Magnetic Resonance Imaging Reports Research Articles

Preoperative magnetic resonance imaging characteristics of oval circumscribed fast enhancing lesions in patients with newly diagnosed breast cancer.

The aim of this study was to investigate the follow-up results and characteristics of oval circumscribed lesions with fast initial enhancement on preoperative magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer.Preoperative data from consecutive patients newly diagnosed with breast cancer between 2010 and 2013 were retrospectively reviewed. Only MRI reports containing, “oval shape, circumscribed margin, and fast initial enhancement,” were extracted and analyzed. Follow-up results and clinical and pathological findings were evaluated.A total of 430 oval circumscribed lesions with fast initial enhancement were included. Forty-eight lesions were pathologically confirmed at initial workup and 382 were followed up. Among the 48 lesions, 14 were found to have additional malignancy and 34 were benign. Among the 382 followed-up lesions, only 1 was subsequently confirmed to be malignant. There were no evident changes in any of the remaining lesions during follow-up. The overall rate of malignancy was 3.5% (15/430). When lesions exhibited delayed washout enhancing kinetics (P < .001), were located ipsilaterally (P = .007), and closer to the primary tumor (P = .012), the possibility of malignancy was high. High T2-weighted imaging signal intensity suggested benignity (P = .043).Although the probability of being diagnosed with malignancy during follow-up in this study was low (0.3%), this investigation revealed several preoperative MRI characteristics that should alert clinicians to the possibility of malignancy.

Extracardiac findings at cardiac MR imaging: a single-centre retrospective study over 14years.

To determine the prevalence and significance of extracardiac findings (ECF) in a large set of cardiac magnetic resonance (MR) imaging examinations. The institutional review board (IRB) of the Charité approved this retrospective, single-centre study. A total of 4376 cardiac MR imaging reports of 3553 patients (age 37.4 ± 20years, 60.8 % male) examined from 2000 to 2014 were included. Findings with a recommendation for follow-up were considered "major ECF". To analyse the association of indication, age and gender with ECF, Poisson regression and computed incidence rate ratios (IRR) were evaluated. The overall prevalence of ECF was 34% (95% confidence interval [CI] 32.5-35.6%). Major ECF were present in 3.4% (95% CI 2.9-4.1%) while findings that changed patient management were found in 0.9% (95% CI 0.7-1.3%). In the cases of congenital heart disease, ECF prevalence was higher compared to myocarditis (IRR, 6.0; 95% CI 5.1-7.1%; p < 0.001), while the prevalence of major ECF was lower (IRR, 0.2; 95% CI 0.02-0.51%; p < 0.05). Older patient age was associated with more nonvascular ECF (p < 0.001). Female patients had the same probability of having an ECF as male patients (IRR, 1.04; 95% CI 0.95-1.1%; p = 0.43). ECF in cardiac MR imaging are present in about every third patient while relevant ECF that change patient management can be found in about one out of 100 patients. Our data suggest that it is important to involve well-trained radiologists in reading cardiac MR images, which often reveal ECF if congenital heart disease is the clinical indication. • Extracardiac findings are present in about every third patient. • Relevant ECF changing patient management are found in one out of 100 findings. • Chance of ECF is high in patients with CHD and vascular indications.

High Rate of Missed Lateral Meniscus Posterior Root Tears on Preoperative Magnetic Resonance Imaging.

