Positive Magnetic Resonance Imaging Findings Research Articles

Pediatric Cervical Spine Clearance after Blunt Trauma and Negative CT: What is the Role of MRI?

Background and purposeThe cervical spine in children has marked anatomical and biomechanical differences compared to adults, leading to significantly different patterns and incidence of spinal injury, and consequently to different X-Ray and computed tomography (CT) imaging recommendations. Magnetic resonance imaging (MRI) has been validated to clear cervical spine trauma in adults, but not in pediatric patients. We hypothesized that MRI findings have a low probability to change management in children with spine trauma and negative CT findings. Materials and methodsWe reviewed records for admitted pediatric patients due to blunt trauma from January 2011 to May 2021, and identified 212 patients who underwent MRI within 3 days of a negative CT. Two neuroradiologists independently reviewed all CT and MRI images for the following categories: fracture, subluxation, spinal canal compromise, ligamentous injury, spinal canal hemorrhage, cord contusion and soft tissue hemorrhage. We identified follow-up MRI examinations as negative or positive for the above categories, and calculated the prevalence of each category as a percentage of cases with negative CT. We also evaluated whether negative and positive MRI groups differed significantly with respect to age and sex of the patients. Results and conclusionsIn our study of 212 children with cervical spine trauma and a negative CT, most follow-up MRI scans were found to be negative (79.9%). Positive MRI findings consisted mainly of ligamentous sprain without disruption (15.1%). Ligamentous disruption and epidural or soft tissue hemorrhage were found in 4.5%, and focal cord contusion in 0.5%. There was no statically significant difference between negative and positive MRI groups with respect to age (P = 0.45) and sex (P = 0.52). ConclusionIn our patient group with a negative CT, MRI did not significantly impact management nor contribute to cervical spine clearance in children.

Predictive Factors for Extracapsular Extension of Prostate Cancer to Select the Candidates for Nerve-sparing Radical Prostatectomy.

Nerve-sparing radical prostatectomy (NSRP) for prostate cancer (PC) enables better postoperative recovery of continence and potency but may increase the risk of positive surgical margins. This study aimed to investigate preoperative predictive factors for extracapsular extension (ECE) of PC to select patients for NSRP. We retrospectively evaluated 288 patients with PC (576 lobes) diagnosed with 12-core transrectal ultrasound-guided biopsy and magnetic resonance imaging (MRI) who underwent laparoscopic or robot-assisted radical prostatectomy at our institution. Surgical specimens and preoperative parameters (prostate-specific antigen, prostate volume, biopsy and MRI findings, preoperative therapy) were analyzed. Of 576 prostate lobes, the incidence Ipsilateral ECE was identified in 97 (16.8%) lobes. The higher number of unilateral positive biopsy cores, the highest Gleason score 8 or more and positive unilateral findings on MRI are significant higher in prostate sides with ECE in univariate analysis. In multivariate analysis, positive unilateral MRI findings (odds ratio [OR], 2.86; p < 0.001) and unilateral biopsy positive core ≥ 3 (OR, 3.73; p < 0.001) were independent predictors of unilateral ECE. The detection rate of unilateral ECE in those cases with two factors (side-specific positive biopsy core 2 or less and side-specific MRI findings negative) was 7.1% (19/269). Patients with fewer unilateral positive biopsy cores and negative unilateral MRI findings might be good candidates for NSRP.

MRI findings of peroneal tendon tears do not necessarily correlate to clinical findings in paediatric and adolescent patients.

Pathologic abnormality of the peroneal tendons are thought to be an under-appreciated source of vague ankle and hindfoot pain in paediatric patients, partly because they can be difficult to diagnose and differentiate from lateral ankle ligament injuries. While magnetic resonance imaging (MRI) is the primary imaging modality used to detect peroneal tendon pathology, previous studies in adults have found that positive MRIs demonstrate a positive predictive value (PPV) of associated clinical findings around 48%. There are no similar known published studies in the paediatric population. Our objective was to determine the positive predictive value of peroneal tendon pathology as diagnosed by MRI as related to positive clinical exam findings in the paediatric and adolescent population. This IRB approved retrospective study was conducted at a tertiary children's hospital. Inclusion criteria included patients under 18years from our tertiary care institution with (a) ankle MRI findings indicating pathology of the peroneus brevis/longus tendons confirmed by a board certified paediatric musculoskeletal radiologist and (b) formal review of the clinical examination by a fellowship trained paediatric orthopaedic surgeon. Patients with congenital deformities or previous surgical intervention of the lateral ankle were excluded. Forty-seven patients (with 48 MRIs) met inclusion criteria over a tenyear period. The majority of the positive MRI scans (70%) demonstrated a peroneus brevis split tear. Of the patients with positive findings on MRI, 17 patients had an associated positive clinical exam. The positive predictive value of MRI for peroneal tendon tears with positive clinical findings was 35.41% (95% confidence interval = 31.1% to 41.6%). There were 31 patients with MRI positive findings with a negative clinical exam. Despite having a negative clinical exam, a high percentage of patients had positive MRI findings suggestive of peroneal tendon pathology which confirms findings of adult populations demonstrating a high rate of incidental finding of peroneal tendon pathology on MRI in paediatric patients.

