Magnetic Resonance Imaging Results Research Articles

Validation of 3- and 5-point severity scales to assess ARIA-E.

Anti-amyloid-β (Aβ) monoclonal antibodies (mAbs) offer the promise of disease modification and are emerging treatment options in Alzheimer's disease. Anti-Aβ mAbs require brain magnetic resonance imaging (MRI) examinations to detect anti-amyloid-induced amyloid-related imaging abnormalities (ARIA), important adverse drug reactions associated with some anti-Aβ mAbs currently available in the United States and in clinical development. We present a simple rating system for ARIA-edema (ARIA-E) that can assess severity on a 3- or 5-point scale based upon a single linear measurement of the largest area of lesion, and dissemination in space, termed the 3-point Severity Scale of ARIA-E (SSAE-3) and the 5-point Severity Scale of ARIA-E (SSAE-5), respectively. MRI results were collected from 75 participants from the SCarlet RoAD (NCT01224106) and Marguerite RoAD (NCT02051608) studies of gantenerumab. Three neuroradiologists experienced with the detection of ARIA-E were selected to read all cases independently. One rater was then chosen for a second read to assess intra-reader reproducibility. The three raters had high agreement in identifying and grading ARIA-E. The Cohen/Fleiss kappa (κ) scores (95% confidence interval [CI]) for the inter- and intra-reader comparisons for SSAE-3 and SSAE-5 were 0.79 (0.70-1.00), 0.94 (0.94-1.00), 0.73 (0.66-1.00), and 0.90 (0.90-1.00), respectively. Our study suggests that SSAE-3 and SSAE-5 are valid ARIA-E rating scales for use in routine clinical practice by experienced radiologists in specialized settings. The application of these scales in everyday use in clinical practice will support the expansion of anti-Aβ mAbs as a treatment option for people living with Alzheimer's disease. A simple rating scale is needed to rate severity of amyloid-related imaging abnormalities-edema (ARIA-E) in both research and clinical settings.The 3- and 5-point Severity Scales of ARIA-E (SSAE-3/-5) have good inter- and intra-reader agreement.The SSAE-3/-5 have been used in most major Alzheimer's disease (AD) trials to date and are suitable for large-scale use in routine clinical practice, which may help support the expansion of anti-amyloid antibodies as treatment options for AD.

Application of double-layer detector spectral CT calcicum supression technique in the diagnosis of traumatic bone marrow edema in the knee

ObjectiveTo investigate the accuracy of calcicum supression (CaSupp) technique derived from double-layer detector spectral computed tomography (DSCT) in the diagnosis of traumatic bone marrow edema in the knee. MethodsTwenty-three patients with trauma in the knee who underwent DSCT and Magnetic Resonance Imaging (MRI) in the Third Hospital of Hebei Medical University from October 2021 to March 2022 were retrospectively collected. To make the evaluation more detailed and accurate, each knee was divided into 10 partitions. Bone marrow edema in each partition of the knee was evaluated by two physicians (physician A and B) using CaSupp images combined with conventional CT-CaSupp fusion false-color images. MRI results were used as the gold standard and the accuracy of the CaSupp technique was analyzed in the diagnosis of traumatic bone marrow edema in the knee. The CaSuppCT values of the normal bone marrow area and the bone marrow edema area were delineated, and receiver operating curve (ROC curve) was drawn to find the optimal cut-off value of CaSuppCT as the quantitative parameter for the diagnosis of bone marrow edema. ResultsThe diagnostic sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of physician A were 83.1 %, 98.1 %, 95.5 % and 92.1 %, respectively; those of physician B were 93.5 %, 97.4 %, 94.7 % and 96.8 %, respectively. The CaSuppCT values in the bone marrow edema areas were higher than those in the normal areas, and the difference was statistically significant. The area under the receiver operating characteristic curve (AUC) of the CaSuppCT values was 0.979, and the cut-off value was 7.05Hu*. The corresponding diagnostic sensitivity was 87.0 %, and specificity was 100.0 %. ConclusionThe CaSupp technique derived from DSCT has high sensitivity and specificity in the detection of traumatic bone marrow edema in the knee, and can provide more imaging information for clinical practice.

