MRI Procedures Research Articles

Prevalence of anterolateral complex injury and associated injuries in knees with acute complete and partial anterior cruciate ligament injury

Aim: Kaplan fibers, capsule, ligament (ALL) and Iliotibial band are defined as secondary stabilizers of the internal tibial rotation of the knee. These structures have been summarized as the Anterolateral complex (ALC). We aimed to determine the ALC injury prevalence and the association between Anterior cruciate ligament (ACL) and ALC injury patterns. Materials and Methods: MRI scans of ACL injuries were retrospectively evaluated for the presence of the ACL injury pattern (partial or complete), ALL, iliotibial band, Kaplans fiber, meniscus, bone marrow edema (BME) and collateral ligament pathology. The patients were divided into groups according to the ACL injury pattern. The prevalence of injury of the anatomical structures between groups was examined. Results: MRI scans of 152 patients (152 knees) were evaluated. The mean age of the patients was 28.5±8.6 (range, 18-55). 138 patients were male and 14 were female. Complete ACL injury was detected in 127 (83.6%) patients confirmed by MRI and arthroscopic procedure and partial ACL injury was detected in 25 (16.4%) patients confirmed by MRI. 90 (59.2%) patients had an ALL injury, 87 (57.2%) had an iliotibial band injury, 82 (53.9%) patients had a Kaplans fiber injury, 53 (34.9%) patients had a meniscal injury, 99 (65.1%) patients had BME and 70 (46.1%) patients had a collateral ligament injury. In the complete ACL injury group, the ratio of ALL, iliotibial band, Kaplan fiber, meniscal injury, BME, collateral ligament injury was significantly higher than the partial ACL injury group (p 0.05). Conclusion: The prevalence of injury in at least one anatomic structure of ALC was significantly higher in patients with a complete ACL injury (73.2%) than those with partial ACL injury (32%) at our institution. This study demonstrated that ALC injuries were statistically higher as well as meniscal injuries, BME, collateral ligament injuries after complete ACL injury compared to partial ACL injury.

Guidance on the use of MRI for treatment planning in radiotherapy clinical trials.

The aim of this article is to propose meaningful guidance covering the technical and safety issues involved when designing or conducting radiotherapy clinical trials that use MRI for treatment planning. The complexity of imaging requirements will depend on the trial aims, design and MRI methods used.The use of MRI within the RT pathway is becoming more prevalent and clinically appropriate as access to MRI increases, treatment planning systems become more versatile and potential indications for MRI-planning in RT are documented. Novel MRI-planning opportunities are often initiated and validated within clinical trials.The guidance in this document is intended to assist researchers designing RT clinical trials involving MRI, so that they may provide sufficient information about the appropriate methods to be used for image acquisition, post-processing and quality assurance such that participating sites complete MRI to consistent standards. It has been produced in collaboration with the National Radiotherapy Trials Quality Assurance Group (RTTQA).As the use of MRI in RT is developed, it is highly recommended for researchers writing clinical trial protocols to include imaging guidance as part of their clinical trial documentation covering the trial-specific requirements for MRI procedures. Many of the considerations and recommendations in this guidance may well apply to MR-guided treatment machines, where clinical trials will be crucial. Similarly, many of these recommendations will apply to the general use of MRI in RT, outside of clinical trials.This document contains a large number of recommendations, not all of which will be relevant to any particular trial. Designers of RT clinical trials must therefore take this into account. They must also use their own judgement as to the appropriate compromise between accessibility of the trial and its technical rigour.

Safety and cost of drug-induced sleep endoscopy outside the operating room.

