MRI Appearance Research Articles

Imaging of non-neurogenic peripheral nerve malignancy-a case series and systematic review.

To evaluate the frequency, clinico-pathologic and imaging features of malignant tumors in peripheral nerves which are of non-neurogenic origin (non-neurogenic peripheral nerve malignancy-PNM). We retrospectively reviewed our pathology database for malignant peripheral nerve tumors from 07/2014-07/2019 and performed a systematic review. Exclusion criteria were malignant peripheral nerve sheath tumor (MPNST). Clinico-pathologic and imaging features, apparent diffusion coefficient (ADCmin), and standard uptake values (SUVmax) are reported. After exclusion of all neurogenic tumors (benign = 196, MPNST = 57), our search yielded 19 non-neurogenic PNMs (7%, n = 19/272), due to primary intraneural malignancy (16%, n = 3/19) and secondary perineural invasion from an adjacent malignancy (16%, n = 3/19) or metastatic disease (63%, n = 12/19). Non-neurogenic PNMs were located in the lumbosacral plexus/sciatic nerves (47%, n = 9/19), brachial plexus (32%, n = 6/19), femoral nerve (5%, n = 1/19), tibial nerve (5%, n = 1/19), ulnar nerve (5%, n = 1/19), and radial nerve (5%, n = 1/19). On MRI (n = 14/19), non-neurogenic PNM tended to be small (< 5cm, n = 10/14), isointense to muscle on T1-W (n = 14/14), hyperintense on T2-WI (n = 12/14), with enhancement (n = 12/12), low ADCmin (0.5-0.7 × 10-3mm2/s), and variable metabolic activity (SUVmax range 2.1-13.1). A target sign was absent (n = 14/14) and fascicular sign was rarely present (n = 3/14). Systematic review revealed 89 cases of non-neurogenic PNM. Non-neurogenic PNMs account for 7% of PNT in our series and occur due to metastases and primary intraneural malignancy. Although non-neurogenic PNMs exhibit a non-specific MRI appearance, they lack typical signs of neurogenic tumors such as the target sign. Quantitative imaging features identified by DWI (low ADC) and F18-FDG PET/CT (high SUV) may be helpful clues to the diagnosis.

Cystic and Syndromic Disorders of the Pancreas

Several clinically significant cystic diseases and syndromes are known to afflict the pancreas. They are often incidentally encountered in radiologic studies obtained for unrelated indications. Cystic pancreatic lesions are encountered in about 2.6% of abdominal multidetector CT studies and in about 20% of MRI studies.1 The imaging findings of these cystic lesions and syndromes often appear overwhelming to inexperienced radiologists, including radiologists in training, and may result in misdiagnosis. We review the CT and MRI appearance of various cystic and syndrome-related disorders of the pancreas.

MRI quantifies lumbosacral nerve root and sciatic nerve hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy

PurposeChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a treatable, immune-mediated condition characterised by progressive or relapsing motor and sensory neurological deficits. The diagnosis is based on a combination of clinical, neurophysiological and supportive criteria, but can be challenging. In this study, we quantified the diameter and cross-sectional area of the lumbosacral nerve roots, and explored the imaging characteristics of the sciatic nerves, in patients with CIDP versus healthy controls using MRI. MethodsMRI of the lumbosacral plexus and both thighs was performed at 3 T. Orthogonal diameter and cross-sectional area of the lumbosacral nerve roots were measured, along with sciatic nerve cross-sectional area at the mid-thigh level. The MRI appearance of the sciatic nerves was also evaluated qualitatively. All measurements were performed by an observer blinded to the diagnosis. Results10 patients with CIDP and 10 healthy controls (age and sex-matched) were studied. Lumbosacral nerve root diameter and cross-sectional area were significantly increased in patients with CIDP compared to controls (mean diameter 6.0 ± 1.1 mm vs 4.8 ± 0.3 mm; p = 0.006), with a high sensitivity (89 %) and specificity (90 %) on ROC analysis. Sciatic nerve cross sectional area was also significantly increased in the CIDP group, and was accompanied by qualitative MRI changes. ConclusionsQuantitative MRI reveals significant hypertrophy of the lumbosacral nerve roots and sciatic nerves in patients with CIDP compared to controls. This study provides further evidence for the inclusion of lumbosacral nerve root and sciatic nerve hypertrophy on MRI as a supportive feature in the diagnostic criteria for CIDP.

