Negative Predictive Value Of Magnetic Resonance Imaging Research Articles

Comparison of Ultrasound and MRI in Detecting Breast Cancer: A Retrospective Study in Mumbai Hospitals, India

Introduction: Breast cancer is the most common cancer in women throughout the world. Early detection of breast cancer is very important to increase the chances of cure. Ultrasonography (USG) and magnetic resonance imaging (MRI) are two imaging methods commonly used to detect breast cancer. The aim of this study was to compare the accuracy of ultrasound and MRI in detecting breast cancer in female patients at Mumbai Hospital, India.
 Methods: A retrospective study was conducted on 2435 female patients who underwent ultrasound and MRI examinations at Mumbai Hospital, India between 2018 and 2023. Patient data was collected from electronic medical records and analyzed to compare the accuracy of ultrasound and MRI in detecting breast cancer.
 Results: The research results show that MRI is more accurate than ultrasound in detecting breast cancer. MRI sensitivity was 95.2%, while ultrasound sensitivity was 78.3%. The specificity of MRI was 98.7%, while the specificity of USG was 94.3%. The positive predictive value of MRI was 95.2%, while the positive predictive value of USG was 87.5%. The negative predictive value of MRI was 98.7%, while the negative predictive value of USG was 94.3%.
 Conclusion: MRI is recommended as the primary imaging method for detecting breast cancer in female patients. Ultrasound can be used as a complementary method to MRI.

Evaluation of diagnostic value of pelvic MRI in endometriosis in comparison with surgical findings: A cross-sectional study.

Endometriosis is a multifocal gynecologic disorder during the fertility period in women. Magnetic resonance imaging (MRI) is an important diagnostic modality for this disease and can either be used alone or along with transvaginal ultrasonography. This study aims to compare the accuracy of pelvis MRI in pelvic deep endometriosis with laparoscopic findings in women referred to Shahid Sadoughi hospital in one year. This cross-sectional study was conducted on 40 women suspicious of endometriosis who referred to Shahid Sadoughi hospital, Yazd, Iran from November 2020-2021. Based on clinical findings and history, participants were referred to the imaging center for pelvic MRI. Finally, the results of MRI and diagnostic laparoscopy were compared with pathologic findings. The sensitivity and specificity of MRI for pelvic endometriosis were 94.8% and 20%, respectively. Also, the positive predictive value and negative predictive value of MRI were 90.2% and 33.3%, respectively. Laparoscopy is still the gold standard of endometriosis diagnosis, but MRI with susceptibility-weighted imaging sequence is the best noninvasive diagnostic method.

Assessing lateral femoral condyle cartilage prior to medial UKA: MRI vs. Valgus stress radiograph

BackgroundThe cartilage quality of the lateral compartment needs to be clarified prior to medial unicompartmental knee arthroplasty (UKA). Valgus stress radiograph has been recommended as the preferred tool. Some studies also show that magnetic resonance imaging (MRI) has a higher diagnostic value. So, we conducted this study to compare whether valgus stress radiographic lateral joint space width (LJSW) and MRI grading can accurately reflect cartilage quality and its screening value for UKA-suitable patients.MethodsOne hundred and thirty eight knees proposed for UKA were enrolled prospectively. Valgus stress radiograph was taken to measure LJSW. LJSW > 4 mm was considered normal and suitable for UKA. For weight-bearing area cartilage of lateral femoral condyle, Recht grade was assessed by MRI preoperatively. Recht grades ≤ 2 were treated as non-high-grade injuries while Recht grades > 2 were treated as high-grade injuries. Outerbridge grade was the gold standard and was assessed intraoperatively. Patients with Outerbridge grades 0–2 (non-high-grade injuries) underwent UKA, and patients with Outerbridge grades 3–4 (high-grade injuries) underwent total knee arthroplasty (TKA). The diagnostic parameters of valgus stress radiograph and MRI for the selection of UKA candidates were calculated, and receiver operating characteristic curves were drawn. P < 0.05 was considered significant.ResultsOf 138 knees, 120 underwent UKAs, and 18 underwent TKAs. In terms of selecting UKA candidates, the sensitivity was close between MRI (95.0%) and valgus stress radiograph (96.7%), and the specificity, accuracy, positive predictive value and negative predictive value of MRI (94.4%, 94.9%, 99.1%, 73.9%, respectively) were higher than that of valgus stress radiograph (5.9%, 85.5%, 88.0%, 20.0%, respectively). The difference in area under the curve (AUC) between MRI (0.950) and LJSW (0.602) was significant (P = 0.001).ConclusionCompared with valgus stress radiograph, MRI has excellent evaluation value in diagnosing lateral weight-bearing cartilage injuries and can be used as a reliable tool for selecting suitable UKA patients.