Drug-induced sleep endoscopy (DISE) is used to assess site of obstruction for patients in a pharmacologically induced sleep-like state. It is traditionally performed in the operating room (OR), however, no data exists regarding the feasibility of this intervention outside the OR in children. The objective is to compare the safety of DISE performed in the MRI induction room to those performed in the OR. Prospective case-series of patients undergoing DISE in the MRI induction room (study group) to those assessed in the OR (controls) in a single-institution pediatric tertiary care center. Consecutive patients undergoing DISE examination for persistent obstructive sleep apnea (OSA) after adenotonsillectomy from September 2016 to September 2017 were included. Overall, 118 patients (38 study patients, 80 controls) with a mean age of 10.6 years (95% confidence interval [CI], 9.3-11.9) underwent DISE; 39.8% (47/118) were female. The most frequent comorbidity was cardiac disease (22.0%, 26/118). The mean obstructive apnea-hypopnea index was 12.2 events/hour (95% CI, 8.8-15.6) for controls and 13.5 events/hour (95% CI, 8.7-18.3) for study patients (P = .76). No major complication or unplanned admissions occurred in either group. Induction time was similar (12 vs. 13 minutes, P = .7) as was total procedure time (12 vs. 14 minutes, P = .3) for procedures performed in both settings. There were no significant complications for DISE performed in the OR or the MRI induction room and procedure times were similar. Further assessment of patient outcomes and resource utilization is needed. 4 Laryngoscope, 130: 2076-2080, 2020.

Transient pelvic limb neuropathy following proximal metatarsal and tarsal magnetic resonance imaging in seven horses

Pelvic limb neuropathy is a rare post-anaesthetic complication. In the authors' experiences, the incidence of post-anaesthesia neuropathy is increased following MRI of the proximal metatarsus and tarsal regions when compared with previously reported incidences of post-anaesthetic neuropathy. This study reports the incidence, diagnosis, treatment and outcome of seven horses with post-anaesthesia neuropathy following proximal metatarsal and tarsal MRI. Retrospective case series. Case record review of horses receiving general anaesthesia for MRI between 1 January 2012 and 31 December 2017. A total of 1134 MRI procedures were performed and reviewed for analysis. Eight cases of neuropathy were identified in 1088 limb scans (0.74%). Of these cases, one was subsequent to thoracic limb imaging (1/834; 0.12%) and seven were subsequent to imaging of proximal metatarsal and/or tarsal structures (7/181; 3.9%). Following proximal metatarsal and/or tarsal MRI, transient nondependent limb femoral neuropathy developed in six of the seven affected horses, with one additional horse developing peroneal neuropathy of the dependent limb. Recovery of pelvic limb function occurred within 72h and 9days in six and one horse, respectively. Anaesthetic protocol and neuropathy treatment for the affected horses were not standardised. Though an uncommon complication in horses, transient neuropathy may occur more frequently following MRI of the proximal metatarsal and tarsal structures when compared with other MRI scans. This may be due to patient positioning and the requirement for limb traction for MRI of more proximal regions. Supportive care facilitates rapid return to function.

Experimental assessment of clinical MRI-induced global SAR distributions in head phantoms

ObjectiveAccurate estimation of SAR is critical to safeguarding vulnerable patients who require an MRI procedure. The increased static field strength and RF duty cycle capabilities in modern MRI scanners mean that systems can easily exceed safe SAR levels for patients. Advisory protocols routinely used to establish quality assurance protocols are not required to advise on the testing of MRI SAR levels and is not routinely measured in annual medical physics quality assurance checks. This study aims to develop a head phantom and protocol that can independently verify global SAR for MRI clinical scanners. MethodsA four-channel birdcage head coil was used for RF transmission and signal reception. Proton resonance shift thermometry was used to estimate SAR. The SAR estimates were verified by comparing results against two other independent measures, then applied to a further four scanners at field strengths of 1.5 T and 3 T. ResultsScanner output SAR values ranged from 0.42 to 1.52 W/kg. Percentage SAR differences between independently estimated values and those calculated by the scanners differed by 0–2.3%. ConclusionWe have developed a quality assurance protocol to independently verify the SAR output of MRI scanners.

