MRI Screening Research Articles

Two-Stage Recruitment Design to Reduce Magnetic Resonance Imaging Screening Cost for a Theoretical Clinical Trial of White Matter Hyperintensity Progression.

White matter hyperintensities (WMH) and their progression are associated with risk of dementia and stroke, so are an important target for clinical trials. The cost of broad magnetic resonance imaging (MRI) screening to identify eligible individuals, however, limits the feasibility of designing clinical trials targeting WMH. A low-cost retinal or clinical screening measure before MRI could reduce recruitment costs versus an MRI-only screening design in a hypothetical clinical trial. Data from the Atherosclerosis Risk in Communities study with valid retinal and WMH measurements (N=1311) were used. To identify a population at greater likelihood of significant WMH on MRI and thus reduce the number of screening MRIs required, we evaluated 3 theoretical prescreening measures: (1) retinal, (2) clinical, (3) combined clinical-retinal. Given a target sample for clinical trials (N=646), we calculated screening sample sizes based on the proportion within the population having an elevated score for each prescreening measure (separately) multiplied by the proportion of significant WMH among those with that prescreening feature. Recruitment costs were calculated using estimated retinal and MRI cost estimates. Compared with the estimated cost of MRI-only screening (>$4.24 million, requiring MRI on 6526 participants), prescreening for a high clinical score resulted in total cost of $2.47 million, with an initial screening group of 52 778 participants, with MRI in 3801. A high clinical-retinal score cutoff resulted in costs of $2.9 million while requiring 13 572 participants, with 3801 completing MRI. A 2-stage design with low-cost prescreening measures is a promising approach, resulting in reduced theoretical recruitment costs compared with an MRI-only design.

Performance of breast MRI for high-risk screening during lactation.

To assess the diagnostic performance of breast MRI during lactation in the setting of high-risk breast cancer screening. Screening breast MRIs performed between April 2008 and March 2024 were retrospectively reviewed. Background parenchymal enhancement (BPE) grade was compared between lactating patients and patients who recently stopped lactating using the Mann-Whitney test. Breast Imaging Reporting and Data System (BI-RADS) scores prevalence rates were compared between lactating patients and controls encompassing young non-lactating patients using the Chi-square test. Diagnostic performance was calculated for patients with a biopsy reference or a 1-year radiologic follow-up. One-hundred forty-two screening breast MRIs were performed in lactating patients (n = 104, median age, 36.0 ± 6.0 years). Marked BPE appeared in 82% of cases (116/142), with a higher BPE grade in exams performed during lactation as compared with those performed in patients who had recently ceased lactating (p < 0.001). Screening MRIs performed during lactation had a higher rate of BI-RADS 3 scores (40/142, 28% vs. 683/8922, 7%, p < 0.001) and a lower rate of BI-RADS 1/2 scores (88/142, 62% vs. 7549/8922, 84.6%, p = 0.002) compared with those performed in controls (n = 8922). One pregnancy-associated breast cancer was detected, and one interval-cancer occurred. All MRI-guided biopsies were negative (n = 13). Screening breast MRI during lactation had 50% sensitivity (1/2), 60% specificity (72/120), 2.0% positive predictive value (1/49), and 98.6% negative predictive value (71/82). The efficacy of breast MRI for high-risk screening during lactation is limited by prominent BPE, leading to an increased rate of BI-RADS 3 categorization and diminished overall specificity. Question Studies on breast MRI during lactation were solely focused on studies conducted in patients with known cancer but not in the screening setting. Findings Screening breast MRI during lactation usually results in marked background parenchymal enhancement, negatively impacting its diagnostic performance. Clinical relevance Despite the lower performance, and amidst the significant risk of pregnancy-associated breast cancer, this screening approach remains relevant for lactating patients with high-risk profiles, such as BReast Cancer (BRCA) carriers. Radiologists should be familiar with the normal appearance of breast MRI duringlactation.

