MRI Assessment Research Articles

MRI Assessment of Diastolic Dysfunction in People Living With the Human Immunodeficiency Virus: Correlation With Markers of Disease Activity.

Despite the advent of combination antiretroviral therapy, people living with human immunodeficiency virus (PLWH) are at an increased risk for cardiac disease. To explore the presence and extent of diastolic atrial and left ventricular dysfunction in PLWH using cardiac MRI in correlation with clinical markers of disease activity. Prospective. A total of 163 participants comprising 101 HIV-infected individuals (age: 52 years [42-62 years]; 92% male) and 62 age- and sex-matched healthy volunteers (age: 51 years [30-72 years]; 85% male). 3.0 T, cardiac MRI including balanced steady-state free precession (SSFP) for the short-axis, two-, three-, and four-chamber views were performed. Assessment of cardiac function and strain analysis were accomplished by CVI42 software. Blood samples for CD4+ T cells and cardiac risk factors were also collected before MRI. Independent t tests, Mann-Whitney U test, Pearson's correlation analysis, and multivariate linear analyses (significance level: P < 0.05). PLWH had a significantly larger left atrial volume maximum index (LAVImax: 32.6 ± 8.7 vs. 28.7 ± 8.1 mL/m2), minimum (LAVImin: 14.8 ± 5.5 vs. 11.5 ± 5.4 mL/m2,), and prior to atrial contraction (LAVIpre-a: 23.4 ± 6.7 vs. 19.7 ± 7.2 mL/m2) as compared to healthy volunteers. The LA reservoir (LAtEF: 55.0 ± 10.2 vs. 61.4 ± 10.4; Sls: 29.0 ± 8.1 vs. 33.8 ± 11.8), conduit (LApEF: 28.4 ± 8.2 vs. 32.3 ± 11.3, P = 0.01; Sle: 16.3 ± 6.5 vs. 18.9 ± 8.2), and booster pump function (LAaEF: 37.4 ± 12.4 vs. 42.7 ± 13.1, P = 0.01, Sla: 12.7 ± 5.1 vs. 14.9 ± 5.7) were all significant impaired in PLWH. Global circumferential left ventricular diastolic strain rate (LVGCS-d) was significantly lower in the HIV patients. Multivariate analysis results showed that Nadir CD4+ T cells had a significant adverse association with LVGCS-d (β = 0.51). LA structure abnormalities and LV diastolic dysfunction were manifested in PLWH, with Nadir CD4+ T cell counts potentially serving as a risk factor for early cardiac diastolic dysfunction. 2 TECHNICAL EFFICACY: Stage 3.

Treatment of massive irreparable rotator cuff tears by different surgical technigues: comparative analysis of early outcomes

Background. Massive rotator cuff tears are up to 40% and can progress to the stage of irreparable ones. Nowadays, there are many treatment options available for irreparable rotator cuff injuries, from conservative treatment and arthroscopic reconstructions to reverse shoulder arthroplasty. Currently, the comparative effectiveness of various treatment methods remains uncertain, and therefore there is no clear algorithm for choosing treatment tactics of such orthopedic shoulder pathologies. The aim of the study is to compare short-term treatment outcomes of patients with irreparable rotator cuff tears using arthroscopic partial rotator cuff repair, latissimus dorsi tendon transfer, pectoralis major tendon transfer and reverse shoulder arthroplasty. Methods. The study enrolled 75 patients who underwent the following types of surgical interventions: partial arthroscopic repair, posterior and anterior arthroscopically assisted latissimus dorsi tendon transfer, pectoralis major tendon transfer and reverse shoulder arthroplasty. Treatment results were assessed using measurements of the range of active movements in the shoulder joint, the ASES and Constant-Murley Score (CMS) questionnaires, the Visual Analog Scale (VAS), assessment of radiographs and MRI. The assessments were performed preoperatively and at 6 and 12 months after surgery. Results. In all groups, there was a statistically significant improvement by all indicators (p0.05). Clinical and functional results at the short-term follow-up after partial rotator cuff repair and various options of latissimus dorsi tendon transfer are largely comparable, while at the same time superior to the results of reverse shoulder arthroplasty and pectoralis major tendon transfer. Conclusions. The use of partial rotator cuff repair and musculotendinous transfers at the short-term follow-up gives comparable and better results in comparison with the use of reverse shoulder arthroplasty, which allows to consider “joint-preserving” interventions as an option in patients with massive irreparable rotator cuff tears.