A Cross-sectional Study on Neuroimaging in Epilepsy: Diagnostic Value of T2 Relaxometry in Mesial Temporal Lobe Epilepsy

Introduction: The use of Magnetic Resonance Imaging (MRI) T2 relaxometry and spectroscopy has added new dimensions to the imaging of Temporal Lobe Epilepsy (TLE). Advanced techniques like MRI diffusion and MRI perfusion are new additions to the MRI protocol for epilepsy. Aim: To study the diagnostic value of T2 relaxation time in Electroencephalogram (EEG) confirmed seizure cases. Materials and Methods: A single-centre, cross-sectional study was conducted at Department of Radiodiagnosis, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, from December 2020 to November 2022 at a tertiary care hospital. All patients were subjected to MRI with a special epilepsy protocol and T2 relaxometry. Hippocampal T2 relaxation values for each slice were measured by placing a Region of Interest (ROI) on the representative image obtained from the T2 relaxometry sequence, focusing on the hippocampus in both the control and study groups. The control group (n=30) consisted of healthy volunteers, whereas the case group (n=36) comprised patients presenting with a history of seizures with positive MRI and EEG findings. Mean T2 relaxation time was calculated in each ROI, and an average was derived. Mean and Standard Deviation (SD) were calculated for the continuous variables, while ratios and proportions were calculated for the categorical variables. To determine the association of T2 relaxometry values in the study and control groups, an unpaired t-test was used. Results: The mean age of participants was 25.14±9.35 years (ranging from 9 to 51 years). The male-to-female ratio was 1.25:1. Hippocampal atrophy (32 out of 36 cases) and T2 signal alteration (30 out of 36 cases) were the most commonly identified features in Mesial Temporal Sclerosis (MTS). MRI without T2 relaxometry had a sensitivity of 94%. In two cases, where only mild hippocampal atrophy was identified in the conventional MRI sequence, making the diagnosis dubious, T2 relaxometry revealed increased T2 relaxation time in the head of the hippocampus and guided a proper diagnosis. EEG was able to lateralise seizures in 8 out of 13 right MTS cases (61.5%), 10 out of 17 left MTS cases (58.9%), and 5 out of 6 cases of bilateral MTS (83%). Conclusion: T2 relaxometry allows quantification of hippocampal signal intensity, allowing the detection of even subtle changes in signal intensity that are difficult to perceive by visual assessment.

Artificial intelligence for the detection of sacroiliitis on magnetic resonance imaging in patients with axial spondyloarthritis.

Magnetic resonance imaging (MRI) is important for the early detection of axial spondyloarthritis (axSpA). We developed an artificial intelligence (AI) model for detecting sacroiliitis in patients with axSpA using MRI. This study included MRI examinations of patients who underwent semi-coronal MRI scans of the sacroiliac joints owing to chronic back pain with short tau inversion recovery (STIR) sequences between January 2010 and December 2021. Sacroiliitis was defined as a positive MRI finding according to the ASAS classification criteria for axSpA. We developed a two-stage framework. First, the Faster R-CNN network extracted regions of interest (ROIs) to localize the sacroiliac joints. Maximum intensity projection (MIP) of three consecutive slices was used to mimic the reading of two adjacent slices. Second, the VGG-19 network determined the presence of sacroiliitis in localized ROIs. We augmented the positive dataset six-fold. The sacroiliitis classification performance was measured using the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). The prediction models were evaluated using three-round three-fold cross-validation. A total of 296 participants with 4,746 MRI slices were included in the study. Sacroiliitis was identified in 864 MRI slices of 119 participants. The mean sensitivity, specificity, and AUROC for the detection of sacroiliitis were 0.725 (95% CI, 0.705-0.745), 0.936 (95% CI, 0.924-0.947), and 0.830 (95%CI, 0.792-0.868), respectively, at the image level and 0.947 (95% CI, 0.912-0.982), 0.691 (95% CI, 0.603-0.779), and 0.816 (95% CI, 0.776-0.856), respectively, at the patient level. In the original model, without using MIP and dataset augmentation, the mean sensitivity, specificity, and AUROC were 0.517 (95% CI, 0.493-0.780), 0.944 (95% CI, 0.933-0.955), and 0.731 (95% CI, 0.681-0.780), respectively, at the image level and 0.806 (95% CI, 0.729-0.883), 0.617 (95% CI, 0.523-0.711), and 0.711 (95% CI, 0.660-0.763), respectively, at the patient level. The performance was improved by MIP techniques and data augmentation. An AI model was developed for the detection of sacroiliitis using MRI, compatible with the ASAS criteria for axSpA, with the potential to aid MRI application in a wider clinical setting.