Potentially Reversible and Recognizable Acute Encephalopathic Syndromes: Disease Categorization and MRI Appearances.

"Encephalopathy" is a vague term that encompasses varying definitions, often with a nonspecific clinical presentation and numerous possible pathophysiologic causes. Hence, MR imaging plays a crucial role in the early diagnosis and treatment by identifying imaging patterns when there is limited clinical history in such patients with acute encephalopathy. The aim of this review was to aid in remembrance of etiologies of potentially reversible acute encephalopathic syndromes on MR imaging. The differential includes vascular (reversible cerebral vasoconstriction syndrome, transient global amnesia, disseminated intravascular coagulation, and thrombotic microangiopathy), infection (meningitis, encephalitis), toxic (posterior reversible encephalopathy syndrome, acute toxic leukoencephalopathy; carbon monoxide, alcohol-related, medication- and illicit drug-related toxic encephalopathies), autoimmune, metabolic (osmotic demyelination syndrome, uremic, acute hepatic encephalopathy), idiopathic/inflammatory (stroke-like migraine attacks after radiation therapy syndrome), neoplasm-related encephalopathy, and seizure-related encephalopathy.

MRI of the sacroiliac joints: what is and what is not sacroiliitis?

MRI has, as the only imaging modality, the ability to visualize both the inflammatory and destructive aspects of sacroiliitis and is a crucial element in the diagnosis and classification of axial spondyloarthritis (axSpA). However, the MRI appearance of several potential differential diagnoses may resemble axSpA sacroiliitis. The appearances of sacroiliac joint (SIJ) MRIs of various diseased and healthy populations have recently been intensively studied. BME, the key requirement in the Assessment of Spondyloarthritis international Society (ASAS) definition of a 'MRI positive of sacroiliitis' may also be found in degenerative disease, athletes and healthy persons, and, particularly, postpartum women. Certain pattern of BME (high extent, large depth from articular surface, close relation to other lesion types) as well as the presence of structural lesions, particularly bone erosion, backfill or ankylosis increase the likelihood/specificity of being axSpA. Furthermore, old and novel MRI approaches to best distinguish the sacroiliitis of early axSpA from differential diagnoses have recently been tested and compared. Significant new and clinically relevant knowledge has been gained, but further research is still needed to optimally distinguish what is and what isn't sacroiliitis.

MRI appearance of jogger's foot.

To characterize the MRI findings present in patients with clinically proven or suspected jogger's foot. Ten years of medical charts in patients clinically suspected of having jogger's foot and who had MRI studies completed were identified utilizing a computer database search. Six study cases were identified. The MRI examinations of the study cases and an age- and gender-matched control group were reviewed in a blinded fashion by two musculoskeletal radiologists. Size and signal intensity of the medial plantar nerve were measured and characterized. The medial foot musculature was assessed for acute or chronic denervation changes. The medial plantar nerve was found to have moderately increased T2 signal compared with normal skeletal muscle in 3/6 study group cases and markedly increased T2 signal in the remaining 3/6 cases. In all control cases, the nerve was reported to have T2 signal equal or minimally higher than normal skeletal muscle. The mean total size of the medial plantar nerve was significantly larger in the study group when compared with that in the control group at all measured locations (p < 0.04). Abnormal thickness and T2 hyperintensity of the medial plantar nerve centered at the master knot of Henry are characteristic MRI findings in patients with jogger's foot when compared with control subjects. Muscular denervation changes may also be seen, most commonly in the flexor hallucis brevis muscle.