Background:Lateral meniscus posterior root tears (LMPRTs), if left untreated, can cause devastating effects to the knee, with rapid articular cartilage degeneration and loss of the meniscus as a secondary stabilizer. Detection and surgical repair of these defects have been linked to favorable outcomes, but preoperative identification of LMPRTs continues to be challenging.Purpose:To determine the rate of LMPRTs diagnosed preoperatively on magnetic resonance imaging (MRI) in a consecutive series of arthroscopically confirmed LMPRTs.Study Design:Case series; Level of evidence, 4.Methods:A retrospective cohort of 45 consecutive patients with arthroscopically confirmed LMPRTs between 2010 and 2017 were included in this study. The preoperative MRI report for each patient was evaluated and compared with intraoperative findings. Each preoperative MRI study was then reviewed by 2 fellowship-trained musculoskeletal radiologists who worked in consensus.Results:A total of 45 patients (32 males, 13 females) with arthroscopically confirmed LMPRTs and a mean age of 27 years (range, 14-54 years) were included in the study. Only 15 of 45 LMPRTs (33%) were initially diagnosed on preoperative MRI. Past or concurrent anterior cruciate ligament (ACL) reconstruction was present in 37 of 45 cases (82%). Upon retrospective review, 15 of the 30 missed LMPRTs were “clearly evident,” 12 “subtly evident,” and 3 “occult” (unavoidably missed). There were no significant differences in the rate of LMPRT diagnosis based on history of prior knee surgery, meniscus extrusion, or tearing of the meniscofemoral ligament.Conclusion:Despite improved identification of other meniscus tear patterns on MRI, a high percentage of LMPRTs were still missed. In the setting of previous ACL reconstruction, if the root cannot be confidently identified, the MRI interpretation should indicate that “the root is poorly visualized” to alert the surgeon to thoroughly evaluate this structure. The surgeon should maintain a high index of suspicion and carefully probe the posterior root of the lateral meniscus at the time of arthroscopy, especially in cases of ACL injury.

Non-invasive detection of adeno-associated viral gene transfer using a genetically encoded CEST-MRI reporter gene in the murine heart

Research into gene therapy for heart failure has gained renewed interest as a result of improved safety and availability of adeno-associated viral vectors (AAV). While magnetic resonance imaging (MRI) is standard for functional assessment of gene therapy outcomes, quantitation of gene transfer/expression relies upon tissue biopsy, fluorescence or nuclear imaging. Imaging of gene expression through the use of genetically encoded chemical exchange saturation transfer (CEST)-MRI reporter genes could be combined with clinical cardiac MRI methods to comprehensively probe therapeutic gene expression and subsequent outcomes. The CEST-MRI reporter gene Lysine Rich Protein (LRP) was cloned into an AAV9 vector and either administered systemically via tail vein injection or directly injected into the left ventricular free wall of mice. Longitudinal in vivo CEST-MRI performed at days 15 and 45 after direct injection or at 1, 60 and 90 days after systemic injection revealed robust CEST contrast in myocardium that was later confirmed to express LRP by immunostaining. Ventricular structure and function were not impacted by expression of LRP in either study arm. The ability to quantify and link therapeutic gene expression to functional outcomes can provide rich data for further development of gene therapy for heart failure.

The Distended Fetal Hypopharynx: A Sensitive and Novel Sign for the Prenatal Diagnosis of Esophageal Atresia

Background/PurposeAlthough advances have been made in the prenatal diagnosis of esophageal atresia (EA), most neonates are not identified until after birth. The distended hypopharynx (DHP) has been suggested as a novel prenatal sign for EA. We assess its diagnostic accuracy and predictive value on ultrasound (US) and magnetic resonance imaging (MRI), both alone and in combination with the esophageal pouch (EP) and secondary signs of EA (polyhydramnios and a small or absent fetal stomach). MethodsWe retrospectively reviewed fetal US and MRI reports and medical records of 88 pregnant women evaluated for possible EA from 2000 to 2016. Seventy-five had postnatal follow-up that confirmed or disproved the diagnosis of EA and were included in our analysis. ResultsSeventy-five women had 107 study visits (range 1–4). DHP and/or EP were seen on US and/or MRI in 36% of patients, and 78% of those patients had EA. DHP was 24% more sensitive for EA than EP, while EP was 30% more specific. After 28weeks of gestation, DHP had a predictive accuracy for EA of 0.929 (P=0.001). ConclusionsDHP is a sensitive additional prenatal sign of EA. More accurate diagnosis of EA allows for improved counseling regarding delivery, postnatal evaluation, and surgical correction. Type of StudyDiagnostic. Level of EvidenceLevel II.

