Normal MRI Scans Research Articles

Intracranial Hypertension Revealing Neuro-Behçet Disease With Favourable Outcome After Ventriculoperitoneal Shunt

A 39-year-old man had been diagnosed after rolling out all the other possible causes as having intracranial hypertension with bilateral papilledema secondary to Behçet’s disease with normal MRI scan. Despite treatment with steroids, methylprednisolone and repetitive LPs, he had little to no improvement. The patient later underwent a ventriculoperitoneal shunt operation with corticosteroid therapy and adjuvant treatment with topiramate and acetazolamide, which resulted in symptoms improvement. Thus, it is important to consider NBD in the differential diagnosis of patients with intracranial hypertension and bilateral papilledema and also ventriculoperitoneal shunting as an effective therapeutic alternative when medical treatment fail to normalize the intracranial hypertension building up

Assessing the applicability of the 2023 international MOGAD panel criteria in real-world clinical settings

IntroductionMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified demyelinating disorder with a diverse clinical spectrum. Diagnosing MOGAD traditionally relies on clinical judgment, highlighting the necessity for precise diagnostic criteria. Banwell et al. proposed criteria, aiming to refine the diagnostic spectrum. This study evaluates these criteria in a real-life cohort, comparing their performance with clinical judgment and describe the cohort of MOGAD patients.MethodsThis retrospective study, conducted at Hadassah Medical Center, included 88 patients with MOG-IgG antibodies. Patients with a positive or borderline MOG-IgG antibodies by cell-based assay were included. Demographics, clinical and MRI data were recorded. Cases were divided into definite MOGAD and Non-MOGAD groups as determined by the treating physician. We assessed the sensitivity and specificity of the new criteria in comparison to treating physicians’ evaluations. Additionally, we examined clinical differences between the MOGAD and Non-MOGAD groups.ResultsWe observed a strong concordance (98%) between the new MOGAD criteria and treating physicians' diagnoses. Clinical disparities between MOGAD and Non-MOGAD groups included lower EDSS scores, normal MRI scans, preserved brain volume, negative OCB results, and distinct relapse patterns. Also, compared to relapsing patients, monophasic MOGAD patients have greater brain volume and a lower age at onset.ConclusionThe study demonstrates robust accuracy of new MOGAD criteria, emphasizing their potential to enhance diagnostic precision. Treatment response integration into the MOGAD diagnosis is crucial, as it could aid in distinguishing MOGAD from other demyelinating disorders. Distinct clinical profiles highlight the importance of informed decisions in managing MOGAD and similar disorders.

Clinical characteristics and rehabilitation potential in children with cerebral palsy based on MRI classification system.

The correlation of clinical characteristics of cerebral palsy (CP) and the magnetic resonance imaging classification system (MRICS) for (CP) is inconsistent. Specifically, the variance in rehabilitation potential across MRICS remains underexplored. To investigate the clinical characteristics and potential for rehabilitation in children with CP based on MRICS. Children with CP admitted to the Department of Rehabilitation, Children's Hospital of Chongqing Medical University between 2017 and 2021 were included in the study. Qualified cases underwent a follow-up period of at least one year. The clinical characteristics of CP among different MRICS were analyzed, then the rehabilitation potential was explored by a retrospective cohort study. Among the 384 initially enrolled children, the male-to-female ratio was 2.3:1, and the median age of diagnosis was 6.5 months (interquartile range: 4-12). The most prevalent MRICS categorization was predominant white matter injury (40.6%), followed by miscellaneous (29.2%) and predominant gray matter injury (15.6%). For the predominant white matter injury and miscellaneous categories, spastic diplegia emerged as the leading subtype of CP, with incidences of 59.6% and 36.6%, respectively, while mixed CP (36.7%) was the most common type in children with predominant gray matter. Notably, 76.4% of children with predominant white matter injury were classified as levels I-III on the gross motor function classification system (GMFCS), indicating significantly less severity than other groups (χ2 = 12.438, p = 0.013). No significant difference across MRICS categories was observed for the manual ability classification system (MACS) (H = 8.176, p = 0.085). Rehabilitation potential regarding fine motor function and adaptability based on Gesell assessment was dependent on MRICS over the follow-up period. Children with normal MRI scans exhibited superior rehabilitation outcomes. Commencing rehabilitation at an earlier stage produced consistent and beneficial results in terms of fine motor function and adaptability across all MRICS categories. Moreover, participants below 2 years of age demonstrated enhanced rehabilitation potential regarding fine motor outcomes and adaptability within the MRICS framework. MRICS displayed a significant association with clinical characteristics and rehabilitation efficacy in children with CP.