Automated alignment detection of an additively manufactured Z-frame marker to process instrument targeting signals in interventional MRI

Abstract MRI-guided interventions (iMRI, e.g. prostate biopsy) are usually performed under a free-hand instrument targeting approach to guide and feed the instrument (e.g. biopsy needle) along the desired trajectory. However, this technique requires many iterative movements either from the interventionist or of the patient (with the MRI table) in and out of the MRI tunnel, which is cumbersome, time-consuming and expensive. To overcome these downsides, interventional MRI procedures can be facilitated with remotely controllable assistance systems for instrument alignment. Such systems require an accurate registration and tracking of the position and orientation of the instrument. Passive fiducial marker frames (e.g. additively manufactured Z-frame marker) are capable of providing full information about a device´s orientation within the image. In this paper, we present an automated alignment detection algorithm to track a Z-marker from system-independent screen-captured images. We evaluated the precision of the detection algorithm by analysing its computation results from schematic gold standard images in different marker orientations in comparison to MR-images with the same orientations. Our combined setup consists of a precise alignment system, an additively manufactured Z-frame marker and the related detection algorithm. It offers a fast, simple, independent and accurate automated instrument targeting for iMRI. For future work, we plan to conduct phantom targeting tests in combination with robotic alignment systems.

The LONI QC System: A Semi-Automated, Web-Based and Freely-Available Environment for the Comprehensive Quality Control of Neuroimaging Data.

Quantifying, controlling, and monitoring image quality is an essential prerequisite for ensuring the validity and reproducibility of many types of neuroimaging data analyses. Implementation of quality control (QC) procedures is the key to ensuring that neuroimaging data are of high-quality and their validity in the subsequent analyses. We introduce the QC system of the Laboratory of Neuro Imaging (LONI): a web-based system featuring a workflow for the assessment of various modality and contrast brain imaging data. The design allows users to anonymously upload imaging data to the LONI-QC system. It then computes an exhaustive set of QC metrics which aids users to perform a standardized QC by generating a range of scalar and vector statistics. These procedures are performed in parallel using a large compute cluster. Finally, the system offers an automated QC procedure for structural MRI, which can flag each QC metric as being ‘good’ or ‘bad.’ Validation using various sets of data acquired from a single scanner and from multiple sites demonstrated the reproducibility of our QC metrics, and the sensitivity and specificity of the proposed Auto QC to ‘bad’ quality images in comparison to visual inspection. To the best of our knowledge, LONI-QC is the first online QC system that uniquely supports the variety of functionality where we compute numerous QC metrics and perform visual/automated image QC of multi-contrast and multi-modal brain imaging data. The LONI-QC system has been used to assess the quality of large neuroimaging datasets acquired as part of various multi-site studies such as the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study and the Alzheimer’s Disease Neuroimaging Initiative (ADNI). LONI-QC’s functionality is freely available to users worldwide and its adoption by imaging researchers is likely to contribute substantially to upholding high standards of brain image data quality and to implementing these standards across the neuroimaging community.

First-Trimester Exposure to Gadolinium-based Contrast Agents: A Utilization Study of 4.6 Million U.S. Pregnancies.

BackgroundThe safety of gadolinium-based contrast agent (GBCA) exposure during pregnancy has not been established, and the use of GBCAs during pregnancy is not recommended unless it is essential to the health of the woman or fetus.PurposeTo examine the prevalence of GBCA exposure in a large sample of pregnancies resulting in a live birth.Materials and MethodsThe Sentinel Distributed Database was used to retrospectively identify U.S. pregnancies that resulted in live births between 2006 and 2017 from 16 data partners. The main outcome was the prevalence of MRI procedures with and without GBCAs, sorted by anatomic location and trimester, among pregnant and matched comparator women.ResultsAmong 4 692 744 pregnancies resulting in a live birth, we identified 6879 exposures to GBCAs in 5457 pregnancies, representing one contrast-enhanced MRI examination per 860 pregnancies (0.12% of all pregnancies). Most contrast-enhanced MRI examinations were performed in the head (n = 3499), although pelvic and abdominal MRI constituted 22.3% (n = 1536) of all contrast-enhanced MRI examinations during pregnancy. The majority (70.2%) of GBCA exposures occurred during the first trimester, with a 4.3-fold greater prevalence compared with that in the second trimester and a 5.1-fold greater prevalence compared with that in the third trimester.ConclusionThis study identified higher rates of gadolinium-based contrast agent (GBCA) exposure during the first few weeks of pregnancy compared with the later weeks of pregnancy, suggesting inadvertent exposure to GBCAs might occur before pregnancy is recognized.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Kallmes and Watson in this issue.

