectal fusion prostate biopsy in the initial diagnosis of clinically significant prostate cancer

Transrectal (TR) prostate biopsy is the gold standard in diagnosis of prostate cancer (PC). It requires aprecise and safe technique for sample acquisition. Several approaches will be discussed to avoid overdiagnosis, false-negative results, and complications of the procedure. We analyzed national and European guidelines, systematic reviews, meta-analyses, as well as prospective and retrospective studies to describe current trends in indication and performance of biopsies. Incorporation of risk calculators and magnetic resonance imaging (MRI) into daily routine reduces biopsy rates and results in amore precise diagnosis of clinically significant prostate cancer (csPC). Combination of random- and MRI-fusion guided biopsy-but also extending the radius of sampling by 10 mm beyond the MRI lesion and atransperineal (TP) sampling approach- lead to ahigher tumor-detection rate. Bleeding is the most common complication after prostate biopsy and is usually self-limiting. Postbiopsy infection rates can be reduced through TP biopsy. TR MRI-fusion guided biopsy is awidely acknowledged tool in primary diagnostics of csPC. Higher detection rates and safety can be achieved through aTP sampling approach.

Evolution of Magnetic Resonance Imaging Lesions at the Sacroiliac Joints During and After Pregnancy by Serial Magnetic Resonance Imaging From Gestational Week Twenty to Twelve Months Postpartum.

Sacroiliac (SI) joint magnetic resonance imaging (MRI) findings simulating sacroiliitis related to axial spondyloarthritis (SpA) may occur in women before and after birth. This study was undertaken to explore the prevalence, evolution, and topography of SI joint MRI lesions in pregnant and postpartum women. A prospective cohort study included 103 first-time mothers who underwent up to 5 serial SI joint MRI between gestational week 20 and 12 months postpartum. After calibration, 3 assessors independently evaluated bone marrow edema (BME), including sacroiliitis according to the Assessment of SpondyloArthritis international Society (ASAS), as well as structural lesions, using the Spondyloarthritis Research Consortium of Canada (SPARCC) and a novel 2-plane assessment method. BME was frequent both during pregnancy and the postpartum period, peaking at 3 months postpartum with a prevalence of 69% (SPARCC) and 80% (2-plane method), but still present in 54% (SPARCC) and 58% (2-plane method) of subjects at 12 months postpartum. At 12 months postpartum, sacroiliitis according to the current ASAS definition was met in 41%, while 21% and 14% of women fulfilled the newly proposed ASAS MRI thresholds for active and structural SI joint lesions, respectively. BME clustered in the anterior middle joint portions at all time points, and ligamentous BME was rare. At 12 months postpartum, SPARCC erosion scores ≥3 (ASAS threshold) were observed in only 2.8% of women. At 12 months postpartum, 41% of women met the current ASAS sacroiliitis definition, which may result in false-positive assignments of axial SpA diagnosis in postpartum women with back pain. The topographical BME distribution and virtually absent erosions (ASAS threshold) at 12 months postpartum may help discriminate postpartum strain-related conditions from axial SpA-related sacroiliitis.

Correlation of Mammographic Microcalcifications with Final Surgical Pathology After Neoadjuvant Chemotherapy for Breast Cancer.

Imaging guidelines for post-neoadjuvant chemotherapy (NAC) breast cancer patients lack specificity on appropriateness and utility of individual modalities for surgical planning. Microcalcifications confound mammographic interpretation. We examined the correlation between the mammographic extent of microcalcifications present post-NAC, corresponding magnetic resonance imaging (MRI) lesions, and definitive surgical pathology. In this retrospective cohort study, patients with calcifications on mammography were collected from a database of consecutive breast cancer patients receiving NAC. The primary objective was to determine the correlation between maximum dimension of post-NAC calcifications with surgical pathology (invasive disease, tumor bed, and ductal carcinoma in situ [DCIS]), stratified by tumor receptor subgroup. Secondarily, we examined the correlation of residual disease with MRI mass enhancement (ME) and non-ME (NME). Pearson's correlation coefficient was used to evaluate statistical significance (strong: R2 ≥70%; moderate: R2=25-70%; weak: R2 ≤25%). Overall, 186 patients met the inclusion criteria. Mammographic calcifications correlated poorly with invasive disease (R2=10.8%), overestimating by 57%. In patients with calcifications on mammography, MRI ME and NME correlated weakly with the maximum dimension of invasive disease and DCIS. In triple-negative breast cancer (TNBC) patients, invasive disease correlated strongly with the maximum dimension of calcifications (R2=83%) and moderately with ME (R2=37.7%) and NME (R2=28.4%). Overall, current imaging techniques correlate poorly and overestimate final surgical pathology. This poor correlation may lead to uncertainty in the extent of required surgical excision and the exclusion of potential candidates for non-surgical management in ongoing trials. TNBCs would be good candidates for these trials given the stronger observed correlations between pathology and imaging.