Seventeen years of prenatal magnetic resonance imaging at the Institute of Mother and Child in Warsaw.

PurposeThe purpose of this paper is to summarise and to present the experience of the main Polish centre for prenatal magnetic resonance imaging (MRI) and to discuss the place and role of MRI in antenatal diagnosis, management, and counselling.Material and methodsRetrospective analysis of the examinations performed in the years 2001-2017.ResultsIn total, 1221 medical records and/or image files were collected. The full documentation of ultrasonography and MRI referrals, reports, and images was not available in every case. During the first three years 98 pregnant women were examined (approximately 33 per year, one study per fortnight). After purchase of own MR scanner, the number of examinations grew constantly, reaching 208 in 2017, which means almost one per day, and the highest number was eight in one day. We examined 45 pairs of twins, including three pairs of conjoined twins.ConclusionsMRI at our Institute is a practically used second-line foetal imaging tool, necessary to confirm, complete, or correct sonographic diagnoses, with important impact on clinical decisions concerning management of pregnancy and of the neonate, termination of pregnancy, choice of the time, place, and mode of delivery, and neonatal care, as well as on counselling. In experienced hands, MRI is to date the last and the best non-invasive method of diagnosis in utero. It is frequently requested by the interdisciplinary team for foetal diagnosis and therapy and routinely performed in everyday practice.

Relationship between thoracic kyphosis and neural axis abnormalities in patients with adolescent idiopathic scoliosis.

PurposePrevious studies have suggested an association between increased thoracic kyphosis and neural axis abnormalities in patients with adolescent idiopathic scoliosis (AIS). However, the basis for this finding is unclear, and this association has been mainly noted in retrospective studies on a non-consecutive series of patients. The purpose of this study was to assess the relationship between thoracic kyphosis and neural axis abnormalities in patients with AIS.MethodsWe studied a consecutive series of AIS patients treated with spinal fusion. Thoracic kyphosis (T2 to T12) was measured from preoperative lateral radiographs. All patients underwent a spine magnetic resonance imaging (MRI) prior to surgery, and MRI reports were reviewed to determine the presence of neural axis abnormalities. Statistical analyses included descriptive statistics and chi-squared analysis.ResultsThis study included 210 patients with AIS. There were no significant differences in age or gender between patients with thoracic hypokyphosis (kyphosis < 20°), normal thoracic kyphosis (kyphosis 20° to 40°) and thoracic hyperkyphosis (kyphosis > 40°) (p > 0.05). Neural axis abnormalities were present in 17.9% of patients with thoracic hypokyphosis, 9.8% of patients with normal thoracic kyphosis and 13.6% of patients with thoracic hyperkyphosis (p = 0.60). There were no significant differences in rates of Chiari malformation, syrinx, intra-spinal masses and other central nervous system abnormalities between groups (p > 0.05).ConclusionsThoracic kyphosis was not associated with neural axis abnormalities in our consecutive series of patients with AIS. Increased thoracic kyphosis may not be a reliable indicator for the presence of neural axis abnormalities in patients with AIS.Level of EvidenceIV

Changes in Primary Care Health Care Utilization after Inclusion of Epidemiologic Data in Lumbar Spine MR Imaging Reports for Uncomplicated Low Back Pain.

