Magnetic Resonance Imaging MRI Research Articles

The utility of prostate MRI within active surveillance: description of the evidence

PurposeWe present an overview of the literature regarding the use of MRI in active surveillance of prostate cancer.MethodsBoth MEDLINE® and Cochrane Library were queried up to May 2020 for studies of men on active surveillance with MRI and later confirmatory biopsy. The terms studied were ‘prostate cancer’ as the anchor followed by two of the following: active surveillance, surveillance, active monitoring, MRI, NMR, magnetic resonance imaging, MRI, and multiparametric MRI. Studies were excluded if pathologic reclassification (GG1 → ≥ GG2) and PI-RADS or equivalent was not reported.ResultsWithin active surveillance, baseline MRI is effective for identifying clinically significant prostate cancer and thus associated with fewer reclassification events. A positive initial MRI (≥ PI-RADS 3) with GG1 identified at biopsy has a positive predictive value (PPV) of 35–40% for reclassification by 3 years. MRI possessed a stronger negative predictive value, with a negative MRI (≤ PI-RADS 2) yielding a negative predictive value of up to 85% at 3 years. Surveillance MRI, obtained after initial biopsy, yielded a PPV of 11–65% and NPV of 85–95% for reclassification.ConclusionMRI is useful for initial risk stratification of prostate cancer in men on active surveillance, especially if MRI is negative when imaging is obtained during surveillance. While useful, MRI cannot replace biopsy and further research is necessary to fully integrate MRI into active surveillance.

Acute Primary Epiphyseal Osteomyelitis of Proximal Tibia - A Case Report and Review of the Literature.

Introduction:Acute pyogenic epiphyseal osteomyelitis is a rare condition, mostly affecting children. This case report discusses the importance of clinical suspicion and the role of adjuncts in the diagnosis of these cases.Case Presentation:A 12-year-old female presented with pain in the right knee for 1 week and difficulty in walking for 4 days. Diagnosis was made with the help of magnetic resonance imaging MRI and guided biopsy. Pseudomonas aeruginosa was isolated from culture. She was treated with intravenous antibiotics with a good response.Discussion:Despite being a rarely reported entity, primary epiphyseal osteomyelitis should be kept as one of the differentials of the painful swollen knee in a child. Early diagnosis with the help of proper radiological investigations is the key to prevent the sequelae of this disease.

Structural and Functional Abnormalities in Knee Osteoarthritis Pain Revealed With Multimodal Magnetic Resonance Imaging.

The knee osteoarthritis (KOA) pain is the most common form of arthritis pain affecting millions of people worldwide. Long-term KOA pain causes motor impairment and affects affective and cognitive functions. However, little is known about the structural and functional abnormalities induced by long-term KOA pain. In this work, high-resolution structural magnetic resonance imaging (sMRI) and resting-state functional MRI (rs-fMRI) data were acquired in patients with KOA and age-, sex-matched healthy controls (HC). Gray matter volume (GMV) and fractional amplitude of low-frequency fluctuation (fALFF) were used to study the structural and functional abnormalities in patients with KOA. Compared with HC, patients with KOA showed reduced GMV in bilateral insula and bilateral hippocampus, and reduced fALFF in left cerebellum, precentral gyrus, and the right superior occipital gyrus. Patients with KOA also showed increased fALFF in left insula and bilateral hippocampus. In addition, the abnormal GMV in left insula and fALFF in left fusiform were closely correlated with the pain severity or disease duration. These results indicated that long KOA pain leads to brain structural and functional impairments in motor, visual, cognitive, and affective functions that related to brain areas. Our findings may facilitate to understand the neural basis of KOA pain and the future therapy to relieve disease symptoms.

Radiographic and clinical evaluation of single-level lateral interbody fusion in patients with severe stenosis analyzed using cluster analysis.

This study was a retrospective review of patients treated in a single institution. We performed a cluster analysis of the degree of preoperative stenosis to investigate the effect of indirect neural decompression in single-level lateral lumbar interbody fusion (LLIF). Surgery is generally indicated for patients with severe stenosis. On the other hand, severe lumbar spinal stenosis is a relative contraindication to LLIF and is excluded in most studies. If LLIF, which is less invasive to treatment, can be applied to severe stenosis patients, it may help treatment. Cluster analysis classified 80 patients into 3 groups based on preoperative central canal area (CCA), preoperative canal diameter (CD), and preoperative Schizas grade: group 1 with severe stenosis (n = 43); group 2 with moderate stenosis (n = 27); and group 3 with mild stenosis (n = 10). Preoperative and immediately postoperative CCA and CD in magnetic resonance imaging were compared between groups. Disc angle (DA) and anterior, posterior, and average disc heights (AvDH) (anterior disc height, posterior disc height, average disc height AvDH) were measured using standing lateral plain radiographs. For clinical analysis, a numeric rating scale was used to evaluate clinical outcomes. DA, anterior disc height, posterior disc height, and AvDH increased significantly after the operation in all groups, but the average changes in these factors did not differ. Mean midsagittal CD and axial CCA on MRI magnetic resonance imaging increased significantly in all groups, but as with DA and DH, the changes in axial CCA and midsagittal CD did not differ between groups. The numeric rating scale score did not differ between groups at any time. The cluster analysis results suggested that postoperative changes in indirect neural decompression for severe stenosis after LLIF similar for moderate and mild stenosis and that pain did not differ according to the severity of stenosis after surgery.

Pediatric cervical kyphosis in the MRI era (1984-2008) with long-term follow up: literature review.

Pediatric cervical kyphosis in the MRI era (1984-2008) with long-term follow up: literature review.

Role of multi-parametric MRI in the differentiation between mucinous breast carcinoma and fibroadenoma

BackgroundThe purpose of this study was to evaluate diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and functional MRI (diffusion and MR spectroscopy) using the latest MRI breast imaging reporting and data system (MRI-BIRADS) descriptors and non-BIRADS items for differentiation of mucinous breast carcinomas from fibroadenomas.MethodsWe included 19 cases of mucinous breast carcinoma and 37 cases of fibroadenoma. DCE-MRI, Diffusion-weighted MR imaging (DWI) and multi-voxel MR spectroscopy (MRS) were done, MRI-BIRADS (5th edition) analysis of the lesions was performed, and histopathological examination of all cases was done.ResultsAccording to univariate analysis, mucinous carcinoma was frequently detected in older age-group (COR = 1.4, 95% CI = 1.1–1.7 and p value < 0.001) and had more frequent irregular borders and non-circumscribed margins than fibroadenoma (COR = 11.6, 95% CI = 2–66.4 and p value = 0.002). All mucinous carcinoma had high T2 signal. Fibroadenomas had more frequent homogenous enhancement than mucinous carcinoma; none of the fibroadenomas had rim enhancement nor enhancing internal septations; mucinous carcinoma had more frequent rim enhancement and (n = 6, p value < 0.001) and enhancing internal septations (n = 7, p value < 0.001). Fibroadenoma had frequent dark non-enhancing internal septations than mucinous carcinoma (p value < 0.001). On multivariate analysis, mucinous carcinoma had significant combination of being common in older age, larger in size, with irregular shape, and non-circumscribed margins. On ADC map and MRS, mucinous carcinoma had higher ADC values and higher CHO.SNR than fibroadenoma. The mean ADC value of mucinous carcinoma was 1.3 ± 0.1 × 10−3mm2/s, which was significantly higher than that of fibroadenoma (1.1 ± 0.1 × 10−3mm2/s), with p = 0.002. Also, the mean CHO.SNR was significantly higher in mucinous carcinoma (3.1 ± 0.8) than fibroadenoma (0.8 ± 0.5) with p value < 0.001. According to our results, the presence of type 3 (washout curve), dark internal septations, non-circumscribed margins and irregular shape of the lesion showed the highest sensitivity and accuracy for differentiation of mucinous carcinomas and fibroadenomas (100, 78.6%), (89.4, 82%), (86.5, 80.3%) and (81, 71.4%), respectively.ConclusionThe combined use of DCE-MRI, DW-MRI and MRS with breast MRI-BIRADS descriptors and non-BIRADS items increases the diagnostic accuracy for differentiation of mucinous carcinomas from fibroadenomas.