Performance of Non-EPI DW MRI for Pediatric Cholesteatoma Follow-Up.

To evaluate the accuracy, sensitivity, and specificity of nonecho planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI)to detect residual cholesteatoma in children. Retrospective study. Tertiary comprehensive hospital. Children operated on for a first-stage cholesteatoma procedure from 2010 to 2019 were included. MRIs were performed with non-EPIDW sequences. Initial reports were collected, indicating the presence or absence of hyperintensity suggestive of cholesteatoma. Three hundred twenty-three MRIs were correlated with the subsequent surgery (66%) or year-later MRI (21%), or were considered accurate if performed 5 years or more after the last surgery (13%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging procedure for the detection of cholesteatoma were calculated. Two hundred twenty-fourchildren with mean age of 9 ± 4 years old presented with cholesteatoma. MRIs were performed 27 ± 24 months after surgery. Residual cholesteatoma was diagnosed in 35%. The sensitivity, specificity, PPV, and NPV of MRI were 62%, 86%, 74%, and 78%, respectively. Accuracy, sensitivity, and specificity increased significantly over time (multivariate analysis). The mean delay after last surgery was of 30 ± 2.0 months for accurate MRI (true positive or negative) versus 17 ± 2.0 months for nonaccurate (false positive or negative) MRIs (p < .001). However, long the delay after the last surgery, the sensitivity of non-EPI diffusion sequence MRI in children has limitations for the detection of residual cholesteatoma. Surveillance for residual cholesteatoma should incorporate findings at primary surgery, surgeon experience, a low threshold for second-look procedures, and routine imaging.

Effect of Increased Time to Surgery on the Ability of MRI to Rule Out Medial Meniscal Tears in Young Athletes With ACL Injury.

The prevalence of meniscal tears in patients with anterior cruciate ligament (ACL) injury increases with extended time between injury and ACL reconstruction. The purpose of this study was to determine if there is a relationship between time from magnetic resonance imaging (MRI) to ACL reconstruction and the predictive value of MRI to diagnose meniscal tears in the young active population. It was hypothesized that increased time between MRI and ACL reconstruction would lead to a decrease in the negative predictive value of MRI in diagnosing meniscal tears, as more injuries may accrue over time in the ACL-deficient knee. Case series; Level of evidence, 4. Included were patients aged 13 to 25 years at the authors' institution who underwent primary ACL reconstruction from January 2017 to June 2020. Time from MRI to surgery as well as descriptions of medial and lateral meniscal tears on both MRI and operative reports were documented. Time from MRI to surgery was divided into 4 intervals: 0 to 6 weeks, >6 weeks to 3 months, >3 to 6 months, and beyond 6 months. Multivariable analysis was used to determine the positive and negative predictive values of MRI in diagnosing a meniscal tear as compared with arthroscopic findings. A total of 432 patients were included with a mean age of 17.9 ± 3.4 years. The mean time from MRI to surgery was 70.5 ± 98 days. There was a significant decrease in the negative predictive value of MRI to identify a medial meniscal tear in patients who underwent ACL reconstruction >6 months after imaging (odds ratio, 0.16 [95% CI, 0.05-0.53]; P = .003). This same relationship was not shown for lateral meniscal tears, nor was any other predictor significant. The utility of MRI to rule out a medial meniscal tear significantly diminished in the young athletic population when >6 months passed between MRI and ACL reconstruction. These data suggest these tears occur between the time of the MRI and surgery and that the medial meniscus is more susceptible than the lateral meniscus to new injury once the ACL has torn.

Predictive ability of prebiopsy magnetic resonance imaging and biopsy for side-specific negative lymph node metastasis at radical prostatectomy.