Research on automatic recognition radiomics algorithm for early sacroiliac arthritis based on sacroiliac MRI imaging

ObjectiveTo create an automated machine learning model using sacroiliac joint MRI imaging for early sacroiliac arthritis detection, aiming to enhance diagnostic accuracy.MethodsWe conducted a retrospective analysis involving 71 patients with early sacroiliac arthritis and 85 patients with normal sacroiliac joint MRI scans. Transverse T1WI and T2WI sequences were collected and subjected to radiomics analysis by two physicians. Patients were randomly divided into training and test groups at a 7:3 ratio. Initially, we extracted the region of interest on the sacroiliac joint surface using ITK-SNAP 3.6.0 software and extracted radiomic features. We retained features with an Intraclass Correlation Coefficient > 0.80, followed by filtering using max-relevance and min-redundancy (mRMR) and LASSO algorithms to establish an automatic identification model for sacroiliac joint surface injury. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated. Model performance was assessed by accuracy, sensitivity, and specificity.ResultsWe evaluated model performance, achieving an AUC of 0.943 for the SVM-T1WI training group, with accuracy, sensitivity, and specificity values of 0.878, 0.836, and 0.943, respectively. The SVM-T1WI test group exhibited an AUC of 0.875, with corresponding accuracy, sensitivity, and specificity values of 0.909, 0.929, and 0.875, respectively. For the SVM-T2WI training group, the AUC was 0.975, with accuracy, sensitivity, and specificity values of 0.933, 0.889, and 0.750. The SVM-T2WI test group produced an AUC of 0.902, with accuracy, sensitivity, and specificity values of 0.864, 0.889, and 0.800. In the SVM-bimodal training group, we achieved an AUC of 0.974, with accuracy, sensitivity, and specificity values of 0.921, 0.889, and 0.971, respectively. The SVM-bimodal test group exhibited an AUC of 0.964, with accuracy, sensitivity, and specificity values of 0.955, 1.000, and 0.875, respectively.ConclusionThe radiomics-based detection model demonstrates excellent automatic identification performance for early sacroiliitis.