A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the distal biceps brachii.

The biceps brachii myotendinous unit is a common source of shoulder, arm, and elbow pain. Its complex anatomy can present a challenge when interpreting MR images. We discuss the clinical and imaging presentations of injury related to the proximal biceps brachii separately in another manuscript. The purpose of this manuscript is to review the distal biceps anatomy along with pathology and post-operative appearance as seen on MRI.

Post-operative MRI and US appearance of the Achilles tendons.

The Achilles tendon is one of the most commonly ruptured tendons in the human body. Minimally invasive and open surgical repairs are commonly undertaken to manage acute Achilles ruptures. This article describes the postoperative imaging findings and their evolution after surgery. Ultrasound and magnetic resonance imaging provide crucial information regarding the morphology, structure, vascularization and mobility of the Achilles tendon on the surrounding planes. Morphologically, a repaired tendon is physiologically larger and wider than an intact one, with a loss of its fibrillary structure; the presence of surgical material in the context of the tendon is normal after the rupture has been repaired. After surgery, the tendon is more vascularized in power-Doppler imaging. Elastography and diffusion tensor Imaging are innovative tools which allow for the visualization of microstructural abnormalities not apprehensible using conventional imaging techniques. A treated Achilles tendon is unlikely to regain a normal imaging appearance, and the health care professional must distinguish between postoperative findings and actual pathological features. In this context, clinical examination still reigns supreme.

Temporal Bone Trauma: Typical CT and MRI Appearances and Important Points for Evaluation.

Temporal bone trauma is frequently encountered in the emergency department. Technologic advances have enabled timely acquisition of thin-section images and multiplanar reconstructions such that temporal bone anatomy can be evaluated in great detail, with excellent delineation of fractures. The temporal bone is composed of a myriad of tiny structures, including many fissures and canals, that must be distinguished from true fractures. In addition, injury to important structures may result in serious complications such as hearing loss, dizziness, imbalance, perilymphatic fistula, cerebrospinal fluid leakage, facial nerve paralysis, and vascular injury. Structures that should be examined include the tympanic cavity and tegmen, the ossicular chain, the bony labyrinth, the facial canal, the internal carotid artery, the jugular foramen and venous sinuses, and the intracranial contents. Radiologists should be familiar with the anatomy of the temporal bone and be able to describe any pathologic findings and make suggestions to referring clinicians to guide management and determine the prognosis. The authors describe the typical CT and MRI appearances of temporal bone trauma, entities that mimic this injury and thus must be differentiated, and compulsory points for evaluating clinically relevant associated complications. Instruction is provided for acquiring the diagnostic skills necessary to report suggested injury status, complications, and likely sequelae to clinicians.©RSNA, 2020.

Posterior rectal pouch after large full-thickness disc excision of deep endometriosis infiltrating the low/mid rectum and relationship with digestive functional outcome

IntroductionThe aim of our study is to describe MRI appearance of a posterior rectal pouch (PRP) for patients managed for low rectal endometriosis by large full-thickness disc excision and to assess its relationship with postoperative functional digestive symptoms. Material and MethodsSingle center retrospective study including patients managed by low/mid rectal disc excision using a semi-circular stapler (the Rouen technique) from June 2009 to October 2016. Intraoperative findings and data provided by standardized gastrointestinal self-questionnaires (GIQLI, KESS, Wexner and Bristol), before and 1 year after the surgery, were prospectively recorded. Postoperative pelvic MRI were reviewed and PRP was assessed in three planes and its volume was estimated on a 3D T2 weighted sequence. ResultsEighteen patients were included in the study. All patients had postoperative PRP while none of them presented with rectal stenosis. The mean (± SD) volume of the PRP was estimated at 66 ± 32 mL. The mean antero-posterior diameter was 56 mm ± 22 mm, mean height at 44 mm ± 15 mm and mean width at 46 mm ± 11 mm. No positive correlation between the volume of the PRP and the GIQLI questionnaire was found at one year after surgery (r = −0.24, 95%CI -0.51−0.69, p = 0.44). ConclusionLarge disc excision of low and mid rectum leads to a posterior rectal pouch, with no significant impact on postoperative functional digestive outcomes, but it is not followed by bowel stenosis.