Incidence of Game-Related, High School Football Lower Extremity and Surface Impact Trauma Requiring Elective Imaging and Surgery across Artificial Turf Systems of Various Infill Weight

Objectives:Artificial turf surfaces are developed to duplicate playing characteristics of natural grass. With the newer generations of sand and rubber infill systems, infill weight is a common component that varies between fields. With the increasing concerns of rising medical costs, the potential for long-term articular changes, and perceived higher incidence of articular trauma while playing on artificial turf, infill weight could be a critical factor that could influence sport trauma and subsequent elective medical decisions. Therefore, this study quantified the incidence of game-related, high school football lower extremity and surface impact trauma requiring elective medical procedures across artificial turf systems of various infill weight.Methods:Artificial turf systems were divided into two sand/rubber infill weight groups by lbs per square foot: 6.0 to ≥9.0, and 0.0-5.9. Fifty-seven high schools participated across four states over 5 seasons. Outcomes of interest included elective medical procedures by injury category (player-turf surface impact trauma, trauma from shoe: surface interaction during physical collision/contact, trauma from shoe: surface interaction during physical noncontact). Data were subject to multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using general linear model procedures.Results:Of 1,837 games documented, 1,049 games were played on 6.0 to ≥9.0 lbs infill/sq. ft, and 788 on 0.0-5.9 lbs infill/sq. ft, with 4,655 total injuries reported. MANOVA indicated a significant main effect across elective medical procedures by injury category (F3,3977 = 16.574; P < .0001). Post hoc analyses indicated significantly lower injury incidence rates (IIR per 10 game season) requiring radiography and MRI procedures following player-turf surface impact trauma [1.7, (95% CI, 1.5 -1.9) vs 3.2 (2.9-3.5); P = .001], trauma from shoe: surface interaction during physical collision/contact [2.4, (95% CI, 2.1-2.6) vs 3.2 (2.9-3.5); P = .001], and trauma from shoe: surface interaction during physical noncontact [0.4, (95% CI, 0.3-0.5) vs 0.7 (0.5-0.9); P = .01], while competing on the 6 to ≥9.0 lbs infill/sq. ft when compared to the lighter infill weight systems, respectively. No significant differences in surgical procedures by injury category were observed between infill weight.Conclusion:As the artificial infill surface weight decreased, the incidence of game-related, high school football lower extremity and surface impact trauma, and subsequent elective medical procedures significantly increased. Based on findings, high school football fields should minimally contain 6.0 to ≥9.0 lbs infill/sq. ft. This is the first longitudinal study to investigate the influence of artificial infill weight influence on high school sport trauma and elective medical decisions.

Is an intact hippocampus necessary for answering 3 × 3? – Evidence from Alzheimer’s disease

