Preoperative MRI Scans Research Articles

Utility of 3D Reconstruction for Surgical Planning in the Treatment of Retroperitoneal Sarcomas

Abstract Introduction Retroperitoneal sarcomas (RPS) are rare tumors that present significant challenges due to their location and proximity to vital structures. Accurate surgical planning is essential to optimize outcomes, and 3D reconstruction has emerged as a valuable tool for preoperative planning and intraoperative guidance. Methods We present our experience of 20 cases of RPS where 3D reconstruction was integrated into the surgical planning process. We retrospectively reviewed 20 patients who underwent surgery at our institution from 2021 to 2024. Preoperative CT or MRI scans were performed on all patients and used to generate 3D models of the tumors with specialized software. These 3D models facilitated the planning of surgical approaches, assessing resectability, and provided immersive visualization through virtual reality (VR) tools for enhanced surgical preparation. Results All 20 patients underwent curative-intent surgery using tailored surgical approaches based on 3D modeling insights. The models offered detailed visualization of the tumors and their relationships with adjacent structures, improving the precision of resection and margin assessment. Conclusion 3D reconstruction proved to be a useful tool in the surgical treatment of RPS, improving preoperative planning and intraoperative guidance. It also provided benefits in medical education and enhanced patient understanding of their disease and treatment plan.

P0402 Preoperative body composition parameters are associated with postoperative complications and endoscopic postoperative recurrence in patients with Crohn’s disease

Abstract Background Alterations in body composition are common among patients with Crohn’s disease (CD) and may represent a modifiable risk factor for dismal postoperative outcomes. This study aimed to investigate the association of preoperative body composition with postoperative complications and endoscopic postoperative recurrence (ePOR) in CD patients following ileocolic (re-)resection (ICR). Methods CD patients (≥16 years) scheduled for ICR with a preoperative CT or MRI scan (<12 months prior to ICR) were identified from an ongoing prospective, multicenter cohort study. Cross-sectional area normalized for body height (i.e. index) and lipid content (i.e. radiation attenuation on CT or signal intensity on MRI) of sketelal muscle (SM), subcutaneous adipose (SAT), and visceral adipose tissue (VAT) were analyzed at L3 level. Cut-offs were based on sex-specific tertiles. The primary outcome was postoperative complications (Clavien-Dindo grade I-IV) within 30 days. Secondary outcomes were moderate-to-severe complications (Clavien-Dindo grade ≥II), infectious complications (intra- or extra-abdominal), and ePOR (modified Rutgeerts’ score ≥i2b) at six months postoperatively. Multivariable logistic regression was performed to assess the association of preoperative body composition with study outcomes. Results In total, 227 patients were included. Preoperative characteristiscs and postoperative outcomes are shown in Table 1. Median interval from preoperative imaging to ICR was 2.3 months (IQR 1.1–4.6). High lipid content of SM (i.e. myosteatosis) was associated with postoperative complications (aOR 2.51; 95%CI 1.21–5.22), moderate-to-severe complications (aOR 2.34; 95%CI 1.13–4.85), and infectious complications (aOR 2.20; 95%CI 1.01–4.80) (Figure 1). Low VAT-index was protective against postoperative complications (aOR 0.17; 95%CI 0.05–0.58). Low lipid content of VAT (aOR 3.98; 95%CI 1.15–13.78) and a high SAT-index (aOR 3.38; 95%CI 1.12–10.15) were associated with infectious complications. High SM-index was associated with ePOR (aOR 2.51; 95%CI 1.09–5.77). Preoperative body mass index (BMI) showed no association with study outcomes in uni- and multivariable analyses. Conclusion Preoperative myosteatosis on abdominal imaging is consistently associated with postoperative complications in patients with CD following ICR. Low VAT-index was identified as protective factor for postoperative complications, while low lipid content of VAT and a high SAT-index were associated with infectious complications. Surprisingly, high SM increased the risk of ePOR. Future research should identify strategies for preoperative improvement of body composition, rather than relying solely on BMI, and investigate if these improvements correlate with better postoperative outcomes.

Measuring multifidus muscles atrophy after midline lumbar fusion with cortical bone trajectory screws due to spinal instability and spondylolisthesis: a retrospective case series.

This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy. MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies. This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05. The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant. Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.