Tau‐PET in retired contact sport athletes

AbstractBackgroundLong term effects of concussions and sub‐concussions in athletes can include delayed neurodegeneration as seen in Alzheimer’s disease (AD) and chronic traumatic encephalopathy (CTE). The PET tracer [18F]AV1451 has high affinity and selectivity for paired helical filament‐tau in vivo, the pathological form of tau in CTE and AD. The aim of this study was to assess the effect of tau‐PET binding on brain atrophy in former contact sports athletes and evaluate differences between subjects with and without tau‐PET binding.Method31 retired athletes (age:53±15; sex: 29M, 2F; concussions/athlete: 7±6) negative for AD (CSF: p‐tau <68 pg/mL and ATI >0.8 and/or normal range of plasma p‐tau181) and 54 normal controls (age: 50±13) were included. All athletes completed MRI, [18F]AV1451 tau‐PET, the Sport Concussion Assessment tool 2 (SCAT2) and the Personality Assessment Inventory (PAI) depression and anxiety scales. Tau‐PET standardized uptake value ratios (SUVR) images were created using cerebellar gray matter (GM); tau‐PET positivity was set to ≥1.30 SUVR. Normal control MRI scans were used to create age/intracranial volume corrected GM volume maps.ResultGM volumes were significantly lower in tau‐PET positive voxels in retired athletes ≥40 y.o. (N = 25; ‐0.48±0.40 vs. ‐0.42±0.41; p = .02) and there was a trend for lower GM volumes in tau‐PET positive voxels across athletes of all ages (N = 30; ‐0.40±0.42 vs. ‐0.35±0.41; p = .09), compared to tau‐PET negative voxels. Mean tau‐PET SUVR values in the cortical GM were used to divide retired athletes into tau‐PET positive (N = 20; SUVR ≥1.30) and negative (N = 11; SUVR <1.30) groups. The tau‐PET positive group did not differ in age (52±16 vs. 56±12; p = .4) or concussion number (9±7 vs. 7±5; p = 1.0) from the tau‐PET negative group; the tau‐PET positive group had significantly higher SCAT2 symptom severity (28.26±25.15 vs. 8.89±12.67; p = .01), PAI anxiety t‐scores (49.90±11.25 vs. 42.55±4.13; p = .01), and a trend for higher PAI depression t‐scores (54.75±16.58 vs. 47.09±8.08; p = .095), compared to the tau‐PET negative group.ConclusionTau‐PET may be useful for identifying those at risk for delayed neurodegeneration. Older athletes showed relatively greater brain atrophy in tau‐PET positive regions, suggesting that detection of tau‐PET at a younger age may enable interventions to prevent future degeneration.

Walking on water: subchondral vascular physiology explains how joints work and why they become osteoarthritic.

This review of bone perfusion introduces a new field of joint physiology, important in understanding osteoarthritis. Intraosseous pressure (IOP) reflects conditions at the needle tip rather than being a constant for the whole bone. Measurements of IOP in vitro and in vivo, with and without proximal vascular occlusion confirm that cancellous bone is perfused at normal physiological pressures. Alternate proximal vascular occlusion may be used to give a perfusion range or bandwidth at the needle tip more useful than a single IOP measure. Bone fat is essentially liquid at body temperature. Subchondral tissues are relatively delicate but are micro-flexible. They tolerate huge pressures with loading. Collectively, the subchondral tissues transmit load mainly by hydraulic pressure to the trabeculae and cortical shaft. Normal MRI scans demonstrate subchondral vascular marks which are lost in early osteoarthritis. Histological studies confirm the presence of those marks and possible subcortical choke valves which support hydraulic pressure load transmission. Osteoarthritis appears to be at least partly a vasculo-mechanical disease. Understanding subchondral vascular physiology will be key to better MRI classification and prevention, control, prognosis and treatment of osteoarthritis and other bone diseases.

Supraspinatus muscle atrophy in relation to aging with or without shoulder pathology: A radiographic study

IntroductionSupraspinatus muscle atrophy is commonly associated with shoulder disease, but the effect of ageing on atrophy is not well understood. It was the aim of this study to investigate this effect using MRI scans in older patients. Methods and materialsA retrospective review of MRI scans in patients aged >70 years was performed between Jan 2016–Dec 2018.Both normal and abnormal scans were included in the analysis which included quantifying muscle atrophy of the supraspinatus using Thomazeu's occupation ratio. ResultsThere were 39 normal shoulder MRI scans with a mean age of 75 years (range: 70–88) and 163 abnormal scans with a mean age of 77 years (range: 70–93). The mean supraspinatus occupation ratio for normal MRI scans was 0.57 (range: 0.33–0.86) and abnormal scans 0.35 (range: 0.17–0.90). Occupation ratio was maintained with advancing until the age of 85 years before undergoing a significant declin following this. ConclusionThis study has shown that the occupation ratio is significantly reduced with shoulder disease, but normal shoulders do not undergo significant atrophy of supraspinatus tendon with increasing age. An occupation ratio of <0.32 is unlikely to occur in normal shoulders and this awareness may be useful when planning shoulder surgery, specifically shoulder arthroplasty.

Distinguishing Patients with MRI-Negative Temporal Lobe Epilepsy from Normal Controls Based on Individual Morphological Brain Network.