Magnetic Resonance Imaging Follow-up of Targeted Biopsy–negative Prostate Lesions

BackgroundThe optimal radiological follow-up of prostate lesions negative on magnetic resonance imaging (MRI)-targeted biopsy (MRI-TB) is yet to be optimised. ObjectiveTo present medium-term radiological and clinical follow-up of biopsy-negative lesions. Design, setting, and participantsThe records for men who underwent multiparametric MRI at the UCLH one-stop clinic for suspected prostate cancer between September 2017 and March 2020 were reviewed (n = 1199). Patients with Likert 4 or 5 lesions were considered (n = 495), and those with a subsequent negative MRI-TB comprised the final study population (n = 91). Outcome measurements and statistical analysisBaseline and follow-up MRI and biopsy data (including prostate-specific antigen [PSA], prostate volume, radiological scores, and presence of any noncancerous pathology) were extracted from reports. The last follow-up date was the date of the last test or review in clinic. Results and limitationsMedian follow-up was 1.8 yr (656 d, interquartile range [IQR] 359–1008). At baseline, the median age was 65.4 yr (IQR 60.7–70.0), median PSA was 7.1 ng/ml (IQR 4.7–10.0), median prostate volume was 54 ml (IQR 39.5–75.0), and median PSA density (PSAD) was 0.13 ng/ml2 (IQR 0.09–0.18). Eighty-six men (95%) had Likert 4 lesions, while the remaining five (5%) had Likert 5 lesions. Only 21 men (23%) had a single lesion; most had at least two. Atrophy was the most prevalent pathology on MRI-TB, present in 64 men (74%), and followed by acute inflammation in 42 (46%), prostatic intraepithelial neoplasia in 33 (36%), chronic inflammation in 18 (20%), atypia in 13 (14%), and granulomatous inflammation in three (3%). Fifty-eight men had a second MRI study (median 376 d, IQR 361–412). At the second MRI, median PSAD decreased to 0.11 ng/ml2 (IQR 0.08–0.18). A Likert 4 or 5 score persisted only in five men (9%); 40 men (69%) were scored Likert 3, while the remaining 13 (22%) were scored Likert 2 (no lesion). Of 45 men with a Likert ≥3 score, most only had one lesion at the second MRI (28 men; 62%). Of six men with repeat MRI-TB during the study period, two were subsequently diagnosed with prostate cancer and both had persistent Likert 4 scores (at baseline and at least one follow-up MRI). ConclusionsMost biopsy-negative MRI lesions in the prostate resolve over time, but any persistent lesions should be closely monitored. Patient summaryLesions in the prostate detected via magnetic resonance imaging (MRI) scans that are negative for cancer on biopsy usually resolve. Repeat MRI can indicate persistent lesions that might need a second biopsy.

Diagnosis and Treatment of Chronic Non-bacterial Osteomyelitis: A Survey on Current Practices Adopted by Pediatric Rheumatologists in Saudi Arabia.

Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease usually managed by pediatric rheumatologists (PRs). There is a need for a consensus treatment plan to minimize the diversity in clinical practice in the diagnosis and management of CNO. In this study, we explored the practice of PRs in Saudi Arabia on the diagnosis and treatment of patients with CNO. This is a cross-sectional study that was conducted among PRs in Saudi Arabia (May to September 2020). A survey was performed among PRs registered in the Saudi Commission for Health Specialties using an electronic-based questionnaire. The survey consisted of 35 closed-ended questions about the diagnosis and management of CNO patients. We explored the approaches adopted by PRs in diagnosing and monitoring the disease activity, their awareness of clinical possibilities that necessitate ordering bone biopsy, and the treatment choices they considered for CNO patients. We scrutinized data from a total of 77% (n=41/53) PRs who responded to our survey. Magnetic resonance imaging (MRI) was reported as the most frequently used modality in suspected CNO (82%, n=27/33), followed by plain X-ray (61%) and bone scintigraphy (58%). Magnetic resonance imaging of a symptomatic site is the imaging modality of choice for the diagnosis of CNO (82%), Followed by X-ray (61%) and bone scintigraphy (58%). The reasons for performing bone biopsy were unifocal lesions (82%), unusual sites of presentation (79%), and multifocal lesions (30%). The preferred treatment regimens were bisphosphonates (53%), non-steroidal anti-inflammatory drugs alone (43%), or biologics with bisphosphonates (28%). The reasons to upgrade the treatment in CNO included the development of vertebral lesions (91%), the development of new lesions in MRI (73%), and the elevation of inflammatory markers (55%). The disease activity was assessed by history and physical examination (91%), inflammatory markers (84%), MRI of targeted symptomatic site (66%), and a whole-body MRI (41%). The approach todiagnosis and treatment of CNO varies among PRs in Saudi Arabia. Our findings provide a background for the development of a consensus treatment plan for challenging CNO patients.

MP09-01 DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ON MRI: A COMPARISON OF AN ARTIFICIAL INTELLIGENCE MODEL VERSUS RADIOLOGISTS

You have accessJournal of UrologyCME1 Apr 2023MP09-01 DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ON MRI: A COMPARISON OF AN ARTIFICIAL INTELLIGENCE MODEL VERSUS RADIOLOGISTS Simon John Christoph Soerensen, Richard E. Fan, Indrani Bhattacharya, David S. Lim, Sarir Ahmadi, Xinran Li, Sulaiman Vesal, Mirabela Rusu, and Geoffrey A. Sonn Simon John Christoph SoerensenSimon John Christoph Soerensen More articles by this author , Richard E. FanRichard E. Fan More articles by this author , Indrani BhattacharyaIndrani Bhattacharya More articles by this author , David S. LimDavid S. Lim More articles by this author , Sarir AhmadiSarir Ahmadi More articles by this author , Xinran LiXinran Li More articles by this author , Sulaiman VesalSulaiman Vesal More articles by this author , Mirabela RusuMirabela Rusu More articles by this author , and Geoffrey A. SonnGeoffrey A. Sonn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Automated detection of prostate cancer on magnetic resonance imaging (MRI) may help target biopsies and avoid unnecessary biopsies of false-positive lesions. We sought to develop an artificial intelligence (AI) model to rapidly and accurately identify cancer foci on MRI and compare its performance against radiologists. METHODS: A total of 1504 subjects underwent multiparametric MRI at more than 30 institutions in the US, followed by MRI-ultrasound fusion biopsy at one institution. We used T2-weighted images (T2WI), apparent diffusion coefficient maps (ADC), and diffusion-weighted imaging (DWI) from 1404 cases to train an AI model. MRI lesions were initially identified and outlined by a radiologist using T2WIs, DWIs, ADC, and contrast enhanced images (DCE). Cancers were confirmed by biopsy. Only lesions containing Gleason 3+3 (≥ 40% cancer core length) or Gleason ≥3+4 (any amount) in at least one targeted biopsy core were considered for training and testing the model. All other MRI lesions were removed. Systematic cores with significant cancer were also included for model training. We tested the AI model on 100 independent cases and compared it against trained radiologists. We computed lesion-level AUC, sensitivity, specificity, and negative predictive value (NPV). RESULTS: AI and radiologists had similar performances across all metrics, and all differences were non-significant. The AI model had an AUC of 0.79±0.22, NPV of 0.66±0.26, sensitivity of 0.34±0.41, and specificity of 0.99±0.05. Radiologists had an AUC of 0.81±0.22, NPV of 0.69±0.28, sensitivity of 0.37±0.45, and specificity of 0.99±0.05. CONCLUSIONS: In this study, we trained and tested an AI model on a large and diverse multi-institutional cohort of MRIs. The model matched the performance of radiologist experts. In future work, we envision comparing model performance against radiologists at different skill levels and comparing radiologist + AI vs radiologist performance alone. Source of Funding: Departments of Radiology and Urology, Stanford University, National Cancer Institute of the National Institutes of Health (R37CA260346 to M.R), and the generous philanthropic support of our patients (G.S.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e103 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon John Christoph Soerensen More articles by this author Richard E. Fan More articles by this author Indrani Bhattacharya More articles by this author David S. Lim More articles by this author Sarir Ahmadi More articles by this author Xinran Li More articles by this author Sulaiman Vesal More articles by this author Mirabela Rusu More articles by this author Geoffrey A. Sonn More articles by this author Expand All Advertisement PDF downloadLoading ...