Comparison of contrast-enhanced ultrasonography and MRI results obtained by expert and novice radiologists indicating short-term response after transarterial chemoembolisation for hepatocellular carcinoma

To evaluate inter-reader agreement between novice and expert radiologists in assessing contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) images for detecting viable tumours with different sizes after conventional transarterial chemoembolisation (cTACE). This prospective study included patients who had less than five hepatomas and who underwent cTACE. Hepatomas with one or two feeding arteries were selected as target lesions. CEUS and MRI were performed within 1 week after cTACE to evaluate viable tumours. The expert group had higher kappa values in evaluating all tumour sizes via CEUS compared with MRI. The novice group had similar kappa values. In patients with tumours measuring ≤3 cm, the expert group had higher kappa values in reading CEUS compared with MRI images; however, in the novice group, the kappa value was lower in evaluating CEUS compared with MRI images. In patients with tumours measuring >3 cm, the expert and novice groups had good to excellent kappa values. The confidence level of the two groups in reading MRI images was high; however, the novice group had a lower confidence level. CEUS is a convenient, cost-effective, and easy to apply imaging tool that can help interventionists perform early detection of viable hepatocellular carcinoma post-TACE. It has a higher inter-rater agreement in interpreting CEUS images compared with MRI images among expert radiologists even when they are extremely familiar with post-cTACE MRI images. In novice radiologists, there may be a learning curve to achieve good consistency in CEUS interpretation.

Neuroimaging in facial nerve neuropathy

The timing and volume of neuroimaging for patients with facial nerve neuropathy (FNN) are a cause for discussion.Aim. To study the current volume of neuroimaging in patients with FNN and to determine the essential diagnostic protocol.Material and methods. Magnetic resonance imaging (MRI) data analysis of adult patients with FNN (n = 833). Protocols were taken from the Uni fi ed Medical Information and Analytical System of Moscow (EMIAS). The essential diagnostic protocol was created. A prospective study was conducted with new protocol.Results. According to EMIAS, the timing of MRI was 3 months from the fi rst symptoms to do diagnostics, the longest period from diagnosis to appointment to MRI was 83 days. The list of pulse sequences was given in the protocol in ¾ of cases. The most indicated regimes were T1 WI (80.7%), T2 WI (90.6%), T2 FLAIR (73.2%), less often DWI (54.9%). Studies with contrast amounted to 22.8%. In total, the pathology was detected in 429 (51.5%) patients, including 88 (20.5%) intracranial tumors. In 216 (25.9%) patients, the changes were most likely associated with FNN, of which in 44.5% of cases were in fl ammatory, 21.3% — tumor, 16.2% — demyelinating process, 11.2% — postoperative changes.According to the new protocol, the cause of FNN was directly identi fi ed in 56.6% of patients, of which in idiopathic — 31,6% of cases, in symptomatic — 70.6% (p = 0.005). Changes that cannot be associated with FNN, but require the participation of a specialist, were detected in a 1/4 of patients. Only in 20.8% of cases, the MRI results were normal.Conclusion. Recommended volume of neuroimaging for patients with FNN is MRI of the brain and parotid salivary glands with contrast within 1 month from the fi st symptoms. Regimes: T1 WI, T2 WI, FLAIR (with a slice thickness of 1 mm), DWI, 3D TOF, free recession in equilibrium (SSFP, FIESTA-C, CISS, FFE, etc.), sensitive to magnetic fi eld inhomogeneity (T2*, SWI, SWAN, etc.), and also T1 WI after intravenous contrast.

The use of artificial intelligence-supported communication technologies in neurological fields: A case study on brain tumor detection

Objective: The global health system is being shaped by multidisciplinary studies on the diagnosis of diseases and the provision of effective treatment services. Information and communication technologies have been developing laboratory and imaging studies through artificial intelligence-supported systems for the last twenty years. Studies with high accuracy levels in the diagnosis and treatment protocols of diseases make important contributions to making healthy decisions. Artificial intelligence applications have been actively used in the treatment processes of neurological cancer cases in the field of health, as in many fields in recent years. Among these applications, the machine learning model has started to be preferred in the detection of brain tumors because it can provide remarkable results. The main purpose of the study is to provide a supportive analysis for the organization of early diagnosis and rapid treatment in areas such as intracranial pressure, tumor treatment and radiotherapy of patients during intensive care processes. Materials and Methods: In this study, the method developed by doctors with machine learning Kaggle and developers of samples in the network through an example of an application that was developed through machine learning on brain tumors, brain tumor detection carried on with the validation of the data sets includes four classifications. Results: The study consists of two different study systems, namely practice and test. Sectional images from 2865 brain magnetic resonance imaging (MRI )and computed tomography (CT) samples were examined as training in the first stage of the application using the convolutional neural network (CNN) model, and the detected tumors were classified. In this context, MRI results were obtained on 2865 samples with 2470 units and 86.23% with tumors, and 395 units and 13.76% no tumors. Conclusion: In the study, samples with tumors were detected in a 3-month period for brain tumor detection with artificial intelligence and classified typologically. Accordingly, the reliability of the application was proven by providing 98.55% verification on 2865 samples, 3 different tumor types and no tumor data.