Temporal Lobe Epilepsy (TLE) is the most common subtype of focal epilepsy and the most refractory to drug treatment. Roughly 30% of patients do not have easily identifiable structural abnormalities. In other words, MRI-negative TLE has normal MRI scans on visual inspection. Thus, MRI-negative TLE is a diagnostic and therapeutic challenge. In this study, we investigate the cortical morphological brain network to identify MRI-negative TLE. The 210 cortical ROIs based on the Brainnetome atlas were used to define the network nodes. The least absolute shrinkage and selection operator (LASSO) algorithm and Pearson correlation methods were used to calculate the inter-regional morphometric features vector correlation respectively. As a result, two types of networks were constructed. The topological characteristics of networks were calculated by graph theory. Then after, a two-stage feature selection strategy, including a two-sample t-test and support vector machine-based recursive feature elimination (SVM-RFE), was performed in feature selection. Finally, classification with support vector machine (SVM) and leave-one-out cross-validation (LOOCV) was employed for the training and evaluation of the classifiers. The performance of two constructed brain networks was compared in MRI-negative TLE classification. The results indicated that the LASSO algorithm achieved better performance than the Pearson pairwise correlation method. The LASSO algorithm provides a robust method of individual morphological network construction for distinguishing patients with MRI-negative TLE from normal controls.

ANATOMIC FACTORS ASSOCIATED WITH PARTIAL DISTAL BICEPS TENDON TEARS: A COMPARATIVE CONTROL STUDY

A larger radial tuberosity, and therefore a smaller radioulnar space, may cause mechanical impingement of the DBT predisposing to tear. We sought to investigate anatomic factors associated with partial DBT tears by retrospectively reviewing 3-T MRI scans of elbows with partial DBT tears and a normal elbow comparison group3-T MRI scans of elbows with partial DBT tears and elbows with no known pathology were reviewed retrospectively by two independent observers. Basic demographic data were collected and measurements of radial tuberosity length, radial tuberosity thickness, radio-ulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardised technique. The presence or absence of enthesophytes and the presence of a single or double DBT were noted.26 3-T MRI scans of 26 elbows with partial DBT tears and 30 3-T MRI scans of 30 elbows without pathology were included. Basic demographic data was comparable between the two groups. The tear group showed statistically significant larger mean measurements for radial tuberosity length (24.3mm vs 21.3mm, p=0.002), and radial tuberosity thickness (5.5mm vs 3.7mm, p=&lt;0.0001. The tear group also showed statistically significant smaller measurements for radio-ulnar space (8.2mm vs 10.0mm, p=0.010), and radial tuberosity-ulnar space (7.2mm vs 9.1mm, p=0.013). There was a statistically significant positive correlation between partial DBT tears and presence of enthesophytes (p=0.007) as well as between partial DBT tears and having two discrete DBTs rather than a single or interdigitating tendon (p=&lt;0.0001).Larger radial tuberosities, and smaller radio-ulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. This may be due to chronic impingement, tendon delamination and consequent weakness which ultimately leads to tears. Enthesophytes may be associated with tears for the same reason. Having two discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears.

Long-Term Outcome of Pediatric Patients with Anti-NMDA Receptor Encephalitis in a Single Center

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is the most common autoimmune encephalitis in children. There is a high probability of recovery if treated promptly. We aimed to analyze the clinical features and long-term outcomes of pediatric patients with anti-NMDA receptor encephalitis. We conducted a retrospective study with definite diagnoses of anti-NMDA receptor encephalitis in 11 children treated in a tertiary referral center between March 2012 and March 2022. Clinical features, ancillary tests, treatment, and outcomes were reviewed. The median age at disease onset was 7.9 years. There were eight females (72.7%) and three males (27.3%). Three (27.3%) patients initially presented with focal and/or generalized seizures and eight (72.7%) with behavioral change. Seven patients (63.6%) revealed normal brain MRI scans. Seven (63.6%) had abnormal EEG results. Ten patients (90.1%) received intravenous immunoglobulin, corticosteroid, and/or plasmapheresis. After a median follow-up duration of 3.5 years, one patient was lost to follow-up at the acute stage, nine (90%) had an mRS ≤ 2, and only one had an mRS of 3. With the early recognition of anti-NMDA receptor encephalitis based on its clinical features and ancillary tests, we were able to treat patients promptly with first-line treatment and achieve favorable neurological outcomes.

