Magnetic Resonance Imaging Changes Research Articles

A pilot randomized controlled trial evaluating outdoor community walking for knee osteoarthritis: walk

ObjectivesTo determine the feasibility of a randomized controlled trial (RCT) examining outdoor walking on knee osteoarthritis (KOA) clinical outcomes and magnetic resonance imaging (MRI) structural changes.MethodThis was a 24-week parallel two-arm pilot RCT in Tasmania, Australia. KOA participants were randomized to either a walking plus usual care group or a usual care control group. The walking group trained 3 days/week. The primary outcome was feasibility assessed by changes being required to the study design, recruitment, randomization, program adherence, safety, and retention. Exploratory outcomes were changes in symptoms, physical performance/activity, and MRI measures.ResultsForty participants (mean age 66 years (SD 1.4) and 60% female) were randomized to walking (n = 24) or usual care (n = 16). Simple randomization resulted in a difference in numbers randomized to the two groups. During the study, class sizes were reduced from 10 to 8 participants to improve supervision, and exclusion criteria were added to facilitate program adherence. In the walking group, total program adherence was 70.0% and retention 70.8% at 24 weeks. The walking group had a higher number of mild adverse events and experienced clinically important improvements in symptoms (e.g., visual analogue scale (VAS) knee pain change in the walking group: − 38.7 mm [95% CI − 47.1 to − 30.3] versus usual care group: 4.3 mm [− 4.9 to 13.4]).ConclusionsThis study supports the feasibility of a full-scale RCT given acceptable adherence, retention, randomization, and safety, and recruitment challenges have been identified. Large symptomatic benefits support the clinical usefulness of a subsequent trial.Trial registration number12618001097235.Key Points• This pilot study is the first to investigate the effects of an outdoor walking program on knee osteoarthritis clinical outcomes and MRI joint structure, and it indicates that a full-scale RCT is feasible.• The outdoor walking program (plus usual care) resulted in large improvements in self-reported knee osteoarthritis symptoms compared to usual care alone.• The study identified recruitment challenges, and the manuscript explores these in more details and provides recommendations for future studies.

Imaging changes following surgery for ischiofemoral impingement

Partial resection of the lesser trochanter (LT plasty) has been increasingly recommended to treat ischiofemoral impingement. However, there is a lack of studies on the imaging findings following LT plasty. The purpose of this study was to assess magnetic resonance imaging (MRI) changes on the lesser trochanter and surrounding musculotendinous structures following LT plasty to treat ischiofemoral impingement. Twenty-one patients (21 hips) were studied. The LT length and cross-sectional area of the iliopsoas muscle were measured on MRI before and after surgery. The MRIs were performed on average 11 months (range, 3 to 25 months) after surgery. The mean ± standard deviation amount of LT resected (difference between pre- and postoperative LT length) was 7.3 mm ± 2.5 mm. The iliopsoas cross-sectional area decreased after the LT plasty in 95% of the hips (20/21) by an average of 35% ± 16%. The reduction in iliopsoas size had no significant correlation with improvement on the modified Harris Hip Score at a mean follow-up of 17 months after surgery (r = −0.13, P = 0.58). The iliopsoas muscle size decreased on average 35% following endoscopic LT plasty. The decrease was not correlated with midterm functional outcomes.

Effect of Bevacizumab Treatment in Cerebral Radiation Necrosis : Investigation of Response Predictors in a Single-Center Experience.