Influencing Factors on the Registration Accuracy of a Learned Feature Descriptor in Laparoscopic Liver Surgery

Abstract In laparoscopic liver surgery, image-guided navigation systems provide crucial support to surgeons by supplying information about tumor and vessel positions. For this purpose, these information from a preoperative CT or MRI scan is overlaid onto the laparoscopic video. One option is performing a registration of preoperative 3D data and 3D reconstructed laparoscopic data. A robust registration is challenging due to factors like limited field of view, liver deformations, and 3D reconstruction errors. Since in reality various influencing factors always intertwine, it is crucial to analyze their combined effects. This paper assesses registration accuracy under various synthetically simulated influences: patch size, spatial displacement, Gaussian deformations, holes, and downsampling. The objective is to provide insights into the required quality of the intraoperative 3D surface patches. LiverMatch serves as the feature descriptor, and registration employs the RANSAC algorithm. The results of this paper show that ensuring a large field of view of at least 15-20% of the liver surface is necessary, allowing tolerance for less accurate depth estimation.

Predicting functional outcome after open lumbar fusion surgery: A retrospective multicenter cohort study

PurposeWe aimed to develop and externally validate a tool for predicting short-term functional outcome after lumbar fusion surgery. MethodsData of 1520 patients underwent lumbar fusion from three institutions was analyzed. A total of 855 and 1251 radiomics features from paraspinal muscles were extracted from preoperative CT and MRI scans, respectively. Multivariable logistic regression was used to identify independent risk factors of poor functional status after surgery. We developed and externally validated a combined model by integrating radiomics score and clinical features. We evaluated the clinical utility and stability of the model using decision curve and calibration curve analysis. SHAP plot was used for interpretation of predictive results. ResultsAt multivariable analysis, radiomics score and 4 clinical features were identified as independent risk factors of poor functional outcome, and then a combined model was generated. This model had excellent performance, with AUCs of 0.85(95 %CI, 0.81–0.88), 0.82(95 %CI, 0.77–0.84), 0.79(95 %CI, 0.73–0.84) and 0.80(95 %CI, 0.76–0.83) in the derivation dataset and three independent test datasets, respectively. Moreover, this model showed great calibration and utility, outperforming the clinical model and radiomics score alone (both p < 0.05). ConclusionThe combined model allows for accurate prediction of functional outcome after lumbar fusion surgery. The model could guide clinical decisions about the necessity of surgery for potential functional recovery.

The prognostic importance of glioblastoma size and shape

PurposeExtent of resection, MGMT promoter methylation status, age, functional level, and residual tumor volume are established prognostic factors for overall survival in glioblastoma patients. Preoperative tumor volume has also been investigated, but the results have been inconclusive. We hypothesized that the surface area and the shape were more representative of the tumor’s infiltrative capacities, and thus, the purpose of this study was to assess the prognostic value of tumor size and shape in patients with glioblastoma.MethodsIn total, 271 patients with primary, unifocal glioblastoma were included from two centers in Norway and Sweden, respectively. All tumors were automatically segmented on preoperative MRI scans and manually validated. Tumor volume was used as a measurement of size, whereas sphericity index and area-to-volume ratio defined the shape complexity of the tumor. Contact surface area of the tumor was considered a measurement of both size and shape. Multivariable Cox proportional hazards models were used to assess the prognostic value of the respective tumor measurements, with previously established prognostic factors as covariates.ResultsThere were no associations between preoperative tumor volume and overall survival. Contact surface area (HR = 1.013, p = 0.002) and sphericity index (HR = 2.223, p = 0.001) were both significant independent prognostic factors for survival in the multivariable Cox models. Contact surface area was also associated with MGMT promoter methylation (p = 0.039) and extent of resection (p = 0.017).ConclusionTumor shape complexity appears to be an independent prognostic factor in glioblastoma patients and may also be associated with MGMT promoter methylation status and extent of surgical resection.