Sexual dimorphism of the fetal brain biometry: an MRI-based study.

Fetal growth assessment is a key component of prenatal care. Sex-specific fetal brain nomograms on ultrasound are available and are clinically used. In recent years, the use of fetal MRI has been increasing; however, there are no sex-specific fetal CNS nomograms on MRI. The study aimed to assess the differences in fetal brain biometry and growth trajectories and to create population-based standards of the fetal brain on MRI. In this cross-sectional study, brain structures of singleton fetuses with normal brain MRI scans were analyzed: biparietal diameter, occipitofrontal diameter, trans-cerebellar diameter, and the corpus callosum were measured and converted into centiles. Sex-specific nomograms were created. A total of 3848 MRI scans were performed in one tertiary medical center between 2011 and 2019; of them, 598 fetuses met the inclusion criteria, 300 males and 298 females between 28- and 37-weeks' gestation. Males had significantly larger occipitofrontal diameter than females (median 75%, IQR 54-88%; median 61%, IQR 40-77%) and biparietal diameter (median 63%, IQR 42-82%; median 50%, IQR 25-73%), respectively (p < 0.001). The cerebellum had the greatest growth rate, with a 1.5-fold increase in diameter between 28 and 37weeks' gestation, with no measurement difference between the sexes (p = 0.239). No significant difference was found in the corpus callosum (p = 0.074). Measuring both sexes on the same nomograms may result in over-estimation of male fetuses and under-estimation of females. We provide fetal sex-specific nomograms on two-dimensional MRI.

IBCL-301 Primary Extranodal Marginal Zone B-Cell Lymphoma Located in the Lower Eyelid Case Treated With Rituximab

The majority of lymphoma cases are accompanied by painless enlargement of several cervical lymph nodes. However, its primary site may be also extranodal and unusual in some cases. Sharing an unusual case report of primary lower eyelid extranodal marginal zone B-cell Lymphoma treated with rituximab. A case report. In January 2021, a 53-year-old woman was admitted to our clinic with a subcutaneous change in her lower eyelid. The patient had a history of hypertension and had undergone IVF several years ago. There was a positive family history of cancer. There were no palpable lymph nodes in the periphery in physical examination. The hemogram and laboratory examinations were normal, as was the abdominal echo examination. An MRI scan of the cranium/orbits revealed the presence of a mass with a size of 15×8×13mm in the canthal angle/lower right cover OD, with no signs of intra-bulbar infiltration. A mass biopsy was performed, and the HP diagnosis revealed an extranodal marginal zone B-cell lymphoma (CD20+) (Bcl2+) (CD138+). Once the nature of the disease and the location of the mass had been determined, treatment with Rituximab 375mg/m2 every 28 days was planned. After 10 cycles of treatment, a PET-CT scan was performed, and a small region with low metabolic activity SUV max 3.0 was detected retrobulbar laterally on the right side. A cranial MRI scan revealed no evidence of recurrence or other pathological signs. The laboratory, abdominal, and neck echo exams were all normal. The patient's condition remains stable despite receiving rituximab 375 mg/m2 every two months, with no signs of disease and a normal MRI scan. The prognosis of this type of tumor is difficult to predict because the long-term response to the primary treatment must be closely monitored.

Observation on the Effect of Shoulder Pain Caused by Volleyball Training Injury Based on MRI Image Scanning.

