Magnetic Resonance Imaging In Patients Research Articles

Advantages of using T1-mapping in cardiac magnetic resonance imaging in patients with acromegaly

Aim. To determine the incidence of interstitial myocardial fibrosis (MF) in acromegaly, which leads to the development of cardiac arrhythmias and conduction disorders. Materials and methods. A single-center study was conducted, including 70 patients with acromegaly. All patients underwent standard medical examinations, including hormonal blood tests, electrocardiograms, echocardiography, Holter monitoring electrocardiograms and magnetic resonance imaging (MRI) of the heart with gadolinium contrast, additionally 48 patients underwent T1-mapping, which is an MRI method that allows the detection of diffuse changes by measuring the values of myocardial relaxation time – T1. Results. The study revealed a high incidence of MF – 53 (75.7%) cases (21 women, 32 men). The duration of the disease was found to be critical for myocardial remodeling (p=0.006). Compliance criteria for the T1-mapping technique were determined, with reduced T1-mapping values observed in 85.2% of cases. The ROC analysis (Receiver Operator Characteristic) determined the diagnostic value of post-contrast T1-mapping: AUC (Area Under the Curve)=0.906 (95% confidence interval 0.789–1.000), a sensitivity of 90%, and a specificity of 76.5%, indicating high diagnostic efficiency. According to the Youden index, a cut-off point of 372.5 ms was selected. Conclusion. Myocardial T1-mapping is a novel MRI method that allows to assess the degree of MF without the need for myocardial biopsy. The obtained information is crucial for the diagnosis and prognostic assessment of heart diseases, particularly in cases of hypertrophic cardiomyopathy or infiltrative diseases. The T1-mapping method, which is actively developing, can serve as a marker for early diffuse myocardial fibrosis and help determine the prognosis for patients with acromegalic cardiomyopathy.

Heterogeneity and Penumbra of White Matter Hyperintensities in Small Vessel Diseases Determined by Quantitative MRI.

White matter hyperintensities (WMHs) are established structural imaging markers of cerebral small vessel disease. The pathophysiologic condition of brain tissue varies over the core, the vicinity, and the subtypes of WMH and cannot be interpreted from conventional magnetic resonance imaging. We aim to improve our pathophysiologic understanding of WMHs and the adjacently injured normal-appearing white matter in terms of microstructural and microvascular alterations using quantitative magnetic resonance imaging in patients with sporadic and genetic cerebral small vessel disease. Structural T2-weighted imaging, multishell diffusion imaging, and dynamic contrast-enhanced magnetic resonance imaging were performed at 3T in 44 participants with sporadic cerebral small vessel disease and 32 participants with monogenic cerebral small vessel disease (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; 59±12 years, 41 males) between June 2017 and May 2020 as part of the prospective, multicenter (Edinburgh, the United Kingdom; Maastricht, the Netherlands; and Munich, Germany), observational INVESTIGATE-SVDs study (Imaging Neurovascular, Endothelial and Structural Integrity in Preparation to Treat Small Vessel Diseases). The mean diffusivity, free water content, and perfusion (all derived from multishell diffusion imaging), as well as the blood-brain barrier leakage and plasma volume fraction (derived from dynamic contrast-enhanced magnetic resonance imaging), were compared between deep and periventricular WMH types using paired t tests. Additional spatial analyses were performed inside and outside the WMH types to determine the internal heterogeneity and the extent of the penumbras, that is, adjacent white matter at risk for conversion to WMH. Periventricular WMH had higher mean diffusivity, higher free water content, and more plasma volume compared with deep WMH (P<0.001, P=0.01, and P<0.001, respectively). No differences were observed in perfusion (P=0.94) and blood-brain barrier leakage (P=0.65) between periventricular and deep WMHs. The spatial analyses inside WMH and the adjacent white matter revealed a gradual gradient in white matter microstructure, free water content, perfusion, and plasma volume but not in blood-brain barrier leakage. We showed different pathophysiological heterogeneity of the 2 WMH types. Periventricular WMHs display more severe damage and fluid accumulation compared with deep WMH, whereas deep WMHs reflect stronger hypoperfusion in the lesion's core. URL: https://www.isrctn.com; Unique identifier: ISRCTN10514229.

Normative Population-Derived Data for MRI Manifestations of Cerebral Small Vessel Disease.