Prostate cancer localization is reportedly associated with the laterality of lymph nodemetastasis. Thus, it may be feasible to predict side-specific lymph node metastasis (LNM) at radical prostatectomy (RP). To investigate whether multiparametric magnetic resonance imaging and biopsy findings can predict side-specific negative LNM and to explore the feasibility of unilateral lymph node dissection (LND) at RP. A total of 500 patients who were diagnosed with prostate cancer with prebiopsy multiparametric magnetic resonance imaging of the prostate and subsequent prostate biopsy and who underwent RP and extended LND without neoadjuvant treatment were enrolled. Multiparametric magnetic resonance imaging, biopsy findings, and LNM were assessed for each side. The negative predictive value (NPV) of multiparametric magnetic resonance imaging or biopsy or both for ipsilateral LNM was examined. LNM was found in 9.2% (46/500) and 15.6% (28/180) of patients in the overall and high-risk cohorts, respectively. Magnetic resonance imaging and biopsy findings were negative in 408 and 262 sides, respectively, in the overall cohort and 144 and 100 sides, respectively, in the high-risk cohort. The NPVs of magnetic resonance imaging, biopsy, and both for ipsilateral LNM were 98.3%, 98.5%, and 99.1%, respectively, in the overall cohort, and 95.8%, 97.1%, and 97.6%, respectively, in the high-risk cohort. Unilateral LND may be indicated based on side-specific LNM risk as assessed by prebiopsy multiparametric magnetic resonance imaging and biopsy.

Diagnostic Validity of Magnetic Resonance Imaging for the Detection of Ependymoma among Bangladeshi Children

Background: Detection of ependymoma is very essential for the management of the patients.&#x0D; Objective: The purpose of the present study was to validate as well as to find out the Magnetic Resonance Imaging (MRI) findings of ependymoma among paediatric patients.&#x0D; Methodology: This cross-sectional study was carried out from January 2010 to June 2011 for a period of one year and six months in the Department of Radiology &amp; Imaging at Dhaka Medical College, Dhaka, Bangladesh. Pediatric Patients having clinically suspected brain tumours of ependymoma variant who were undergone MRI of brain were included in this study. The pediatric patients clinically suspected for brain tumor in posterior cranial fossa region with the suspicion of ependymoma having no contraindication for MRI was underwent MRI examination. The postoperative resected tissues were examined histopathological in the respective department. All the clinical profiles and demographic data were collected.&#x0D; Result: This study included 33 patients with clinical features compatible with posterior fossa tumors. Out of all cases 4 cases were diagnosed as ependymoma in MRI and confirmed by histopathological evaluation. Out of 4 histologicaly proved cases, all cases were in ventricle. However, 2 cases were hypointense and 2 cases were isointense in TIWI and 3 cases were hyperintense in T2WI .3 cases are solid and 1 case was mixed. All cases had irregular margin and mass effect. All cases also had peri-lesional oedema. Marked enhancement was present in 3 cases. The sensitivity of MRI for the detection of ependymoma was 75.0% (95% CI 19.41% to 99.37%). However, the specificity of MRI was very high which was 96.5% (95% CI 82.24% to 99.91%). The positive predictive values and negative predictive value of MRI were 75.0% (95% CI 28.73% to 95.71%) and 96.5% (95% CI 83.66% to 99.35%) respectively. The accuracy was 93.9% (95% CI 79.77% to 99.26%).&#x0D; Conclusion: In conclusion accuracy of MRI for the detection of ependymoma is very high.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 147-151

Imaging features and clinic value of mri and ct in diagnosis of clear cell renal cell carcinoma

Abstract To investigate the imaging features and clinic value of magnetic resonance imaging (MRI) and computed tomography (CT) in the diagnosis of clear cell renal cell carcinoma (ccRCC). 139 RCC patients underwent MRI and CT examination before surgery, and the sensitivity, specificity, accuracy, positive and negative predictive values of MRI and CT in diagnosing ccRCC were analyzed and compared. There were 93 true-positive, 11 false-positive, 11 false-negative and 24 true-negative in MRI screening with sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 89.42%, 68.57%, 84.17%, 89.42% and 68.57% respectively. Whereas there were 72 true-positive, 4 false-positive, 32 false-negative and 31 true-negative in CT screening with the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 69.23%, 88.57%, 74.10%, 94.74% and 49.21% respectively. The sensitivity and negative predictive value of MRI were better than those of CT, while the specificity of CT was better than that of MRI. MRI and CT have respective advantages in the diagnosis of ccRCC. The sensitivity and negative predictive value of MRI are superior to those of CT, while the specificity of CT is superior to that of MRI. Clinically, different examinations are selected according to different situations.