Delays in diagnostic tests used to identify transthyretin amyloid cardiomyopathy (ATTR-CM) in the EU4 + UK

Abstract Background Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed, progressive disease characterised by amyloid protein deposits building in the left ventricle. The symptoms of ATTR-CM are like those associated with heart failure, and specialised tests are needed to identify ATTR-CM. Purpose This paper examines the tests used to identify ATTR-CM in France, Germany, Italy, Spain and United Kingdom and the time between these tests. Methods Ipsos' ATTR-CM Therapy Monitor was fielded between November 2020 and December 2020, with 210 (FR: 46, DE: 40, IT: 43, ES: 42, UK: 39) treating doctors providing data on 320 (FR: 71, DE: 63, IT: 64, ES: 63, UK: 59) patients diagnosed with ATTR-CM. Ipsos analysed information provided on the diagnostic tests ordered for the 320 patients to understand how ATTR-CM is diagnosed across the five markets, and also tracked the order in which the tests were conducted, across four batteries, to understand the flow of the diagnostic procedures. Results Overall, the patients in our study went through 6 diagnostic tests on average before receiving a confirmed ATTR-CM diagnosis via Echocardiogram (ECHO) with strain imaging (83%), Cardiac Magnetic Resonance Imaging MRI (75%), Genetic tests (69%), Laboratory tests (59%), Scintigraphy tests (52%), and Biopsy tests (51%) as the top tests ordered. Overall, 15% of the reported patients had an unknown order of tests. Patients in Germany, France and Italy received the most tests on average (FR: 6, DE: 7, IT: 6, ES: 5 and UK: 5). Patients in Germany also experienced the shortest delays between batteries of tests (3.2 wks. between 1st and 2nd batteries; 3.9 wks. between 2nd and 3rd batteries) and were most likely to receive a Genetic test (84%) or Biopsy test (68%) to confirm diagnosis. In comparison, patients in Spain experienced the longest testing delays (7.3 wks. between 1st and 2nd batteries; 5.8 wks. between 2nd and 3rd batteries) and went through only 5 diagnostic tests before receiving a confirmed diagnosis. Across the markets, 59% of doctors experienced a decline in ability to diagnose patients with ATTR-CM due to COVID-19, with the degree of impact differing drastically by region (FR: 43%, DE: 20%, IT: 79%, ES: 88% and UK: 64%). With doctors indicating that 16% of their patients were untreated due to late diagnosis with advanced disease (FR: 15%, DE: 10%, IT: 16%, ES: 20% and UK: 21%), identifying suspected ATTR-CM and running the necessary tests to diagnose ATTR-CM early are essential. Conclusion Overall, the patients reported on in this study received upwards of 6 diagnostic tests before confirmation of ATTR-CM, with 4.5 weeks between each battery of tests. In addition to regional nuances in regard to test choice, we see evidence that there are country level differences between how quickly patients receive diagnostic tests. Further research is needed to identify ways of increasing the speed of testing and subsequent diagnosis. Funding Acknowledgement Type of funding sources: None. Diagnostic Procedures by Region

Unexpected (123I)FP-CIT SPECT findings: SWIDD, SWEDD and all DAT.

Although the diagnosis of Parkinson's disease (PD) is essentially clinical, the implementation of imaging techniques can improve diagnostic accuracy. While some techniques (e.g. magnetic resonance imaging-MRI, computerized tomography-CT) are used to exclude secondary syndromes, presynaptic dopaminergic imaging including imaging of dopamine transporter (DAT)-can help the Neurologist in the differential diagnosis between neurodegenerative parkinsonian syndromes and parkinsonism without dopamine deficiency. DAT imaging can be useful in cases in which the clinical picture is not univocal, as in case of overlapping clinical features in patients with early disease, atypical syndromes or unsatisfying response to therapy. Currently, (123I)FP-CIT ([123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane) (trade name DaTSCAN) is the only agent approved by international regulatory agencies for this purpose. With the increasing use of this technique, some unexpected findings have been reported, including patients clinically diagnosed with PD with a normal SPECT scan [e.g. Scans Without Evidence of Dopaminergic Deficit (SWEDD)]; PD patients with a greater dopaminergic deficit in the striatum ipsilateral to the clinicallymore affected side [e.g. Scans With Ipsilateral Dopaminergic Deficit (SWIDD)]; as well as some artifacts. Moreover, the neurologist must remember that structural lesions and administration of some drugs might alter the result of DAT imaging. Unexpected findings, artifacts, and misinterpretation of imaging findings can lead to an erroneous diagnosis and inappropriate therapy, neglect of other medical conditions that might explain the clinical picture, and undermine the selection phase in clinical trials. The aim of the present review is to bring clarity on these controversial (and sometimes erroneous) results, in order to informof these possibilities the clinicians requesting a DaTSCAN in clinical practice.