Recent evidence has suggested that the hippocampus supports learning and retrieval of arithmetic facts during childhood and adolescence. Whether the hippocampus is also involved in retrieving overlearned arithmetic facts (such as 3 × 5 = 15) during adult age is open for investigation. In this study, we assessed whether patients with hippocampal atrophy due to Alzheimer’s disease (AD) are still able to retrieve overlearned arithmetic facts from memory. Sixteen patients (n = 13 with AD, n = 3 with Mild Cognitive Impairment – MCI) were evaluated using standard radiological, neurological, and neuropsychological test procedures. We adopted a multiple single-case analysis in order to acknowledge possible dissociations between hippocampal degeneration and intact arithmetic fact retrieval. All patients performed a neuropsychological screening battery assessing episodic memory as well as arithmetic processing, and underwent a 3-Tesla MRI procedure. A morphometric analysis comprising estimation of both cortical thickness and hippocampal volume, which also included a subfield analysis, was conducted. All patients had marked hippocampal atrophy (bilateral n = 15, unilateral n = 1) in comparison to healthy matched controls and showed deficits in episodic memory (delayed recall). However, 13 out of 16 patients performed in the average range of standardised norms during retrieval of overlearned arithmetic facts (i.e. multiplication tables). Our results suggest that intact retrieval of consolidated arithmetic facts from memory does not depend on the integrity of the hippocampus. This is in line with the view that the hippocampus plays a dynamic and time-limited role in arithmetic processing. While the hippocampus seems to be necessary for learning and consolidating new arithmetic facts in memory, it might not be critically involved in retrieving arithmetic facts when these are well consolidated in memory.

Diagnostic techniques and surgical outcomes for persistent pediatric obstructive sleep apnea after adenotonsillectomy: A systematic review and meta-analysis

ObjectiveTo evaluate the efficacy of upper airway surgery for children with persistent obstructive sleep apnea after adenotonsillectomy and to assess sleep study outcomes when Drug Induced Sleep Endoscopy, Cine MRI, or other imaging procedure is performed to assist in identifying the location of obstruction and planning surgery. MethodsSystematic review and meta-analysis was performed. Inclusion criteria was English-language studies with original data including pediatric patients with persistent OSA after T&A. Exclusion criteria included case reports and lack of pre and post-operative sleep study data. Data Sources were PubMed, Cochrane Central, and Embase from 2000 to 2018. PRISMA standards were followed for the selection and review of articles. The Newcastle-Ottawa Quality Assessment scale was used to score the quality of evidence of the studies. All manuscripts were reviewed independently by two investigators. Primary outcome measures were apnea-hypopnea index and minimum oxygen saturation. Data was pooled using a random-effects model. ResultsOf the 1902 abstracts identified, 11 studies (214 patients) met inclusion criteria for systematic review, 5 with Drug Induced Sleep Endoscopy as the diagnostic technique, 4 with Cine MRI, and 2 with MRI/CT. All studies were case series. Most subjects had syndromic comorbidities and/or obesity. Ten studies (198 patients) were included in the meta-analysis. Overall, there was a change in apnea hypopnea index of −6.51 (95% CI, −8.17 to – 4.85; p < 0.001) and an increase in minimum oxygen saturation by 3.24% (95% CI, 1.49%–4.98%; p < 0.001) following surgical intervention. Both Drug Induced Sleep Endoscopy and Cine MRI directed surgeries resulted in significant improvement in sleep study parameters. The two techniques could not be directly compared due to significant differences in co-morbidity rates between patients. ConclusionsSurgery for pediatric persistent obstructive sleep apnea improves apnea hypopnea index and minimum oxygen saturation but does not resolve the disease. This is true when both Drug Induced Sleep Endoscopy and Cine MRI findings were used to direct surgery.

Dexmedetomidine/propofol versus dexmedetomidine/ketamine versus dexmedetomidine as a sole agent for pediatric sedation during MRI