Brain magnetic resonance imaging (MRI) findings in central precocious puberty patients: is routine MRI necessary for newly diagnosed patients?

The overall incidence of central precocious puberty (CPP) has increased in recent decades, and brain magnetic resonance imaging (MRI) evaluations are recommended in cases of suspected brain lesions. This study aimed to investigate the prevalence of MRI abnormalities and to evaluate the need for routine brain MRI in patients with newly diagnosed CPP. This retrospective study reviewed the data of patients newly diagnosed with CPP who underwent routine pituitary MRI at Korea University Anam Hospital from March 2020 to September 2021. A total of 199 girls and 24 boys was enrolled in this study. Positive MRI findings were categorized as abnormal pituitary, nonpituitary incidental, and pathological. In addition, we investigated the incidence of MRI abnormalities and evaluated their associations with clinical and biochemical factors. Positive brain MRI findings were observed in 84 patients (37.7%). Pituitary abnormalities were found in 54 patients (24.2%), with Rathke cleft cysts being the most common (16.1%). Incidental nonpituitary findings were observed in 29 patients (13.0%), while a pathological brain lesion (diagnosed as hypothalamic hamartoma) was observed in only 1 female patient (0.4%). No significant differences in sex or age were found in incidence of pituitary abnormalities or nonpituitary incidental findings. Compared with headache controls, significant associations were observed between abnormal pituitary findings on MRI and CPP (unadjusted odds ratio, 3.979; 95% confidence interval, 1.726-9.173). True pathological findings were rare, even though the prevalence of abnormalities on pituitary MRI in patients with CPP was relatively high. Considering its cost-effectiveness, MRI screenings should be carefully considered in patients with CPP.

Refractory shoulder injury related to vaccine administration: correlation with culture presence of Cutibacterium acnes

Shoulder pain following intramuscular administration of vaccine is common. However, a small number of patients experience prolonged pain and dysfunction atypical to normal transient postvaccination shoulder pain. Shoulder Injury Related to Vaccine Administration (SIRVA) remains incompletely understood, whether a robust immune response to vaccine antigen or inappropriate injection technique with needle placement in synovial or bursal tissue, or some combination of the two. Symptoms overlap with those of Cutibacterium acnes (C. acnes) infection but the relationship between the two, if any, has not been evaluated. Clinical case files were reviewed for 3 cases of SIRVA with positive cultures for C. acnes were reviewed. Presentation, treatment, and clinical outcomes were compared. In all cases, patients were thin (body mass index < 23), females, who had high injection placement of a vaccine, all patients had positive magnetic resonance imaging findings of increased signal in the subacromial bursa, and/or greater tuberosity. All patients underwent arthroscopic débridement and culture harvest and cultures were positive for C. acnes. A combination of oral and intravenous antibioticswas used, and all patients demonstrated clinical improvement from the preoperativestate. This case series presents 3 patients with refractory SIRVA who ultimately underwent arthroscopic irrigation and débridement with culture biopsy. Each case had culture results positive for C.acnes and all responded, at least partially, to arthroscopic débridement and intravenous antibiotic therapy. The purpose of this manuscript is to raise awareness of potential coexistence of SIRVA and C.acnes which may be of assistance to surgeons treating refractory cases of SIRVA.

