MRI Protocol Research Articles

Background: Cardiovascular (CV) risk factors such as hypertension have been linked to accelerated cognitive decline with aging but underlying hemodynamic mechanisms are unclear. Aortic stiffening, quantified by pulse wave velocity (PWV), may contribute to microvascular injury by elevating transmitted pulsatility and triggering vascular adaptations that limit blood flow. Using a novel single-session 4D flow MRI protocol we assessed heart-brain hemodynamics in cognitively asymptomatic adults with and without hypertension. Hypotheses: Age, higher CV disease (CVD) risk, and aortic PWV are associated with amplified intracranial pulsatility and reduced flow/velocity. Methods: Data have been collected in 24 cognitively asymptomatic adults (62.3±7.4 years; 7 males; 8 hypertensive; Telephone-MoCA≥17). CVD risk was determined using the simplified Framingham model, and physical activity was assessed by self-report. CV and intracranial 4D flow research sequences were acquired at 3T (Prisma, Siemens). Preprocessing and segmentation of aorta and Circle of Willis (CoW) were applied. Mean and peak velocity (Vmean, Vmax; m/s), and time-to-peak (TTP; ms) were quantified voxel-wise. Flow (ml/s), pulsatility index (PI), and aortic PWV were quantified as detailed in Fig 1. PWV was inverse transformed (PWV.T; ms/m). Results: Hypertensive participants were older (69.1±7.4 vs 58.9±4.5 years, p<0.01), had higher CoW PI (1.16±0.28 vs 0.99±0.09, p=0.04), and lower CoW Vmax (0.71±0.06 vs 0.79±0.09 m/s, p=0.03) than controls. CVD risk score was associated with higher PI and lower velocities in the CoW (Fig 2). Higher physical activity was associated with higher CoW Vmean, Vmax, and flow (rho=0.47-0.48; p=0.02-0.03) and lower PI (rho=-0.43, p=0.04). Inverse relationships were found for: CoW Vmax with aortic PWV.T (r=-0.46, p=0.03), and CoW PI with TTP in both regions (r aorta =-0.43, p=0.04; r CoW =-0.45; p=0.03). CoW and aortic TTP showed moderate correlation (r=0.41, p=0.04; Fig 3). Conclusion: Preliminary results show correlations between heart and brain hemodynamic measures. Hypertension and CVD risk were related to adverse CoW hemodynamics, while physical activity showed favorable associations. Aortic PWV was related to lower intracranial peak velocity, suggesting a possible downstream effect. Expected association between aortic PWV and CoW PI was not observed. Findings highlight the complexity of heart-brain hemodynamics and support ongoing recruitment for stratified age-matched analysis.

Intraventricular and subarachnoid neurocysticercosis (IVSN) represents a severe extraparenchymal manifestation of Taenia solium infection, frequently leading to obstructive hydrocephalus and increased intracranial pressure. Despite advances in medical therapy, standardized protocols for endoscopic management remain lacking. The authors aimed to establish a comprehensive diagnostic and surgical workflow for IVSN and evaluate the clinical outcomes of neuroendoscopic management in a large single-center cohort. The medical records of 51 patients (mean age 43.4 years, 68.6% male) with IVSN treated via endoscopic surgery from 2009 to 2025 were retrospectively reviewed. Preoperative diagnostics included high-resolution T2-weighted 3D SPACE MRI and lateral view radiographic imaging of the lower legs to enhance the detection of cysts. Endoscopic procedures involved cyst excision, endoscopic third ventriculostomy, and septostomy. Postoperative management included corticosteroids, albendazole, and antiepileptics. Outcomes were assessed via radiological follow-up and clinical monitoring over a mean period of 98.3 months. Complete cyst removal was achieved in 88.2% of patients. Three-dimensional SPACE (sampling perfection with application-optimized contrast using different flip angle evolutions) MRI enabled clear visualization of cyst membranes in all cases, outperforming conventional sequences. Intramuscular calcifications were detected in 94.1% of patients via lateral leg radiographic imaging. The recurrence rate was 2.0%, and only 9.8% of patients required ventriculoperitoneal shunt placement. Postoperative complications were minimal, with intracranial infections in 2 cases (3.9%), both of which were successfully managed. No neurological deficits were observed following surgery. Neuroendoscopic surgery offers a safe and effective treatment for IVSN when combined with advanced imaging and structured medical therapy. The integration of 3D SPACE MRI and standardized endoscopic protocols facilitates accurate diagnosis, complete cyst removal, and long-term disease control with low complication and recurrence rates.

Optimization strategy for fat-suppressed T2-weighted images in liver imaging: The combined application of AI-assisted compressed sensing and respiratory triggering.

In the routine clinical practice, only a few key sequences allow positive diagnosis of brain metastasis. The aim of our study was to investigate the diagnostic accuracy of a reduced protocol including only 2 sequences of interest for the detection of brain lesions in lung cancer. Fifty four patients undergoing MRI in the initial staging of lung cancer were included in this monocentric, retrospective study. Four radiologists reviewed the data from a short protocol with 2 sequences of interest (3D FLAIR and 3D T1w-SE sequences) and from the standard reference protocol (DWI, T2*, 3D FLAIR, non-enhanced T1, post-contrast 3D T1w-GRE and post-contrast 3D T1w-SE sequences). Diagnostic performances were assessed on a per-patient and per-lesion basis. In our population, 35% of patients had brain metastases. The short protocol detected 22 metastatic patients with 3 false positives. The analysis showed excellent diagnostic performance of the short protocol with more than 90% sensitivity and specificity, for both per-patient and per-lesion evaluations. Metastatic classification was not significantly influenced by the reviewer's experience. Seven major secondary findings were identified, including 3 ischemic events and 1 aneurysm that were only detected when the long protocol was used. A short MRI brain protocol, including only 3D FLAIR and post-contrast T1w-SE sequences, demonstrated diagnostic accuracy equivalent to standard protocols for BM screening in lung cancer patients. The subsequent reduction in examination time can potentially improve access to MRI.

Given the lack of consensus in lumbar spine MRI protocols, this study sought to characterize current practice patterns among musculoskeletal radiologists in the United States. An anonymous 13-item web-based survey covering protocol sharing, sequence selection, and advanced techniques was distributed to members of the Society of Skeletal Radiology and the Society of Academic Bone Radiologists from 12/2022 to 2/2023. Frequency counts and proportions were calculated from the collected responses. One hundred ninety-three musculoskeletal radiologists completed the survey; 171/193 (88.6%) actively interpret lumbar spine MRI, and 137/193 (71%) reported using a shared protocol with neuroradiologists. The most common protocol combines sagittal T1-weighted, T2-weighted, and short tau inversion recovery (STIR) sequences (150/193 (77.7%)). For axial imaging, respondents use a T1- and T2-weighted pair (102/193, 54.5%) or T2-weighted imaging alone (64/193, 34.2%). Fat suppression is applied to postcontrast T1-weighted images more frequently in the sagittal plane (149/193 (77.2%)) than axially (102/193 (52.8%)), with use dictated by indication or subspecialty preference (less frequent in neuroradiologists' protocols). Specialized sequences are uncommon (3D imaging (19/193, 9.8%), diffusion-weighted imaging (4/193, 2.1%), chemical-shift imaging (17/193, 9.7%)) and are typically reserved for specific indications. Practices in the United States converge on a core lumbar spine MRI protocol-sagittal T1-weighted, T2-weighted, and STIR sequences with axial T2-weighted imaging-yet diverge in optional elements. Musculoskeletal radiologists use fat-suppressed imaging more than neuroradiologists, while specialized techniques are deployed selectively. Recognizing these variations could potentially enhance interpretive consistency, standardize protocols for research, and support rapid protocol development.

