MRI Unit Research Articles

Urologist-Administered MRI-Guided Transurethral Ultrasound Ablation of the Prostate Using a Mobile Treatment Center: A Case Series

Introduction: Transurethral ultrasound ablation (TULSA) relies on real-time MRI to precisely control the treatment of prostate cancer and avoid side effects. To overcome limited urologist access to MRI, we present a case series on the first use of a mobile TULSA treatment center. Methods: Clinical outcomes were retrospectively reviewed from our institutional database. A mobile MRI scanner was installed next to a surgical hospital, equipped with the ablation system and MRI-compatible anesthesia. Manufacturer testing confirmed that mobile TULSA continued to meet the requirements of fixed installations. Patients underwent preoperative assessment of candidacy for anesthesia and treatment in a mobile MRI setting. Positioning, anesthesia induction, and device placement were performed in the MRI scanner room. The intended ablation zone was delineated by the urologist using magnetic resonance images acquired with treatment devices in place. Ablation was controlled by the treatment software and monitored by the urologist using real-time MRI. A Foley catheter was placed for postoperative drainage; the patients awoke in the mobile MRI before transfer to postanesthesia care unit. Results: Six patients underwent TULSA in the mobile treatment unit, with no intraoperative complications. The median procedure time was 3.2 hours, with workflow improvements during equipment setup, patient positioning, and treatment planning. Contrast-enhanced images confirmed devascularization of the index lesion and successful nerve sparing. Six-month follow-up demonstrated promising PSA and MRI findings, and improvements in lower urinary tract symptoms. Conclusions: TULSA can be safely administered by urologists using a mobile MRI treatment center. Mobile MRI units could be used to expand patient access to TULSA.

Magnetic resonance cholangiopancreatography (MRCP) based diagnosis of pancreaticobiliary disorders: Three years study at a tertiary care Hospital

Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive imaging modality that has high accuracy for evaluation of the biliary and pancreatic ducts. The current study aims to assess the role of MRCP in finding various pancreaticobiliary pathologies. It was a retrospective study, data was collected from 659 patients who underwent MRCP at MRI unit Holy Family Hospital, Rawalpindi. Chi-Square was applied to find the difference in the prevalence of various disorders. The presenting indication in our data shows 72% of patients with pain (abdominal, epigastric and right hypochondrium) followed by jaundice in 11.3% participants. Our results indicate that the most common pancreaticobiliary disorders were obstructive including cholelithiasis along with choledocholithiasis (8.3%), cholelithiasis (17.8%) CBD stricture (16.4%) and acute pancreatitis (10.9%). Moreover, our data also showed that the obstructive disorders particularly cholelithiasis (20.9%vs 13.7%) was more common in females as compared to males. We also showed that neoplastic disorders were more prevalent in the age group 53-65, whereas strictures were more common in the 39-52 age group, and we have observed higher prevalence of inflammatory disorders in age group 27-39. MRCP allows the evaluation of pancreaticobiliary disorders with high accuracy. Being non-invasive, MRCP can be used in early diagnosis and preventive treatment of pancreaticobiliary disease thereby facilitating accurate diagnosis and subsequent clinical management.

Canadian Medical Imaging Inventory 2022–2023: MRI

MRI is a noninvasive imaging modality that uses powerful electromagnetic and radiofrequency fields to produce cross-sectional images of the body. MRI is primarily used for neurologic exams (28%), followed by musculoskeletal (23%) and oncology exams (17%). In total, 432 MRI units in 11 jurisdictions were identified by the Canadian Medical Imaging Inventory (CMII) in its 2022 to 2023 national survey. Most sites are publicly funded hospitals located in urban centres. Canada has an average of 10.8 MRI units per million people. The greatest density of units per million people is in Yukon, Quebec, and New Brunswick. Overall, 2,214,157 publicly funded MRI examinations were performed in the 2022–2023 fiscal year. This represents a national average of 55.6 exams per 1,000 people, an increase of 4.3% since 2019– Canada is positioned in the bottom 25% of Organisation for Economic Co-operation and Development (OECD) countries in units per million population and the bottom 50% of OECD countries for average volume of publicly funded MRI exams per 1,000 population. The average age of MRI equipment in Canada is 8.4 years; 62.8% of MRI units are 10 years old or newer, 23.3% are 11 to 15 years old, and 13.9% are more than 15 years old. On average, MRI units operate 15.3 hours per day and 97.4 hours per week. Overall, 76.0% of sites reported MRI operation on weekends and 17% of sites reported operating 24 hours a day.