Association of Cerebral Oximetry With Brain Ischemic Lesions and Functional Outcomes in Arch Repair

BackgroundThis exploratory analysis of the randomized controlled Aortic Surgery Cerebral Protection Evaluation CardioLink-3 trial sought to determine if cerebral oximetry desaturation during elective proximal arch repair is associated with detrimental postoperative neuroradiologic and neurofunctional outcomes. MethodsCerebral oximetry and pre- and postoperative brain magnetic resonance imaging data from 101 participants were analyzed. Oximetry data from the trial allocation groups were compared; the relationships between cerebral oximetry indices and new ischemic cerebral lesions on magnetic resonance imaging and neurologic outcomes were also evaluated. ResultsTotal cerebral desaturation events (>20% decrease from baseline) on the left (median [interquartile range], 1 [1-3] vs 1.5 [0.5-3] with innominate and axillary cannulation; P = .80) were comparable to those on the right (1 [1-3] vs 1 [0-3]; P = .75) as were the total area under the curve of desaturation (left, P = .61; right, P = .84). Seventy patients had new ischemic lesions, among whom 36 had new severe lesions. Total desaturation events and area under the curve of desaturation were similar in patients with and without new ischemic lesions or severe lesions. The nadir regional cerebral saturation was lower on the left (49% [41-56]) than the right (53% [44-59]); left desaturation episodes were associated with lower postoperative cognitive test scores (P = .004). ConclusionsThe innominate and axillary cannulation techniques for elective proximal arch repair with unilateral antegrade cerebral perfusion were associated with similar occurrences of cerebral oximetry desaturation and neither were associated with new ischemic lesions.

Comparison of ultrasonic shear wave elastography, AngioPLUS planewave ultrasensitive imaging, and optimized high-resolution magnetic resonance imaging in evaluating carotid plaque stability.

This study aimed to compare the efficiency of evaluating carotid plaque stability using ultrasonic shear wave elastography (SWE), AngioPLUS planewave ultrasensitive imaging (AP), and optimized high-resolution magnetic resonance imaging (MRI). A total of 100 patients who underwent carotid endarterectomy at our hospital from October 2019 to August 2022 were enrolled. Based on the final clinical diagnosis, these patients were divided into vulnerable (n=62) and stable (n=38) plaque groups. All patients were examined using ultrasound SWE, AP, and optimized high-resolution MRI before surgery. The clinical data and ultrasound characteristics of patients of the two groups were compared. Considering the final clinical diagnosis as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SWE, AP, high-resolution MRI, and the final clinical diagnosis of vulnerable plaque were calculated. Pearson's correlation test was used to analyze the correlations of AP, SWE, and MRI results with the grading results of carotid artery stenosis. Statistically significant differences were noticed in terms of the history of smoking and coronary heart disease, plaque thickness, surface rules, calcified nodules, low echo area, and the degree of carotid artery stenosis between the two groups (P<0.05). Considering the final clinical diagnosis as the gold standard, the sensitivity, specificity, PPV, and NPV of SWE-based detection of carotid artery vulnerability were 87.10% (54/62), 76.32% (29/38), 85.71% (54/63) and 78.38% (29/37), respectively, showing a general consistency with the final clinical results (Kappa = 0.637, P<0.05). Considering the final clinical diagnosis as the gold standard, the sensitivity, specificity, PPV and NPV of AP-based detection of carotid artery vulnerability were 93.55% (58/62), 84.21% (32/38), 90.63% (58/64), and 88.89% (32/36), respectively, which agreed with the final clinical detection results (Kappa = 0.786, P<0.05). Considering the final clinical diagnosis as the gold standard, the sensitivity, specificity, PPV and NPV of high-resolution MRI-based detection of carotid artery vulnerability were 88.71% (55/62), 78.95% (30/38), 87.30% (55/63), and 81.08% (30/37), respectively, showing consistency with the final clinical results (Kappa = 0.680, P<0.05). AP, SWE, and MRI results were positively correlated with the results of carotid artery stenosis grading (P<0.05). AP technology is a non-invasive, inexpensive, and highly sensitive method to evaluate the stability of carotid artery plaques. This method can dynamically display the flow of blood in new vessels of plaque in real time and provide a reference for clinical diagnosis and treatment.

Transcranial Magnetic Stimulation Measures, Pyramidal Score on Expanded Disability Status Scale and Magnetic Resonance Imaging of Corticospinal Tract in Multiple Sclerosis.

Probing the cortic ospinal tract integrity by transcranial magnetic stimulation (TMS) could help to understand the neurophysiological correlations of multiple sclerosis (MS) symptoms. Therefore, the study objective was, first, to investigate TMS measures (resting motor threshold-RMT, motor evoked potential (MEP) latency, and amplitude) of corticospinal tract integrity in people with relapsing-remitting MS (pwMS). Then, the study examined the conformity of TMS measures with clinical disease-related (Expanded Disability Status Scale-EDSS) and magnetic resonance imaging (MRI) results (lesion count) in pwMS. The e-field navigated TMS, MRI, and EDSS data were collected in 23 pwMS and compared to non-clinical samples. The results show that pwMS differed from non-clinical samples in MEP latency for upper and lower extremity muscles. Also, pwMS with altered MEP latency (prolonged or absent MEP response) had higher EDSS, general and pyramidal, functional scores than pwMS with normal MEP latency finding. Furthermore, the RMT intensity for lower extremity muscles was predictive of EDSS functional pyramidal scores. TMS/MEP latency findings classified pwMS as the same as EDSS functional pyramidal scores in 70-83% of cases and were similar to the MRI results, corresponding to EDSS functional pyramidal scores in 57-65% of cases. PwMS with altered MEP latency differed from pwMS with normal MEP latency in the total number of lesions in the brain corticospinal and cervical corticospinal tract. The study provides preliminary results on the correspondence of MRI and TMS corticospinal tract evaluation results with EDSS functional pyramidal score results in MS.

Aktif Sakroiliitin Manyetik Rezonans Görüntülemesinde Gözlemciler Arasındaki Uyum

Introduction &#x0D; Axial spondyloarthritis has characteristic clinical features such as enthesitis, sacroiliitis and spondylitis, and extra-articular manifestations. Sacroiliitis (SI) occurs as a result of inflammation of the sacroiliac joint. Magnetic resonance imaging (MRI) of sacroiliac (SI) joints is used to detect early sacroiliitis. Sometimes, there can be variations in the interpretation of MRI findings of the SI joint among observers. Our aim was to investigate the inter-observer agreement among the observers.&#x0D; Materials and methods&#x0D; The study included the MRI results of 1150 patients who were diagnosed with active or chronic sacroiliitis based on the findings from sacroiliac MRIs, or whose MRI was deemed indicative of sacroiliitis by the rheumatologist. 1150 MRIs were re-evaluated by a different and expert radiologist.&#x0D; Results&#x0D; Out of the total 1150 patients investigated within the scope of this study. A statistically significant disparity emerged between the assessments provided by the expert radiologists and those obtained from outsourced radiologist evaluations.&#x0D; Conclusion&#x0D; The diagnosis of spondyloarthropathy may be delayed for some reasons. If the patient's clinic and MRI report are not consistent, the patient should not be removed from follow-up.

Comprehensive investigations of cerebral hemodynamic responses in CSVD patients with mental disorders: a pilot study.

Although a portion of patients with cerebral small vessel disease (CSVD) present mental disorders, there is currently a lack of appropriate technologies to evaluate brain functions that are relevant to neurovascular coupling. Furthermore, there are no established objective criteria for diagnosing and distinguishing CSVD-induced mental disorders and psychiatric diseases. In this study, we report the first comprehensive investigation of the cerebral hemodynamics of CSVD patients who also presented with mental disorders. Two CSVD patients with similar magnetic resonance imaging (MRI) outcomes but with non-identical mental symptoms participated in this study. The patients were instructed to perform the verbal fluency task (VFT), high-level cognition task (HCT), as well as voluntary breath holding (VBH). A functional near-infrared spectroscopy (fNIRS) was used to measure the cerebral oxygenation responses. Additionally, a diffuse correlation spectroscopy (DCS) was used to measure the cerebral blood flow (CBF) responses. Both technologies were also applied to a healthy subject for comparison. The fNIRS results showed that both CSVD patients presented abnormal cerebral oxygenation responses during the VFT, HCT, and VBH tasks. Moreover, the patient with cognition impairment showed fluctuations in CBF during these tasks. In contrast, the patient without cognition impairment mostly presented typical CBF responses during the tasks, which was consistent with the healthy subject. The cognitive impairment in CSVD patients may be due to the decoupling of the neurons from the cerebrovascular, subsequently affecting the autoregulation capacity. The results of the fNIRS and DCS combined provide a comprehensive evaluation of the neurovascular coupling and, hence, offer great potential in diagnosing cerebrovascular or psychiatric diseases.

Surveillance and treatment of primary hepatocellular carcinoma (aka. STOP HCC): protocol for a prospective cohort study of high-risk patients for HCC using GALAD-score

