MRI Pathology Research Articles

Correlation of clinically significant prostate cancer sites across multiparametric MRI, prostate biopsy, and whole-mount pathology for optimal prostate biopsy strategy

Data from patients with suspicious lesions on multiparametric magnetic resonance (mpMRI) and a diagnosis of clinically significant prostate cancer (csPCa) who underwent radical prostatectomy (RP) were collected. The aim was to compare csPCa sites identified through whole-mount pathological analysis (WMA) after RP with PI-RADS ≥ 3 lesions identified on mpMRI, and with csPCa foci detected through targeted-biopsy (TB) or combined targeted + systematic biopsy (TSB). A paired Student’s t-test and Pearson correlation analysis were performed to evaluate the agreement between these diagnostic methods. A total of 106 patients were included in the TSB group and 95 in the TB group. The correlation between mpMRI, PB, and WMA was moderate and comparable in both groups. No correlation between PB and WMA was found in the TB group for PI-RADS3 lesions, while a moderate-strong correlation was observed when comparing mpMRI, PB, and WMA for PI-RADS > 3 lesions. About 50% of csPCa sites remained undetected by mpMRI. TSB was able to identify 16.5% more csPCa sites than TB. mpMRI is an accurate method in the diagnosis of PCa, especially for PI-RADS > 3 lesions, although some csPCa sites remained undetected. The use of TSB improved the location agreement between PB and WMA, increasing detection rates up to 79%.

Prevalence of neoplasms in acromegaly: a Turkish single-center retrospective study

Aims: This study aimed to investigate the prevalence of benign and malignant neoplasms and to assess associated clinical conditions in patients with acromegaly. Methods: In this single center, retrospective and observational study, data from 71 patients with acromegaly followed at an endocrinology and metabolism diseases outpatient clinic between January 2010 and December 2023 were reviewed through the hospital's electronic database. Patients' medical histories, demographic data, blood examinations, medications, pituitary MRI scans, thyroid ultrasound, mammography, colonoscopy, endoscopy, and pathology reports were evaluated. Acromegaly diagnosis was based on elevated insulin-like growth factor-1 (IGF-1) levels and unsuppressed growth hormone (GH) levels after oral glucose tolerance testing. The chi-square test and Mann-Whitney U test were used to compare patients with malignancy to other patients in terms of demographic and clinical characteristics. Results: The study included predominantly female patients (60.6%) with an average age of 55.6 years. The mean age at diagnosis was 44.3±11.3 years, and the mean disease duration was 11.3±8.4 years. Malignancies, including breast, thyroid, and colorectal cancers, were detected in 9.9% of patients. Additionally, thyroid nodules were present in 62% of patients, and colon polyps in 14.1%. No significant differences were observed in clinical features including age, gender, disease duration, GH levels, IGF-1 levels, adenoma size, or remission frequency between patients with and without malignancy (p>0.05 for all). Conclusion: This study reveals an increased prevalence of breast, colon, and thyroid cancers in patients with acromegaly. Performing cancer screenings in patients with acromegaly more comprehensively and at an earlier stage compared to the normal population may be beneficial.

Accuracy of pre-operative tumor size assessment compared to final pathology and frequency of adjuvant treatment in patients with FIGO 2018 stage IB2 cervical cancer

ObjectiveThe primary aim of our study was to compare tumor size assessment by pre-operative evaluation (physical examination and/or imaging) with tumor size on final pathology. As a secondary outcome, we...

PATH-07. CLINICAL AND RADIOGRAPHIC FEATURES OF DIFFUSE GLIOMA MOLECULAR SUBTYPES IN ACCORDANCE WITH THE 2021 CNS5 WHO CLASSIFICATION