Canadian Medical Imaging Inventory 2022–2023: Provincial and Territorial Overview

The average age of imaging equipment in Canada has increased for all imaging modalities over the past 2 decades. Most imaging equipment is more than 5 years old, and at least one-third of equipment is more than 10 years old. Investing in new equipment to meet growing demand may not increase imaging capacity without also considering staffing. There is no current international benchmark for the optimal number of imaging units per population, but there is a general assumption that too few units may limit access and increase wait times while too many units may encourage low-value imaging. Canada remains below the average for Organisation for Economic Co-operation and Development (OECD) countries and is positioned in the bottom 30% of OECD countries in units per million population for CT, MRI, and PET-CT. Canada is positioned in the bottom 50% of OECD countries for volume of publicly funded CT, MRI, and PET-CT exams per 1,000 population. Since 2012, both the overall numbers of MRI, PET-CT, and SPECT-CT units and the numbers of MRI, PET-CT, and SPECT-CT units per million people have grown. The number of units for all modalities operating in Canada has increased since 2019–2020, except for SPECT units. In most provinces, the number of SPECT units per population decreased, indicating that population growth outpaced installation. The imaging workforce is under strain. Clearing the backlog of exams deferred during the pandemic has exacerbated existing staffing shortages. New investment in radiology staffing, particularly imaging technologists, is required, including improved recruitment and retention policies. Compared to the prepandemic period, there are now fewer full-time radiology professionals in practice across Canada, with medical physicists experiencing the largest decline per million population. Wait times for medical imaging remain above the recommended maximum wait time in many jurisdictions and are influenced by a variety of factors. The adoption of supportive tools and technologies — such as clinical decision support tools, automated order entry, and AI-driven solutions — can assist the workforce, add value to imaging services, and increase access to medical imaging.

Multicenter validation of synthetic FLAIR as a substitute for FLAIR sequence in acute ischemic stroke.

To evaluate performance of synthetic and real FLAIR for identifying early stroke in a multicenter cohort. This retrospective study was conducted using DWI and FLAIR extracted from the Endovascular Treatment in Ischemic Stroke image registry (2017-2021). The database was partitioned into subsets according to MRI field strength and manufacturer, and randomly divided into training set (70%) used for model fine-tuning, validation set (15%), and test set (15%). In test set, five readers, blinded to FLAIR sequence type, assessed DWI-FLAIR mismatch using real and synthetic FLAIR. Interobserver agreement for DWI-FLAIR rating and concordance between synthetic and real FLAIR were evaluated with kappa statistics. Sensitivity and specificity for identification of ⩽4.5 h AIS were compared in patients with known onset-to-MRI delay using McNemar's test. 1454 complete MRI sets (1172 patients, median (IQR) age: 73 years (62-82); 762 women) acquired on 125 MRI units were analyzed. In test set (207 MRI), interobserver reproducibility for DWI-FLAIR mismatch labeling was substantial for real and synthetic FLAIR (Fleiss κ = 0.79 (95%CI: 0.73-0.84) and 0.77 (95%CI: 0.71-0.82), respectively). After consensus, concordance between real and synthetic FLAIR was excellent (κ = 0.85 (95%CI: 0.78-0.92)). In 141 MRI sets with known onset-to-MRI delay, diagnostic performances for ⩽4.5 h AIS identification did not differ between real and synthetic FLAIR (sensitivity: 60/71 (85%) vs 59/71 (83%), p = .56; specificity: 65/70 (93%) vs 65/70 (93%), p > 0.99). A deep-learning-based FLAIR fine-tuned on multicenter data can provide comparable performances to real FLAIR for early AIS identification. This approach may help reducing MR protocol duration and motion artifacts.

Role of MRI in Patellofemoral Pain Syndrome (Anterior Knee Pain)

Abstract Background MRI is a good diagnostic tool in identifying cartilage and soft tissue lesions as well as detecting underlying predisposing anatomical factors of patellar instability, it has a high specification for detecting the grades and the types of some of these diseases or factors that may predispose to them such as trochlear dysplasia and patella alta. Aim of the Work The aim of this study was to evaluate the role of MRI in diagnosis of Patellofemoralpain syndrome which is the most common cause of anterior knee pain. Patients and Methods This prospective study was done on patients referred from the orthopedic clinic to the department of radiodiagnosis, MRI unit at Ain Shams University hospitals.Thirty patients were included (18 females and 12 males) and their age ranged from 20 to 64 years. Conclusion This study shows that MRI is useful in detecting various predisposing anatomical factors of patellofemoral instability and associated lesions of knee joint thereby enabling orthopedic surgeons to treat joint pathology as well as correct underlying anatomical abnormality.