Annual whole-body MRI (WB-MRI) is recommended for early cancer detection in individuals with Li-Fraumeni syndrome (LFS). However, there is no agreement on a standardized MRI protocol. This study evaluated the diagnostic performance of different MRI sequences to suggest an optimized protocol for LFS surveillance. In this prospective bicentric study, 113 participants with LFS underwent annual WB-MRI and were included in the analysis. The protocol comprised turbo-spin echo (TSE) T1-weighted and inversion-recovery T2-weighted (TIRM) images of the whole body in coronal orientation, and T2-weighted (HASTE), diffusion-weighted (DWI), and T1-weighted DIXON images (pre- and post-contrast agent administration) from head to thighs in axial orientation. An additional fluid-attenuated inversion recovery (FLAIR) sequence imaged the skull only. Initial clinical interpretation was conducted by staff radiologists. The visibility of reported mass lesions was independently graded in all sequences by three experienced radiologists using a Likert scale. Sequence combinations were compared to inform the design of an optimal MRI protocol. Over 30 months, 189 WB-MRI examinations were performed in 113 participants (mean age 40 years, ±12.7 years [standard deviation], 91 women). 188 mass lesions were detected and confirmed as malignant (n = 38), benign (n = 120) or ambiguous (n = 30). In the multi-reader analysis, all new malignant lesions could have been detected by a combination of cranial FLAIR, whole-body DWI, and whole-body HASTE in the axial direction. A shortened, contrast-agent-free WB-MRI protocol combining cranial FLAIR, WB-HASTE, and WB-DWI promises to be an effective and patient-friendly approach for annual cancer surveillance in LFS. Question Annual whole-body MRI (WB-MRI) is recommended for early cancer detection for individuals with Li-Fraumeni syndrome (LFS), but a standardized sequence protocol has yet to be established. Findings The combination of cranial FLAIR, whole-body HASTE, and whole-body DWI in the axial plane enabled visualization of all newly developed malignant lesions in our study cohort. Clinical relevance A shortened, standardized WB-MRI protocol enables efficient, sensitive early cancer detection in individuals with LFS, minimizing patient burden by reducing examination time and contrast agent use. This approach may improve surveillance participation while enhancing comparability across centers.

This study aimed to compare the detection rates and inter-rater agreements of the sagittal T2w-TSE and sagittal short tau inversion recovery (STIR) sequence versus the axial T2w-TSE sequence with full spinal cord coverage in identifying spinal cord lesions in patients with suspected demyelinating diseases and diagnosed multiple sclerosis (MS). 104 patients were prospectively enrolled in this study and underwent MRI, including a sagittal T2w-TSE and STIR sequence, as well as an axial T2w-TSE sequence with full spinal cord coverage. Two experienced neuroradiologists, blinded to clinical parameters, independently evaluated the scans in separate sessions. After blinded readings, raters re-evaluated all sequences to assess if lesions could be retrospectively identified in other sequences. Spinal cord lesions were found in 81 patients. The highest inter-rater reliability was observed for the sagittal T2w-TSE sequence (κ = 0.73, 95%-CI 0.66-0.79), followed by the axial T2w-TSE (κ = 0.71, 95%-CI 0.63-0.79) and the sagittal STIR sequence (κ = 0.65, 95%-CI 0.58-0.73). The axial T2w-TSE sequence demonstrated superior lesion detection rates, identifying significantly more lesions (n = 361) compared to the STIR (n = 293) and T2w-TSE sagittal (n = 224) sequence (p < 0.001). Axial T2w-TSE sequences with full spinal cord coverage provide superior lesion detection compared to sagittal sequences and should be included in standard MRI protocols for MS patients. They may accelerate meeting MRI criteria for MS, improve monitoring of disease progression, and enhance prediction of future disability.