Abstract BACKGROUND The incorporation of molecular parameters into WHO CNS5 has led to reclassification of many gliomas. We undertook to describe presenting clinical and radiographic features of diffuse adult gliomas according to CNS5 category. METHODS We reviewed pathology reports, clinical and MRI data at presentation of 972 adult patients with glioma diagnosed between 1/2010-2/2022. Continuous variables were presented as median; categorical variables as numbers and percentages, and comparison were performed using chi-square test. RESULTS 736 patients had sufficient data for CNS5 re-classification and were included in the analysis: Grade 2 IDH-mutant (IDHmut) astrocytoma (A2) n=69, grade 3 IDHmut astrocytoma (A3) n=37, grade 4 IDHmut astrocytoma (A4), n=32, grade 2 oligodendroglioma (O2) n=60, grade 3 oligodendroglioma (O3) n=23, and grade 4 IDH-wildtype glioblastoma (GBM) n=515. Age at presentation significantly differed between grade 2&3 gliomas and grade 4 (mean age:39 versus 61.7; p<0.001); A4 were also younger than GBM (39.8 versus 63.1). A majority in all categories except grade 2 gliomas were male. Seizure was more common in IDHmut gliomas than GBM (58.4% versus 31.8%;p<0.001), while cognitive impairment was more common in GBM than in IDHmut gliomas (64.4% versus 34.4%;p<0.001) and in A4 (64% versus 40.6%;p=0.013). Focal deficits at presentation were more frequent in GBM than in IDHmut gliomas (74.2% versus 30.5%;p<0.001), but not significantly different compared to A4 (74.2% versus 58.1%;p=0.06). Contrast enhancement on MRI was more frequent in GBM compared to IDHmut gliomas (93% versus 48%;p<0.001), but similar frequency with A4 (93% versus 96%;p=1.00). The minimum ADC was significantly higher in IDHmut glioma including A4 than GBM(p<0.001). Calcification was more common in oligodendroglioma than astrocytoma and GBM (p<0.001), and more frequent in A4 than GBM(p=0.016). CONCLUSION Significant differences in the clinical presentation and radiologic features exist among CNS5 glioma subtypes, informing potential diagnosis, management and prognosis at initial presentation.

Application of Linear Algebra in Image Processing for Medical Electronics

A very important part of medical electronics is the use of linear algebra in picture processing to improve the accuracy of diagnosis, treatment plans, and medical study. This abstract talks about the basic ideas and real-world uses of linear algebra in this area, showing how important it is for improving healthcare tools. Linear algebra gives us a strong way to change and understand pictures, which is very important in many types of medical imaging, like MRI, CT scans, ultrasound, and digital pathology. Images and how they are represented and changed are two of the most basic uses of linear algebra. A lot of the time, images are shown as matrices or tensors, where each part is a pixel strength or color value. Linear changes, like translations, rotations, and scaling, are needed to line up pictures, fix errors, and make sure that image data is the same across all modes. In medical image analysis, linear algebra methods like eigenanalysis and matrix decomposition (for example, Singular Value Decomposition) are also used to get information from images and make them simpler. These techniques help doctors and researchers find important patterns, oddities, and structures in pictures, which makes automatic analysis and disease classification easier. Medical image registration is a very important step for lining up pictures from different sources or places in time. Linear algebra makes it easier to figure out transformation matrices that get the best spatial alignment. This is very important for continuous studies and tracking of treatment, where exact comparison and analysis depend on perfectly aligned images. Linear algebra is also very important in methods for improving and fixing images. For example, filtering processes based on convolution matrices are used to get rid of noise, boost contrast, and bring out features in medical pictures, which makes them easier for doctors to see and understand. In computer imaging and tomography, linear algebra makes it possible to rebuild three-dimensional structures from two-dimensional picture slices. This makes it possible to see internal details and diseases more clearly. Overall, combining linear algebra with image processing in medical electronics not only makes medical pictures better and easier to understand, but it also leads to new diagnosis tools and treatment plans. Employing mathematical methods to pull useful data from large sets of images helps healthcare professionals make better choices, which ultimately leads to better patient results and progress in medical study.

Local extension findings on MRI compensate for the ability of pathological staging to predict oncological outcome.

We investigated whether local extension findings on preoperative MRI and excisional pathology are associated with positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy. We identified 704 of our patients that underwent robot-assisted radical prostatectomy between 2012 and 2020, and extracted the 326 patients who had preoperative MRI scans and a radiologist reading. These patients were classified into groups according to the presence of local extension on MRI and pathological findings: ≤ cT2pT2 (195 cases), ≤ cT2pT3 (55 cases), cT3pT2 (31 cases), and cT3pT3 (45 cases). We compared positive surgical margin and biochemical recurrence between them. Median age was 69years, positive surgical margin rate was 20.2%, and five-year biochemical recurrence rate was 20.3%. Of the 226 patients without local invasion on excisional pathology, those with local extension on MRI (cT3pT2) had relatively higher positive surgical margin rate (29.0% vs. 14.4%, p = 0.05) and significantly higher five-year biochemical recurrence rate (25.8% vs. 9.3%, p = 0.01) than those without local extension on MRI (≤ cT2pT2). Similarly, among the 100 patients with local extension on excisional pathology, those with cT3pT3 had relatively higher positive surgical margin (37.8% vs. 21.8%, p = 0.08) and significantly higher five-year biochemical recurrence (53.3% vs. 29.3%, p = 0.01) than those with ≤ cT2pT3. In multivariate analysis, local extension on MRI was an independent predictor of biochemical recurrence (OR 2.1, 95%CI 1.1-3.9, p = 0.01). Local extension on MRI is a prognostic factor independent of pathological stage. The use of MRI may complement the prognostic value of excisional pathology of prostate cancer.

Childhood brainstem lesions

Brainstem gliomas are more common in the paediatric age group as compared to adults. They have variable clinical presentations, which can range from mild to severe. Radiographic appearance on MRI, anatomical location, and molecular pathology plays a key role in management and prognostication. A multidisciplinary approach based upon the extent and type of tumour is followed. In our study, we have reported 3 such cases who presented in different ways and were diagnosed as brainstem glioma. We have also discussed various modalities of investigation and management.

Comparative analysis of FISTA and inertial Tseng algorithm for enhanced image restoration in prostate cancer imaging

The Inertial Tseng Algorithm (ITA) and the Fast Iterative Shrinkage-Thresholding Algorithm (FISTA) are well-established methods that provide effective ways to approximate zeros of the sum of monotone operators. In this study, we applied both ITA and FISTA in the restoration process of prostate cancer and osteosarcoma images that were degraded with known blur functions and additive noise. The test images comprised osteosarcoma tumours I and II, prostate fused, and prostate MRI pathology. Both algorithms incorporated the TV-regularizer and l 1 -regularizer. Numerical simulations revealed that the ITA method consistently outperforms the FISTA method in terms of image quality, despite FISTA's computational efficiency advantage. Additionally, the study found that, for both methods, images restored using the TV-regularizer exhibit higher quality compared to those restored using the l 1 -regularizer. Overall, the study revealed the effectiveness of the algorithms employed and highlight the significance of integrating mathematical models with well established mechanism in medical image restoration.

Dynamic disability measures decrease the clinico-radiological gap in people with severely affected multiple sclerosis

BackgroundExpanded Disability Status Scale (EDSS) is limited when utilized in highly disabled people with multiple sclerosis (pwMS). ObjetiveTo explore the relationship between disability measures and MRI outcomes in severely-affected pwMS. MethodsPwMS recruited from The Boston Home (TBH), a specialized residential facility for severly-affected pwMS and University at Buffalo (UB) MS Center were assessed using EDSS, MS Severity Scale, age-related MSS, Scripps Neurological Rating Scale (SNRS) and Combinatorial Weight-Adjusted Disability Score (CombiWISE). In all scores except SNRS, higher score indicates greater disability. MRI measures of T1, T2-lesion volume (LV), whole brain, gray matter, medulla oblongata and thalamic volumes (WBV, GMV, MOV, TV) and thalamic dysconnectivity were obtained. ResultsGreatest disability differences between the TBH and UB pwMS were in SNRS (24.4 vs 71.9, p < 0.001, Cohen's d = 4.05) and CombiWISE (82.3 vs. 38.9, p < 0.001, Cohen's d = 4.02). In combined analysis of all pwMS, worse SNRS scores were correlated with worse MRI pathology in 8 out of 9 outcomes. EDSS only with 3 measures (GMV, MOV and TV). In severely-affected pwMS, SNRS was associated with T1-LV, T2-LV and WBV (not surviving false discovery rate (FDR) correction for multiple comparisons) whereas EDSS did not. ConclusionGranular and dynamic disability measures may bridge the clinico-radiologcal gap present in severely affected pwMS.

Plasma Markers of Alzheimer's Disease Pathology, Neuronal Injury, and Astrocytic Activation and MRI Load of Vascular Pathology and Neurodegeneration: TheSMART-MR Study.