Magnetic resonance imaging predicts outcomes of conservative treatment in patients with lateral epicondylitis

BackgroundThe clinical validity of positive magnetic resonance imaging findings in lateral epicondylitis is controversial. We hypothesized that magnetic resonance imaging could predict the outcome of conservative treatment. This study determined the relationship between magnetic resonance imaging-defined disease severity and treatment outcomes in patients with lateral epicondylitis. MethodsThis retrospective single-cohort study included 43 conservatively managed and 50 surgically treated patients with lateral epicondylitis. The magnetic resonance imaging scores and clinical outcomes were examined six months post-treatment, and the former was compared between patients with good and poor treatment outcomes. We developed operating characteristic curves of magnetic resonance imaging scores for treatment outcomes, and divided patients into magnetic resonance imaging-mild and severe groups according to the obtained cut-off value of the scores. We compared the outcomes of conservative treatment with that of surgery for each magnetic resonance imaging severity. ResultsTwenty-nine (67.4%) conservatively treated patients had good outcomes, while 14 (32.6%) had poor outcomes. The magnetic resonance imaging score was higher in patients with poor outcomes; the cut-off value was 6. Forty-three (86.0%) surgically treated patients had good outcomes, while 7 (14.0%) had poor outcomes. There was no significant difference in magnetic resonance imaging scores between patients with good and poor surgical outcomes. In the magnetic resonance imaging-mild group (score ≤ 5), the outcome showed no significant difference between the conservative and surgical treatment groups. In the magnetic resonance imaging-severe group (score≥6), the outcome of conservative treatment was significantly worse than that of surgical treatment. ConclusionsThe magnetic resonance imaging score was associated with conservative treatment outcomes. A treatment strategy that includes surgery should be considered for patients with severe magnetic resonance imaging findings; this is not recommended for those with mild magnetic resonance imaging findings. Magnetic resonance imaging is helpful in determining the best treatment strategies for patients with lateral epicondylitis. Level of evidenceIII, Retrospective cohort study.

MP44-14 PREBIOPSY MRI APPROACH FOR PROSTATE CANCER DIAGNOSIS IS ASSOCIATED WITH LOWER RISK OF BIOCHEMICAL RECURRENCE AFTER TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP44-14 PREBIOPSY MRI APPROACH FOR PROSTATE CANCER DIAGNOSIS IS ASSOCIATED WITH LOWER RISK OF BIOCHEMICAL RECURRENCE AFTER TREATMENT Fernando Blank, Neha Debnath, Shima Tayebi, Amy Cherry, Juliana Tobler, Sadhna Verma, and Abhinav Sidana Fernando BlankFernando Blank More articles by this author , Neha DebnathNeha Debnath More articles by this author , Shima TayebiShima Tayebi More articles by this author , Amy CherryAmy Cherry More articles by this author , Juliana ToblerJuliana Tobler More articles by this author , Sadhna VermaSadhna Verma More articles by this author , and Abhinav SidanaAbhinav Sidana More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine the impact of prebiopsy prostate magnetic resonance imaging (MRI) followed by a targeted biopsy (TBx) approach for initial diagnosis on oncological outcomes after prostate cancer (PCa) treatment. METHODS: We performed a retrospective review of all patients who underwent prostate biopsy followed by radiation therapy (RT) or radical prostatectomy (RP) as their first treatment at our center from 2014-2020. Patients were separated into two cohorts based on the diagnostic approach: prebiopsy prostate MRI during initial evaluation and those who did not receive MRI. Patients with positive MRI findings underwent a combination of TBx and systematic biopsy (SBx) to confirm diagnosis while those without MRI underwent SBx only. Patients with prostate specific antigen (PSA) >20 were excluded. Kaplan-Meier curve analysis was used to compare biochemical recurrence (BCR, defined as PSA>0.2ng/ml after RP or a rise of 2ng/ml after RT) between cohorts. Cox proportional hazard analysis was done to determine the predictors of the BCR. RESULTS: 366 patients (174 diagnosed by SBx only, and 192 diagnosed by prebiopsy MRI and TBx) with a median follow-up of 40 months were included in the study. 245 men (67%) had RP as their first treatment. Median age and PSA were 64.7 and 7.9 respectively in the SBx cohort and 65.0 and 8.3 respectively in TBx cohort. There was a significant difference in BCR rate between the TBx (7.98%) versus SBx (19.28%, p<0.05 by log rank). After adjusting for age, race, PSA, biopsy path, DRE, and family history, prebiopy MRI and TBx approach for diagnosis was found to be an independent negative predictor (p=0.001); with patients diagnosed with the above approach 71% less likely to have BCR during the study period. CONCLUSIONS: Our study shows that patients undergoing prebiopsy MRI followed by TBx have lower rates of BCR compared to men diagnosed without prebiopsy MRI. To our knowledge, this study is the first to show the positive impact of prebiopsy MRI on oncological outcomes, likely due to its role in risk stratification, treatment selection and surgical staging and planning. Further longitudinal studies are needed to discern the true long-term benefits of prebiopsy MRI on oncological outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e617 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fernando Blank More articles by this author Neha Debnath More articles by this author Shima Tayebi More articles by this author Amy Cherry More articles by this author Juliana Tobler More articles by this author Sadhna Verma More articles by this author Abhinav Sidana More articles by this author Expand All Advertisement PDF downloadLoading ...