A modified anterior cruciate ligament reconstruction with BTB autograft

Background. Central third of the patellar tendon is a well know graft for anterior cruciate ligament (ACL) reconstruction. However, it’s usage can be difficult in case of long patella tendon, which causes graft length discrepancy. The aim of this article is to evaluate the results of arthroscopic anterior cruciate ligament reconstruction with a help of original method of bone patella tendon bone graft preparation. Methods. 26 males operated for ACL tear have been included in the study. On the preoperative MRI scans the approximate length of ACL, tibial tunnel, patella tendon length and tibial bone plug length have been measured. The technique of tibial bone plug cut was optimized based on preoperative MRI assessment. Results. In all cases, MRI-based assessments were consistent with intraoperative measurements, hence there was possible to avoid graft length discrepancy. In a period of 12 weeks the average score on the step-and-holds test was 23.8±1.1, the single-leg squat test was 6.7±0.9 and the Y-balance test was 83.2±1.4. The average IKDS score was 64.9±5.7. Conclusion. The proposed method is appropriate for anterior cruciate ligament reconstruction in patients with long patella tendon.

Role of MRI in Assessment of Central Nervous System Lesions and Post Treatment Complications in Pediatric Patents with Leukemia

Abstract Background In terms of pediatric oncology, leukemia is one of the most frequent deadly illnesses. Early CNS problem identification and appropriate therapy were enhanced by MRI. Aim Describe the MRI results brought on by leukemia's involvement in CNS structures and treatment-related CNS side effects, and evaluate their efficacy for early therapy and preventing long-term adverse effects. Patients and Methods A prospective observational study included 52 children with leukemia. All patients undergone MR examination including conventional MRI, MR diffusion imaging and MR venography (MRV). Results Regarding MRI finding of CNS, leukemic infiltration was found in 57.7%, sub volimic changes in mild manner in 50% and about 26% in a moderate manner while absent in 23.1%, PRES was present in 19.2%, venous thrombosis present in 30.8% and post treatment complications were found in 7.7%. Conclusion Diffusion-weighted MRI proved very helpful in the early diagnosis and distinction of various CNS lesions seen in young patients with leukemia and post-treatment CNS sequelae. These techniques included conventional, post- contrast, MR venography, and diffusion-weighted MRI.

MRI in Postero-Lateral Corner Injuries of the Knee Joint: Clinical-Radiological Correlation

Abstract Background The posterolateral corner (PLC) was once regarded as the “dark side of the knee” owing to the complex and variable anatomy superimposed on the inconsistent terminology used in the literature to describe the structures in this region. Aim of the Work To describe the role of MRI in assessment of posteriolateral corner injury of knee joint. Patients and Methods This cross sectional study was conducted in department of Radiology in Ain Shams University, the data collected from database to reach sample size number and enrolled data of 20 patients in period was 18-24 months. Results We were able to show that the MRI procedure we gave accurately visualises the majority of the complex individual components of the posterolateral knee, as well as damage to these structures, in this investigation. When the diagnosis of grade III injuries to the posterolateral knee is in doubt, we believe that MRI of the posterolateral knee is a useful complement to the surgeon. In our capacity to correctly diagnose damaged structures on MRI, there were no clear differences between acute and chronic knee injuries. On MRI, avulsions or tears of the direct arm or anterior arm insertion off the fibular styloid show focal discontinuity, nonvisualization, increased signal intensity, or proximal retraction, often with a contemporaneous bone avulsion. The damage pattern can also be seen in axial and sagittal views. Conclusion When posterolateral rotatory instability is suspected, the MRI approaches that described for visualizing particular injuries to the posterolateral knee will almost always reveal the bulk of the affected structures. When a posterolateral knee injury is assessed on MRI, using a special MRI protocol that covers the full fibular head and styloid on all imaging sequences will help in identifying these structures.

Significance of Ultrasound in Assessment of Painful Knee: A Comparative Study to Magnetic Resonance Imaging

Abstract Background Knee pain is one of the most frequent symptoms that bring patients to the hospital. It affects approximately 25% of adults, with an increasing incidence nowadays the pain may result from the muscles, ligaments, tendons, and menisci, from trauma due to non-traumatic injuries like infection, bursitis, osteoarthritis, and tendinitis. Aim of the Work Aim of study is to evaluate the role of US in assessment of painful knee compared to conventional MRI sequences as an alternative cost-effective screening modality for an accurate diagnosis. Patients and Methods This study is a cross-sectional study was conducted at Ain Shams University Hospitals at Radiology department. Our study included forty patients complaining of acute knee pain from (1 day to 3 months’ duration). The main source of data for this study was the prospectively conducted scans and clinical history of the patients referred to the MRI section of the department of Radiology, Ain Shams University Hospitals at 6 months. Results Forty patients complaining of acute knee pain from. Every single one of them went through MRI and US assessments indiscriminately and independently, US succeeded in evaluating soft tissue structures pathologies including knee effusion, meniscal injury (degeneration, tear, and extrusion), MCL, LCL, bursitis. muscle, tendon injury and osteoarthritic changes. aside from the cruciate ligaments. US showed an overall sensitivity of 70.1% and specificity of 99.2% with accuracy of 95.2%. The overall PPV and NPV were 93.1% and 95.5% respectively. Conclusion US has proved that it can be used as an alternative cost effective screening modality for patients complaining of acute pain, US has reasonable sensitivity, specificity and accuracy in detecting knee effusion, meniscal injury including degeneration, tear, and extrusion, collateral ligaments, bursitis, baker cyst. Muscle, tendon injury and osteoarthritic changes, with no contraindications it can be used as the first choice in assessment of acute knee pain. MRI can be reserved for further workup if clinically warranted.