NIMG-79. A RADIOMIC-RISK SCORE FOR SURVIVAL PREDICTION IN GLIOMA: A LARGE MULTI-INSTITUTIONAL RETROSPECTIVE VALIDATION STUDY

Abstract Gliomas have dismal survival. Recently, radiomics has demonstrated success in developing non-invasive image-based biomarkers for survival prediction in gliomas. However, clinical applicability of radiomics-based biomarkers will ultimately require rigorous validation on large, multi-institutional data. This work attempts to evaluate a radiomic-based survival risk-assessment prognostic score on a multi-institutional cohort of Glioma patients. Our rationale is that optimizing and validating radiomic features that capture intensity-based textural variations and morphology-based changes (e.g., local curvature and global contour) on large multi-institutional cohorts can allow for robust risk assessment in Glioma. n=668 pre-operative T1w MRI scans for Glioma patients from 4 cohorts: University of California San Francisco “UCSF” (n=495), LUMIERE (n=86)), xCures (n=13), and Cleveland Clinic (CCF) (n=74) were analyzed. Subjects from UCSF, CCF, and xCures were used for training, whereas the LUMIERE cohort was used for hold-out testing. Following pre-processing, expert-vetted tumor segmentation into Edema (ED) and Enhancing tumor (ET) regions was performed. A total of n=1558 radiomic features were extracted from the tumor regions (779 per region), namely, 31 global contour, 20 curvature-based, 624 gradient co-occurrence statistics, and 104 Collage features. Cox regression model was employed to create a radiomic risk score (RRS) for every subject, which included radiomics features as well as on clinical and demographic variables (IDH, MGMT, sex, age), for survival analysis. RRS incorporated a total of 43 radiomic features, and the associated clinical and demographic variables (CDS), yielding significant differences between high and low risk groups in the training (RRS: p=0.043, HR = 2, CSD: p=0.0031, HR = 2.8) and testing sets (RRS: p=0.0096, HR = 1.8, CSD: p=0.0071, HR = 1.8). Combining RRS and CDS improved the OS prediction at group level (p=3.6e-6, 0.0011, HR=5.4, 2, for training and testing, respectively). Radiomics-based risk-stratification may be promising for reliable risk-stratification in glioma.

NIMG-60. SUBTYPING GLIOBLASTOMA FROM JOINT CLUSTERING OF IMAGING AND GENOMIC DATA

Abstract PURPOSE To comprehensively unravel the heterogeneity of glioblastoma, we developed a subtyping method using integrated imaging and genomic data. METHODS We assembled a retrospective cohort of 571 IDH-wildtype glioblastoma patients, obtaining pre-operative multi-parametric MRI (T1, T1-GD, T2, T2-FLAIR, DSC, DTI) scans (available for 462 patients) and targeted next-generation sequencing (NGS) data (available for 355 patients). We extracted 971 radiomic features from these MRI scans, selecting 12 significant dimensions through L21-norm minimization guided by 13 key driver genes from the five most frequently altered pathways in glioblastoma compared to healthy controls (RB1, P53, MAPK, PI3K, and RTK). Subtypes were identified using a joint clustering approach that integrated radiomics and genomics. RESULTS Our method identified three glioblastoma subtypes with distinct risk levels: high-risk (subtype 1), medium-risk (subtype 2), and low-risk (subtype 3), each characterized by their differential overall survival outcomes (Kaplan-Meier analysis, p &amp;lt; 0.05). The intensities of axial diffusivity in enhancing tumor regions and radial diffusivity in non-enhancing cores increased across three subtypes. All subtypes shared a common tendency for more frequent mutation co-occurrence pattern in [TP53,RB1] but exhibited unique molecular characteristics. For example, subtype 1 displayed a relatively high frequency of co-occurring mutations in [TP53,KDR] and [NOTCH2,MDM4]; subtype 2 had six co-occurring pairs [TP53,KDR], [PTPN11,NF1], [RB1,FUBP1], [PTEN,CIC], [PTEN,KRAS], and [NOTCH2,CDKN2A]; subtype 3 showed six co-occurring pairs [PTPN11,NF1], [PDGFRA,NF1], [NTRK1,NOTCH2], [MET,ATRX], [KRAS,KDR], and [FGFR2,DNMT3A] plus four significant patterns of mutual exclusivity in [TP53,PTPN11], [TP53,EGFR], [EGFR,RB1], and [EGFR,NF1]. CONCLUSION Our study discovered distinct glioblastoma subtypes, revealing complex patterns and structures across multiple data modalities without relying on prior clinical assumptions. This is promising to help enhance the precision of diagnosis and treatment of glioblastoma.