Cerebral small vessel disease (SVD) is manifested on magnetic resonance imaging (MRI) by white matter hyperintensities, lacunes, microbleeds, and atrophy. While these manifestations can be part of normal aging, a high burden has been associated with cognitive impairment and vascular events. Distinguishing between normal versus abnormal SVD lesion burden in clinical practice remains complex. Our objective is to establish age- and sex-specific normative data for MRI manifestations of SVD, to support clinical assessment in individual patients. We used 11 465 MRI scans from 5402 participants of the Rotterdam Study, the Netherlands, an ongoing prospective population-based cohort since 1990, to develop percentile curves for white matter hyperintensities and brain parenchymal fraction and probability curves for the prevalence and count of lacunes and microbleeds, across ages 45 to 100 years, stratified by sex. Participants were primarily White (≈97%), with a mean age at first scan of 64.7 (range, 45.7-97.9) years, and 55.7% being female participants. For all SVD MRI manifestations, the curves demonstrated nonlinear trends, with accelerating burden with advancing age (eg, doubling of white matter hyperintensity fraction every 10 years). Regarding brain parenchymal fraction, a decline was seen earlier in male participants (≈45 years) than female participants (≈60 years) and was more pronounced in male participants over time. Female participants had slightly higher white matter hyperintensity fractions compared with male participants across all ages. Lacunes and microbleeds were more frequently found in male participants than in female participants, and microbleeds were more prevalent than lacunes. We provide comprehensive normative data for different MRI manifestations of SVD, presented as percentile and probability curves by age, stratified by sex. This can aid clinicians to actually quantify the SVD burden on an individual patient's MRI scans and detect patterns of abnormality.

Hepatic Tissue Alterations in ST-Elevation Myocardial Infarction: Determinants and Prognostic Implications.

The presence and clinical significance of hepatic tissue alterations as assessed by cardiac magnetic resonance imaging in patients with ST-segment-elevation myocardial infarction (STEMI), are unclear. This study aimed to investigate associations of hepatic T1 patterns with myocardial tissue damage and clinical outcomes in patients suffering from STEMI. We analyzed 485 patients with STEMI treated with percutaneous coronary intervention who were enrolled in the prospective magnetic resonance imaging in acute ST-elevation myocardial infarction study (MARINA STEMI). Myocardial function and left and right ventricular (RV) infarct characteristics were assessed by cardiac magnetic resonance within the first week after STEMI. Native hepatic T1 times and extracellular volume were evaluated from standard cardiac T1 maps at baseline and 4 months thereafter. Median hepatic T1 times were 559 ms (interquartile range, 514-605) at baseline and decreased to 542 ms (interquartile range, 507-577) at 4 months (P<0.001). Hepatic T1 times at baseline were independently associated with female sex (β 0.116; P=0.008), hyperlipidemia (β -0.116; P=0.008), and myocardial tissue damage (infarct size: β 0.178; P<0.001; microvascular obstruction: β 0.193; P<0.001; RV infarction: β 0.161; P<0.001). Determinants of hepatic T1 times at 4 months were female sex (β 0.123; P=0.002), multivessel disease (β 0.121; P=0.002), N-terminal pro-B-type natriuretic peptide (β 0.101; P=0.010), RV infarction (β 0.501; P<0.001), and RV end-systolic volume index (β 0.087; P=0.031). Patients without a decrease exhibited a higher frequency of major adverse cardiovascular events (13% versus 5%; P=0.003). Hepatic T1 times at baseline (hazard ratio, 1.87 [95% CI, 1.40-2.50]; P<0.001), 4 months (hazard ratio, 2.69 [95% CI, 2.15-3.36]; P<0.001), and hepatic extracellular volume at 4 months (hazard ratio, 1.59 [95% CI, 1.33-1.90]; P<0.001) were associated with major adverse cardiovascular events. After adjustment for univariable associates, only hepatic T1 times at 4 months were independently associated with adverse outcomes (hazard ratio, 2.86 [95% CI, 1.99-4.12]; P<0.001). Hepatic tissue alterations determined by T1 mapping were associated with female sex, hyperlipidemia, multivessel disease, N-terminal pro-B-type natriuretic peptide, and left and RV myocardial tissue damage. These alterations can persist into the chronic phase after STEMI and indicate a worse clinical outcome. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04113356.

Pancreatic volume, fat content and T1 relaxation time using magnetic resonance imaging in patients with prior gestational diabetes mellitus.