Desmoplastic Fibroblastoma: An Uncommon Tumor With a Relatively Characteristic MRI Appearance

OBJECTIVE. We undertook this study to determine the radiologic features of desmo-plastic fibroblastoma. MATERIALS AND METHODS. We reviewed available radiologic images for 29 pathologically confirmed desmoplastic fibroblastomas, including images from MRI, radiography, ultrasound (US), and CT. RESULTS. The patient population included 14 women and 15 men (mean age, 60 years; range, 23-96 years). Typically, lesions were oval or lobulated and relatively small (mean, 5.6 cm). In 14 of the 22 cases that included patient histories, lesions had grown slowly, with two eventually causing pain. The remaining eight were discovered incidentally. All lesions involved or were below the deep fascia. Lesions were well-defined and associated with muscle (45%), deep fascia (28%), joint (21%), or tendon (7%). MR images were available in 26 cases; 14 included unenhanced and contrast-enhanced studies. On MR imaging all lesions were well-defined and adjacent to dense connective tissue. On T1-weighted images, lesions showed varying amounts of low and intermediate signal intensity similar to that of tendon and skeletal muscle, respectively. On fluid-sensitive images, lesions were more heterogeneous, generally showing a wider spectrum of decreased to intermediate signal intensity. On contrast-enhanced MR images, enhancement was characteristically peripheral and septal with patchy areas of homogeneity. In the 10 cases with radiographs, images showed negative findings or a nonmineralized mass. The 10 available ultrasound studies showed mixed echogenicity. In eight patients, unenhanced CT showed lesions having attenuation similar to that of skeletal muscle. CONCLUSION. Desmoplastic fibroblastoma is an uncommon neoplasm with a relatively characteristic MRI appearance.

SUN-298 Spectrum of Imaging in Immune Checkpoint Inhibitor Induced Hypophysitis

Background: Hypophysitis (HP) is a known immune related adverse event of immune checkpoint inhibitors (CPIs), commonly associated with CTLA-4 inhibitors and rarely with PD-1/PD-L1 inhibitors. Prior studies of MRIs at HP diagnosis noted pituitary enlargement with resolution within a few weeks. In this study, we examine MRI changes in patients with CPI-induced HP. Methods: Subjects with biochemical evidence of central hypothyroidism or central adrenal insufficiency and MRIs were reviewed by endocrinology and neuroradiology. MRIs were classified relative to HP diagnosis: baseline (at least 21 days prior), diagnosis (within 21 days), and follow up (over 21 days). Patient characteristics included age at CPI initiation, sex, race/ethnicity, personal and family history of autoimmunity, type of cancer and CPI. Results: Twenty-six subjects met the inclusion criteria. The mean age was 59 years; 62% were male and 86% were non-Hispanic white. Nineteen percent had a personal history and 31% a family history of autoimmunity. Fifty percent had melanoma. At HP diagnosis, 46% were on PD-1/PD-L1 inhibitors, 42% were on combination PD-1/CTLA-4 inhibitors and 12% were on CTLA-4 inhibitors.Median time from CPI initiation to HP diagnosis was 95 days. Time to HP was shorter on a CTLA-4 inhibitor combination or monotherapy (median 82 days) compared to a PD-1/PD-L1 inhibitor monotherapy (median 220 days; Wilcoxon rank sum, p <0.01). Central adrenal insufficiency was present in all patients not yet on steroids. Central hypothyroidism was common (10/19) in those without primary thyroid disease and was not associated with type of CPI (Fisher’s exact, p=0.18).Thirteen subjects had baseline MRIs, 18 had MRIs at HP diagnosis and 13 had MRIs in the follow up period. Baseline MRIs were normal in 12/13; one subject had an enlarged pituitary. At diagnosis, 10 had an enlarged pituitary, 7 a normal pituitary and 1 a partially empty sella. CTLA-4 inhibitor exposure was associated with pituitary enlargement at diagnosis: 9/11 compared to 1/7 on PD-1/PD-L1 inhibitor (Fisher’s exact, p <0.04). Of the subjects who had follow-up MRIs, 3 had an enlarged pituitary, 7 a normal pituitary and 3 a partially empty sella. Follow up imaging did not differ between treatment types (Fisher’s exact, p >0.05). Timing of MRI was significantly associated with pituitary appearance (Fisher’s exact, p <0.01). Conclusion: The MRI appearance of HP presents as a spectrum, from a partially empty sella, normal pituitary to an enlarged pituitary. HP diagnosed in the setting of CTLA-4 inhibitor treatment occurs earlier and is more likely to induce an enlarged pituitary gland compared to PD-1/PD-L1 monotherapy, which occurs later and is associated with a normal appearing MRI at diagnosis. This suggests that the pathogenesis of HP following CPI exposure may vary depending on the type of CPI.

