Repeat Magnetic Resonance Imaging Research Articles

Abstract PO5-20-06: Paraneoplastic cerebellar degeneration in anti-Yo antibody and HER2-positive metastatic breast carcinoma

Abstract Paraneoplastic cerebellar degeneration (PCD) in the context of breast carcinoma affects less than 1% of patients. In most cases, breast cancer diagnosis follows several months or even years after the onset of neurological symptoms. The first association between PCD and occult gynecologic cancers (breast or ovarian) was identified in 1938 with the discovery of antibodies directed against cytoplasmic antigens of Purkinje cells (“anti-Yo antibodies”). Since then, evidence has grown significantly to support anti-Yo antibodies as excellent diagnostic markers of PCD with underlying gynecologic and breast carcinoma. This case study evaluates a 57-year-old female who initially presented with headache and subacute cerebellar ataxia. Her symptoms progressed over a period of three months with multiple falls, onset of speech difficulties, and diplopia. She also reported 30-pound weight loss, which she attributed to dieting and starting semaglutide. Magnetic resonance imaging (MRI) of the brain and spine were unremarkable and autoimmune workup was normal. Cerebral spinal fluid (CSF) and serum studies demonstrated positive anti-Yo antibodies. Computed tomography (CT) of the abdomen and pelvis showed an enlarged left axillary lymph node concerning for metastatic disease with a 1.2cm focus of asymmetric density in the central inferior left breast parenchyma. Diagnostic mammogram one year prior was reportedly normal. Ataxia symptoms improved after a course of empiric intravenous immunoglobulins and steroids. Ultrasound-guided biopsy of the left axillary lymph node revealed metastatic mammary carcinoma: estrogen and progesterone receptor negative and human epidermal growth factor receptor 2 (HER2)-positive, cT0N2aM0, ypTxN1aM0, stage IIIa (AJCC 8th edition). She underwent further metastatic workup, including repeat CSF studies and MRI. MRI of the spine was remarkable for multiple hemangiomas throughout the cervical, thoracic, and lumbar spine, with subsequent unremarkable bone scan. MRI of the abdomen was remarkable for right hepatic lobe hemangioma and a right adrenal nodule. CSF studies showed no sign of metastases. After multidisciplinary discussion, TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab) neoadjuvant therapy was initiated and repeat imaging demonstrated favorable treatment response with a shrinking axillary mass; no primary breast mass was identified. The patient underwent left sentinel lymph node biopsy with a positive frozen section intraoperative for invasive cancer, therefore proceeded with left axillary lymph node dissection. She was offered a mastectomy but elected for only axillary surgery. Pathology revealed 1 of 14 lymph nodes were positive for metastatic ductal carcinoma. She remains in a rehabilitation center and her ataxia is improving, but her functional status remains below baseline. She is undergoing radiation to whole breast and regional lymph nodes. With this case, we aim to continue to build upon the limited base of the exceedingly rare presentation of breast cancer-associated paraneoplastic syndrome. In addition, several studies and case reports have demonstrated a strong correlation between HER2 overexpression and anti-Yo associated PCD. As we continue to diagnose and monitor breast cancer patients, we could consider starting to screen for anti-Yo antibodies in HER2-positive patients to gain insight into a patient’s prognosis and development of PCD. Citation Format: You Kim, Alison Coogan, Andrea Madrigrano. Paraneoplastic cerebellar degeneration in anti-Yo antibody and HER2-positive metastatic breast carcinoma [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-06.

Early experience with the use of Cissus quadrangularis and Dalbergia sissoo therapy on bone marrow edema and knee pain associated with degenerative medial compartment knee osteoarthritis

Background: Bone marrow edema (BME) refers to the accumulation of excess fluid in the bone marrow, often indicative of injury or inflammation. