Magnetic Resonance Imaging Procedures Research Articles

Clinical Evaluation of Oral Midazolam Containing Cyclodextrin in Pediatric Magnetic Resonance: A Retrospective Cohort Study.

Reducing a child's level of anxiety before magnetic resonance imaging (MRI) procedures allows for better behavioral outcomes. The aim of this retrospective study was to evaluate anxiolytic efficacy of Midazolam/γ-cyclodextrin oral formulation. We retrospectively reviewed 100 medical charts of children who, between 1 February and 31 July 2022, underwent MRI under general anesthesia with or without premedication with midazolam/γ-cyclodextrin. Primary outcome was comparison of behavior to facemask positioning, while secondary endpoints were degree of drugs acceptance, anxiolytic effect evaluation, child's behavior on separation, and sevoflurane need. Facemask positioning was accepted by 58% of the midazolam/γ-cyclodextrin group compared to 22% of children in the control group. The rate of acceptance was >90%. At the moment of separation from parent, none of the premedicated children needed to be restrained compared to 18% in the control group. A lower percentage of sevoflurane was needed for eye-closure at induction of anesthesia and for anesthesia maintenance. At emergence from anesthesia, 46% of children in the premedicated group compared to 66% of children in the control group showed transient agitation. Midazolam/γ-cyclodextrin showed a good profile of acceptance, satisfactory anxiolytic properties, and reduced need for anesthetics when administered to children before MRI under general anesthesia.

Resting state networks of awake adolescent and adult squirrel monkeys using ultra-high field (9.4T) functional magnetic resonance imaging.

Resting state networks (RSNs) are increasingly forwarded as candidate biomarkers for neuropsychiatric disorders. Such biomarkers may provide objective measures for evaluating novel therapeutic interventions in nonhuman primates often used in translational neuroimaging research. This study aimed to characterize the RSNs of awake squirrel monkeys and compare the characteristics of those networks in adolescent and adult subjects. Twenty-seven squirrel monkeys (n=12 adolescents [6 male/6 female] ∼2.5 years and n=15 adults [7 male/8 female] ∼9.5 years) were gradually acclimated to awake scanning procedures; whole-brain fMRI images were acquired with a 9.4 Tesla scanner. Group level independent component (ICA) analysis (30 ICs) with dual regression was used to detect and compare RSNs. Twenty ICs corresponding to physiologically meaningful networks representing a range of neural functions, including motor, sensory, reward, and cognitive processes were identified in both adolescent and adult monkeys. The reproducibility of these RSNs was evaluated across several ICA model orders. Adults showed a trend for greater connectivity compared to adolescent subjects in two of the networks of interest: (1) in the right occipital region with the OFC network and (2) in the left temporal cortex, bilateral occipital cortex, and cerebellum with the posterior cingulate network. However, when age was entered into the above model, this trend for significance was lost. These results demonstrate that squirrel monkey RSNs are stable and consistent with RSNs previously identified in humans, rodents, and other nonhuman primate species. These data also identify several networks in adolescence that are conserved and others that may change into adulthood.Significance Statement Functional magnetic resonance imaging procedures have revealed important information about how the brain is modified by experimental manipulations, disease states, and aging throughout the lifespan. Preclinical neuroimaging, especially in nonhuman primates, has become a frequently used means to answer targeted questions related to brain resting-state functional connectivity. The present study characterized resting state networks (RSNs) in adult and adolescent squirrel monkeys; twenty RSNs corresponding to networks representing a range of neural functions were identified. The RSNs identified here can be utilized in future studies examining the effects of experimental manipulations on brain connectivity in squirrel monkeys. These data also may be useful for comparative analysis with other primate species to provide an evolutionary perspective for understanding brain function and organization.

Evaluating Sedation Strategies for Magnetic Resonance Imaging: A Comprehensive Review of Intravenous Fentanyl, Butorphanol, and Midazolam in Adult and Pediatric Populations.

Magnetic resonance imaging (MRI) is a critical diagnostic tool that often requires patient sedation to ensure optimal image quality and patient comfort, particularly in those with anxiety or an inability to remain still. This comprehensive review examines the efficacy, safety, and practical considerations of three commonly used intravenous sedatives, namely, fentanyl, butorphanol, and midazolam, in adult populations undergoing MRI procedures. This review highlights the pharmacological profiles, advantages, and limitations associated with each sedative agent through a detailed analysis of current literature, clinical guidelines, and practice-based evidence. Fentanyl is noted for its potent analgesic properties and rapid onset of action, making it suitable for painful procedures. Butorphanol, with its unique opioid agonist-antagonist activity, presents an alternative with a balance between analgesia and sedation, potentially offering a safer profile for certain patient populations. Midazolam, widely recognized for its anxiolytic and amnestic effects, remains a staple in managing procedure-related anxiety. The review further discusses patient selection criteria, dosing strategies, and the importance of individualized sedation planning to enhance patient experience and procedural outcomes. Future directions highlight the potential of emerging sedation agents and non-pharmacological approaches to improve patient comfort and compliance. The findings underscore the necessity for healthcare providers to adapt sedation practices to the specific needs of each patient, considering both the clinical context and the inherent characteristics of the sedative agents. This review aims to guide clinicians in selecting the most appropriate sedation strategy for adult patients undergoing MRI, optimizing patient care and diagnostic efficacy.

Comparison of Detomidine or Romifidine in Combination with Morphine for Standing Magnetic Resonance Imaging in Horses.

The aim of this study was to determine the most appropriate sedation protocol for a standing magnetic resonance imaging (MRI) examination in horses, comparing continuous rate infusions (CRIs) of detomidine and romifidine combined with a single bolus of morphine. Sixteen horses referred for standing low-field open-magnet MRI were randomly assigned to one of two sedation protocols. The horses were premedicated with 0.03 mg/kg of intramuscular acepromazine, and those animals belonging to Group D received an intravenous (IV) loading dose of detomidine (0.01 mg/kg) 30 min later, while those of Group R received romifidine (0.04 mg/kg). If the horses were inadequately sedated, an additional dose of IV detomidine (0.005 mg/kg) or romifidine (0.02 mg/kg) was administered, according to the animal's group. During the MRI, a single IV bolus of morphine (0.05 mg/kg) was administered, and according to which group it belonged to, the animal started the administration of detomidine (0.01 mg/kg/h) or romifidine (0.02 mg/kg/h). Heart rate (HR), respiratory rate (RR), rectal temperature (RT), depth of sedation, and degree of ataxia were evaluated every 10 min during MRI. Two horses belonging to Group D and four horses from Group R needed additional sedation before entering the MRI unit because they were unsatisfactorily sedated. No side effects were observed following morphine bolus administration. During the MRI procedure, five horses in Group R received an additional IV romifidine bolus (0.01 mg/kg) because the depth of sedation score was 1 and the ataxia score was 0. Any substantial differences were recorded between the two treatments in terms of HR, RR, and RT. In conclusion, at the doses used, a detomidine-morphine combination following a CRI of detomidine appears more suitable than a romifidine-morphine combination following a CRI of romifidine for maintaining an adequate depth of sedation and adequate immobility in horses undergoing standing MRI.

Effectiveness and usage of written and verbal counselling information on anxiety in MRI at a tertiary care hospital in Chennai

Background: Many people have considerable anxiety when having magnetic resonance imaging (MRI). Fear during an MRI causes the process to drag on longer and the quality of the images to decline, which increases expenses and requires labor loss. Objective: This study sought to determine how vocal and written information affected patients' anxiety during MRI procedures. Materials and Methods: A prospective cross-sectional study with 300 participants was conducted. The investigation occurred in March and April of 2022 at the tertiary care hospital's radiology department. Three participant groups were formed: group 1 received textual material, group 2 served as the control group, and so on; and group 3 learned about counseling. The State-Trait Anxiety Inventory (STAI), a measure of anxiety levels, was used to determine the people's traits and state of anxiety. Results: The three groups' trait anxiety scores did not significantly differ (p = 0.20) from each other's demographic features. Statistically speaking, group 3's state anxiety levels were lower than those of group 2 and the control group. Group 2's state anxiety levels were statistically lower (p<0.001) than those of the control group. Conclusion:Verbal and written information can help to lessen MRI anxiety. Written information may not be as good at lowering MRI anxiety as verbal information.

Evaluation of 12-lead electrocardiogram at 0.55T for improved cardiac monitoring in magnetic resonance imaging

The 12-lead electrocardiogram (ECG) is a standard diagnostic tool for monitoring cardiac ischemia and heart rhythm during cardiac interventional procedures and stress testing. These procedures can benefit from magnetic resonance imaging (MRI) information; however, the MRI scanner magnetic field leads to ECG distortion that limits ECG interpretation. This study evaluated the potential for improved ECG interpretation in a "low field" 0.55T MRI scanner. The 12-lead ECGs were recorded inside 0.55T, 1.5T, and 3T MRI scanners, as well as at scanner table "home" position in the fringe field and outside the scanner room (seven pigs). To assess interpretation of ischemic ECG changes in a 0.55T MRI scanner, ECGs were recorded before and after coronary artery occlusion (seven pigs). ECGs was also recorded for five healthy human volunteers in the 0.55T scanner. ECG error and variation were assessed over 2-minute recordings for ECG features relevant to clinical interpretation: the PR interval, QRS interval, J point, and ST segment. ECG error was lower at 0.55T compared to higher field scanners. Only at 0.55T table home position, did the error approach the guideline recommended 0.025mV ceiling for ECG distortion (median 0.03mV). At scanner isocenter, only in the 0.55T scanner did J point error fall within the 0.1mV threshold for detecting myocardial ischemia (median 0.03mV in pigs and 0.06mV in healthy volunteers). Correlation of J point deviation inside versus outside the 0.55T scanner following coronary artery occlusion was excellent at scanner table home position (r2 =0.97), and strong at scanner isocenter (r2 =0.92). ECG distortion is improved in 0.55T compared to 1.5T and 3T MRI scanners. At scanner home position, ECG distortion at 0.55T is low enough that clinical interpretation appears feasible without need for more cumbersome patient repositioning. At 0.55T scanner isocenter, ST segment changes during coronary artery occlusion appear detectable but distortion is enough to obscure subtle ST segment changes that could be clinically relevant. Reduced ECG distortion in 0.55T scanners may simplify the problem of suppressing residual distortion by ECG cable positioning, averaging, and filtering and could reduce current restrictions on ECG monitoring during interventional MRI procedures.

Cardiac MR modelling of systolic and diastolic blood pressure

AimsBlood pressure (BP) is a crucial factor in cardiovascular health and can affect cardiac imaging assessments. However, standard outpatient cardiovascular MR (CMR) imaging procedures do not typically include BP measurements...

Testing a Home Solution for Preparing Young Children for an Awake MRI: A Promising Smartphone Application.

Thanks to its non-invasive nature and high-resolution imaging capabilities, magnetic resonance imaging (MRI) is a valuable diagnostic tool for pediatric patients. However, the fear and anxiety experienced by young children during MRI scans often result in suboptimal image quality and the need for sedation/anesthesia. This study aimed to evaluate the effect of a smartphone application called COSMO@home to prepare children for MRI scans to reduce the need for sedation or general anesthesia. The COSMO@home app was developed incorporating mini-games and an engaging storyline to prepare children for learning goals related to the MRI procedure. A multicenter study was conducted involving four hospitals in Belgium. Eligible children aged 4-10 years were prepared with the COSMO@home app at home. Baseline, pre-scan, and post-scan questionnaires measured anxiety evolution in two age groups (4-6 years and 7-10 years). Eighty-two children participated in the study, with 95% obtaining high-quality MRI images. The app was well-received by children and parents, with minimal technical difficulties reported. In the 4-6-year-old group (N = 33), there was a significant difference between baseline and pre-scan parent-reported anxiety scores, indicating an increase in anxiety levels prior to the scan. In the 7-10-year-old group (N = 49), no significant differences were observed between baseline and pre-scan parent-reported anxiety scores. Overall, the COSMO@home app proved to be useful in preparing children for MRI scans, with high satisfaction rates and successful image outcomes across different hospitals. The app, combined with minimal face-to-face guidance on the day of the scan, showed the potential to replace or assist traditional face-to-face training methods. This innovative approach has the potential to reduce the need for sedation or general anesthesia during pediatric MRI scans and its associated risks and improve patient experience.

Incidence and risk factors for complications associated with equine general anaesthesia for elective magnetic resonance imaging.

Complications are a practical consideration for elective magnetic resonance imaging (MRI) studies performed under general anaesthesia but relatively little is known about their distribution and risk factors. To describe the incidence of complications associated with MRI performed under general anaesthesia at a large referral facility and evaluate potential risk factors for these complications. Retrospective case-control study. Patient information and details of the MRI procedure were collected retrospectively from medical records of all horses that had undergone an MRI under general anaesthesia at the University of Pennsylvania, New Bolton Center, between September 2005 and April 2012. Complications and categorical variables were examined by chi-squared or Fisher's exact tests as appropriate. A mixed-effects logistic regression approach was used to evaluate associations between explanatory variables and the outcome variable (complications or pyrexia). A univariable screen was used to select variables (likelihood ratio test p < 0.2) for inclusion in the multivariable analysis. Statistical significance was inferred when p ≤ 0.05. Complications were noted after MRI in 51 (17.4%) of 293 events eligible for inclusion. Complications included pyrexia (n = 35), pneumonia (n = 14), colic (n = 10), facial/nerve paralysis (n = 6), diarrhoea (n = 4), and other (n = 3). The odds of developing a post-anaesthetic complication were significantly decreased in horses that received peri-anaesthetic antimicrobials (OR 0.29, 95% CI 0.14-0.63, p = 0.002). Increased age (OR 0.87, 95% CI, 0.76-0.99, p = 0.03) and peri-anaesthetic antimicrobial administration (OR 0.23, 95% CI 0.08-0.65, p = 0.005) were associated with a decreased odds of developing pyrexia. Single centre retrospective design. Potential complications including pyrexia, pneumonia and colic should be recognised when pursuing MRI under general anaesthesia. The administration of peri-anaesthetic antimicrobials decreased the odds of a complication and warrants consideration, particularly in horses that might be classified as high risk.

Possible Occurrence of Delayed Leukoencephalopathy Following Acute Ischemic Stroke With Large‐Vessel Occlusion

Background Typically detected at least 14 days after acute ischemic stroke onset, delayed leukoencephalopathy (DL) involves diffuse hyperintensities restricted to white matter on fluid‐attenuated inversion recovery accompanied mostly by partial diffusion‐weighted image hyperintensities. DL cases, which are rarely reported, have occurred after large‐vessel occlusion (LVO). Herein, we aim to elucidate the incidence and factors associated with DL. Methods Our study covers consecutive ischemic strokes involving: (1) onset‐to‐door time within 7 days and (2) available scans from at least a second magnetic resonance imaging procedure at least 14 days after onset. First, we examined the incidence of DL generally and whether LVO could be a risk factor for DL in ischemic strokes generally, and second, we examined the incidence and risk factors associated with DL in patients with LVO. Results We screened 1857 consecutive patients with ischemic stroke and selected 792 general patients—573 (72%) men, median age 67 years—and 183 patients with LVO—128 (70%) men, median age 67 years. DL was detected in 2.3% of the general patients and 9.2% of the patients with LVO ischemic stroke. LVO was strongly associated with DL (odds ratio [OR], 69.1 [95 CI, 9.06–526]; P &lt;0.001). Among patients with LVO, DL‐associated factors were age/10 years (OR, 1.76 [95% CI, 1.13–2.75]; P =0.012), low‐density lipoprotein cholesterol/10 mg/dL (OR, 0.863 [95% CI, 0.745–1.00]; P =0.049), complete recanalization (OR, not calculable; P &lt;0.001), and endovascular therapy (OR, 17.4 [95% CI, 4.44–68.5]; P &lt;0.001). Conclusion DL might not be rare following LVO. We speculate that certain risk factors and their combinations are key in the development of DL.

Mediating effect of amygdala activity on response to fear vs. happiness in youth with significant levels of irritability and disruptive mood and behavior disorders.

Irritability, characterized by a tendency to exhibit increased anger, is a common clinical problem in youth. Irritability is a significant clinical issue in youth with various psychiatric diagnoses, especially disruptive behavior, and mood disorders (Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Disruptive Mood Dysregulation Disorder). Although there have been previous studies focusing on functional alteration in the amygdala related to irritability, there is no comprehensive model between emotional, neuronal, and behavioral characteristics. Using an functional magnetic resonance imaging (fMRI) procedure, we investigated the relationships between behavioral irritability, selective impairments in processing facial emotions and the amygdala neural response in youth with increased irritability. Fifty-nine youth with disruptive mood and behavior disorder completed a facial expression processing task with an event-related fMRI paradigm. The severity of irritability was evaluated using the Affective Reactivity Index. In the result of behavioral data, irritability, and reaction time (RT) differences between interpreting negative (fear) and positive (happiness) facial expressions were positively correlated. In the fMRI result, youth showed higher activation in the right cingulate gyrus, bilateral cerebellum, right amygdala, right precuneus, right superior frontal gyrus, right middle occipital gyrus, and middle temporal gyrus, during the happiness condition vs. fear condition. No brain region exhibited greater activation in the fear than in the happiness conditions. In the result of the mediator analysis, increased irritability was associated with a longer RT toward positive vs. negative facial expressions. Irritability was also positively associated with the difference in amygdala blood oxygen level-dependent responses between the two emotional conditions (happiness > fear). This difference in amygdala activity mediated the interaction between irritability and the RT difference between negative and positive facial expressions. We suggest that impairment in the implicit processing of facial emotional expressions with different valences causes distinct patterns of amygdala response, which correlate with the level of irritability. These results broaden our understanding of the biological mechanism of irritability at the neural level and provide information for the future direction of the study.

CT and MRI image fusion based on variance and pixel significance

In the medical imaging field, images are obtained using various modalities, including the computed tomography procedure and the magnetic resonance imaging procedure. In which every image contains different information from the other image. For better treatment and diagnosis of a patient, a single composite image must be created by fusing all the pertinent data. This process is known as image fusion. We present an innovative and effective image fusion technique utilizing ILWT and DCT for combining brain-related medical images acquired through there are two steps to this strategy. First, the variance is employed as a contrast evaluation in the DCT domain to combine the approximation coefficients generated by the ILWT decomposition. Second, the coefficients representing the fine details are combined by finding the ideal weighted average based on the importance of the pixels in the ILWT domain. Our method is straightforward, making it simple and suitable for deployment in real-time applications. The experimental results demonstrate our method's outstanding performance with regard to both result quality and in contrast to a number of picture fusion techniques.

Clinical Observation and Analysis of Thyroglossal Duct Cyst Carcinoma: A Report of 5 Cases.

Thyroglossal duct cyst carcinoma (TGDCCa) is a rare condition with only approximately 300 cases reported to date. There is a lack of comprehensive reporting on its clinical manifestations, ultrasound, contrast-enhanced computed tomography, magnetic resonance imaging (MRI) features, immunophenotyping, procedure, and prognosis following modified Sistrunk's procedure. This study aimed to address these gaps by analyzing and summarizing the clinical features of 5 cases of papillary carcinoma arising in thyroglossal duct cysts (TGDC).Five patients with papillary carcinoma in TGDC treated by modified Sistrunk's procedure were included. Their clinical manifestation, physical examination findings, iconography, pathological findings, treatment, and outcomes were analyzed in aiding the diagnosis and treatment of TGDCCa. Immunohistochemistry was used to confirm the papillary carcinoma subtype. The BRAFV600E mutation was detected in 2 patients. No evidence of cancer recurrence, distant metastases, and malignant changes in the thyroid was found after a mean follow-up of 29.8 months.The management of TGDCCa with papillary carcinoma in low-risk patients can be accomplished by performing a modified Sistrunk's procedure along with a regular follow-up imaging of the thyroid and neck. Although postoperative pathological diagnosis is the gold standard for diagnosis, it is equally crucial to comprehend the clinical manifestations and auxiliary diagnostic techniques before surgical intervention.

Provision of Safe Anesthesia in Magnetic Resonance Environments: Degree of Compliance with International Guidelines in Saudi Arabia.

The lack of local guidelines and regulations for the administration of anesthesia in magnetic resonance imaging (MRI) units presents a potential risk to patient safety in Saudi Arabia. Hence, this study aimed to evaluate the extent to which hospitals in Saudi Arabia follow international guidelines and recommendations for the safe and effective administration of anesthesia in an MRI environment. This study used a questionnaire that was distributed to 31 medical facilities in Saudi Arabia that provided anesthesia in MRI units. The findings of the study revealed that the mean compliance with the 17 guidelines across the 31 sites was 77%; 5 of the 31 sites (16.1%) had a compliance rate of less than 50% with the recommended guidelines. Only 19.4% of the institutes provided general safety education. Communication breakdowns between anesthesia providers and MRI teams were reported. To conclude, this survey highlights the status of anesthesia standards in Saudi Arabian MRI units and emphasizes areas that require better adherence to international guidelines. The results call for targeted interventions, including the formulation of specific national anesthesia guidelines for MRI settings. Communication breakdowns between anesthesia providers and MRI teams were reported at a rate of 83.9% during the administration of a gadolinium contrast agent. There were additional breakdowns, particularly for high-risk patients with implants, such as impaired respirators (74.2%), thus requiring further investigation due to potential safety incidents during MRI procedures. While considering the limitations of this study, such as potential biases and the low response rate, it provides a valuable foundation for refining protocols and promoting standardized practices in Saudi Arabian healthcare.

Internalizing and externalizing behaviors in school-aged children are related to state anxiety during magnetic resonance imaging

Magnetic resonance imaging (MRI) procedures often evoke anxiety in children. Further, anxious children may be less likely to participate in MRI research, leading to a possible selection bias, and may be more likely to move during image acquisition, resulting in lower image quality and possible information bias. Therefore, state anxiety is problematic for functional and structural MRI studies. Children with behavioral problems, such as internalizing and externalizing behaviors, may be more likely to experience state anxiety prior to and during MRI scanning. Therefore, our first aim was to investigate the relationship between internalizing/externalizing behavior and children’s MRI-related state anxiety. Our second aim was to investigate the relationship between internalizing and externalizing behaviors and MRI research participation. Our final aim was to investigate the effect of internalizing and externalizing behaviors as well as MRI-related anxiety on image quality in children. We included 1,241 six- to ten-year-old children who underwent a mock MRI. Afterward, if not too anxious, these children were scanned using a 3-Tesla GE Discovery MRI system (n = 1,070). Internalizing and externalizing behaviors were assessed with the child behavior checklist. State anxiety was assessed with a visual analog scale. Internalizing behaviors were positively associated with child state anxiety, as reported by the child, parent, and researcher. For state anxiety reported by the parent and researcher, this relationship was independent of externalizing behaviors. Externalizing behaviors were related to state anxiety as reported by the child, parent, and researcher, but this difference was not independent of internalizing behaviors, pointing toward a relationship via the shared variance with internalizing behaviors. Further, children with more internalizing and externalizing behaviors were less likely to participate in the actual MRI-scanning procedure. Lastly, MRI-related state anxiety, reported by the child and the researcher, was associated with worse image quality. These results underscore the potential for biases and methodological issues related to MRI-related state anxiety in children.

Advances in neonatal brain imaging: A comparative analysis of MRI, CT scans, and ultrasound

This scholarly investigation undertakes a comprehensive comparison of the diagnostic efficacy, precision, and sensitivity associated with neonatal brain Magnetic Resonance Imaging (MRI) in contrast to its counterparts, Computed Tomography (CT) scans and ultrasound. As the medical community has progressively become attuned to the long-term health implications of radiation exposure from CT scans, the imperative of a strategy mitigating this risk has gained prominence. In this context, ultrasound emerges as an alternative modality devoid of ionizing radiation. Employing a methodical approach rooted in systematic literature review, this study synthesizes five pertinent research works to unravel its research objectives. Empirical evidence substantiates that neonatal brain MRI surpasses both neonatal brain CT and ultrasound in diagnostic effectiveness. The underpinning rationale for this phenomenon lies in the heightened accuracy inherent to neonatal brain MRI procedures. To unravel the intricacies associated with disparities between neonatal and adult brain MRI procedures, the study meticulously investigates structural, shape, and size distinctions. This endeavor underscores the necessity for bespoke MRI apparatuses designed to account for these nuances. In pursuit of this objective, the integration of technologically advanced components such as compact scanners and refinements in magnetic and coil technologies has engendered tangible improvements. This innovation confluence bears testimony to the augmentation of patient safety, conferring a cascade effect wherein the precision of acquired MRI data underwrites accurate diagnoses and consequent therapeutic interventions. Conclusively, the study underscores the pivotal role played by recent MRI technological advancements in amplifying its efficacy within the niche domain of neonatal brain imaging. Prospective innovations within the MRI ambit stand poised to recalibrate performance benchmarks, thereby amplifying its diagnostic potency and broadening its scope of application.

Magnetic resonance imaging, computed tomography, and gross anatomy of forelimb joints in New Zealand rabbit (Oryctolagus cuniculus L.).

The present study aimed to define the anatomical structures by comparing the transversal computed tomography (CT) and magnetic resonance (MR) images of the forelimb joints of the rabbits with the cross-sectional plastinated images. A total of 14 (seven females, seven males) one-year-old adult New Zealand rabbits were used in the study. After the CT and MR imaging procedures were completed, the forelimbs were removed from the body. The forelimbs were plastinated using the silicone plastination method and sectioned transversal. Cross-sectional plastinates were evaluated and correlated anatomically with conjugate CT and MR images. Joint and surrounding anatomical structures were defined in sections. Cross-sectional plastinated samples were highly correlated with CT and MR images in terms of bone and soft tissue, respectively. It is thought that the anatomical and radiological data obtained from the forelimb joints of rabbits will provide a basis for scientists who are involved in both experimental surgical interventions and clinical anatomy education.

Conventional and Advanced Magnetic Resonance Imaging Assessment of Non-Enhancing Peritumoral Area in Brain Tumor.

The non-enhancing peritumoral area (NEPA) is defined as the hyperintense region in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images surrounding a brain tumor. The NEPA corresponds to different pathological processes, including vasogenic edema and infiltrative edema. The analysis of the NEPA with conventional and advanced magnetic resonance imaging (MRI) was proposed in the differential diagnosis of solid brain tumors, showing higher accuracy than MRI evaluation of the enhancing part of the tumor. In particular, MRI assessment of the NEPA was demonstrated to be a promising tool for distinguishing high-grade gliomas from primary lymphoma and brain metastases. Additionally, the MRI characteristics of the NEPA were found to correlate with prognosis and treatment response. The purpose of this narrative review was to describe MRI features of the NEPA obtained with conventional and advanced MRI techniques to better understand their potential in identifying the different characteristics of high-grade gliomas, primary lymphoma and brain metastases and in predicting clinical outcome and response to surgery and chemo-irradiation. Diffusion and perfusion techniques, such as diffusion tensor imaging (DTI), diffusional kurtosis imaging (DKI), dynamic susceptibility contrast-enhanced (DSC) perfusion imaging, dynamic contrast-enhanced (DCE) perfusion imaging, arterial spin labeling (ASL), spectroscopy and amide proton transfer (APT), were the advanced MRI procedures we reviewed.

PO-05-009 SAFETY OF MAGNETIC RESONANCE IMAGING IN PATIENTS WITH SURGICALLY IMPLANTED PERMANENT EPICARDIAL LEADS

Magnetic resonance imaging (MRI) safety in patients with an epicardial cardiac implantable electronic device (CIED) is uncertain. To assess the safety and adverse effects of MRI in patients who had surgically implanted epicardial CIED. Patients with surgically implanted CIEDs who underwent MRI between January 2008 and January 2021 were prospectively studied in two clinical centers. All patients underwent close cardiac monitoring through MRI procedures. Outcomes were compared between the epicardial CIED group and matched transvenous CIED group. Twenty-nine consecutive patients with epicardial CIED (male 41.4%, mean age of 43 years) underwent 52 MRIs in the 57 anatomic regions. Sixteen patients had pacemakers, 9 had cardiac defibrillators or cardiac resynchronization therapy defibrillators, and 4 had no device generators. There were no significant adverse events in epicardial or transvenous CIED groups. The battery life, pacing, sensing thresholds, lead impedance and cardiac biomarkers were not significantly changed, except one patient had a transient decrease in atrial lead sensing function. MRI of CIEDs with epicardially implanted leads does not represent a greater risk than the transvenous CIEDs.

Safety of magnetic resonance imaging in patients with surgically implanted permanent epicardial leads

Magnetic resonance imaging (MRI) safety in patients with an epicardial cardiac implantable electronic device (CIED) is uncertain. The purpose of this study was to assess the safety and adverse effects of MRI in patients who had surgically implanted epicardial CIED. Patients with surgically implanted CIEDs who underwent MRI with an appropriate cardiology-radiology collaborative protocol between January 2008 and January 2021 were prospectively studied in 2 clinical centers. All patients underwent close cardiac monitoring through MRI procedures. Outcomes were compared between the epicardial CIED group and the matched non-MRI-conditional transvenous CIED group. Twenty-nine consecutive patients with epicardial CIED (41.4% male; mean age 43 years) underwent 52 MRIs in 57 anatomic regions. Sixteen patients had a pacemaker, 9 had a cardiac defibrillator or cardiac resynchronization therapy-defibrillator, and 4 had no device generator. No significant adverse events occurred in the epicardial or transvenous CIED groups. Battery life, pacing, sensing thresholds, lead impedance, and cardiac biomarkers were not significantly changed, except 1 patient had a transient decrease in atrial lead sensing function. MRI of CIEDs with epicardially implanted leads does not represent a greater risk than transvenous CIEDs when performed with a multidisciplinary collaborative protocol centered on patient safety.