A New Computer-Aided Diagnosis System for Breast Cancer Detection from Thermograms Using Metaheuristic Algorithms and Explainable AI

Advances in the early detection of breast cancer and treatment improvements have significantly increased survival rates. Traditional screening methods, including mammography, MRI, ultrasound, and biopsies, while effective, often come with high costs and risks. Recently, thermal imaging has gained attention due to its minimal risks compared to mammography, although it is not widely adopted as a primary detection tool since it depends on identifying skin temperature changes and lesions. The advent of machine learning (ML) and deep learning (DL) has enhanced the effectiveness of breast cancer detection and diagnosis using this technology. In this study, a novel interpretable computer aided diagnosis (CAD) system for breast cancer detection is proposed, leveraging Explainable Artificial Intelligence (XAI) throughout its various phases. To achieve these goals, we proposed a new multi-objective optimization approach named the Hybrid Particle Swarm Optimization algorithm (HPSO) and Hybrid Spider Monkey Optimization algorithm (HSMO). These algorithms simultaneously combined the continuous and binary representations of PSO and SMO to effectively manage trade-offs between accuracy, feature selection, and hyperparameter tuning. We evaluated several CAD models and investigated the impact of handcrafted methods such as Local Binary Patterns (LBP), Histogram of Oriented Gradients (HOG), Gabor Filters, and Edge Detection. We further shed light on the effect of feature selection and optimization on feature attribution and model decision-making processes using the SHapley Additive exPlanations (SHAP) framework, with a particular emphasis on cancer classification using the DMR-IR dataset. The results of our experiments demonstrate in all trials that the performance of the model is improved. With HSMO, our models achieved an accuracy of 98.27% and F1-score of 98.15% while selecting only 25.78% of the HOG features. This approach not only boosts the performance of CAD models but also ensures comprehensive interpretability. This method emerges as a promising and transparent tool for early breast cancer diagnosis.

Organ-Specific Iron Overload in Non-Transfusion-Dependent Thalassemia Patients: Insights from Quantitative MRI Evaluation

ObjectiveTo elucidate the iron load in different organs of non-transfusion-dependent thalassemia (NTDT) patients using magnetic resonance imaging (MRI) T2* scan. MethodsThirty-four NTDT patients, including 28 NTDT iron chelation without and 6 NTDT with iron chelation, together with 15 normal controls, underwent MRI examination between December 2022 and July 2024 were enrolled in the study. Measured T2* of the pituitary gland, kidney cortex, heart, liver, pancreas, spleen. Liver and spleen volumes were evaluated. ResultsOf the 28 patients in NTDT without iron chelation group, 19 patients with iron overload in the liver, 9 patients with iron overload in the kidneys, and 4 patients with iron overload in the spleen. Most patients with abnormal kidney and spleen iron (76.9 %) had liver iron overload. Compared with the control group, NTDT without iron chelation patients had lower T2* in the liver, kidney, and spleen (p < 0.05). And heart T2* was correlated with kidney T2* (r = 0.480, p = 0.010) and pancreas (r = 0.411, p = 0.037). Liver T2* was correlated with spleen T2* (r = 0.479, p = 0.011). Pancreas T2* was correlated with pituitary T2* (r = -0.433, p = 0.031). ConclusionsNTDT patients exhibit significant organ-specific iron overload, particularly in the liver, kidneys, and spleen. The correlations between iron levels in different organs suggest interconnected mechanisms of iron accumulation. These findings highlight the importance of regular MRI screening to monitor and manage iron overload in NTDT patients.

Prevalence and characteristics of minimal pleural fluid on screening chest MRI

BackgroundMinimal pleural fluid is often seen incidentally on chest MRI. However, its prevalence and clinical characteristics remain unknown. MethodsThis retrospective observational study included 2726 participants who underwent comprehensive medical check-ups for screening, including chest CT and MRI, and transthoracic echocardiography between March 2018 and February 2019. Pleural fluid on MRI was manually measured for maximum thickness. Its distribution, change over time, and relevance to participant characteristics were analyzed. The pulmonary function data of 82 participants and their associations with fluid were also analyzed. ResultsOf the 2726 participants (mean age ± standard deviation, 59 ± 11 years), 2009 (73.7%) had minimal pleural fluid (thickness, 1–9 mm) on either side, with right-sided fluid being more frequent than left-sided fluid (P < 0.001). Negligible changes in fluid thickness were observed one year later. The following parameters were associated with less fluid: age, ≥65 years (P < 0.001); male sex (P = 0.006); current smoking (P < 0.001); body mass index, ≥25 kg/m2 (P < 0.001); and mean arterial pressure, ≥100 mmHg (P = 0.01), whereas a ratio between early mitral inflow velocity and mitral annular early diastolic velocity>14 was associated with more fluid (P = 0.01). The presence of fluid was an independent explanatory variable for a higher percentage of predicted vital capacity (P = 0.048). ConclusionsMRI was highly sensitive in detecting minimal pleural fluid. Pleural fluid found on MRI for health screening was assumed to be physiological and fluid thickness at the steady state might be variable among participants depending on age, sex, smoking habits, body shape, blood pressure, and cardiac diastolic capacity.