Acute Pancreatitis and Acute Recurrent Pancreatitis in Children: Imaging Findings and Outcomes.

The prevalence of acute pancreatitis and acute recurrent pancreatitis in children has increased over the years, and there are limited data about imaging findings. This study aimed to reveal the imaging findings of acute pancreatitis and acute recurrent pancreatitis in children at a tertiary care hospital. The patients with acute pancreatitis and acute recurrent pancreatitis diagnosed between January 2007 and December 2018 were included. Demographic and clinical features, follow-up period, and interventions were noted. Imaging features were evaluated for pancreatic enlargement, peripancreatic fluid, and biliary ducts for initial examination and pancreas parenchymal necrosis, peripancreatic collection, walled-off necrosis, pseudocyst, parenchymal atrophy, and biliary ductal dilatation for follow-up. The study included 74 patients with a mean age of 9 ± 4.9 years. The most common causes of acute pancreatitis and acute recurrent pancreatitis were biliary tract anomalies (n = 21), biliary ductal stones (n = 9), and cystic fibrosis (n = 8). Findings consistent with acute pancreatitis were determined by ultrasound in 40.5% (n = 30/74), whereas by magnetic resonance imaging in 60% (n = 39/65). Forty-one percent of the patients (n = 16) with positive magnetic resonance imaging findings did not show any findings on ultrasound. Acute recurrent pancreatitis was seen in 32 patients (43.2%). Follow-up imaging was performed in 55 patients (74.3%) between 2 months and 11 years. At follow-up, 8 patients had peripancreatic collections (6 walled-off necrosis and 2 pseudocysts). Recognizing the imaging findings of acute pancreatitis and its complications is crucial. Magnetic resonance imaging should be preferred as a second option following ultrasound, with the advantages of biliary ductal system delineation and better characterization of complications.

Reoperation for Recurrent and Persistent Cushing's Disease without Visible MRI Findings.

Transsphenoidal surgery is the first-line treatment for Cushing's disease (CD), even with negative preoperative magnetic resonance imaging (MRI) results. Some patients with persistent or recurring hypercortisolism have negative MRI findings after the initial surgery. We aimed to analyze the efficacy of repeat surgery in two groups of patients and determine if there is an association between positive MRI findings and early remission. Clinical, imaging, and biochemical information of 42 patients who underwent repeat surgery by a single neurosurgeon between 2002 and 2021 was retrospectively analyzed. We compared the endocrinological, histopathological, and surgical outcomes before and after repeat surgery among 14 CD patients with negative MRI findings and 28 patients with positive MRI findings. Immediate remission was achieved in 29 patients (69.0%) who underwent repeat surgery. Among all patients, 28 (66.7%) had MRI findings consistent with solid lesions. There was no significant difference in remission rates between the recurrence and persistence groups (77.8% vs. 57.1%, odds ratio = 2.625, 95% confidence interval = 0.651 to 10.586). Patients in remission after repeat surgery were not associated with positive MRI findings (odds ratio = 3.667, 95% confidence interval = 0.920 to 14.622). In terms of recurrence, repeat surgery in patients with either positive or negative MRI findings showed reasonable remission rates. For persistent disease with positive MRI findings, repeat surgery is still an option; however, more solid evidence is needed to determine if negative MRI findings are predictors for failed reoperations for persistent hypercortisolism.

Retrospective Review of Radiographic Imaging of Tibial Bony Stress Injuries in Adolescent Athletes With Positive MRI Findings: A Comparative Study.