Two of the main causes for dementia are Alzheimer's disease (AD) and vascular pathology, with most patients showing mixed pathology. Plasma biomarkers for Alzheimer's disease-related pathology have recently emerged, including Aβ (amyloid-beta), p-tau (phosphorylated tau), NfL (neurofilament light), and GFAP (glial fibrillary acidic protein). There is a current gap in the literature regarding whether there is an association between these plasma biomarkers with vascular pathology and neurodegeneration. Cross-sectional data from 594 individuals (mean [SD] age: 64 [8] years; 17% female) were included from the SMART-MR (Second Manifestations of Arterial Disease-Magnetic Resonance) study, a prospective cohort study of individuals with a history of arterial disease. Plasma markers were assessed using single molecular array assays (Quanterix). Magnetic resonance imaging markers included white matter hyperintensity volume, presence of infarcts (yes/no), total brain volume, and hippocampal volume assessed on 1.5T magnetic resonance imaging. Linear regressions were performed for each standardized plasma marker with white matter hyperintensity volume, total brain volume, and hippocampal volume as separate outcomes, correcting for age, sex, education, and intracranial volume. Logistic regressions were performed for the presence of lacunar and cortical infarcts. Higher p-tau181 was associated with larger white matter hyperintensity volume (b per SD increase=0.16 [95% CI, 0.06-0.26], P=0.015). Higher NfL (b=-5.63, [95% CI, -8.95 to -2.31], P=0.015) was associated with lower total brain volume and the presence of infarcts (odds ratio [OR], 1.42 [95% CI, 1.13-1.78], P=0.039). Higher GFAP levels were associated with cortical infarcts (OR, 1.45 [95% CI, 1.09-1.92], P=0.010). Plasma biomarkers that have been associated with tau pathology, axonal injury, and astrocytic activation are related to magnetic resonance imagingmarkers of vascular pathology and neurodegeneration in patients with manifest arterial disease.

Postoperative radiotherapy omission in selected patients with early breast cancer following preoperative breast MRI (PROSPECT): primary results of a prospective two-arm study

Adjuvant breast radiotherapy as a standard component of breast-conserving treatment for early cancer can overtreat many women. Breast MRI is the most sensitive modality to assess local tumour burden. The aim of this study was to determine whether a combination of MRI and pathology findings can identify women with truly localised breast cancer who can safely avoid radiotherapy. PROSPECT is a prospective, multicentre, two-arm, non-randomised trial of radiotherapy omission in patients selected using preoperative MRI and postoperative tumour pathology. It is being conducted at four academic hospitals in Australia. Women aged 50 years or older with cT1N0 non-triple-negative breast cancer were eligible. Those with apparently unifocal cancer had breast-conserving surgery (BCS) and, if pT1N0 or N1mi, had radiotherapy omitted (group 1). Standard treatment including excision of MRI-detected additional cancers was offered to the others (group 2). All were recommended systemic therapy. The primary outcome was ipsilateral invasive recurrence rate (IIRR) at 5 years in group 1. Primary analysis occurred after the 100th group 1 patient reached 5 years follow-up. Quality-adjusted life-years (QALYs) and cost-effectiveness of the PROSPECT pathway were analysed. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000810011). Between May 17, 2011, and May 6, 2019, 443 patients with breast cancer underwent MRI. Median age was 63·0 years. MRI detected 61 malignant occult lesions separate from the index cancer in 48 patients (11%). Of 201 group 1 patients who had BCS without radiotherapy, the IIRR at 5 years was 1·0% (upper 95% CI 5·4%). In group 1, one local recurrence occurred at 4·5 years and a second at 7·5 years. In group 2, nine patients had mastectomy (2% of total cohort), and the 5-year IIRR was 1·7% (upper 95% CI 6·1%). The only distant metastasis in the entire cohort was genetically distinct from the index cancer. The PROSPECT pathway increased QALYs by 0·019 (95% CI 0·008-0·029) and saved AU$1980 (95% CI 1396-2528) or £953 (672-1216) per patient. PROSPECT suggests that women with unifocal breast cancer on MRI and favourable pathology can safely omit radiotherapy. Breast Cancer Trials, National Breast Cancer Foundation, Cancer Council Victoria, the Royal Melbourne Hospital Foundation, and the Breast Cancer Research Foundation.

Optimizing surgical strategy in locally advanced breast cancer: a comparative analysis between preoperative MRI and postoperative pathology after neoadjuvant chemotherapy.