Clinical experience on the limited role of ultrasound for breast cancer screening in BRCA1 and BRCA2 mutations carriers aged 30–39 years

PurposeIn BRCA germline pathogenic sequence variants (PSV) carriers aged 30–39 years imaging is recommended at six-month intervals. The European society for medical oncology recommendation of the use of 6-monthly MRI six-monthly MRI screening is being considered at our institution, particularly for younger carriers under the age of 35, although it is not mandatory. If 6-monthly MRI is unavailable, annual MRI may be supplemented by ultrasound (with or without mammography). The aim of this study was to evaluate the utility of ultrasound screening added to mammography, as a 6-month supplement to annual MRI in BRCA PSV carriers aged 30–39 years. Materials and methodsThis IRB approved retrospective study included BRCA PSV carriers aged 30–39 years, who underwent breast cancer screening at our institution between January 2015 and March 2023. Participants were divided into two groups, those who had supplemental whole-breast US and mammography at six months and underwent screening before March 2019, and those who had only mammography without supplemental US and enrolled in screening after March 2019. Patient characteristics, cancer detection rates and cancer characteristics were compared between the two groups. ResultsOverall, 200 asymptomatic BRCA1/2 PSV carriers undergoing screening in our institution were included in the study. Mean age was 35.7 ± 3.5 years, and mean follow-up time was 37.4 ± 38.0 months. There were 118 (59 %) women screened with supplemental US, and 82 (41 %) women without. Eight cancers were diagnosed during the study period, four in women with supplemental US and four in women without. The sensitivity of whole-breast screening US was 25 % (1/4), specificity 85.7 % (222/259), PPV 2.6 % (1/38), and NPV 98.7 % (222/225). Of the four cancers detected in women screened with supplemental US, one was diagnosed by whole-breast US, two by MRI, and one by mammography. Of eight cancers included in this study, two were not detectable by targeted second-look US. All eight cancers were detectable by MRI. ConclusionThe addition of whole-breast ultrasound to mammography and MRI screening in BRCA PSV carriers aged 30–39 years offered limited incremental benefit. MRI with 6 months supplemental mammography without US detected all cancer cases.

Defining the Need for Services for Patients at High Risk of Breast Cancer at a Safety-Net Hospital: An Approach to Narrowing the Disparities Gap.

The National Accreditation Program for Breast Cancer (NAPBC) standards were recently revised to promote breast cancer (BC) risk assessment and subsequent referral for high-risk services. This project sought to estimate the proportion of patients at high risk for BC in the authors' safety-net hospital system, gauge patient interest in high-risk services, and define resources for program development. Women presenting for breast imaging during 2 weeks in 2023 were surveyed. Thirty-five patients with a history or diagnosis of BC were excluded. The Tyrer-Cuzick (TC) model version 8 was used to calculate BC risk. High/intermediate risk was defined as a 10-year risk of 5% or more, a lifetime risk of 15% or more, or both. The criteria for genetic counseling and testing referral were based on National Comprehensive Cancer Network guidelines. A total of 257 patients had a TC risk assessment showing 14.8% (n = 38) with a 10-year BC risk of 5% or more (consideration of endocrine therapy), 6.2% (n = 16) with a lifetime BC risk of 20% or more (qualifying for annual screening MRI), and 10.5% (n = 27) with a lifetime BC risk of 15% or more (consideration of high-risk screening). The criteria for genetic counseling/testing were met by 61 (23.7%) of the 257 patients. Overall, 31.5% (n = 81) qualified for high/intermediate-risk screening, risk reduction, and/or genetic assessment/testing, 92.8% of whom were interested in referrals for additional information and care. In the authors' community, almost one third of patients undergoing breast imaging qualify for BC high-risk assessment and services. The majority of the patients expressed interest in pursuing such services. These data will be used in financial planning and resource allocation to develop a high-risk program at the authors' institution in line with NAPBC guidelines. They are hopeful that these efforts will improve oncologic outcomes and survival from BC in their community.

Projected Annual Lecanemab Treatment Eligibility in an Irish Regional Specialist Memory Clinic.

