Signal Intensity Measurements Research Articles

Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: None. Background the prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. Aim to evaluate the prevalence and the clinical and prognostic impact of papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease. Methods 391 patients with >500/24h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF and no cardiac disease, were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). The end-systolic hypointensity was defined when its measured signal intensity (SI) was lower than the SI of the septum in early post-contrast cine CMR images. Dark-Paps was defined when both the main papillary muscles had systolic hypointensity. Mitral valve prolapse, mitral annular disjunction (MAD), myocardial LGE were considered. The outcome of hard cardiac events was define as a composite of cardiac death, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) shock, sustained ventricular tachycardia (lasting ≥30 s at ≥100 beats/min). Results Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve (Figure) analysis patients with Dark-Paps were at higher risk of events than those without (p<0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models performed. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p =0.03), to LGE (NRI 0.25, p =0.04), and to NSVT + LGE (NRI 0.32, p =0.02). Conclusions Dark-Paps sign could be considered a novel imaging prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction.

Use of quantitative indocyanine green near-infrared fluorescence imaging in bariatric surgery: early results

Introduction Indocyanine green fluorescence angiography (ICG-FA) is commonly used in general surgery, but its use in bariatric surgery is still marginal. Moreover, post-operative leaks remain a dramatic complication after this surgery and the leak tests available have poor performance preventing them. The aim of the present paper is to assess the use and utility of a new innovative technology based on quantitative measures of fluorescence signal intensity. Material and methods From January 2022 to June 2022, 40 consecutive patients with a median age of 51 years and a preoperative median body mass index of 45.2 kg/m2 underwent bariatric surgery with quantitative ICG fluorescence angiography in our center. Two different types of surgery, based on the multidisciplinary evaluation, were performed: laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB). For ICG visualization, quantitative laparoscopic ICG platform was used to identify the vascular supply. Results Thirteen patients underwent LSG and 27 patients underwent OAGB. ICG was performed in all patients with no adverse events. An adequate and satisfactory blood supply was assessed in each case. No case of post-operative leak was detected. Conclusions The quantitative ICG-FA seems to be a useful and promising tool for the prevention of complications in bariatric surgery but further studies are mandatory.

Characteristics of electromagnetic vector field generated from rock fracturing

Rock fracturing is often accompanied by electromagnetic phenomenon. As a vector field, in addition to the intensity that is widely concerned, the generated electromagnetic field also has obvious directionality. To this end, a set of electromagnetic antennas capable of simultaneous three-axis measurement is used to monitor the electromagnetic vector field generated from rock fracturing based on Brazilian tests. The signal amplitude on each axis can represent the magnitude of actual magnetic flux density component on the three axes. The intensity and directional characteristics of electromagnetic signals received at different positions are studied using vector synthesis. The directionality of electromagnetic radiation measured using a three-axis electromagnetic antenna shows that the direction of the magnetic flux intensity generated by rock fracturing tends to be parallel to the crack surface, and the measured signal intensity is greater in a direction closer to the crack surface.

Using bioluminescence to image gene expression and spontaneous behavior in freely moving mice.

Bioluminescence imaging (BLI) of gene expression in live animals is a powerful method for monitoring development, tumor growth, infections, healing, and other progressive, long-term biological processes. BLI remains an effective approach for reducing the number of animals needed to monitor dynamic changes in gene activity because images can be captured repeatedly from the same animals. When examining these ongoing changes, it is sometimes necessary to remove rhythmic effects on the bioluminescence signal caused by the circadian clock's daily modulation of gene expression. Furthermore, BLI using freely moving animals remains limited because the standard procedures can alter normal behaviors. Another obstacle with conventional BLI of animals is that luciferin, the firefly luciferase substrate, is usually injected into mice that are then imaged while anesthetized. Unfortunately, the luciferase signal declines rapidly during imaging as luciferin is cleared from the body. Alternatively, mice are imaged after they are surgically implanted with a pump or connected to a tether to deliver luciferin, but stressors such as this surgery and anesthesia can alter physiology, behavior, and the actual gene expression being imaged. Consequently, we developed a strategy that minimizes animal exposure to stressors before and during sustained BLI of freely moving unanesthetized mice. This technique was effective when monitoring expression of the Per1 gene that serves in the circadian clock timing mechanism and was previously shown to produce circadian bioluminescence rhythms in live mice. We used hairless albino mice expressing luciferase that were allowed to drink luciferin and engage in normal behaviors during imaging with cooled electron-multiplying-CCD cameras. Computer-aided image selection was developed to measure signal intensity of individual mice each time they were in the same posture, thereby providing comparable measurements over long intervals. This imaging procedure, performed primarily during the animal's night, is compatible with entrainment of the mouse circadian timing system to the light cycle while allowing sampling at multi-day intervals to monitor long-term changes. When the circadian expression of a gene is known, this approach provides an effective alternative to imaging immobile anesthetized animals and can removing noise caused by circadian oscillations and body movements that can degrade data collected during long-term imaging studies.