Purpose To determine whether inclusion of an epidemiologic statement in radiology reports of lumbar magnetic resonance (MR) imaging influences downstream health care utilization in the primary care population. Materials and Methods Beginning July 1, 2013, a validated epidemiologic statement regarding prevalence of common findings in asymptomatic patients was included in all lumbar MR imaging reports at a tertiary academic medical center. Data were collected from July 1, 2012, through June 30, 2014, and retrospective analysis was completed in September 2016. The electronic medical record was reviewed to capture health care utilization rates in patients for 1 year after index MR imaging. Of 4527 eligible adult patients with low back pain referred for lumbar spine MR imaging during the study period, 375 patients had their studies ordered by in-network primary care providers, did not have findings other than degenerative disease, and had at least one follow-up encounter within the system within 1 year of index MR imaging. In the before-and-after study design, a pre-statement-implementation cohort was compared with a post-statement-implementation cohort by using univariate and multivariate statistical models to evaluate treatment utilization rates in these groups. Results Patients in the statement group were 12% less likely to be referred to a spine specialist (137 of 187 [73%] vs 159 of 188 [85%]; P = .007) and were 7% less likely to undergo repeat imaging (seven of 187 [4%] vs 20 of 188 [11%]; P = .01) compared with patients in the nonstatement group. The intervention was not associated with any change in narcotic prescription (53 of 188 [28%] vs 54 of 187 [29%]; P = .88) or with the rate of low back surgery (24 of 188 [13%] vs 16 of 187 [9%]; P = .19). Conclusion In this study, inclusion of a simple epidemiologic statement in lumbar MR imaging reports was associated with decreased utilization in high-cost domains of low back pain management. © RSNA, 2018.

Determination of High Density Impact for Cognitive Variations from Brain MRI Analysis

Medical analysis improvised day-by-day processing huge amount of data related to brain MRI (Magnetic Resonance Imaging) reports which ensures gray matter stability in human through various cognitive performances. Epidemiological includes distribution and control of disease, to view genetic variation which symbolizes and characterize the detailed molecular and cellular mechanisms that forwards via actively and privately relevant to check brain function. Also, this information features the immense capability of non-human primate models in propelling our comprehension of human hereditary variety affecting conduct and neuropsychiatric illness risk. In the paper, to enhance the performance and decrease the complexity includes in the medicinal picture segmentation process. Brain tumor segmentation process depends on Berkeley wavelet transform (BWT) mechanism. The Support Vector Machine (SVM) based classifier utilized to enhance the accurateness and quality rate and related features are extricated from every fragmented tissue. The proposed framework accomplished for recognizing normal and abnormal tissues from cerebrum MRI pictures. It estimated and verified for performance and quality investigation on magnetic resonance cerebrum pictures. Based on Experimental evaluations, proposed algorithm enhances sensitivity 2.6%, specificity 14.46%, and accuracy 6.47% of the proposed framework contrasted than previous classifiers.

Clinical importance of second-opinion interpretations by radiologists specializing in gynecologic oncology at a tertiary cancer center: magnetic resonance imaging for endometrial cancer staging.

ObjectiveTo determine whether there are substantive differences between the initial interpretations of magnetic resonance imaging (MRI) scans acquired at outside facilities and the second-opinion interpretations of radiologists specializing in gynecologic oncology at a tertiary cancer center, among patients referred for endometrial cancer staging.Materials and MethodsThis was a retrospective, comparative analysis of 153 initial and second-opinion MRI reports for endometrial cancer staging officially submitted for review by radiologists specializing in gynecologic oncology. For each case, the relationship between the initial and second-opinion reports, regarding the suggested diagnosis and the clinically relevant MRI findings reported, was categorized as "agreement" or "disagreement". Histopathology was used in order to establish the definitive diagnosis.ResultsDisagreement was found in 58 (37.9%) of the 153 cases. Second-opinion interpretations reported findings that affected the preoperative cancer staging and could have led to a change in treatment in 38 cases (24.8%); that did not affect the preoperative staging but provided information that was more accurate in 8 (5.2%); and that suggested a new cancer diagnosis in 12 (7.8%). In 37 cases (24.2%), there was a potential for changes in patient care. Among the 58 cases of disagreement, a definitive (histopathological) diagnosis was made in 41 (70.7%). In 31 (75.6%) of those 41 cases, the second-opinion report was more accurate than was the initial report.ConclusionDiscordant interpretations of MRI examinations, which can have a substantial effect on the clinical management of patients, appear to be common.