To compare the volume, fat content, and T1 relaxation time of the pancreas in participants with and without prior gestational diabetes mellitus (GDM). In this prospective case-control study, we enrolled 29 women with prior GDM, and divided them into three groups (normoglycemic, prediabetic, and diabetic) based on their glycaemic status in the postpartum period; and a group of 13 participants as controls who had normoglycemia during pregnancy. Participants underwent MR examination including an axial multi-echo DIXON-based sequence and an axial-oblique T1 mapping sequence. The average proton density fat fraction (PDFF) and T1 value of the pancreas were measured by drawing multiple circular regions of interest (ROIs). Average hepatic PDFF was similarly calculated. Pancreatic volume was computed by summating cleaned freehand ROIs outlining pancreatic parenchyma. Women were evaluated at a mean age of 32.9 ± 4.0 years and with a mean BMI of 25.2 ± 2.9kg/m2. The median (IQR) duration of follow-up after childbirth was 24 (34-44) months. In controls, the pancreatic PDFF, T1 value, and volume were 5.4 ± 2.3%, 850.6 ± 101.6 ms, and 69.3 ± 16.2cm³, respectively, while in subjects with a history of GDM, these values were 4.7 ± 2.0%, 844.6 ± 91.8 ms, and 69.8 ± 16.6cm³, respectively. No statistical differences were observed (all p > 0.05). Mean hepatic PDFF was significantly higher in the diabetic and prediabetic groups (12.2 ± 6.4% and 11.0 ± 7.6% respectively) than in the control and normoglycemic groups (7.9 ± 7.3 and 4.7 ± 1.6% respectively; p -0.01). We did not find any significant changes in pancreatic volume, fat content, or fibrosis in women with prior GDM and with different glycaemic categories when evaluated in the early postpartum period, compared to the control group. These findings may be a consequence of the transient state of insulin resistance in GDM and the finite duration of the disease course in new-onset prediabetes and diabetes patients.

Comparing HeartModelAI and cardiac magnetic resonance imaging for left ventricular volume and function evaluation in patients with dilated cardiomyopathy

BackgroundIntegration of artificial intelligence enhances precision, yielding dependable evaluations of left ventricular volumes and ejection fraction despite image quality variations. Commercial software like HeartModelAI provides fully automated 3DE quantification, simplifying the measurement of left chamber volumes and ejection fraction. In this manuscript, we present a cross-sectional study to assess and compare the diagnostic accuracy of automated 3D echocardiography (HeartModelAI) to the standard Cardiac Magnetic Resonance Imaging in patients with dilated cardiomyopathy.MethodsIn this cross-sectional study, 30 patients with dilated cardiomyopathy referring to the Tehran Heart Center with cardiac magnetic resonance imaging and comprehensive 3D transthoracic echocardiography within 24 h were included. All 3D volume analysis was performed with fully automated quantification software (HeartModelAI) using 3D images of 2,3, and 4-chamber views at the end of systole and diastole.ResultsExcellent Inter- and Intra-observer correlation coefficient was reported for HeartModelAI software for all indexes. HeartModelAI displayed a remarkable correlation with cardiac magnetic resonance for left ventricular end-systolic volume index (r = 0.918 and r = 0.911); nevertheless, it underestimated left ventricular end-systolic volume index and left ventricular end-diastolic volume index. Conversely, ejection fraction, stroke volume, and left ventricular mass were overestimated. It was found that manual contour correction can enhance the accuracy of automated model estimations, particularly concerning EF in participants needing correction.ConclusionHeartModelAI software emerges as a rapid and viable imaging approach for evaluating the left ventricle’s structure and function. In our study, LV volumes assessed by HeartModelAI demonstrated strong correlations with cardiac magnetic resonance imaging.

Cerebrovascular Function in Sporadic and Genetic Cerebral Small Vessel Disease

ObjectiveCerebral small vessel diseases (SVDs) are associated with cerebrovascular dysfunction, such as increased blood–brain barrier leakage (permeability surface area product), vascular pulsatility, and decreased cerebrovascular reactivity (CVR). No studies assessed all 3 functions concurrently. We assessed 3 key vascular functions in sporadic and genetic SVD to determine associations with SVD severity, subtype, and interrelations.MethodsIn this prospective, cross‐sectional, multicenter INVESTIGATE‐SVDs study, we acquired brain magnetic resonance imaging in patients with sporadic SVD/cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), including structural, quantitative microstructural, permeability surface area product, blood plasma volume fraction, vascular pulsatility, and CVR (in response to CO2) scans. We determined vascular function and white matter hyperintensity (WMH) associations, using covariate‐adjusted linear regression; normal‐appearing white matter and WMH differences, interrelationships between vascular functions, using linear mixed models; and major sources of variance using principal component analyses.ResultsWe recruited 77 patients (45 sporadic/32 CADASIL) at 3 sites. In adjusted analyses, patients with worse WMH had lower CVR (B = −1.78, 95% CI −3.30, −0.27) and blood plasma volume fraction (B = −0.594, 95% CI −0.987, −0.202). CVR was worse in WMH than normal‐appearing white matter (eg, CVR: B = −0.048, 95% CI −0.079, −0.017). Adjusting for WMH severity, SVD subtype had minimal influence on vascular function (eg, CVR in CADASIL vs sporadic: B = 0.0169, 95% CI −0.0247, 0.0584). Different vascular function mechanisms were not generally interrelated (eg, permeability surface area product~CVR: B = −0.85, 95% CI −4.72, 3.02). Principal component analyses identified WMH volume/quantitative microstructural metrics explained most variance in CADASIL and arterial pulsatility in sporadic SVD, but similar main variance sources.InterpretationVascular function was worse with higher WMH, and in WMH than normal‐appearing white matter. Sporadic SVD‐CADASIL differences largely reflect disease severity. Limited vascular function interrelations may suggest disease stage‐specific differences. ANN NEUROL 2024

Correction to: Routine application of cardiac magnetic resonance imaging in patients with suspected myocarditis from immune checkpoint inhibitor therapy.