Quantitative infrapatellar fat pad signal intensity alteration as an imaging biomarker of knee osteoarthritis progression

ObjectiveTo determine the association of quantitative infrapatellar fat pad (IPFP) signal intensity alteration with knee osteoarthritis (OA) progression.MethodThis study was performed based on the Foundation for the National Institutes of...

Differentiation of focal nodular hyperplasia and hepatocellular adenoma using qualitative and quantitative imaging features and classification and regression tree analysis.

To assess qualitative and quantitative analysis of gadoxetate disodium-enhanced hepatobiliary phase MR imaging (MRI) and assess the performance of classification and regression tree analysis for the differentiation of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). This retrospective study was approved by our local ethics committee. One hundred seventy patients suspected of having FNH or HCA underwent gadoxetate disodium-enhanced MRI. The reference standard was either pathology or follow-up imaging. Two readers reviewed images to identify qualitative imaging features and measure signal intensity on unenhanced, dynamic, and hepatobiliary phase images. For quantitative analysis, contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), signal intensity ratio (SIR), and relative signal enhancement ratio (RSER) were calculated. A classification and regression tree (CART) analysis was developed. Eighty-five patients met the inclusion criteria, with a total of 97 FNHs and 43 HCAs. For qualitative analysis, the T1 signal intensity on the hepatobiliary phase provided the highest overall classification performance (91.9% sensitivity, 90.1% specificity, and 90.9% accuracy). For quantitative analysis, RSER in the hepatobiliary phase with a threshold of 0.723 provided the highest classification performance (92.6% sensitivity and 89.4% specificity) to differentiate FNHs from HCAs. A CART model based on five qualitative imaging features provided an accuracy of 94.4% (95% confidence interval 90.0-98.9%). Gadoxetate disodium-enhanced hepatobiliary phase provides high diagnostic performance as demonstrated in quantitative and qualitative analysis in differentiation of FNH and HCA, supported by a CART decision model.

Long-term examinations of the lumbal disc and facet joint changes in 5 German Shepard dogs

The purpose of this first-time long-term observational study was to evaluate the changes of the caudal lumbar spine at the locations L5/6, L6/7, and L7/S1 in 5 German shepherd dogs over a 6-year time period using computed tomography (CT) and magnetic resonance imaging (MRI). The dogs had a mean age of 26 months at the time of the first examination. In addition, it was evaluated whether a breeding examination, with regard to disc degeneration, is justified in young dog. The locations L7/S1, L6/7, and L5/6 were examined in more detail with regard to their signal intensity changes, the facet joint angle changes in dorsal (dors) and transverse (trans) planes, and disc surface changes in sagittal (sag) and transverse (trans) reconstruction planes with CT and MRT in 2015 and 2021. All data were collected computer-based and analyzed statistically. Subsequently, the results were compared to the measured signal intensity and to the subjective disc degeneration grading according to Seiler used in practice. Over the period of 6 years a significant loss of the measured signal intensity of the intervertebral discs in the transverse plane and an overall facet joint widening in the transverse plane of 0.54° as well as in the dorsal plane of 1.8° was evident. In addition, there was no evidence of a relationship between the size of the facet joint angle and the degree of disc degeneration. Furthermore, regardless of the initial degree of degeneration, the discs showed low signal intensity and higher Seiler grade during follow-up. The results of the present study group indicate that an inconspicuous condition of the lumbar intervertebral discs at the time of the initial breeding examination in the young dog does not allow an accurate prediction of the subsequent degree of degeneration and that there are ongoing remodeling processes at the facet joints even in healthy German shepherd dogs.