BackgroundVietnam and Saudi Arabia have high disease burden of primary hepatocellular carcinoma (HCC). Early detection in asymptomatic patients at risk for HCC is a strategy to improve survival outcomes in HCC management. GALAD score, a serum-based panel, has demonstrated promising clinical utility in HCC management. However, in order to ascertain its potential role in the surveillance of the early detection of HCC, GALAD needs to be validated prospectively for clinical surveillance of HCC (i.e., phase IV biomarker validation study). Thus, we propose to conduct a phase IV biomarker validation study to prospectively survey a cohort of patients with advanced fibrosis or compensated cirrhosis, irrespective of etiologies, using semi-annual abdominal ultrasound and GALAD score for five years.MethodsWe plan to recruit a cohort of 1,600 patients, male or female, with advanced fibrosis or cirrhosis (i.e., F3 or F4) and MELD ≤ 15, in Vietnam and Saudi Arabia (n = 800 each). Individuals with a liver mass ≥ 1 cm in diameter, elevated alpha-fetoprotein (AFP) (≥ 9 ng/mL), and/or elevated GALAD score (≥ -0.63) will be scanned with dynamic contrast-enhanced magnetic resonance imaging (MRI), and a diagnosis of HCC will be made by Liver Imaging Reporting and Data System (LiRADS) assessment (LiRADS-5). Additionally, those who do not exhibit abnormal imaging findings, elevated AFP titer, and/or elevated GALAD score will obtain a dynamic contrast-enhanced MRI annually for five years to assess for HCC. Only MRI nearest to the time of GALAD score measurement, ultrasound and/or AFP evaluation will be included in the diagnostic validation analysis. MRI will be replaced with an abdominal computed tomography scan when MRI results are poor due to patient conditions such as movement etc. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MRI will not be carried out in study sites in both countries. Bootstrap resampling technique will be used to account for repeated measures to estimate standard errors and confidence intervals. Additionally, we will use the Cox proportional hazards regression model with covariates tailored to the hypothesis under investigation for time-to-HCC data as predicted by time-varying biomarker data.DiscussionThe present work will evaluate the performance of GALAD score in early detection of liver cancer. Furthermore, by leveraging the prospective cohort, we will establish a biorepository of longitudinally collected biospecimens from patients with advanced fibrosis or cirrhosis to be used as a reference set for future research in early detection of HCC in the two countries.Trial registrationName of the registry: ClinicalTrials.govRegistration date: 22 April 2022Trial registration number: NCT05342350URL of trial registry record

Brain Magnetic Resonance Imaging in Indonesian Patients with Cerebral Palsy

Purpose: Cerebral palsy (CP) is a neurological health problem that affects children around the world and warrants particular attention. Magnetic resonance imaging (MRI) can be used to visualize brain disorders, as it provides a clear view of the brain’s anatomy, including the location of any damage or structural abnormalities. The objective of this study was to obtain a detailed MRI representation of patients with CP. Methods: This study employed a retrospective design involving the examination of medical records. It included CP patients aged between 1 and 16 years who had undergone brain MRI examinations. The Gross Motor Function Classification System scale was used to classify limitations in functional motor ability among these patients. The brain MRI results were categorized as either normal or abnormal. Results: Of 60 CP cases, 50% were classified as severe, with the remaining cases considered mild to moderate. Epilepsy was present in 66.7% of patients with severe CP. The most common type of CP, among both mild-to-moderate and severe cases, was quadriplegia. Gray matter lesions on brain MRI were more common in severe than mild-to-moderate cases, while vascular insult lesions and brain malformations were less frequent. A significant difference was observed in the severity of CP when a gray matter lesion was present on MRI. Conclusion: Most children with CP exhibited abnormal results on brain MRI. Lesions of the white and gray matter were the most frequently observed. MRI plays a crucial role in understanding the underlying pathological brain abnormalities in CP.

Relation between morphological features of initial breast MRI and breast cancer molecular subtypes

BackgroundBecause different gene receptors might cause each case of breast cancer, the disease is classified as a heterogeneous form because it can be subdivided into molecular subtypes. These molecular subtypes are different in disease manifestation, therapeutic response, and prognosis. Magnetic resonance imaging (MRI) has many applications in breast cancer's initial diagnosis and assessment of treatment response. The purpose of this research was to determine whether or not there is a correlation between specific morphological aspects of breast MRI in breast cancer and specific breast cancer subtypes and their impact on treatment decisions.ResultsThere was an insignificant difference between different mass shapes and different molecular subtypes (P > 0.05). One hundred percent of triple-negative breast cancers (TNBC) were rounded. Molecular subtypes and the spiculated mass border diverged significantly statistically (P = 0.023). The percentage of the hormonal receptor (HR)-positive breast cancers with a spiculated border (80%) was greater than TNBC (0%) and distinctively different (P = 0.044). Surgical alternatives were observed to correlate significantly with the MRI mass border type (P = 0.030). There was an insignificant difference between molecular subtypes and tumor size (P = 0.602), lymph nodes (P = 0.283), multicentricity (P = 0.386), and curve type (P = 0.107).ConclusionsMRI breast imaging has an important role in diagnostic and prognostic settings. The morphological results of MRI can be a helpful tool in distinguishing between the various subtypes of breast cancer. There was a statistically significant difference between different molecular subtypes and the spiculated mass border (P = 0.023). There was a statistically significant difference between the type of breast cancer surgery and the mass border (P = 0.030).