Diagnostic MRI for deep pelvic endometriosis: towards a standardized protocol?

To assess the diagnostic efficacy of an MRI protocol and patient preparation in detecting deep pelvic endometriosis (DPE). The cohort is from the ENDOVALIRM database, a multicentric national retrospective study involving women who underwent MRI followed by pelvic surgery for endometriosis (reference standard). Two senior radiologists independently analyzed MRI findings using the deep pelvic endometriosis index (dPEI) to determine lesion locations. The study evaluated the impact of bowel preparation, vaginal and rectal opacification, MRI unit type (1.5-T or 3-T), additional sequences (thin slice T2W or 3DT2W), and gadolinium injection on reader performance for diagnosing DPE locations. Fisher's exact test assessed differences in diagnostic accuracy based on patient preparation and MRI parameters. The final cohort comprised 571 women with a mean age of 33.3 years (± 6.6 SD). MRI with bowel preparation outperformed MRI without bowel preparation in identifying torus/uterosacral ligament (USL) locations (p < 0.0001) and rectosigmoid nodules (p = 0.01). MRI without vaginal opacification diagnosed 94.1% (301/320) of torus/USL locations, surpassing MR with vaginal opacification, which diagnosed 85% (221/260) (p < 0.001). No significant differences related to bowel preparation or vaginal opacification were observed for other DPE locations. Rectal opacification did not affect diagnostic accuracy in the overall population, except in patients without bowel preparation, where performance improved (p = 0.04). There were no differences in diagnostic accuracy regarding MRI unit type (1.5-T/3-T), presence of additional sequences, or gadolinium injection for any endometriotic locations. Bowel preparation prior to MRI examination is preferable to rectal or vaginal opacification for diagnosing deep endometriosis pelvic lesions. Accurate diagnosis and staging of DPE are essential for effective treatment planning. Bowel preparation should be prioritized over rectal or vaginal opacification in MRI protocols. Optimizing MRI protocols for diagnostic performance with appropriate opacification techniques will help diagnose deep endometriosis more accurately. Evaluating deep endometriosis in collapsible organs such as the vagina and rectum is difficult. Bowel preparation and an absence of vaginal opacification were found to be diagnostically beneficial. Bowel preparation should be prioritized over rectal or vaginal opacification in MRI protocols.

Gender-wise Description of Morphometric Measures of Knee Joint Based on Magnetic Resonance Imaging Scan: A Descriptive Cross-sectional Study

Background: Customization of Total Knee Replacement (TKR) and the design of knee prostheses are paramount. Conventionally, surgeons select from a spectrum of pre-fabricated implants, assessing their fit based on the patient’s knee morphology via magnetic resonance imaging. Aim and Objective: This research endeavours to identify and quantify gender-related variations in knee morphometry by examining the distal femur and proximal tibia of the population of North India. Materials and Methods: A Descriptive cross-sectional study included 59 males and 59 females’ knees. A 1.5 TESLA MRI unit (Avanto Magnetomtim + dot system, Siemens, Erlangen, Germany) was utilized for imaging. The morphological features of proximal Tibia and distal femur were taken. Correlation between morphometric parameters were calculated using Karl Pearson’s correlation coefficient. P-value &lt;0.05 was set statistically significant. Results: All the FEMUR parameters were significantly higher in males than females. The mean FML in males was 8.04±0.50SD and in females was 6.97±0.33SD (P&lt;0.05). Mean FMAP in males was 5.98±0.46SD and in females it was 5.36±0.35SD (P&lt;0.05). All the TIBIA parameters were significantly higher in males than females. The mean TML in males was 7.56±0.37SD and in females was 6.49±0.28SD (P&lt;0.05). Mean TAP in males was 4.64±0.41SD and in females it was 4.13±0.25 (P&lt;0.05). Conclusion: Variations in bone dimensions were attributed to a complex interplay of genetic, ethnic, and environmental factors. In conclusion, this study makes a substantial contribution to the understanding of knee joint morphology.

