Magnetic Resonance Imaging Exams Research Articles

Prostate Imaging for Local Recurrence Reporting and Data System for Biparametric Magnetic Resonance Imaging: A Proposal.

We investigated a novel dedicated Prostate Imaging for Local Recurrence Reporting and Data System (PI-RRADS) in biochemical recurrence after radiotherapy (RT) and rad- ical prostatectomy (RP) evaluating biparametric magnetic resonance imaging (bpMRI) exams, at 3T MRI of 55 patients. Associating bpMRI and biochemical recurrence data, we calculated bpMRI diagnostic accuracy. Four probability categories, from 1 (very low) to 4 (very high), were distinguished. In 20 patients with radiotherapy, 25% and 75% of lesions were reported as PI-RRADS 3, and 4, respectively. In 35 patients with radi- cal prostatectomy, 7.7% of lesions were included in PI-RRADS 1-2, whereas 40.4% and 51.9% in PI-RRADS 3 and 4 categories, respectively. Excellent agreement and significant correlation between bpMRI and biochemical recurrence were found. BpMRI showed sensitivity, specificity, positive predictive value, negative predictive value, false-posi- tive value, false-negative value, and total diagnostic accuracy of 96.15%, 86.7%, 97.4 %, 81.25%, 13.3%, 3.8% and 94.6%, respectively. BpMRI-based PI-RRADS allows the detection and localization local recurrence in biochemical recurrence after RT and RP contributing in clinical management and treatment.

Virtual Reality (VR) Simulation for Magnetic Resonance Imaging (MRI) Patient Preparation

This study aimed to compare the effectiveness of virtual reality (VR) simulation as a patient preparation method for Magnetic Resonance Imaging (MRI) examinations. A total of 138 participants were divided into VR and non-VR groups. The study found that anxiety levels were significantly different between the VR group before and during MRI exams (p<.001), but there was no significant difference in the non-VR group (p=.138). Noise, space, and strapping were moderately correlated with anxiety levels. The study suggests that VR could be an accessible pre-medical procedure option, improving patient experience, future treatment planning, and reducing costs associated with premature MRI exams.

Effect of hormonal treatment on evolution of endometriomas: An observational study

ObjectiveTo evaluate the evolution of endometriomas with or without medical treatment. MethodsThis retrospective observational study was performed at the Gynaecological Center, Hôpital La Conception (Assistance Publique Hopitaux de Marseille). We reviewed clinical data of patients with at least one endometrioma diagnosed by magnetic resonance imaging (MRI) and at least one other MRI exam after more than three months. Patients were divided into groups receiving medical treatment and without medical treatment (high-dose progestins, low-dose progestins or combined contraceptives). The primary objective was to evaluate the evolution of endometriomas with or without hormonal treatment. The primary evaluation criterion was the diameter of the endometriomas, and the secondary evaluation criterion was the number of endometriomas for each patient observed. The secondary objective was to evaluate whether different categories of hormonal treatment have different efficacity in the evolution of endometriomas. ResultsWe included 68 patients, 39 (57,4%) with hormonal treatment and 29 (42,6%) without hormonal treatment. There were 105 total endometriomas identified at the first MRI, 52 in patients with hormonal treatment and 53 in patients without treatment. The mean diameter of the endometriomas in patients with hormonal treatment was 31,48 ± 18,1 mm at the first MRI and 23,60 ± 15,3 mm at the second MRI. The mean diameter of the endometriomas in patients without treatment was 33,57 ± 19,7 mm at the first MRI and 40,11 ± 25,7 mm at the second MRI (statistically significant difference, p = 0.01). The mean number of endometriomas in patients with treatment was 1,79 ± 1,1 at the first MRI and 1,18 ± 0,9 at the second MRI, while the mean number of endometriomas in patients without hormonal treatment was 1,38 ± 0,6 at the first MRI and 1,97 ± 1,5 at the second MRI (difference not statistically significant, p = 0.38). The subgroup analysis differentiated by category of hormonal treatment did not show statistically significant results. ConclusionsThe present study shows that there is a positive effect of hormonal treatment on reducing the diameter of endometriomas and also a significative increase in endometrioma size in the absence of treatment. There is no evidence of an advantage of a single category of hormonal treatment on this effect on endometriomas. Thus, any medical treatment could be proposed as a first-line therapy for endometriomas that would reduce the size of the endometrioma and thereby help to avoid surgical intervention.