3D CRANI, a novel MR neurography sequence, can reliable visualise the extraforaminal cranial and occipital nerves

ObjectivesWe aim to validate 3D CRANI, a novel high-field STIR TSE, MR neurography sequence in the visualisation of the extraforaminal cranial and occipital nerve branches on a 3-T system. Furthermore, we wish to evaluate the role of gadolinium administration and calculate nerve benchmark values for future reference.MethodsEleven consecutive patients underwent MR imaging including the 3D CRANI sequence before and immediately after intravenous gadolinium administration. Two observers rated suppression quality and nerve visualisation using Likert scales before and after contrast administration. Extraforaminal cranial and occipital nerves were assessed. Nerve calibers and signal intensities were measured at predefined anatomical landmarks, and apparent signal intensity ratios were calculated.ResultsThe assessed segments of the cranial and occipital nerves could be identified in most cases. The overall intrarater agreement was 79.2% and interrater agreement was 82.7% (intrarater κ = .561, p < .0001; interrater κ = .642, p < .0001). After contrast administration, this significantly improved to an intrarater agreement of 92.7% and interrater agreement of 93.6% (intrarater κ = .688, p < .0001; interrater κ = .727, p < .0001).Contrast administration improved suppression quality and significant changes in nerve caliber and signal intensity measurements. Nerve diameter and signal intensity benchmarking values were obtained.Conclusion3D CRANI is reliable for the visualization of the extraforaminal cranial and occipital nerves. Intravenous gadolinium significantly improves MR neurography when applying this sequence. Benchmarking data are published to allow future assessment of the 3D CRANI sequence in patients with pathology of the extraforaminal cranial and occipital nerves.Key Points• MR neurography using the 3D CRANI sequence is a reliable method to evaluate the extraforaminal cranial and occipital nerves.• Gadolinium contrast administration significantly improves suppression quality and nerve visualisation.• Benchmarking values including apparent signal intensity ratios and nerve calibers depend on contrast administration and might play an important role in future studies evaluating extraforaminal cranial and occipital neuropathies.

Intravoxel incoherent motion (IVIM) MRI in pediatric patients with synovitis of the knee joint: a prospective pilot study

BackgroundDiagnosing synovial inflammation by administration of gadolinium-based contrast agents is limited by invasiveness and possible side effects, especially in children and adolescents.PurposeWe investigated diagnostic accuracy of diffusion-weighted (DWI) MRI with intravoxel incoherent motion (IVIM) imaging compared to contrast-enhanced MRI for detecting synovitis of the knee in a population of pediatrics and young adults. In addition we compared quantitative measures of synovial diffusion and perfusion to a group of healthy volunteers.MethodsIn this prospective study, 8 pediatric patients with 10 symptomatic knees (6 girls and 2 boys, mean age 13 years) with known or suspected synovitis underwent pre- and post-contrast 3.0 T MRI of the knee joint and additional DWI sequences between October 2016 and July 2019. For comparison we enrolled 5 healthy young adults (2 women and 3 men, median age 27 years) with contrast-free MRI of both knees. Post-contrast T1w images and DWI images at b = 1000s/mm2 with apparent diffusion coefficient (ADC) maps of patients were separately rated by two independent and blinded readers with different levels of experience for the presence or absence and degree of synovitis along with the level of confidence. We measured signal intensity on DWI of synovium, joint effusion and muscle with regions of interests and calculated the IVIM-parameters tissue diffusion coefficient (D) and perfusion fraction (f) for patients and volunteers.ResultsAll patients showed at least some synovial contrast enhancement, 8 (80%) children knees were diagnosed with synovitis on contrast-enhanced (= ce)-T1w, the diagnostic standard. Ratings by the first and second reader on ce-T1w and DWI showed full agreement (kappa = 1) in diagnosing synovitis and substantial agreement (k = 0,655) for the degree of synovial enhancement. Interobserver agreement on DWI showed fair agreement (k = 0,220) between both readers. Diagnostic confidence was lower on DWI. Mean D- and f-values of muscle was comparable between patients and volunteers. Effusion mean D was higher, mean f was lower, synovial mean D was lower, mean f higher in patients than in volunteers. All differences were statistically significant (p < 0.001).ConclusionsDiffusion-weighted MRI with IVIM imaging remains a promising, though reader-dependent alternative to i.v. contrast-enhanced imaging in pediatric patients to reliably diagnose, or rule out, synovitis of the knee joint. We detected significantly restricted synovial diffusion and increased perfusion in patients compared to healthy volunteers.Trial registrationEthical Comitee University Hospital Ulm, Nr. 320/16.