Role of diffusion weighted imaging with background body signal suppression (DWIBS) in diagnosis of breast masses and correlation with histopathological findings

BackgroundDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the important tool in breast imaging. However, two major limitations are represented by its specificity and by the injection of contrast material. Diffusion weighted imaging (DWI) provides important functional information without the need for contrast material. A newly introduced diffusion weighted imaging with background suppression (DWIBS) sequence is an accurate and rapid tool for the identification and characterization of breast lesions, with its short examination time, high lesion-to-background contrast and lack of need for intravenous contrast agents.ObjectiveTo assess the role of DWIBS sequence in the evaluation of indeterminate and suspicious breast masses and to compare its accuracy with DCE-MRI in correlation with histopathological findings.MethodsThirty-five patients were included in the study, referred from sono-mammography clinic to MRI unit for further MRI assessment of probably benign, suspicious and malignant looking breast masses (BIRADS 3, BIRADS 4 & BIRADS 5) on sono-mammography imaging results. MRI breast protocol which included DCE-MRI and DWIBS sequences were obtained for characterization and were verified by core needle biopsy or excisional biopsy. The results were statistically analyzed. Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative predictive value (NPV) were calculated for DCE-MRI and DWIBS. Apparent diffusion co-efficient (ADC) values were calculated with ADC ≤ 1.2 × 10−3 mm2/s was considered suspicious for malignancy. The results were then compared with the histological findings.ResultsThirty-five female patients had 39 breast masses included in our study. By DCE-MRI, 8 (20.5%) masses were categorized as benign and 31(79.5%) masses were categorized as malignant. By DWIBS sequence, 7 (17.9%) masses were categorized as benign and 32 (82.1%) masses were categorized as malignant. By histopathology, 14 (35.9%) masses were benign and 25 (64.1%) masses were malignant. DCE-MRI obtained accuracy, sensitivity, specificity, PPV and NPV values of 84.6, 100, 57.1, 80.6 and 100%, respectively. DWIBS sequences obtained accuracy, sensitivity, specificity, PPV and NPV values of 82.1, 100, 50, 78.1and 100%, respectively.ConclusionsDWIBS can be added to DCE-MRI, as complementary tool to make radiologist more confident about the diagnosis. It can also be used instead of DCE-MRI sequences in certain circumstances such as in cases of renal impairment.

The Role of Treatment-Related Parameters and Brain Morphology in the Lesion Volume of Magnetic-Resonance-Guided Focused Ultrasound Thalamotomy in Patients with Tremor-Dominant Neurological Conditions.

To determine the best predictor of lesion volume induced by magnetic resonance (MR)-guided focused ultrasound (MRgFUS) thalamotomy in patients with tremor-dominant symptoms in Parkinson's disease (PD) and essential tremor (ET) patients. Thirty-six neurological patients with medication-refractory tremor (n°19 PD; n°17 ET) were treated using a commercial MRgFUS brain system (Exablate Neuro 4000, Insightec) integrated with a 1.5 T MRI unit (Sigma HDxt; GE Medical System). Linear regression analysis was used to determine how the demographic, clinical, radiological (Fazekas scale), volumetric (total GM/WM/CSF volume, cortical thickness), and MRgFUS-related parameters [Skull Density Ratio (SDR), n° of transducer elements, n° of sonications, skull area, maximal energy delivered (watt), maximal power delivered (joule), maximal sonication time delivered, maximal mean temperature reached (T°C_max), accumulated thermal dose (ATD)] impact on ventral intermediate (VIM)-thalamotomy-related 3D volumetric lesions of necrosis and edema. The VIM thalamotomy was clinically efficacious in improving the tremor symptoms of all the patients as measured at 1 week after treatment. Multiple regression analysis revealed that T°C_max and n° of transducer elements were the best predictors of the necrosis and edema volumes. Moreover, total WM volume also predicted the size of necrosis. Our study provides new insights into the clinical MRgFUS procedures that can be used to forecast brain lesion size and improve treatment outcomes.