Automatic deep learning method for detection and classification of breast lesions in dynamic contrast-enhanced magnetic resonance imaging.

The purpose of this study was to develop a deep learning-based system with a cascade feature pyramid network for the detection and classification of breast lesions in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). This retrospective study enrolled 191 consecutive patients with pathological confirmed breast lesions who underwent preoperative magnetic resonance imaging (MRI) at the Second Affiliated Hospital of Xi'an Jiaotong University. Patients were randomly divided into a training set comprising 153 patients with 126 malignant and 27 benign lesions and a validation set containing 38 patients with 31 malignant and 7 benign lesions under 5-fold cross-validation. Two radiologists annotated the location and classification of all lesions. After augmentation with pseudo-color image fusion, MRI images were fed into the developed cascade feature pyramid network system, feature pyramid network, and faster region-based convolutional neural network (CNN) for breast lesion detection and classification, respectively. The performance on large (>2 cm) and small (≤2 cm) breast lesions was further evaluated. Average precision (AP), mean AP, F1-score, sensitivity, and false positives were used to evaluate different systems. Cohen's kappa scores were calculated to assess agreement between different systems, and Student's t-test and the Holm-Bonferroni method were used to compare multiple groups. The cascade feature pyramid network system outperformed the other systems with a mean AP and highest sensitivity of 0.826±0.051 and 0.970±0.014 (at 0.375 false positives), respectively. The F1-score of the cascade feature pyramid network in real detection was also superior to that of the other systems at both the slice and patient levels. The mean AP values of the cascade feature pyramid network reached 0.779±0.152 and 0.790±0.080 in detecting large and small lesions, respectively. Especially for small lesions, the cascade feature pyramid network achieved the best performance in detecting benign and malignant breast lesions at both the slice and patient levels. The deep learning-based system with the developed cascade feature pyramid network has the potential to detect and classify breast lesions on DCE-MRI, especially small lesions.

Outcome Predictors of Lesional Posterior Cortex Epilepsy Surgery.

Lesional posterior cortex epilepsy (PCE) is often drug resistant and may benefit from surgical intervention. In this study, we aimed to identify potential predictive factors associated with seizure recurrence after epilepsy surgery in lesional PCE. We retrospectively reviewed patients with PCE who underwent surgery between 1998 and 2021. They were divided into 2 groups according to seizure outcome; the seizure-free group (group 1) and the non-seizure-free group (group 2). The relationship among clinical factors, electroencephalography (EEG) or cranial magnetic resonance imaging findings, disease, and seizure outcome was investigated. A total of 60 patients, with a mean age of 27.26 ± 12.35 years (range, 9-61 years), were included in the study. There were 31 patients (51.66%) in group 1 (Engel class I) and 29 patients (48.33%) in group 2 (13 [21.66%], 10 [16.66%], and 6 [10%] patients in Engel class II, III, and IV, respectively), with a mean follow-up of 8.95 ± 6.96 years (range, 1-24 years). No difference was observed regarding age, gender, age at seizure onset, operation type, treatment gap, and presence of bilateral lesions between the groups (P > 0.05). However, bilateral findings on interictal EEG and gliosis as the underlying disease were predictors of seizure recurrence (P < 0.05). More than half of the patients (including 2 with bilateral magnetic resonance imaging lesions) were seizure free at long-term follow-up. However, patients with bilateral findings on interictal EEG and gliosis were more likely to have recurrent seizures after surgery. Because lesional PCE is almost always drug resistant and has a potential for favorable outcomes, epilepsy surgery should be considered early.