The role of magnetic resonance imaging and magnetic resonance diffusion weighted image in preoperative staging of rectal cancer in comparison to postoperative histopathology

Background: With outstanding soft tissue contrast, functional imaging capabilities, and multiplanar capacity, high-resolution phased-array magnetic resonance imaging MRI is considered as a basic imaging modality for preoperative local staging of rectal cancer. And so MRI fills a void in clinical practice by allowing for precise local staging of rectal cancer prior to treatment decisions. The diffusion-weighted image used as enhancing utility for MRI in patients with rectal cancer. Objectives: The aim of work was to assess the role of MRI imaging including the (diffusion weighted imaging DWI and Apparent diffusion coefficient ADC map) in preoperative rectal cancer staging, in comparison to post-operative histopathology. Patients and methods: A total of 50 patients were included in the study, presented to South Valley University hospital and underwent MRI examination in MRI unit at South Valley University hospital. Results: Regarding the circumferential resection margin (CRM) infiltration, MRI diagnosed CRM involvement in 15 cases while rest 35 cases showing free CRM. From these positive cases only 13 were truly positive with histopathology, other two cases proved to be positive with histopathology not diagnosed by MRI. MRI showed MRF infiltration in only 18 cases. Histopathological assessment showed that MRF infiltration in only 15 cases and the rest 35 cases showing free MRF (agreement 83.3%). Conclusion: The results of this study demonstrate that preoperative MRI has a great value in achieving the best treatment strategy through accurate staging of rectal cancer, prediction of negative CRMs and involvement of the perirectal and pelvic LNs.

Brodie’s Abscess of the Proximal Humerus Metaphysis: A Case Report

Introduction:Primary subacute pyogenic osteomyelitis, or Brodie’s abscess was initially documented by Sir Benjamin Brodie in 1832. We present a case report with a 6-months follow-up period, demonstrating the successful diagnosis and surgical treatment of a focal lesion of the proximal metaphysis of the right humerus in a 21-years-old female. The pathology of hematologic osteomyelitis and its role in the development of a subacute abscess along with a review of literature and an in detail description of the pathogenesis of Brodie’s abscess is discussed and submitted.Case Presentation:A 21- years -old healthy female with a history of fall sustaining injury to the right shoulder one 1 year back followed by which she presented to the outpatient clinic with a swelling over her right shoulder. The patient was managed conservatively with analgesics and was relieved of pain over a course of one 1 week of medications, the patient now presents with pain and swelling in the right shoulder joint on and off since the episode of fall one 1 year back, which had increased over a period of past one 1 week. A week before the most recent presentation she started experiencing some discomfort and pain in her right shoulder. No recent trauma was reported. A mild swelling appeared over the proximal part of the humerus. There were no constitutional symptoms of fever or any illness reported. On examination, there was noted a painful restriction of ROM at the right shoulder joint with no rotator cuff injury. Laboratory investigations were suggestive of raised inflammatory markers. Radiograph of the right shoulder taken in the true antero-posterior view with the shoulder in the neutral rotation was suggestive of an oval lucency with surrounding sclerosis in the proximal metaphyseal region of the humerus. Magnetic resonance imaging MRI of the right shoulder joint showed features consistent with Brodie’s abscess in the proximal metaphyseal region of the humerus. Surgical debridement of the abscess was planned. The right shoulder of the patient was immobilized by a universal shoulder immobilizer for 3 days post -operatively and then Pphysiotherapy for shoulder range of movements was started. Infectious parameters decreased and there were no complications in the postoperative period. Regular follow follow-up for two 2 weeks showed clinical improvement. At 6 months follow- up, the patient had made full recovery with radiographic improvement.Conclusion :Brodie’s abscess was first described by Sir Benjamin Brodie in 1832. Primary hematogenous subacute osteomyelitis is rarely seen in the proximal metaphysis of the humerus. With appropriate surgical debridement and aggressive antibiotic cover, a near 100% success rate is observed in the treatment of Brodie’s abscess with no residual deformities in the affected bones or restrictions in the range of movements in the neighboring joints.