Validation of Accuracy of Non-Invasive Imaging Methods (Magnetic Resonance Imaging (MRI) Fat Fraction Calculation and Computed Tomography (CT) Liver Attenuation Index) for Hepatic Graft Fat Quantification in Living Liver Transplant Donors.

BackgroundDiagnosis of significant hepatic graft steatosis remains vital for success of any transplant program as it has an impact on donor morbidity and recipient survival. Even histopathological quantification faces limitations. The present study compared the diagnostic accuracy of CT-LAI and MRI fat fraction imaging with histopathological analysis for donor graft parenchymal fat quantification.Material/MethodsCT-LAI and MR-FF values and histopathological fat quantification results of 273 patients were identified from electronic records of the author’s institutes from September 2015 to April 2020. Data analysis was done using SPSS version 21.0.ResultsMost participants were young with nearly equal sex distribution and significant number of overweight and obese patients. Moderate agreement and significant positive correlation were found between MR fat fraction (%) and biopsy-macrosteatosis (%). Diagnostic accuracy and negative predictive value of MRI for fat fraction calculation was high (95.24% and 98.07% for fat fraction of 10% threshold, respectively), and it further improved for fat fraction threshold of 15%.ConclusionsMRI-based fat quantification calculation displayed near-perfect negative predictive values and very high diagnostic accuracy, suggesting that it can obviate the need for biopsy in patients with graft fat percentage <10% on MRI.

Prediction of Myometrial Invasion in Stage I Endometrial Cancer by MRI: The Influence of Surgical Diagnostic Procedure.

Simple SummaryFertility sparing treatment can be considered for young women with clinical stage 1A endometrial cancer (EC) without myometrial invasion (MI). Surgical diagnostic procedures (SDP) were needed to make diagnosis of EC, but different extents of SDP including diagnostic hysteroscopic biopsy (DHB, group 1), operative hysteroscopic partial resection (OHPR, group 2), operative hysteroscopic complete resection (OHCR, group 3), and cervical dilatation and fractional curettage (D&C, group 4) may affect the accuracy of MI assessment by magnetic resonance imaging (MRI) after SDP. Here, we retrospectively review those initially diagnosed with stage 1A EC and compare MI status on MRI reports and final histopathology of hysterectomy. We found that the MRI accuracy of MI was better in patients with EC diagnosed with D&C. Three diagnostic procedures using hysteroscopy might interfere with the diagnostic power of MI on MRI. Thus, D&C for diagnosis of EC and further hysteroscopic complete resection with hormone as a fertility sparing treatment for those confirmed as stage 1A without MI from MRI may be a choice in the future.Young women with endometrial cancer (EC) can choose fertility-sparing treatment for stage 1A disease without myometrial invasion (MI). The surgical diagnostic procedure (SDP) may affect the accuracy of magnetic resonance imaging (MRI) to assess MI. Here, we evaluated different SDP and compared the MI on MRI results with further pathologic results after hysterectomy. We retrospectively collected data on 263 patients with clinical stage IA EC diagnosed between January 2013 and December 2015. Patients were classified into four groups based on SDP, including diagnostic hysteroscopic biopsy (DHB, group 1), operative hysteroscopic partial resection (OHPR, group 2), operative hysteroscopic complete resection (OHCR, group 3), and cervical dilatation and fractional curettage (D&C, group 4). The sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value of MRI to assess MI were 73.1%, 46.7%, 63.9%, 71.8%, and 48.3%, respectively. Three hysteroscopic procedures (groups 1 to 3) had a trend with a higher odds ratio of discrepancy between MRI and histopathology (p = 0.068), especially in group 2 (odds ratio 2.268, p = 0.032). Here, we found MRI accuracy of MI was better in patients with EC diagnosed with D&C. Three diagnostic procedures using hysteroscopy might interfere with the diagnostic power of MI on MRI.

Evaluation of the Diagnostic Performance of Positron Emission Tomography/Magnetic Resonance for the Diagnosis of Liver Metastases.

