Magnetic Resonance Imaging Group Research Articles

A Prospective Multicenter Comparison Study of Risk-adapted Ultrasound-directed and Magnetic Resonance Imaging–directed Diagnostic Pathways for Suspected Prostate Cancer in Biopsy-naïve Men

BackgroundEuropean Association of Urology guidelines recommend a risk-adjusted biopsy strategy for early detection of prostate cancer in biopsy-naïve men. It remains unclear which strategy is most effective. Therefore, we evaluated two risk assessment pathways commonly used in clinical practice. ObjectiveTo compare the diagnostic performance of a risk-based ultrasound (US)-directed pathway (Rotterdam Prostate Cancer Risk Calculator [RPCRC] #3; US volume assessment) and a magnetic resonance imaging (MRI)-directed pathway. Design, setting, and participantsThis was a prospective multicenter study (MR-PROPER) with 1:1 allocation among 21 centers (US arm in 11 centers, MRI arm in ten). Biopsy-naïve men with suspicion of prostate cancer (age ≥50 yr, prostate-specific antigen 3.0–50 ng/ml, ± abnormal digital rectal examination) were included. InterventionBiopsy-naïve men with elevated risk of prostate cancer, determined using RPCRC#3 in the US arm and Prostate Imaging Reporting and Data System scores of 3–5 in the MRI arm, underwent systematic biopsies (US arm) or targeted biopsies (MRI arm). Outcome measurements and statistical analysisThe primary outcome was the proportion of men with grade group (GG) ≥2 cancer. Secondary outcomes were the proportions of biopsies avoided and GG 1 cancers detected. Categorical (nonparametric) data were assessed using the Mann-Whitney U test and χ2 tests. Results and limitationsA total of 1965 men were included in the intention-to-treat population (US arm n = 950, MRI arm n = 1015). The US and MRI pathways detected GG ≥2 cancers equally well (235/950, 25% vs 239/1015, 24%; difference 1.2%, 95% confidence interval [CI] −2.6% to 5.0%; p = 0.5). The US pathway detected more GG 1 cancers than the MRI pathway (121/950, 13% vs 84/1015, 8.3%; difference 4.5%, 95% CI 1.8–7.2%; p < 0.01). The US pathway avoided fewer biopsies than the MRI pathway (403/950, 42% vs 559/1015, 55%; difference −13%, 95% CI −17% to −8.3%; p < 0.01). Among men with elevated risk, more GG ≥2 cancers were detected in the MRI group than in the US group (52% vs 43%; difference 9.2%, 95% CI 3.0–15%; p < 0.01). ConclusionsRisk-adapted US-directed and MRI-directed pathways detected GG ≥2 cancers equally well. The risk-adapted US-directed pathway performs well for prostate cancer diagnosis if prostate MRI capacity and expertise are not available. If prostate MRI availability is sufficient, risk assessment should preferably be performed using MRI, as this avoids more biopsies and detects fewer cases of GG 1 cancer. Patient summaryAmong men with suspected prostate cancer, relevant cancers were equally well detected by risk-based pathways using either ultrasound or magnetic resonance imaging (MRI) to guide biopsy of the prostate. If prostate MRI availability is sufficient, risk assessment should be performed with MRI to reduce unnecessary biopsies and detect fewer irrelevant cancers.

Comparative analysis of functional outcome for CT-based versus MRI-based evaluation in acute ischemic stroke prior to mechanical thrombectomy

BackgroundThis study aims to compare functional outcome for Computed tomography (CT)-based versus Magnetic resonance imaging (MRI)-based evaluation in acute ischemic stroke patients prior to Mechanical thrombectomy (MT) in less than 6-h window period in anterior circulation stroke. Participants were patients admitted from September 2, 2018 to September 2, 2020 with an acute ischemic stroke who underwent mechanical thrombectomy treatment. Total duration of MRI stroke protocol and CT scan with Computed tomography angiography (CTA) was 12 min 57 s, and 9 min 23 s, respectively. Follow-up for periodic Modified Rankin Scale (MRS) was performed at 3 months.ResultsNumber of patients included in the study were 152 with mean age of 54.6 (range 22–80) years with male predominance (n = 102). Mean GCS on admission was 12 (4–15) and 13(4–14) in CT and MRI group, respectively. National Institute of Health stroke scale (NIHSS) on admission was 17 (4–30) and 16(4–30) and at discharge was 7 (2–23) and 6(2–22) in CT-based group and MRI-based group, respectively. In the MRI group 65.5% had good outcome with mRS (0–2) at 3-month follow-up compared to 35.51% in CT group.ConclusionThe current standard neuroimaging in acute ischemic stroke patients is CT and CTA brain. Using MRI over CT scan for acute ischemic stroke may improve clinical outcomes for the subgroup of patients who have an unclear diagnosis and who have higher risk of complications with MT. Even though MRI and MRA take longer period to acquire, patient’s clinical outcome was better in MRI group in comparison to CT group and was comparable to that of the five major endovascular trials.