Canagliflozin could improve the levels of renal oxygenation in newly diagnosed type 2 diabetes patients with normal renal function

ObjectiveTo evaluate the effects of canagliflozin on the renal oxygen level and blood perfusion in newly diagnosed type 2 diabetes mellitus (T2DM) patients with normal renal function. MethodsWe conducted a prospective, randomised, and drug-controlled trial to determine the reno-protective effect exerted by canagliflozin in newly diagnosed T2DM patients with normal renal function using blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) and arterial spin labelling MRI (ASL-MRI). This provides an experimental basis for a first-line of defence for the prevention of diabetic nephropathy. ResultsCanagliflozin induced a significant decrease in body weight and diastolic blood pressure compared with glimepiride (all p < 0.05). The high baseline mean estimated glomerular filtration rate (eGFR) in both groups was indicative of a GFR level at a relatively high status that was significantly alleviated after 24 weeks of canagliflozin treatment (change from baseline, p = 0.04, and change versus glimepiride control, p = 0.048). However, neither drug regimen significantly affected renal blood perfusion. The R2* values were inversely proportional to the tissue oxygen content. Compared to the baseline, 24 weeks of canagliflozin treatment decreased the R2* values of the renal cortex and medulla by 22.3% (p = 0.005) and 29.2% (p = 0.0002) respectively, and these decreases were significantly greater than in the glimepiride control group (p = 0.0004 and p = 0.02). ConclusionsCanagliflozin improved the levels of renal oxygenation in newly diagnosed T2DM patients with normal renal function independent of changes in renal blood perfusion.

Pediatric Patient with Ischemic Stroke: Initial Approach and Early Management.

Acute Ischemic Stroke (AIS) in children is an acute neurologic emergency associated with significant morbidity and mortality. Although the incidence of AIS in pediatric patients is considerably lower than in adults, the overall cumulative negative impact of the quality of life could be even higher in children. The age-related variable clinical presentation could result in a delay in diagnosis and could negatively influence the overall outcome. The early management should be based on early recognition, acute transfer to pediatric AIS centre, standardised approach (ABCDE), early neurologic examination together with neuroimaging (preferable Magnetic Resonance Imaging—MRI). The treatment is based on supportive therapy (normoxemia, normocapnia, normotension and normoglycemia) in combination with intravenous/intraarterial thrombolytic therapy and/or mechanical thrombectomy in selected cases. Pediatric stroke centres, together with the implementation of local stroke management protocols, could further improve the outcome of pediatric patients with AIS.

Multiple vertebral fractures after suspension of denosumab. A series of 56 cases.

Denosumab is a monoclonal antibody approved for the treatment of postmenopausal osteoporosis. The withdrawal of denosumab produces an abrupt loss of bone mineral density and may cause multiple vertebral fractures (MVF). The objective of this study is to study the clinical, biochemical, and densitometric characteristics in a large series of postmenopausal women who suffered MVF after denosumab withdrawal. Likewise, we try to identify those factors related to the presence of a greater number of vertebral fractures (VF). Fifty-six patients (54 women) who suffered MVF after receiving denosumab at least for three consecutive years and abruptly suspended it. A clinical examination was carried out. Biochemical bone remodelling markers (BBRM) and bone densitometry at the lumbar spine and proximal femur were measured. VF were diagnosed by magnetic resonance imaging MRI, X-ray, or both at dorsal and lumbar spine. Fifty-six patients presented a total of 192 VF. 41 patients (73.2%) had not previously suffered VF. After discontinuation of the drug, a statistically significant increase in the BBRM was observed. In the multivariate analysis, only the time that denosumab was previously received was associated with the presence of a greater number of VF (P=.04). We present the series with the largest number of patients collected to date. 56 patients accumulated 192 new VF. After the suspension of denosumab and the production of MVF, there was an increase in the serum values of the BBRM. The time of denosumab use was the only parameter associated with a greater number of fractures.