The aim of this study was to compare the performance of positron emission tomography (PET)/magnetic resonance (MR) versus stand-alone PET and stand-alone magnetic resonance imaging (MRI) in the detection and characterization of suspected liver metastases. This multi-institutional retrospective performance study was approved by the institutional review boards and was Health Insurance Portability and Accountability Act compliant, with waiver of informed consent. Seventy-nine patients with confirmed solid extrahepatic malignancies who underwent upper abdominal PET/MR between February 2017 and June 2018 were included. Where focal hepatic lesions were identified, the likelihood of a diagnosis of a liver metastasis was defined on an ordinal scale for MRI, PET, and PET/MRI by 3 readers: 1 nuclear medicine physician and 2 radiologists. The number of lesions per patient, lesion size, and involved hepatic segments were recorded. Proof of metastases was based on histopathologic correlation or clinical/imaging follow-up. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, and receiver operator characteristic curve analysis. A total of 79 patients (53 years, interquartile range, 50-68; 43 men) were included. PET/MR had a sensitivity of 95%, specificity of 97%, positive predictive value of 97%, and negative predictive value of 95%. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI were 88%, 98%, 98%, and 90% and for PET were 83%, 97%, 97%, and 86%, respectively. The areas under the curve for PET/MRI, MRI, and PET were 95%, 92%, and 92%, respectively. Contrast-enhanced PET/MR has a higher sensitivity and negative predictive value than either PET or MRI alone in the setting of suspected liver metastases. Fewer lesions were characterized as indeterminate by PET/MR in comparison with PET and MRI. This superior performance could potentially impact treatment and management decisions for patients with suspected liver metastases.

Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma

Neoadjuvant therapy in breast cancer can downstage axillary lymph nodes and reduce extent of axillary surgery. As such, accurate determination of nodal status after neoadjuvant therapy and before surgery impacts surgical management. There are scarce data on the diagnostic accuracy of breast magnetic resonance imaging (MRI) for nodal evaluation after neoadjuvant therapy in patients with invasive lobular carcinoma (ILC), a diffusely growing tumor type. We retrospectively analyzed patients with stage 1–3 ILC who underwent pre-operative breast MRI after either neoadjuvant chemotherapy or endocrine therapy at our institution between 2006 and 2019. Two breast radiologists reviewed MRIs and evaluated axillary nodes for suspicious features. All patients underwent either sentinel node biopsy or axillary dissection. We evaluated sensitivity, specificity, negative and positive predictive values, and overall accuracy of the post-treatment breast MRI in predicting pathologic nodal status. Of 79 patients, 58.2% received neoadjuvant chemotherapy and 41.8% neoadjuvant endocrine therapy. The sensitivity and negative predictive value of MRI were significantly higher in the neoadjuvant endocrine therapy cohort than in the neoadjuvant chemotherapy cohort (66.7 vs. 37.9%, p = 0.012 and 70.6 vs. 40%, p = 0.007, respectively), while overall accuracy was similar. Upstaging from clinically node negative to pathologically node positive occurred in 28.0 and 41.7%, respectively. In clinically node positive patients, those with an abnormal post-treatment MRI had a significantly higher proportion of patients with ≥4 positive nodes on pathology compared to those with a normal MRI (61.1 versus 16.7%, p = 0.034). Overall, accuracy of breast MRI for predicting nodal status after neoadjuvant therapy in ILC was low in both chemotherapy and endocrine therapy cohorts. However, post-treatment breast MRI may help identify patients with a high burden of nodal disease (≥4 positive nodes), which could impact pre-operative systemic therapy decisions. Further studies are needed to assess other imaging modalities to evaluate for nodal disease following neoadjuvant therapy and to improve clinical staging in patients with ILC.

Correlation between Magnetic Resonance Imaging (MRI) Findings with Histological Grading of Patients with Supratentorial Diffusely Infiltrating Astrocytomas

Correlation between Magnetic Resonance Imaging (MRI) Findings with Histological Grading of Patients with Supratentorial Diffusely Infiltrating Astrocytomas

Accuracy of magnetic resonance imaging in assessing types of degeneration in leiomyomas

Background: Leiomyomas are the most common benign uterine neoplasms arising from smooth muscle cells. Magnetic resonance (MR) imaging is the most accurate imaging technique for detecting and localizing leiomyomas. As leimyomas grow, they may outgrow their blood supply resulting in various types of degeneration such as myxoid, hyaline, cystic, red, and calcification. Degenerated leiomyomas have variable appearances on T2-weighted images and contrast-enhanced images. Materials and Methods: This was a retrospective hospital-based study done in Government Medical College, Srinagar, from January 2018 to December 2019. The study included 78 patients with more than 2 cm pathologically proven fibroids who underwent myomectomy or hysterectomy and preoperative MR imaging (MRI). We assessed the accuracy of MR for picking degeneration in fibroids. Aim and Objective: The aim and objective of this study is to determine the sensitivity, specificity, positive, and negative predictive value of MRI in assessing degeneration in uterine fibroids. Results: The sensitivity, specificity, positive and negative predictive values of MRI in assessing degeneration in uterine fibroids were 60%, 93.7%, 85.7%, and 78.9% respectively. Menorrhagia followed by dysmenorrhea was the most common presenting symptom. Conclusion: MRI has average sensitivity and very good specificity for picking fibroid degenerations. MRI has high accuracy for picking up myxoid, cystic, and red degeneration.