Detection of Apical Cancer with Novel Imaging Modalities to Predict Apical Margin Positivity in Robotic Assisted Radical Prostatectomy

ObjectivesTo evaluate margin positivity at apex utilizing preoperative magnetic resonance imaging [MRI], micro-ultrasound [MUS], prostate specific membrane antigen positron emission tomography PSMA PET] scan, biopsy location and intraoperative timing of deep venous complex [DVC] ligation during robot assisted radical prostatectomy [RARP]. MethodsInstitution review board approved retrospective study underwent RARP between November 2022 to March 2024. All patients underwent preoperative MRI, MUS and PSMA PET scan. Patients underwent RARP using either standard DVC [done prior apical dissection] ligation or delayed DVC [after prostate removal] technique. All patients underwent intra operative frozen section analysis by an experienced genitourinary pathologist. Descriptive statistics were performed. Data analyzed using R software version 4.3.3. ResultsTotal 619 prostate cancer patients underwent RARP. Of these, 365 men underwent RARP using delayed DVC ligation technique and 254 men using standard DVC ligation technique. There was no statically significant difference in 2 groups on demographic parameters, MRI, MUS and PSMA-PET scan features. Sensitivity of MRI, MUS, PSMA-PET and prostate biopsy for detection of apical positive margin were 66%, 81%, 81% and 73% respectively. Specificity of MRI, MUS, PSMA-PET and prostate biopsy for detection of apical positive margin were 45%, 14%, 16% and 30% respectively. When all modalities are used accumulatively, apical cancer was missed only in 1% of cases. ConclusionsWith proper preoperative understanding of apical lesion location, timing of DVC ligation [standard vs delayed] doesn't impact apical positive surgical margins. Combination of MRI, MUS, PSMA-PET and prostate biopsy reduce apical positive surgical margin rates significantly.

Stepwise Corrected Attention Registration Network for Preoperative and Follow-Up Magnetic Resonance Imaging of Glioma Patients.

The registration of preoperative and follow-up brain MRI, which is crucial in illustrating patients' responses to treatments and providing guidance for postoperative therapy, presents significant challenges. These challenges stem from the considerable deformation of brain tissue and the areas of non-correspondence due to surgical intervention and postoperative changes. We propose a stepwise corrected attention registration network grounded in convolutional neural networks (CNNs). This methodology leverages preoperative and follow-up MRI scans as fixed images and moving images, respectively, and employs a multi-level registration strategy that establishes a precise and holistic correspondence between images, from coarse to fine. Furthermore, our model introduces a corrected attention module into the multi-level registration network that can generate an attention map at the local level through the deformation fields of the upper-level registration network and pathological areas of preoperative images segmented by a mature algorithm in BraTS, serving to strengthen the registration accuracy of non-correspondence areas. A comparison between our scheme and the leading approach identified in the MICCAI's BraTS-Reg challenge indicates a 7.5% enhancement in the target registration error (TRE) metric and improved visualization of non-correspondence areas. These results illustrate the better performance of our stepwise corrected attention registration network in not only enhancing the registration accuracy but also achieving a more logical representation of non-correspondence areas. Thus, this work contributes significantly to the optimization of the registration of brain MRI between preoperative and follow-up scans.

The utility of ultrafast MRI and conventional DCE-MRI for predicting histologic aggressiveness in patients with breast cancer.

Prediction of histologic prognostic markers is important for determining management strategy and predicting prognosis. To identify important features of ultrafast and conventional dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) that can predict histopathologic prognostic markers in patients with breast cancer. Preoperative MRI scans of 158 consecutive women (mean age = 54.0 years; age range = 29-86 years) with 163 breast cancers between February 2021 and August 2022 were retrospectively reviewed. Inter-observer agreements for ultrafast MRI parameters were analyzed by two radiologists. The qualitative and quantitative MRI parameters were correlated with histopathologic prognostic markers including molecular subtypes and histologic invasiveness. Inter-observer agreements for ultrafast MRI parameters were excellent (intraclass correlation coefficients of area under the kinetic curve [AUC], maximum slope [MS], maximum enhancement [ME], and slope = 0.987, 0.844, 0.822, and 0.760, respectively). Triple-negative breast cancers (TNBC) were significantly associated with rim enhancement (odds ratio [OR] = 9.4, P = 0.003) and peritumoral edema (OR = 17.9, P = 0.002), compared to luminal cancers. Invasive cancers were associated with lesion type-mass, increased delayed washout, angiovolume, ME, slope, MS, and AUC, compared to in situ cancers. In regression analysis, the combination of MS (>46.2%/s) (OR = 5.7, P = 0.046) and delayed washout (>17.5%) (OR = 17.6, P = 0.01), and that of AUC (>27,410.3) (OR = 9.6, P = 0.04), delayed washout (>17.5%) (OR = 8.9, P = 0.009), and lesion-type mass (OR = 4.6, P = 0.04) were predictive of histologic invasiveness. Conventional DCE-MRI with ultrafast imaging can provide useful information for predicting histologic underestimation and aggressive molecular subtype. MS and AUC on ultrafast MRI can be potential imaging markers for predicting histologic upgrade from DCIS to invasive cancer with high reliability.