Tracking longitudinal thalamic volume changes during early stages of SCA1 and SCA2

PurposeSpinocerebellar ataxia SCA1 and SCA2 are adult-onset hereditary disorders, due to triplet CAG expansion in their respective causative genes. The pathophysiology of SCA1 and SCA2 suggests alterations of cerebello-thalamo-cortical pathway and its connections to the basal ganglia. In this framework, thalamic integrity is crucial for shaping efficient whole-brain dynamics and functions. The aims of the study are to identify structural changes in thalamic nuclei in presymptomatic and symptomatic SCA1 and SCA2 patients and to assess disease progression within a 1-year interval.Material and methodsA prospective 1-year clinical and MRI assessment was conducted in 27 presymptomatic and 23 clinically manifest mutation carriers for SCA1 and SCA2 expansions. Cross-sectional and longitudinal changes of thalamic nuclei volume were investigated in SCA1 and SCA2 individuals and in healthy participants (n = 20).ResultsBoth SCA1 and SCA2 patients had significant atrophy in the majority of thalamic nuclei, except for the posterior and partly medial nuclei. The 1-year longitudinal evaluation showed a specific pattern of atrophy in ventral and posterior thalamus, detectable even at the presymptomatic stage of the disease.ConclusionFor the first time in vivo, our exploratory study has shown that different thalamic nuclei are involved at different stages of the degenerative process in both SCA1 and SCA2. It is therefore possible that thalamic alterations might significantly contribute to the progression of the disease years before overt clinical manifestations occur.

Quantitative assessment of preoperative brain development in pediatric congenital heart disease patients by synthetic MRI

ObjectivesThis study investigated the quantitative assessment and application of Synthetic MRI (SyMRI) for preoperative brain development in children with congenital heart disease (CHD).MethodsForty-three CHD patients aged 2–24 months were prospectively included in the observation group, and 43 healthy infants were included in the control group. The SyMRI scans were processed by postprocessing software to obtain T1, T2, and PD maps. The values of T1, T2, and PD in different brain regions were compared with the scores of the five ability areas of the Gesell Development Scale by Pearson correlation analysis.ResultsIn the observation group, the T1 values of the posterior limb of the internal capsule (PLIC), Optic radiation (PTR), cerebral peduncle, centrum semiovale, occipital white matter, temporal white matter, and dentate nucleus were greater than those in the control group. In the observation group, the T2 values of the PLIC, PTR, frontal white matter, occipital white matter, temporal white matter, and dentate nucleus were greater than those in the control group. Pearson correlation analysis revealed that the observation group had significantly lower Development Scale scores. In the observation group, the T2 value of the splenium of the corpus callosum was significantly positively correlated with the personal social behavior score. The AUCs for diagnosing preoperative brain developmental abnormalities in children with CHD using T1 values of the temporal white matter and dentate nucleus were both greater than 0.60.ConclusionsQuantitative assessment using SyMRI can aid in the early detection of preoperative brain development abnormalities in children with CHD.Critical relevance statementT1 and T2 relaxation values from SyMRI can be considered as a quantitative imaging marker to detect abnormalities, allowing for early clinical evaluation and timely intervention, thereby reducing neurodevelopmental disorders in these children.Key PointsT1 and T2 relaxation values by SyMRI are related to myelin development.Evaluated development quotient markers were lower in the observation compared to the control group.SyMRI can act as a reference indicator for brain development in CHD children.Graphical

Progression of brain injuries associated with methotrexate chemotherapy in childhood acute lymphoblastic leukemia.