The advent of Disease Modifying Therapies (DMTs) for the treatment of Alzheimer's Disease (AD) has the potential to transform the lives of those with early AD. Timely identification of eligible patients is needed to ensure treatments are delivered during a narrow window of therapeutic opportunity. Appropriate clinical service design will hinge on improved understanding of future demands, thus there is a pressing need to investigate patient eligibility in real world clinical cohorts. The primary aim of this study is to assess the eligibility by appropriate use criteria (AUC) for lecanemab therapy in a real-world, undifferentiated clinical patient cohort attending a Regional Specialist Memory Clinic (RSMC), with the secondary aims of determining the proportion of patients with biomarker positive Alzheimer's Disease (AD) who would be eligible for lecanemab therapy by AUC. Clinical trial eligibility criteria were also applied to both groups and discrepancies that exist between eligibility rates explored. A retrospective cohort study of all new patients attending a RSMC from 1st January 2022 to 31st December 2022 was conducted. Data collected included demographic details, outcomes of diagnostic assessments and comorbidities. MRI images, where indicated, were reviewed. Amyloid positivity was defined as either Amyloid and Tau positive (A+T+) or Amyloid positive with a positive P-Tau/Ab42 ratio on cerebrospinal fluid (CSF) testing. Appropriate use criteria (AUC) and clinical trial criteria for lecanemab were applied. Proportion of eligible patients was calculated. Eleven (5.9%) of 188 new patient attenders were eligible (average age 66.7years [SD 8.9], 63.6% female) by AUC, with 26.2% of patients with biomarker positive Alzheimer's Disease eligible for lecanemab therapy. The most common reason for exclusion was a lack of biomarker confirmation of AD pathology followed by cognitive ineligibility (based on defined cognitive testing cut-offs) at the time of referral and/or initial assessment. Only 40.4% of patients had CSF testing for AD biomarkers while almost 20% of the patients with biomarker positive AD were excluded due to lack of a screening MRI in the previous 12months. In this study, the potential eligibility rate by AUC of the entire patient cohort (5.9%) was limited by the small proportion of patients who had CSF testing for AD biomarkers. So while disease-modification with Lecanemab is a welcome therapeutic advance, although only a small proportion of people currently attending specialist services will be eligible. Successful delivery of DMTs will require significant resource allocation and optimisation of referral pathways to facilitate early identification of potentially eligible patients.

Abstract A136: Design and interim review of a pragmatic stepped wedge cluster randomized clinical trial testing behavioral economic implementation strategies to increase supplemental breast MRI screening among patients with extremely dense breasts

Abstract INTRODUCTION Supplementing routine screening mammography with breast MRI can significantly increase cancer detection among women with extremely dense breasts, but breast MRI is not widely utilized. At Penn Medicine in 2021, only 8% of women with extremely dense breasts completed supplemental breast MRI screening, with even lower completion among Black women (3%). METHODS We designed a pragmatic trial to evaluate whether sending “nudges” (messages informed by behavioral economics) promoting breast MRI to patients, clinicians, or both increases breast MRI utilization among women with extremely dense breasts. Given baseline inequities, we also sought to assess whether nudges could reduce racial differences in MRI screening rates. This trial is being performed in a state with newly mandated insurance coverage for supplemental MRI screening for patients with extremely dense breasts. Patients aged 40-74 with extremely dense breasts reported on non-actionable mammograms are identified and independently randomized to receive a patient nudge or not. Patient nudges are delivered via text message following confirmation of identify and interest. Prior to launching the trial, rapid cycle approaches (RCAs) tested a set of messages in a diverse patient sample to optimize and de-risk nudge content. Clinicians receive nudges embedded within the mammogram report or through electronic health record in-basket messages. The primary outcome of the trial is ordering and/or scheduling of breast MRI within 6 months of a mammogram. Enrollment numbers and preliminary data on the implementation of the trial has been collected. RESULTS In 8 months, 990 women with extremely dense breasts have been enrolled. The study population currently includes 618 White women, 170 Black women, and 202 women of other races. In total, 36% of women in the patient nudge arm opted to receive the nudge. Patient nudge reception was 35% for White patients and 38% for Black patients. Additionally, 18% of women in the patient nudge arm opted out of receiving the nudge, with 18% of White patients and 22% of Black patients declining the nudge. The provider nudge was successfully delivered 97% of the time. Overall, MRIs have been ordered for about 22% of patients across all study arms. When stratified by race, the order rate was 25% for White patients compared to 16% for Black patients. While follow-up periods have not been completed for many patients, MRIs have been scheduled for 13% of all patients. CONCLUSIONS Despite laws mandating insurance coverage of supplemental screening and emerging evidence of the benefits of supplemental breast MRI for women with extremely dense breasts, there is still inequity in utilization. This trial aims to determine whether nudges can help reduce this existing inequity. Our early results suggest that patient acceptance of text message nudges was similar for White and Black patients. We eagerly await full analyses to determine the efficacy of nudges in increasing uptake and in improving equity of MRI screening among women with extremely dense breasts. Citation Format: Elizabeth Mack, Daniel Blumenthal, Claudia Fernandez Perez, Rinad Beidas, Justin Bekelman, David A. Asch, Anna-Marika Bauer, Alison M. Buttenheim, Emily F. Conant, Abigail Doucette, Oluwadamilola M. Fayanju, Peter Gabriel, Carmen Guerra, Linda W. Nunes, Martina Plag, Katharine A. Rendle, Rachel C. Shelton, Lawrence Shulman, Sue Ware, Bernadette C. Wheeler, Paul Wileyto, Robert Schnoll, Anne Marie McCarthy. Design and interim review of a pragmatic stepped wedge cluster randomized clinical trial testing behavioral economic implementation strategies to increase supplemental breast MRI screening among patients with extremely dense breasts [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A136.