MRI signal intensity ratio reflects the quality of the anterior talofibular and calcaneofibular ligaments in patients with chronic lateral ankle instability

BackgroundLigament quality can affect clinical outcomes of ligament repair in chronic lateral ankle instability (CLAI). Magnetic resonance imaging (MRI) is used to assess the morphological changes of ligaments, but the measurement of signal intensity enables quantitative evaluation, which can evaluate the degree of the ligament quality. This study aimed to evaluate the qualitative diagnostic capacity for anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injuries of the signal intensity on MRI. MethodsThirty-eight and 20 ankles with and without CLAI, respectively, were included. The regions of interest (ROIs) were set in the ATFL, CFL, and tibialis anterior tendon (TAT) on MRI, and the signal intensities were measured. The signal intensities of the ATFL and CFL were corrected using TAT as the signal intensity ratio (SIR). The SIRs of the ATFL and CFL in the control and CLAI groups were compared. The relationship between the SIR of the ATFL and the arthroscopic findings was analyzed. Finally, the SIRs of the CFL in CLAI with and without CFL repair were compared. ResultsThe mean SIR of the ATFL in the CLAI group (6.1 ± 2.4) was significantly higher than that in the control (2.1 ± 0.4) (P < 0.01). The SIR of the ATFL was associated with the arthroscopic grading. The mean SIR of the CFL in the CLAI groups (4.1 ± 2.5) was significantly higher than that in the control (1.7 ± 0.4) (P < 0.01). The SIR of the CFL in patients with the requirement of the CFL repair (6.2 ± 1.9) was significantly higher than that without the CFL repair (2.1 ± 0.5) (P < 0.05). ConclusionsThe SIR is useful for evaluating the quality of the ATFL and CFL, which enables the decision of the treatment strategy of the CLAI.

Radio-luminescent imaging for rapid, high-resolution eye plaque loading verification.

Eye plaque brachytherapy is currently an optimal therapy for intraocular cancers. Due to the lack of an effective and practical technique to measure the seed radioactivity distribution, current quality assurance (QA) practice according to the American Association of Physicists in Medicine TG129 only stipulates that the plaque assembly be visually inspected. Consequently, uniform seed activity is routinely adopted to avoid possible loading mistakes of differential seed loading. However, modulated dose delivery, which represents a general trend in radiotherapy to provide more personalized treatment for a given tumor and patient, requires differential activities in the loaded seeds. In this study, a fast and low-cost radio-luminescent imaging and dose calculating system to verify the seed activity distribution for differential loading was developed. A proof-of-concept system consisting of a thin scintillator sheet coupled to a camera/lens system was constructed. A seed-loaded plaque can be placed directly on the scintillator surface with the radioactive seeds facing the scintillator. The camera system collects the radioluminescent signal generated by the scintillator on its opposite side. The predicted dose distribution in the scintillator's sensitive layer was calculated using a Monte Carlo simulation with the planned plaque loading pattern of I-125 seeds. Quantitative comparisons of the distribution of relative measured signal intensity and that of the relative predicted dose in the sensitive layer were performed by gamma analysis, similar to intensity-modulated radiation therapy QA. Data analyses showed high gamma (3%/0.3 mm, global, 20% threshold) passing rates for correct seed loadings and low passing rates with distinguished high gamma value area for incorrect loadings, indicating that possible errors may be detected. The measurement and analysis only required a few extra minutes, significantly shorter than the time to assay the extra verification seeds the physicist already must perform as recommended by TG129. Radio-luminescent QA can be used to facilitate and assure the implementation of intensity-modulated, customized plaque loading.