478 Magnetic Resonance Biomarkers of Metabolic Dysfunction-Associated Steatotic Liver Disease

OBJECTIVES/GOALS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major public health concern due to its increasing prevalence and association with type 2 diabetes mellitus. Non-invasive magnetic resonance-based biomarkers can aid in the monitoring of disease progression and identification of patients at risk for chronic liver disease. METHODS/STUDY POPULATION: Over 600 subjects will be recruited from the San Antonio Mexican American Family Study and from a second study, which consists of (i) T2DM patients diagnosed with either MASLD or metabolic dysfunction-associated steatohepatitis (MASH) or (ii) metabolically healthy controls. Hydrogen-1 MRS and diffusion-weighted MRI (DW-MRI) will be used to measure liver fat fraction and liver stiffness biomarkers, respectively. Several potential biomarkers of liver stiffness will be evaluated in vivo using the intravoxel incoherent motion (IVIM) model for DW-MRI. To further improve the diagnostic accuracy of patients with liver fibrosis, we will integrate MRI/MRS data with relevant clinical indicators of hepatic metabolism. Results will be compared to biopsy samples to evaluate the model’s diagnostic accuracy. RESULTS/ANTICIPATED RESULTS: Based on preliminary data, we predict that IVIM will be able to accurately diagnose hepatic fibrosis in patients with MASLD, allowing it to be implemented in clinics with high-field MRI units easily. Previous studies have shown correlations between IVIM estimates and fibrosis stages, however, none included additional clinical indicators of liver disease in their models. We have already found significant differences in metabolic measurements such as fasting plasma glucose and HbA1c levels. Additionally, the use of machine learning in developing these models has shown improvements in the ability to extract features from the data. The aim is to achieve high accuracy and robustness in the staging of liver fibrosis. DISCUSSION/SIGNIFICANCE: Over 100 million people in the US are affected by MASLD. Without treatment, it progresses from hepatic steatosis to MASH, fibrosis (liver stiffening), and ultimately to hepatic cirrhosis and hepatocellular carcinoma (HCC). Continued research efforts and clinical implementation of MRI and MRS are vital in combating the growing burden of MASLD.

Role of Magnetic Resonance Imaging in the Evaluation of Age- and Gender-Related Changes in the Dimensions of the Pituitary Gland in the Indian Population.

Background MRI is the standard tool for imaging the pituitary gland. MRI is useful in detecting pathological conditions in the pituitary. Changes in the size and shape of the pituitary among different age groups are seen in MRI. Linear growth is seen in the pituitary during puberty except for growth spurts at the 1st, 10th, and 15th years, followed by a decline in pituitary height and cross-sectional area with increasing age. A convex upper margin was seen in females more than in males. There is a shortage of information about pituitary dimensions and volume in various age groups and among both genders in the Indian population. Hence, a study is needed to assess these parameters. Materials and methods A retrospective cross-sectional study was done in the MRI unit of Radiology, Saveetha Medical College and Hospital, Chennai. A total of 200 patients in the age group of 11-80 years who underwent MRI free from neuroendocrine, neurological, and psychiatric disorders were included in this study. Statistical analysis Measurements were made of the pituitary gland's height, volume, and anteroposterior and transverse dimensions. Using SPSS Statistics software (IBM Corp. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp.), the data was input and examined. The ANOVA test revealed the relationship between anteroposterior dimension, transverse dimension, height, and volume with age. In contrast, an independent t-test determined the association of the same parameters with sex. The Chi-square test was used to assess the association of the shape of the pituitary gland with age and sex. Results Anteroposterior dimension, height, and volume of the pituitary gland were found to be statistically significant with age (p<0.05), but the transverse dimension was not significant with age (p>0.05). However, the independent t-test showed highly significant differences between the anteroposterior dimension in males and females. The shape of the pituitary gland was found to be statistically significant with age and gender. In contrast, the pituitary gland's transverse diameter, height, and volume showed no significance. Conclusion The study helps identify the substantial changes in the pituitary gland during a person's lifespan, which are affected by age and gender. The pituitary height and volume will reflect physiological neuroendocrine differences between younger and older male and female subjects.

Is Canada Prepared for the Surge of Dementia?

What Was the Question?&#x0D; &#x0D; How can health policy decision-makers prepare for the potential future use of new and emerging treatments for Alzheimer disease (AD) and other dementias?&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; We identified emerging technologies for early diagnosis.&#x0D; We assessed the infrastructural capacity to deliver amyloid-targeted therapy in Canada, including the availability of PET-CT imaging equipment for confirming treatment eligibility, access to MRI units for monitoring treatment side effects, and IV infusion clinics for administering the treatment.&#x0D; We engaged with clinicians who treat people with dementia, researchers involved with dementia-related health research, and people with dementia and their caregivers.&#x0D; &#x0D; What Did We Find?&#x0D; &#x0D; There are several emerging diagnostic technologies — including blood, imaging, saliva, and ocular tests, and artificial intelligence algorithms — that could diagnose AD in its early stages more easily and quickly.&#x0D; The availability of PET-CT and MRI units, radiopharmaceuticals, and cyclotrons is currently not sufficient to accommodate the implementation of amyloid-targeted therapies in Canada.&#x0D; People living with dementia described barriers to accessing adequate, appropriate, and equitable care. Clinicians and researchers said that access to timely and reliable diagnosis must be improved.&#x0D; &#x0D; What Does This Mean?&#x0D; &#x0D; Our work highlights recent advances in AD diagnosis and treatment, related health system gaps in terms of accessing diagnostic testing and treatment, and the unmet needs of people living with dementia and their caregivers.&#x0D; It is important that health systems prepare for the potential surge in the number of people with dementia who might need additional diagnostic tests, treatments, monitoring, and models of care.&#x0D;