HP52 : Significance of electrodiagnostic study and magnetic resonance imaging findings in diagnostics of cervical and lumbosacral radiculopathy

Electrodiagnostic study (EMG/NCS) and magnetic resonance imaging (MRI) are both mainstay methods in diagnosing radiculopathy with a wide range of sensitivity documented. The aim of this study was to determine the significance of EMG/NCS and MRI and correlation between them in diagnosing radiculopathy. Materials and methods. 36 patients with clinical picture of cervical root (CR) and 35 patients with lumbosacral root (LR) damage was enrolled in a retrospective cohort study. MRI findings were divided into three groups: Grade 0- no changes in MRI; grade 1-initial degenerative changes without compression of nerve root; grade 2- evidence of nerve root compression. Electrodiagnosticaly proven root damage - reinnervation or deinervation with reinnervation process in at least two corresponding muscles on electromyography (EMG). Results. Multiple level unilateral and/or bilateral root damage was present in majority of patients. Totally 110 CR levels and 73 LR levels were analyzed. There were 30% (n=33) roots in CR group and 36,99% (n=27) in LR group, with grade 2 changes on MRI. In this group 72,72% (n=24) CR cases and 70,37% (n=20) LR cases had changes on EMG related to root damage. 40% (n=44) levels in CR group and 36,99% (n=27) in LR group, with grade 1 changes on MRI. In this grope 70,45% (n=31) CR cases had changes in EMG related to radiculopathy and 76,92% (n=20) in LP group. Conclusions. There is no significant difference in EMG/NCS sensitivity in both MRI groups, therefore we suggest performing EMG/NCS for root damage diagnostic in cases with minor alterations in MRI.

Comparison of magnetic resonance imaging versus computed tomography-based thrombolysis treatment in patients with acute ischemic stroke.

To evaluate the efficacy and safety of magnetic resonance imaging (MRI)-based comparing with computed tomography (CT)-based selection for intravenous thrombolysis in patients with acute ischemic stroke (AIS). Totally 462 consecutive AIS patients treated with intravenous thrombolysis within a 4.5h window from Jan. 2016 to Dec. 2019 were enrolled. The primary endpoint was the good functional outcome defined by a modified Rankin Scale (mRS) of 0-2 at 3months. Secondary outcomes include the excellent functional outcome defined by a mRS of 0-1 at 3months, occurrences of symptomatic intracranial hemorrhage (SICH), 7-day mortality, and 3-month mortality. Overall 172 patients received MRI and 290 received CT before they were treated with thrombolysis. The difference in the good or excellent functional outcome was not statistically significant between MRI and CT groups (both P > 0.05). The incidences of 7-day mortality (3.5% vs. 8.6%, P < 0.01), 30-day mortality (12.8% vs. 21.0%, P=0.03), and SICH (12.2% vs. 20.3%, P < 0.01) were obviously lower for MRI-based regimen compared with CT-based regimen. Multivariate logistic regression indicated that MRI-based regimen was significantly associated with a lower risk of 7-day mortality (OR=0.72, 95% CI: 0.53-0.91; P < 0.01), 30-day mortality (OR=0.58, 95% CI: 0.47-0.73; P < 0.01), and SICH (OR=0.44, 95% CI: 0.20-0.65; P < 0.01) after controlling for potential confounding factors. Despite MRI-based thrombolysis was not demonstrated to be associated with the good functional outcome, it significantly reduced risks of mortality and SICH in patients with AIS compared with CT-based thrombolysis.