Triple-negative breast cancer on contrast-enhanced MRI and synthetic MRI: A comparison with non-triple-negative breast carcinoma

PurposeThis study aimed to compare the characteristics of triple-negative breast cancer (TNBC) with non-TNBC on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and synthetic MRI. MethodThis retrospective study included 79 patients with histopathologically proven breast cancer (TNBC: 16, non-TNBC: 63) who underwent synthetic MRI. Using synthetic MR images, we obtained T1 and T2 relaxation times in breast lesions before (Pre-T1, Pre-T2, Pre-PD) and after (Gd-T1, Gd-T2, Gd-PD) contrast agent injection. Subsequently, we calculated the ΔT1 (Pre-T1 – Gd-T1), ΔT2 (Pre-T2 – Gd-T2), Pre-T1/T2, and Gd-T1/T2. We compared the aforementioned quantitative values, as well as several morphologic features between TNBCs and non-TNBCs that were identified on DCE-MRI. ResultsThe multivariate analyses revealed that the Pre-T2 (P = 0.037) and the presence of rim enhancement (P-RIM) (P = 0.034) were significant and independent predictors of TNBC. The area under the receiver operating characteristics curve for all breast cancers was greater when a combination of Pre-T2 and P-RIM (Pre-T2＋P-RIM; Method 3, AUC (area under the curve) = 0.858) was used to distinguish between TNBCs and non-TNBCs versus the use of either Pre-T2 alone (Method 1, AUC = 0.786) or P-RIM alone (Method 2, AUC = 0.747). ConclusionsPre-T2 obtained using synthetic MRI and P-RIM identified on DCE-MRI allowed the differentiation between TNBCs and non-TNBCs. However, these results are preliminary and need to be verified by further studies.

Deep Learning-Based Studies on Pediatric Brain Tumors Imaging: Narrative Review of Techniques and Challenges.

Brain tumors diagnosis in children is a scientific concern due to rapid anatomical, metabolic, and functional changes arising in the brain and non-specific or conflicting imaging results. Pediatric brain tumors diagnosis is typically centralized in clinical practice on the basis of diagnostic clues such as, child age, tumor location and incidence, clinical history, and imaging (Magnetic resonance imaging MRI / computed tomography CT) findings. The implementation of deep learning has rapidly propagated in almost every field in recent years, particularly in the medical images’ evaluation. This review would only address critical deep learning issues specific to pediatric brain tumor imaging research in view of the vast spectrum of other applications of deep learning. The purpose of this review paper is to include a detailed summary by first providing a succinct guide to the types of pediatric brain tumors and pediatric brain tumor imaging techniques. Then, we will present the research carried out by summarizing the scientific contributions to the field of pediatric brain tumor imaging processing and analysis. Finally, to establish open research issues and guidance for potential study in this emerging area, the medical and technical limitations of the deep learning-based approach were included.

Dynamic Functional Connectivity in the Main Clinical Phenotypes of Multiple Sclerosis.

Introduction: Dynamic functional connectivity (dFC) allows capturing recurring patterns (states) of interaction among functional networks. In this study, we investigated resting state (RS) dFC abnormalities across the different clinical phenotypes of multiple sclerosis (MS) and assessed their correlation with motor and cognitive performances. Methods: RS functional magnetic resonance imaging (fMRI) and 3D T1-weighted MRI data were acquired from 128 MS patients (69 relapsing-remitting [RR] MS, 34 secondary progressive [SP] MS, and 25 primary progressive [PP] MS) and 40 healthy controls (HC). RS fMRI data underwent independent component analysis and sliding-window correlations, to identify recurring dFC states and between-group dFC differences in the main networks. Results: dFC identified three recurring connectivity states: State 1 (frequency of appearance during fMRI acquisition = 57%, low dFC strength), State 2 (frequency = 19%, middle-high dFC strength), and State 3 (frequency = 24%, high sensorimotor and visual dFC strength). Compared to HC, MS (as a whole), RRMS, and PPMS patients exhibited lower State1/State 3 dFC (p = 0.0001, corrected) between sensorimotor, cerebellar, and cognitive networks, and some dFC increments (p = 0.001-0.05, uncorrected) in sensorimotor, visual, default-mode, and frontal/attention networks in States 2 and 3. Similar results were observed in SPMS versus RRMS patients. In MS, dFC decrease in sensorimotor, default-mode, and frontal/attention networks was correlated with worse motor and cognitive performances. Conclusions: MS patients exhibited overall lower dFC, and marginally higher dFC in sensorimotor/cognitive networks in the less-frequent middle/high-connected States. dFC abnormalities became more severe in progressive MS and correlated with motor and cognitive impairment, suggesting the presence of maladaptive mechanisms concomitant with accumulation of damage. Impact statement This is the first study exploring reorganization of dynamic functional connectivity in patients with multiple sclerosis (MS) across the main clinical phenotypes of the disease. Here, we demonstrated abnormalities of connectivity dynamism, which were present at all disease stages, but became more severe in progressive MS and correlated with worse motor and cognitive performances. These findings suggested that progressive MS patients might experience a maladaptive neuronal response to transient loss of dynamic coordination and flexibility among sensory and cognitive brain regions, leading to the progression of clinical impairment.