Correction to: Routine application of cardiac magnetic resonance imaging in patients with suspected myocarditis from immune checkpoint inhibitor therapy.

A real-life clinical application of cardiac magnetic resonance imaging in patients with acute myocarditis - one-center observational retrospective study.

The diagnosis of acute myocarditis is complex, with cardiac magnetic resonance (CMR) being a recommended diagnostic method. This study aimed to evaluate the real-life use of CMR in the diagnosis of acute myocarditis and to correlate CMR results with the degree of myocardial damage. This is a retrospective, observational tertiary single-center study of 90 consecutive patients (F/M:18/72, mean age:39 ± 14 years) hospitalized between 2015-2022 with a clinical diagnosis of acute myocarditis. The study population was divided into two groups: patients who underwent CMR+ and those who did not undergo CMR - In the CMR+ group, various sequences, including T1/T2-weighted imaging, late gadolinium enhancement (LGE), and mapping techniques, were used to assess myocardial inflammation and damage. CMR was performed in 39 patients (43.3%, F/M:10/29, mean age:41 ± 16 years). In this group, myocardial edema (increased T2 signal intensity) was detected in 29 patients, and LGE (signal intensity 2 standard deviations cabove normal on T1 images) was found in 39 patients. Diagnosis based on Lake Louise Criteria was possible in 29 cases. Edema negatively correlated with TnT levels (r = -0.412, p < 0.05) and positively with the number of LGE segments (r = 0.372, p < 0.05). Significant correlations were found between LVEF and LGE mass (r = -0.360, p < 0.05), and maximal TnT levels (r = -0.38, p < 0.05). CMR+ patients had lower myocardial damage markers and CRP concentrations compared to CMR- patients. CMR is underused in diagnosing acute myocarditis. Myocardial damage markers correlate with CMR-detected edema and volumetric measures, but not LGE extent. More research is needed to enhance risk assessment and treatment.

Morphometric evaluation of the proximal tibiofibular joint among patients with knee joint pain: A pilot study and literature review

Objectives: The proximal tibiofibular joint (PTFJ) serves as a crucial stabilizing component of the entire knee joint complex. Morphometric analysis of the PTFJ can lead to clinically significant conclusions for orthopedic specialists and physiotherapists. The aim of the study was to assess the values of the inclination angle of the PTFJ in the sagittal and coronal planes using magnetic resonance imaging in patients with knee pain. Material and Methods: Measurements of the inclination angle were conducted on 48 patients divided into three groups: Those with damaged medial meniscus (M), those with knee joint cartilage damage (Ca), and the control group (C), in which no deviations from normality were observed in the analyzed imaging study. Results: The mean values of the tibiofibular joint inclination angle in the frontal plane were as follows: (C) 16.927° ± 1.778; (Ca) 16.822° ± 2.537; (M) 14.958° ± 1.760. In the sagittal plane, the corresponding values were: (C) 38.155° ± 1.524; (Ca) 39.392° ± 1.927; (M) 37.471° ± 1.165. Although the mean tibiofibular joint inclination angle was lowest in the group with medial meniscus injury when compared to the control group, these differences did not reach statistical significance. Conclusion: Measuring and observing the variety of PTFJ inclination angles among patients are conducive to better understanding its influence on knee pain. The differences in the PTFJ inclination angle between groups in our pilot study were not statistically significant. Consequently, the study necessitates replication within a substantial population cohort.

Changes in the functional connections of the brain in patients with hypersomnia in acute ischemic stroke