The value of multimodal imaging fusion in preoperative visualization assessment of neurovascular relationship in hemifacial spasm: a single-center retrospective study.

The neurovascular conflict (NVC) at the brainstem exit zone of the facial nerve is considered the primary etiology of primary hemifacial spasm (HFS). Therefore, microvascular decompression (MVD) has become the preferred treatment for HFS. Successful neurovascular decompression can achieve significant therapeutic effects, and accurately identifying the site of compression is crucial for the success of this surgery. Detailed diagnostic neuroimaging plays an important role in accurately identifying the site of compression.The purpose of this study is to explore the feasibility and predictive value of preoperative visualization assessment of the neurovascular relationship in HFS using 3D Slicer software based on multimodal imaging fusion. This aims to reduce the omission of responsible vessels and lower the incidence of postoperative complications, thereby potentially improving the efficacy and safety of the surgery. This study retrospectively analyzed 80 patients with HFS who underwent MVD surgery. All patients underwent preoperative cranial MRI scans, including the 3D-FIESTA and the 3D-TOF MRA sequences. Three-dimensional models were reconstructed from the multimodal MRI images using 3D Slicer software. Independent observers, who were blinded to the surgical outcomes, evaluated the neurovascular relationships using both the three-dimensional models and multimodal MRI images. The assessment results were compared with intraoperative findings, and statistical analysis was conducted using SPSS 22.0 software. The agreement between preoperative assessment using the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence and intraoperative findings was represented by a Kappa value of 0.343, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.637. There was a statistically significant difference between the two methods ( X2 = 18.852, P = 0.001 ). The sensitivity and specificity of the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence for evaluating neurovascular relationships were 92.4% and 100%, respectively, while for three-dimensional reconstruction, both were 100%. The Kappa value for agreement between preoperative the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence prediction of offending vessels and intraoperative findings was 0.625, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.938, showing a statistically significant difference ( X2 = 317.798, P = 0.000 ). The Kappa value for agreement between preoperative the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence assessment of the anatomical location of facial nerve involvement in neurovascular compression and intraoperative findings was 0.608, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.918, also showing a statistically significant difference ( X2 = 504.647, P = 0.000 ). The preoperative visualization assessment of neurovascular relationships in HFS using 3D Slicer software based on multimodal imaging fusion has been demonstrated to be reliable. It is more accurate than combining the 3D-TOF MRA sequence with the 3D-FIESTA sequence and shows higher consistency with intraoperative findings. This method provides guidance for surgical procedures and thereby potentially enhances the efficacy and safety of surgeries to a certain extent.

Local extension findings on MRI compensate for the ability of pathological staging to predict oncological outcome.

We investigated whether local extension findings on preoperative MRI and excisional pathology are associated with positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy. We identified 704 of our patients that underwent robot-assisted radical prostatectomy between 2012 and 2020, and extracted the 326 patients who had preoperative MRI scans and a radiologist reading. These patients were classified into groups according to the presence of local extension on MRI and pathological findings: ≤ cT2pT2 (195 cases), ≤ cT2pT3 (55 cases), cT3pT2 (31 cases), and cT3pT3 (45 cases). We compared positive surgical margin and biochemical recurrence between them. Median age was 69years, positive surgical margin rate was 20.2%, and five-year biochemical recurrence rate was 20.3%. Of the 226 patients without local invasion on excisional pathology, those with local extension on MRI (cT3pT2) had relatively higher positive surgical margin rate (29.0% vs. 14.4%, p = 0.05) and significantly higher five-year biochemical recurrence rate (25.8% vs. 9.3%, p = 0.01) than those without local extension on MRI (≤ cT2pT2). Similarly, among the 100 patients with local extension on excisional pathology, those with cT3pT3 had relatively higher positive surgical margin (37.8% vs. 21.8%, p = 0.08) and significantly higher five-year biochemical recurrence (53.3% vs. 29.3%, p = 0.01) than those with ≤ cT2pT3. In multivariate analysis, local extension on MRI was an independent predictor of biochemical recurrence (OR 2.1, 95%CI 1.1-3.9, p = 0.01). Local extension on MRI is a prognostic factor independent of pathological stage. The use of MRI may complement the prognostic value of excisional pathology of prostate cancer.