MR imaging profile and histopathological characteristics of tumour vasculature, cell density and proliferation rate define two distinct growth patterns of human brain metastases from lung cancer

PurposeNon-invasive prediction of the tumour of origin giving rise to brain metastases (BMs) using MRI measurements obtained in radiological routine and elucidating the biological basis by matched histopathological analysis.MethodsPreoperative MRI and histological parameters of 95 BM patients (female, 50; mean age 59.6 ± 11.5 years) suffering from different primary tumours were retrospectively analysed. MR features were assessed by region of interest (ROI) measurements of signal intensities on unenhanced T1-, T2-, diffusion-weighted imaging and apparent diffusion coefficient (ADC) normalised to an internal reference ROI. Furthermore, we assessed BM size and oedema as well as cell density, proliferation rate, microvessel density and vessel area as histopathological parameters.ResultsApplying recursive partitioning conditional inference trees, only histopathological parameters could stratify the primary tumour entities. We identified two distinct BM growth patterns depending on their proliferative status: Ki67high BMs were larger (p = 0.02), showed less peritumoural oedema (p = 0.02) and showed a trend towards higher cell density (p = 0.05). Furthermore, Ki67high BMs were associated with higher DWI signals (p = 0.03) and reduced ADC values (p = 0.004). Vessel density was strongly reduced in Ki67high BM (p < 0.001). These features differentiated between lung cancer BM entities (p ≤ 0.03 for all features) with SCLCs representing predominantly the Ki67high group, while NSCLCs rather matching with Ki67low features.ConclusionInterpretable and easy to obtain MRI features may not be sufficient to predict directly the primary tumour entity of BM but seem to have the potential to aid differentiating high- and low-proliferative BMs, such as SCLC and NSCLC.

Diagnostic performance of quantitative signal intensity measurements on magnetic resonance imaging for distinguishing cerebellopontine angle meningioma from acoustic schwannoma.

Our study investigated magnetic resonance imaging measurements for differentiating cerebellopontine angle (CPA) meningioma from vestibular schwannoma (VS). This retrospective study compared 36 meningioma and 36 VS patients. The tumor volume (Vtumor) and peritumor edema index (EI) relationship was analyzed. T2-weighted three-dimensional gradient-echo image signal intensity (T23D) and apparent diffusion coefficient (ADC) differentiation cutoff values were defined. Mann-Whitney U test, independent-samples t-test, receiver operating characteristic curve, and Spearman's correlation analyses were applied. Meningioma had higher Vtumor (p=0.009) and EI (p=0.031) values than VS. Meningioma had significantly (p<0.001) lower values than VS for mean ADC (ADCmean: 0.841±0.083×10-3vs.1.173±0.190×10-3mm2/s), minimum ADC (ADCmin: 0.716±0.078×10-3vs.1.045±0.178×10-3mm2/s), tumor:white matter ADC ratio (rADC: 1.198±0.19 vs. 1.59±0.30), mean T23D (T23Dmean: 142.91±19.9 vs. 218.72±84.73), and tumor:adipose T23D ratio (rT23d: 0.19±0.06 vs. 0.30±0.28) Cutoff, sensitivity (Se), and specificity (Sp) values were ADCmin, 0.856×10-3 mm2/s (Se: 96.6%, Sp: 100%); ADCmean, 0.963×10-3 mm2/s (Se: 96.6%, Sp: 95.5%); rADC, 1.3189 (Se: 93.1%, Sp: 81.8%), T23Dmean (Se: 96.6%, Sp: 100%); rT23D, 0.1951 (Se: 89.7%, Sp: 100%), Vtumor, 14828.65 mm3 (Se: 75.0%, Sp: 66.7%), and EI, 1.1025 (Se: 47.2%, Sp: 100%). ADCmin, ADCmean, rADC, T23Dmean, rT23D, Vtumor, and EI, effectively discriminated meningioma from VS.