The use of gadolinium-based contrast agents in Ghana with a focus on residual intracranial gadolinium deposition

IntroductionThe aim of the survey was to identify current practice of the use of gadolinium-based contrast agents (GBCAs) in the wake of recent reports on gadolinium deposition in the brain following repeated administration of GBCAs. MethodA total of 13 facilities in Ghana with magnetic resonance imaging (MRI) departments were contacted via email with a two-page questionnaire. ResultsA response rate of 69.2% (n = 9) was achieved. Gadodiamide (Omniscan) was the most commonly used GBCA. Slightly more than half of respondents were aware of residual deposition of GBCAs in the brain. Majority of the respondents were aware of GBCA deposition in individuals with abnormal renal function, but not aware of its deposition in those with normal renal function. A great majority of the respondents do not record the type and dose of GBCA after each intravenous administration, and such information is not provided in MRI reports. More than half of the respondents do not check eGFR prior to the administration of GBCA even when a high-risk agent is used. ConclusionGadodiamide (Omniscan) a high-risk agent remains the most commonly used GBCA in Ghana. Awareness of current findings of GBCA deposition in the brain following repeated doses are not encouraging as revealed in this study. The need to adopt international standard guidelines into practice cannot be overemphasized in order to reduce the potential long-term effect of this deposition.

A Case of Unusual Presentation of Transverse and Sigmoid Sinus Thrombosis in Puerperium

1. Abstract Cerebral vein thrombosis is an uncommon disorder in puerperium. Patient can present with various manifestations like headache, abnormal vision, or any of the symptoms of stroke such as weakness of the face and limbs on one side of the body, and seizures. We are presenting a case of primigravida with 37+2 Weeks Period of Gestation with Dichorionic Diamniotic twins with breech presentation. Post LSCS on Postoperative day 5. Patient presented with severe headache followed by seizure. MRI report came as transverse and sigmoid sinus thrombosis, managed successfully with heparin and mannitol. Patient was stable and was discharged on day 10 2. Keywords: Cerebral vein thrombosis (CVT); Inj Heparin; Lower segment caesarean section (LSCS); Magnetic resonance imaging (MRI); Seizure

Ultrasound classification of traumatic distal biceps brachii tendon injuries

ObjectiveThe present work is aimed at analysing ultrasound findings in patients with distal biceps brachii tendon (DBBT) injuries to assess the sensitivity of ultrasound in detecting the different forms of injury, and to compare ultrasound results with magnetic resonance imaging (MRI) and surgical results.Materials and methodsA total of 120 patients with traumatic DBBT injuries examined between 2011 and 2015 were analysed. We compared ultrasound results with MRI results when surgery was not indicated and with MRI and surgical results when surgery was indicated.ResultsFor major DBBT injuries (complete tears and high-grade partial tears), the concordance study between exploration methods and surgical results found that ultrasound presented a slight statistically significant advantage over MRI (ultrasound: κ = 0.95—very good—95% CI 0.88 to 1.01, MRI: κ = 0.63—good—95% CI 0.42 to 0.84, kappa difference p < 0.01). Minor injuries, in which most tendon fibres remain intact (tendinopathies, elongations and low-grade partial tears), are the most difficult to interpret, as ultrasound and MRI reports disagreed in 12 out of 39 cases and no surgical confirmation could be obtained.ConclusionsBased on present results and previous MRI classifications, we establish a traumatic DBBT injury ultrasound classification. The sensitivity and ultrasound–surgery correlation results in the diagnosis of major DBBT injuries obtained in the present study support the recommendation that ultrasound can be used as a first-line imaging modality to evaluate DBBT injuries.