Development of a Breast Cancer Risk Prediction Model Integrating Monogenic, Polygenic, and Epidemiologic Risk.

Breast cancer has been associated with monogenic, polygenic, and epidemiologic (clinical, reproductive, and lifestyle) risk factors, but studies evaluating the combined effects of these factors have been limited. We extended previous work in breast cancer risk modeling, incorporating pathogenic variants (PV) in six breast cancer predisposition genes and a 105-SNP polygenic risk score (PRS), to include an epidemiologic risk score (ERS) in a sample of non-Hispanic White women drawn from prospective cohorts and population-based case-control studies, with 23,518 cases and 22,832 controls, from the Cancer Risk Estimates Related to Susceptibility (CARRIERS) Consortium. The model predicts 4.4-fold higher risk of breast cancer for postmenopausal women with no predisposition PV and median PRS, but with the highest versus lowest ERS. Overall, women with CHEK2 PVs had >20% lifetime risk of breast cancer. However, 15.6% of women with CHEK2 PVs and a family history of breast cancer, and 45.1% of women with CHEK2 PVs but without a family history of breast cancer, had low (<20%) predicted lifetime risk and thus were below the threshold for MRI screening. CHEK2 PV carriers at the 10th percentile of the joint distribution of ERS and PRS, without a family history of breast cancer, had a predicted lifetime risk similar to the general population. These results illustrate that an ERS, alone and combined with the PRS, can contribute to clinically relevant risk stratification. Integrating monogenic, polygenic, and epidemiologic risk factors in breast cancer risk prediction models may inform personalized screening and prevention efforts.

Economic Evaluation of Population-Based BRCA1 and BRCA2 Testing in Canada

Population-based BRCA testing can identify many more BRCA carriers who will be missed by the current practice of BRCA testing based on family history (FH) and clinical criteria. These carriers can benefit from screening and prevention, potentially preventing many more breast and ovarian cancers and deaths than the current practice. To estimate the incremental lifetime health outcomes, costs, and cost-effectiveness associated with population-based BRCA testing compared with FH-based testing in Canada. For this economic evaluation, a Markov model was developed to compare the lifetime costs and outcomes of BRCA1/BRCA2 testing for all general population women aged 30 years compared with FH-based testing. BRCA carriers are offered risk-reducing salpingo-oophorectomy to reduce their ovarian cancer risk and magnetic resonance imaging (MRI) and mammography screening, medical prevention, and risk-reducing mastectomy to reduce their breast cancer risk. The analyses were conducted from both payer and societal perspectives. This study was conducted from October 1, 2022, to February 20, 2024. Outcomes of interest were ovarian cancer, breast cancer, additional heart disease deaths, and incremental cost-effectiveness ratio ICER per quality-adjusted life-year (QALY). One-way and probabilistic-sensitivity-analyses (PSA) were undertaken to explore the uncertainty. In the simulated cohort of 1 000 000 women aged 30 years in Canada, the base case ICERs of population-based BRCA testing were CAD $32 276 (US $23 402.84) per QALY from the payer perspective or CAD $16 416 (US $11 903.00) per QALY from the societal perspective compared with FH-based testing, well below the established Canadian cost-effectiveness thresholds. Population testing remained cost-effective for ages 40 to 60 years but not at age 70 years. The results were robust for multiple scenarios, 1-way sensitivity, and PSA. More than 99% of simulations from payer and societal perspectives were cost-effective on PSA (5000 simulations) at the CAD $50 000 (US $36 254.25) per QALY willingness-to-pay threshold. Population-based BRCA testing could potentially prevent an additional 2555 breast cancers and 485 ovarian cancers in the Canadian population, corresponding to averting 196 breast cancer deaths and 163 ovarian cancer deaths per 1 000 000 population. In this economic evaluation, population-based BRCA testing was cost-effective compared with FH-based testing in Canada from payer and societal perspectives. These findings suggest that changing the genetic testing paradigm to population-based testing could prevent thousands of breast and ovarian cancers.