Evaluation of Management of Spondylodiscits in Patients Admitted to Neurosurgery Department of Benha University Hospitals

Background: spondylodiscitis is a spinal infection by a pathogen affecting primarily the intervertebral disc and the adjacent vertebral bodies, starting at the endplates, but with secondary involvement of the intervertebral discs. Patient and methods: this prospective, cross-sectional, observational study conducted in neurosurgery department at benha university hospitals from dec 2019 to april 2021. We included all patients with spondylodiscits without privilege to age or gender, and at any vertebral region, we applying a scoring system for spondylodiscitis, which we term spondt (spondylodiscitis diagnosis and treatment) based on three traits: [1] the inflammatory marker c-reactive protein (crp) (mg/dl), [2] pain according to a numeric rating scale (nrs) and [3] magnetic resonance imaging (mri), to monitor its progression following treatment. Result :from this study on 19 patient the mean range of age was 47 years , 78,9% was spontenous spondylodiscits and 21.1% was post surgical infection , applying spondt score of spondylodiscits on admission was 7 and on discharge was 3 , 36.8% have surgical treatment versus 63.2% have conservative treatment. The lenght of stay in hospital mean range was 4 weaks. Conclusion: although the frequency of spondylolithesis has increased significantly, its diagnosis can be missed due to non specific presentation. We recommended performing laboratory inflammatory markers and mri with contrast to patient with sever low back pain. Conservative treatment is usually sufficient in most cases surgery is reserved to case with neurological deficits due to evident spinal stenosis compression and cases with marked instability.

Methylene tetrahydrofolate reductase A1298C polymorphisms influence the adult sequelae of chemotherapy in childhood-leukemia survivors.

This retrospective correlation study investigated the putative link between methylene tetrahydrofolate reductase (MTHFR) A1298C mutations and chemotherapy-related brain function changes in adult childhood-leukemia survivors. To this end, we determined the relationship between the particular MTHFR1298 genotype (AA, AC or CC) of 31 adult childhood-leukemia survivors, and (1) their CSF Tau and phosphorylated Tau (pTau) levels at the time of treatment, (2) their adult performance intelligence quotient (PIQ), and (3) their regional brain connectivity using diffusion magnetic resonance imaging (dMRI) and resting-state functional MRI (rsfMRI). We confirmed that neuropathology markers Tau and pTau significantly increased in CSF of children after intrathecal methotrexate administration. Highest concentrations of these toxicity markers were found during the induction phase of the therapy. Moreover, CSF concentrations of Tau and pTau during treatment were influenced by the children's particular MTHFR1298 genotype. CSF Tau (but not pTau) levels significantly dropped after folinic acid supplementation. At adult age (on average 13.1 years since the end of their treatment), their particular MTHFR1298 genotype (AA, AC or CC) influenced the changes in PIQ and cortical connectivity that we found to be related to their childhood exposure to chemotherapeutics. In summary, we suggest that homozygous MTHFR1298CC individuals are more vulnerable to the adult sequelae of antifolate chemotherapy.