Analysis of CT and MRI in the Diagnosis of Shoulder Joint Injury

Objective: To observe the effect of multi-slice spiral CT and magnetic resonance imaging (MRI) in the diagnosis of shoulder injury. Methods: 120 patients with shoulder injury who were treated in our hospital (January 2020 to December 2021) and underwent surgical treatment were diagnosed as shoulder injury. They were divided into CT group, MRI group and joint diagnosis group. The detection rates of the two methods were compared. Results: In the diagnosis of shoulder injury, MRI group was higher than CT group, and the joint diagnosis group was higher than the other two groups. Conclusion: In the diagnosis of shoulder injury, the joint examination of multi-slice spiral CT and magnetic resonance imaging (MRI) can obtain a higher diagnostic rate and ideal effect.

Experimental Investigation of the Secondary Changes in Imaging After Lumbar Disc Nucleoplasty in Rabbits.

To explore the changes in imaging after lumbar disc nucleoplasty in rabbits. Twenty-four rabbits were randomly selected for X-ray, computerized tomography (CT), and magnetic resonance imaging (MRI) at 2, 6, and 12 weeks post operation. Moreover, their L3/4, L4/5, and L5/6 intervertebral discs were randomly selected as the untreated, annulus puncture, and nucleoplasty groups, respectively. Changes in disc height index (DHI%) and MRI grade were measured and compared. CT three-dimensional reconstruction was used to evaluate adjacent bone endplate changes. The untreated group's DHI% decreased slightly at different time points (p > 0.05), while that of the nucleoplasty and annulus puncture groups decreased progressively (p < 0.05). At six weeks post operation, the nucleoplasty group's DHI% was significantly lower than that of the annulus puncture group (p < 0.05), with mild osteosclerosis and local rough changes in the endplate. At 12 weeks post operation, a "bone bridge" connection was observed in the nucleoplasty group. There was no significant difference in MRI grade between the untreated and annulus puncture groups at different time points (p > 0.05). MRI grades of the intervertebral disc in the nucleoplasty and annulus puncture groups showed a progressive increase (p < 0.05). Compared with the annulus puncture at the same time point, the nucleoplasty group's MRI grade of the intervertebral disc was significantly higher (p < 0.05). Thus, damage caused by an annulus puncture can lead to progressive degeneration of the lumbar disc. Nucleoplasty may have a cumulative effect with the injury of the annulus puncture. Clinicians need to comprehensively consider advantages and disadvantages of nucleoplasty, strictly grasp indications of treatment, and prevent longterm complications.

LONG-TERM SURVIVAL EFFECTS OF PREOPERATIVE BREAST MRI IN PATIENTS WITH BREAST-CONSERVING SURGERY.

The benefit of breast magnetic resonance imaging (MRI) in breast-conserving surgery (BCS) is unclear. Our study compared breast cancer patients with and without preoperative breast MRI and their long-term oncologic outcomes are reported. A total of 1378 BCS cases with early breast cancer between 1996 and 2017 were reviewed. Patients with carcinoma in situ or neoadjuvant treatment or having breast MRI after tumor excision were excluded. Of 1378 patients, 270 (19.5%) had preoperative MRI. There were no significant differences regarding T and N stage and molecular subtypes between the groups. Surgical margins were significantly wider in the breast MRI group. Five-year overall survival (OS) was 96.9% in the MRI group and 94.3% in the control group, and this difference was not significant (p=0.11). Five-year local-regional recurrence-free survival (LRFS) was not significantly different either (98.8% and 96.5%, respectively, p=0.41). When analyses were repeated only for patients with hormone receptor-negative or triple-negative breast cancer, there was still no significant difference in OS, LRFS, or disease-free survival. In conclusion, MRI does not seem necessary in all patients undergoing BCS. New prospective randomized controlled trials are needed to determine appropriate use of preoperative MRI and its effects on oncologic outcomes in early breast cancer patients.

Prostate Cancer Patients Under Active Surveillance with a Suspicious Magnetic Resonance Imaging Finding Are at Increased Risk of Needing Treatment: Results of the Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium

BackgroundThe inclusion criterion for active surveillance (AS) is low- or intermediate-risk prostate cancer. The predictive value of the presence of a suspicious lesion at magnetic resonance imaging (MRI) at the time of inclusion is insufficiently known. ObjectiveTo evaluate the percentage of patients needing active treatment stratified by the presence or absence of a suspicious lesion at baseline MRI. Design, setting, and participantsA retrospective analysis of the data from the multicentric AS GAP3 Consortium database was conducted. The inclusion criteria were men with grade group (GG) 1 or GG 2 prostate cancer combined with prostate-specific antigen <20 ng/ml. We selected a subgroup of patients who had MRI at baseline and for whom MRI results and targeted biopsies were used for AS eligibility. Suspicious MRI was defined as an MRI lesion with Prostate Imaging Reporting and Data System (PI-RADS)/Likert ≥3 and for which targeted biopsies did not exclude the patient for AS. Outcome measurements and statistical analysisThe primary outcome was treatment free survival (FS). The secondary outcomes were histological GG progression FS and continuation of AS (discontinuation FS). Results and limitationsThe study cohort included 2119 patients (1035 men with nonsuspicious MRI and 1084 with suspicious MRI) with a median follow-up of 23 (12–43) mo. For the whole cohort, 3-yr treatment FS was 71% (95% confidence interval [CI]: 69–74). For nonsuspicious MRI and suspicious MRI groups, 3-yr treatment FS rates were, respectively, 80% (95% CI: 77–83) and 63% (95% CI: 59–66). Active treatment (hazard ratio [HR] = 2.0, p < 0.001), grade progression (HR = 1.9, p < 0.001), and discontinuation of AS (HR = 1.7, p < 0.001) were significantly higher in the suspicious MRI group than in the nonsuspicious MRI group. ConclusionsThe risks of switching to treatment, histological progression, and AS discontinuation are higher in cases of suspicious MRI at inclusion. Patient summaryAmong men with low- or intermediate-risk prostate cancer who choose active surveillance, those with suspicious magnetic resonance imaging (MRI) at the time of inclusion in active surveillance are more likely to show switch to treatment than men with nonsuspicious MRI.

Diagnostic Value Comparison between Multislice Spiral Computerized Tomography and Magnetic Resonance Imaging under Artificial Intelligence Algorithm in Diagnosing Occult Fractures of the Knee Joint.

The aim of this study was to explore the application value of multislice spiral computerized tomography (MSCT) and magnetic resonance imaging (MRI) under intelligent algorithm in the diagnosis of occult fractures of the knee joint (OFKJ). 47 patients with negative X-ray examination and suspected fracture were included for this research. According to the examination methods, the patients were divided into the MSCT group and MRI group. The diagnostic results of the two methods were compared, and then compared with the traditional algorithm to explore their superiorities. The results demonstrated that the algorithm applied in this study had a clearer segmentation than traditional algorithms, and it run significantly faster than other algorithms. The results of MSCT, MRI, and pathological examination were all different, but which was of no statistical significance, P > 0.05. The specificity, accuracy, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of MSCT were 83%, 96%, 94%, and 98%, respectively; and its coincidence rate, missed diagnosis rate, and misdiagnosis rate were 98.20%, 1.60%, and 0.20%, respectively. Compared with MRI, the differences were significant statistically, P < 0.05. The segmentation effect of MSCT was closer to the standard segmentation, with the higher efficiency. MSCT under the intelligent algorithm produced the better diagnostic performance and the higher detection rate than MRI in diagnosing OFKJ. It could be used for clinical auxiliary diagnosis and evaluation of OFKJ, deserving an application value.

Value of diffusion-weighted imaging in preoperative evaluation and prediction of postoperative supplementary therapy for patients with cervical cancer.

BackgroundWith the continuous progress of medical imaging technology, evaluation of cervical cancer is increasingly dependent on imaging methods. Diffusion-weighted imaging (DWI) plays an important role, and apparent diffusion coefficient (ADC) value is a unique quantitative parameter in the research of cervical cancer.MethodsIn this prospective study, a total of 273 patients diagnosed with stage IB1 to IIIC1 cervical cancer based on the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging guidelines who underwent pelvic 3.0T magnetic resonance imaging (MRI), including MRI and DWI, were enrolled, and the diagnostic value of preoperative staging of cervical cancer was compared between the MRI and DWI groups. The DWI group was used to explore the potential association of mean ADC (ADCmean) with different pathological characteristics and receiver operating characteristic (ROC) curves of ADCmean generated to predict the appropriate postoperative supplementary therapy.ResultsThe diagnostic coincidence rate of DWI was higher than that of MRI in preoperative staging of cervical cancer (χ2, P<0.05) and determined as stages IB1 + IB2 + IIA1 (90.91%), IB3 + IIA2 (93.48%), and IIIC1p (95.16%). The DWI staging results were consistent with postoperative pathological staging (Kappa value =0.865, P<0.001). We observed significant differences in ADCmean values in relation to pathological type, histological grade, depth of stromal infiltration, tumor diameter, lymphovascular invasion, and pelvic lymph node metastasis of cervical cancer (all P<0.05). The area under the ROC curve (AUC) was 0.815, with the best predictive value for postoperative supplementary therapy in cervical cancer (sensitivity 80.0%, specificity 74.0%) at ADCmean of 0.910×10−3 mm2/s.ConclusionsThe DWI is a useful tool for preoperative evaluation of cervical cancer. In local cervical lesions, ADCmean varies in relation to different clinicopathological characteristics and a reference index of <0.910×10−3 mm2/s can be effectively applied to predict the need for postoperative supplementary therapy.

Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion

Advanced imaging for patient selection in mechanical thrombectomy is not widely available. To compare the clinical outcomes of patients selected for mechanical thrombectomy by noncontrast computed tomography (CT) vs those selected by computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) in the extended time window. This multinational cohort study included consecutive patients with proximal anterior circulation occlusion stroke presenting within 6 to 24 hours of time last seen well from January 2014 to December 2020. This study was conducted at 15 sites across 5 countries in Europe and North America. The duration of follow-up was 90 days from stroke onset. Computed tomography with Alberta Stroke Program Early CT Score, CTP, or MRI. The primary end point was the distribution of modified Rankin Scale (mRS) scores at 90 days (ordinal shift). Secondary outcomes included the rates of 90-day functional independence (mRS scores of 0-2), symptomatic intracranial hemorrhage, and 90-day mortality. Of 2304 patients screened for eligibility, 1604 patients were included, with a median (IQR) age of 70 (59-80) years; 848 (52.9%) were women. A total of 534 patients were selected to undergo mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI. After adjustment of confounders, there was no difference in 90-day ordinal mRS shift between patients selected by CT vs CTP (adjusted odds ratio [aOR], 0.95 [95% CI, 0.77-1.17]; P = .64) or CT vs MRI (aOR, 0.95 [95% CI, 0.8-1.13]; P = .55). The rates of 90-day functional independence (mRS scores 0-2 vs 3-6) were similar between patients selected by CT vs CTP (aOR, 0.90 [95% CI, 0.7-1.16]; P = .42) but lower in patients selected by MRI than CT (aOR, 0.79 [95% CI, 0.64-0.98]; P = .03). Successful reperfusion was more common in the CT and CTP groups compared with the MRI group (474 [88.9%] and 670 [89.5%] vs 250 [78.9%]; P < .001). No significant differences in symptomatic intracranial hemorrhage (CT, 42 [8.1%]; CTP, 43 [5.8%]; MRI, 15 [4.7%]; P = .11) or 90-day mortality (CT, 125 [23.4%]; CTP, 159 [21.1%]; MRI, 62 [19.5%]; P = .38) were observed. In patients undergoing proximal anterior circulation mechanical thrombectomy in the extended time window, there were no significant differences in the clinical outcomes of patients selected with noncontrast CT compared with those selected with CTP or MRI. These findings have the potential to widen the indication for treating patients in the extended window using a simpler and more widespread noncontrast CT-only paradigm.