A multimodal assessment of cementless tibial baseplate fixation using radiography, radiostereometric analysis, and magnetic resonance imaging.

Fixation in cementless total knee arthroplasty is provided by osseous integration. Radiography, radiostereometric analysis (RSA), and magnetic resonance imaging (MRI) were used simultaneously to investigate fixation. Relationships between RSA-measured implant micromotions and MRI-evaluated osseous integration at the component-bone interface were assessed in 10 patients up to 6 months postoperation. Supine MRI (using multispectral imaging sequences) and RSA exams were performed to evaluate osseous integration and measure longitudinal migration, respectively. Inducible displacement was measured from standing RSA exams. Radiolucent lines were detected on conventional radiographs. Of 10 patients, 6 had fibrous membranes detected on MRI. No fluid or osteolytic interfaces were found, and no components were scored loose. Of 10 patients, 6 had radiolucent lines detected. Average maximum total point motion (MTPM) for longitudinal migration at 6 months was 0.816 mm (range 0.344-1.462 mm). Average MTPM for inducible displacement at 6 months was 1.083 mm (range 0.553-1.780 mm). Fictive points located in fibrous-classified baseplate quadrants had greater longitudinal migration than fictive points located in baseplate quadrants with normal interfaces at 2 weeks (p = 0.031), 6 weeks (p = 0.046), and 3 months (p = 0.047), and greater inducible displacements at 3 months (p = 0.011) and 6 months (p = 0.045). Greater early micromotion may be associated with the presence of fibrous membranes at the component-bone interface. Clinical significance: This multimodal imaging study contributes knowledge of the fixation of modern cementless TKA, supporting the notion that osseous integration is important for optimal implant fixation.

Comparison of Ultrasound and Magnetic Resonance Imaging for Identifying Soft Tissue Abnormalities in the Palmar Aspect of the Equine Digit.

Damage to the soft tissue structures of the digit is a common source of equine lameness. While magnetic resonance imaging (MRI) allows for the most complete diagnostic imaging of the equine digit, ultrasound is more readily available and less expensive. This prospective diagnostic accuracy study compares ultrasound to MRI for the diagnosis of injuries visible with ultrasound within the digit, including the deep digital flexor tendon (DDFT), collateral sesamoidean ligament (CSL), and navicular bursa. Clinical patients underwent an MRI of the digit and a blinded ultrasound of the digit between the heel bulbs, and results of the two modalities were compared. A total of 70 ultrasound and MRI exams of 45 horses were included. Ultrasound had good sensitivity (85%), moderate specificity (60%), and accuracy of 70% for evaluating the dorsal tearing of the DDFT. Accuracy was lower for navicular bursa effusion (67%), navicular bursa proliferation (61%), and CSL enlargement (61%). Tearing of the DDFT distal to the navicular bone was identified with MRI in 27 limbs, 20 of which also had dorsal damage proximal to the navicular bone identified with ultrasound. Ultrasound evaluation remains a useful screening tool, particularly for the assessment of DDFT tearing proximal to the navicular bone but risks under-diagnosing pathology to the navicular bursa and CSL. Clinically significant concurrent damage to the distal DDFT and other osseous and soft tissues in the hoof capsule is unlikely to be identified without MRI.