To assess whether accelerated knee MRI protocols using simultaneous multi-slice (SMS) and deep learning reconstruction (DLR) are non-inferior to a conventional parallel imaging protocol for detecting internal derangement injuries. This retrospective cohort study included 1055 patients who underwent knee MRI followed by arthroscopy within 180days. Patients were scanned using either a conventional protocol (n = 226), an accelerated SMS protocol (n = 406), or a SMS with DLR protocol (n = 423). Each group included consecutive exams. Imaging was performed on 3T MRI using five standardized two-dimensional turbo spin echo sequences. Radiology interpretations were compared with arthroscopy (reference standard) for anterior cruciate ligament (ACL), medial meniscus (MM), and lateral meniscus (LM) tears. Sensitivity and specificity were calculated with 95% confidence intervals using non-parametric bootstrapping. Non-inferiority was concluded if the upper bound of the 95% confidence interval for the difference in sensitivity and specificity was ≤ 0.05. Among all patients, 666 had MM tears, 417 had LM tears, and 220 had ACL tears. Sensitivity for ACL tears was higher with accelerated protocols (0.96 and 0.98) than the conventional (0.85), with non-inferiority confirmed. Specificity was ≥ 0.98 across all protocols. MM sensitivity (0.94-0.95) met non-inferiority criteria. MM specificity (0.88-0.91) and LM sensitivity (0.63-0.68) were not statistically different across protocols but did not meet the non-inferiority margin. LM specificity (0.94) met non-inferiority criteria. Accelerated MRI protocols using SMS and DLR demonstrated comparable diagnostic performance to the reference protocol. Although not all metrics met the strict non-inferiority margin, none showed statistically significant reductions in sensitivity or specificity. These findings support the clinical adoption of accelerated protocols for faster, high-throughput knee imaging.

Current intravoxel incoherent motion (IVIM) MRI protocols typically involve acquiring IVIM images before the injection of intravenous contrast media. The effect of contrast on IVIM model parameters remains unclear. This study aimed to assess the effect of intravenous gadolinium-based contrast media on IVIM parameters (f, D*, and D) in brain MRI. Thirty-one participants in the experimental contrast group (age 38.8±8.81, 22 females, 9 males) and 31 participants in the control group (age 34.7±9.68, 17 females, 14 males) were prospectively recruited. Pre-contrast, immediate post-contrast, and delayed post-contrast IVIM with 14b values following administration of gadoteric acid at 0.1ml per kg body mass were performed in a 3.0T MRI scanner. The IVIM parameters, and the nominal signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated and compared between scans using repeated measures analysis of variance and paired t-tests. No baseline differences in IVIM parameters were observed in the control group across the three scans (p=0.077 to 0.866). In the contrast group, there were reductions in regional f, D*, D, and ADC values between the pre-contrast to post-contrast scan, followed by a return towards baseline in the delayed phase (p<0.050). SNR (p=0.056 to 0.513) and CNR (p=0.359 to 0.999) were not significantly different before and after contrast. Potential alterations in f, D*, D, and ADC are observed following administration of gadolinium-based contrast media. These changes may require consideration when performing IVIM after other contrast sequences.

Multiple sclerosis (MS) is an autoimmune demyelinating disease that attacks myelin. MRI is an important imaging modality for diagnosis and monitoring in MS. However, the current standard MRI protocol for MS lacks sequences capable of detecting molecular changes. To present a saturation-transfer-based MRI protocol, including chemical exchange saturation transfer (CEST) and magnetization transfer indirect spin labeling (MISL) sequences, for quantifying molecular changes and water exchange in the brain of MS patients. Prospective. Fifty-two participants including 31 healthy controls (HC) (18 females and 13 males) and 21 MS patients (18 females and 3 males). 3D inversion-prepared gradient echo T1w, 3D fast spin echo T2w, 3D CUBE CEST and MISL at 3.0 T. Multiple CEST contrasts between HC and MS groups were analyzed using double-step multi-pool Lorentzian fitting (DMPLF) and Lorentzian difference analysis (LDA) to evaluate and compare their diagnostic performance. MISL signals at -20 and -10 ppm were quantified by the normalized signal reduction in cerebrospinal fluid (CSF). T1w MRI was used to quantify brain volumes. Unpaired Student's t-test, receiver operating characteristic (ROC) curve, area under the curve (AUC), and binary logistic regression analysis. p < 0.05 was considered statistically significant. CEST detected decreased signals in the brain of MS patients using both DMPLF and LDA, with DMPLF demonstrating superior performance in differentiating MS from HC (AUC, 0.93; 95% CI: 0.86, 1.00). MS patients showed significantly lower whole brain MISL signals than HCs at both -20 ppm (0.04 ± 0.01 vs. 0.06 ± 0.02) and -10 ppm (0.06 ± 0.02 vs. 0.08 ± 0.02). MS patients showed a significant decrease (-6.57%) in brain tissue and an increase (+20.73%) in CSF volume ratios compared to HCs. The saturation-transfer-based MRI framework can effectively evaluate molecular changes and CSF-tissue water exchange in the brains of MS patients. 2. Stage 3.