Bevacizumab is a feasible option for treating cerebral radiation necrosis (RN). We investigated the clinical outcome of RN after treatment with bevacizumab and factors related to the initial response and the sustained effect. Clinical data of 45 patients treated for symptomatic RN between September 2019 and February 2021 were retrospectively collected. Bevacizumab (7.5 mg/kg) was administered at 3-week intervals with a maximum four-cycle schedule. Changes in the lesions magnetic resonance image (MRI) scans were examined for the response evaluation. The subgroup analysis was performed based on the initial response and the long-term maintenance of the effect. Of the 45 patients, 36 patients (80.0%) showed an initial response, and eight patients (17.8%) showed delayed worsening of the corresponding lesion. The non-responders showed a significantly higher incidence of diffusion restriction on MRI than the responders (100.0% vs. 25.0%, p<0.001). The delayed worsening group showed a significantly higher proportion of glioma pathology than the maintenance group (87.5% vs. 28.6%, p=0.005). Cumulative survival rates with sustained effect were significantly higher in the groups with non-glioma pathology (p=0.019) and the absence of diffusion restriction (p<0.001). Pathology of glioma and diffusion restriction in MRI were the independent risk factors for non-response or delayed worsening after initial response. The initial response of RN to bevacizumab was favorable, with improvement in four-fifths of the patients. However, a certain proportion of patients showed non-responsiveness or delayed exacerbations. Bevacizumab may be more effective in treating RN in patients with non-glioma pathology and without diffusion restriction in the MRI.

Long-term outcomes of adult cryptogenic febrile infection-related epilepsy syndrome (FIRES).

Cryptogenic febrile infection-related epilepsy syndrome (FIRES) is a rare but catastrophic encephalopathic condition. We aimed to investigate the long-term outcome in adult cryptogenic FIRES. This was a retrospective study based on the prospective database in the neuro-intensive care unit of a tertiary hospital in China. Consecutive adult patients with cryptogenic FIRES between July 2007 to December 2021 were included. Long-term outcomes included function independence, the development of drug-resistant epilepsy (DRE), remote recurrent status epilepticus (SE), anti-seizure medications (ASMs), and changes in the brain Magnetic Resonance Imaging (MRI). A total of 11 adult patients with cryptogenic FIRES were identified from 270 patients with SE. Four (36%) patients died in the hospital, with three of them withdrawing treatments, and one patient died 12 months after discharge. After the follow-up ranging from 12 to 112 months, 6 (55%) patients were still alive, and all of them achieved functional independence [modified Rankin Scale (mRS) 0-3]. 45% (5/11) patients developed DRE, 18% (2/11) had remote recurrent SE, and 55% (6/11) were on polytherapy with ASMs at the last follow-up. Most of the patients with initial normal or abnormal MRI had abnormalities in the hippocampus at follow-up, and most of the other MRI abnormalities found in the acute stage disappeared over time. The outcome of adult cryptogenic FIRES is daunting. More than one-third of patients die in the hospital. Survivors of cryptogenic FIRES may regain functional independence, but they usually develop DRE and receive polytherapy of ASMs for a long time.

AlzheimerNet: An Effective Deep Learning Based Proposition for Alzheimer’s Disease Stages Classification From Functional Brain Changes in Magnetic Resonance Images

Alzheimer’s disease is largely the underlying cause of dementia due to its progressive neurodegenerative nature among the elderly. The disease can be divided into five stages: Subjective Memory Concern (SMC), Mild Cognitive Impairment (MCI), Early MCI (EMCI), Late MCI (LMCI), and Alzheimer’s Disease (AD). Alzheimer’s disease is conventionally diagnosed using an MRI scan of the brain. In this research, we propose a fine-tuned convolutional neural network (CNN) classifier called AlzheimerNet, which can identify all five stages of Alzheimer’s disease and the Normal Control (NC) class. The ADNI database’s MRI scan dataset is obtained for use in training and testing the proposed model. To prepare the raw data for analysis, we applied the CLAHE image enhancement method. Data augmentation was used to remedy the unbalanced nature of the dataset and the resultant dataset consisted of 60000 image data on the 6 classes. Initially, five existing models including VGG16, MobileNetV2, AlexNet, ResNet50 and InceptionV3 were trained and tested to achieve test accuracies of 78.84%, 86.85%, 78.87%, 80.98% and 96.31% respectively. Since InceptionV3 provides the highest accuracy, this model is later modified to design the AlzheimerNet using RMSprop optimizer and learning rate 0.00001 to achieve the highest test accuracy of 98.67%. The five pre-trained models and the proposed fine-tuned model were compared in terms of various performance matrices to demonstrate whether the AlzheimerNet model is in fact performing better in classifying and detecting the six classes. An ablation study shows the hyperparameters used in the experiment. The suggested model outperforms the traditional methods for classifying Alzheimer’s disease stages from brain MRI, as measured by a two-tailed Wilcoxon signed-rank test, with a significance of < 0.05.