Teriflunomide and Time to Clinical Multiple Sclerosis in Patients With Radiologically Isolated Syndrome

Radiologically isolated syndrome (RIS) represents the earliest detectable preclinical phase of multiple sclerosis (MS) punctuated by incidental magnetic resonance imaging (MRI) white matter anomalies within the central nervous system. To determine the time to onset of symptoms consistent with MS. From September 2017 to October 2022, this multicenter, double-blind, phase 3, randomized clinical trial investigated the efficacy of teriflunomide in delaying MS in individuals with RIS, with a 3-year follow-up. The setting included referral centers in France, Switzerland, and Turkey. Participants older than 18 years meeting 2009 RIS criteria were randomly assigned (1:1) to oral teriflunomide, 14 mg daily, or placebo up to week 96 or, optionally, to week 144. Clinical, MRI, and patient-reported outcomes (PROs) were collected at baseline and yearly until week 96, with an optional third year in the allocated arm if no symptoms have occurred. Primary analysis was performed in the intention-to-treat population, and safety was assessed accordingly. Secondary end points included MRI outcomes and PROs. Among 124 individuals assessed for eligibility, 35 were excluded for declining to participate, not meeting inclusion criteria, or loss of follow-up. Eighty-nine participants (mean [SD] age, 37.8 [12.1] years; 63 female [70.8%]) were enrolled (placebo, 45 [50.6%]; teriflunomide, 44 [49.4%]). Eighteen participants (placebo, 9 [50.0%]; teriflunomide, 9 [50.0%]) discontinued the study, resulting in a dropout rate of 20% for adverse events (3 [16.7%]), consent withdrawal (4 [22.2%]), loss to follow-up (5 [27.8%]), voluntary withdrawal (4 [22.2%]), pregnancy (1 [5.6%]), and study termination (1 [5.6%]). The time to the first clinical event was significantly extended in the teriflunomide arm compared with placebo, in both the unadjusted (hazard ratio [HR], 0.37; 95% CI, 0.16-0.84; P = .02) and adjusted (HR, 0.28; 95% CI, 0.11-0.71; P = .007) analysis. Secondary imaging end point outcomes including the comparison of the cumulative number of new or newly enlarging T2 lesions (rate ratio [RR], 0.57; 95% CI, 0.27-1.20; P = .14), new gadolinium-enhancing lesions (RR, 0.33; 95% CI, 0.09-1.17; P = .09), and the proportion of participants with new lesions (odds ratio, 0.72; 95% CI, 0.25-2.06; P = .54) were not significant. Treatment with teriflunomide resulted in an unadjusted risk reduction of 63% and an adjusted risk reduction of 72%, relative to placebo, in preventing a first clinical demyelinating event. These data suggest a benefit to early treatment in the MS disease spectrum. ClinicalTrials.gov Identifier: NCT03122652.

Novel Osteochondral Biotemplate Improves Long-term Cartilage Repair Compared With Microfracture in an Ovine Model

Background: Current cartilage repair therapies do not re-create the complex mechanical interface between cartilage and bone, which is critical for long-term repair durability. New biomaterial designs that include hard tissue–soft tissue interface structures offer promise to improve clinical outcomes. Purpose/Hypothesis: The purpose of this study was to evaluate the efficacy and safety of a naturally derived osteochondral biotemplate with a novel contiguous hard tissue–soft tissue interface in an ovine model as a regenerative solution for articular cartilage defects. It was hypothesized that the osteochondral biotemplate would produce structurally superior repair tissue compared with microfracture over a 13-month period. Study Design: Controlled laboratory study. Methods: Osteochondral biotemplates were manufactured from porcine cancellous bone. Skeletally mature sheep (N = 30) were randomly allocated to 3 groups: early healing stage (euthanasia at 4 months), 6-month treatment, and 13-month treatment. In the early healing stage group, an 8 mm–diameter by 5 mm–deep osteochondral defect was created on the medial femoral condyle and treated at the time of iatrogenic injury with an osteochondral biotemplate. The contralateral limb received the same treatment 2 months later. In the 6- and 13-month treatment groups, 1 limb received the same osteochondral procedure as the early healing stage group. In the contralateral limb, an 8 mm–diameter, full-thickness cartilage defect (1-2 mm deep) was created and treated with microfracture. Cartilage repair and integration were quantitatively and qualitatively assessed with gross inspection, histological evaluation, and magnetic resonance imaging (MRI). Wilcoxon signed-rank and McNemar tests were used to compare the treatments. Results: At 6 and 13 months after treatment, the biotemplate was not present histologically. At 13 months, the biotemplate treatment demonstrated statistically higher histological scores than microfracture for integration with surrounding cartilage (biotemplate: 74 ± 31; microfracture: 28 ± 39; P = .03), type 2 collagen (biotemplate: 72 ± 33; microfracture: 40 ± 38; P = .02), total cartilage (biotemplate: 71 ± 9; microfracture: 59 ± 9; P = .01), and total integration (biotemplate: 85 ± 15; microfracture: 66 ± 20; P = .04). The osteochondral biotemplate treatment produced a notable transient nonneutrophilic inflammatory response that appeared to approach resolution at 13 months. MRI results were not statistically different between the 2 treatments. Conclusion: Even with the inflammatory response, after 13 months, the osteochondral biotemplate outperformed microfracture in cartilage regeneration and demonstrated superiority in integration between the repair tissue and host tissue as well as integration between the newly formed cartilage and the underlying bone. Clinical Relevance: This work has demonstrated the clinical potential of a novel biomaterial template to regenerate the complex mechanical interface between cartilage and the subchondral bone.