Background/Objectives: To evaluate whether incorporating both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in pituitary MRI examinations improves differential diagnosis by providing additional diagnostic value. Methods: A retrospective analysis was performed on 88 patients with histologically confirmed sellar or parasellar tumors who underwent 1.5T MRI with DWI and dynamic susceptibility contrast PWI (DSC-PWI) between October 2007 and April 2023. DWI parameters included minimum apparent diffusion coefficient (ADCmin) and relative ADCmin (rADCmin). PWI parameters included mean and maximum relative cerebral blood volume (rCBV, rCBVmax) and relative peak height (rPH, rPHmax), normalized to white matter. Tumor regions of interest were manually segmented, excluding calcified or hemorrhagic areas. Group comparisons and ROC analyses assessed diagnostic performance of individual and combined parameters. Results: Significant differences in diffusion and perfusion metrics were observed among the five tumor types. The combined analysis of DWI and PWI improved diagnostic accuracy in selected comparisons. The greatest benefit occurred in distinguishing meningiomas from solid non-functional pituitary adenomas (pituitary neuroendocrine tumors-PitNET), where the combination of ADCmin and rPHmax yielded an AUC of 0.818, sensitivity of 88%, and specificity of 76%, exceeding the performance of either parameter alone. In other comparisons, including meningiomas versus invasive PitNETs and adamantinomatous craniopharyngiomas, combined analysis did not substantially improve accuracy when single parameters, particularly rCBVmax (AUC = 0.995), already demonstrated excellent performance. Conclusions: Integration of DWI and PWI into pituitary MRI protocols enhances diagnostic performance in selected tumor groups. The additive value is context-dependent, supporting the tailored application of these sequences in the evaluation of sellar and parasellar tumors.

Japanese Radiology 2025 Updates.

ObjectivesTo compare the performance of 3D T1 turbo spin echo (3DT1TSE) and 3D T1 turbo field echo (3DT1TFE) MRI in detecting gadolinium-enhancing lesions in multiple sclerosis (MS).Materials and methodsWe retrospectively analyzed 255 3-T MRIs from MS patients, each including post-contrast 3DT1TSE and 3DT1TFE sequences. Two blinded readers independently assessed enhancing lesions per sequence. A consensus review, incorporating longitudinal imaging and additional sequences, served as the reference standard.ResultsThe consensus identified 70 enhancing lesions in 31 patients. All 70 were visible on 3DT1TSE, while 64 (91%) were detectable on 3DT1TFE. Reader sensitivity was higher for 3DT1TSE (84% and 90%) than 3DT1TFE (45% and 40%) (p < 0.01). Inter-reader agreement was excellent for 3DT1TSE (ICC = 0.90) and moderate for 3DT1TFE (intraclass correlation coefficient = 0.69). Although false positives were more common with 3DT1TSE, they were readily excluded during consensus reading. In six patients, enhancing lesions were detected only on 3DT1TSE, with treatment escalation in two.Conclusion3DT1TSE outperformed 3DT1TFE in sensitivity and reader agreement for enhancing lesion detection in MS. Incorporating 3DT1TSE into standard MRI protocols may improve disease activity assessment and clinical decision-making.Critical relevance statementReplacing 3D gradient-echo with post-contrast 3D T1 turbo spin-echo brain MRI greatly improves the detection of gadolinium-enhancing multiple-sclerosis lesions, boosting diagnostic sensitivity and reader agreement and directly influencing treatment-escalation decisions in routine practice.Key PointsDetecting and enhancing MS lesions is limited by standard 3D T1 turbo field echo (3DT1TFE) MRI.3D T1 turbo spin echo detects significantly more gadolinium-enhancing MS lesions than conventional 3DT1TFE.Greater lesion detection allows more precise activity assessment and optimal treatment management.Graphical