Assessment of MRI Safety Awareness and Practice Standards in Bangladesh

Objectives: The objective of this study was to evaluate the current MRI safety knowledge, awareness and practice standards among MRI technologist in Bangladesh and to perceive if the identified safety principles related to MRI management are in line with international standards. Materials and Methods: The study was carried out with consent option among MRI technologist in Bangladesh. A self-structured questionnaire was used to collect data through email, the questionnaire contained ten parts and 47 questions in all. MRI technologist voluntarily consented and filled out the questionnaire. The questions were to explore knowledge about MRI safety policy and accessories, patient screening, adverse reaction, Infection control, Device labeling, Equipment safety, signage and barriers, access and communication, and MRI safety during pregnancy generally. The collected data were analyzed with the help of Microsoft Excel. Results: Regarding knowledge of MRI equipment, 34% of respondents were unaware of the symbols or signs used to denote the various zones in your MRI suit, and 27% were unaware of the negative effects of quenching magnets. About 45% of respondents, who were asked about emergency/safety accessories’ availability, answered that crash carts and MRI-compatible anesthetic equipment aren’t present in the department. In case of awareness of different zones of the MRI suite, which is crucial for an MRI unit, 46.08% of respondents were unaware in this issue. 50% of respondents do not believe that MRI has any harmful effect to people who are pregnant. This study revealed that many MRI facilities generally are not aware of departmental/equipment safety notices &amp; obstacles. Conclusion: The study showed that awareness about MRI safely and practice standards were not encouraging with many of the MRI technologists due to their insufficient knowledge. They need training along with other supporting staff connected to patient to enhance their knowledge in implementation of safety policy, patient screening tools and exposure of MRI during pregnancy.

Potential application of ultra-low field portable MRI in the ICU to improve CT and MRI access in Canadian hospitals: a multi-center retrospective analysis.

To highlight the value of Portable MRI in ICU and to recommend use case scenarios for portable MRI in ICU patients that may increase capacity for fixed CT and MRI units. Urgent neuroimaging is commonly required in ICU. Typically, ICU patients are transported to Radiology for assessment in fixed CT and MRI units. Portable MRI use in Canadian ICU settings offers the potential advantages of reduced transport risk, earlier diagnosis, improved triaging, as well as the ability to perform frequent re-imaging at the bedside. This frees up time on fixed CT and MRI units, leading to enhanced capacity to perform CT and MRI on other patients. Portable MRI use case scenarios in Canadian institutions have not been established and potential beneficial effect on wait times has not been analyzed. A retrospective semi-quantitative descriptive analysis was performed using all ICU neuroimaging requisitions (CT and MRI) over a 12-month period between January and December 2021, at Kingston Health Sciences Centre, Queen's University (Kingston, Ontario) and St. Michael's Hospital, Unity Health, University of Toronto (Toronto, Ontario). Indications for portable MRI in ICU patients were established. The number of ICU patients who could potentially undergo portable MRI was determined. Fixed CT and MRI scan times saved were calculated. In ICU patients, portable MRI could potentially replace fixed CT in 21% and fixed MRI in 26.5% of cases. This equates to annual capacity increase of 1,676 additional patients being able to undergo fixed CT scans and 324 additional patients being able to undergo fixed MRI. Implementation of portable MRI in the ICU for select neurological indications can have a significant positive impact on CT and MRI wait times in Canadian hospitals.

Association between contrast-enhanced adenosine-stress perfusion cardiac magnetic resonance imaging and invasive coronary angiogram for the detection of coronary artery disease: A retrospective analysis.