Remote MR scanning – A solution for shortage of skilled radiographers

Rapid medical and technological developments in radiology and demographic changes are leading to a rise in demand for MR examinations. According to the World Health Organization, the number of people aged 60 and over is expected to double between 2000 and 2050 [ [1] WHO: Number of people over 60 years set to double by 2050; major societal changes required [Internet]. [zitiert 25. Mai 2023]. Verfügbar unter: https://www.who.int/news/item/30-09-2015-who-number-of-people-over-60-years-set-to-double-by-2050-major-societal-changes-required. Google Scholar ]. The proportion of elderly people in society is increasing worldwide; sub-Saharan Africa is the only place where 43% of the population is younger than 15 [ [2] Population ages 65 and above, total | Data [Internet]. [zitiert 31. Januar 2023]. Verfügbar unter: https://data.worldbank.org/indicator/SP.POP.65UP.TO. Google Scholar ]. The high number of elderly people and the clinical benefit of radiological imaging procedures mean that the number of examinations is rising both rapidly and constantly. At the same time, life expectancy is steadily rising, which means even more demand on radiology services. According to the Organization of Economic Co-operation and Development (OECD), between 2009 and 2019, the number of MR exams in the United States increased by one-third while in Australia, the number of MR examinations more than doubled [ [3] OECD. Health at a Glance 2021: OECD Indicators [Internet]. OECD; 2021 [zitiert 27. März 2023]. (Health at a Glance). Verfügbar unter: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2021_ae3016b9-en. Google Scholar ]. Between 2007 and 2018, the number of MR studies in German hospitals increased by 80%, while worldwide more than 95 million MR examinations are performed each year [ [4] Health care use - Magnetic resonance imaging (MRI) exams - OECD Data [Internet]. theOECD. [zitiert 25. Mai 2023]. Verfügbar unter: http://data.oecd.org/healthcare/magnetic-resonance-imaging-mri-exams.htm. Google Scholar ].

A Machine Learning Approach for Knee Injury Detection from Magnetic Resonance Imaging

The knee is an essential part of our body, and identifying its injuries is crucial since it can significantly affect quality of life. To date, the preferred way of evaluating knee injuries is through magnetic resonance imaging (MRI), which is an effective imaging technique that accurately identifies injuries. The issue with this method is that the high amount of detail that comes with MRIs is challenging to interpret and time consuming for radiologists to analyze. The issue becomes even more concerning when radiologists are required to analyze a significant number of MRIs in a short period. For this purpose, automated tools may become helpful to radiologists assisting them in the evaluation of these images. Machine learning methods, in being able to extract meaningful information from data, such as images or any other type of data, are promising for modeling the complex patterns of knee MRI and relating it to its interpretation. In this study, using a real-life imaging protocol, a machine-learning model based on convolutional neural networks used for detecting medial meniscus tears, bone marrow edema, and general abnormalities on knee MRI exams is presented. Furthermore, the model’s effectiveness in terms of accuracy, sensitivity, and specificity is evaluated. Based on this evaluation protocol, the explored models reach a maximum accuracy of 83.7%, a maximum sensitivity of 82.2%, and a maximum specificity of 87.99% for meniscus tears. For bone marrow edema, a maximum accuracy of 81.3%, a maximum sensitivity of 93.3%, and a maximum specificity of 78.6% is reached. Finally, for general abnormalities, the explored models reach 83.7%, 90.0% and 84.2% of maximum accuracy, sensitivity and specificity, respectively.

Optimizing imaging resolution in brain MRI: understanding the impact of technical factors.