BACKGROUND: The Disorders of cerebral circulation and sleep are inextricably related, since sleep disorders, including hypersomnia, are closely intertwined with cardiovascular diseases and increase the risk of stroke. Research works on visualization of functional brain changes in patients with sleep disorders and acute ischemic stroke are very few and need more study. AIM: to determine the functional connections of the brain in hypersomnia in patients with acute ischemic stroke by performing functional magnetic resonance imaging at rest. A study of 40 patients with acute ischemic stroke and sleep disorders was performed on the basis of the Federal State Budgetary Institution Almazov Research Center of the Ministry of Health of the Russian Federation. All patients underwent neurological examination, assessment of sleepiness, worry and depression, magnetic resonance imaging was performed on tomographs with a magnetic field induction force of 1.5T, using a standard protocol and special pulse sequences of T-gradient echo 3D MPRAGE and BOLD. Functional magnetic resonance imaging of the brain at rest was used to assess functional connections. Postprocessing was performed using specialized CONN-TOOLBOX software with an appropriate graphical representation of quantitative results based on the selection of areas of interest. RESULTS: Among the examined patients, 23 had hypersomnolence; of these, 8 patients were diagnosed with secondary hypersomnia associated with sleep apnea syndrome. Thus, in the examined sample, post-stroke hypersomnolence was detected in 15 patients (34%). Patients with an unspecified subtype of stroke and right-sided lesions showed a high degree of drowsiness (p 0.05). With the help of functional magnetic resonance imaging of the brain at rest, changes in functional connections between the main nodes of the default mode network with the left temporal pole, cerebellum, central cerebral cortex on the left, angular gyrus on the left, with the dorsal attention network on the right are determined (p 0.05). CONCLUSION: The use of complex magnetic resonance imaging, which includes structural and functional magnetic resonance imaging in patients with acute ischemic stroke and sleep disorders, allows us to identify structural changes and changes in functional connectivity and identify neuroimaging markers of this pathology. Hypersomnolence is typical for patients with an unspecified subtype of ischemic stroke and damage to the right hemisphere of the brain.

Resting state functional magnetic resonance imaging in patients with multiple sclerosis before and after high-dose immunosuppressive therapy and autologous hemopoietic stem cell transplantation

BACKGROUND: Multiple sclerosis is a chronic autoimmune disease characterized by multifocal foci of demyelination in the central nervous system, usually affecting people of working age. The disease causes damage to the blood-brain barrier, the development of multifocal inflammation, destruction of the myelin sheath of axons and various degrees of damage. It is clinically manifested by restriction of motor activity, visual acuity, as well as other symptoms leading to loss of performance and disability of the patient. AIM: determination of changes in the functional connectivity of brain neural networks in patients with multiple sclerosis before and after high-dose immunosuppressive therapy and autologous hematopoietic stem cell transplantation by performing functional magnetic resonance imaging at rest. MATERIALS AND METHODS: The data of functional magnetic resonance imaging of patients with multiple sclerosis were analyzed in dynamics before and after the use of high-dose immunosuppressive therapy followed by autologous hematopoietic stem cell transplantation. The study involved 25 patients with a verified diagnosis of multiple sclerosis. Each underwent complex magnetic resonance imaging at two time points (before and after high-dose immunosuppressive therapy followed by autologous hematopoietic stem cell transplantation) with a difference of 12 months, which included structural magnetic resonance imaging - in order to exclude the presence of pathological foci in the brain (in addition to foci of multiple sclerosis) and functional magnetic resonance imaging.-resonance imaging at rest — to assess functional connectivity. Also, according to the method generally accepted in classical neurology, a clinical neurological examination was performed. RESULTS: At the stage of comparing data on the two groups obtained using functional magnetic resonance imaging at rest, changes in functional activity were detected in various parts of the brain, presumably responsible for clinical differences in the studied groups. CONCLUSION: Currently, the links between brain structures and morphological changes that cause cognitive impairment in multiple sclerosis are being studied. To predict the progression of the disease, the development of biomarkers, including those based on functional magnetic resonance imaging, is required. Evaluating changes in the functional connectivity of brain neural networks can help personalize therapeutic and rehabilitation approaches.

Functional study of the brain based on magnetic resonance imaging in patients with insomnia disorders

BACKGROUND: Insomnia has a significant impact on the quality of life of patients. Despite the progress in understanding the pathophysiological mechanisms of insomnia, the possibilities of its objective diagnosis remain insufficiently studied. This study can contribute to understanding the neural mechanisms of insomnia, contribute to the development of new diagnostic and treatment methods, and personalize therapeutic approaches to improve the quality of life of patients with insomnia disorders. AIM: to evaluate changes in the brain connectome in patients with psychophysiological and paradoxical insomnia by performing functional magnetic resonance imaging. MATERIALS AND METHODS: A total of 31 patients were examined who applied for a somnologist appointment at the Federal State Budgetary Institution Almazov National Medical Research Centre of the Ministry of Health of the Russian Federation with diagnosed chronic insomnia. All patients underwent polysomnographic examination using Embla N 7000 (Natus, USA) and SOMNO HD (SOMNOmedics, Germany) for one night with an assessment of the main characteristics of sleep according to the rules of AASM 2.5. Also, all study participants underwent magnetic resonance imaging of the brain on tomographs with a magnetic field induction force of 3.0 Tl at two time points. Statistical analysis of MRI data was performed using MathLab 2023a, CONN v22.a packages. Descriptive statistics, the Kolmogorov–Smirnov criterion were used for processing materials, depending on the characteristics of the data, the Mann–Whitney U-criterion and Pearson Chi-squared were used to analyze demographic data. DISCUSSION: The study demonstrates the possibilities of functional magnetic resonance imaging in obtaining data on the functional connections of the brain in insomnia. The detected changes in the activity of various brain regions indirectly or directly involved in the regulation of sleep and wakefulness are consistent with the most common pathogenetic models of insomnia, in particular with the theory of hyperactivation and the model of sleep reactivity to stress. CONCLUSION: The results of the study emphasize the relevance of studying functional changes in the brain in insomnia, opening up new opportunities for more accurate diagnosis and the development of personalized treatment methods.

