MRI Evaluation Of Patients Research Articles

Combining semi-quantitative rating and automated brain volumetry in MRI evaluation of patients with probable behavioural variant of fronto-temporal dementia: an added value for clinical practise?

To evaluate the diagnostic value of combined semiquantitative and quantitative assessment of brain atrophy in the diagnostic workup of the behavioural-variant of frontotemporal dementia (bvFTD). Three neuroradiologists defined brain atrophy grading and identified atrophy pattern suggestive of bvFTD on 3D-T1 brain MRI of 112 subjects using a semiquantitative rating scale (Kipps'). A quantitative atrophy assessment was performed using two different automated software (Quantib® ND and Icometrix®). A combined semiquantitative and quantitative assessment of brain atrophy was made to evaluate the improvement in brain atrophy grading to identify probable bvFTD patients. Observers' performances in the diagnosis of bvFTD were very good for Observer 1 (k value = 0.881) and 2 (k value = 0.867), substantial for Observer 3 (k value = 0.741). Semiquantitative atrophy grading of all the observers showed a moderate and a poor correlation with the volume values calculated by Icometrix® and by Quantib® ND, respectively. For the definition of neuroradiological signs presumptive of bvFTD, the use of Icometrix® software improved the diagnostic accuracy for Observer 1 resulting in an AUC of 0.974, and for Observer 3 resulting in a AUC of 0.971 (p-value < 0.001). The use of Quantib® ND software improved the diagnostic accuracy for Observer 1 resulting in an AUC of 0.974, and for Observer 3 resulting in a AUC of 0.977 (p-value < 0.001). No improvement was observed for Observer 2. Combining semiquantitative and quantitative brain imaging evaluation allows to reduce discrepancies in the neuroradiological diagnostic workup of bvFTD by different readers.

Editorial Comment.

No AccessJournal of UrologyAdult Urology26 Jan 2023Editorial CommentThis article comments on the following:Impact of Prostate Urethral Lift Device on Prostate Magnetic Resonance Image Quality Subodh K. Regmi Subodh K. RegmiSubodh K. Regmi Department of Urology, University of Minnesota, Minneapolis, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003156.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . MRI evaluation of patients before and after interventions for benign prostatic hyperplasia: an update. AJR Am J Roentgenol. 2021; 218(1):88-99. Google Scholar 2. Impact of prostate urethral lift device on prostate magnetic resonance image quality. J Urol. 2023; 209(4). Google Scholar 3. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int. 2017; 119(5):767-775. Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology11 Jan 2023Impact of Prostate Urethral Lift Device on Prostate Magnetic Resonance Image Quality Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Subodh K. Regmi Department of Urology, University of Minnesota, Minneapolis, Minnesota More articles by this author Expand All Advertisement PDF downloadLoading ...

ROLE OF MRI IN ASSESSMENT OF PATIENTS WITH PAINFUL KNEE JOINT

MRI has revolutionized diagnostic imaging of the knee. It has become the investigation of choice in the assessment of internal joint structures of the knee joint like menisci, cruciate ligaments and articular cartilage. PURPOSE: The objective of this study is assessing the role of MRI to identify and describe various etiologies of painful knee joint. Our study was a hospital MATERIALS AND METHODS: based descriptive study conducted at S.M.S. Medical College and Hospital, Jaipur (Raj). Total 50 patients with painful knee joint were included. Patients referred from orthopedic department for MRI evaluation of painful knee joint were included in the study and post operative cases were excluded from the study. All the MRI scans were performed using 3.0 TESLA MRI Philips Ingenia Machine. Results were analysed by a descriptive analysis and specic ndings were compiled. Out of 50 patients MR images were normal in 2 patient RESULTS: s. Most common knee pathology was meniscus injury in 32 (64%) patients and involved medial meniscus in 22 patients. In ligament tears ACL injury was more common than PCL injury. Other chronic causes of painful knee joint were chondromalacia patellae, osteoarthritis and cystic lesion. MRI evaluation in patients with CONCLUSION: painful knee is of vital importance, as MRI can demonstrate the exact nature and extent of bony as well as soft tissue abnormality. MR imaging is the best non-invasive modality for the diagnosis of meniscal and ligament tears.