It is difficult to diagnose and grade bony stress injury (BSI) in the athletic adolescent population without advanced imaging. Radiographs are recommended as a first imaging modality, but have limited sensitivity and, even when findings are present, advanced imaging is often recommended. It was hypothesized that the significance of radiographs is underestimated for BSI in the adolescent with positive clinical examination and history findings. Case series. Level 4. A total of 80 adolescent athletes with a history of shin pain underwent clinical examination by an orthopaedic surgeon. On the day of clinical examination, full-length bilateral tibial radiographs and magnetic resonance imaging (MRI) scans were obtained. MRI scans were reviewed using Fredericson grading for BSI. At the completion of the study, radiographic images were re-evaluated by 2 musculoskeletal (MSK) radiologists, blinded to MRI and clinical examination results, who reviewed the radiographs for evidence of BSI. Radiographic results were compared with clinical examination and MRI findings. Sensitivity, specificity, negative predictive value, and positive predictive value were calculated based on comparison with MRI. All radiographs were originally read as normal. Of the tibia studied, 80% (127 of 160) showed evidence of BSI on MRI. None of the original radiographs demonstrated a fracture line on initial review by the orthopaedic surgeons. Retrospective review by 2 MSK radiologists identified 27% of radiographs (34 of 127) with evidence of abnormality, which correlated with clinical examination and significant findings on MRI. Review of radiographs found evidence of new bone on 0 of 28 Fredericson grade 0, 0 of 19 Fredericson grade I, 11 of 80 (13.7%) Fredericson grade II, 18 of 28 (64%) Fredericson grade III, and 5 of 5 (100%) Fredericson grade IV. Sensitivity of radiographs showed evidence of new bone on 27% (34 of 127) of initial radiographs, with presence more common with greater degree of BSI, as 23 of 33 (70%) were higher-grade injuries (III of IV) of BSI. Specificity and positive predictive value were 100%, while negative predictive value was 17%. These findings highlight the importance of initial radiographs in identifying high-grade BSI. As radiographs are readily available in most office settings of sports medicine physicians, this information can influence the management of adolescent athletic BSI without the need to delay treatment to obtain an MRI. Adolescent athletes with radiographic evidence of BSI should be treated in a timely and more conservative manner, given the likelihood of higher-grade BSI. In addition, clinicians knowledgeable of the radiographic findings of high-grade BSI should feel more confident that a negative initial radiograph is not likely to be a high-grade BSI and can modify their treatment plans accordingly.

Magnetic resonance imaging findings in patients with idiopathic olfactory dysfunction and normal findings on nasoendoscopy.

In presentations of anosmia or dysosmia, magnetic resonance imaging may be required to screen for intracranial pathology such as olfactory neuroblastomas and other intracranial masses impacting on the olfactory pathway. This study aimed to establish positive magnetic resonance imaging findings of anosmia or dysosmia for scans performed before the coronavirus disease 2019 pandemic. The study examined the outcome of patients who presented with isolated olfactory dysfunction and who underwent magnetic resonance imaging between 2015 and 2019. Of the 131 patients, 41 (31.3 per cent) had normal scan findings, 50 (38.2 per cent) had insignificant paranasal mucosal disease and 6 (4.6 per cent) had mucosal thickening significant enough to require additional intervention. These interventions included repeat nasoendoscopy or commencement of intranasal or oral steroids. No patients had olfactory neuroblastoma. Only 4.6 per cent of the magnetic resonance imaging scans revealed abnormal findings related to anosmia or dysosmia, and none required ENT surgical intervention. None of the magnetic resonance imaging scans identified an olfactory neuroblastoma or intracranial masses impacting on the olfactory pathway.

MRI Changes Among Patients Of Eclampsia And Preeclampsia With Associated Neurological Symptom Analysis.

Pregnancy poses some stress on normal homeostasis of the human body and brings changes in the body which predisposes the individual towards various pathological conditions as well. Objective of the study was to determine the magnetic resonance imaging (MRI) changes and clinical symptoms associated with these changes among patients of eclampsia and preeclampsia managed at tertiary care unit. It was a cross-sectional study, conducted at Gynaecology and obstetrics department Pak Emirates Military Hospital (PEMH) Rawalpindi. January to June 2019. A total of 80 pregnant women who were diagnosed by consultant obstetrician for eclampsia or pre-eclampsia were included in the study. All the patients underwent Plain MRI brain including TIWI, T2WI, FLAIR, DWI, ADC, GRE and SWI sequences at radiology department of PEMH RWP. Positive MRI findings were defined as presence of cerebral oedema, infarction, cerebral venous sinus thrombosis and cerebral haemorrhage. Headache, seizures, altered mental status and visual problems were correlated with MRI changes among the target population. Out of 80 pregnant women with eclampsia or preeclampsia, 49 (61.2%) had no changes on MRI while 31 (38.8%) had significant changes on MRI. Cerebral oedema 12 (15%) was the most common MRI finding followed by cerebral haemorrhage 8 (10%). Mean age of participants was 36.33±2.238 years. With Pearson chi-square analysis, it was found that presence of seizures and altered mental state had statistically significant relationship with presence of MRI findings among the target population. MRI changes were a common finding among the patients of eclampsia or pre-eclampsia. Cerebral oedema was the commonest finding in our study. Patients with serious clinical symptoms like seizures and altered mental state had more chances of having MRI changes as compared to patients without the serious clinical symptoms.