Impact Of Combined Lumbar Traction with Cervical Traction in Chronic Lumbar Disc Herniation

Traction Is Part Of The Evidence Based Manual Physical Therapy Management Due To Its Mechanical Nature. The Efficacy Of Lumbar Traction (Lt) Has Been Established, Lt As The Most Used Method Of Spinal Decompression Therapy (Sdt) Reduces The Intradiscal Pressure And Vertically Increases The Intervertebral Space And Restore Disc Height Allowing Nutrients And Oxygen Supply To The Disc. While Lt Had Recently Been Used As A Conservative Treatment For Chronic Lumbar Disc Herniation (Cldh), Combined Lumbar Traction With Cervical Traction (Cltct) As One Intervention Which Has Been Suggested By (Al-Qudah, M.K) Was Used As A Part Of Rehabilitative Program In Patients With Cldh. Therefore, The Effectiveness Of Cltct Separately At Any Other Interventions Remains Absolutely Unclear And Uncertain.&#x0D; Objective: The Aim Of The Presented Work Is To Identify The Effectiveness Of Cltct [(Positional Sustained Lumbar Traction (Pslt) Combined With Mechanical Sustained Cervical Traction (Msct) As One Intervention] On Patients With Moderate (L4-L5) (L5-S1) Cldh, And To Compare Cltct With Traditional Mechanical Lumbar Traction (Mlt).&#x0D; Methods: In This Study, Twelve Outdoor Male Patients Diagnosed With Magnetic Resonance Imaging (Mri), Had Accepted To Participate The Study. They Were Chosen From Al-Karak Governmental Hospital, From 20th Of December To 1st February 2021. Subjects Were Divided Randomly In To Two Groups, Experimental Group (N=6) Performed Cupping Massage (Cm), Cltct And Core Stabilization Exercise (Cse), While The Control Group (N=6) Performed Cm, Mlt And Cse. All Subjects Were Advised To Perform The Cse Three Times Daily As A Home Program In Addition To One Set During Each Session Under The Therapist Supervision. All Subjects Had Exposed (18) Sessions For (6) Weeks. The Results Were Analyzed Using The Spss System.&#x0D; Results: Indicates That There Was Statistically Significant Difference Between The Pre And Post Measurements In Both Groups In Favor Of The Post Measurements In Term Of Pain And Disability. Also Results Indicate That There Was Statistically Significant Difference Between The Groups In Favor Of Experimental Group.&#x0D; Conclusions: The Present Study Demonstrates That The Use Of Cltct Has A Positive Effect On Patients With Cldh More Than Mlt.&#x0D;

Multiparametric magnetic resonance imaging facilitates the selection of patients prior to fertility-sparing management of endometrial cancer.

To compare the diagnostic performance of biparametric magnetic resonance imaging (bpMRI) versus multiparametric MRI (mpMRI) for the staging of well-differentiated endometrioid endometrial cancer (EC) in potential candidates for fertility-sparing management. This multi-center retrospective study included 48 potential candidates for fertility-sparing management (age <46 years, grade 1 endometroid EC) who did not wish to undergo fertility-sparing management and thus underwent definitive surgery. Two readers (R1, R2) independently reviewed bpMRI (T1, T2, and diffusion-weighted imaging) and mpMRI (bpMRI and dynamic contrast-enhanced imaging, DCE) during two separate sessions spaced one month apart for the presence of myometrial invasion (MI), cervical stromal involvement (CSI), malignant adnexal disease (mAD), and pelvic lymphadenopathy (pLNM). Each reader also recorded maximum tumor diameter, tumor volume, and tumor-to-uterine volume ratio (TVR) on T2-weighted imaging. The diagnostic performance of bpMRI and mpMRI was determined for each reader with surgical pathology serving as a gold standard. The area under the receiver operating curve (AUC) for bpMRI versus mpMRI was 0.76/0.78 (R1/R2) versus 0.84/0.83 for MI, 0.79/0.76 versus 0.99/0.80 for CSI, 0.84/0.84 versus 0.84/0.80 for mAD, and 0.82/0.82 for pLMN. The sensitivity and specificity of MRI for detecting tumor spread beyond the endometrium were 71%/77% and 71%/65% for bpMRI (R1/R2) vs. 84%/90% and 71%/65% for mpMRI (R1/R2), respectively. The AUC of maximum tumor diameter, tumor volume, and TVR for MI was 0.71/0.61, 0.73/0.75, and 0.75/0.77 for R1/R2, respectively. MRI had moderate diagnostic performance across potential candidates for fertility-sparing treatment of EC. mpMRI outperformed bpMRI for detecting EC spreading beyond the endometrium.