In the treatment of breast cancer, neo-adjuvant chemotherapy is often used as systemic treatment followed by tumor excision. In this context, planning the operation with regard to excision margins relies on tumor size measured by MRI. The actual tumor size can be determined through pathologic evaluation. The aim of this study is to investigate the correlation and agreement between pre-operative MRI and postoperative pathological evaluation. One hundred and ninety-three breast cancer patients that underwent neo-adjuvant chemotherapy and subsequent breast surgery were retrospectively included between January 2013 and July 2016. Preoperative tumor diameters determined with MRI were compared with postoperative tumor diameters determined by pathological analysis. Spearman correlation and Bland-Altman agreement methods were used. Results were subjected to subgroup analysis based on histological subtype (ER, HER2, ductal, lobular). The correlation between tumor size at MRI and pathology was 0.63 for the whole group, 0.39 for subtype ER + /HER2-, 0.51 for ER + /HER2 + , 0.63 for ER-/HER2 +, and 0.85 for ER-/HER2-. The mean difference and limits of agreement (LoA) between tumor size measured MRI vs. pathological assessment was 4.6mm (LoA -27.0-36.3mm, n = 195). Mean differences and LoA for subtype ER + /HER2- was 7.6mm (LoA -31.3-46.5mm, n = 100), for ER + /HER2 + 0.9mm (LoA -8.5-10.2mm, n = 33), for ER-/HER2+ -1.2mm (LoA -5.1-7.5mm, n = 21), and for ER-/HER- -0.4mm (LoA -8.6-7.7mm, n = 41). HER2 + and ER-/HER2- tumor subtypes showed clear correlation and agreement between preoperative MRI and postoperative pathological assessment of tumor size. This suggests that MRI evaluation could be a suitable predictor to guide the surgical approach. Conversely, correlation and agreement for ER + /HER2- and lobular tumors was poor, evidenced by a difference in tumor size of up to 5cm. Hence, we demonstrate that histological tumor subtype should be taken into account when planning breast conserving surgery after NAC.

Comparison of MRI-Based Staging and Pathologic Staging for Predicting Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy.

BACKGROUND. Currently most clinical models for predicting biochemical recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP) incorporate staging information from RP specimens, creating a gap in preoperative risk assessment. OBJECTIVE. The purpose of our study was to compare the utility of presurgical staging information from MRI and postsurgical staging information from RP pathology in predicting BCR in patients with PCa. METHODS. This retrospective study included 604 patients (median age, 60 years) with PCa who underwent prostate MRI before RP from June 2007 to December 2018. A single genitourinary radiologist assessed MRI examinations for extraprostatic extension (EPE) and seminal vesicle invasion (SVI) during clinical interpretations. The utility of EPE and SVI on MRI and RP pathology for BCR prediction was assessed through Kaplan-Meier and Cox proportional hazards analyses. Established clinical BCR prediction models, including the University of California San Francisco Cancer of the Prostate Risk Assessment (UCSF-CAPRA) model and the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) model, were evaluated in a subset of 374 patients with available Gleason grade groups from biopsy and RP pathology; two CAPRA-MRI models (CAPRA-S model with modifications to replace RP pathologic staging features with MRI staging features) were also assessed. RESULTS. Univariable predictors of BCR included EPE on MRI (HR = 3.6), SVI on MRI (HR = 4.4), EPE on RP pathology (HR = 5.0), and SVI on RP pathology (HR = 4.6) (all p < .001). Three-year BCR-free survival (RFS) rates for patients without versus with EPE were 84% versus 59% for MRI and 89% versus 58% for RP pathology, and 3-year RFS rates for patients without versus with SVI were 82% versus 50% for MRI and 83% versus 54% for RP histology (all p < .001). For patients with T3 disease on RP pathology, 3-year RFS rates were 67% and 41% for patients without and with T3 disease on MRI. AUCs of CAPRA models, including CAPRA-MRI models, ranged from 0.743 to 0.778. AUCs were not significantly different between CAPRA-S and CAPRA-MRI models (p > .05). RFS rates were significantly different between low- and intermediate-risk groups for only CAPRA-MRI models (80% vs 51% and 74% vs 44%; both p < .001). CONCLUSION. Presurgical MRI-based staging features perform comparably to postsurgical pathologic staging features for predicting BCR. CLINICAL IMPACT. MRI staging can preoperatively identify patients at high BCR risk, helping to inform early clinical decision-making. TRIAL REGISTRATION. ClinicalTrials.gov NCT00026884 and NCT02594202.