Brain bases and progression of methotrexate-associated neurotoxicity and cognitive disturbances remain unknown. We tested whether brain abnormalities worsen in proportion to intrathecal methotrexate(IT-MTX) doses. In this prospective, longitudinal study, we recruited 19 patients with newly diagnosed acute lymphoblastic leukemia 4-to-20 years of age and 20 matched controls. We collected MRI and neuropsychological assessments at a pre-methotrexate baseline and at week 9, week 22, and year 1 during treatment. Patients had baseline abnormalities in cortical and subcortical gray matter(GM), white matter(WM) volumes and microstructure, regional cerebral blood flow, and neuronal density. Abnormalities of GM, blood flow, and metabolites worsened in direct proportions to IT-MTX doses. WM abnormalities persisted until week 22 but normalized by year 1. Brain injuries were localized to dorsal and ventral attentional and frontoparietal cognitive networks. Patients had cognitive deficits at baseline that persisted at 1-year follow-up. Baseline abnormalities are likely a consequence of neuroinflammation and oxidative stress. Baseline abnormalities in WM microstructure and volumes, and blood flow persisted until week 22 but normalized by year 1, likely due to treatment and its effects on reducing inflammation. The cytotoxic effects of IT-MTX, however, likely contributed to continued, progressive cortical thinning and reductions in neuronal density, thereby contributing to enduring cognitive deficits. Brain abnormalities at a pre-methotrexate baseline likely are due to acute illness. The cytotoxic effects of intrathecal MTX contribute to progressive cortical thinning, reductions in neuronal density, and enduring cognitive deficits. Baseline white matter abnormalities may have normalized via methotrexate treatment and decreasing neuroinflammation. Corticosteroid and leucovorin conferred neuroprotective effects. Our findings suggest that the administration of neuroprotective and anti-inflammatory agents should be considered even earlier than they are currently administered. The neuroprotective effects of leucovorin suggest that strategies may be developed that extend the duration of this intervention or adapt it for use in standard risk patients.

Home-Based or Supervised Physical Therapy Shows Similar Functional Outcomes and Healing After Massive Rotator Cuff Repair

PurposeThis study aimed to compare postoperative clinical outcomes at the 3-month, 6-month, 12-month, and latest follow-up in patients undergoing supervised physical therapy (PT) or a home-based exercise program after arthroscopic repair (ARCR) of massive rotator cuff tears (MRCTs). MethodsA retrospective review was conducted on a prospectively maintained database of patients who underwent either supervised PT or home-based therapy after ARCR of MRCTs between January 2015 and December 2018 at a single center with a minimum 24-month follow-up. At their 2-week postoperative routine follow-up, patients are allowed to choose between home-based and supervised PT. Patient-reported outcomes (PROs) and range of motion (ROM) were collected and compared between cohorts preoperatively and at the 3-month, 6-month, 12-month, and latest follow-up. The percentage of patients reaching or exceeding the minimal clinically important difference (MCID) and patient accepted symptomatic state (PASS) for visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon score (ASES), and Subjective Shoulder Value (SSV) were recorded for both cohorts at each time point. Complications, healing, satisfaction, and return to work were reported. Healing was evaluated via ultrasound at the latest follow-up. ResultsNinety-nine patients met the study criteria: 61 in the supervised PT cohort, and 38 in the home-based cohort. The supervised PT and home-based cohorts returned to clinic for their most recent follow-up at 53±20 and 55±16 months (p=0.496) after surgery, respectively. There was no difference when comparing tendon involvement (SS, p=0.574; IS, p=0.288; SSc p=0.592), tear retraction (p=0.603), or high-grade fatty infiltration (SS, p=0.684; IS, p-0.397; SSc p=0.473) based on preoperative MRI assessment and surgery-related factors, including anterior (p=0.473) or posterior (p=0.386) slides, fixation constructs (p=0.829), or complete repair (p=0.912). Both cohorts showed similar PROs and ROM at baseline. Postoperative PROs and ROM were similar among groups at the 3-month, 6-month, 12-month, and latest follow-up. However, ASES (71.4 vs 61.2; p = 0.013) and FF (135° vs 118°; p = 0.023) were significantly higher at 3-month follow-up in the home-based cohort. Both groups comparably achieved MCID and PASS for PROs at the 3-month, 6-month, and12-month follow-up. At the latest follow-up, the supervised PT and home-based cohort achieved MCID and PASS for VAS (75% vs 81%, p=0.573; 70% vs 72%, p=0.911), ASES (76% vs 74%, p=0.777; 72% vs 72%, p=0.873), and SSV (82% vs 84%, p=0.734; 72% vs 66%, p=0.489), respectively. Satisfaction, healing, complication, and return to work rates were similar. ConclusionPatients undergoing rehabilitation using a home-based protocol showed largely similar functional scores and healing to those with supervised PT after ARCR of MRCTs at the latest follow-up. Although patients with home-based therapy achieved higher FF and ASES at the 3-month follow-up, these became comparable starting at the 6-month postoperative mark. MCID and PASS were achieved similarly for PROs at each time point.