19Fluorine-MRI Based Longitudinal Immuno-Microenvironment-Monitoring for Pancreatic Cancer.

Pancreatic cancer has a poor prognosis. Targeting Kirsten Rat Sarcoma (KRAS) mutation and its related pathways may enhance immunotherapy efficacy. While in vivo monitoring of therapeutic response and immune cell migration remains challenging, Fluorine-19 MRI (19F MRI) may allow noninvasive longitudinal imaging of immune cells. Evaluating the potential of 19F MRI for monitoring changes in the tumor immune microenvironment, in response to combined SHP2/MEK inhibition. Pre-clinical animal study. Murine genetically engineered pancreatic cancer model (N = 20, both sexes). 9.4-T, two-dimensional multi-slice Rapid Acquisition with Relaxation Enhancement sequence. Intravenous injection of 19F-perfluorocarbon (PFC) nanoparticles. Upon tumor detection by conventional 1H MRI screening, 19F MRI was performed in mice 24 hours after PFC nanoparticle administration. Animals were randomly assigned to four treatment groups: allosteric Src-homology-2-containing protein tyrosine phosphatase 2 (SHP2) inhibitor SHP099, the mitogen-activated extracellular signal-regulated kinase 1/2 (MEK1/2) inhibitor Trametinib, the combination of both, or a vehicle control (4 to 6 mice each group), administered every other day per oral gavage. 1H and 19F MRI was repeated 7 days and 14 days later. Pancreatic immune cell infiltrates were analyzed by flow cytometry and multiplex immunohistofluorescence (mIHF) upon sacrifice. Independent t-tests and one-way analysis of variance. 19F MRI revealed continuous decrease of PFC-signals in tumors from vehicle controls (100%, 80%, and 74% on days 0, 7, and 14, respectively), contrasting with stable or increasing signals under KRAS-pathway-directed treatment. MEK inhibition showed 100%, 152%, and 84% and dual SHP2/MEK1/2 inhibition demonstrated signals of 100%, 134%, and 100% on days 0, 7, 14, respectively. mIHF analyses indicated CD11b+ macrophages/monocytes as primary contributors to the observed 19F MRI signal differences. 19F MRI might provide non-invasive longitudinal estimates for abundance and spatial distribution of CD11b+ macrophages/monocytes in pancreatic cancer. 1 TECHNICAL EFFICACY: Stage 2.

Magnetic resonance imaging findings in cervical pathologies and its’ correlation with patient´s body mass index in Anambra state, Nigeria: a cross-sectional study

Background: Subsequent to the multitude of cervical pathologies with aging, this study aims to determine the prevalence and pattern of magnetic resonance imaging (MRI) cervical pathologies and its correlation with body mass index (BMI). Methods: A cross-sectional retrospective study was conducted in some selected diagnostic centres in Anambra State, Nigeria using 141 MRI data that met the inclusion criteria. Data were collected from patients` request cards, MRI screening form and MRI scan reports. Both descriptive and inferential (Pearson`s correlation test) were used as tools for statistical analysis. The level of significance was set at the level of less than 0.05. Results: Out of the 141 sample size, the majority 93(66%) were males while females accounted for 48(34%). The greater number 36(25.4%) of patients were within the age range of 61-70years of age. Greater number 83 had normal BMI (18.5-&lt;25) and the least 3 were underweight (&lt;18.5), 50 were overweight (25-&lt;30) and 5 were obese (&gt;30).Out of the 141 patients, most 68(48.2%) had single pathology, 51(36.2%) had double pathologies and few patients 22(15.6%) had multiple pathologies. There was a negative correlation between pathology and BMI that is not statistically significant(r= -0.04, p = 0.63). Also, there was negative correlations between patterns of spinal involvement and BMI, which is not statistically significant ( r= -0.130, p = 0.126).Conclusion: There is prevalence of cervical pathologies mostly in males in their 6th decade and the 4th decade with more of single pattern pathologies. The common level of involvement is at C5 vertebra. Intervertebral osteochondrosis and spondylosis was found to be the commonest cervical pathology among the study population. However, there was no statistically significant correlation between cervical pathologies and its pattern of occurrence with body mass index

Deep Learning Based Automatic Fibroglandular Tissue Segmentation in Breast Magnetic Resonance Imaging Screening.