Magnetic resonance imaging (MRI) exams are essential for diagnostic procedures, but their lengthy duration and associated costs limit their accessibility. Shorter scan times would reduce expenses and allow for more MRI exams, expanding the range of diagnostic procedures. This study investigated technical factors that could decrease scan time without compromising image quality, including field-of-view (FOV), phase field of view, phase oversampling, cross-talk, brain MRI imaging resolution, and scan time. Data were collected from September 2021 to June 2022. All patients underwent brain scans in the transverse plane following a standardized protocol using a 1.5-tesla Siemens Avanto MRI scanner. The protocol employed T2-weighted Turbo Spin Echo imaging. Twenty-four cases were included in this study. Initially, all participants underwent brain MRI scans using the original protocols with axial sections. The results indicated that altering the FOV phase and phase oversampling significantly affected the scan time, whereas other factors did not have a direct impact. The original protocol had a scan time of 3.47 minutes with a FOV of 230 mm, 90% FOV phase, and 0% phase oversampling. After implementing the modified protocol, the scan time was reduced to 2.18 minutes with a FOV of 217 mm and 93.98% phase oversampling of 13.96%. Statistical analysis confirmed the high significance of FOV phase and phase oversampling in reducing scan time. By optimizing these technical factors, MRI exams can be performed more efficiently, resulting in shorter scan times and potentially reducing costs. This would enhance patient comfort and enable a greater number of MRI exams, facilitating a more comprehensive range of diagnostic procedures.

The efficiency of volumetric apparent diffusion coefficient histogram analysis in breast papillary neoplasms

Background/Aim: Papillary neoplasia encompasses both malignant and benign lesions, and core needle biopsy (CNB) is crucial in their diagnosis. Histological findings determine their management. Here we compare volumetric apparent diffusion coefficient (ADC) histogram analysis of carcinomas and benign pathologies identified by histopathology from excisional biopsies. Methods: This retrospective study included 524 patients who underwent breast magnetic resonance imaging (MRI) for a suspicious breast mass from January 2018 to October 2022. Patients with benign lesions, incompatible ultrasound-guided CNB results with papillary neoplasia, and those with MRI exams insufficient for diagnosis due to motion artifacts were excluded. After applying the exclusion criteria, the study included 48 patients (average aged 61.5 (14.8) years; range, 31 to 72 years). After excisional biopsies, 30 benign lesions and 18 carcinomas were identified. MRI was acquired at 1.5 T (Verio; Siemens Medical Solutions, Erlangen, Germany), and the b-values for diffusion-weighted imaging were calculated at 1000 s/mm2. Histogram parameters were computed. Receiver operating characteristic (ROC) curve analysis was performed to investigate diagnostic accuracy, evaluate histogram analysis performance, and determine threshold values. Results: The ADCmin, ADCmean, ADCmax, and all ADC value percentiles were significantly lower in the carcinoma group than in the benign group (P<0.001). The variance, skewness, and kurtosis were higher in the carcinoma group. ADCmax had the highest area under the curve (AUC: 0.985; cut-off 1.247 × 10-3 mm2/s; sensitivity 86%, and specificity 92%), followed by ADCmean (AUC: 0.950; cut-off 0.903 × 10-3 mm2/s; sensitivity 94%, and specificity 96%). Conclusion: Volumetric ADC histogram analysis of papillary neoplasia at higher b-values can be an imaging marker to detect carcinoma and quantitatively reveal the lesions’ diffusion characteristics.

Reducing contrast agent residuals in hospital wastewater: the GREENWATER study protocol

The potential enviromental impact of iodinated (ICAs) and gadolinium-based contrast agents (GBCAs) have recently come under scrutiny, considering the current nonselective wastewater treatment. However, their rapid excretion after intravenous administration could allow their potential recovery by targeting hospital sewage. The GREENWATER study aims to appraise the effective quantities of ICAs and GBCAs retrievable from patients’ urine collected after computed tomography (CT) and magnetic resonance imaging (MRI) exams, selecting ICA/GBCA per-patient urinary excretion and patients’ acceptance rate as study endpoints. Within a prospective, observational, single-centre, 1-year framework, we will enrol outpatients aged ≥ 18 years, scheduled to perform contrast-enhanced CT or MRI, willing to collect post-examination urine in dedicated canisters by prolonging their hospital stay to 1 h after injection. Collected urine will be processed and partially stored in the institutional biobank. Patient-based analysis will be performed for the first 100 CT and 100 MRI patients, and then, all analyses will be conducted on the pooled urinary sample. Quantification of urinary iodine and gadolinium will be performed with spectroscopy after oxidative digestion. The evaluation of the acceptance rate will assess the “environmental awareness” of patients and will aid to model how procedures to reduce ICA/GBCA enviromental impact could be adapted in different settings.Key points• Enviromental impact of iodinated and gadolinium-based contrast agents represents a growing point of attention.• Current wastewater treatment is unable to retrieve and recycle contrast agents.• Prolonging hospital stay may allow contrast agents retrieval from patients’ urine.• The GREENWATER study will assess the effectively retrievable contrast agents’ quantities.• The enrolment acceptance rate will allow to evaluate patients’ “green sensitivity”.