MRI Evaluation of Patients Before and After Interventions for Benign Prostatic Hyperplasia: An Update.

Transurethral resection of the prostate is the most commonly performed procedure for the management of patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). However, in recent years, various minimally invasive surgical therapies have been introduced to treat BPH. These include laser-based procedures such as holmium laser enucleation of the prostate and photoselective vaporization of the prostate as well as thermal ablation procedures such as water vapor thermal therapy (Rezūm), all of which result in volume reduction of periurethral prostatic tissue. In comparison, a permanent metallic device (UroLift) can be implanted to pull open the prostatic urethra without an associated decrease in prostate size, and selective catheter-directed prostate artery embolization results in a global decrease in prostate size. The goal of this article is to familiarize radiologists with the underlying anatomic changes that occur in BPH as visualized on MRI and to describe the appearance of the prostate on MRI performed after these procedures. Complications encountered on imaging after these procedures are also discussed. Although MRI is not currently used in the routine preprocedural evaluation of BPH, emerging data support a role for MRI in predicting postprocedure outcomes.

MRI of placenta accreta: diagnostic accuracy and impact of interventional radiology on foetal-maternal delivery outcomes in high-risk women.

To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI. 26 patients (mean age 36.24 y/o,SD 6.16) with clinical risk-factors and echographic suspicion of IP underwent 1.5 T-MRI. Two readers reviewed images. Gold-standard was histology in hysterectomised patients and obstetric evaluation at delivery for patients with preserved uterus. Accuracy and reproducibility of MRI findings were calculated. Incidence of IP was 50% (13/26) and of PP was 11.54% (3/26). MRI showed 100% sensitivity (95% CI = 75.3-100%) and 92.3% specificity (95% CI = 64.0-100%) in the diagnosis of IP. Gold-standard was histology in 10 cases and obstetric evaluation in 16. MRI findings with higher sensitivity were placental heterogeneity, uterine bulging and black intraplacental bands. Uterine scarring, placental heterogeneity, myometrial interruption and tenting of the bladder showed better specificity. MRI inter-rater agreement with Cohen's K was 1. 11 patients among 14 with MRI diagnosis of IP received IR assistance with positive impact on delivery outcomes in terms of blood loss, red cells count, intense care unit length of stay, days of hospitalisation and risk of being transfused. MRI is an accurate and reproducible technique in prenatal diagnosis of IP. MRI helps planning a safe and appropriate delivery eventually assisted by IR, which positively affects foetal and maternal outcomes. The adoption of MRI evaluation in patients with high risk of invasive placentation allows a more accurate diagnosis in terms of both presence of the disease and its extension to or through or even beyond the myometrium. This led to a better dedicated delivery management with eventual adoption of interventional radiology with a global positive effect on foetal and maternal outcomes.

Whole Body MRI Evaluation in Patients with Multiple Myeloma: A Must

Whole Body MRI Evaluation in Patients with Multiple Myeloma: A Must

Comparison of clinical examination with orbital MRI evaluation in patients with thyroid orbitopathy - do we need imaging and when?

The frequency of Graves’ orbitopathy (GO) in patients with Graves’ disease (GD) depends on the method of assessment. Diagnosis based on clinical symptoms is made in about 30-50% patients, more often (70%) after ophtalmological examination with evaluation of intraocular pressure, whereas MRI reveals GO in up to 90%. Proper identification of active phase of the disease is crucial.

