MRI Techniques Research Articles

A KETOGENIC DIET REDUCES TISSUE SODIUM CONTENT: AN EXPLORATORY STUDY

Objective: Hypertension and diabetes are a substantial global public health problem. The prevalence of these diseases will further increase in the near future, leading to increased health and socioeconomic costs. Hence efficient therapeutic approaches are urgently needed. It has been previously shown that nutritional approaches including a very-low carbohydrate, or a ketogenic diet potentially decrease body weight, blood pressure and glucose levels in patients with type 2 diabetes along with an overall significant reduction in their pill burden. However, the detailed physiological mechanisms underlying the observed induction and maintenance of diabetes remission remain largely unknown. Previous studies have shown that the skin could be a buffer system for sodium and that skin sodium content could be both a pathogenic cause and a marker of hypertension and salt sensitivity. Since a nutritionally created metabolic milieu such as nutritional ketosis can lower blood pressure, we hypothesize that this dietary approach also reduces tissue sodium content. Design and method: By using 7-T 23Na MRI technique, we performed an exploratory study and analyzed skin and muscle sodium concentration before, and after a 6-week ketogenic diet in three healthy probands. Nutritional ketosis was verified by frequent check of blood ketone (beta-hydroxybutyrate; BOHB) levels greater than 0.3 mmol/L. Results: Preliminary data of our planned exploratory study (in patients with chronic kidney disease and type 2 diabetes mellitus and healthy probands) demonstrated that compared to baseline 6 weeks of ketogenic diet decreased tissue sodium content in the skin (16.6 ± 2.1 vs. 12.6 ± 2.1 mmol/L), in the medial gastrocnemius muscle (20.5 ± 0.9 vs. 16.7 ± 0.7 mmol/L), in the lateral gastrocnemius muscle (19.7 ± 1.0 vs. 16.0 ± 1.0 mmol/L) and in the soleus muscle (13.1 ± 0.8 vs. 11.5 ± 0.5 mmol/L). Conclusions: Our results indicate a massive reduction of tissue sodium concentration in healthy volunteers in response to a ketogenic diet which might be associated with the observed clinical benefits and be implicated in the anti-hypertensive effects of this powerful dietary intervention. Findings of this study could have an impact on future treatment strategies of various chronic diseases.

Visualising and semi-quantitatively measuring brain fluid pathways, including meningeal lymphatics, in humans using widely available MRI techniques

Brain fluid dynamics remains poorly understood with central issues unresolved. In this study, we first review the literature regarding points of controversy, then pilot study if conventional MRI techniques can assess brain fluid outflow pathways and explore potential associations with small vessel disease (SVD). We assessed 19 subjects participating in the Mild Stroke Study 3 who had FLAIR imaging before and 20–30 minutes after intravenous Gadolinium (Gd)-based contrast. Signal intensity (SI) change was assessed semi-quantitatively by placing regions of interest, and qualitatively by a visual scoring system, along dorsal and basal fluid outflow routes. Following i.v. Gd, SI increased substantially along the anterior, middle, and posterior superior sagittal sinus (SSS) (82%, 104%, and 119%, respectively), at basal areas (cribriform plate, 67%; jugular foramina, 72%), and in narrow channels surrounding superficial cortical veins separated from surrounding cerebrospinal fluid (CSF) (96%) (all p < 0.001). The SI increase was associated with higher intraparenchymal perivascular spaces (PVS) scores (Std. Beta 0.71, p = 0.01). Our findings suggests that interstitial fluid drainage is visible on conventional MRI and drains from brain parenchyma via cortical perivenous spaces to dural meningeal lymphatics along the SSS remaining separate from the CSF. An association with parenchymal PVS requires further research, now feasible in humans.

The adoption of LI-RADS: a survey of non-academic radiologists.

To understand the practice and determinants of non-academic radiologists regarding LI-RADS and the four current LI-RADS algorithms: CT/MRI, contrast-enhanced ultrasound (CEUS), ultrasound (US), and CT/MRI Treatment Response. Seven themes were covered in this international survey, as follows: (1) demographics of participants and sub-specialty, (2) HCC practice and interpretation, (3) reporting practice, (4) screening and surveillance, (5) HCC imaging diagnosis, (6) treatment response, and (7) CT and MRI technique. Of the 232 participants, 69.4% were from the United States, 25.0% from Canada, and 5.6% from other countries and 45.9% were abdominal/body imagers. During their radiology training or fellowship, no formal HCC diagnostic system was used by 48.7% and LI-RADS was used by 44.4% of participants. In their current practice, 73.6% used LI-RADS, 24.7% no formal system, 6.5% UNOS-OPTN, and 1.3% AASLD. Barriers to LI-RADS adoption included lack of familiarity (25.1%), not used by referring clinicians (21.6%), perceived complexity (14.5%), and personal preference (5.3%). The US LI-RADS algorithm was used routinely by 9.9% of respondents and CEUS LI-RADS was used by 3.9% of the respondents. The LI-RADS treatment response algorithm was used by 43.5% of the respondents. 60.9% of respondents thought that webinars/workshops on LI-RADS Technical Recommendations would help them implement these recommendations in their practice. A majority of the non-academic radiologists surveyed use the LI-RADS CT/MR algorithm for HCC diagnosis, while nearly half use the LI-RADS TR algorithm for assessment of treatment response. Less than 10% of the participants routinely use the LI-RADS US and CEUS algorithms.

Advancing heart failure research using machine learning

Advancing heart failure research using machine learning

AI-assisted compressed sensing and parallel imaging sequences for MRI of patients with nasopharyngeal carcinoma: comparison of their capabilities in terms of examination time and image quality

ObjectiveTo compare examination time and image quality between artificial intelligence (AI)–assisted compressed sensing (ACS) technique and parallel imaging (PI) technique in MRI of patients with nasopharyngeal carcinoma (NPC).MethodsSixty-six patients with pathologically confirmed NPC underwent nasopharynx and neck examination using a 3.0-T MRI system. Transverse T2-weighted fast spin-echo (FSE) sequence, transverse T1-weighted FSE sequence, post-contrast transverse T1-weighted FSE sequence, and post-contrast coronal T1-weighted FSE were obtained by both ACS and PI techniques, respectively. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and duration of scanning of both sets of images analyzed by ACS and PI techniques were compared. The images from the ACS and PI techniques were scored for lesion detection, margin sharpness of lesions, artifacts, and overall image quality using the 5-point Likert scale.ResultsThe examination time with ACS technique was significantly shorter than that with PI technique (p < 0.0001). The comparison of SNR and CNR showed that ACS technique was significantly superior with PI technique (p < 0.005). Qualitative image analysis showed that the scores of lesion detection, margin sharpness of lesions, artifacts, and overall image quality were higher in the ACS sequences than those in the PI sequences (p < 0.0001). Inter-observer agreement was evaluated for all qualitative indicators for each method, in which the results showed satisfactory-to-excellent agreement (p < 0.0001).ConclusionCompared with the PI technique, the ACS technique for MR examination of NPC can not only shorten scanning time but also improve image quality.Clinical relevance statementThe artificial intelligence (AI)–assisted compressed sensing (ACS) technique shortens examination time for patients with nasopharyngeal carcinoma, while improving the image quality and examination success rate, which will benefit more patients.Key Points• Compared with the parallel imaging (PI) technique, the artificial intelligence (AI)–assisted compressed sensing (ACS) technique not only reduced examination time, but also improved image quality.• Artificial intelligence (AI)–assisted compressed sensing (ACS) pulls the state-of-the-art deep learning technique into the reconstruction procedure and helps find an optimal balance of imaging speed and image quality.

Surface Modification of Cellulose Nanocrystals (CNCs) to Form a Biocompatible, Stable, and Hydrophilic Substrate for MRI

This study focused on surface modification of cellulose nanocrystals (CNCs) to create a biocompatible, stable, and hydrophilic substrate suitable for use as a coating agent to develop a dual-contrast composite material. The CNCs were prepared using acid hydrolysis. Hydrolysis was completed using 64% sulfuric acid at 45 °C for 1 h, which was combined with polyethylene glycol and sodium hydroxide (PEG/NaOH). The yield of samples exhibited prominent physicochemical properties. Zeta (ζ) potential analysis showed that the CNCs sample had excellent colloidal stability with a highly negative surface charge. Transmission electron microscopy (TEM) analysis confirmed that the CNCs sample had a rod-like morphology. On the other hand, field-emission scanning electron microscopy (FESEM) analysis showed that the acid hydrolysis process caused a significant reduction in particle size and changed surface morphology. In addition, cellulose nanocrystals with polyethylene glycol and sodium hydroxide (CNCs-PEG/NaOH) have many noteworthy properties such as colloidal stability, small hydrodynamic size, and water dispersibility. Furthermore, the MTT assay test on Hep G2 cells demonstrated good biocompatibility of the CNCs-PEG/NaOH and did not exhibit any cytotoxic effects. Hence, CNCs-PEG/NaOH holds the potential to serve as a dual-contrast agent for MRI techniques and other biomedical applications.

Insights into the Age Dependency of Compositional MR Biomarkers Quantifying the Health Status of Cartilage in Metacarpophalangeal Joints.

(1) Background: We aim to investigate age-related changes in cartilage structure and composition in the metacarpophalangeal (MCP) joints using magnetic resonance (MR) biomarkers. (2) Methods: The cartilage tissue of 90 MCP joints from 30 volunteers without any signs of destruction or inflammation was examined using T1, T2, and T1ρ compositional MR imaging techniques on a 3 Tesla clinical scanner and correlated with age. (3) Results: The T1ρ and T2 relaxation times showed a significant correlation with age (T1ρ: Kendall-τ-b = 0.3, p < 0.001; T2: Kendall-τ-b = 0.2, p = 0.01). No significant correlation was observed for T1 as a function of age (T1: Kendall-τ-b = 0.12, p = 0.13). (4) Conclusions: Our data show an increase in T1ρ and T2 relaxation times with age. We hypothesize that this increase is due to age-related changes in cartilage structure and composition. In future examinations of cartilage using compositional MRI, especially T1ρ and T2 techniques, e.g., in patients with osteoarthritis or rheumatoid arthritis, the age of the patients should be taken into account.

Combined use of intraoperative MRI and awake tailored microsurgical resection to respect functional neural networks: preliminary experience.

The combined use of intraoperative MRI and awake surgery is a tailored microsurgical resection to respect functional neural networks (mainly the language and motor ones). Intraoperative MRI has been classically considered to increase the extent of resection for gliomas, thereby reducing neurological deficits. Herein, we evaluated the combined technique of awake microsurgical resection and intraoperative MRI for primary brain tumours (gliomas, metastasis) and epilepsy (cortical dysplasia, non-lesional, cavernomas). Eighteen patients were treated with the commonly used "asleep awake asleep" (AAA) approach at Lille University Hospital, France, from November 2016 until May 2020. The exact anatomical location was insular with various extensions, frontal, temporal or fronto-temporal in 8 (44.4%), parietal in 3 (16.7%), fronto-opercular in 4 (22.2%), Rolandic in two (11.1%), and the supplementary motor area (SMA) in one (5.6%). The patients had a mean age of 38.4 years (median 37.1, range 20.8-66.9). The mean surgical duration was 4.1 hours (median 4.2, range 2.6-6.4) with a mean duration of intraoperative MRI of 28.8 minutes (median 25, range 13-55). Overall, 61% (11/18) of patients underwent further resection, while 39% had no additional resection after intraoperative MRI. The mean preoperative and postoperative tumour volumes of the primary brain tumours were 34.7 cc (median 10.7, range 0.534-130.25) and 3.5 cc (median 0.5, range 0-17.4), respectively. Moreover, the proportion of the initially resected tumour volume at the time of intraoperative MRI (expressed as 100% from preoperative volume) and the final resected tumour volume were statistically significant (p= 0.01, Mann-Whitney test). The tumour remnants were commonly found posterior (5/9) or anterior (2/9) insular and in proximity with the motor strip (1/9) or language areas (e.g. Broca, 1/9). Further resection was not required in seven patients because there were no remnants (3/7), cortical stimulation approaching eloquent areas (3/7) and non-lesional epilepsy (1/7). The mean overall follow-up period was 15.8 months (median 12, range 3-36). The intraoperative MRI and awake microsurgical resection approach is feasible with extensive planning and multidisciplinary collaboration, as these methods are complementary and synergic rather than competitive to improve patient oncological outcomes and quality of life.

A Systematic Review of PET Contrasted with MRI for Detecting Crossed Cerebellar Diaschisis in Patients with Neurodegenerative Diseases.

There has not been extensive research into crossed cerebellar diaschisis (CCD) in neurodegenerative disorders. CCD is frequently detected using positron emission tomography (PET). However, advanced MRI techniques have come forth for the detection of CCD. The correct diagnosis of CCD is crucial for the care of neurological patients and those with neurodegenerative conditions. The purpose of this study is to determine whether PET can offer extra value over MRI or an advanced technique in MRI for detecting CCD in neurological conditions. We searched three main electronic databases from 1980 until the present and included only English and peer-reviewed journal articles. Eight articles involving 1246 participants met the inclusion criteria, six of which used PET imaging while the other two used MRI and hybrid imaging. The findings in PET studies showed decreased cerebral metabolism in the frontal, parietal, temporal, and occipital cortices, as on the opposite side of the cerebellar cortex. However, the findings in MRI studies showed decreased cerebellar volumes. This study concludes that PET is a common, accurate, and sensitive technique for detecting both crossed cerebellar and uncrossed basal ganglia as well as thalamic diaschisis in neurodegenerative diseases, while MRI is better for measuring brain volume. This study suggests that PET has a higher diagnostic value for diagnosing CCD compared to MRI, and that PET is a more valuable technique for predicting CCD.

Microstructural Brain Pathology in Paranoid Schizophrenia (According to Magnetic Resonance Tractography)

Background: inconsistency of the obtained results of research on the pathology of microstructural connectivity in schizophrenia on the basis of tractography, absence of clinical application of special MRI techniques justify the need to continue scientific search in this direction. Objective: to identify the features of microstructural pathology of the brain in paranoid schizophrenia. Patients and methods: 25 patients diagnosed with paranoid schizophrenia (F20.0) were included in the main group, 30 healthy subjects without neurological and somatic diseases made up the control group. Instrumental studies were carried out on a Philips Ingenia magnetic resonance tomograph (magnetic field strength 1.5 T) using a DTI pulse sequence. Subsequent processing was carried out using “DSI Studio” (software for the analysis of tractor data). Results and discussion: the resulting microstructural brain changes demonstrated differences in the microstructural connectivity of the brain in patients with paranoid schizophrenia compared to the control group. Significant connections were revealed (at the given parameters for constructing connectivity matrices) between the hippocampus and the cingulate gyrus, the hippocampus and thalamus, thalamus and structures of the striopallidar system, and the absence of significant connections between the amygdala in the main group compared to the control group. The results of graph theoretical analysis of neural network indicators of the brain demonstrated higher values of indicators of “clustering” and the “small world” coefficient, characteristic path length, transitivity, density, and lower values of the global efficiency indicator of the main group compared to the control group. Conclusion: the obtained results demonstrate microstructural semiotics of neural network changes of brain in paranoid schizophrenia. Changes in the connectivity of the hippocampus, thalamus, and amygdala appear to be important tractographic semiotic features of the microstructural pathology of the brain in paranoid schizophrenia. The study is one of the stages of the search for a method of objectification and detection of disruption of brain neuroplasticity processes in the endogenous pathology of the schizophrenic spectrum.

Head-To-Head Comparison of PET and Perfusion Weighted MRI Techniques to Distinguish Treatment Related Abnormalities from Tumor Progression in Glioma.

The post-treatment imaging surveillance of gliomas is challenged by distinguishing tumor progression (TP) from treatment-related abnormalities (TRA). Sophisticated imaging techniques, such as perfusion-weighted magnetic resonance imaging (MRI PWI) and positron-emission tomography (PET) with a variety of radiotracers, have been suggested as being more reliable than standard imaging for distinguishing TP from TRA. However, it remains unclear if any technique holds diagnostic superiority. This meta-analysis provides a head-to-head comparison of the diagnostic accuracy of the aforementioned imaging techniques. Systematic literature searches on the use of PWI and PET imaging techniques were carried out in PubMed, Embase, the Cochrane Library, ClinicalTrials.gov and the reference lists of relevant papers. After the extraction of data on imaging technique specifications and diagnostic accuracy, a meta-analysis was carried out. The quality of the included papers was assessed using the QUADAS-2 checklist. Nineteen articles, totaling 697 treated patients with glioma (431 males; mean age ± standard deviation 50.5 ± 5.1 years) were included. The investigated PWI techniques included dynamic susceptibility contrast (DSC), dynamic contrast enhancement (DCE) and arterial spin labeling (ASL). The PET-tracers studied concerned [S-methyl-11C]methionine, 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG), O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) and 6-[18F]-fluoro-3,4-dihydroxy-L-phenylalanine ([18F]FDOPA). The meta-analysis of all data showed no diagnostic superior imaging technique. The included literature showed a low risk of bias. As no technique was found to be diagnostically superior, the local level of expertise is hypothesized to be the most important factor for diagnostically accurate results in post-treatment glioma patients regarding the distinction of TRA from TP.

Current Understanding of the Anatomy, Physiology, and Magnetic Resonance Imaging of Neurofluids: Update From the 2022 "ISMRM Imaging Neurofluids Study group" Workshop in Rome.

Neurofluids is a term introduced to define all fluids in the brain and spine such as blood, cerebrospinal fluid, and interstitial fluid. Neuroscientists in the past millennium have steadily identified the several different fluid environments in the brain and spine that interact in a synchronized harmonious manner to assure a healthy microenvironment required for optimal neuroglial function. Neuroanatomists and biochemists have provided an incredible wealth of evidence revealing the anatomy of perivascular spaces, meninges and glia and their role in drainage of neuronal waste products. Human studies have been limited due to the restricted availability of noninvasive imaging modalities that can provide a high spatiotemporal depiction of the brain neurofluids. Therefore, animal studies have been key in advancing our knowledge of the temporal and spatial dynamics of fluids, for example, by injecting tracers with different molecular weights. Such studies have sparked interest to identify possible disruptions to neurofluids dynamics in human diseases such as small vessel disease, cerebral amyloid angiopathy, and dementia. However, key differences between rodent and human physiology should be considered when extrapolating these findings to understand the human brain. An increasing armamentarium of noninvasive MRI techniques is being built to identify markers of altered drainage pathways. During the three-day workshop organized by the International Society of Magnetic Resonance in Medicine that was held in Rome in September 2022, several of these concepts were discussed by a distinguished international faculty to lay the basis of what is known and where we still lack evidence. We envision that in the next decade, MRI will allow imaging of the physiology of neurofluid dynamics and drainage pathways in the human brain to identify true pathological processes underlying disease and to discover new avenues for early diagnoses and treatments including drug delivery. Evidence level: 1 Technical Efficacy: Stage 3.

Accelerating GRAPPA reconstruction using SoC design for real-time cardiac MRI

Real-time cardiac MRI is a rapidly developing area of research that has the potential to improve the diagnosis and treatment of cardiovascular diseases. However, the acquisition of high-quality real-time cardiac MR (CMR) images is challenging as it requires a high frame rate and temporal resolution. To overcome this challenge, there have been recent efforts on several approaches including hardware-based improvements and image reconstruction techniques such as compressed sensing and parallel MRI. The use of parallel MRI techniques such as GRAPPA (Generalized Autocalibrating Partial Parallel Acquisition) is a promising approach for improving the temporal resolution of MRI and expanding its applications in clinical practice. However, the GRAPPA algorithm involves a significant amount of computation, particularly for high acceleration factors and large datasets. This can result in long reconstruction times, which can limit the ability to achieve real-time imaging or high frame rates. One solution to this challenge is to use specialized hardware i.e. field-programmable gate arrays (FPGAs). In this work, a novel 32-bit floating-point FPGA-based GRAPPA accelerator is proposed with an aim to reconstruct high-quality cardiac MR images at higher frame rates, making it well suited for real-time clinical applications. The proposed FPGA-based accelerator consists of custom-designed data processing units named as dedicated computational engines (DCEs) that allow for a continuous flow of data between the calibration and synthesis stages of GRAPPA reconstruction process. This greatly increases the throughput and reduces the latency of the overall proposed system. Moreover, a high-speed memory module (DDR4-SDRAM) is integrated with the proposed architecture to store the multi-coil MR data. An on-chip quad-core ARM Cortex-A53 processor is used to manage access control information required for data transfer between the DCEs and DDR4-SDRAM. The proposed accelerator is implemented on Xilinx Zynq UltraScale + MPSoC using high-level synthesis (HLS) and hardware descriptive language (HDL) with an aim to explore the trade-offs between the reconstruction time, resource utilization and design effort. Several experiments have been performed using in-vivo cardiac datasets i.e. 18-receiver coil and 30-receiver coil to evaluate the performance of the proposed accelerator. A comparison is performed with the contemporary CPU and GPU-based GRAPPA reconstruction methods in terms of reconstruction time, frames-per-second and reconstruction accuracy (RMSE and SNR). The results show that the proposed accelerator achieves speed-up factors up to 121× and 9× as compared to the contemporary CPU-based and GPU-based GRAPPA reconstruction methods, respectively. Moreover, it has been demonstrated that the proposed accelerator can achieve reconstruction rates of up to ∼27 frames-per-second while maintaining the visual quality of the reconstructed images.

Recent advances in NAFLD: current areas of contention.