MRI of Peliosis Hepatis: A Case Series Presentation With a 2022 Systematic Literature Update.

Peliosis hepatis (PH) is a rare benign condition, characterized by hepatic sinusoidal dilatation and blood-filled cystic cavities, often found incidentally, with still challenging diagnosis by imaging due to polymorphic appearance. Based on a retrospective analysis of our series (12 patients) and systematic literature review (1990-2022), to organize data about PH and identify features to improve characterization. Retrospective case series and systematic review. Twelve patients (mean age 48 years, 55% female) with pathology-proven PH and 49 patients (mean age 52 years, 67% female) identified in 33 studies from the literature (1990-2022). 1,5-T; T1-weighted (T1W), T2-weighted (T2W), diffusion-weighted (DW), contrast-enhanced (CE) T1W imaging. We compared our series and literature data in terms of demographic (gender/age/ethnicity), clinical characteristics (symptoms/physical examination/liver test), associated conditions (malignancies/infectious/hematologic/genetic or chronic disorders/drugs or toxic exposure) percentage. On magnetic resonance imaging lesion numbers/shape/mean maximum diameter/location/mass effect/signal intensity were compared. PH pathological type/proposed imaging diagnosis/patient follow-up were also considered. Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports/Series quality assessment. Intraclass correlation and Cohen's kappa coefficients for levels of inter/intrareader agreement in our experience. Patients were mainly asymptomatic (92% vs. 70% in our study and literature) with associated conditions (83% vs. 80%). Lesions showed homogeneous T1W-hypointensity (58% vs. 65%) and T2W-hyperintensity (58% vs. 66%). Heterogeneous nonspecific (25% vs. 51%), centrifugal (34% vs. 8%), or rim-like centripetal (25% vs. 23%) patterns of enhancement were most frequent, with hypointensity on the hepatobiliary phase (HBP), without restricted diffusivity. Good inter- and intrareader agreement was observed in our experience. Concerning JBI Checklist, 19 out of 31 case reports met at least 7 out of 8 criteria, whereas 2 case series fulfilled 5 and 6 out of 10 items respectively. A homogeneous, not well-demarcated T1W-hypointense and T2W-hyperintense mass, with heterogeneous nonspecific or rim-like centripetal or centrifugal pattern of enhancement, and hypointensity on HBP, may be helpful for PH diagnosis. Among associated conditions, malignancies and drug exposures were the most frequent. 4 TECHNICAL EFFICACY: Stage 2.

2D versus 3D MRI of osteoarthritis in clinical practice and research.

Accurately detecting and characterizing articular cartilage defects is critical in assessing patients with osteoarthritis. While radiography is the first-line imaging modality, magnetic resonance imaging (MRI) is the most accurate for the noninvasive assessment of articular cartilage. Multiple semiquantitative grading systems for cartilage lesions in MRI were developed. The Outerbridge and modified Noyes grading systems are commonly used in clinical practice and for research. Other useful grading systems were developed for research, many of which are joint-specific. Both two-dimensional (2D) and three-dimensional (3D) pulse sequences are used to assess cartilage morphology and biochemical composition. MRI techniques for morphological assessment of articular cartilage can be categorized into 2D and 3D FSE/TSE spin-echo and gradient-recalled echo sequences. T2 mapping is most commonly used to qualitatively assess articular cartilage microstructural composition and integrity, extracellular matrix components, and water content. Quantitative techniques may be able to label articular cartilage alterations before morphological defects are visible. Accurate detection and characterization of shallow low-grade partial and small articular cartilage defects are the most challenging for any technique, but where high spatial resolution 3D MRI techniques perform best. This review article provides a practical overview of commonly used 2D and 3D MRI techniques for articular cartilage assessments in osteoarthritis.