Functional and Structural Cerebellar-Behavior Relationships in Aging.

Healthy aging is associated with deficits in cognitive performance and brain changes, including in the cerebellum. Yet, the precise link between cerebellar function/structure and cognition in aging remains poorly understood. We explored this relationship in 138 healthy adults (aged 35-86, 53% female) using resting-state functional connectivity MRI (fcMRI), cerebellar volume, and cognitive and motor assessments in an aging sample. We expected to find negative relationships between lobular volume for with age, and positive relationships between specific lobular volumes with motor and cognition respectively. We predicted lower cerebellar fcMRI to cortical networks and circuits with increased age. Behaviorally, we expected higher cerebello-frontal fcMRI cerebellar connectivity with association areas to correlate with better behavioral performance. Behavioral tasks broadly assessed attention, processing speed, working memory, episodic memory, and motor abilities. Correlations were conducted between cerebellar lobules I-IV, V, Crus I, Crus II, vermis VI and behavioral measures. We found lower volumes with increased age as well as bidirectional cerebellar connectivity relationships with increased age, consistent with literature on functional connectivity and network segregation in aging. Further, we revealed unique associations for both cerebellar structure and connectivity with comprehensive behavioral measures in a healthy aging population. Our findings underscore cerebellar involvement in behavior during aging.

Can whole-body MRI assessment replace clinical joint examination in assessing disease activity in children with juvenile idiopathic arthritis?

Can whole-body MRI assessment replace clinical joint examination in assessing disease activity in children with juvenile idiopathic arthritis?

LGG-18. BEVACIZUMAB: GOOD FOR EYES AND MRI’S! A NATIONAL UK ASSESSMENT OF VISUAL AND RADIOLOGICAL OUTCOMES OF BEVACIZUMAB THERAPY IN PAEDIATRIC LOW-GRADE GLIOMA (PLGG)

Abstract INTRODUCTION Bevacizumab (BEV) is increasingly used for PLGGs in varying manners despite limited evidence. The potential for BEV to preserve or rescue vision in OPGs has not yet been explored. We performed a nationwide UK evaluation of BEV use for PLGG to provide large cohort safety &amp; efficacy (radiological &amp; visual) data. METHODS A retrospective UK multi-centre analysis of patients treated with BEV for PLGG 2009-2020. Clinical patient, tumour, treatment and toxicity data were analysed from medical records. Age-adjusted LOGMAR visual acuity and radiological MRI assessments (RANO) were reviewed from initiation of BEV until latest follow-up. Standardized radiological &amp; visual criteria assessed efficacy and clinical–radiological correlation. RESULTS 88 PLGG patients from 11 PTCs received BEV either 3rd-line with irinotecan (85%) or alongside 1st/2nd line chemotherapy (15%) at median age 6 years (0.65-17). Median duration from diagnosis to BEV was 38 months. PLGGs included:15% Non-OPGs, 85% OPGs. Cohort OS 92% at median follow-up 34 months(3-106). Toxicity was limited and minimal. 8% stopped BEV for CTCAE grade 2+ toxicities, &amp; 3 patients had SAEs (2 intracranial haemorrhages, 1 thrombosis) after stopping BEV without obvious alternative cause. Overall radiological response (SD/PR/CR) was 88%; median duration to best response 3 months. Overall visual response (stable/improved) was 72%; median duration to best response 3-6 months. Superior visual outcomes were seen in NF1-OPGs (p=0.02). Concordance between visual and radiological responses was 36%; 48% using best eye only visual responses. 65% patients with treatment response had tumour progression (all-cause) within 8 months of BEV cessation. Visual responses endured significantly longer than radiological responses (p0.03). CONCLUSIONS BEV is a generally safe and effective treatment for PLGG. Most patients demonstrated on-treatment radiological and visual response. Preservation of response after BEV was limited, though visual responses endured better than radiological responses. BEV may have a unique role as a sight-saving strategy in OPG.