The objective of this study was to determine the diagnostic value of stress perfusion CMR for the detection of coronary artery disease. The was a retrospective cross sectional study in which 43 subjects were included from Cardiac MRI unit in the Hayatabad Medical Complex, Peshawar for study from 1st April 2020 to 30th November 2020. All the subjects who had been referred for stress perfusion CMR with suspected CAD were included in the study. Cardiac MRI both at rest and with adenosine stress perfusion was performed which was followed by invasive coronary angiography. A total of 43 patients were enrolled for the detection or exclusion CAD who underwent stress perfusion CMRI and invasive coronary artery angiography. The study revealed strong and statistically significant association between positive stress perfusion CMR and positive coronary angiogram vs negative stress perfusion CMR and negative coronary angiogram (p= value 0.0001). Stress perfusion CMRI can be considered as a first line, relatively safe, noninvasive test with significant accuracy to diagnose coronary artery disease in patients with suspected CAD without subjecting these patients to invasive coronary angiogram.

Analysis of anatomical variations of the Cystic Duct in Magnetic Resonance Cholangiopancreatography&amp;nbsp;&amp;nbsp;

Background and objectives- Anatomical variants of the cystic duct (CD) are important be identified and described in the radiological report. This facilitates proper interpretation of the pathological process related to the biliary tree. Also, prior information is important before surgical, percutaneous and endoscopic interventional procedures related to the biliary tree, to avoid inadvertent complications and for successful outcomes. Magnetic Resonance Cholangiopancreatography (MRCP)is the best non-invasive imaging modality in detecting anatomy of the non-dilated cystic duct. This study was carried out to demonstrate imaging appearance of the cystic duct and its anatomical variants detected on MRCP and to document their prevalence in the study group. Methods- This is a single centre retrospective cross-sectional study including all consecutive patients who underwent MRCP form May 2020 to May 2021 at the neurosurgical MRI unit at National Hospital of Sri Lanka. Patients who had undergone cholecystectomies and images with poor quality were excluded.Results- Total 180 MRCP studies were analysed. Normally inserting CD to the lateral aspect of the Common Hepatic Duct (CHD) was observed in 127cases out of 180 (70.5%). 10(5.5%) demonstrated high inserting CD.12(6.6%) cases demonstrated low inserting CD.3(1.6%) had short CD. Parallel course of CD was noted in 12(6.6%). Low and medially inserting CD was present in 4(2.2%) cases. Anterior insertion was demonstrated in 5(2.7%) cases, and posterior insertion was demonstrated in 7(3.8%). Conclusion- Anatomical variants of the CD observed in our study group were comparable to reported frequencies, however posterior insertion was lesser than that found in literature.

Correlation between ADC Values and Split Renal Function by Renal Isotope Scan in Assessment of Nephropathy

Background Early assessment of renal structure and function is crucial for the proper management and treatment of renal disease. DW-MRI show the Brownian motion of water molecules using the ADC values yielding information on water diffusion in the extracellular and extravascular space and capillary perfusion. Aim of the Work to study the ability of DWI in assessing and evaluating the individual renal function by correlating the ADC values calculated with split GFR obtained from dynamic renal scan among cases and healthy control group. Patients and Methods This prospective study was conducted on 30 patients and 30 control healthy group. Both MR examination and dynamic renal scan were performed on 30-case group, only MR examination was done on 30-healthy control group. DWI (b = 0, 200, 800 s/mm2) was done on 1.5T MRI unit. ADC map was calculated for every kidney. Split GFRs were measured from 99-Tcm DTPA scintigraphy. Results our study revealed that ADC values of normal control group is lower than that of case group. Cut off value of ADC, that discriminate between case and control group (using average ADC value of both kidneys), was ≤2.1 x10-3 mm2/s with Sensitivity = 87% and Specificity = 47%. We classified renal dysfunction, according to the total GFR measured from the dynamic renal scan and comparing it with the standard normalized GFR ranges according to age and sex in to 3 groups : suboptimal, decompensated and deteriorated renal dysfunction, the mean ADC values were 2.07 ± 0.21, 2.01 ± 0.13 and 1.45 ± 0.19 x10-3 mm2/s respectively. Conclusion There is a positive relationship between the ADC values and split GFR. DWI has a potential value for evaluating individual renal function, and may provide functional and morphological information at the same time.