Value of ultrasound combined with MRI in the diagnosis of primary and recurrent hepatocellular carcinoma.

Ultrasound (US) combined with magnetic resonance imaging (MRI) in the diagnosis of primary hepatocellular carcinoma (PHCC) and recurrent hepatocellular carcinoma (RHCC) were compared. The clinical data of 329 patients with hepatocellular carcinoma (HCC) admitted to Qingdao Women and Children's Hospital from June 2015 to December 2017 were collected. One hundred and sixty patients with PHCC were regarded as the PHCC group, and the other 169 patients with RHCC were regarded as the RHCC group. US and MRI were used in the imaging diagnosis of both groups and the results of US combined with MRI, US, and MRI alone were compared. The lesion size in the PHCC group was significantly higher than that in the RHCC group (P<0.05). The MRI fast-in and fast-out rates of the two groups were significantly higher than those of the other three methods (P<0.05). The coincidence rate of MRI in the two groups was higher than that of computed tomography (CT), US, and US combined with MRI (P<0.05). The coincidence rates of CT, US, MRI, and US combined with MRI in PHCC group were significantly higher than those in RHCC group. In PHCC group, MRI was superior to the other methods in the detection of micro HCC (P<0.05). In RHCC group, MRI was significantly better than US in the detection of micro HCC (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of MRI were significantly better than the other three methods (P<0.05). MRI alone has the best diagnostic efficacy for micro HCC-type lesions. The diagnostic efficacy of MRI, US, CT, and US combined with MRI in PHCC was better than those in RHCC. In addition to imaging examination, the diagnosis of RHCC should be combined with other indicators for comprehensive diagnosis.

Confirming the Presence of Unrecognized Meniscal Injuries on Magnetic Resonance Imaging in Pediatric and Adolescent Patients With Anterior Cruciate Ligament Tears.

Prior research has shown decreased accuracy of meniscal injury detection using magnetic resonance imaging (MRI) for anterior cruciate ligament (ACL)-deficient adult patients as well as ACL-deficient pediatric and adolescent patients. The objectives of this study were the following: (1) assess the diagnostic ability of MRI in detecting meniscal injuries for pediatric and adolescent patients undergoing arthroscopic ACL reconstruction and (2) characterize the unrecognized meniscal injuries. The sensitivity, specificity, positive predictive value, and negative predictive value of meniscal tears (medial, lateral, or both) on MRI were calculated for the 107 patients in this cohort. Fisher exact tests were used to compare event frequencies between medial meniscal (MM) and lateral meniscal (LM) tears. One-way analysis of variance tests were performed to compare event rates between the location and type of unrecognized meniscal tears. The median age of the cohort was 15 (range: 7 to 18). The sensitivity, specificity, positive predictive value, and negative predictive value of MRI in detecting meniscal tears (medial, lateral, or both) in ACL-deficient pediatric and adolescent patients was 62.3%, 68.4%, 78.2%, and 50.0%, respectively. There were 26 (24.3%) cases in which a meniscal injury was not detected on MRI, but was discovered arthroscopically (MM: 5 knees, LM: 20 knees, both: 1 knee). These unrecognized meniscal injuries were more commonly the LM than the MM (77.8%, P-value=0.100), a vertical/longitudinal tear type (77.8%, P-value <0.001), and located in the posterior horn (74.1%, P-value <0.001). In this ACL-deficient pediatric and adolescent cohort, there were 26 (24.3%) patients with unrecognized meniscal injuries. A vertical tear in the posterior horn was the most commonly unrecognized meniscal injury, supporting the findings of prior research postulating that the location and configuration of a tear influence the accuracy of MRI in detecting these injuries. More research is needed to investigate strategies to improve the detection of meniscal tears in pediatric and adolescent patients preoperatively. These findings have implications with regard to patient counseling, operative planning, anticipatory guidance with regard to postoperative rehabilitation, recovery expectations, and surgical outcomes. Level IV.