Immunofluorescence signal intensity measurements as a semi-quantitative tool to assess sarcoglycan complex expression in muscle biopsy.

Sarcoglycanopathies are highly heterogeneous in terms of disease progression, muscular weakness, loss of ambulation and cardiac/respiratory involvement. Their clinical severity usually correlates with the residual protein amount, which makes protein quantification extremely relevant. Sarcoglycanopathy diagnosis is genetic, but skeletal muscle analysis - by both immunohistochemistry and Western blot (WB) - is still mandatory to establish the correct diagnostic process. Unfortunately, however, WB analysis cannot be performed if the bioptic specimen is scarce. This study provides a sensitive tool for semi-quantification of residual amount of sarcoglycans in patients affected by sarcoglycanopathies, based on immunofluorescence staining on skeletal muscle sections, image acquisition and software elaboration. We applied this method to eleven sarcoglycanopathies, seven Becker muscular dystrophies, as pathological control group, and four age-matched controls. Fluorescence data showed a significantly reduced expression of the mutated sarcoglycan in all patients when compared to their respective age-matched healthy controls, and a variable reduction of the other sarcoglycans. The reduction is due to the effect of gene mutation and not to the increasing age of controls. Fluorescence normalized data analyzed in relation to the age of onset of the disease, showed a negative correlation of a-sarcoglycan fluorescence signal vs fibrosis in patients with an early age of onset and a negative correlation between d-sarcoglycan signal and fibrosis in both intermediate and late age of onset groups. The availability of a method that allows objective quantification of the sarcolemmal proteins, faster and less consuming than WB analysis and able to detect low residual sarcoglycan expression with great sensitivity, proves useful also in view of possible inferences on disease prognosis. The proposed method could be employed also to monitor the efficacy of therapeutic interventions and during clinical trials.

New advances in medical imaging technology for the evaluation of anthracycline-induced cardiotoxicity.

New advances in medical imaging technology for the evaluation of anthracycline-induced cardiotoxicity.

Successful Retreatment With Venetoclax in a Patient With Chronic Lymphocytic Leukemia.

Successful Retreatment With Venetoclax in a Patient With Chronic Lymphocytic Leukemia.

Assessment of myocardial lipomatous metaplasia using an optimized out-of-phase cine steady-state free-precession sequence: Validation and clinical implementation.

Myocardial lipomatous metaplasia, which can serve as substrate for ventricular arrhythmias, is usually composed of regions in which there is an admixture of fat and nonfat tissue. Although dedicated sequences for the detection of fat are available, it would be time-consuming and burdensome to routinely use these techniques to image the entire heart of all patients as part of a typical cardiac MRI exam. Conventional steady-state free-precession (SSFP) cine imaging is insensitive to detecting myocardial regions with partial fatty infiltration. We developed an optimization process for SSFP imaging to set fat signal consistently "out-of-phase" with water throughout the heart, so that intramyocardial regions with partial volume fat would be detected as paradoxically dark regions. The optimized SSFP sequence was evaluated using a fat phantom, through simulations, and in 50 consecutive patients undergoing clinical cardiac MRI. Findings were validated using standard Dixon gradient-recalled-echo (GRE) imaging as the reference. Phantom studies of test tubes with diverse fat concentrations demonstrated good agreement between measured signal intensity and simulated values calculated using Bloch equations. In patients, a line of signal cancellation at the interface between myocardium and epicardial fat was noted in all cases, confirming that SSFP images were consistently out-of-phase throughout the entire heart. Intramyocardial dark regions identified on out-of-phase SSFP images were entirely dark throughout in 33 patients (66%) and displayed an India-ink pattern in 17 (34%). In all cases, dark intramyocardial regions were also seen in the same locations on out-of-phase GRE and were absent on in-phase GRE, confirming that these regions represent areas with partial fat. In conclusion, if appropriately optimized, SSFP cine imaging allows for consistent detection of myocardial fatty metaplasia in patients undergoing routine clinical cardiac MRI without the need for additional image acquisitions using dedicated fat-specific sequences.

Setting Bias Specifications Based on Qualitative Assays With a Quantitative Cutoff Using COVID-19 as a Disease Model.