A Tumour and Liver Automatic Segmentation (ATLAS) Dataset on Contrast-Enhanced Magnetic Resonance Imaging for Hepatocellular Carcinoma

Liver cancer is the sixth most common cancer in the world and the fourth leading cause of cancer mortality. In unresectable liver cancers, especially hepatocellular carcinoma (HCC), transarterial radioembolisation (TARE) can be considered for treatment. TARE treatment involves a contrast-enhanced magnetic resonance imaging (CE-MRI) exam performed beforehand to delineate the liver and tumour(s) in order to perform dosimetry calculation. Due to the significant amount of time and expertise required to perform the delineation process, there is a strong need for automation. Unfortunately, the lack of publicly available CE-MRI datasets with liver tumour annotations has hindered the development of fully automatic solutions for liver and tumour segmentation. The “Tumour and Liver Automatic Segmentation” (ATLAS) dataset that we present consists of 90 liver-focused CE-MRI covering the entire liver of 90 patients with unresectable HCC, along with 90 liver and liver tumour segmentation masks. To the best of our knowledge, the ATLAS dataset is the first public dataset providing CE-MRI of HCC with annotations. The public availability of this dataset should greatly facilitate the development of automated tools designed to optimise the delineation process, which is essential for treatment planning in liver cancer patients.

Synthesizing human brain CT images from MRI with deep learning

Rapid development of artificial intelligence techniques significantly promotes important medical imaging applications such as disease diagnosis, medical image analysis and cross-modality synthesis. It is valuable to synthesize Computed Tomography (CT) scans of human brains from Magnetic Resonance Imaging (MRI) scans because CT images contain particular information for diseases such as malignant tumors, cerebrovascular malformations and aneurysms. Although there has been many studies trying to apply machine learning methods (e.g., fully convolutional neural networks and generative adversarial networks) to predict CT images based on MRI, there are still opportunities to increase the quality of synthesized CT images using the latest machine learning algorithms. In this study, we aim to synthesize high-credibility human brain CT images from MRI images using machine learning approaches. We build a dataset of both CT and MRI images of 41 patients from The Cancer Imaging Archive. A data pre-processing pipeline is designed to guarantee that the processed images are suitable as inputs to machine learning algorithms. The pipeline includes (1) pairing MRI and CT scans according to a certain time interval between CT and MRI exams of the same patient, (2) registering all MRI images to a standard MRI template, (3) registering all CT images to paired MRI images, (4) intensity normalization and (5) extracting 2D slices from 3D CT and MRI volumes. Three deep neural networks with encoder–decoder structure are selected and implemented including U-Net, U-Net++ and pix2pix to synthesize human brain CT images from MRI images. Experimental results illustrate that U-Net++ shows better performance than U-Net and pix2pix in synthesizing CT images from MRI by achieving a Mean Squared Error of 0.025, a Mean Absolute Error of 0.082 and a Peak Signal-to-Noise Ratio of 67.90, respectively. The trained machine learning models from this work can be applied in future human brain CT image prediction where CT images are absent and MRI images are available for specific patients, thereby supporting disease diagnosis based on CT images.