Altered Cerebrospinal Fluid Neurofilament Light Chain but Not Neurogranin Levels Are Associated with Response to Ocrelizumab Treatment in Relapsing-Remitting Multiple Sclerosis: A Preliminary Study

Introduction: Ocrelizumab is a CD20-targeting monoclonal antibody used for treatment of multiple sclerosis (MS). Serum and cerebrospinal fluid (CSF) neurofilament light (NFL) chain levels are reduced in MS patients under ocrelizumab treatment indicating a preventive action against neuro-axonal degeneration. Our aim, in this preliminary study, was to explore the impact of ocrelizumab treatment on synaptic integrity through assessment of neurogranin levels. Methods: Thirteen relapsing-remitting multiple sclerosis (RRMS) patients resistant to first-line immunomodulating agents were enrolled and followed up for 24 months under ocrelizumab treatment. Disease activity was monitored by periodic EDSS, MSSS, and cranial-spinal MRI assessments. No evidence of disease activity (NEDA)-3 was determined, and CSF levels of NFL (marker of neuro-axonal integrity) and neurogranin (marker of synaptic integrity) were measured by ELISA at baseline and 12-month ocrelizumab treatment. Results: Seven RRMS patients, who preserved NEDA-3 status during 24-month follow-up, showed ≥30% NFL level decrease, whereas 6 patients with stable/increased NFL levels displayed relapse, MRI lesion, or disability progression. Although most RRMS patients exhibited increased CSF levels of neurogranin under ocrelizumab treatment, patients with and without neurogranin level increase did not differ in terms of clinical features and NEDA-3 status. Baseline neurogranin levels negatively correlated with baseline EDSS scores. Conclusion: Our results confirm that NFL effectively monitors treatment response of RRMS patients under ocrelizumab treatment. Neurogranin does not appear to exhibit a similar benefit in screening of RRMS disease activity. Nevertheless, lower neurogranin levels are associated with increased disability in RRMS indicating a potential disease activity biomarker function.

LMIC-07. OUTCOMES OF NEUROFIBROMATOSIS TYPE 1-ASSOCIATED OPTIC PATHWAY GLIOMAS AT A SINGLE TERTIARY PEDIATRIC ONCOLOGY CENTER IN EGYPT: BORG EL ARAB UNIVERSITY HOSPITAL (BAUH) EXPERIENCE

Abstract BACKGROUND Neurofibromatosis type 1 (NF-1) is a multisystem disease inherited in an autosomal dominant fashion. About 15% of the pediatric cases have associated brain tumors, among which the optic pathway gliomas (OPG) remain the most common. Due to their location, OPG can cause visual impairment, and endocrinal dysfunction, hence requiring therapeutic interventions, more commonly in sporadic non-NF-1 cases. METHODS NF-1 children with associated OPG followed at a single tertiary pediatric oncology center since its establishment from 2018 to 2023 were retrospectively evaluated. RESULTS Forty patients were identified either as firstly diagnosed NF-1 cases in our center or referred to us for follow up. Twenty-three of them who had associated OPG (mean age at diagnosis 83.7 months) were included in our study. The commonest clinical presentation was the bilateral initial visual affection occurring in 13 patients. Six had hormonal imbalance and four presented with seizures. Biopsy was taken only in 30%, with histopathology being mainly pilocytic astrocytoma. In terms of treatment, 10 cases received only one line of chemotherapy, six patients were kept on follow up, and the rest received more than one line of therapy. Overall survival (OS) was 100% throughout the study period, and progression-free survival was 64.1% at 1.5 years, and 46.8% at 5 years. Visual assessment at the end of treatment was stable in 71%, better in 22%, and worse in 7% of cases. Same pattern was observed in MRI assessment post therapy showing 57% stable disease, 39% regression, and 4% progression. CONCLUSIONS Survival of children with OPG is different in every center of the world as decisions regarding their management being challenging. Therefore, NF-1 multidisciplinary clinics are important to be established, with a high emphasis on early detection and referral of patients, standardization of symptoms grading and indications to start treatment.

Automated MRI Quality Assessment of Brain T1-weighted MRI in Clinical Data Warehouses: A Transfer Learning Approach Relying on Artefact Simulation

The emergence of clinical data warehouses (CDWs), which contain the medical data of millions of patients, has paved the way for vast data sharing for research. The quality of MRIs gathered in CDWs differs greatly from what is observed in research settings and reflects a certain clinical reality. Consequently, a significant proportion of these images turns out to be unusable due to their poor quality. Given the massive volume of MRIs contained in CDWs, the manual rating of image quality is impossible. Thus, it is necessary to develop an automated solution capable of effectively identifying corrupted images in CDWs. This study presents an innovative transfer learning method for automated quality con- trol of 3D gradient echo T1-weighted brain MRIs within a CDW, leveraging artefact sim- ulation. We first intentionally corrupt images from research datasets by inducing poorer contrast, adding noise and introducing motion artefacts. Subsequently, three artefact- specific models are pre-trained using these corrupted images to detect distinct types of artefacts. Finally, the models are generalised to routine clinical data through a transfer learning technique, utilising 3660 manually annotated images. The overall image quality is inferred from the results of the three models, each designed to detect a specific type of artefact. Our method was validated on an independent test set of 385 3D gradient echo T1-weighted MRIs. Our proposed approach achieved excellent results for the detection of bad quality MRIs, with a balanced accuracy of over 87%, surpassing our previous approach by 3.5 percent points. Additionally, we achieved a satisfactory balanced accuracy of 79% for the detection of moderate quality MRIs, outperforming our previous performance by 5 percent points. Our framework provides a valuable tool for exploiting the potential of MRIs in CDWs.