Shape matters: unsupervised exploration of IDH-wildtype glioma imaging survival predictors

Abstract Objectives This study examines clustering based on shape radiomic features and tumor volume to identify IDH-wildtype glioma phenotypes and assess their impact on overall survival (OS). Materials and methods This retrospective study included 436 consecutive patients diagnosed with IDH-wt glioma who underwent preoperative MR imaging. Alongside the total tumor volume, nine distinct shape radiomic features were extracted using the PyRadiomics framework. Different imaging phenotypes were identified using partition around medoids (PAM) clustering on the training dataset (348/436). The prognostic efficacy of these phenotypes in predicting OS was evaluated on the test dataset (88/436). External validation was performed using the public UCSF glioma dataset (n = 397). A decision-tree algorithm was employed to determine the relevance of features associated with cluster affiliation. Results PAM clustering identified two clusters in the training dataset: Cluster 1 (n = 233) had a higher proportion of patients with higher sphericity and elongation, while Cluster 2 (n = 115) had a higher proportion of patients with higher maximum 3D diameter, surface area, axis lengths, and tumor volume (p &lt; 0.001 for each). OS differed significantly between clusters: Cluster 1 showed a median OS of 23.8 compared to 11.4 months of Cluster 2 in the holdout test dataset (p = 0.002). Multivariate Cox regression showed improved performance with cluster affiliation over clinical data alone (C index 0.67 vs 0.59, p = 0.003). Cluster-based models outperformed the models with tumor volume alone (evidence ratio: 5.16–5.37). Conclusion Data-driven clustering reveals imaging phenotypes, highlighting the improved prognostic power of combining shape-radiomics with tumor volume, thereby outperforming predictions based on tumor volume alone in high-grade glioma survival outcomes. Clinical relevance statement Shape-radiomics and volume-based cluster analyses of preoperative MRI scans can reveal imaging phenotypes that improve the prediction of OS in patients with IDH-wild type gliomas, outperforming currently known models based on tumor size alone or clinical parameters. Key Points Shape radiomics and tumor volume clustering in IDH-wildtype gliomas are investigated for enhanced prognostic accuracy. Two distinct phenotypic clusters were identified with different median OSs. Integrating shape radiomics and volume-based clustering enhances OS prediction in IDH-wildtype glioma patients.

Comparison of the Preoperative MRI Evaluation of Glandular Tissue in Subcutaneous Mastectomy and its Influence on the Implant Volume.

This study examined the influence of preoperative MRI on the choice of implant volume in patients undergoing subcutaneous mastectomy with immediate breast reconstruction. It was postulated that preoperative MRI scans can adequately estimate glandular tissue, which in turn correlates with implant size. Preoperative and postoperative MRI scans were used in oncological and prophylactical subcutaneous mastectomy scenarios in 67 cases at the Department of Gynaecology, Breast Cancer Center, University of Cologne, Germany. The preoperative MRI was used to estimate the resected tissue and the postoperative MRI was used to scan for residual glandular tissue. In addition, a correlation found by Malter et al. in 2021 was evaluated with the available data. Preoperative MRIs result in an adequate estimation of resected tissue. This in turn correlates with implant volume. The correlation by Malter et al. also holds when estimating implant volume. The likelihood of residual gland was low if the preoperatively estimate volume was removed. Our results indicate that the use of preoperative and postoperative MRI scans for subcutaneous mastectomies is advantageous. We suggest a routine estimation of glandular tissue, especially for small breasts.

Relationship between facet joint osteoarthritis and lumbar paraspinal muscle atrophy: a cross-sectional study.