Magnetic resonance imaging findings in patients with low backache

Introduction: Low backache is commonly experienced by adults at some time during their lives. Though it is caused by degenerative changes, spinal stenosis, neoplasm, infection and trauma, lumbar disc degeneration is the most commonly diagnosed abnormalities associated. As Magnetic Resonance Imaging (MRI) is non invasive imaging technique with excellent spatial and contrast resolution, it has become the investigation of choice in evaluation of patients with low back pain. This study was designed to determine the patterns of degenerative disc disease on MRI in patients with low backache.Methods: A retrospective hospital based study was done by reviewing MRI report of 202 patients who underwent MRI of lumbar spine for complaint of chronic low back pain, radicular pain, neurogenic claudication or various other symptoms and signs suggestive of lumbar degenerative disc disease from January 2014 till June 2014. The patients having MRI findings of acute spinal infection, recent trauma, tumors, spinal dysraphism and metabolic conditions were excluded from the study.Results: Out of the 202 patients included in the study, 116 patients (57.4%) were male and 86 patients (42.6%) were female. The mean age of the study population was 44.26 ±15.61 (13-83) years. Multiple contiguous level disc disease was the most common type of involvement which was noted in 109 (54%) patients. Grade 4 lumbar disc degeneration (graded as per classification given by Pfirrmann et al) was noted in 65.3% (132) cases followed by Grade 2 in 25.2%(51) cases and Grade 1in 5.5% (11) cases. The most common involvement was observed at L4-L5 level (76.7%) and L5-S1 levels (55.9%) followed by L3-L4 (30.6%) in decreasing order of frequency. The most common category was disc bulge note in 46.5% (94) of cases. Nerve root compression was observed in 56% (114) of the total cases. Nerve root compromise was also noted most frequently compressing L5 nerve (28.23% of cases). Annular tear was observed in 14.4% (29) of cases and among them 20% (6) of cases had torn at two intervertebral discs. It is most frequently noted involving L4-L5 intervertebral disc (72.5% of cases), followed by L5-S1 (24.2% of cases).Conclusion: Disc generation is most common at L4-L5 level with multiple contiguous involvement of grade 4. Annular tear though not common can occur and is also common at L4-L5 level.Journal of Society of Surgeons of Nepal, 2015; 18 (2)

In Vivo MR Imaging of Dual MRI Reporter Genes and Deltex-1 Gene-modified Human Mesenchymal Stem Cells in the Treatment of Closed Penile Fracture.

The purpose of this study was to investigate the feasibility of dual magnetic resonance imaging (MRI) reporter genes, including ferritin heavy subunit (Fth) and transferrin receptor (TfR), which provide sufficient MRI contrast for in vivo MRI tracking, and the Deltex-1 (DTX1) gene, which promotes human mesenchymal stem cell (hMSC) differentiation to smooth muscle cells (SMCs), to treat closed penile fracture (CPF). Multi-gene co-expressing hMSCs were generated. The expression of mRNA and proteins was assessed, and the original biological properties of hMSCs were determined and compared. The intracellular uptake of iron was evaluated, and the ability to differentiate into SMCs was detected. Fifty rabbits with CPF were randomly transplanted with PBS, hMSCs, Fth-TfR-hMSCs, DTX1-hMSCs, and Fth-TfR-DTX1-hMSCs. In vivo MRI was performed to detect the distribution and migration of the grafted cells and healing progress of CPF, and the results were correlated with histology. The mRNA and proteins of the multi-gene were highly expressed. The transgenes could not influence the original biological properties of hMSCs. The dual MRI reporter genes increased the iron accumulation capacity, and the DTX1 gene promoted hMSC differentiation into SMCs. The distribution and migration of the dual MRI reporter gene-modified hMSCs, and the healing state of CPF could be obviously detected by MRI and confirmed by histology. The dual MRI reporter genes could provide sufficient MRI contrast, and the distribution and migration of MSCs could be detected in vivo. The DTX1 gene can promote MSC differentiation into SMCs for the treatment of CPF and effectively inhibit granulation tissue formation.