Intraductal papillary neoplasm of the bile duct (IPNB): CT and MRI appearance with radiology-pathology correlation

PurposeIntraductal papillary neoplasm of the bile duct (IPNB) is a precursor to invasive carcinoma and is a distinct pathologic diagnosis. The purpose of this study was to evaluate imaging features of IPNB on cross-sectional imaging studies with histopathologic correlation. Materials and methodsIn this IRB approved, HIPAA compliant retrospective observational analysis of 23 pathology proven IPNB tumors 22 imaging studies were reviewed, 14 CT and 8 MRI scans. Features evaluated in consensus by two subspecialty-trained abdominal radiologists included: presence of specific lesion/mass within the bile duct, location within the biliary tree, size, morphology, enhancement characteristics, and bile duct caliber. ResultsMajority of the subjects (16/18, 90%) had definite intraluminal mass, of which 7 (39%) had a polypoid mass with upstream diffuse biliary ductal dilation and 5 (28%) had a plaque-like mass with focal stricture and upstream biliary ductal dilatation. 6/18 (33%) subjects had low grade dysplasia, most commonly intestinal subtype, 7/18 (39%) subjects presented with invasive component, commonly pancreaticobiliary subtype, and 5/18 (28%) presented with high grade dysplasia. ConclusionIPNB has increased predilection for extrahepatic bile ducts, commonly presenting as either an intraluminal polypoidal mass with associated upstream biliary ductal dilation or a focal plaque like mass with associated ductal stricture at the site of the tumor.

P112 Muscles in myositis with normal MRI appearance have higher quantitative T2 compared to those in healthy controls