Association between linear measurements of corpus callosum and gait in the elderly

Segmentation and diffusion-tensor-imaging of the corpus callosum (CC) have been linked to gait impairment. However, such measurements are impracticable in clinical routine. The purpose of this study was to evaluate the association between simple linear measurements of CC thickness with gait. Two hundred and seventy-two community-dwelling subjects underwent neurological assessment and brain MRI. Mid-sagittal reformats of T1-weighted images were used to determine CC thickness. The association of measurements with clinical evaluation of gait was assessed by multivariate regression, controlling for numerous clinical and imaging confounders. Differences in CC thickness were, moreover, compared between subgroups with no, moderate or severe impairment of gait. In univariate analyses, thickness of the genu and body of CC but not the splenium were associated with postural stability (P < 0.01). Multivariate regression revealed thickness of CC genu as the only imaging variable independently associated with gait (P = 0.01). Genu thickness was significantly different between subjects with high and low (P = 0.0003) or high and moderate (P = 0.001) risk of fall. Atrophy of the CC genu is an imaging marker of gait impairment in the elderly suggesting higher risk of fall. Simple linear measurements of CC can help in MRI evaluation of patients with gait impairment. • Regional atrophy of the corpus callosum reflects disruption of gait regulation • Genu thickness on cranial MRI is an independent marker of gait impairment • Findings help in the MRI evaluation of patients with gait impairment.

Association between etiopathogenesis of morbidly adherent placenta and adenomyosis

The association between etio-pathogenesis of morbidly adherent placenta (MAP) or placenta cretas and adenomyosis has never been described in medical literature. Contrary to the believe that MAP is due to direct invasion of trophoblastic tissues into the adjacent normal myometrium due to prior uterine surgeries, this article describes how pre-existence of adenomyosis acts as a precursor for the development of placenta cretas. It elucidates how prior uterine traumas such as surgeries, repeated childbirths and endometritis cause endometrial tissues to invade the myometrium as a result of disruption of decidua basalis. The invaded endometrial tissues cause hyper-plasia and hypertrophy of surrounding myometrium to form the clinical entity called adenomyosis. The over-expression of bcl-2 oncogene in the endometrium causes inhibition of apoptosis of endometrial cells removing the barrier of trophoblastic tissues to invade the myometrium to form MAP. This hypothesis is based on the similarity of their clinical perspectives, similar pathological description of the two disease entities and their common molecular components. Both diseases increase with age; more in women older than 35 years and also in those with history of previous endometrial traumas such as surgeries, childbirth and endometritis. Both diseases also share common pathological factors and molecular components due to absence of deciduas basalis and over-expression of bcl-2 oncoprotein gene, inhibition of cell apoptosis and failure to find genetic abnormalities such as mutations of K-ras, P53 or LOH. An ongoing study looking at uterine specimens from cesarean hysterectomies and pelvic MRI evaluation of patients with retained placentas to prove that pre-existing adenomyosis may be a precursor to the development of morbidly adherent placenta is near to conclusion.

M1555 MRI Evaluation of Patients with Possible Adenocarcinoma of the Head of the Pancreas – Do We Still Need Laparoscopy?

M1555 MRI Evaluation of Patients with Possible Adenocarcinoma of the Head of the Pancreas – Do We Still Need Laparoscopy?

Dark Lumen Magnetic Resonance Enteroclysis in Combination With Mri Colonography for Whole Bowel Assessment in Patients With Crohnʼs Disease: First Clinical Experience

Magnetic resonance enteroclysis (MRE) is a recently introduced imaging technique that assesses the small bowel with similar sensitivity and specificity as the fluoroscopically performed conventional enteroclysis. Magnetic resonance imaging colonography (MRC) seems to be a promising technique for polyp assessment in the colon. In this feasibility study, we evaluated the combination of small bowel MRI with unprepared MRC as an integrative diagnostic approach of the whole bowel in patients with Crohn's disease. Thirty patients with known Crohn's disease were prospectively examined. No particular colonic preparation was applied. Applying the dark lumen technique in all patients, MRE and MRC were performed within 1 session using an integrative examination protocol. T2-weighted and contrast-enhanced T1-weighted sequences were acquired. Inflammation assessment (grades 0 to 2) of the colon was compared with conventional colonoscopy in 29 patient and with surgery in 1 patient. The entire colon was graded fair to good distended in all patients. In 11 of 210 evaluated colonic segments, feces hindered an adequate intraluminal bowel assessment. Twenty-three of 30 patients had complete colonoscopy as the gold standard. In 7 patients, complete colonoscopy could not be performed because of an inflamed stenosis. Correct grading of colonic inflammation was performed with 55.1% sensitivity and 98.2% specificity in all segments. Considering only more extensive inflammation (grade 2), the sensitivity of MRC increased to 70.2% with a specificity of 99.2%. The combination of MRE and MRC could improve the diagnostic value of abdominal MRI evaluation in patients with Crohn's disease. However, MRC can not replace conventional colonoscopy in subtle inflammation assessment.