In Vivo Long-Term Tracking of Neural Stem Cells Transplanted into an Acute Ischemic Stroke model with Reporter Gene-Based Bimodal MR and Optical Imaging

Transplantation of neural stem cells (NSCs) is emerging as a new therapeutic approach for stroke. Real-time imaging of transplanted NSCs is essential for successful cell delivery, safety monitoring, tracking cell fate and function, and understanding the interactions of transplanted cells with the host environment. Magnetic resonance imaging (MRI) of magnetic nanoparticle-labeled cells has been the most widely used means to track stem cells in vivo. Nevertheless, it does not allow for the reliable discrimination between live and dead cells. Reporter gene-based MRI was considered as an alternative strategy to overcome this shortcoming. In this work, a class of lentiviral vector-encoding ferritin heavy chain (FTH) and enhanced green fluorescent protein (EGFP) was constructed to deliver reporter genes into NSCs. After these transgenic NSCs were transplanted into the contralateral hemisphere of rats with acute ischemic stroke, MRI and fluorescence imaging (FLI) were performed in vivo for tracking the fate of transplanted cells over a long period of 6 wk. The results demonstrated that the FTH and EGFP can be effectively and safely delivered to NSCs via the designed lentiviral vector. The distribution and migration of grafted stem cells could be monitored by bimodal MRI and FLI. FTH can be used as a robust MRI reporter for reliable reporting of the short-term viability of cell grafts, whereas its capacity for tracking the long-term viability of stem cells remains dependent on several confounding factors such as cell death and the concomitant reactive inflammation.

Clinical significance of prostate 18F-labelled fluorodeoxyglucose uptake on positron emission tomography/computed tomography: A five-year review.

AIMTo determine the significance and need for investigation of incidental prostatic uptake in men undergoing 18F-labelled fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for other indications.METHODSHospital databases were searched over a 5-year period for patients undergoing both PET/CT and prostate magnetic resonance imaging (MRI). For the initial analysis, the prostate was divided into six sectors and suspicious or malignant sectors were identified using MRI and histopathology reports respectively. Maximum and mean 18F-FDG standardised uptake values were measured in each sector by an investigator blinded to the MRI and histopathology findings. Two age-matched controls were selected per case. Results were analysed using a paired t-test and one-way ANOVA. For the second analysis, PET/CT reports were searched for prostatic uptake reported incidentally and these patients were followed up.RESULTSOver a 5-year period, 15 patients underwent both PET/CT and MRI and had biopsy-proven prostate cancer. Malignant prostatic sectors had a trend to higher 18F-FDG uptake than benign sectors, however this was neither clinically nor statistically significant (3.13 ± 0.58 vs 2.86 ± 0.68, P > 0.05). 18F-FDG uptake showed no correlation with the presence or histopathological grade of tumour. 18F-FDG uptake in cases with prostate cancer was comparable to that from age-matched controls. Forty-six (1.6%) of 2846 PET/CTs over a 5-year period reported incidental prostatic uptake. Of these, 18 (0.6%) were investigated by PSA, 9 (0.3%) were referred to urology, with 3 (0.1%) undergoing MRI and/or biopsy. No cases of prostate cancer were diagnosed in patients with incidental 18F-FDG uptake in our institute over a 5-year period.CONCLUSION18F-FDG uptake overlaps significantly between malignant and benign prostatic conditions. Subsequent patient management was not affected by the reporting of incidental focal prostatic uptake in this cohort.