58 Relationship Between Early Laboratory Measures and Neurological Injury in Neonates Undergoing Therapeutic Hypothermia

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Hypoxic-ischemic encephalopathy (HIE) is a major contributor to morbidity and mortality. Therapeutic hypothermia (TH) is the standard of care for neonates with moderate to severe HIE. Brain magnetic resonance imaging (MRI) is the imaging modality of choice for confirmation of HIE, assessment of injury severity, and prognostication. Reliable, inexpensive and widely available laboratory measures for early identification of risk for neurological injury can play a critical role in the optimal management of neonatal HIE, especially in the resource-limited setting. Our study examined whether derangements in early routine laboratory measures (acid-base, haematological, metabolic) were worse in neonates with MRI findings of neurological injury. Objectives Primary objective: To evaluate the role of early laboratory measures in predicting neurological injury as detected by MRI at 72 hours. Secondary objective: To evaluate the role of early laboratory measures in predicting survival to NICU discharge in patients with HIE. Design/Methods This single-centre, retrospective cohort study included neonates ≥ 35 weeks gestation with moderate to severe HIE, who had undergone therapeutic hypothermia. Based on findings of brain MRI completed within 72 hours of life, our cohort was divided into 2 groups: neonates with, and without, evidence of neurological injury consistent with HIE. Baseline characteristics, as well as laboratory measures, were compared between groups, and a receiver operating characteristic (ROC) curve analysis was conducted to determine the cut-off for prediction of neurological injury based on the highest sensitivity and specificity values. Results 104 neonates were analyzed. Baseline characteristics (Table 1) were similar between both groups, except for cord venous pH and base excess (BE), which were significantly lower in the abnormal MRI group (p = 0.02). In bivariate analysis, pH (at 1 h of age, p = 0.027), BE (at 1 h, p = 0.001, and 6 h of age, p = 0.004), ionized calcium (at 6 h of age, p = 0.02), and platelets (at 1 h of age, p = 0.004) were significantly different in neonates with abnormal MRI. In ROC curve analysis, BE at 1 h of life was the best predictor of abnormal MRI (AUC = 0.71, p = 0.002), with a cut-off value of ≤ -14.95, sensitivity of 67% and specificity of 66% (Figure 1). Conclusion Among neonates with HIE undergoing TH, early laboratory measures such as acid-base status, ionized calcium, and platelet count were worse in neonates with abnormal MRI, in comparison to neonates with normal MRI. Base excess at 1 h of life is a good predictor of abnormal MRI. Future prospective studies to validate these findings are needed

Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis\xa0(MIPA)

ObjectivesPreoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue.MethodsThis observational study enrolled women aged 18–80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases.ResultsOf 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001).ConclusionsClinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup.Key Points• In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes.• The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate.• Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.

Use of Magnetic Resonance Imaging in Acute Traumatic Brain Injury Patients is Associated with Lower Inpatient Mortality.

Objectives:While magnetic resonance imaging (MRI) has higher sensitivity than computed tomography for certain types of traumatic brain injury (TBI), it remains unknown whether the increased detection of intracranial injuries leads to improved clinical outcomes in acute TBI patients, especially given the resource requirements involved in performing MRI. We leveraged a large national patient database to examine associations between brain MRI utilization and inpatient clinical outcomes in hospitalized TBI patients.Material and Methods:The National Inpatient Sample database was queried to find 3,075 and 340,090 hospitalized TBI patients with and without brain MRI, respectively, between 2012 and 2014 in the United States. Multivariate regression analysis was performed to independently evaluate the association between brain MRI utilization and inpatient mortality rate, complications, and resource requirements.Results:The MRI group had a lower unadjusted mortality rate of 0.75% compared to 2.54% in the non-MRI group. On multivariate regression analysis, inpatient brain MRI was independently associated with lower mortality (adjusted OR 0.32, 95% CI 0.12–0.86), as well as higher rates of intracranial hemorrhage (adjusted OR 2.20, 95% CI 1.27–3.81) and non-home discharge (adjusted OR 1.33, 95% CI 1.07–1.67). Brain MRI was independently associated with 3.4 days (P < 0.001) and $8,934 (P < 0.001) increase in the total length and cost of hospital stay, respectively.Conclusion:We present the first evidence that inpatient brain MRI in TBI patients is associated with lower inpatient mortality, but with increased hospital resource utilization and likelihood of non-home discharge.

Necessity of Immediate MRI Imaging in the Acute Care of Severely Injured Patients.

Background and Objectives: The standard diagnostic procedure for a patient with a suspected polytrauma injury is computed tomography (CT). In individual cases, however, extended acute imaging using magnetic resonance imaging (MRI) can provide valuable and therapy-relevant information. The aim of our cohort study was to find such cases and to describe their characteristics in order to be able to give possible recommendations for MRI application in acute trauma situations. Materials and Methods: In the study period from 2015–2019, an evaluation of the imaging performed on polytrauma patients was carried out. The specific diagnostic and therapeutic criteria of the MRI group were further defined. Results: In total, 580 patients with an ISS ≥16 (injury severity score) were included in the study. Of these 580 patients, 568 patients received a CT scan and 12 patients an MRI scan as part of the initial diagnostic. Altogether, 66.67% of the MRIs took place outside of regular service hours. The main findings for MRI indications were neurological abnormalities with a focus on myelon injuries. Further MRI examinations were performed to rule out vascular injuries. All in all, 58.3% of the MRIs performed resulted in modified therapeutic strategies afterward. Conclusions: MRI in the context of acute diagnostic of a severely injured patient will likely remain reserved for special indications in the future. However, maximum care hospitals with a high flow of severely injured patients should provide 24/7 MR imaging to ensure the best possible care, especially in neurological and blunt vascular injuries.