The paraspinal muscles play an essential role in the stabilization of the lumbar spine. Lumbar paraspinal muscle atrophy has been linked to chronic back pain and degenerative processes within the spinal motion segment. However, the relationship between the different paraspinal muscle groups and facet joint osteoarthritis (FJOA) has not been fully explored. In this cross-sectional study, the authors analyzed adult patients who underwent lumbar spinal surgery between December 2014 and March 2023 for degenerative spinal conditions and had preoperative MRI and CT scans. The fatty infiltration (FI) and functional cross-sectional area (fCSA) of the psoas, erector spinae, and multifidus muscles were assessed on axial T2-weighted MR images at the level of the upper endplate of L4 based on established studies and calculated using custom-made software. Intervertebral disc degeneration at each lumbar level was evaluated using the Pfirrmann grading system. The grades from each level were summed to report the cumulative lumbar Pfirrmann grade. Weishaupt classification (0-3) was used to assess FJOA at all lumbar levels (L1 to S1) on preoperative CT scans. The total lumbar FJOA score was determined by adding the Weishaupt grades of both sides at all 5 levels. Correlation and linear regression analyses were conducted to assess the relationship between FJOA and paraspinal muscle parameters. A total of 225 patients (49.7% female) with a median age of 61 (IQR 54-70) years and a median BMI of 28.3 (IQR 25.1-33.1) kg/m2 were included. After adjustment for age, sex, BMI, and the cumulative lumbar Pfirrmann grade, only multifidus muscle fCSA (estimate -4.69, 95% CI -6.91 to -2.46; p < 0.001) and FI (estimate 0.64, 95% CI 0.33-0.94; p < 0.001) were independently predicted by the total FJOA score. A similar relation was seen with individual Weishaupt grades of each lumbar level after controlling for age, sex, BMI, and the Pfirrmann grade of the corresponding level. Atrophy of the multifidus muscle is significantly associated with FJOA in the lumbar spine. The absence of such correlation for the erector spinae and psoas muscles highlights the unique link between multifidus muscle quality and the degeneration of the spinal motion segment. Further research is necessary to establish the causal link and the clinical implications of these findings.

The effect of brace treatment history on bone density in preoperative patients with adolescent idiopathic scoliosis (AIS) assessed by vertebral bone quality (VBQ) score: a retrospective propensity score-matched analysis

IntroductionAdolescent idiopathic scoliosis (AIS), a prevalent condition among teenagers, is often accompanied by osteopenia. However, the impact of brace treatment on bone density in AIS patients remains a matter of debate. The Vertebral bone quality (VBQ) score, derived from MRI signal intensity, has been shown to correlate with bone mineral density (BMD). Yet, no studies to date have drawn comparisons between VBQ scores in preoperative AIS patients who had brace treatment history and those who have not received brace treatment.ObjectiveThis study aims to elucidate the influence of brace treatment on bone density in AIS patients using VBQ score.MethodsA retrospective analysis was conducted on 243 AIS patients, each with Cobb angles ranging from 50–70°, who had undergone preoperative MRI scans. The patients were segregated into two cohorts: those who received brace treatment (n = 174) and those who did not (n = 69). Through propensity score matching, a total of 53 matched pairs were selected for further analysis. VBQ scores were extracted from T1-weighted MRI scans.ResultsPost-matching, no significant baseline discrepancies were observed between the two groups. Interestingly, brace-treated patients exhibited lower average VBQ scores than their non-brace-treated counterparts (2.43 ± 0.11 vs. 2.55 ± 0.12, p < 0.01), suggesting a higher bone density. Furthermore, a negative correlation was observed between VBQ scores and the duration of brace usage (R2 = 0.3853, p < 0.01).ConclusionBrace treatment may potentially enhance bone density in AIS patients by mitigating vertebral fat infiltration. The utilization of VBQ scores presents an alternative, potentially robust approach to assessing bone quality.

Arthroscopic Repair of Extruded Meniscus Tears: Impact on Symptom Relief and Functional Improvement - A 2-Year Follow-Up Study.