Magnetic resonance imaging in patients with cardiac implantable electronic devices: the RESONANCE Spanish registry.

Despite increasing evidence demonstrating the safety of magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs), this procedure is often neglected in this population. This Spanish registry aimed to determine the proportion of MRI referrals and performance among patients with pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). This prospective, multicenter, open-label registry involved 21 Spanish centers. Data were collected upon implant of PMs or ICDs from BIOTRONIK and one year after, and included the number of MRIs and computed tomography scans prescribed, performed and denied, and reasons for denial. Data from 1105 patients (mean age: 74.2 years) were analyzed and 982 completed the follow-up. Of them, 82.2% had a PM and 17.8% an ICD. A total of 351 imaging tests were prescribed in 220 patients (19.9%), including 52 MRIs in 39 patients (3.5%) and 299 computed tomography scans in 196 patients (17.8%). Among the MRIs, 44 (84.6%) were performed, five (9.6%) were not performed, and three (5.8%) were replaced by an alternative test. Most of the indicated computed tomography scans were performed (97.7%). The proportion of patients with an MRI scan referral was 4.6% during the pre-COVID-19 period and 2.6% during the COVID-19 period. No MRI-related arrhythmic ventricular event was reported. This registry revealed that only 3.5% of patients with CIEDs had an MRI referral over the study, with rates decreasing to 2.6% during the COVID-19 period. These rates contrast with the 85 MRIs conducted per 1000 inhabitants in Spain in 2020.

Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry Analysis

IntroductionOsimertinib is now a standard first-line (1L) therapy for EGFR-mutated (EGFRm) advanced NSCLC. We aimed to characterize patterns of therapy and longitudinal risk of brain and liver metastasis in a cohort of EGFRm NSCLC. MethodsPatients with metastatic EGFRm NSCLC who received 1L systemic therapy at sites within the Academic Thoracic Medical Investigator’s Consortium were included; demographic and clinical data including treatment patterns were described. Analyses of overall survival, time to next treatment, and incident brain and liver metastasis were performed using the Kaplan-Meier method, Cox regression, and cumulative incidence functions on patients who started 1L therapy in 2015 or later. ResultsThe full cohort included 1132 patients and the mean age of the participants was 63.4 years; among the participants, 53% were White individuals, 68% were female individuals, and 67% were nonsmokers. Among the participants, 830 patients received 1L systemic therapy in 2015 or later. The predominant first EGFR–tyrosine kinase inhibitor was erlotinib (65%) before 2018 and osimertinib (81%) after 2018. The median time to the next treatment after the start of 1L therapy was 13.9 months overall and the longest in patients receiving 1L osimertinib (28 months). In the post-2015 cohort, the baseline prevalence of brain metastasis (BM) was 54% and among patients without baseline brain metastasis, the probability of incident BM at 12, 24, and 48 months was 8%, 22%, and 44%, respectively. Development of an on-treatment brain metastasis among patients without baseline brain metastasis was associated with a 3.2 times higher risk of death. ConclusionEven in a contemporary era with prevalent osimertinib use, the baseline and longitudinal risk of BM development was high. The ongoing risk of developing BM, together with the associated survival detriment, argues for routine surveillance of the brain through magnetic resonance imaging for patients with EGFRm NSCLC, which is not currently included in the guidelines.

Routine application of cardiac magnetic resonance imaging in patients with suspected myocarditis from immune checkpoint inhibitor therapy