Accuracy of magnetic resonance imaging for subscapularis tendon tear comparison with arthroscopy

Background: This study was conducted with the aim of determining the diagnostic accuracy of a magnetic resonance imaging (MRI) scan before surgery in evaluating the tear of the subscapularis tendon in comparison with the actual results obtained from arthroscopy. Materials and Methods: This retrospective study was conducted on medical records of 85 patients who underwent shoulder arthroscopic surgery suspected to subscapularis tendon tears which referred to the Besat Hospital (Hamadan, Iran) during 2012–2013. In the present study, the MRI was considered as a screening method and arthroscopy results were considered as the gold standard, and sensitivity, specificity, positive predictive value and negative predictive value were computed for MRI compared arthroscopy. Results: The sensitivity, specificity, positive predictive value and negative predictive value of MRI for the identification of incomplete tear were 28.57%, 100%, 100% and 63.77%, respectively, whereas had perfect sensitivity, specificity and positive and negative predictive value for detecting complete tear. In overall, sensitivity, specificity, positive and negative predictive values of MRI for detecting all types of ruptures were 39.02%, 100%, 100% and 63.77%, respectively. Conclusion: According to this study, MR images are a highly specific method with high positive and negative predictive values for the diagnosis of complete subscapularis tendon tear. However, the sensitivity for the incomplete tear of subscapularis tendon is not such high.

Application of positron emission computed tomography/magnetic resonance imaging coregistration in improving epileptic foci detection rate of structural intractable epilepsy in children

Objective To study the predictive value of magnetic resonance imaging (MRI), positron emission computed tomography (PET) and PET/MRI coregistration in intractable epilepsy of children. Methods A retrospectively analysis was performed based on the surgery data at the Department of Children Epilepsy Center of Peking University First Hospital from September 2015 to March 2016.The clinical data, surgery and follow-up study data, interictal and ictal electroencephalogram, MRI, PET and PET/MRI coregistration data were collected.By comparison with the epileptogenic zone designed by pre-surgical workup, the accuracy of MRI, PET and PET/MRI coregistration in detecting lesion was assessed.In the patients who had no seizure during ≥1 year follow-up, their sensitivity, specificity, positive predictive value, negative predictive value of MRI, PET and PET/MRI coregistration were calculated. Results (1)A total of 62 patients underwent surgery, 30 boys and 32 girls.The average age on epilepsy onset was 2.50 years (2 days-11.70 years), and average age on surgery was 5.10 years old(0.75-15.60 years old). (2)Surgical treatment of 62 cases included the resection of the focal or lobar(32 cases, 51.6%), and the multilobar (16 cases, 25.8%). Hemispherotomy was done in 14 cases (22.6%). During ≥1 year follow-up, seizure outcome was Engel class Ⅰ in 57 cases (91.9%) out of the 62 patients, Engel class Ⅱ to Engel class Ⅳ in 1 case, 3 cases, and 1 case, respectively.(3) Referred to epileptogenic zone designed by presurgical workup, MRI represented 64.5%(40/62 cases) results with accordance, PET and PET/MRI coregistration was 72.5%(45/62 cases) and 85.5%(53/62 cases), respectively, and the difference was significant(χ2=7.25, P=0.03). (4) Based on the patients of Engel class Ⅰ, their sensitivity and specificity were 66.7%, 60.0% in MRI, 75.4%, 60.0% in PET %, and 85.9%, 80.0% in PET/MRI coregistration, respectively.(5)There were 11 non-lesion cases of all focal cortical dysplasia in pathology, and subtle structural abnormalities were de tected in 9 cases by reviewing MRI. Conclusions PET/MRI coregistration can improve lesion detection of intractable epilepsy in children. Key words: Intractable epilepsy; Magnetic resonance imaging; Positron emission computed tomography; Positron emission computed tomography/magnetic resonance imaging coregistration; Epileptogenic zone

Differential diagnostic value of 18F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging.