BACKGROUND This retrospective study from a single center in Turkey aimed to evaluate 2-year outcomes of 21 patients undergoing knee arthroscopic repair of extruded meniscus tears without root tear. MATERIAL AND METHODS The retrospective study comprised 21 individuals who underwent arthroscopic extruded meniscus repair and were followed up for at least 2 years. The study analyzed the meniscus extrusion amounts in preoperative and postoperative MRI scans, the Kellgren-Lawrence stages in knee radiographs, and the Lsyhom and The International Knee Documentation Committee (IKDC) scores of the included patients. RESULTS In this study, the repair operation extrusion levels were 3.30 mm from 4.01 mm preoperatively (P<0.001). After the repair, there was a significant increase in the Lsyhom and IKDC scores (P<0.001). According to the Kellgren-Lawrence scale, 12 patients were evaluated as stage 0, 6 patients as stage 1, and 3 patients as stage 2. According to the radiographs taken at the last follow-up, 2 patients progressed from stage 0 to stage 1, 2 patients progressed from stage 1 to stage 2, and 1 patient progressed from stage 2 to stage 3. CONCLUSIONS Arthroscopic treatment of extruded meniscus tears can enhance functional status and increase patients' functional status. Nevertheless, the absence of successful centralization extruded meniscus tears. This study discovered that radiological extrusion did not diminish beyond the critical threshold of 3 mm, which is associated with the development of osteoarthritis. This highlights the necessity of taking these elements into account when devising a treatment plan.

Tumor necrosis in magnetic resonance imaging predicts urothelial carcinoma with squamous differentiation in muscle-invasive bladder carcinoma.

This study investigated radiologic features on preoperative MRI to differentiate urothelial carcinoma with squamous differentiation (UCSD) from conventional urothelial carcinoma (UC) in muscle-invasive bladder carcinoma. Ninety-nine patients who underwent radical cystectomy and a preoperative bladder MRI scan within three months before surgery were retrospectively enrolled. Various MRI features, including tumor length, location, multiplicity, long-to-short axis ratio, morphology, radiologic stage, and degree of severe necrosis, were analyzed. Univariable and multivariable logistic regression analyses were performed to identify MRI features predictive of UCSD. The diagnostic performance of a significant MRI feature was assessed using 5-fold cross-validation. Among the MRI features, significant radiologic findings associated with UCSD in the univariable analysis included heterogeneous tumor signal intensity in T2-weighted images (odds ratio [OR], 3.365; 95% confidence interval [CI], 1.213-9.986; P = 0.022) and contrast-enhanced T1-weighted images (OR, 4.428; 95% CI, 1.519-12.730; P = 0.007), as well as marked (≥ 50%) severe necrosis (OR, 17.100; 95% CI, 4.699-73.563; P < 0.001). In the multivariable analysis, marked (≥ 50%) severe necrosis (odds ratio [OR], 13.755; 95% confidence interval [CI], 2.796-89.118; P = 0.004) was a significant predictor of UCSD. Marked (≥ 50%) severe necrosis showed a high specificity of 95.0% with a precision of 65.0% for diagnosing UCSD based on 5-fold cross-validation. Preoperative bladder MRI revealing marked severe necrosis may be indicative of UCSD and can assist in distinguishing it from conventional UC.

The Spaghetti Sign: Nerve Root Redundancy in Lumbar Spinal Stenosis

Redundant nerve roots (RNRs) seen in conjunction with lumbar spinal stenosis (LSS) are well-described radiographic findings. Several studies suggest their presence may be a negative prognostic indicator of postoperative outcome. Our hypothesis was that severe RNR (informally known as the spaghetti sign [SS]) can serve as a reliable marker of LSS that would benefit from surgical decompression. We sought to evaluate a grading scale for RNR, characterize the association with stenosis, and investigate the clinical implications of RNR. We conducted a retrospective chart review of 72 patients who underwent lumbar spine surgery from 2016 to 2018 at 1 institution. Preoperative T2 magnetic resonance imaging scans were graded by 3 reviewers for severity of stenosis (0-4), severity of RNR (0-3), and rostral versus caudal RNR. SS was defined as RNR score ≥2 (clear-cut or marked nerve root irregularity). Preoperative and postoperative Oswestry Disability Index scores were analyzed by stenosis and RNR severity. Seventy-one (98%) patients had severe stenosis (score ≥3) and 25 (35%) had a SS. SS was 100% specific for high-grade stenosis. If patients had a SS, it was more likely rostral (P=0.02). Postoperative Oswestry Disability Index scores improved significantly, but there were no differences related to RNR score, presence of SS, or stenosis severity. The study demonstrated that there is a significant association between SS and severe LSS and that presence of RNR is not a negative prognostic indicator for postoperative outcomes.