Abstract Background Myositis is an autoimmune disease which can cause a decrease in quality of life and increased mortality, presenting with muscle weakness, raised muscle enzymes and myalgia. Diagnosis is reliant on subjective clinical examinations, blood tests, conventional MRI and invasive muscle biopsies. Quantitative T2 MRI offers a non-invasive measurement of muscle oedema which could help improve the understanding of muscle pathology and potentially inform diagnosis. The aim of this study was to evaluate whether quantitative T2 MRI of muscles is sensitive enough to detect differences in myositis patients compared to healthy controls, and how it compares with current radiologist scoring methods. Methods 16 myositis patients were recruited (10/16 female, 10 polymyositis, 6 dermatomyositis, mean age 50 ± 26), median CK 1000IU/L ± 3100IU/L, and 16 age and gender matched healthy controls were recruited. MRI of the dominant thigh were performed. Imaging was performed using a fat-suppressed turbo-spin echo sequence. Quantitative T2 measurements were obtained from regions of interest (ROI) drawn manually within the individual muscles that make up the quadriceps and hamstrings with no distinction made between affected and unaffected muscles. A mono-exponential fit was used to obtain an estimate of the T2 from each ROI. Two radiologists blinded to the diagnosis, semi-quantitatively scored by consensus the muscles on a 4-point visual scale as either no oedema (0), mild oedema (1), moderate oedema (2) or severe oedema (3). Muscle strength was assessed using an isokinetic dynamometer. Results T2 values were higher in myositis patients compared to healthy controls [mean (SD) hamstring myositis 47.8ms (7.7ms), healthy 39.9ms (1.5ms), p &amp;lt; 0.001; quadriceps myositis 53.8ms (12.1ms), healthy 42.1ms (2.1ms), p &amp;lt; 0.001]. Quantitative T2 correlated with the radiologists’ oedema scores with rs=0.7 in the hamstrings (p &amp;lt; 0.001) and rs=0.6 in the quadriceps (p &amp;lt; 0.001), with an upward trend in T2 as radiologist scored visible oedema increased. Patients who had been classified as normal by the radiologists were compared with matched healthy controls (n = 8), T2 values for patients with ‘normal muscle’ were still higher than those for healthy controls: mean T2 in the hamstrings (myositis 42.2ms, healthy controls 38.7ms, p = 0.004); mean T2 in the quadriceps (myositis 43.9ms, healthy controls 40.1ms, p = 0.001). T2 was inversely correlated with muscle strength in all participants. Conclusion Quantitative T2 measurements can detect muscle differences between myositis patients and healthy control groups, which suggests that this measurement could be used as an objective method to monitor muscles. They are also sensitive to differences that may not be detected by radiologists. This suggests that subtle systemic changes in muscle in myositis patients, which go undetected in semi-quantitative visual scoring, can be detected using quantitative T2 measurements. This shows the potential for T2 measurements to be a diagnostic measure in the diagnosis and management of myositis. Disclosures M. Farrow None. J. Biglands None. A. Grainger None. E. Hensor None. P. O'Connor None. A. Ladas None. S. Tanner None. A. Aslam None. P. Emery None. A. Tan None.

A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the proximal biceps brachii.

The biceps brachii myotendinous unit, particularly the long head of the biceps tendon and its labral attachment, is a common cause of shoulder and arm pain. Its complex anatomy and normal variations can present a challenge when interpreting MR images. The purpose of this manuscript is to review the proximal biceps anatomy, variants, pathology, and post-operative appearance as seen on MRI. Recent data regarding the accuracy of clinical examination and MRI will be summarized.

Reader response: Teaching NeuroImages: A rare case of Jacobsen syndrome with global diffuse hypomyelination of brain.

With interest we read the report by Patel et al.1 concerning a patient with Jacobsen syndrome due to an 11q23–11q24 deletion and MRI evidence for leukodystrophy with improvement at a follow-up, substantiated by FLAIR images. The authors claimed that these abnormalities represent hypomyelination. Hypomyelination is defined as a significant and permanent myelin deficit.2 Its MRI appearance is characterized by a diffusely hyperintense T2 white matter (WM) signal, which is less high than the signal in other leukodystrophies2,3 and certainly less high than the WM signal in the patient discussed here,1 who has strongly T2-hyperintense WM signal abnormalities.

Abstract P6-16-06: Improved early stratification of invasive cancer risk using MRI in a ductal carcinoma in-situ short-term active surveillance cohort treated with neoadjuvant endocrine therapy