PurposeThe purpose of this study was to evaluate the differential diagnostic value of 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for benign and malignant vertebral compression fractures (VCFs), where the diagnostic accuracy of 18F-FDG PET/CT was compared with magnetic resonance imaging (MRI).Patients and methodsBetween 2015 and 2017, we retrospectively evaluated 87 patients with 116 VCFs. MRI was performed in all the 87 patients, whereas 18F-FDG PET/CT was executed in 51 patients. Three malignant features (convex posterior cortex, epidural mass formation, and pedicle enhancement) from MRI and the maximum standardized uptake value (SUVmax) from 18F-FDG PET/CT were evaluated in benign and malignant VCFs, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI and 18F-FDG PET/CT were compared in the differentiation of malignant from benign VCFs.ResultsThe results of our investigation showed that the sensitivity and specificity for predicting malignant VCFs were 75.6% and 77.3% for convex posterior cortex, 82.9% and 813% for epidural mass formation, and 85.7% and 70.8% for pedicle enhancement. 18F-FDG PET/CT demonstrated higher sensitivity (100%) but lower specificity (38.9%) as compared to MRI with regard to differentiation between benign and malignant VCFs. A significant difference in the SUVmax values was observed between the benign and malignant fractures (2.9 ± 1.0 vs 5.0 ± 1.8, P < 0.01). Besides the value of SUVmax, it has been noticed that the FDG uptake pattern differed in malignant and benign fractures.ConclusionSignificant MRI findings such as convex posterior cortex, epidural mass formation, and pedicle enhancement are highly suggestive of malignancy. 18F-FDG PET/CT reliably differentiated the fractures of malignant from benign based on both SUVmax and 18F-FDG uptake pattern. In a situation where MRI findings are not diagnostic, 18F-FDG PET/CT provides additional information as it has high sensitivity and is semiquantitative.

Abstract OT2-02-01: Brazilian randomized study - Impact of preoperative magnetic resonance in the evaluation for breast cancer conservative surgery (BREAST-MRI trial)

Abstract Background: A precise preoperative evaluation of the tumor is essential to improve breast cancer surgical management. Currently, mammography associated with ultrasound and clinical exam are the standard techniques for evaluating extension and tumor localization. However, approximately one third of the lesions in patients eligible for conservative surgical treatment are misevaluated by these methods. Breast magnetic resonance imaging (MRI) has a high sensitivity (95-100%) in detecting invasive neoplasms, and is able to detect occult tumors, multifocal and/or multicentric disease, and contralateral breast cancer more accurately than mammography and ultrasound. Until now, there are only three randomized trials assessing the role of preoperative MRI. These trials have different designs and contradictory results. Trial design: BREAST-MRI is a randomized, open label, unblinded trial designed to compare the accuracy of breast MRI in the preoperative planning of surgical treatment of breast cancer to standard protocol (clinical exam of the breast, mammography and/or breast ultrasound) and the impact of breast MRI on breast cancer outcome. Patients are randomized on a 1:1 basis, stratified for mammary density, into two groups: 1)MRI group: patients are submitted to MRI and standard protocol 2)Control group: standard protocol. First phase: patient recruitment and data collection up until surgery. Second phase: follow-up for five years or until death. Eligibility criteria: women aged 18 years or older with breast cancer stages I to III candidates for conservative surgery (CC). Specific aims: The aim of this study is to evaluate the ability of MRI in selecting patients for conservative treatment of breast cancer. Primary outcomes are: false positive rates, false negative rates, positive predictive value and negative predictive value of MRI in breast cancer CC. Secondary outcomes are: rates of positive margins on pathological examination; reoperation rates; number of conversions to mastectomy; accuracy of MRI according to mammographic density, immunohistochemical subtype and histopathology of the tumor; rates of multicentricity, multifocality and bilateralality of tumors; disease-free survival after 3 and 5 years; and cost-effectiveness of breast MRI. Statistical methods: The calculated total case number for this trial is 372, assuming a recurrence rate of 10% for CC and 1% for mastectomies. The Shapiro-Whilks test will be used to verify if distribution of the quantitative variables follows normal distribution. The baseline population will be analyzed using the t-Student test, or the Mann-Whitney test when appropriate. To test the existence of a possible association between outcomes and the categorized characteristics, chi-square and Fisher's exact test will be performed. Disease progression will be reassessed at 3 and 5 years follow-up, in order to produce a log-rank Kaplan-Meier curve of survival. Present accrual and target accrual: In June 2017, randomizations are at approximately 90% of the target sample size. Citation Format: Dória MT, Mota BS, Reis YN, Ricci MD, Piato JRM, Ferreira VCCS, Shimizu C, Barros N, Filassi JR, Baracat EC. Brazilian randomized study - Impact of preoperative magnetic resonance in the evaluation for breast cancer conservative surgery (BREAST-MRI trial) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-02-01.