Diagnostic value of CT and MRI combined with serum LDH, NSE, CEA, and MYCN in pediatric neuroblastoma.

To analyze thediagnostic value of computed tomography (CT), magnetic resonance imaging (MRI) combined with serum lactate dehydrogenase (LDH), neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), and N-myc (MYCN) in the diagnosis of pediatric neuroblastoma. Fifty-two children diagnosed with neuroblastoma were selected as the neuroblastoma group. During the same period, 52 children who visited our hospital with abdominal distension, diarrhea, constipation, and vomiting but were finally excluded from neuroblastoma were selected as the control group. CT and MRI were performed on all children. Fifty-two cases of neuroblastoma of the central nervous system were confirmed by pathological examination. The levels of LDH, NSE, CEA, and MYCN in the neuroblastoma group were clearly higher than those in the control group (P < 0.05). The results of CT and MRI combined with serum LDH, NSE, CEA, and MYCN were false positive in 10 cases and false negative in 6 cases, which were consistent with the pathological results. The sensitivity of CT and MRI combined with serum LDH, NSE, CEA, and MYCN in the diagnosis of neuroblastoma was notably higher than that of the three alone (P < 0.05). The imaging findings of CT and MRI in children with central nervous system neuroblastoma were definitely characteristic. MRI had higher diagnostic value than CT. The diagnostic value of CT and MRI combined with serum LDH, NSE, CEA, and MYCN was improved to some extent.

Results of Magnetic Resonance Imaging (MRI) Screening in Patients at High Risk for Breast Cancer.

Screening MRI as an adjunct to mammography is recommended by the ACS for patients with a lifetime risk for breast cancer > 20%. While the benefits are clear, MRI screening is associated with an increase in false-positive results. The purpose of this study was to analyze our institutional database of high-risk patients and assess the uptake of screening MRI examinations and the results of those screenings. Our institutional review board-approved High-Risk Breast Cancer Database was queried for patients enrolled from January 2017 to January 2023 who were at high risk for breast cancer in a comparative analysis between those who were screened versus not screened with MRIs. Variables of interest included risk factor, background, MRI screening uptake, and frequency and results of image-guided breast biopsies. A total of 254 of 1106 high-risk patients (23%) had MRI screening. Forty-six of 852 (5.3%) patients in the non-MRI-screened cohort and nine of 254 (3.5%) patients in the MRI-screened cohort were diagnosed with a malignant lesion after image-guided biopsy (p = 0.6). There was no significant difference between MRI and non-MRI guided biopsies in detecting breast cancer. All malignant lesions were T1 or in situ disease. The 254 patients in the MRI-screened group underwent 185 biopsies. Fifty-seven percent of MRI-guided biopsies yielded benign results. Although the addition of MRI screening in our high-risk cohort did not produce a significant number of additional cancer diagnoses, patients monitored in our high-risk cohort who developed breast cancer were diagnosed at very early stages of disease, underscoring the benefit of participation in the program.

Magnetic resonance radiomics-derived sphericity correlates with seizure in brain arteriovenous malformations.

Angioarchitectural analysis of brain arteriovenous malformations (BAVMs) is qualitative and subject to interpretation. This study quantified the morphology of and signal changes in the nidal and perinidal areas by using MR radiomics and compared the performance of MR radiomics and angioarchitectural analysis in detecting epileptic BAVMs. From 2010 to 2020, a total of 111 patients with supratentorial BAVMs were retrospectively included and grouped in accordance with the initial presentation of seizure. Patients' angiograms and MR imaging results were analyzed to determine the corresponding angioarchitecture. The BAVM nidus was contoured on time-of-flight MR angiography images. The perinidal brain parenchyma was contoured on T2-weighted images, followed by radiomic analysis. Logistic regression analysis was performed to determine the independent risk factors for seizure. ROC curve analysis, decision curve analysis (DCA), and calibration curve were performed to compare the performance of angioarchitecture-based and radiomics-based models in diagnosing epileptic BAVMs. In multivariate analyses, low sphericity (OR: 2012.07, p = .04) and angiogenesis (OR: 5.30, p = .01) were independently associated with a high risk of seizure after adjustment for age, sex, temporal location, and nidal volume. The AUC for the angioarchitecture-based, MR radiomics-based, and combined models was 0.672, 0.817, and 0.794, respectively. DCA confirmed the clinical utility of the MR radiomics-based and combined models. Low nidal sphericity and angiogenesis were associated with high seizure risk in patients with BAVMs. MR radiomics-derived tools may be used for noninvasive and objective measurement for evaluating the risk of seizure due to BAVM. Low nidal sphericity was associated with high seizure risk in patients with brain arteriovenous malformation and MR radiomics may be used as a noninvasive and objective measurement method for evaluating seizure risk in patients with brain arteriovenous malformation. • Low nidal sphericity was associated with high seizure risk in patients with brain arteriovenous malformation. • The performance of MR radiomics in detecting epileptic brain arteriovenous malformations was more satisfactory than that of angioarchitectural analysis. • MR radiomics may be used as a noninvasive and objective measurement method for evaluating seizure risk in patients with brain arteriovenous malformation.