Магнитно-резонансная томография при гипоксически-ишемических поражениях мозга у новорожденных: эволюция взглядов и перспективы развития

Aim: Based on the study of a large amount of available information, to create an idea of the use of magnetic resonance imaging (MRI) in hypoxic-ischemic brain lesions in newborns, to present the available research algorithms, classifications, the scope of the technique and its information content in the named pathology. Key points. MRI has long been a common practice in a neuropediatric hospital. To date, examination by this method has absolute significance in the diagnosis of perinatal hypoxic-ischemic brain lesions. In addition, MRI data help to objectify the effectiveness of therapeutic interventions and predict the further development of a child with perinatal brain damage. There are several classifications of MRI changes in hypoxic-ischemic brain lesions in newborns. These classifications have varying degrees of sensitivity to the initial hypoxic-ischemic changes in the child's brain, however, allow us to roughly represent the process of their formation in dynamics in the morphological aspect according to the scheme “periventricular white matter — subcortical ganglia and thalamus — subcortical structures of the hemispheres and cerebral cortex”. Thus, the target structures of hypoxic ischemic lesions allow us to identify its main patterns: lesions of neuronal structures, leukopathy, and their combination. Conclusion. Studies of MRI phenomena as predictors of developmental pathology show that an increase in detail increases the accuracy of the prognosis. However, the available data do not currently allow us to form a spatial model for the development of hypoxic-ischemic changes in the brain of a newborn. It seems necessary to create such a model depending on the time and intensity of the impact of the ischemic process. This will allow developing a morphological and pathophysiological classification of perinatal encephalopathies. Keywords: magnetic resonance imaging, hypoxia-ischemia, hypoxic-ischemic brain damage, newborns, cerebral palsy.

Can basic magnetic resonance imaging along with neuropsychological assessment be used as a cost-effective means for the detection of early dementia in the Indian sub-continent?

ABSTRACT Introduction: The mild cognitive impairment (MCI) stage occurs sporadically between healthy aging and the onset of Alzheimer’s disease (AD). MCI shows significant defacement in magnetic resonance imaging (MRI) of the brain along with neuropsychological and behavioral parameters. Aim: Assessment of neuropsychological, behavioral, and structural MRI changes in MCI and their relation with each other. Methodology: Seventy-eight participants in the MCI group and healthy controls (HC) were assessed using Addenbrooke’s Cognitive Examination (ACE), Mini-Mental Status Examination (MMSE), Clinical Dementia Rating Scale (CDR); and behavioral assessment by using Behavioral Pathology In AD (BEHAVE-AD). MRI brain volumetric analysis was performed using the software MYRIAN. Statistical analysis was performed using the Mann–Whitney U test, unpaired t-test (P = &lt;0.05), and Spearman’s rank correlation. Results: MCI group showed significant impairments in ACE, MMSE, and CDR and significantly higher behavioral symptoms on BEHAVE-AD. Episodic memory had a significant positive correlation with normalized right hippocampal volume and total intracranial volume (TICV). Remote memory had a significant negative correlation with normalized left hippocampal volumes. Global CDR score had a moderately negative correlation with normalized right and left hippocampal volumes. Affective disturbances were negatively correlated with TICV. Conclusions: Comparable analysis of correctly scaled neuropsychological assessments may provide unbiased proxies for MRI-based measures of dementia risk.