BackgroundPropofol use in MRI procedures is growing worldwide especially for infants and children. Propofol causes unintended deep sedation and respiratory depression. The safety and efficacy of dexmedetomidine–propofol versus ketamine–dexmedetomidine versus dexmedetomidine alone as a based sedation regimen in specific age range of children is the study concern.ObjectiveThe aim of this study is to compare the efficacy of dexmedetomidine/propofol mixture, dexmedetomidine/ketamine, and dexmedetomidine alone for pediatric MRI sedation.Patients and methodsNinty infants and children whose body weight is more than 10 kg were enrolled in a double-blind comparative study and assigned into three equal groups for sedation, group (DK) dexmedetomidine/ ketamine, group (DP) dexmedetomidine/propofol, and group (D) dexmedetomididne alone. All patients were given premedication in the form of oral midazolam 0.5 mg/kg 30 min before the procedure. Sedation was according to group: Group (DK) received ketamine 1.5 mg /kg intravenous bolus as a loading dose and maintenance dose done by dexmedetomidine infusion with a concentration of 0.004 mg/ml and infusion rate of 1 μg/kg/h for the first 10 min then reduced infusion dose to be in between 0.6 and 1 μg/kg/h to keep the patient sedated to a Ramsay sedation score more than 4. Group (DP) received propofol 1.5 mg/kg intravenous bolus as a loading dose, then maintenance dose infusion was a mixture of dexmedetomidine with a concentration of 0.004 mg/ml and propofol 4 mg/ml; this combination is compatible (Trissel et al., 2002; Cayo, 2013). This combination will be started by a loading dose of 1 μg/kg/h for the first 10 min then 0.6 to 1 μg/kg/h, sedated with a Ramsay sedation score of more than 4. Group (D) received dexmedetomidine with a dose of 2–3 μg/kg/h as loading for 10 min then 0.6 to 1 μg/kg/h to keep the patient sedated with a Ramsay sedation score of more than 4.ResultsThere was a significant difference between the DP group induction recovery time, hemodynamics, and Ramsey sedation score up to 5 min after the induction to the other two groups, and there was a significant difference between the DK group to the other two groups concerning emergence phenomena (agitation, altered perception, hallucination) and sedation failure.ConclusionThe combination of dexmedetomidine to propofol with a low dose for sedation during MRI gives better induction + recovery time, improves hemodynamics, and decreases incidence of emergence phenomena and sedation failure.

Comparison of Propofol and Thiopental in Sedation of Children for MRI Procedure

Comparison of Propofol and Thiopental in Sedation of Children for MRI Procedure

MR-Conditional SMA-Based Origami Joint.

Foldable origami structures have been implemented into robotics as a way of compacting joints and circuitry into smaller structures. This technique is especially useful in minimally invasive surgical instruments, where the goal is to create slimline devices that can be inserted through small incisions. Origami also has the potential to cut costs by reducing the amount of material required for assembly. Origami devices are especially suitable for MRI-guided procedures, where instruments must be nonmagnetic because origami is more suitable for flexible, non-metallic materials. MR conditional surgical instruments enable intraoperative MRI procedures that provide superior imaging capabilities to physicians to allow for safer procedures. This work presents an MR conditional joint developed using origami techniques that reduces costs by eliminating assembly of various components and has potential applications in endoscopy. The joint is a compliant rolling-contact element that employs curved-folding origami techniques. A chain of these joints can be constructed from a single sheet of material, eliminating assembly of numerous materials to produce a final product, which is specifically advantageous for constructing low-cost, disposable surgical devices. The prototype contains a degree of bending of ±9 degrees per joint, a response time of less than 4 seconds and an actuation force of 0.5 N using a 1.25 A current. The MRI results showed a minimal artifact of less than 1 mm measured from the boundary of the joint chain and a SNR reduction of less than 10%.