A Useful MRI Classification for Symptomatic Discoid Lateral Meniscus

PurposeThe purpose of this study is to classify the discoid lateral meniscus (DLM) according to the signal and shape in magnetic resonance imaging (MRI), and to provide information not only in diagnosis but also in treatment.Materials and MethodsWe reviewed 162 cases who diagnosed with DLM by MRI and underwent arthroscopic procedures from April 2010 to March 2018. Three observers reviewed MRI findings of all cases and predicted arthroscopic tear using three MRI criteria (criterion 1,2 and 3). Among three criteria, the criterion that most accurately predicts arthroscopic tear was selected. Using this criterion, the cases of predicted tear were named group 1. In addition, group 1 was divided into three subgroups (group 1a, 1b and 1c) by deformation or displacement on MRI and arthroscopic type of tear and procedures were analyzed according to these subgroups.ResultsThe intra-meniscal signal change itself (criterion 3) on MRI showed the highest agreement with the arthroscopic tear. No meniscal deformation and displacement on MRI (group 1a) showed no specific type of tear and more cases of meniscal saucerization. The meniscal deformation on MRI (group 1b) showed more simple horizontal tears and more cases of meniscal saucerization. The meniscal displacement on MRI (group 1c) showed more peripheral tears and more cases of meniscal repair and subtotal meniscectomy. Comparing arthroscopic type of tear and type of arthroscopic procedure between three subgroups, there were significant differences in three groups (P < .05).ConclusionsIntra-meniscal signal change itself on MRI is the most accurate finding to predict arthroscopic tear in symptomatic DLM. In addition, subgroup analysis by deformation or displacement on MRI is helpful to predict the type of arthroscopic tear and procedures.

Low-Rank Matrix Denoising Algorithm-Based Magnetic Resonance Imaging Combined with Computed Tomography Images in the Diagnosis of Cerebral Aneurysm

This study was to analyze the diagnostic effects of computed tomography (CT) and magnetic resonance imaging (MRI) in patients with cerebrovascular diseases (CVDs) based on low-rank matrix denoising (LRMD) algorithm. The LRMD algorithm was adopted for MRI diagnosis and CT diagnosis for comparative analysis. 129 CVD patients were selected as the research objects, 43 cases were diagnosed by CT, 43 cases were diagnosed by MRI under LRMD, and the other 43 cases were diagnosed by CT + MRI. The results showed that the diagnostic compliance rates (DCRs) of CT group in the cerebral hemorrhage (CH), cerebral infarction (CI), and cerebral aneurysm (CA) were 95.1%, 94.7%, and 70%, respectively, while those in the MRI group were 99.01%, 97.71%, and 100%, respectively. Thus, it was obtained that MRI diagnosis was much better than CT diagnosis, and CT + MRI showed the best diagnosis efficacy, showing statistical differences ( P &lt; 0.05 ). The accuracy, sensitivity, and specificity of MRI diagnosis under the LRMD algorithm were 96.28%, 88.76%, and 90.62%, respectively, which were superior to those of CT diagnosis (92.71%, 84.94%, and 80.71%, respectively). The diagnosis cost per case (DC/C) (799.73 ± 100.02 yuan) and the total diagnosis cost (TDC) (58,521.67 ± 301.62 yuan) in the MRI group were higher than those in the CT group (601.42 ± 83.61 yuan and 39,819.2 ± 198.72, respectively) ( P &lt; 0.05 ). In conclusion, CT + MRI under the LRMD algorithm showed good potential in diagnosis of CVD; MRI based on the LRMD algorithm showed a higher positive rate in the diagnosis of CA and was better than CT diagnosis, and CT + MRI showed the best diagnosis effect and could improve the clinical diagnosis rate.

Deep Learning-Based Magnetic Resonance Imaging Image Features for Diagnosis of Anterior Cruciate Ligament Injury.