Abstract Background Cardiovascular adverse events including myocarditis associated with immune checkpoint inhibitor (ICI) therapy remain a challenge in clinical practice. Diagnostic assessment of ICI-related myocarditis (ICI-M) is challenging due to a variable phenotype, confounding effects and limited sensitivity of diagnostic tools. Cardiac magnetic resonance imaging (CMR) is used to diagnose non-ICI myocarditis, but evidence on diagnostic sensitivity is low, particularly in patients with a discrete phenotype. Here, we aim to assess the impact of CMR in patients with suspected ICI-related myocarditis and relate to final diagnosis including endomyocardial biopsy findings. Methods All consecutive patients receiving CMR for suspected ICI-M between September 2019 and January 2024 were included and retrospectively analysed. CMR parameters were correlated with clinical, laboratory and echocardiographic parameters and stratified for presence or absence of myocarditis as per final diagnosis. Results A total of 55 patients who received CMR for suspected ICI-related myocarditis were analysed, including 25 patients with confirmed ICI-M as per final diagnosis and 30 patients with cardiotoxicity other than myocarditis or no cardiotoxicity (ICI-O). The mean age (ICI-M versus ICI-O) was 65.7±13.6 versus (vs.) 67.3±9.9 (p=0.61) years, 32.0% vs. 26.7% (p=0.67) were female, and 40.0% vs. 26.7% (p=0.29) had pre-existing coronary heart disease. Cardiac biomarkers and echocardiographic data did not differ between the groups. In CMR analysis, presence of late gadolinium enhancement (LGE) was associated with ICI-M (56.0% vs. 26.7%, p=0.027). Myocardial oedema was generally rare and not associated with ICI-M. Endomyocardial biopsy (EMB) was used in 6 out of 55 patients (10.9%) with suspected ICI-M. In 4 of these 6 patients (66.7%) EMB confirmed ICI-M diagnosis. Of note, only 2/4 patients with EMB-confirmed myocarditis showed abnormal CMR findings. Conclusion The diagnostic assessment of ICI-M is challenged by low sensitivity of common diagnostic measures, often requiring a multimodal approach. Presence of LGE in CMR was associated with ICI-M, but sensitivity and specificity are low. Our data emphasize the high value of EMB in patients with clinically suspected ICI-M despite inconspicuous CMR. Prospective data to improve diagnostic criteria are needed.

Assessment of sub clinical right ventricular ischemia using oxygen sensitive cardiac magnetic resonance imaging in patients with systemic sclerosis: mechanistic insights from advanced cardiac imaging

Abstract Background Cardiac involvement in Systemic Sclerosis (SSc) is common, with manifestations ranging from subclinical to life-threatening 1. Cardiopulmonary complications, including, right ventricular (RV) dysfunction is the leading cause of SSc-related mortality2. Pulmonary arterial hypertension (PAH) occurs in 8-12% of SSc patients and remains a leading cause of death, with a 3-year survival rate around 50%2. The progressive decline in RV function in PAH is often attributed to RV ischemia3. Oxygen Sensitive Cardiac Magnetic Resonance imaging (OS-CMR) has been previously used by our group to assess RV myocardial oxygenation in patients with PAH3, including SSc-associated PAH 3. The objective of this study was to use OS-CMR to assess RV myocardial oxygenation in SSc patients prior to the onset of PAH. Methodology In this prospective, multicentre study, three study groups were established. Group 1 comprised SSc patients without PAH or known cardiac disease. Group 2 included stable PAH patients confirmed by right heart catheterization, matched for age and sex, but without SSc. Group 3 comprised healthy normal volunteers (NV), matched for age and sex. All patients underwent a 3T CMR which included: cine images, rest cine OS-CMR, stress cine OS-CMR, native T1 mapping, stress perfusion, and late gadolinium enhancement (LGE). The primary outcome was change in inferior RV myocardial signal intensity (SI) in diastole, measured by the change in OS-CMR between rest and stress within each group. Two experienced independent reviewers performed the CMR analysis with an inter-assessor correlation coefficient of 0.8, 95% Cl [0.3, 0.9]. Results A total of 44 patients were enrolled. Of these, n=26 group 1 (SSc), n=8 group 2 (PAH), n=10 group 3 (NV). Study results are listed in Table 1. Mean age within the SSc, PAH, and NV groups were 59±10, 67±12 and 57 ±7 years respectively (p=0.482). The RV OS-CMR SI was significantly lower in the SSc group when compared to the NV group (p=0.017). In contrast, there was no significant difference between the PAH and SSc groups (p=0.426), indicating a similar degree of RV ischemia in the established PAH patients and the SSc patients. All SSc patients exhibited inferior and anterior RV insertion fibrosis, with no perfusion defects noted. Five (19%) of SSc patients presented with LGE hyperenhancement in the LV. Eighteen (69%) of SSc patients obtained at least 1 abnormal T1 mapping segment in the LV. Conclusion SSc patients without overt PAH had a similar degree of RV ischemia when compared to patients with overt PAH from other causes. Our findings imply that in SSc, RV adverse effects occur prior to the onset of PAH, and that this effect is mediated by RV ischemia secondary to changes in the microvasculature. Our findings may have screening and/or therapeutic implications.