Use of Dexmedetomidine as an Adjuvant in Pediatric MRI Procedures

Use of Dexmedetomidine as an Adjuvant in Pediatric MRI Procedures

Initial misdiagnosis of Vogt-Koyanagi-Harada disease

PurposeTo report the initial misdiagnosis of patients with Vogt–Koyanagi–Harada (VKH) disease. MethodsThe medical records of 76 consecutive patients diagnosed with VKH disease were reviewed retrospectively at The Eye Center, Riyadh, Saudi Arabia. Patients were referred to The Eye Center from Saudi Arabia and other Middle Eastern countries. The initial diagnosis was made by an ophthalmologist or neurologist. The main outcome measure was to evaluate cases with VKH disease who were initially misdiagnosed. ResultsIn 7 (9.2%) out of the 76 patients the initial diagnosis was incorrect. Patients were initially misdiagnosed as optic neuritis (1.3%), intracranial hypertension (1.3%), brain tumor (1.3%), Susac disease (1.3%), migraine (1.3%), rhegmatogenous retinal detachment (1.3%) or anterior granulomatous uveitis of unknown etiology (1.3%). Patients underwent unnecessary tests including MRI and invasive procedures including CSF analysis and anterior chamber paracentesis. ConclusionThe initial diagnosis of patients with VKH disease was incorrect in 9 % of the cases. Delay in the diagnosis of VKH disease may lead to delay in management and may cause irreversible damage to the photoreceptors with poor visual outcome.

The effect of incorporating the quantitative analysis besides visual assessments of 18F-FDG brain PET images for the localization of epileptogenic zones

Introduction: FDG Brain PET is a valuable paraclinical tool for presurgical assessments of patients suffering from refractory epilepsy. By the widespread accessibility of PET, recognizing the functional lesions has become a current practical method especially in preoperative evaluations of the partial epilepsy disorders. The aim of our study was to assess the impact of quantitative software-aided method in localizing epileptic zones in human brain using 18F-FDG Brain PET scan beside the physician qualitative interpretations. Materials and Methods: The subjects have been selected among patients referred to brain PET imaging who were suffering from refractory epilepsy. Seventeen patients (9 men, 8 women ; 25±11 YO) underwent PET scan. Quantitative analysis of brain functional images were applied by the Scenium software which provided statistical color-coded images of Z-scores and standard deviations (1). We considered Z-scores<-2 as an abnormal range of brain metabolism. It is worth mentioning that, we categorized the patients based on their MRI investigations to lesional and non-lesional groups. Two physicians presented visual assessments in order to localizing epileptic spots. Also, the kappa index had been calculated as an agreement coefficient via SPSS (V.19.0) software. Results: In the case of assessing the accordance of lesions’ localization among MRI, EEG, and PET/CT evaluations, the agreement level of EEG versus quantitative and qualitative method were reported 0.67 and 0.12, respectively, which were related to non-lesional group. Also, in the lesional category, the kappa indices for quantitative and qualitative analysis against the suspicious lesions on MRI were 0.56 and 0.27, respectively Conclusion: Epilepsy disorder has destructive effects on quality of life. Thereby, accurate diagnosis of lesion locations could have a vital impact in order to patients’ treatment, exclusively in refractory epilepsy which might treat through doing the brain’s operation (2). The foregoing discussion is a confirmation of the supplementary role of quantitative software alongside visual assessments, in order to do pre-surgical evaluations of epileptic positions in human brain via 18F-FDG Brain PET images. Hence, utilizing of quantitative software could be a complementary method together with MRI and EEG procedures to improve the confidence of surgeon about the epileptic spots(3).

Gd-EOB-DTPA dynamic contrast-enhanced magnetic resonance imaging is more effective than enhanced 64-slice CT for the detection of small lesions in patients with hepatocellular carcinoma.

This study aimed to compare the sensitivity and accuracy for the detection of small lesions in patients with hepatocellular carcinoma (HCC) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and 64-slice computed tomography (CT) enhanced scanning, and to evaluate the necessity to perform MRI in patients diagnosed with HCC by CT.The clinical data from 209 patients with HCC diagnosed prior to surgery in the Affiliated Hospital of Guilin Medical University, China were retrospectively analyzed. The 64-slice dynamic contrast-enhanced multi-detector CT (MDCT) and 3.0 T Gd-EOB-DTPA DCE MRI procedures were successively carried out on all patients who were enrolled in a self-controlled study including detection and diagnosis of HCC lesions by MRI and CT, respectively.A total of 243 lesions were detected and both imaging methods could accurately detect lesions of diameter >2 cm. For lesions <2 cm, MRI detected 47, while CT detected 25 lesions indicating that the detection rate of MRI was 88% higher than that of CT. In addition, MRI detected lesions in 15 cases (7.81% in the total of 209 cases) that were not diagnosed by CT. Among these cases, 2 patients were diagnosed to have no lesion by CT.Gd-EOB-DTPA DCE-MRI performed as a routine check prior to surgery in HCC patients can improve the detection of small HCC lesions.