Клинико-инструментальная диагностика ранних изменений атлантоаксиальной области при анкилозирующем спондилите

The purpose — to assess the early imaging changes in the atlantoaxial area and to compare them with clinical and laboratory characteristics in patients with ankylosing spondylitis (AS). Material and methods. 20 patients with AS were examined, the average age is 44.2 ± 12.66 y. o. Activity (ASDAS(CRP)): very high — 85%, high — 5%, low — 10%. X-ray stage of sacroiliitis: 2 — 60%, 3 — 15%, 4 — 25%. Functional deficiency (FD): 3 — 55%, 2 — 20%, 1 — 25%. The duration of illness was 176 [2; 360] months. The extended clinical examination included: assessment of neurological status, presence of components of neuropathic pain (NP) and central sensitization (CS), assessment of quality of life, degree of functional disorders. Magnetic resonance imaging (MRI) of the craniovertebral junction was performed with the measurement of 5 craniometric parameters (CMP) for the presence of translocation of the dens axis. Results. Neck pain syndrome — 75%: inflammatory — 95%, non-inflammatory — 80% (NP — 65%, CS — 50%). VAS: 5.75 ± 2.09. FD: BASMI — 3.86 [2; 7], BASFI — 4,84 [0,7; 8,7]. 75% — limitation of neck rotation, 65% — increase in the distance of the trestle-wall. CMP: 100% — decrease in the retroflex angle, 20% — increase in the anterior atlantodental index, 15% — translocation relative to the Chamberlain line, 10% increase in pB-C2, 5% — decrease in the posterior atlantodental index. A correlation was revealed between the CMP with the X-ray stage (rSp = 0.629; p = 0.021), BASMI (rSp = 0.575; p = 0.04) and the psychological component SF-36 (rSp = 0.570; p = 0.042). The angle of retroflexion with the duration of the disease (rSp = -0.580; p = 0.038), CRP (rSp = 0.624; p = 0.023). Conclusions. All patients with AS had pathological MRI changes in the form of initial manifestations of translocation of the dens, which had nonspecific clinical manifestations. Changes in craniovertebral transition to MRI did not correlate with disease activity (ASDAS (CRP)), but were associated with the level of CRP, duration of the disease, X-ray stage of sacroiliitis and functional indices (BASMI).

Evaluation of neurologically symptomatic and asymptomatic patients in childhood Wilson's disease with central nervous system involvement: A retrospective observational study

Abstract Objective: The aim was to evaluate the clinical and laboratory characteristics of children with Wilson's disease (WD) with and without neurological presentation with abnormalities on brain magnetic resonance imaging (MRI) and to describe the relationship of these observations with disease severity and functional outcome and their impact on prognosis. Materials and methods: Demographic, neuropsychiatric findings, laboratory, disease severity and functional results of 48 children with neurologically symptomatic and asymptomatic WD were evaluated retrospectively. Results: A significant positive correlation was found between the neurologic symptom score and functional outcome in WD with neurological presentation (p &lt;0.001). A significant positive correlation was found between disease severity scores (PELD, MELD, Child Pugh and Dhwin score) and modified Rankin scores (mRS) in WD without neurological presentation (p &lt;0.001, 0.004, &lt;0.001, 0.001, respectively). In addition, a significant positive correlation was found between total bilirubin, direct bilirubin and Internationel Normalized Ratio (INR) values and mRS scores (p= 0.006, 0.012, 0.004, respectively). Kayser-Fleischer Ring sign in the eye was higher in the group with neurological symtomatic WD (p &lt;0.001). The number of patients presenting with clinic of fulminant hepatitis and hepatic encephalopathy was significantly higher in the neurological asymptomatic group (p &lt;0.001) Conclusion: Brain MRI changes may occur even in hepatic WD and presymptomatic cases, although infrequently, regardless of the presence of neurological symptoms. It should be known that neurological symptoms in children and adolescents may occur without significant liver disease. Even without neurological symptoms, all children with WD should have a brain MRI before treatment.

Clinical and Magnetic Resonance Image Changes of Platelet-Rich Plasma Therapy in Combination with Human Mesenchymal Stem Cells from Autologous Adipose Tissue for Knee Osteoarthritis Treatment

Clinical and Magnetic Resonance Image Changes of Platelet-Rich Plasma Therapy in Combination with Human Mesenchymal Stem Cells from Autologous Adipose Tissue for Knee Osteoarthritis Treatment

Antipsychotics and structural brain changes: could treatment adherence explain the discrepant findings?