Reverse myocardial remodeling according to cardiac magnetic resonance imaging in patients with heart failure and atrial fibrillation receiving dapagliflozin

Aim. To determine the effect of dapagliflozin on cardiac remodeling parameters and left ventricular mass according to cardiac magnetic resonance imaging in patients with heart failure (HF) with reduced ejection fraction (EF) and atrial fibrillation (AF).Material and methods. The study included 60 patients with HF and AF receiving triple therapy for heart failure for at least 3 months, which were divided into two groups. Patients in the first group (1) were prescribed dapagliflozin, while patients in the second group (2) formed the comparison group. The study analyzed the following cardiac remodeling parameters and left ventricular (LV) mass measured using cardiac magnetic resonance imaging at baseline and after 6 months.Results. Dapagliflozin led to a significant increase in LVEF from 29±6 (27-31) to 37±9 (33-40)% (p&lt;0,001), and a decrease in the volumetric and linear dimensions of the LV and left atrium as follows: end-diastolic dimension from 70 (64-73) to 63 (60-70) mm (p&lt;0,001), end-systolic dimension from 55±7 (52-58) to 50±7 (47-52) mm (p&lt;0,003), end-diastolic volume from 239±50 (220-258) to 207±43 ml/m2 (191-223) (p&lt;0,001), end-systolic volume from 170±40 (155-185) to 140±33 ml/m2 (p&lt;0,001), left atrium from 48±5 (46-49) to 44±6 (42-46) mm (p&lt;0,001), and a decrease in LV mass from 156,5 (130-180) to 109 (98-145) g (p=0,001).Conclusion. In patients with HF with reduced LVEF and AF, dapagli­flozin therapy promotes reverse myocardial remodeling processes and increases cardiac contractility.

Sympathetic activity markers in patients with resistant hypertension with renal dysfunction

Aim. To study the informativeness of sympathetic activity markers and perirenal adipose tissue (PRAT) in assessing renal function decline in patients with resistant hypertension (RH).Material and methods. The study included 63 patients with RH of both sexes aged 40-80 years. The main group included 19 patients with chronic kidney disease (CKD). The control group consisted of 44 patients with RH without CKD. All patients were assessed for uric acid, blood lipid profile, beta-adrenergic reactivity of erythrocyte mem­branes, free metanephrine and normetanephrine in plasma and 24-hour urine. The renal function was assessed by the glomerular filtra­tion rate calculated using the CKD-EPI equation. Twenty-four hour blood pressure monitoring was performed on the brachial artery of one arm at intervals of 15 minutes during the day and 30 minutes at night. Kidney size and PRAT were calculated based on the magnetic reso­nance imaging.Results. In both groups of patients, a significant increase in blood normetanephrine and beta-adrenergic reactivity of erythrocyte mem­branes relative to the reference values was shown. Blood and 24-hour urine metanephrine were within the reference intervals. No differences were found between the sympathetic activity indices in the main and control groups. In the main group patients, the PRAT thickness was greater (p=0,013), and the kidney diameter was smaller (p=0,046) than in the control group patients.Conclusion. CKD in RH patients is not accompanied by additional significant changes in sympathetic regulation, assessed by the blood and 24-hour urine catecholamine levels, the degree of beta-adrenergic receptor desensitization and variability of blood pressure. PRAT increase according to magnetic resonance imaging in patients with RH is associated with a decrease in renal filtration function.

Morphometric evaluation of facial and vestibulocochlear nerves using magnetic resonance imaging in patients with Menière's disease.

Menière's disease (MD) is a condition of unknown etiology, involving genetic predisposition, autoimmune processes, viral infections, cellular apoptosis, and oxidative stress. This study aimed to investigate potential differences in the VIIth and VIIIth cranial nerves in MD patients using Hydrops-MRI (FLAIR) for morphometric evaluations. Using a 3T MRI scanner, constructive-interference-in-steady-state (CISS) and 3D-FLAIR-inversionrecovery (FLAIR) sequences were acquired. We evaluated the morphometrics of the VIIth and VIIIth cranial nerves from the cerebellopontine angle to the internal auditory canal fundus, comparing the non-affected and affected sides. Furthermore, we examined the findings in relation to symptom duration and evaluated feasibility of FLAIR-imaging in morphometry of cranial nerves. A total of 53 MD patients with unilateral symptoms were included. After statistical analysis, no significant differences were found regarding morphometric changes in the affected side compared to the non-affected side of the VIIth and VIIIth cranial nerves. There was also no significant difference between morphometric evaluations of patients with different symptom durations. The morphometric evaluation using Hydrops-MRI-Sequences (FLAIR) showed no significant difference compared to established morphometric highly T2-weighted imaging (CISS). Our data found no differences in nerve morphometry between clinically non-affected and affected sides in unilateral MD patients, nor any correlation with symptom duration. This contrasts with previous findings of correlations between clinical features and endolymphatic hydrops. A disease process starting before clinical symptom onset could be a possible explanation. Morphometric evaluation of brain nerves using Hydrops-MRI-Sequences is practical and provides similar results to T2-weighted imaging, improving patient comfort and reducing MRI scan time. CN = cochlear nerve; CPA = cerebellopontine angle; CSA = cross-sectional area; FN = facial nerve; IAC = internal auditory canal; IVN = inferior vestibular nerve; LD = long diameter; MD = Menière's disease; SD = short diameter; SVN = superior vestibular nerve.