Double inversion recovery to detect cervical spinal cord multiple sclerosis lesions.

Magnetic resonance imaging (MRI) plays a key role in diagnosing and monitoring multiple sclerosis (MS). Double inversion recovery (DIR) is a pulse sequence that has proven highly effective at detecting cortical lesions but is understudied in the spinal cord. We hypothesize that DIR images obtained during brain MRI can be of value in assessing the upper spinal cord of MS patients. We retrospectively examined brain MRI exams of 64 patients with established MS, who had also undergone cervical spine MRI. Two blinded MS expert readers, who assessed the scans for lesion numbers and rated lesion visibility and overall image quality, reviewed brain 3-dimensional DIR sagittal and coronal images. Standardized mean contrast-to-noise ratios (C/N) and standard deviation (SD) were calculated in representative lesions for each patient and compared to those of 3-dimensional FLAIR images. For the analysis of lesions categorized as "definite lesions," the sensitivity was 87%, specificity was 61%, and negative predictive value was 80%. On the other hand, for "definite" plus "probable" lesions, the sensitivity was 91%, the specificity was 54%, and negative predictive value was 86%. DIR demonstrated lesions with an average C/N of 7.56 with an SD of 1.77. FLAIR sequence demonstrated lesions with an average C/N of 0.67 and SD of 1.27. Sagittally acquired brain DIR can provide useful information on upper spinal cord lesions, with high C/N. In theory, this should facilitate the attainment of McDonald's or the Magnetic Resonance Imaging in MS (MAGNIMS) criteria in some cases, without a dedicated cervical spine MRI exam.

An economic impact of incorrect referrals for MRI and CT scans: A retrospective analysis.

Up to date, no research on the economic efficacy of diagnostic modalities, such as magnetic resonance imaging (MRI) and computerized tomography (CT), has been done in Central Asia. The aim of this study was to analyse the inappropriate appointments of MRI and CT scanning procedures in Kazakhstan. We used the imaging diagnostic reports and medical records from 9725 planned outpatient CT and MRI exams performed in two major hospitals in Almaty. The study period was for the period 2014-2019. The independent experts-radiologists evaluated the MRI and CT exams for validity using the ACR® compliance standards and RCR recommendations. The results showed that the combined costs of MRI and CT scans increased by $17.982 between 2014 ($22.537) and 2019 ($40.519), p = 0.002. The highest rate of MRI examinations was observed in 2019, with a rate of 6.9 per 10,000 people. It was determined that in 2019 the highest rate for men who undertook CT was equal to 12.4 per 10,000 people, while for women it was equivalent to 5.7 per 10,000 patients. The majority of non-corresponding imaging examinations (n = 1304) were referred for MRI and CT scans by general practitioners. We detected the irrational referrals for head and neck radiological examinations in n = 178 (13.7%) cases, and the abdominal cavity checks in n = 249 (19.1%) cases (p = 0.001). The main portion of erroneously unreasonable referrals for examination of the abdominal organs was made by surgeons in n = 43 (3.3%) cases. The findings indicated an increase in the number of referrals for unnecessary CT and MRI tests over the research period (2014-2019). It had a substantial impact on the rise in healthcare system expenses. The results demonstrate the need for the education of GPs and improving the approaches for diagnostics.