To study and explore the adoption value of magnetic resonance imaging (MRI) in the diagnosis of anterior cruciate ligament (ACL) injuries, a multimodal feature fusion model based on deep learning was proposed for MRI diagnosis. After the related performance of the proposed algorithm was evaluated, it was utilized in the diagnosis of knee joint injuries. Thirty patients with knee joint injuries who came to our hospital for treatment were selected, and all patients were diagnosed with MRI based on deep learning multimodal feature fusion model (MRI group) and arthroscopy (arthroscopy group). The results showed that deep learning-based MRI sagittal plane detection had a great advantage and a high accuracy of 96.28% in the prediction task of ACL tearing. The sensitivity, specificity, and accuracy of MRI in the diagnosis of ACL injury was 96.78%, 90.62%, and 92.17%, respectively, and there was no considerable difference in contrast to the results obtained through arthroscopy (P > 0.05). The positive rate of acute ACL patients with bone contusion and medial collateral ligament injury was substantially superior to that of chronic injury. Moreover, the incidence of chronic injury ACL injury with meniscus tear and cartilage injury was notably higher than that of acute injury, with remarkable differences (P < 0.05). In summary, MRI images based on deep learning improved the sensitivity, specificity, and accuracy of ACL injury diagnosis and can accurately determined the type of ACL injury. In addition, it can provide reference information for clinical treatment plan selection and surgery and can be applied and promoted in clinical diagnosis.

Electroencephalogram versus Magnetic Resonance Imaging Brain as the Initial Investigation of Choice in Neurologically Normal Children with First Afebrile Seizure in India.

Background and PurposeTo compare the rates of clinically relevant information provided by electroencephalogram (EEG) and magnetic resonance imaging (MRI) brain in first afebrile seizure (FAS) in children.MethodsIn this prospective randomized controlled trial, neurologically normal children between the age of 2 and 14 years, presenting with first episode of unprovoked, afebrile generalized or partial seizures, were included. Enrolled patients were randomized into two groups. After stabilization, initial workup and management, group I-patients underwent an EEG followed by MRI, whereas group II-patients underwent an initial MRI brain followed by an EEG. The patients were followed up after results of both the investigations and then every 3 months for seizure recurrence. The primary outcome was the proportion of investigations, providing clinically relevant information. The secondary outcomes were to determine the etiological diagnosis of FAS and record adverse events associated with EEG and MRI.ResultsOut of 170 enrolled patients, 52 patients (61.2%) in initial EEG group and 53 patients (70.6%) in initial MRI group had abnormal results on first investigation. An etiological diagnosis could not be made in any patient in initial EEG group. Neuroimaging revealed an etiological diagnosis in 53 patients (70.6%) in initial MRI group. Inflammatory granuloma was found to be the most common cause of FAS, followed by idiopathic epilepsy.ConclusionsThe results of our study done in neurologically normal children with FAS showed a high diagnostic yield with an initial MRI. We recommend MRI brain to be considered as the initial investigation for evaluation of FAS in children.

Prediction of Pathologic Complete Response in Breast Cancer Patients Comparing Magnetic Resonance Imaging with Ultrasound in Neoadjuvant Setting.

Some subgroups of breast cancer patients receiving neoadjuvant chemotherapy (NACT) show high rates of pathologic complete response (pCR) in the breast, proposing the possibility of omitting surgery. Prediction of pCR is dependent on accurate imaging methods. This study investigated whether magnetic resonance imaging (MRI) is better than ultrasound (US) in predicting pCR in breast cancer patients receiving NACT. This institutional, retrospective study enrolled breast cancer patients receiving NACT who were examined by either MRI or combined US and mammography before surgery from 2016 to 2019. Imaging findings were compared with pathologic response evaluation of the tumor. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for prediction of pCR were calculated and compared between MRI and US. Among 307 patients, 151 were examined by MRI and 156 by US. In the MRI group, 37 patients (24.5 %) had a pCR compared with 51 patients (32.7 %) in the US group. Radiologic complete response (rCR) was found in 35 patients (23.2 %) in the MRI group and 26 patients (16.7 %) in the US group. In the MRI and US groups, estimates were calculated respectively for sensitivity (87.7 % vs 91.4 %), specificity (56.8 % vs 33.3 %), PPV (86.2 % vs 73.8 %), NPV (60.0 % vs 65.4 %), and accuracy (80.1 % vs 72.4 %). In predicting pCR, MRI was more specific than US, but not sufficiently specific enough to be a valid predictor of pCR for omission of surgery. As an imaging method, MRI should be preferred when future studies investigating prediction of pCR in NACT patients are planned.