Progressive structural brain changes are well documented in schizophrenia and have been linked to both illness progression and the extent of antipsychotic treatment exposure. Literature reporting longitudinal changes in brain structure in individuals with schizophrenia is selectively reviewed to assess the roles of illness, antipsychotic treatment, adherence and other factors in the genesis of these changes. This narrative review considers literature investigating longitudinal changes in brain structure in individuals with schizophrenia. The review focusses on structural changes in the cortex, basal ganglia and white matter. It also examines effects of medication non-adherence and relapse on the clinical course of the illness and on structural brain changes. Studies investigating structural magnetic resonance imaging changes in patients treated with long-acting injectable antipsychotics are reviewed. Temporal changes in brain structure in schizophrenia can be divided into those that are associated with antipsychotic treatment and those that are not. Changes associated with treatment include increases in basal ganglia and white matter volumes. Relapse episodes may be a critical factor in illness progression and brain volume reductions. Medication adherence may be an important factor that could explain the findings that brain volume reductions are associated with poor treatment response, higher intensity of antipsychotic treatment exposure and more time spent in relapse. Improved adherence via long-acting injectable antipsychotics and adherence focussed psychosocial interventions could maximize protective effects of antipsychotics against illness progression.

Short-Term Effects of an American Football Game on Cognitive Function, Memory, and Brain Functional Connectivity

ABSTRACT Introduction/Purpose Head impacts associated with American football have been associated with short- and long-term disrupted cognitive performance. In this study, we aimed to determine the effects of an acute game of American football on cognitive function, memory, morphological changes, and functional connectivity in the brain. Methods Twelve members (mean ± standard deviation: age, 26.8 ± 5.2 yr; height, 183 ± 6.5 cm; weight, 98.8 ± 23.6 kg) of the Israel National American Football team were assessed 1 wk before (PRE) and 24-h post (24P) game. No head injuries to any of the players participating in the study occurred. All study participants were scanned using a Siemens Prisma 3-T magnetic resonance imaging (MRI) scanner to determine changes in resting-state functional MRI (fMRI) by measuring each participant’s connectivity of subcortical regions. In addition, brain-derived neurotrophic factor (BDNF) concentration and cognitive function were measured at each assessment. Results A significant increase in BDNF concentration (33%, P = 0.007) was noted at 24P. In addition, significant increases (p &lt; 0.05) in cerebral connectivity within the hippocampus, amygdala, and the connections between the hippocampus and the somatomotor areas were noted between PRE and 24P. Elevations in hippocampus connectivity were correlated with changes in acute memory (r = 0.72, P = 0.03), and decreases in somatomotor–hippocampus connectivity were significantly correlated with a greater change in BDNF concentration (r = −0.67, P = 0.01). No significant changes were found in brain volume, cognitive function, or between brain connectivity and other regions. Conclusions The fMRI results suggested that, even during an American football game in which no known head injury occurred, changes in neurotrophin concentrations were correlated with morphological changes in the parietal and frontal regions of the brain.

Curcumin Coated Ultra-Small Iron Oxide Nanoparticles as T1 Contrast Agents for Magnetic Resonance Imaging of Cancer Cells.

The application of nanotechnology in the molecular diagnosis and treatment of cancer is essential. This study aimed to investigate the influence of curcumin-coated ultra-small superparamagnetic iron oxide (USPIO) as a T1 contrast agent in Magnetic Resonance Imaging (MRI). In this experimental study, the influence of curcumin-coated USPIO (Fe3O4@C) on the diagnosis of the cancer cell line was investigated. After synthesis, characterization, and relaxation of Fe3O4@C, the contrast changes in T1-weight MRI to mouse colon carcinoma 26 cell line were evaluated in vitro. Fe3O4@C nanoparticles (NPs) are good at imaging; based on a relaxometry test, the r1 and r2 relaxivities of Dotarem were 3.139 and 0.603 mM-1s-1, respectively. Additionally, the r1 and r2 relaxivities of Fe3O4@C were 3.792 and 1.3 mM-1s-1, respectively, with the rate of 2.155 of r2/r1 NPs. The NPs can be identified as a positive contrast agent with a weight of T1 in MRI. The coresh-ell Fe3O4@C NPs can be effective in cancer treatment and diagnosis because of the therapeutic effects of curcumin and the properties of USPIO.