MWSR-YLCA: Improved YOLOv7 Embedded with Attention Mechanism for Nasopharyngeal Carcinoma Detection from MR Images

Nasopharyngeal carcinoma (NPC) is a malignant tumor, and early diagnosis and timely treatment are important for NPC patients. Accurate and reliable detection of NPC lesions in magnetic resonance (MR) images is very helpful for the disease diagnosis. However, recent deep learning methods need to be improved for NPC detection in MR images. Because NPC tumors are invasive and usually small in size, it is difficult to distinguish NPC tumors from the closely connected surrounding tissues in a huge and complex background. In this paper, we propose an automatic detection method, named MWSR-YLCA, to accurately detect NPC lesions in MR images. Specifically, we design two modules, the multi-window settings resampling (MWSR) module and an improved YOLOv7 embedded with a coordinate attention mechanism (YLCA) module, to detect NPC lesions more accurately. First, the MWSR generates a pseudo-color version of MR images based on a multi-window resampling method, which preserves richer information. Subsequently, the YLCA detects the NPC lesion areas more accurately by constructing a novel network based on an improved YOLOv7 framework embedded with the coordinate attention mechanism. The proposed method was validated on an MR image set of 800 NPC patients and obtained 80.1% mAP detection performance with only 4694 data samples. The experimental results show that the proposed MWSR-YLCA method can perform high-accuracy detection of NPC lesions and has superior performance.

Classification of Breast Lesions on DCE-MRI Data Using a Fine-Tuned MobileNet

It is crucial to diagnose breast cancer early and accurately to optimize treatment. Presently, most deep learning models used for breast cancer detection cannot be used on mobile phones or low-power devices. This study intended to evaluate the capabilities of MobileNetV1 and MobileNetV2 and their fine-tuned models to differentiate malignant lesions from benign lesions in breast dynamic contrast-enhanced magnetic resonance images (DCE-MRI).

P-61 Characterization of subclinical optic nerve magnetic resonance imaging lesions in the N-Momentum trial

P-61 Characterization of subclinical optic nerve magnetic resonance imaging lesions in the N-Momentum trial

Diffusion tensor imaging (DTI) studies of cerebral white matter integrity in normal to moderate cardiovascular risk patients

Background &amp; Objectives: The cerebral small vessel disease (CSVD) manifest as white matter lesion (WML) in magnetic resonance imaging (MRI). The diffusion tensor imaging (DTI) study shows a lower white matter integrity in white matter lesion (WML) and its penumbra region, suggesting cerebral white matter damage. The aim of this study is to establish correlation between the DTI values of white matter with the age related white matter changes (ARWMC) visual rating score and identify predictors of ARWMC score. Methods: 63 brain MRI images of subjects were selected. Relevant clinical information of the subjects which satisfied QRISK2 risk factors were retrieved from the patients’ folder. DTI parameters were obtained via postprocessing at OsiriX DTImap workstation. Results: FA frontal (r = -0.36; p = 0.003) and AD frontal (r = -0.26; p = 0.040) had a substantial and negative correlation with the ARWMC score. There was a significant positive correlation shown between the ARWMC score and RD frontal (r = 0.30; p = 0.018). There were positive significant association between the ARWMC score and age (b(95%CI): 0.106 (0.061, 0.151); p&lt;0.001) and QRISK2 score (b(95%CI): 0.235 (0.036, 0.433)). Conclusion: DTI is a good method to study the cerebral white matter integrity. It was found that frontal lobe is the first region affected in relation to ageing, in particular the myelin integrity. Increasing age and higher QRISK2 cardiovascular risk factors were shown to increase the ARWMC score.

Analysis of false-positive biopsy results of PIRADS 4 lesions in multiparametric magnetic resonance imaging of the prostate: Experience from a single nonacademic center using cognitive fusion.