Abstract Purpose Standard treatment for ductal carcinoma in situ (DCIS) involves surgical excision and radiation treatment, and often adjuvant endocrine therapy (ET). However, this may constitute overtreatment for some women. The purpose of this neoadjuvant ET study in patients with biopsy-proven DCIS was to evaluate the relationship between the primary outcome of upstaging at surgery (invasive disease) and changes in the pre- and post-ET MRI appearances of both (1) lesion and (2) background parenchymal enhancement (BPE), with the goal to better inform de-escalated therapy. Methods Outcomes of patients with DCIS who were prospectively enrolled in a neoadjuvant ET trial between 2002 and 2009 were retrospectively analyzed with IRB approval. All patients had dynamic contrast-enhanced breast MRI prior to and following an average of 3.1 months of ET (range 1.9 – 5 months), followed by surgical excision within one year of the second MRI. Pathology reports were used to confirm initial biopsy results and to determine the nature and extent of disease postoperatively. Surgeon and radiologist’s reports were used to assess improvement of lesion after ET based on 1) less prominently enhancing pattern or 2) reduction in size of DCIS lesion after treatment. BPE response to ET on imaging was assessed by two radiologists specialized in breast imaging who compared pre- and post-ET MRI’s, blinded to all imaging reports. The change in BPE of the ipsilateral breast with treatment was scored subjectively as increased, decreased, or unchanged. Readers reached a consensus on discordant classifications of the change in BPE. The correlation between imaging change (of lesion and BPE) and incidence of invasive ductal carcinoma (IDC) at surgery was determined using Fisher’s exact test. Results: Of 34 patients evaluated, six (18%) had IDC at surgery. The prevalence of IDC in each group is shown in Table 2. Those with improvement of lesion on MRI had a lower likelihood of IDC at surgery compared to patients with no imaging improvement (Table 2, p= 0.048). Addition of change in BPE to the evaluation of lesion improvement significantly increased the chance of identifying specific patients who were much more likely to have an underlying invasive cancer at surgery (Table 2, p= 0.032). The risk of having IDC at surgery was considerably higher in the group whose lesion was assessed as not improved and who had decreased BPE scores on MRI (Table 2, p= 0.018). Conclusion: In our unique population of patients with mostly ER+ DCIS receiving pre-operative endocrine therapy, the combination of lack of lesion improvement and reduction in BPE score in blinded reads was significantly associated with the finding of invasive disease at surgical excision. This result may reflect the unmasking of a more aggressive lesion in those with underlying IDC and help identify patients with a higher likelihood of the presence of IDC at surgery. Although this study is small, it suggests that risk-stratifying patients with DCIS based on lesion and parenchymal imaging features associated with treatment response may aid in tailoring therapy for DCIS. We are testing this prospectively in an active surveillance cohort. Table 1. Incidence of IDC at surgery depending on image features (n= 34)Improvement of lesion in MRINo Improvement of lesion in MRIP-value (Fisher’s Exact Test)&amp; No Reduction in BPE&amp; Reduction in BPE&amp; No Reduction in BPE&amp; Reduction in BPEIncidence of IDC at surgery (n)0204Incidence of Not IDC at surgery (n)121024%IDC at surgery when assessing lesion only (%)9.1%40%0.048*%IDC at surgery when assessing lesion AND BPE (%)0%16.7%0%50%0.032*%IDC at surgery when assessing lesion AND BPE (%)8.3%50%0.018* Citation Format: Paul Kim, Heather I. Greenwood, Rita I. Freimanis, Gillian L Hirst, Megan Fischer-Colbrie, Jessica Gibbs, Nola M Hylton, Christina Yau, Eun-Sil Shelley Hwang, Laura J. Esserman, Rita A Mukhtar. Improved early stratification of invasive cancer risk using MRI in a ductal carcinoma in-situ short-term active surveillance cohort treated with neoadjuvant endocrine therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-16-06.