In light of the global increase in breast cancer cases and the crucial importance of the density of fibroglandular tissue (FGT) in assessing risk and predicting the course of the disease, the accurate measurement of FGT emerges as a significant challenge in diagnostic imaging. The current study focuses on the automatic segmentation of breast glandular tissue in MRI scans using a deep learning model. The aim is to establish a solid foundation for the development of methods for the precise quantification of fibroglandular tissue. For this purpose, the publicly available 'Duke Breast Cancer MRI' dataset was systematically processed to train a deep neural network model utilizing the nnU-Net ('no-new-Net') framework, which was then subjected to a quantitative evaluation. The results show the following macro-averaged metrics with standard deviation: Dice Similarity Coefficient 0.827 ± 0.152, accuracy 0.997 ± 0.003, sensitivity 0.825 ± 0.158, and specificity 0.999 ± 0.001. The effectiveness of our model in segmenting FGT is underscored by the high values of the Dice coefficient, Accuracy, Sensitivity, and Specificity, which reflect the precision and reliability of our results. The findings of this study lay a solid foundation for developing automated methods to quantify FGT. Our research efforts, especially driven by clinical studies at the University Hospital Augsburg, are focused on further exploring and validating these potentials.

Natural history of spinal cord compression stage AFMS3 in infants with achondroplasia: retrospective cohort study

Background and objectiveForamen magnum stenosis (FMS) is a common, serious complication of achondroplasia in infancy and associated with sudden infant death. The Achondroplasia Foramen Magnum Score (AFMS; 0–4) is used...

Measuring patient-reported distress from breast magnetic resonance imaging: Development and validation of the MRI-related distress scale (MRI-DS).

Although breast magnetic resonance imaging (MRI) is a valuable screening tool, breast MRI testing burden was associated with cancer worry and quality of life. We aimed to develop and validate the MRI-related distress scale (MRI-DS) to assess comprehensive distress specifically related to breast MRI. We enrolled women aged above 18 years, diagnosed breast cancer, had MRI examination at least one time, and who could speak and read Korean in phase I and enrolled women aged above 18 years, visited outpatient clinic of breast general surgery, had undergone MRI examination at least once, and could speak and read Korean in phase II. We excluded patients who had any physical or psychiatric conditions in both phases. We recruited from a tertiary university-based hospital in South Korea between April and August 2023. All 18 items had acceptable levels of item correlation (≥0.30) in the explanatory factor analysis with a four-factor solution. The fit indices for the four-factor solution model were good. The discriminant validity of the MRI-DS had a moderate correlation with general anxiety or quality of life. In the known-group analysis, those who reported MRI as the most burden breast examination had higher total scores. The validity of the MRI-DS has been confirmed as a scale for measuring the specific distress caused by breast MRI. The MRI-DS is recommended to health professional to communicate with patients with MRI. It can be used to assess the distress associated with MRI screening in breast cancer patients. Physician could use MRI-DS to discuss the reasons for distress caused by breast MRI screening and to address specific sources of discomfort associated with it.

Detection of Contralateral Malignancies on Breast MRI.

Women with unilateral breast cancer are at increased risk for having simultaneous cancer of the contralateral breast. Overall, earlier detection of contralateral breast cancer prevents the burden of additional surgery or chemotherapy rounds and is associated with higher overall survival. However, MRI screening for the contralateral breast is seldom done following an initial unilateral breast cancer diagnosis. The purpose of this study is to retrospectively evaluate patients with known, biopsy-proven malignancy who went on to obtain a breast MRI and were later found to have cancer of the contralateral breast. Methods: This was a retrospective study that reviewed the charts of women aged over 18 years who were determined to have synchronous bilateral breast cancer from January 2017 to January 2022 at the University of Florida, Gainesville, FL. The study extracted data from this institution's cancer registry database, which provided information on patients with breast cancer diagnoses. The study conducted a review of mammography (MAM) and MRI imaging reports to ascertain the presence or absence of contralateral breast cancer identified by each respective imaging modality. Surgical pathology reports from the biopsy of the contralateral breast were reviewed to obtain information on the histological type of cancer and TNM (tumor, node, metastasis) staging. Of the 17 cases in which MAM missed contralateral cancer, follow-up MRI detected contralateral malignancy in 12 cases (70.59%) and subsequently changed management, resulting in additional imaging, biopsy, and eventual diagnosis and treatment of contralateral breast cancer. Examining the number of contralateral breast cancers detected by patients who had undergone MAM followed by MRI and those who had only undergone MAM, the study found that the detection rate of contralateral breast cancer from MAM was 45.45% (15/33). The tumor stages of the missed cancers were all T1 or Tis stage with one T1mi, and there was no nodal involvement. Conclusion: In addition to its utility in staging breast cancers, MRI also has the superior ability to detect otherwise undetected contralateral breast malignancy. This retrospective study found that MRI imaging led to a considerable increase in the detection of contralateral cancer. The study found that these undetected contralateral breast cancers by MAM were often of lower staging with no nodal involvement, highlighting the opportunity for MRI to assist in early cancer detection while the patient's prognosis is still good. Its high cost should be balanced with staging and occult malignancy detection utility in future practice.