Ferumoxytol-enhanced MRI assessment of venous Thrombus resolution and macrophage content in a murine deep vein thrombosis model

BackgroundImaging evaluation of acute deep vein thrombosis (DVT) or post-thrombotic syndrome (PTS) in animal or clinical models is limited to anatomical assessment of the location and extent of thrombi. We hypothesize that Fe-MRI, used to evaluate macrophage content in other inflammatory diseases, can be useful to evaluate the thromboinflammatory features after DVT over time. MethodsNineteen wild-type CD-1 mice underwent surgical IVC ligation to induce DVT. Mice received either saline or 5 mg/kg of 14E11, a Factor XI inhibitor, before the procedure. Fe-MRI was performed on days 6–7 after ligation to evaluate thrombus volume, perfusion, and macrophage content via T2-weighted images. Mice were euthanized at days 3–15 after surgery. The thrombi and adjacent vein walls were excised, weighed, formalin-fixed, and paraffin-embedded for immunohistological analysis. Specimens were stained with specific antibodies to evaluate macrophage content, collagen deposition, neovascularization, and recanalization. Significance was determined using the Mann-Whitney U or Student's t-test. ResultsAfter IVC-ligation in control mice, thrombus weights decreased by 59 % from day 3 to 15. Thrombus volumes peaked on day 5 before decreasing by 85 % by day 13. FXI inhibition led to reduced macrophage content in both thrombi (p = .008) and vein walls (p = .01), decreased thrombus volume (p = .03), and decreased thrombus mass (p = .01) compared to control mice. CCR2+ staining corroborated these findings, showing significantly reduced macrophage presence in the thrombi (p = .002) and vein wall (p = .002). ConclusionsFe-MRI T2 relaxation times can be used to characterize and quantify post-thrombotic changes of perfusion, macrophage content, and thrombus volume over time in a surgical mouse model of venous thrombosis. This approach could lead to better quantification of in vivo inflammation correlating monocyte and macrophage content within resolving thrombi and veins and may serve as a useful tool for research and clinically in the evaluation of the post-thrombotic environment.

Neoadjuvant dalpiciclib combined with aromatase inhibitors in stage I-III HER2 negative luminal B breast cancer (DANCER): Preliminary findings from an ongoing phase II study.

e12622 Background: CDK4/6 inhibitors, in combination with endocrine therapy, have shown efficacy as neoadjuvant treatment in HR+/HER2- breast cancer (BC). This study investigates the efficacy and safety of dalpiciclib, a CDK4/6 inhibitor, combined with aromatase inhibitors (AI) as a neoadjuvant treatment for luminal B BC (defined as ER+/HER2- BC, with either Ki67≥20% and/or PR&lt;20%). Methods: This single-arm, single-center, phase II study (NCT05640778) enrolled patients aged 18-75 with clinical stage I-III luminal B BC, primary tumor size ≥2 cm, and ECOG PS 0-1. Eligible patients, regardless of menopausal status, received AI therapy (either anastrozole 1 mg daily or letrozole 2.5 mg daily) combined with dalpiciclib (150 mg daily on days 1-21) starting from cycle 1 day 1 (C1D1), for four 28-day cycles, followed by surgery. Pre-/peri-menopausal patients received AI therapy 14 days prior to the first dose of dalpiciclib (C0D1-C0D14), concurrent with a GnRH agonist administered every 28 days from C0D1. Ki67 levels were assessed through serial biopsies at baseline, C1D15, and surgery. MRI assessments were performed at baseline, C2D28, and before surgery per RECIST v1.1. Serial plasma samples were collected for circulating tumor DNA (ctDNA) analysis. The primary endpoint was the complete cell cycle arrest (CCCA: Ki67≤2.7%) rate at 2 weeks (C1D15). Results: From Oct 2022 to Dec 2023, 23 patients with a median age of 52 years (range 38-73) were enrolled and received study treatment. Of these patients, 11 (47.8%) were pre-/peri-menopausal. Sixteen (69.6%) were diagnosed with stage II and the remaining had stage III disease. High Ki67 expression (≥20%) was observed in 21 patients (91.3%). As of Jan 7, 2024, all patients underwent the C1D15 Ki67 evaluation and the CCCA rate was 82.6% (95% CI: 60.5%-94.3%). The ctDNA concentration at C2D28 and post-surgery was significantly higher in patients who did not achieve CCCA compared to those who achieved CCCA ( P = 0.003 and 0.011, respectively). Ki67 expression decreased by a geometric mean of 93.1% (95% CI:76.0%-98.8%) from baseline to C1D15. Out of 20 patients who completed 2 cycles of treatment and received an MRI scan, 12 achieved a partial response, yielding an ORR of 60.0% at C2D28. Among 17 who completed all neoadjuvant therapy and underwent surgery, the ORR before surgery was 82.4% with 14 partial responses; none demonstrated residual cancer burden (RCB) 0/1, seven exhibited RCB 2, and 10 had RCB 3; one reached breast pathological complete response (ypTisN1). Grade ≥3 treatment-emergent adverse events included neutrophil count decreased (16, 69.6%), white blood cell decreased (9, 39.1%), and oral mucositis (1, 4.3%). Conclusions: Dalpiciclib plus anastrozole or letrozole exhibited biological and clinical activity with manageable toxicities in neoadjuvant treatment for stage I-III luminal B/HER2- BC. Clinical trial information: NCT05640778 .