Ectopic pregnancy with implanted gestational sac in the cesarean scar

Introduction: Implantation of a pregnancy in the cesarean scar is considered a rarest presentation of ectopic pregnancy with high morbidity and mortality. The use of imaging tests is capable of early diagnosing such cases and assisting in the management of pregnancy. The present article reports two cases of ectopic pregnancy in the cesarean scar, illustrating the main aspects in ultrasound tomography (UST) and magnetic resonance imaging (MRI) exams. In addition, a bibliographic search was carried out in a database that presented data about this clinical condition. Case Series: Case 1: A 44-year-old patient, without comorbidities, G2P1cA0, with a pregnancy of 9w4d, admitted with bleeding for 03 days. Ultrasound tomography showed a single gestational sac with an embryo of anomalous morphology, with no heartbeat and in isthmic topography, in an exophytic position, over the topography of a scar from a previous cesarean section. The initial diagnosis was placental accreta. After MRI of the pelvis, an ectopic pregnancy with a gestational sac implanted in the cesarean section scar (type II—exogenous), with signs of trophoblast/placental accreta. Case 2: A 30-year-old patient, without comorbidities, G2P1c, with a 7w3d pregnancy, with abdominal pain. Ultrasound tomography showed a single gestational sac with a gestational sac implanted in the cesarean section scar, transmural type I (endogenous), which was later confirmed by pelvic MRI. Conclusion: It is necessary to highlight the importance of early diagnosis of ectopic pregnancy with implantation in a cesarean scar, given the possibility of making an appropriate therapeutic decision depending on the clinical context, aiming to reduce the possible complications of the condition.

How Different Preparation Techniques Affect MRI-Induced Anxiety of MRI Patients: A Preliminary Study

Magnetic resonance imaging (MRI) exams may cause patients to feel anxious before or during the scan, which affects the scanning outcome and leads to motion artifacts. Adequate preparation can effectively alleviate patients' anxiety before the scan. We aimed to assess the effect of different preparation methods on MRI-induced anxiety: We conducted a prospective randomized study on MRI patients between March and May 2022. We divided 30 patients into two groups: the control group, which received routine preparation (RP), and the experimental group, which received video preparation (VP). We used the State-Trait Anxiety Inventory (STAI) to measure anxiety levels before and after the interventions. We assessed patients' self-satisfaction after the scan: After preparation, VP (STAI mean = 10.7500) and RP (STAI mean = 12.7857), we observed a significant association between the pre- and post-STAI results in VP (p = 0.025). The effects of both methods in decreasing anxiety were more significant for first-timers (p = 0.009 in RP/0.014 in VP). We noted high satisfaction levels for both forms of preparation. The VP technique was superior in reducing patient anxiety, especially in first-time MRI patients. Hence, VP techniques can be used in different clinical settings to reduce anxiety and facilitate patients' understanding of the instructions given.

The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis.

To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years. A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division. Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001). A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions. IV.

Regional skeletal muscle perfusion distribution in diabetic feet may differentiate short-term healed foot ulcers from non-healed ulcers.

The purpose of this study was to leverage a magnetic resonance imaging (MRI) approach to characterize foot perfusion distribution in patients with diabetes, with or without foot ulcers, and determine the ability of the regional perfusion measurements to identify ulcer-healing status. Three groups of participants (n = 15 / group) were recruited: controls (without diabetes), type II diabetes, and type II diabetes with foot ulcers. All participants underwent MRI evaluating foot perfusion in three muscle layers (from plantar to dorsal) at rest and during a standardized toe-flexion exercise. The exercise perfusion and perfusion reserve values were analyzed around and away from ulcers. Participants with foot ulcers were followed up 3months after the MRI exams to determine the foot healing status. Foot plantar muscle perfusion reserves were progressively lower from controls to diabetes, and to diabetes with foot ulcers (e.g., 2.58 ± 0.67, 1.48 ± 0.71, 1.12 ± 0.35, p < 0.001). In controls, the plantar layer had significantly higher perfusion reserve than the dorsal layer, whereas in either diabetes group, there was no significant difference in perfusion reserve among muscle layers. Using the ratio of total exercise perfusion around ulcers to that away from ulcers, the sensitivity and specificity to differentiate healing from non-healed ulcers were 100% and 86%, respectively. Our study reveals significantly different foot perfusion distribution among controls, diabetes, and diabetes with foot ulcers. The prognostic value of MRI regional perfusion assessments has the potential to monitor interventions to improve ulcer healing outcomes. • Contrast-free MRI permits quantitative assessment of regional foot muscle perfusion at rest and during isometric exercise. • Patients with diabetes and foot ulcers, without clinical evidence of peripheral arterial disease, had significantly impaired foot muscle perfusion and perfusion reserve. • Regional foot perfusion distribution may be used to predict the short-term healing status of foot ulcers in diabetes.