Role of diffusion-weighted imaging and dynamic contrast enhanced magnetic resonance imaging in the diagnosis of early sacroiliitis in seronegative spondyloarthropathies, correlation with levels of acute phase reactants

Objective: Seronegative spondyloarthropathy (SpA) is a destructive disease. Early diagnosis is crucial to prevent morbidity. Magnetic resonance imaging (MRI) is the only imaging modality that can show early sacroiliitis. We aimed to investigate the utility of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in the detection, quantification and staging of early/acute SpA. We also investigated the relationship between contrast enhancement properties and apparent diffusion coefficient (ADC) values with laboratory parameters for inflammation such as ESR and CRP measurments. Patients and Methods: Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed on 85 patients that fulfilled the criteria. A positive MRI finding was defined as inflammation in subchondral bone representing active sacroiliitis. Kinetic analyses were performed, apparent diffusion coefficient (ADC) values were calculated, ESR and CRP levels were measured for quantification of inflammation. Statistical analyses were performed. Results: In acute SpA group; quantity, area and level of enhancement, values of ADC and Fenh, levels of CRP were significantly higher than those with chronic SpA. A high level of agreement was found between the ADC threshold value of 0.831x10 − 3 mm2/s and diagnosis according to Assessment of SpondyloArthritis International Society (ASAS) criteria (Kappa=0.794;p<0.001). Conclusion: Dynamic contrast-enhanced magnetic resonance imaging and DWI are advanced MR techniques which enable quantification of active inflammation. They are hallmarks for early SpA. Their combined use is superior to one alone in the diagnosis of early sacroiliitis.

Clinical Utility of Germline Genetic Testing in Japanese Men Undergoing Prostate Biopsy.

BackgroundMultiple common variants and also rare variants in monogenic risk genes such as BRCA2 and HOXB13 have been reported to be associated with risk of prostate cancer (PCa); however, the clinical setting in which germline genetic testing could be used for PCa diagnosis remains obscure. Herein, we tested the clinical utility of a 16 common variant–based polygenic risk score (PRS) that has been developed previously for Japanese men and also evaluated the frequency of PCa-associated rare variants in a prospective cohort of Japanese men undergoing prostate biopsy.MethodsA total of 1336 patients undergoing first prostate biopsy were included. PRS was calculated based on the genotype of 16 common variants, and sequencing of 8 prostate cancer–associated genes was performed by multiplex polymerase chain reaction based target sequencing. PRS was combined with clinical factors in logistic regression models to assess whether addition of PRS improves the prediction of biopsy positivity.ResultsThe top PRS decile was associated with an odds ratio of 4.10 (95% confidence interval = 2.46 to 6.86) with reference to the patients at average risk, and the estimated lifetime absolute risk approached 20%. Among the patients with prostate specific antigen 2-10 ng/mL who had prebiopsy magnetic resonance imaging, high PRS had an equivalent impact on biopsy positivity as a positive magnetic resonance imaging finding. Rare variants were detected in 19 (2.37%) and 7 (1.31%) patients with positive and negative biopsies, respectively, with BRCA2 variants being the most prevalent. There was no association between PRS and high-risk rare variants.ConclusionsGermline genetic testing could be clinically useful in both pre- and post-PSA screening settings.

The Diagnostic Value of Clinical Sacroiliac Joint Pain Provocation Tests for Detection of Sacroiliitis Identified by MRI in Sampled Iraqi Patients with Inflammatory Back Pain.

Background:Sacroiliitis has been considered as the keystone in the diagnosis of axial spondyloarthritis (SPA). The diagnosis can be challenging in early stages of sacroiliitis, as conventional radiographs may be normal. Pain provocative tests can be very helpful to give a clue whether sacroiliitis is present in suspected patient by reproducing the patient’s pain.Objective:To assess the validity of clinical sacroiliac joint pain provocation tests for sacroiliitis in comparison with magnetic resonance imaging (MRI).Patients and methods:A total of 65 patients were selected from cohort of patients with persistent inflammatory low back pain during their attendance to the Rheumatology Consultant Clinic at Baghdad Teaching Hospital. Data were collected using questionnaire and interview. Socio-demographic characteristics, disease duration and clinical data were recorded for all patients. Data from four different clinical examination tests (Flexion Abduction and External Rotation [FABER], direct compression, distraction, and lateral compression) with subsequent MRI findings of sacroiliac joint for each patient were analysed. Positive MRI findings were further subdivided into active and chronic lesions according to the new ASAS (association of spondyloarthritis international society) criteria of positive imaging in spondyloarthropathy.Results:A total of 65 patients were included in this study, age range 18–39 years, 69.2% were men. The prevalence of sacroiliitis in the study was 67.7% (43.1% bone marrow oedema, 18.5% erosions, 15.4% sclerosis, 6.2 % for each of effusion; ankyloses and capsulitis). In the whole study group, the highest association with sacroiliitis was for FABER test with sensitivity of 75% while the most specific one was the lateral compression test (71.4%). In men, sacroiliitis was associated with sacroiliac joint (SIJ) clinical tests assessed in multi-test regimens; significant association was found by combining direct compression and FABER test with sensitivity of 51% and specificity of 28.5%.Conclusion:This study identified the reliability of a number of clinical examination tests of SIJ, which increase as they are used in multi-test regimen rather than each one alone, this had a significant association for men only.