In Vivo Thermal Ablation of Deep Intrahepatic Targets Using a Super-Convergent MRgHIFU Applicator and a Pseudo-Tumor Model.

HIFU ablation of liver malignancies is particularly challenging due to respiratory motion, high tissue perfusion and the presence of the rib cage. Based on our previous development of a super-convergent phased-array transducer, we aimed to further investigate, in vivo, its applicability to deep intrahepatic targets. In a series of six pigs, a pseudo-tumor model was used as target, visible both on intra-operatory MRI and post-mortem gross pathology. The transcostal MRgHIFU ablation was prescribed coplanar with the pseudo-tumor, either axial or sagittal, but deliberately shifted 7 to 18 mm to the side. No specific means of protection of the ribs were implemented. Post-treatment MRI follow-up was performed at D7, followed by animal necropsy and gross pathology of the liver. The pseudo-tumor was clearly identified on T1w MR imaging and subsequently allowed the MRgHIFU planning. The peak temperature at the focal point ranged from 58-87 °C. Gross pathology confirmed the presence of the pseudo-tumor and the well-delineated MRgHIFU ablation at the expected locations. The specific design of the transducer enabled a reliable workflow. It demonstrated a good safety profile for in vivo transcostal MRgHIFU ablation of deep-liver targets, graded as challenging for standard surgery.

Neoadjuvant endocrine therapy for early-stage breast cancer: An institutional experience during the COVID19 pandemic.

e12625 Background: Neoadjuvant Endocrine therapy (NET) is under-utilized for locally advanced hormone receptor + breast cancer (BC) despite literature to date concluding that chemotherapy and NET have comparable response rates but with lower toxicity for the latter. The COVID19 pandemic presented a unique occasion to extend the use of NET for localized BC. Many surgical procedures across the country, including at Dartmouth-Hitchcock Medical Center (DHMC) were postponed in order to redirect resources. The American Society of Breast Surgeons released guidelines to manage patients in which surgery was delayed. For Estrogen Receptor + (ER+), HER2- early-stage tumors, the guidelines recommended NET as first-line treatment. Herein we review the rate of adoption of NET and patient/tumor characteristics associated with NET adoption at DHMC during the lockdown. Methods: A Retrospective analysis of patients diagnosed with early-stage ER+, HER2- BC between December 2019 and June 2020. Inclusion criteria included patients with non-metastatic hormone receptor + BC. Data extracted from chart review included age, menopausal status, tumor stage/grade, body mass index (BMI). A delay in surgery was defined as days between surgical consult and surgery over 14 days. Descriptive statistics will be applied to data collected on patient/tumor characteristics, and the number of patients accepting or declining NET. Results: 109 cases were identified within the study period with 42 cases designated as experiencing delays in surgery. The median age of the group (n = 42) was 62 and the majority was post-menopausal. 36 patients received NET with most started on an aromatase inhibitor. Median BMI was 28.5. Median duration of treatment was 39.5 days. Tumor response to NET was not clearly described in the pathology reports. Three cases were noted to have some decrease in cellularity for pathologic partial response and four had no definite response. Imaging modalities were compared to pathology size and MRI was found to be a fair predictor of size obtained from pathology specimens with a correlation metric of 0.78 indicating that it may serve as the best proxy for pre-treatment size. Pre-surgical MRIs were obtained in 51.3% of cases. The majority of patients on NET had no change in the grade of their pathology. During the course of the pandemic long-term adherence of adjuvant endocrine therapy decreased from 78% for those diagnosed in early 2020 to 56% for those diagnosed in late 2020. Conclusions: The COVID19 crisis was an unprecedented challenge to healthcare systems. Delays in surgery resulted in increased use of NET in early-stage BC. We plan to integrate other data including impact of NET on long-term adherence to endocrine therapy. Change in clinical vs pathologic stage will be reported for those with or without NET. This experience may help guide care during healthcare crises or in resources limited settings.

A different pattern of clinical, muscle pathology and brain MRI findings in MELAS with mt-ND variants.