Observer Variation in MRI Evaluation of Patients Suspected of Lumbar Disk Herniation

Our objective was to assess observer variation in MRI evaluation in patients suspected of lumbar disk herniation. Two experienced neuroradiologists independently evaluated 59 consecutive patients with lumbosacral radicular pain. Per patient, three levels (L3-L4 through L5-S1) and the accompanying roots were evaluated on both sides. For each segment, the presence of a bulging disk or a herniation and compression of the root was reported. Images were interpreted twice: once before and once after disclosure of clinical information. Interobserver agreement was expressed as unweighted kappa values. Without clinical information, interobserver agreement for the presence of herniation or bulging disk was moderate (full agreement, 84%; kappa = 0.63; 95% confidence interval [CI], 0.53-0.72). Of a total of 352 segments evaluated, there was disagreement on 58 segments (17%): bulging disk versus no defect in 26 (7.4%), bulging disk versus herniation in five (1.4%), and hernia versus no defect in 27 (7.7%). With clinical information, twice as many bulging disks were reported but no new herniations were detected. Agreement slightly decreased, but not significantly (full agreement, 77%; kappa = 0.59; 95% CI, 0.49-0.69; p = 0.12). On average, more than 50% of interobserver variation in MRI evaluation of patients with lumbosacral radicular pain is caused by disagreement on bulging disks. Knowledge of clinical information does not influence the detection of herniations but lowers the threshold for reporting bulging disks.

Voxel-by-Voxel Comparison of Automatically Segmented Cerebral Gray Matter—A Rater-Independent Comparison of Structural MRI in Patients with Epilepsy

Quantitative evaluation of MRI in patients with epilepsy can give more information than qualitative assessment. Previously developed volume-of-interest-based methods identified subtle widespread structural changes in the neocortex beyond the visualized lesions in patients with malformations of cortical development (MCD) and hippocampal sclerosis (HS) and also in MRI-negative patients with juvenile myoclonic epilepsy (JME). This study evaluates a voxel-based automated analysis of structural MRI in epilepsy. After fully automated segmentation of cerebral gray matter from structural T1-weighted, high-resolution MRI scans, we applied the automated and objective technique of statistical parametric mapping (SPM) to the analysis of gray matter of 35 control subjects, 10 patients with partial seizures and MCD, 10 patients with left temporal lobe epilepsy (TLE) and HS, 10 patients with left TLE and normal MR quantitation of the hippocampus, and 20 patients with JME. At a corrected threshold of P < 0.05, significant abnormalities were found in 3/35 controls; in all 10 patients with MCD, 6 of whom had additional lesions beyond the margins of the visualized abnormalities; in 2/10 TLE patients with HS; in 2/10 MRI-negative TLE; and in 4/20 JME patients. Group comparisons between control subjects and HS patients identified the affected left temporal lobe with an increase in gray matter in the posterior temporal lobe, but did not identify hippocampal atrophy. The group of MRI-negative TLE patients showed no abnormalities compared with control subjects. Group comparison between control subjects and JME patients identified a mesial frontal increase in gray matter. The SPM-based voxel-by-voxel comparison of gray matter distribution identified MCD and abnormalities beyond the visualized lesion in individual MCD patients. The method did not reliably identify HS in individual patients or identify abnormalities in individual MRI-negative patients with TLE or JME in a proportion larger than the chance findings in the control group. Using group comparisons, structural abnormalities in the neocortical gray matter of patients with TLE and HS were lateralized to the affected temporal lobe. In patients with JME as a group, an increase in gray matter was localized to the mesial frontal area, corroborating earlier quantitative MRI findings.