Association of Positive MRI Findings and Clinical Outcomes in Sub-acute and Chronic Phases of Pediatric Mild Traumatic Brain Injury

This study aims to examine the rates of incidental findings (IF) and radiologic common data elements (rCDE), and to explore how these magnetic resonance imaging (MRI) findings contribute to a broad assessment of clinical outcomes (symptoms, cognitive and behavioral functioning, and quality of life) in the sub-acute (SA: ∼1 week), early chronic (EC: ∼4 months), and late chronic (LC: ∼1 year) phases of pediatric mild traumatic brain injuries (pmTBI). It is unclear whether MRI findings have clinical implications following injury. Two hundred thirty-three pmTBI patients and 168 HC aged 8-18 completed an MRI scan and a comprehensive clinical assessment at SA visit, with a subset completing the clinical assessment at EC (182 pmTBI; 158 HC) and LC (143 pmTBI; 141 pmTBI) visits. All MRI findings were noted by board-certified neuroradiologists and coded based on published criteria for rCDE by 2 independent researchers, who were blinded to diagnosis group. A series of 2 × 3 (group [pmTBI vs HC] × MRI findings [IF vs rCDE vs normal]) generalized linear model was conducted for outcomes at each visit. Possible and probable rCDE were pooled for the latter analyses. One hundred sixty-four participants (40.9%) showed positive MRI findings (113 IF, 43 possible rCDE, 8 probable rCDE). As expected, probable rCDE was exclusively observed in pmTBI patients (Fisher's exact one-sided = 0.012), however the incidence of IF and possible rCDE was similar between groups (χ2 = 2.969; p's = 0.085). While group effects were observed on several outcome measures, no interaction of Group × MRI findings survived the correction for multiple comparisons (p's > 0.01). An MRI findings effect (p < 0.001) was observed on child-rated Children's Behavior Questionnaire at SA visit (normal > IF and rCDE; p's = 0.009). However, this effect was no longer significant at EC and LC (p's = 0.439). Overall, the current results do not suggest that MRI findings have clinical implications or interacts with pmTBI to worsen outcomes.

Foot and ankle functions and deformities focus on posterior tibial tendon dysfunction using magnetic resonance imaging in patients with rheumatoid arthritis.

Posterior tibial tendon dysfunction (PTTD) affects the support of the medial longitudinal arch and stability of the hindfoot. The purpose of this study was to assess the relationships of PTTD with foot and ankle functions and foot deformities in patients with rheumatoid arthritis (RA). A total of 129 patients (258 feet) who underwent magnetic plain and contrast-enhanced magnetic resonance imaging were enrolled in this study. Positive magnetic resonance imaging findings were defined as tenosynovitis and incomplete and complete rupture of the posterior tibial tendon. Foot and ankle functions were assessed using the Japanese Society for Surgery of the Foot standard rating system for the RA foot and ankle scale (JSSF-RA) and self-administered foot evaluation questionnaire. Plain radiographs were examined for the hallux valgus angle, first metatarsal and second metatarsal angle, lateral talo-first metatarsal angle, and calcaneal pitch angle. PTTD was associated with motion in the JSSF-RA (p = .024), activities of daily living in JSSF-RA (p = .017), and pain and pain-related factors in the self-administered foot evaluation questionnaire (p = .001). The calcaneal pitch angle was significantly lower in the feet with PTTD than in those without PTTD (median: 16.2° vs. 18.0°; p = .007). The present study shows that PTTD was associated with foot and ankle functions and flatfoot deformity. Thus, a better understanding of PTTD in patients with RA is important for the management of foot and ankle disorders in clinical practice.

Predictors of discogenic pain in magnetic resonance imaging: a retrospective study of provocative discography performed by posterolateral approach.

BackgroundProvocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD.MethodsRecords of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out.ResultsA total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11.ConclusionsIn patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.