This brief review focuses on two contentious issues within the field of non-alcoholic fatty liver disease (NAFLD); the first is the recent effort to redefine NAFLD as metabolic (dysfunction)-associated fatty liver disease (MAFLD). The modification of "NAFLD" to "MAFLD" is expected to highlight the role of metabolic factors in the disease aetiology, which is hoped to improve patient understanding of the disease, facilitate patient-physician communication and highlight the importance of public health interventions in prevention and management. The diagnostic criteria for MAFLD allow it to coexist with other forms of liver disease, which recognises that metabolic dysfunction contributes towards disease progression in other liver pathologies, such as alcoholic liver disease. However, there remain concerns that renaming NAFLD may be premature without fully considering the broader implications, from diagnostic criteria to trial endpoints; therefore, the new definition has not yet been accepted by major societies. Another contentious issue within the field is the gap in our understanding of how patients undergoing therapeutic interventions should be monitored to assess amelioration/attenuation or the worsening of their liver disease. Biomarker scoring systems (such as the ELF test and FIB-4 test) and imaging techniques (such as transient elastography [TE] and magnetic resonance imaging [MRI] techniques) are proven to be reasonably accurate, and comparable with histology, in the diagnosis of NAFLD and evaluation of disease severity; however, their use in monitoring the response of disease to therapeutic interventions is not well established. Whilst biomarker scoring systems and TE are limited by poor diagnostic accuracy in detecting moderate fibrosis (e.g. F2 liver fibrosis defined by histology), more accurate MRI techniques are not practical for routine patient follow-up due to their expense and limited availability. More work is required to determine the most appropriate method by which therapeutic interventions for NAFLD should be monitored in clinical practice.

The Current State of Functional MR Imaging for Trauma Prognostication.

In this review, we discuss the basics of functional MRI (fMRI) techniques including task-based and resting state fMRI, and overview the major findings in patients with traumatic brain injury. We summarize the studies that have longitudinally evaluated the changes in brain connectivity and task-related activation in trauma patients during different phases of trauma. We discuss how these data may potentially be used for prognostication, treatment planning, or monitoring and management of trauma patients.

PD-0664 How do motion-compensated MRI techniques affect visualization of a moving object for RT planning?

PD-0664 How do motion-compensated MRI techniques affect visualization of a moving object for RT planning?

An MRI for Every Patient with Back Pain?

An MRI for Every Patient with Back Pain? Abstract. Imaging in spinal disorders has changed in the past years. Improved MRI techniques allow for better image interpretation. Unchanged, however, close correlation between clinical evaluation and imaging results remains crucial for correct diagnoses and subsequent therapeutical decisions. Reimbursement cuts have made MRI more affordable in Switzerland while being widely available. This allows - if used according to guidelines - for optimal treatment of patients with spinal disorders.

Standardized and advanced MRI techniques in the diagnosis of pediatric brain tumours

Standardized and advanced MRI techniques in the diagnosis of pediatric brain tumours

Neuroimaging alterations of the suicidal brain and its relevance to practice: an updated review of MRI studies.

Suicide is a leading cause of death in the United States. Historically, scientific inquiry has focused on psychological theory. However, more recent studies have started to shed light on complex biosignatures using MRI techniques, including task-based and resting-state functional MRI, brain morphometry, and diffusion tensor imaging. Here, we review recent research across these modalities, with a focus on participants with depression and Suicidal Thoughts and Behavior (STB). A PubMed search identified 149 articles specific to our population of study, and this was further refined to rule out more diffuse pathologies such as psychotic disorders and organic brain injury and illness. This left 69 articles which are reviewed in the current study. The collated articles reviewed point to a complex impairment showing atypical functional activation in areas associated with perception of reward, social/affective stimuli, top-down control, and reward-based learning. This is broadly supported by the atypical morphometric and diffusion-weighted alterations and, most significantly, in the network-based resting-state functional connectivity data that extrapolates network functions from well validated psychological paradigms using functional MRI analysis. We see an emerging picture of cognitive dysfunction evident in task-based and resting state fMRI and network neuroscience studies, likely preceded by structural changes best demonstrated in morphometric and diffusion-weighted studies. We propose a clinically-oriented chronology of the diathesis-stress model of suicide and link other areas of research that may be useful to the practicing clinician, while helping to advance the translational study of the neurobiology of suicide.

Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy.

The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part II of a two-part series focusing on initial and repeat biopsies, and biopsy technique. Please refer to Part I for discussion of initial prostate cancer screening recommendations. The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000-November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles. The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsies, and biopsy technique. The evaluation of prostate cancer risk should be focused on the detection of clinically significant prostate cancer (Grade Group 2 or higher [GG2+]). The use of laboratory biomarkers, prostate MRI, and biopsy techniques described herein may improve detection and safety when a prostate biopsy is deemed necessary following prostate cancer screening.