To explore the clinical characteristics of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) caused by mitochondrial DNA-encoded complex I subunit (mt-ND) variants. In this retrospective study, the clinical, myopathological and brain MRI features of patients with MELAS caused by mt-ND variants (MELAS-mtND) were collected and compared with those of MELAS patients carrying the m.3243A > G variant (MELAS-A3243G). A total of 18 MELAS-mtND patients (female: 7; median age: 24.5 years) represented 15.9% (n = 113) of all patients with MELAS caused by mtDNA variants in our neuromuscular center from January 2012 to June 2022. In this MELAS-mtND cohort, the two most common variants were m.10191 T > C (4/18, 22.2%) and m.13513 G > A (3/18, 16.7%). The most frequent symptoms were seizures (14/18, 77.8%) and muscle weakness (11/18, 61.1%). Compared with 87 MELAS-A3243G patients, MELAS-mtND patients were significantly more likely to have a variant that was absent in blood cells (40% vs. 1.4%). Furthermore, MELAS-mtND patients had a significantly lower MDC score (7.8 ± 2.7 vs. 9.8 ± 1.9); less hearing loss (27.8% vs. 54.0%), diabetes (11.1% vs. 37.9%), and migraine (33.3% vs. 62.1%); less short stature (males ≤ 165 cm; females ≤ 155 cm; 23.1% vs. 60.8%) and higher body mass index (20.4 ± 2.5 vs. 17.8 ± 2.7). MELAS-mtND patients had significantly more normal muscle pathology (31.3% vs. 4.1%) and fewer RRFs/RBFs (62.5% vs. 91.9%), COX-deficient fibers/blue fibers (25.0% vs. 85.1%) and SSVs (50.0% vs. 81.1%). Moreover, brain MRI evaluated at the first stroke-like episode showed significantly more small cortical lesions in MELAS-mtND patients (66.7% vs. 12.2%). Our results suggested that MELAS-mtND patients have distinct clinical, myopathological and brain MRI features compared with MELAS-A3243G patients.

2nd and 3rd generation full endoscopic lumbar spine surgery: clinical safety and learning curve.

2nd and 3rd generation endoscopic spine surgery techniques offer visualisation of familiar inter-laminar anatomy to spinal surgeons. We have prospectively evaluated the clinical outcome, complications and learning curve associated with these techniques in patients with lumbar spine radiculopathy. This is a prospective study of 50 consecutive patients with radicular pain from disc herniation and/or lateral recess stenosis. In 6 patients, endoscopy couldn't be done. Operating times, PROM's (VAS, ODI and EQ-5D scores) and complication rates of 44 patients were evaluated after mean FU of 52months (range 39-65). MRI was used to divide these into protrusions (n = 19), extrusions (n = 17) and lateral recess stenosis (n = 8). Evidence about the learning curve was gathered by curvilinear regression analyses. Using a composite clinical success criterion, 95% patients had a successful outcome, with no major complications. ODI, VAS and EQ-5D scores had a statistically significant improvement and achieved MCID. Revision discectomy rate was only 4.5% (n = 2). MRI based grouping, case sequence and degree of difficulty influenced the duration of surgery and a learning curve was found for protrusions and lateral recess decompressions, but not for extrusions. A learning curve effect was also observed with respect to the ODI. Although anatomy visualised in 2nd and 3rd generation endoscopy is familiar to spinal surgeons, our learning curve experience suggests a careful and MRI pathology based take up of this technique in clinical practice, despite its clinical safety in our series. Level 3, prospective cohort study.

Distinction of Pseudoprogression and Progression in Glioblastoma Multiforme After Treatment: Utility of Ratio of Decrease in rCBV and rCBF Values on Serial Perfusion MRIs