A DESCRIPTIVE STUDY OF MR DEFECOGRAPHY FOR EVALUATION OF OBSTRUCTED DEFECATION SYNDROME

Objective:-This study aims to ascertain the role of MR Defecography in the evaluation of obstructed defecation syndrome (ODS) with objective to describe spectrum of MR Defecography findings in obstructed defecation syndrome (ODS) and describe a number of reference lines and measurement points used to diagnose and grade pelvic floor disorders and Document the MRI appearance of disorders associated with ano-rectal dysfunction. MR Defecography demonstrated the profile of obstructed defecation syndrome on the basis of MR defecography and demonstrate its utility in simultaneous &amp; objective evaluation of all three pelvic compartments. This diagnostic modalities provide a detailed pelvic floor anatomy and functional evaluation, as well as their respective abnormalities, making a precise diagnosis and provides valuable information on treatment planning &amp; decrease chance of postoperative recurrence.&#x0D; Subjects and Methods: It was Cross-sectional and prospective (quantitative) hospital based descriptive type of observational study carried out at a tertiary hospital SMS hospital, jaipur. Chosen the patients diagnosed with ODS as per Rome criteria (III) whose colonoscopy or rectosigmoidoscopy, had been done to rule out other findings from Feb 2018 to September 2019.MR defecography (static and dynamic) with 3 T (PHILIPS INGENIA) MRI system having tunnel configuration. After written and informed consent, patient was positioned supine in MR machine gantry . Static imaging performed in the axial T1WI high resolution, axial, coronal and sagittal T2WI high resolution images at rest for anatomical evaluation. Following this,after ultrasound gel instilled in the patient’s rectum and intravaginaly ,dynamic imaging were taken in the midsagittal plane through the anal canal using a T2 weighted sequence. This sequence was ran for almost 2 min, while the patient performs various maneuvers (Kegel (squeeze), valsalva menuvere (strain), and defecation). MR defecography structurally and functionally evaluated in all 3 pelvic floor compartments and associated defects noted and grading of specific findings like organ specific prolapse, pelvic floor relaxiation and descent were measured.&#x0D; Results: In our study most common findings were pelvic floor descent and anorectal junction descent in 92.68% cases each followed by rectocele in 82.93% cases. Among the females, vaginal/uterine prolapse were observed in 65.31% cases. Least common findings were paradoxical contraction (8.54%) and sigmoidocele (0%). Significant difference was observed in MRI functional parameters in resting state and during defecation/maximal strain position, utilising HMO system for pelvic floor relaxation and descent, as significant difference (p &lt;0.001S) was observed in all parameters including H line, M line, bladder base descent, cervical/vaginal and anorectal junction descent during resting state and during defecation/maximal strain position. Out of 82 conservative biofeedback therapy was given to 79.27 % patients, surgical management was done in (7.32%) and combination of both therapies was given in 13.41% of cases. Out of 82 patients 68.29% showed benefit from management and showed improvement on follow and 31.71% patients were not improved on follow up.&#x0D; Conclusion: As complete survey of the entire pelvis is necessary before surgical repair Magnetic resonance imaging permits evaluation of all three pelvic compartments and as we demonstrated in our study more than one compartment are frequently affected in obstructed defecation syndrome. Static MR Imaging can be also useful to identify the defects responsible for pelvic organ prolapse and stress urinary incontinence, and so help perform site specific repair in surgery, to avoid the high recurrence rates.Findings reported at dynamic MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach as detection rate of pathologies increased during defecation / maximal straning as concluded by our study.

Ultrasound of glenoid labrum with MR arthrographic correlation.

Ultrasound (US) is a reliable non-invasive method to image the rotator cuff tendons. Even though glenoid labral pathology is common, it is not routinely looked at as part of the shoulder ultrasound protocol. Currently, the gold standard for labral imaging remains MR arthrography. However, given the rather long waiting list and cost implications, US may be used as a modality to quickly screen the shoulder for gross labral pathology. Whilst there is relative paucity of the literature outlining labral pathology on US, there is none correlating sonographic and corresponding MRI appearances. We present a pictorial review highlighting scanning positioning, US and corresponding MRI appearances of a normal labrum and various labral pathologies. We discuss useful scanning tips and characteristic US signs which can help the radiologist.

MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation

Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, injuries to this region may require surgical repair. However, due to their location and lack of general knowledge regarding their different types and associated appearances on magnetic resonance imaging, ramp lesions are routinely underreported. This is compounded by the fact that ramp lesions are also often overlooked during conventional anterior portal arthroscopy when direct visualization is not achieved. To demonstrate MRI appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on pre-operative imaging.