The loss of smell (anosmia) has been noted in numerous diseases, including COVID-19. Inflammatory and microstructural alterations are possible underlying mechanisms of anosmia in COVID-19. However, no atlas exists to study olfaction and the associated tissue property changes. To develop the sense of smell (SoS) atlas, including gray matter regions and white matter tracts of the olfactory circuit, to investigate the underpinnings of COVID-19 related anosmia. Retrospective. For the SoS atlas, high-resolution tractograms of 10 healthy controls (HC) of the Human Connectome Project (7 females, 22-35 years) were used. The SoS atlas was applied to 8 subjects with persistent anosmia following COVID-19 (COVID-P, 7 females, 52 ± 12 years), 19 subjects that recovered from COVID-19 anosmia (COVID-R, 14 females, 38 ± 13 years), and 17 HC (8 females, 39 ± 12 years). 3 T, 3D inversion recovery, 3D fast field echo, and spin-echo echo-planar imaging sequences. To create the SoS atlas, regions were identified and tracts were extracted via tractography following biological constraints. MRI metrics sensitive to alterations in neuroinflammation, axonal degeneration, myelin and macromolecular density, and iron were analyzed. Region-based analysis (p-value < 0.05, false discovery rate (FDR) corrected) and voxel-based analysis (p-value < 0.001 uncorrected, FDR-corrected cluster extent = 5 voxels) were performed on 15 multisequence-MRI metrics between the three groups. The SoS atlas consisted of 35 regions and, after anatomical curation, the initial 506 tracts were refined to 78. Compared to HC, COVID-P presented alterations in neuroinflammation-related (mean: 41% of total alterations) and axonal degeneration-related (31%) MRI metrics, while COVID-R presented alterations of myelin-related metrics (68%). COVID-P alterations mainly affected the hindbrain (56%), while COVID-R the hindbrain (39%). A novel tool, the SoS atlas, was developed to study the olfactory system and applied in combination with multisequence-MRI metrics to investigate the mechanisms of COVID-19 related anosmia. 3. Stage 1.

Sagittal FOCUS-MUSE Diffusion-weighted Imaging MRI Improves the Accuracy of Rectal Cancer Location: A Prospective Observational Study.

Clinical MRI-Defined Plaque Morphology Predicts Guidewire Crossing Failure in Below-the-Knee Occlusions in a Translational Model Using Amputated Lower limbs.

Background: Idiopathic Intracranial Hypertension (IIH), or pseudotumor cerebri, is characterized by elevated intracranial pressure without a detectable secondary cause. The condition has an estimated incidence of 0.9 per 100,000 in the general population, rising to 19 per 100,000 among obese women of reproductive age. IIH is associated with significant morbidity, particularly vision loss, if not diagnosed and managed promptly. Methodology: This retrospective case series analyzed five patients evaluated between May 2024 and May 2025 who met the modified Dandy criteria for IIH and underwent standardized MRI and MRV protocols. Patient selection involved the exclusion of secondary intracranial hypertension, and two radiologists independently reviewed images. Results: All patients (100%) exhibited either partial or complete empty Sella, 80% (4/5) showed transverse sinus stenosis, 60% (3/5) had Meckel's cave enlargement; and 60% (3/5) had perioptic CSF space dilation; visual disturbances correlated with perioptic CSF distention. The study highlights the value of neuroimaging biomarkers in confirming IIH, guiding clinical management, and differentiating from secondary causes. However, the limited sample size and single-center scope restrict generalizability. Conclusion: Early radiological identification and intervention are crucial to prevent irreversible complications, emphasizing the need for multi-disciplinary care and further research involving advanced imaging and long-term outcomes.