A clinical case report: stroke in a young patient with systemic lupus erythematosus on the background of secondary antiphospholipid syndrome

The article describes a clinical case report of a young patient with ischemic stroke on the background of antiphospholipid syndrome (APLS). The uniqueness of this case lies in the complex diagnostic search that we performed. On admission, the patient had general cerebral, general infectious and focal syndromes. We suspected encephalitis due to the peculiarities of the onset of the disease and the results of computed tomography. However, after the results of lumbar puncture, the diagnosis of encephalitis required careful differential diagnosis. We performed an extensive diagnostic search. Based on clinical-laboratory, instrumental and immunological data the patient had the following final diagnosis: “Ischemic cardioembolic stroke in the right middle cerebral artery pool (15.10.17) (ICD 11: 8B11.5). Acute period with left pyramidal reflex insufficiency and changes in magnetic resonance imaging. Systemic lupus erythematous (ICD 11: 4A40.0), subacute course, activity II, with the lesion of skin (transient erythematous rash), kidneys (proteinuria, transient impaired renal function), lungs (bilateral pleurisy with immunological disorders). Secondary APLS (ICD 11: 4A45) (Acute iliofemoral thrombosis, May 2017; chronic thrombosis of the inferior vena cava, iliac veins, positive IgG to cardiolipin, beta 2 glycoproteins). Thus, we have to link thrombotic complications in young patients with APLS and to examine the patients for antiphospholipid antibody presence.

Pathognomonic neuroradiological signs in Wilson's disease – Truth or myth?

IntroductionWilson's disease (WD) is a treatable genetic disorder caused by impaired copper metabolism. Early diagnosis and correct anti-copper treatment are crucial for therapeutic success. Brain magnetic resonance imaging (MRI) is used both for diagnosis and treatment monitoring. Several neuroradiological signs have been proposed to be pathognomonic for WD; however, their frequency and significance are not established. The frequency and significance of these brain MRI signs were analyzed in a large cohort of WD patients. MethodsWe retrospectively analyzed 100 newly diagnosed, treatment-naive WD patients. Brain MRI was performed and the frequency of typical MRI changes was analyzed with demographic, clinical and laboratory characteristics of WD. ResultsPotentially pathognomonic brain MRI signs for WD occurred in 24% patients and in 43% (24/55) patients with neurological WD. Signs detected included the “face of the giant panda” in 15% of all patients (27.3% of neurological cases), “miniature panda” in 12% (21.8% of neurological cases), “split thalamus” in 7% (12.7% of neurological cases), and “bright claustrum” and “whorl” signs in 1 patients each. Signs were observed only in patients with neurological symptoms and were significantly associated with early age of onset/diagnosis, more severe neurological presentation and lower ceruloplasmin level (all p < 0.05). ConclusionsPotentially brain MRI pathognomonic signs occurred relatively rarely across all patients, most often in patients with early onset and severe neurological symptoms, and this knowledge may improve WD diagnosis. However, as these signs are also found in brain MRI in other disorders, they may not be truly pathognomonic of WD.

Importance of Identifying Cognitive Impairment in Multiple Sclerosis.

This article aims to highlight the impact of cognitive impairment on outcomes and quality of life for people with multiple sclerosis (MS) and to review current evidence for the efficacy of disease-modifying therapies (DMTs) and other interventions. In addition, we provide clinical practice insights regarding screening and management of cognitive impairment in people with MS. Evidence suggests that cognitive deterioration often accompanies magnetic resonance imaging changes. Neocortical volume and deep grey matter atrophy correlate with cognitive impairment. Similarly, cognitive decline is predictive of a higher lesion burden. Cognitive impairment is an important clinical measure of disability and negatively impacts quality of life. Phase 3 studies suggest that DMTs such as natalizumab, ozanimod and fingolimod may provide long-lasting, clinically meaningful effects on cognition in people with MS. Further data are needed to support the use of adjunct cognitive behavioural and exercise interventions for people with MS who have cognitive impairment. More data are needed to define appropriate management strategies for cognitive impairment in people with MS. Baseline and periodic screening for cognitive impairment and inclusion of cognitive impairment as a clinical trial endpoint will help to inform efforts to manage this important aspect of MS.