Role of MRI Diffusion Tensor Imaging in Early Diagnosis of Cervical Spondylotic Myelopathy (CSM)

Abstract Background and Purpose Cervical spondylotic myelopathy (CSM) is a common degenerative disorder of the cervical spine and is considered as the most common cause of spinal cord dysfunction in older individuals worldwide. Assessing the severity of the disease objectively remains a challenge and there is still remaining controversy in terms of the optimal timing and indications for surgical intervention. The conventional MRI is the gold standard for radiographic evaluation of the spinal cord; however, it cannot assess the underlying microstructural deficits of the spinal cord and it has a limited application in determining prognosis and recovery of the disease [1]. We sought to assess the utility of MR diffusion tensor imaging as an imaging technique in clinically suggested CSM patients by obtaining the microstructural parameters (Fractional anisotropy; FA and apparent diffusion coefficient; ADC) in the cervical spinal cord segments. Patient &amp; methods our study was a prospective cross-sectional study including 40 patients with clinical manifestations of cervical spondylotic myelopathy. The patients were sorted according to the European myelopathy score into three categories as follows: grade 1 (with mild symptoms), grade 2 (with moderate symptoms) and grade 3 (with severe symptoms). All the patients were investigated with a 1.5 T MRI unit acquiring conventional MRI and DTI sequences. FA and ADC values at each spinal segment from C2/C3 to C6/C7 were generated and measured using manual drawing of multiple ROIs within the cervical cord in the sagittal and axial combined anatomical and color-coded images. For each of these cases, the patient’s age, gender, DTI parameters at each spinal segment level, maximum compression level, conventional T2WI characteristics and EMS score were recorded, analyzed and compared. Results The study included 23 females (57.5%) and 17 males (42.5%). Their age ranged from 30 to 72 years with a mean age of 47.3 ± 9.79 years. The study revealed a significant difference in the mean FA and ADC values between stenotic and non-stenotic segments of the cervical spinal cord. There was a significant correlation between the European myelopathy score and DTI parameters (FA and ADC). FA and ADC values performed better in recognizing myelopathic changes in patients who were classified as grade 1 according to EMS compared to conventional MRI T2WI which performed very poorly in recognizing myelopathy changes in the same patients, therefore DTI indices were more sensitive in the detection of CSM patients compared to conventional MRI especially in early myelopathic stages. T2 weighted images were highly significant in recognizing myelopathy changes in patients who were classified as grade 3 according to EMS. The CSM patients had significant FA decrease and ADC increase at the most compressed part of the cervical spinal cord and there was a significant correlation between the number of patients who had myelopathic changes by DTI parameters and the severity of disease. The FA sensitivity and specificity in recognition of myelopathic changes were 73.5% and 83.3% respectively and the ADC sensitivity and specificity were 100% and 70.6% respectively. Conclusion In conclusion, diffusion tensor imaging enhances the efficacy and accuracy of MRI in the diagnosis of cervical spondylotic myelopathy. Therefore, it can be used as a non-invasive modality for detection of the spondylotic myelopathy changes in the early stages helping to decide the appropriate timing of decompression surgery before attaining the irreversible chronic changes. Abbreviations ADC: Apparent diffusion coefficient; CSM: Cervical spondylotic myelopathy; DTI: Diffusion tensor imaging; FA: Fractional Anisotropy; EMS: European myelopathy score

Usefulness of Diffusion Weighted MRI in Differentiating Benign from Malignant Bone Lesions

Background Bone tumors represent a wide spectrum of disease in children &amp; adult ranging from benign lesions to an aggressive malignancy, so finding a noninvasive diagnostic tool was needed. Objective We aimed to differentiate between benign and malignant bone lesions and to limits the number of patient with benign lesion who undergo biopsy. Patients and Methods Our study was carried out on 32 patients were diagnosed with bone tumors (21 benign &amp; 11 malignant), at the MRI unit of the Radiology Department Ain Shams University, outpatient clinics and private centers after getting approval from each ethical committee. They were assessed with conventional &amp; diffusion MR images, DW EPI carried out using different b values including 0 s/ mm², 500 s/ mm², and 800 s/ mm². ADC map were automatically calculated. Results The mean ADC value for benign tumors was 1.6±0.4 x 10 -3 mm2/s. while malignant tumors were 1.2±0.3 x 10 -3 mm2/s. ROC analysis was used to define the best cut off mean ADC value for detecting malignancy which was &amp;lt;1.3, with sensitivity of 81.8% specificity of 81%. Conclusion The present study showed high specificity and sensitivity of DWI as a complementary sequence with conventional MRI and ADC value measurements in discrimination between benign and malignant bone tumors with significant cut-off value, making it a noninvasive tool for increasing the accuracy in identifying bone lesions.