Pediatric stroke is garnering increased attention due to its rising incidence and significant impact on affected children, families, and the health care system. Arterial ischemic stroke (AIS) is a major subtype of pediatric stroke and often results from arterial occlusion. Diagnosis and treatment of acute ischemic stroke in children pose unique challenges, primarily because of nonspecific symptoms, lack of pediatric-focused imaging protocols, distinct causes (compared with in adults), and the large number of stroke mimics. Despite several advances in imaging and treatment strategies, the emergency management of pediatric AIS remains challenging and varies across health care centers. This inconsistency underscores the need for further research to establish standardized assessment protocols and neuroimaging guidelines and refine therapeutic strategies. The authors outline key aspects of pediatric AIS, including early recognition, emergency neuroimaging techniques, an abbreviated MRI protocol, and management pathways in the emergency department. An abbreviated MRI protocol is critical because it provides high sensitivity for detecting ischemia and aids in identifying stroke causes as well as accurately detecting stroke mimics and significantly minimizing the necessity for prolonged sedation or anesthesia. The authors emphasize the value of a multidisciplinary streamlined approach to management of pediatric AIS to ensure the best possible outcomes. ©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Fung and Rutten in this issue.

75 Background: Multidisciplinary (MD) cancer care benefits patients, providers, and health systems, especially in spine oncology (SO), where delays, miscommunication, and inappropriate referrals can affect outcomes. In 2014, an MD team of spine surgeons, medical oncologists, radiation oncologists, and radiologists (SOaR 2 ) established a literature-based care pathway for patients with spinal malignancies. The program aimed to reduce treatment time, simplify diagnosis and therapy, improve collaboration, and optimize resources, with the goal of becoming a center of excellence. The pathway is regularly updated to meet evolving stakeholder needs. Objective: To develop and implement a SO program that enhances MD care for patients with spinal tumors. Methods: Patients with symptoms suggestive of spinal malignancy were evaluated across the five hospitals of an academic health system. A rapid MRI protocol with reserved daily slots, optimized sequences, and a novel SO imaging score (SOIS) reporting protocol for instability risk and spinal cord compression with automatic electronic notification (AEN) was created to promptly identify oncologic emergencies. Rapid-access clinics in radiation oncology and neurosurgery provided expedited CT simulation and urgent outpatient evaluations, minimizing emergency department use and unnecessary hospital admissions. Stable patients were reviewed at the MD SO tumor board, where discussions focused on diagnosis confirmation, spinal stability, neural compression, and systemic therapy. Consensus recommendations were distributed electronically to each member of each individual patient care team. Patients were co-evaluated by radiation oncology and neurosurgery in an MD spine clinic. CT/MRI simulation for radiation therapy (RT) or surgical intervention was guided by consensus and shared decision-making. Postoperative patients were appropriately reassessed for adjuvant RT. RT was delivered using conventional or stereotactic body radiation therapy (SBRT). A standardized RT workflow was implemented, supported by a dedicated spine SBRT planning team, including credentialed physicians and physicists. A six-degree-of-freedom couch improved treatment precision. Results: SOIS adoption has been robust, with nearly 3,500 reports issued since 2021. AEN of MRI results were associated with earlier SO visits and treatments. Growth was observed in the SBRT program between FY24 and FY25: consultations increased from 79 to 111 (141%), treated patients from 104 to 163 (157%), and treatment sessions from 255 to 464 (182%). Average time from symptom onset to safe community return was reduced from multiple months to 6–8 weeks. Conclusions: A dedicated MD SO program improved care coordination, accelerated time-to-treatment, and enhanced resource utilization for patients with spinal malignancies. Continued system integration will support the growing demands of this complex population.

MRI versus radiography as eligibility screening tool for knee osteoarthritis clinical trials: Data from the osteoarthritis initiative.