Aim: To assess the value of perfusion magnetic resonance imaging (pMRI) in the differentiation of early pseudoprogression from true progression in glioblastoma multiforme (GBM) patients taking Temozolomide (TMZ) with radiotherapy (RT) treatment. Materials and Methods: Pre-RT and post-RT cranial pMRI scans of 23 GBM patients treated with RT-TMZ were reviewed. Relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) of the residual enhancing lesions were measured on serial pMRI scans and proportioned. Receiver operating characteristic (ROC) analysis was performed to determine a threshold ratio of decrease in rCBV and rCBF. Results: There were nine patients (39%) with signs of radiological progression, of whom six (67%) had real progression and three (33%) had pseudoprogression based on follow-up MRI studies, clinical parameters and/or pathology. Ratio of decrease was 2.928 in rCBV and 2.510 in rCBF in the pseudoprogression group, which were significant according to Mann-Whitney U test (p=0.02). Cut-off ratio of decrease value of 1.73 for rCBV and 1.62 for rCBF between pre-RT and post-RT pMRI study, could differentiate the presence of early pseudoprogression with 100% sensitivity and 100% specificity. Conclusion: Ratio of decrease in rCBV and rCBF is a reliable predictor of early pseudoprogression in GBM patients under RT-TMZ treatment.

MRI Assessment of Extramural Venous Invasion Before and After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer and Its Association with Disease-Free and Overall Survival.

Extramural venous invasion (EMVI) on baseline MRI is associated with poor prognosis in patients with locally advanced rectal cancer. This study investigated the association of persistent EMVI after total neoadjuvant therapy (TNT) (chemoradiotherapy and systemic chemotherapy) with survival. Baseline MRI, post-TNT MRI, and surgical pathology data from 175 patients with locally advanced rectal cancer who underwent TNT and total mesorectal excision between 2010 and 2017 were retrospectively analyzed for evidence of EMVI. Two radiologists assessed EMVI status with disagreement adjudicated by a third. Pathologic EMVI status was assessed per departmental standards. Cox regression models evaluated the associations between EMVI and disease-free and overall survival. EMVI regression on both post-TNT MRI and surgical pathology was associated with disease-free survival (hazard ratio, 0.17; 95% confidence interval (CI), 0.04-0.64) and overall survival (hazard ratio, 0.11; 95% CI, 0.02-0.68). In an exploratory analysis of 35 patients with EMVI on baseline MRI, only six had EMVI on pathology compared with 18 on post-TNT MRI; these findings were not associated (p = 0.2). Longer disease-free survival was seen with regression on both modalities compared with remaining positive. Regression on pathology alone, independent of MRI EMVI status, was associated with similar improvements in survival. Baseline EMVI is associated with poor prognosis even after TNT. EMVI regression on surgical pathology is common even with persistent EMVI on post-TNT MRI. EMVI regression on surgical pathology is associated with improved DFS, while the utility of post-TNT MRI EMVI persistence for decision-making and prognosis remains unclear.

Low IQ predicts worse long-term seizure outcome after resective epilepsy surgery – A propensity score matched analysis

ObjectiveTo describe long-term seizure outcomes in patients with IQ < 70 undergoing resective epilepsy surgery and to analyse whether baseline IQ predicts seizure outcome. MethodsPatients undergoing focal resective epilepsy surgery 1995–2017 at age ≥ 4 years were identified in the population-based Swedish National Epilepsy Surgery Register. Two-year, five-year and long-term (10–20-year follow-up) outcomes were analysed. Seizure outcomes of patients with IQ ≥ 70 and IQ < 70 at baseline were compared in the full cohort and between propensity score matched groups. ResultsFollow-up data were available for 884 patients, 79 of whom had IQ < 70. Matched controls were found for 74 of the IQ < 70 patients. Preoperative MRI pathology was unifocal in 54 % and 79 % of IQ < 70 and IQ ≥ 70 patients before matching compared to 58 % and 62 % after matching, respectively. Patients with IQ < 70 achieved significantly worse seizure outcomes at all time points both when analysing the full cohort and the matched groups. After matching, the proportions of seizure-free patients in the IQ < 70 group were 28 %, 32 % and 32 % at the 2-year, 5-year and long-term follow-ups, respectively. Corresponding figures in the IQ ≥ 70 group were 54 %, 62 % and 60 % (p for difference between IQ groups 0.004, 0.002 and 0.049). In the IQ < 70 group, 36 %, 29 % and 45 % had a ≥ 75 % reduction in seizure frequency at the respective three follow-ups. ConclusionLow preoperative IQ predicts lower chances of seizure freedom after resective epilepsy surgery and few patients with IQ < 70 remain completely seizure-free in the long term. Nevertheless, a significant proportion had a reduction in seizure frequency of at least 75 % at long-term follow-up, indicating an important palliative potential of resective surgery for epilepsy patients with intellectual disability.