In order to observe the effect of MRI image scanning on shoulder pain caused by volleyball training injury, this paper proposes to analyze the value of MR arthrography and conventional MRI image scanning in the diagnosis of shoulder injury. Taking the female volleyball players in a no. 1 middle school for nearly ten years as the research object, the injury investigation and statistics were carried out. The shoulder joint injury was investigated using arthroscopy and no injury was found. All patients underwent MR arthrography and routine MRI image scanning after admission. All patients underwent MR arthrography and routine MRI image scanning after admission. The patient took the flat lying position and put their arms flat on both sides of the body, and the Philips Achieva 3.0T MRI image scanning and Sense Flex M soft coil for MRI image scanning detection were used. The plain scan included oblique sagittal, axial, and oblique coronal proton density weighted image sequences; echo chain ETL = 6, TR/TE 2300/25 ms; and oblique sagittal and oblique coronal SET1W1; TRTE is 400/10 ms. Comparison was made with regard to the sensitivity, specificity, Jordan index, and accuracy of MR arthrography versus conventional MRI imaging in the diagnosis of shoulder injuries. The results were 38 true positives, 19 true negatives, 1 false positive, and 2 false negatives; a normal MRI scan showed 33 true positives, 13 true negatives, 7 false positives, and 7 false negatives. MR arthrography is more accurate than MRI image scanners in the diagnosis of shoulder injuries.

A novel approach for early detection of Alzheimer’s disease using deep neural networks with magnetic resonance imaging

Since there is no cure for Alzheimer’s disease (AD), early detection is essential to mitigate the symptoms. However, early detection is extremely challenging because brain MRI scans during these initial stages look very similar to normal MRI scans to the human eye. To assist in early disease detection, we developed a convolution neural network deep learning model using a transfer learning approach to extract features and a custom dense layer to detect and classify the early stages of AD. We collected MRI scans from Kaggle and ADNI institutes at several stages of AD (mild, moderate, severe) as well as healthy control scans. We used Resnet-50, VGG-16, and DenseNet-169 base models and compared their performances for classifying the stages of AD. The test area under the curve (AUC) for each of the base models Resnet-50, VGG-16 and DenseNet-169 were 0.8334, 0.9047 and 0.8898, respectively, based on 1279 Kaggle MRI images and 0.7332, 0.7383 and 0.7133, respectively, based on 132 ADNI MRI images. VGG-16 outperformed both DenseNet-169 and Resnet-50 models and showed more accurate results. Our deep learning approach also detected and extracted the region of interest (ROI) as the superior frontal gyrus (SFG) and the hippocampus for the Kaggle and ADNI brain axial MRI images, respectively.

AI to Dismiss Normal Breast MRI Scans and Reduce Workload

AI to Dismiss Normal Breast MRI Scans and Reduce Workload

Skull-base temporal encephalocele: Hidden cause of temporal lobe epilepsy

Among patients with Temporal lobe epilepsy (TLE), up to 30% can have normal (non-lesional) MRI scans. With increased use of high resolution MRI (3 T) scans, many of the MRI‐negative TLE cases turn out to be lesional TLE. Skull-base temporal encephalocele (TE), has to be suspected and specifically searched for among patients with apparent MRI negative TLE. The study aims to analyse patients with TLE for temporal lobe encephalocoele.

Anthropometric measurements of non-arthritic knees in an Egyptian population: an MRI-based study