Is Magnetic Resonance Imaging (MRI) Reliable in the Diagnosis of Ankle Instability

Category: Ankle, Sports, Trauma Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. The aim of this study was to specifically analyse the reliability of MRI reported lateral ligament findings in relation to examination under anaesthesia and stress X-rays in patients with symptomatic ankle instability. Methods: A single centre, single surgeon consecutive series of patients who had undergone examination under anaesthesia and stress X-rays preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and procedure findings were extracted and analysed. Results: Between April 2012 and December 2016, 49 patients who fulfilled the above criteria were included. There were 25 male and 24 female patients, the average age was 43.1. The average time interval between MRI scan and examination under anaesthesia was 9.7 months (2-49 months). There is a significant association between MRI reported lateral ligament findings and status of ankle stability detected on examination under anaesthesia and stress views, p=0.003 (Chi-square analysis for association). In 34 patients who had abnormal lateral ligament findings on MRI, 20 patients (58.8%) had stable findings and 14 (41.2%) had unstable findings on stress views. There was, however, a 100% concordance between MRI reported normal lateral ligament findings and stability on examination under anaesthesia and stress views (N=15). Conclusion: MRI is accurate in diagnosing the status of ankle ligaments and in particular, in predicting true stability.

Is Magnetic Resonance Imaging (MRI) Reliable in the Diagnosis of Osteochondral Lesions (OCL’s)?

Category: Ankle, Arthroscopy Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. Musculoskeletal radiologists aim to determine and report both chondral and/or osseous stability/instability of each lesion. The aim of this study was to specifically analyse the reliability of MRI reported findings in predicting the stability of OCL’s in symptomatic patients. Methods: A single centre, single surgeon consecutive series of patients who had undergone an ankle arthroscopy procedure preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and arthroscopic findings were extracted and analysed. Arthroscopy findings were taken as the gold standard. Results: Between April 2012 and July 2016, 48 patients who fulfilled the criteria were included. There were 27 male and 21 female patients, the average age was 43.4. Average time interval between MRI and arthroscopy was 9 months. There was a significant negative relationship between OCL’s reported as stable on MRI to arthroscopic findings, r=-.31, p=0.03. Of the 21 patients who had OCL’s reported as stable on the MRI, all had unstable lesions on arthroscopic evaluation (100%). One patient had an unstable OCL reported on the MRI and it was also unstable arthroscopically. In 27 patients, there was no mention of the stability of the reported OCL on the MRI, 22 patients (81.5%) had unstable lesions and 5 patients (18.5%) had stable lesions on arthroscopic findings. Conclusion: This study demonstrates that MRI has a poor predictive value for the stability of OCL’s of the ankle. Therefore we recommend that in the symptomatic patient an arthroscopy is indicated irrespective of MRI findings.

PE24 - Comparison of 3D printed prostate models with standard radiological information to aid understanding of the precise location of prostate cancer: A construct validation study

Background To investigate the reliability with which healthcare professionals with different levels of expertise are able to impart the exact location of prostate cancer (PCA) after (A) reading written magnetic resonance imaging (MRI) reports, (B) attending MRI presentations in multidisciplinary team meetings (MDT), and (C) examining 3D printed prostate models, which represents a new technology to describe the location of PCA lesions. Methods We used three different PCA cases to assess the three information tools. Construct validation was performed using two healthcare groups with different levels of expertise: (1) Nine expert urologists in PCA, and (2) nine medical students. After each information tool, the study participants plotted the tumor location in a 2-dimensional prostate diagram. A scoring system was established to evaluate the drawings in terms of accuracy of plotting tumor position. Data are shown as median scores with interquartile range. Results Within the expert group, no significant difference was seen in the overall scoring results between the information tools (p = 0.34). Medical students performed significantly worse with MDT information (p = 0.03). Experts performed better in all three information tools compared to students, resulting in a significantly 25% higher overall total score (25.0[22.3–26.7] vs. 20.0[15.0–24.0], p<0.001). The difference was largest after MDT information, with experts showing a 49% better scoring (p<0.001), and second largest with the 3D printed models, showing a 17% better scoring of the experts (p = 0.07). No difference was found in the written MRI report scoring results between experts and students. Conclusions 3D printed models provided better orientation guide to medical students compared to MDT MRI presentations. This indicates that the 3D printed models might be easier to understand than the current gold standard MDT conferences. Therefore, 3D models may play an increasingly important role in providing guidance for orientation for less experienced individuals, such as surgical trainees.