ObjectivesAutomated qualitative serology assays often measure quantitative signals that are compared against a manufacturer-defined cutoff for qualitative (positive/negative) interpretation. The current general practice of assessing serology assay performance by overall concordance in a qualitative manner may not detect the presence of analytical shift/drift that could affect disease classifications.MethodsWe describe an approach to defining bias specifications for qualitative serology assays that considers minimum positive predictive values (PPVs) and negative predictive values (NPVs). Desirable minimum PPVs and NPVs for a given disease prevalence are projected as equi-PPV and equi-NPV lines into the receiver operator characteristic curve space of coronavirus disease 2019 serology assays, and the boundaries define the allowable area of performance (AAP).ResultsMore stringent predictive values produce smaller AAPs. When higher NPVs are required, there is lower tolerance for negative biases. Conversely, when higher PPVs are required, there is less tolerance for positive biases. As prevalence increases, so too does the allowable positive bias, although the allowable negative bias decreases. The bias specification may be asymmetric for positive and negative direction and should be method specific.ConclusionsThe described approach allows setting bias specifications in a way that considers clinical requirements for qualitative assays that measure signal intensity (eg, serology and polymerase chain reaction).

MRI Tracking of Iron Oxide Labelled Canine Mesenchymal Stem Cells in Artificial Stifle Defects.

The aim of this study was to describe ultrasmall superparamagnetic iron oxides labelling of canine adipose-derived mesenchymal stem cells (AdMSCs) and the detection and semiquantitative evaluation of the labelled cells after implantation in artificial canine stifle defects using magnetic resonance imaging. Magnetic resonance imaging examinations of 10 paired (n = 20) cadaveric stifle joints were evaluated after creation of chondral defects and embedding of ultrasmall superparamagnetic iron oxides labelled canine mesenchymal stem cells. To prove the feasibility of the labelling for in vivo usage, Prussian blue staining, cell vitality tests and intralesional administration of labelled cells were conducted. Magnetic resonance imaging of ex vivo defects filled with different cell concentrations was obtained to depict the cell content semiquantitatively via signal intensity measurements (region of interest). Prussian blue staining showed that the labelling was effective. According to the vitality tests, it had no significant short-term influence on cell viability and proliferation rate. For the evaluation of the defect T2* sequences were feasible and stifle defects were visible allowing measurements of the signal intensity in all cases. Increasing the cell concentration within the chondral defects resulted in an inversely proportional, significant reduction of signal intensity according to the region of interest. Ultrasmall superparamagnetic iron oxides labelling was effective. The detection of the AdMSCs in a complex anatomical structure like the surface of the femoral condyle was possible and the T2* signal intensity of the implant region was significantly correlated with the concentration of the AdMSCs.

Investigation of how stimulation intensity of rTMS affects magneto permeabilization of the Blood–Brain Barrier (BBB)

ABSTRACT The present study aimed to assess the effect of the rTMS (repetitive Transcranial Magnetic Stimulation) intensity on the permeability of the BBB for brain-targeted drug delivery. For this purpose, different rTMS intensities including 70%, 100%, and 130% of Resting Motor Threshold (RMT) assessed in three groups of rats (three groups of 5 rats). Stimulation applied over the right hemisphere of the animals. The first phase of the study was composed of intravenous administration of Evans Blue Dye (EBD), rTMS stimulation and EBD uptake measurement in both brain hemispheres. The second examination was included rTMS stimulation, injection of the MRI Contrast Agent (CA), and signal intensity measurement in post-contrast images. Each exam also included five rats in a sham group. Thus, the total of 40 male Wistar rats enrolled in this study. There was no significant difference in the amount of EBD accumulated between the right hemisphere of the brain in the sham group and the group with 70% RMT magnetic stimulation, while this figure was significantly higher than the sham group for both 100 and 130% RMT groups. There was also a significant difference in this index between 100 and 130% groups. All of the results from the first phase of the study were consistent with the second assessment representing an upward trend of induced permeability by rising rTMS intensity. The results of this study imply that to cause an effective temporary disruption in the BBB the intensity of 100% RMT or above should be used for stimulation.