Using only MRI is moderately reliable in the prediction of meniscal tear reparability.

The purpose of this study was to evaluate the role of surgeons' experience with meniscal repairs and meniscectomy decisions, and to determine the factors affecting the disagreement between meniscal repairs and meniscectomy decisions. In total, 223 patients with meniscal tears, 106 meniscal repairs, and 117 meniscectomies were included. Six orthopedic surgeons (3: > 5years; 3: < 5years' arthroscopy experience) were blinded, and they independently reviewed all preoperative MR images for over a month. Their reviews were compared with arthroscopic interventions performed by a surgeon with > 10years' arthroscopy experience. Reparability-associated factors were also evaluated using multivariate logistic regression. The first and second evaluation results did not differ significantly between groups (n.s.). There was good agreement between MRI predictions and arthroscopic interventions for both groups (< 5years' experience: k = 0.248, agreement 62.3%; > 5years' experience: k = 0.351, agreement 67.3%). Sex, side, and distance of tear from the meniscocapsular junction were not significantly different between agreements and disagreements. Disagreement regarding meniscectomy was significantly higher than those regarding meniscus repair (p = 0.002). Concomitant anterior cruciate ligament (ACL) injury, osteochondral lesions, and medial meniscal tear increased the likelihood of meniscal repair (p = 0.0063, p = 0.0010, and p = 0.0369, respectively). An increased risk of disagreement between MRI and surgical procedure was found in the presence of bucket-handle, horizontal or complex tear, chronic tear, high sports activity and expectation level. Surgeon's experience level may influence the prediction of meniscus reparability. Concomitant ACL injury, osteochondral lesions, and presence of medial meniscal tear increase the likelihood of meniscal repair. Tear type, tear chronicity, patient's activity and expectation level may influence the surgeon's operative decision in addition to MRI. III.

P068] Management of clinical MRI workflow and gadolinium dosing using a dedicated software tool

Purpose To ensure the place of MRI in the future of value-based healthcare, patient safety and cost-efficiency needs to be increased. It has been shown in other imaging modalities, that accessible management software-tools provide insights into everyday workflow, and facilitate optimization of practices [1] . In this study, we demonstrate the added value of such software in a clinical MRI setting. Methods DICOM data from 3 months was automatically collected from 3 Siemens MR systems (1.5T, two 3T) on a server, using software from GE Healthcare. Operational and clinical data (procedure- and sequence-timing, gadolinium contrast agents (GDCA) volume, etc.) was extracted in excel-format. Descriptive statistics of MRI workflow were generated, and the administration of GDCA was compared to standards [2] . Results Data from 3409 MRI procedures was collected; 2733 (80,2%) were performed without GDCA, 659 (19,3%) and 1 ( [1] . In only 0,4% of GDCA enhanced procedures the maximum allowed injected volume was exceeded. However, in 56,4% of cases the injected volume was larger than the guideline [2] prescribes, indicating optimization possibilities. When excluding overnight stops, between-patient time was significantly different between one of the 3T scanners and the 1.5T scanner (averages 14m34s and 16m6s; t-test p-value = 0,006). Opportunities for optimizing patient-throughput are to be investigated; minimizing between-patient time can increase cost-efficiency. Conclusions Easy data-access on GDCA administration is of interest because of recent concerns about their safety [3] . Volume of GDCA can be readily tracked and optimized using this software, showing its contribution to patient safety. Additionally, between-patient time can be monitored and minimized to increase cost-efficiency. Future work will be focused on further development of features for patient safety (SAR levels, contrast allergies, implant safety).