Clinical characteristics of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy in children: A case series of 16 patients

PurposeTo investigate the clinical characteristics of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy in children. MethodsWe reviewed the medical records of Children's Hospital of Chongqing Medical University from January 2020 to September 2021 and retrospectively analysed the clinical features, magnetic resonance imaging (MRI) findings, laboratory findings, treatment and outcome of children with autoimmune GFAP astrocytopathy. ResultsSixteen patients were included: 6 and 10 tested positive for GFAP-IgG in cerebrospinal fluid (CSF) and both CSF and serum, respectively. The median patient age was 115 months (range: 36–180 months), and 7 patients (43.8%) were male. All patients had the clinical syndrome of encephalitis/meningoencephalitis with or without myelitis: encephalitis (8), meningoencephalitis (3), encephalomyelitis (1) and meningoencephalomyelitis (4). The most common clinical symptoms were fever (11), altered consciousness (11), headache (10) and seizure (9). Four patients developed central respiratory failure for which mechanical ventilation was needed. All patients showed hyperintense T2-weighted lesions on brain MRI in the cerebral white matter (13), brainstem (11), basal ganglia (11), thalamus (9), and cerebellum (3). Nine patients (56%) had abnormal hyperintense lesions in the bilateral basal ganglia and thalamus. Six of 12 patients who underwent gadolinium-enhanced brain MRI showed abnormal enhancement images, and five of them showed linear perivascular radial enhancement. The modified Rankin scale (mRS) score decreased significantly in most patients after immunotherapy. Two patients with coexisting neural autoantibodies relapsed; however, 15 patients who were followed up successfully had favorable outcomes at the last follow-up. ConclusionChildren with autoimmune GFAP astrocytopathy usually have a clinical syndrome of encephalitis/meningoencephalitis with or without myelitis. Except for the linear perivascular radial gadolinium enhancement pattern, hyperintense lesions in the bilateral basal ganglia and thalamus might be another characteristic brain MRI finding of autoimmune GFAP astrocytopathy in children. Although a few patients with coexisting neural autoantibodies might relapse, children with autoimmune GFAP astrocytopathy usually have favorable outcomes after immunotherapy.

Hypothesis on the pathophysiology of syringomyelia based on analysis of phase-contrast magnetic resonance imaging of Chiari-I malformation patients.

Background: Despite several hypotheses, our understanding of syringomyelia's pathophysiology remains limited. The hypothesis proposed by Oldfield et al. suggests that piston-like movement of the cerebellar tonsils propels the cerebrospinal fluid (CSF) into the syrinx via the spinal perivascular space. However, a significant question remains unanswered: how does the CSF enter and stay in the syrinx, which has a higher pressure than the subarachnoid space. In the current study, we attempted to verify Oldfield's hypothesis using phase-contrast magnetic resonance imaging (MRI) data from patients with syringomyelia. Methods: We analyzed phase-contrast MRI scans of 18 patients with Chiari-I malformation associated with syringomyelia, all of whom underwent foramen magnum decompression, and 21 healthy volunteers. We obtained velocity waveforms for CSF and brain tissue from regions of interest (ROI) set at the various locations. These waveforms were synchronized at the peak timing of downward CSF flow. We compared the preoperative patient data with the control data and also compared the preoperative patient data with the postoperative patient data. Results: The syrinx shrank in 17 (94%) of the patients, and they experienced significant clinical improvement. When comparing pre- and postoperative MRI results, the only significant difference noted was the preoperative elevated velocity of the cerebellar tonsil, which disappeared post-surgery. The CSF velocities in the subarachnoid space were higher in the preoperative patients than in the controls, but they did not significantly differ in the postoperative MRI. The tonsillar velocity in the preoperative MRI was significantly lower than that of the CSF, suggesting that the elevated tonsillar velocity was more of an effect, rather than the cause, of the elevated CSF velocity. Conclusions: Given these findings, a completely new paradigm seems necessary. We, therefore, propose a novel hypothesis: the generative force of syringomyelia may be the direction-selective resistance to CSF flow in the subarachnoid space.