321 Background: Multiparametric magnetic resonance imaging (mpMRI) of the prostate has been increasingly used in the algorithm of the initial diagnosis of patients suspected to harbor prostate cancer (PCa) with the aim of improving the selection of patients who really need a biopsy. Yet patients with PI-RADS 5 lesions almost always have cancer found in their prostates, the same is not true for patients with PI-RADS 4. In this study we sought to describe pathological findings in target biopsies of PI-RADS4, and to identify clinical data that could predict those patients with benign findings. Methods: A retrospective study was conducted in a data bank collected prospectively from December 2015 through April 2022 in a single nonacademic center. The whole series consist of 547 patients, all of whom had a mpMRI of the prostate (reports as per PI-RADS version 2) followed by cognitive fusion prostate biopsy performed by a single, experienced radiologist. All biopsy specimens were read by a specialist in urological pathology. Out of these, 259 had PI-RADS 4 lesion, and 83 had PI-RADS 5. Results: We found a false positive rate of 29% and 3.7% for any cancer in PI-RADS 4 and 5 lesions, respectively. Different histologic patterns were observed among target biopsies. At multivariate analysis, PIRADS lesion ≤ 6 mm and previous negative biopsy were independent predictors of false positive PI-RADS4 lesions. The 76 cases showed normal histology (n = 22), a combination of chronic inflammation, reactive epithelium, and glandular atrophy (n = 18), glandular atrophy (n = 9), stromal proliferation consistent with nodular hyperplasia (n =7), a combination of chronic inflammation, reactive epithelium and glandular atrophy (n = 6), chronic inflammation (n = 4) and HGPIN (n = 10). The small number (n=3) of false PI-RADS5 lesions precluded further analyses. Conclusions: Benign findings are common in PI-RADS4 lesions and most of them did not show obvious glandular or stromal hypercellularity as expected in hyperplastic nodules. Size ≤ 6 mm and previous negative biopsy predict higher probability of false positive results in patients with PI-RADS 4 lesions.[Table: see text]

Prediction of significant prostate cancer in equivocal MRI lesions: A high-volume international multicenter study.

311 Background: The decision of performing prostate biopsy in men with equivocal findings in prostate magnetic resonance imaging (MRI) is challenging as they have a low but still relevant risk of harboring significant prostate cancer (sPC). Objective: To identify clinical predictors of sPC in men with equivocal findings in prostate MRI. Secondly, we aimed to analyze the hypothetical effect of incorporating prostate-specific antigen density (PSAD) into biopsy decision. Methods: We analysed a retrospective multinational cohort from 10 academic centers comprising 1476 men who underwent combined prostate biopsy (MRI-targeted plus systematic) between 02/2012 – 04/2021 due to an equivocal lesion found in prostate MRI (Prostate Imaging Reporting and Data System 3). Primary outcome was the detection of sPC (ISUP ≥ 2) in combined biopsy. Regression analysis was performed to identify predictors for this outcome. Descriptive statistics were applied to evaluate the hypothetical effect of involving PSAD into biopsy decision. Results: 273/1476 (18.5%) men were diagnosed with sPC by combined biopsy. MRI-targeted biopsy diagnosed less sPC as compared to combined strategy: 183/1476 (12.4%) vs. 273/1476 (18.5%), p&lt;0.01. Regression analysis confirmed age (OR 1.10 [95% CI: 1.05 – 1.15]; p &lt; 0.001), prior negative biopsy (OR 0.46 [0.24 – 0.89]; p = 0.022) and PSAD (p&lt;0.001) as independent predictors for sPC. Applying a PSAD cut-off of 0.15 for biopsy decision, 817/1398 (58.4%) of the biopsy procedures would have been avoided at the cost of missing sPC in 91 (6.5%) men. Limitations were the retrospective design, heterogeneity of the study cohort due to the long inclusion period and a missing central revision of MRI. Conclusions: Age, previous biopsy status and PSAD were found independent predictors of sPC in men with equivocal prostate MRI. Implementation of PSAD into biopsy decision can avoid a large proportion of unnecessary biopsies. Clinical parameters such as PSAD need validation in a prospective setting.