Diagnostic value of T2 and diffusion-weighted imaging (DWI) in local staging of endometrial cancer

BackgroundEndometrial cancer (EC) is the eighth most prevalent cancer globally. T2-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) help anatomical localization and local staging of lesions. The present study was performed to assess the diagnostic value of the simultaneous use of T2 and DWI techniques in EC evaluation. MethodsSeventy-eight histopathological-proven EC cases were included in this study. Patients were assessed using a complete MRI exam, including T2 and DWI. The myometrial invasion, cervical, serosal or adnexal, vaginal or parametrial, and pelvic lymph node involvements and accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated in each sequence distinctly and was compared with the pathology findings and full standard protocol using post-contrast multiphasic contrast-enhanced series. ResultsDeep myometrial invasion in EC cases was detected in 38.5% by T2-DWI and 37.2% by pathology. The pathology diagnosed cervical, serosal, and vaginal involvements and pelvic lymph node metastases in 20.5%, 7.7%, 6.4% and 11.5% of cases respectively, while the numbers for T2-DWI were 26.9%, 7.7%, 7.7%, and 15.4%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of T2-DWI in the diagnosis of myometrial invasion were 93.5%, 93.1%, 93.8%, 90%, and 93.8%, respectively. A slightly higher Kappa coefficient of DWI (0.973) in the diagnosis of myometrial invasion was identified compared to T2 (0.946). The T2-DWI technique had a 52.6% intraclass correlation coefficient in the diagnosis of IA stage. ConclusionThe simultaneous consideration of T2 and DWI technique may signify a noninvasive, rapid, safe, and accurate approach for precisely assessing myometrial invasion and EC staging. Elimination of intravenous contrast material result in prevention of contrast related side effects beside significant cost reduction for health care systems and patients with a comparable result to contrast enhanced MRI.

Magnetic resonance imaging detects onset and association with lung disease severity of bronchial artery dilatation in cystic fibrosis.

Bronchial artery dilatation (BAD) is associated with haemoptysis in advanced cystic fibrosis (CF) lung disease. Our aim was to evaluate BAD onset and its association with disease severity by magnetic resonance imaging (MRI). 188 CF patients (mean±sd age 13.8±10.6 years, range 1.1-55.2 years) underwent annual chest MRI (median three exams, range one to six exams), contributing a total of 485 MRI exams including perfusion MRI. Presence of BAD was evaluated by two radiologists in consensus. Disease severity was assessed using the validated MRI scoring system and spirometry (forced expiratory volume in 1 s (FEV1) % pred). MRI demonstrated BAD in 71 (37.8%) CF patients consistently from the first available exam and a further 10 (5.3%) patients first developed BAD during surveillance. Mean MRI global score in patients with BAD was 24.5±8.3 compared with 11.8±7.0 in patients without BAD (p<0.001) and FEV1 % pred was lower in patients with BAD compared with patients without BAD (60.8% versus 82.0%; p<0.001). BAD was more prevalent in patients with chronic Pseudomonas aeruginosa infection versus in patients without infection (63.6% versus 28.0%; p<0.001). In the 10 patients who newly developed BAD, the MRI global score increased from 15.1±7.8 before to 22.0±5.4 at first detection of BAD (p<0.05). Youden indices for the presence of BAD were 0.57 for age (cut-off 11.2 years), 0.65 for FEV1 % pred (cut-off 74.2%) and 0.62 for MRI global score (cut-off 15.5) (p<0.001). MRI detects BAD in patients with CF without radiation exposure. Onset of BAD is associated with increased MRI scores, worse lung function and chronic P. aeruginosa infection, and may serve as a marker of disease severity.