Accelerating breast MRI acquisition with generative AI models.

To investigate the use of the score-based diffusion model to accelerate breast MRI reconstruction. We trained a score-based model on 9549 MRI examinations of the female breast and employed it to reconstruct undersampled MRI images with undersampling factors of 2, 5, and 20. Images were evaluated by two experienced radiologists who rated the images based on their overall quality and diagnostic value on an independent test set of 100 additional MRI examinations. The score-based model produces MRI images of high quality and diagnostic value. Both T1- and T2-weighted MRI images could be reconstructed to a high degree of accuracy. Two radiologists rated the images as almost indistinguishable from the original images (rating 4 or 5 on a scale of 5) in 100% (radiologist 1) and 99% (radiologist 2) of cases when the acceleration factor was 2. This fraction dropped to 88% and 70% for an acceleration factor of 5 and to 5% and 21% with an extreme acceleration factor of 20. Score-based models can reconstruct MRI images at high fidelity, even at comparatively high acceleration factors, but further work on a larger scale of images is needed to ensure that diagnostic quality holds. The number of MRI examinations of the breast is expected to rise with MRI screening recommended for women with dense breasts. Accelerated image acquisition methods can help in making this examination more accessible. Accelerating breast MRI reconstruction remains a significant challenge in clinical settings. Score-based diffusion models can achieve near-perfect reconstruction for moderate undersampling factors. Faster breast MRI scans with maintained image quality could revolutionize clinic workflows and patient experience.

Baseline surveillance in Li Fraumeni syndrome using whole-body MRI: a systematic review and updated meta-analysis.

Li-Fraumeni syndrome (LFS) is a cancer syndrome associated with early-onset neoplasias. The use of whole-body magnetic resonance imaging (WBMRI) is recommended for regular cancer screening, however, evidence supporting the benefits in asymptomatic LFS patients is limited. This study aims to assess the clinical utility of WBMRI in germline TP53 mutation carriers at baseline and follow-up. We systematically searched PubMed, Cochrane, and Embase databases for studies evaluating WBMRI as an early detection method for tumor screening in patients with LFS. We pooled the prevalence of the included variables along with their corresponding 95% confidence intervals (CIs). Statistical analyses were performed using R software, version 4.3.1. From 1687 results, 11 comprising 703 patients (359 females (51%); with a median age of 32 years (IQR 1-74)) were included. An estimated detection rate of 31% (95% CI: 0.28, 0.34) for any suspicious lesions was found in asymptomatic TP53 carriers who underwent baseline WBMRI. A total of 277 lesions requiring clinical follow-up were identified in 215 patients. Cancer was confirmed in 46 lesions across 39 individuals. The estimated cancer diagnosis rate among suspicious lesions was 18% (95% CI: 0.13, 0.25). WBMRI detected 41 of the 46 cancers at an early-disease stage, with an overall detection rate of 6% (95% CI: 0.05, 0.08). The incidence rate was 2% per patient round of WBMRI (95% CI: 0.01, 0.04), including baseline and follow-up. This meta-analysis provides evidence that surveillance with WBMRI is effective in detecting cancers in asymptomatic patients with LFS. Our study demonstrates that whole-body MRI is an effective tool for early cancer detection in asymptomatic Li-Fraumeni Syndrome patients, highlighting its importance in surveillance protocols to improve diagnosis and treatment outcomes. Current evidence for whole-body MRI screening of asymptomatic Li-Fraumeni Syndrome (LFS) patients remains scarce. Whole-body MRI identified 41 out of 46 cancers at an early stage, achieving an overall detection rate of 6%. Whole-body MRI surveillance is a valuable method for detecting cancers in asymptomatic LFS patients.

Cardiac MRI Screening for Cardiovascular Disease in Idiopathic Inflammatory Myopathies: Findings from a Pilot Cross-Sectional Study

Cardiac MRI Screening for Cardiovascular Disease in Idiopathic Inflammatory Myopathies: Findings from a Pilot Cross-Sectional Study