BackgroundKnee anthropometric characteristics were evaluated for different ethnicities; however, data from North African populations are deficient. The primary aim was to investigate the Egyptian knees’ anthropometric characteristics as a representative of North African populations. Secondary aims are as follows: (1) to study the anthropometric gender difference, (2) to compare results with other ethnic groups, and (3) to study the mismatch in comparison to geometric characteristics of modern TKA implant designs.MethodsTwo hundred normal knee MRI scans (100 females and 100 males, aging from 18 to 60) were obtained for analysis. Linear measurements (anteroposterior (AP), mediolateral (ML), and aspect ratio (AR)) of the planned cut surface of the distal femur (f) and the proximal tibia (t) were evaluated.ResultsA significant difference between both sexes was found, males had larger measurements in anteroposterior [fAP: 60.97 ± 3.1 vs 54.78 ± 3.3 (P < 0.001), tAP: 46.89 ± 3.0 vs 41.35 ± 2.9 (P < 0.001)] and mediolateral [fML: 74.89 ± 3.2 vs 67.29 ± 3.7 (P < 0.001), tML: 76.01 ± 3.0 vs 67.26 ± 3.2 (P < 0.001)], the mean femoral and tibial AP and ML measurements were different from other ethnic groups. None of the seven studied TKA systems matched the largest ML or the smallest AP dimensions of the distal femur in the current study population.ConclusionA significant difference was found between males’ and females’ knee anthropometric characteristics. Some of the commonly used TKA implants in our area could not provide a perfect fit and coverage.Trial registrationClinicalTrials.gov identifier: NCT03622034, registered on July 28, 2018.

Frequency and Causes of False Negative Diffusion-Weighted Imaging in Acute Ischemic Stroke

Objective: The high sensitivity of diffusion-weighted magnetic resonance imaging (DWI MRI) has led to its frequent use in the diagnosis of acute ischemic stroke (AIS). However, false negative DWI MRI results have been obtained for some patients diagnosed with stroke, which led us to initiate this study. Our aim was to determine the prevalence of false negative DWI MRI scans and prevent the clinician from making a late diagnosis or misdiagnosis by relying on MRI results only.Methods: In a retrospective file screening conducted between February 2017- February 2019, after the patients hospitalized with a diagnosis of ischemic stroke who couldn't have an MRI or who were diagnosed with transient ischemic attack were excluded, the frequency of patients with a normal initial cranial DW MRI scan whose follow up scans revealed acute diffusion restriction was identified, and vascular anatomical localization of stroke was classified according to OCSP (Oxfordshire Community Stroke Project).Results: Of 235 patients admitted to our clinic with a diagnosis of ischemic stroke, 21 couldn't have a DWI MRI, and of 214 stroke patients who had a DWI MRI, 23 were admitted with a transient ischemic stroke attack. Of the remaining 191 patients, 14 had initially negative DWI MRI images but their clinical findings lasted longer than 24 hrs so they had a follow up MRI, which revealed an ischemic lesion in brain diffusion. In our clinic, the percentage of false negative diffusion MR images was 7.3% (14/191). The distribution of ischemia in the aforementioned 14 patients was as follows: 6 patients with posterior circulation ischemia (POCI), including 4 in brain stem and 2 in cerebellum, 2 patients with lacunar stroke (LACI), 5 patients with partial anterior circulation ischemia (PACI) and 1 patient with total anterior circulation ischemia (TACI).When the time of symptom onset was questioned, data could be derived from only 8 patients' files, and DWI MR images were obtained within the first 6 hours according to the onset of the symptoms.Conclusion: In acute stroke patients, if symptoms of the patient are consistent with stroke during physical examination, the diagnosis of stroke should not be automatically ruled out even if brain DWI MRI is negative. The decision of urgent thrombolytic or endovascular intervention that can be taken for eligible patients should not be overlooked based on false negative DWI MRI findings. With this study, we aim to help clinicians avoid misdiagnosis or delays in diagnosis.

Fetal Brain Biometric Measurements on 3D Super-Resolution Reconstructed T2-Weighted MRI: An Intra- and Inter-observer Agreement Study.