Nature of pathological changes on magnetic resonance imaging of the CNS in patients with focal forms of acute tick-borne encephalitis

Introduction. Tick-borne encephalitis (TBE) is a widespread natural focal viral neuroinfection in Russia and the Sverdlovsk region. The high level of morbidity, leading to disability, and the annual registration of focal forms and lethal cases determine the relevance of the search for early differential diagnostic criteria for acute tickborne encephalitis (TBE). A promising direction in the early diagnosis of TBE is acquired by magnetic resonance imaging (MRI).The aim of the study was to study the features of the MRI picture in patients with focal forms of TBE.Material and methods. The study included 38 patients with focal forms of OKE who were treated in the neurological department of Sverdlonsk regional clinical hospital № 1 since 2009 to 2019.Results. In the acute period of focal forms of TBE, pathological changes of an inflammatory nature during MRI of the CNS were more often detected in the cerebral hemispheres (mainly in the white matter) in 40.4 % and subcortical structures in 36.8 %, in the brainstem in 16.7 %, less often in 6.1 % – in the region of the cerebellum and spinal cord. Bilateral nature and combined lesions of the CNS structures were detected 2 times more often. Discussion A detailed analysis of the localization and nature of MRI changes in the CNS in patients with severe focal forms of the disease, in contrast to single descriptions of the MRI picture of TBE according to the literature, made it possible to identify combined lesions of the frontal and parietal lobes characteristic of TBE in combination with pathological changes in the region of the thalamus and basal ganglia.Conclusion. Identification of typical MRI changes in the CNS in patients with a clinical picture of viral encephalitis in the spring-summer period contributes to the early diagnosis of a severe course of TBE.

Structural Changes in Brain Magnetic Resonance Imaging Associated With Psychogenic Non-epileptic Seizures: An Analytical Cross-Sectional Study.

Background Psychogenic non-epileptic seizures (PNES) are often seen as indicators of poor motor and sensory function caused by psychological responses to stressful experiences. A seizure might trigger these reactions. The aim of our study was to assess the structural changes in brain MRI associated with psychogenic non-epileptic seizures. Methodology A retrospective analytical cross-sectional study at the Department of Medicine and Neurology, Ayub Teaching Hospital, Abbottabad, was conducted from October 2020 to September 2021. The medical records of patients with confirmed PNES were collected and retrospectively evaluated. Results Medical records and MRI scans were accessible for 52 patients with PNES; 10 patients were excluded from the study. The average age of the patients (standard deviation) was 34 (±9) years, and the average age at onset was 31.6 (±5.8) years. Based on the video-EEG recordings, 57.1% of patients (n=24) were classified as having broadly generalized motor seizures, 40% of patients (n=17) were classified as having predominantly akinetic seizures defined primarily by blank spells, and only one patient was classified as having focal motor seizures. Only three patients (7%) had a positive epilepsy family history. Twenty-four (47.6%) patients with brain MRI scans reported abnormal findings, while 22 (52.4%) had normal MRI findings. The majority of patients with abnormal MRIs had nonspecific white matter changes (50%), mesial temporal sclerosis (15%), and cysts (15%). In a statistical analysis, age at the beginning of PNES (p = 0.04), duration of PNES (p=0.01), concomitant epilepsy (p = 0.05), generalized motor seizures (p= 0.03), and focal motor seizures (p= 0.02) were strongly associated with abnormal brain MRI findings. Conclusion Research reveals that persons with PNES have a higher-than-average prevalence of anatomical brain abnormalities. The main takeaway is that these findings lend credence to the growing body of data suggesting that PNES may not be a medical mystery but rather a disorder with physical foundations in the brain. Important implications for diagnosing and treating PNES patients are discussed, as are the outcomes of earlier neuroimaging investigations of PNES. Studying the involvement of structural brain anomalies in the etiology of psychogenic non-epileptic seizures requires further well-designed multicenter studies with larger sample sizes and a consistent imaging approach (PNES). It is crucial to consider any confounding variables, such as co-occurring mental diseases, while designing this study.