Prognostic Value of MRI Assessment of Residual Peritumoral Edema in Breast Cancer Treated With Neoadjuvant Chemotherapy.

Peritumoral edema (PE) identified on T2-weighted breast MRI is a factor for poor prognosis in breast cancer. To assess the prognostic value of residual PE (rPE) in patients with PE positive breast cancer prior to neoadjuvant chemotherapy (NACT) who subsequently underwent curative surgery. Retrospective. In total, 128 patients with nonmetastatic invasive breast cancer who underwent breast MRI before and after NACT. Axial precontrast 2D fast spin echo T2W fat-suppressed sequence. Axial dynamic 3D gradient echo T1W fat-suppressed sequence. PE was diagnosed when a signal intensity as high as water was detected surrounding the tumor on a T2-weighted breast MRI. PE was qualitatively evaluated by three readers with more than 20 years of experience in interpreting breast field imaging findings. Residual cancer burden (RCB) were assessed post-NACT. Recurrence-free survival (RFS) and overall survival (OS) were evaluated as the endpoints of this study. Chi-square test; Kaplan-Meier method, log-rank test, and Cox proportional hazard model. A P-value <0.05 was considered statistically significant. Pre-PE was observed in 64 out of 128 patients. Of these, rPE was observed in 21. In the log-rank test, breast cancer with rPE had significantly worse RFS and OS than that without rPE. Cox proportional hazard analysis identified rPE as a significant prognostic factor for recurrence (hazard ratio, 11.6; 95% confidence interval [CI], 3.05-43.8) and death (hazard ratio, 17.8; 95% CI, 3.30-96.3). Breast cancer with rPE had significant worse RFS and OS than that without rPE in RCB class II, and significant worse OS in pathological complete response, class I and class II in the log-rank test. rPE on a T2-weighted breast MRI was a significant factor for breast cancer recurrence and death in patients with pre-PE-positive breast cancer treated with NACT. Stage 2.

Heterogeneous blood-brain barrier dysfunction in cerebral small vessel diseases.

We explored how blood-brain barrier (BBB) leakage rate of gadolinium chelates (Ktrans) and BBB water exchange rate (kw) varied in cerebral small vessel disease (cSVD) subtypes. Thirty sporadic cSVD, 40 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and 13 high-temperature requirement factor A serine peptidase 1 (HTRA) -related cSVD subjects were investigated parallel to 40 healthy individuals. Subjects underwent clinical, cognitive, and MRI assessment. In CADASIL, no difference in Ktrans, but lower kw was observed in multiple brain regions. In sporadic cSVD, no difference in kw, but higher Ktrans was found in the whole brain and normal-appearing white matter. In HTRA1-related cSVD, both higher Ktrans in the whole brain and lower kw in multiple brain regions were observed. In each patient group, the altered BBB measures were correlated with lesion burden or clinical severity. In cSVD subtypes, distinct alterations of kw and Ktrans were observed. The combination of Ktrans and kw can depict the heterogeneous BBB dysfunction. We measured BBB leakage to gadolinium-based contrast agent (Ktrans) and water exchange rate (kw) across BBB in three subtypes of cSVD. CADASIL is characterized by lower kw, HTRA1-related cSVD exhibits both higher Ktrans and lower kw, while sporadic cSVD is distinguished by higher Ktrans. There are distinct alterations in kw and Ktrans among subtypes of cSVD, indicating the heterogeneous nature of BBB dysfunction.