We present the comparison of two-dimensional (2D) fetal brain biometry on magnetic resonance (MR) images using orthogonal 2D T2-weighted sequences (T2WSs) vs. one 3D super-resolution (SR) reconstructed volume and evaluation of the level of confidence and concordance between an experienced pediatric radiologist (obs1) and a junior radiologist (obs2). Twenty-five normal fetal brain MRI scans (18–34 weeks of gestation) including orthogonal 3-mm-thick T2WSs were analyzed retrospectively. One 3D SR volume was reconstructed per subject based on multiple series of T2WSs. The two observers performed 11 2D biometric measurements (specifying their level of confidence) on T2WS and SR volumes. Measurements were compared using the paired Wilcoxon rank sum test between observers for each dataset (T2WS and SR) and between T2WS and SR for each observer. Bland–Altman plots were used to assess the agreement between each pair of measurements. Measurements were made with low confidence in three subjects by obs1 and in 11 subjects by obs2 (mostly concerning the length of the corpus callosum on T2WS). Inter-rater intra-dataset comparisons showed no significant difference (p > 0.05), except for brain axial biparietal diameter (BIP) on T2WS and for brain and skull coronal BIP and coronal transverse cerebellar diameter (DTC) on SR. None of them remained significant after correction for multiple comparisons. Inter-dataset intra-rater comparisons showed statistical differences in brain axial and coronal BIP for both observers, skull coronal BIP for obs1, and axial and coronal DTC for obs2. After correction for multiple comparisons, only axial brain BIP remained significantly different, but differences were small (2.95 ± 1.73 mm). SR allows similar fetal brain biometry as compared to using the conventional T2WS while improving the level of confidence in the measurements and using a single reconstructed volume.

Morphometric Study of Lateral Ventricles of Brain by MRI in Healthy Adults in Northern Zone of Bangladesh

Background &amp; Objective: The present study was done to provide information about the morphometric measurement of lateral ventricles of human brain in relation to age and sex in northern Bangladeshi people.&#x0D; Methods: This cross-sectional study was conducted in the Department of Anatomy, Rajshahi Medical College, Rajshahi over a period one year from July 2014 to June 2015. All patients attending at Radiology &amp; Imaging Department of Rajshahi Medical College Hospital and at different private hospitals and clinics of Rajshahi city and had normal MRI scan of brain were the study population. A total of 60 individuals of both sexes and age ranging between 18-50 years were included in the study. Having obtained ethical clearance from the Ethical Committee and verbal consent from the patients, the data collection was commenced. Patients were asked to lie on the MRI table in supine position with head fixed and coil placed around the head. MRI was done with MRI machine (Airis II Hitachi 0.3 Tesla) and images were taken by T1WI, T2WI, STAIR, FLAIR. Images were taken from axial, sagittal and coronal planes with sequence slice thickness being 7 mm. From the images of axial slices, six proper slices were selected.&#x0D; Result: Age distribution of the subjects with respect to sex shows that nearly two-thirds (63.3%) of the female subjects were 30 or younger than 30 years old, whereas 50% of the male subjects were early middle-aged (p = 0.110). The mean lengths of frontal horn of right and left lateral ventricles in male subjects were significantly greater than those in female subjects (p = 0.002 and p = 0.001 respectively). Likewise, the right and left ventricular bodies in male subjects were significantly longer than those of their female counterparts (p = 0.033 and p = 0.012 respectively). The length of frontal horn of the lateral ventricles was found to increase with age up to 40 years in both right and left ventricles and then it began to decrease. The mean lengths of frontal horn of right and left lateral ventricles at ages ≤ 30, 31-40 and &gt; 40 years were 27.25, 28.74 and 26.0 mm and 27.57, 28.93 and 27.19 mm respectively. While the three measures of length of frontal horn of right lateral ventricles were significantly heterogeneous (p = 0.049), the three measures of length of frontal horn of left lateral ventricles were not significantly different (p = 0.141).The mean lengths of body of right and left lateral ventricles at different ages were 40.40, 43.98, 45.11 mm and 41.06, 44.52 and 45.21 mm respectively (p = 0.001 andp = 0.001 respectively).&#x0D; Conclusion: The present study concluded that the lateral ventricles vary in size within certain limit according to age, sex and laterality. All the parameters of lateral ventricles (lengths of frontal horn, length of ventricular body) were significantly larger in males than those in females. While the length of frontal horn of the lateral ventricles (of both sides) increases in size up to the age of 40 years and thereafter regresses, the length of ventricular body bears a linear relationship with age throughout life-span.&#x0D; Ibrahim Card Med J 2020; 10 (1&amp;2): 45-50