Temporal changes of PIRADS scoring by radiologists and correlation to radical prostatectomy pathological outcomes.

To assess temporal improvement of prostate image reporting and data system (PIRADS) 3-5 lesion correlation to histopathologic findings from radical prostatectomy (RP) in prostate cancer (PCa). A total of 1481 patients who underwent RP for biopsy-proven PCa between 2015 and 2019 were divided into 14 groups of 100 sequential readings for the evaluation of histopathological correlation with PIRADS readings. Temporal trends of PIRADS distribution and predictive performance for RP pathology were evaluated to assess underlying changes in prostate magnetic resonance imaging (MRI) interpretation by radiologists. PIRADS 4-5 lesions were significantly correlated with the increasing rates of Gleason Group (GG) upgrade (p=0.044) and decreasing rate of GG downgrade (p=0.016) over time. PIRADS ≥3 lesions read after median 2years of experience were shown to independently predict intermediate-high-risk (GG≥3) PCa (odds ratio 2.93, 95% confidence interval 1.00-8.54; P=0.049) in RP pathology. Preoperative GG≥3 biopsy lesions with PIRADS 4-5 lesions were significantly more susceptible to GG upgrade (P=0.035) and GG≥4 RP pathology (p=0.003) in experienced reads, in contrast to insignificant findings in early readings (p=0.588 and 0.248, respectively). Preoperative MRI reports matched with RP pathology suggest an improved prediction of adverse pathology in PIRADS 3-5 lesions over time, suggesting a temporal change in PIRADS interpretation and predictive accuracy. Institutions with low volume experience should use caution in solely relying on MRI for predicting tumor characteristics. Future prospective trials and larger scale assessments are required to further validate our results.

Assessment of clinical profile of patients with non-radiographic axial spondyloarthropathy in a tertiary health-care center

Background: Axial spondyloarthritis (nr-axSpA) is an inflammatory and immune-mediated condition comprising clinically differentiated ankylosing spondylitis (AS) and nonradiographic nr- axSpA. Clinically, as the name suggests, non-radiographic nr- axSpA has an absence of definitive plain X-ray evidence of structural damage to the sacroiliac joint. Aims and Objectives: The aim of the study was to assess and evaluate the clinical profile of patients with non-radiographic axial spondyloarthropathy. Materials and Methods: This study was conducted in the department of Medicine over 18 months in a tertiary health care institution, being a prospective and observational type done with 43 subjects. Results: We observed a major improvement as per ASDAS criteria present among 53.49% of subjects, followed by clinically significant improvement among 27.91% of subjects. About 18.60% of subjects did not show any improvement. About 9.3% of subjects showed radiological progression. Out of eight cases that did not show improvement, all presented with low back pain and morning stiffness. About 62.5% had peripheral arthritis. About 87.5% had Schober’s test positive, FABER test (62.50%) and sacroiliac joint tenderness found among 7.5% of subjects. A total of 4 (9.3%) patients showed radiological progression. All of them have low back ache and morning stiffness, and three of them having peripheral arthritis at presentation. We found that patients who showed progression had higher mean ESR and CRP (45 and 36.5, respectively) values and a very high disease activity as per ASDAS and BASDAI criteria. Conclusion: There is a great scope and need for research to differentiate the magnetic resonance imaging (MRI) changes in the normal population against the ones patients with spinal diseases to be able to use MRI with precision in patients with non-radiographic axial spondyloarthropathy (nr-axSpA). As assessed, currently physiotherapy and NSAIDS are first line therapy for patients suffering from non-radiographic axial spondyloarthropathy.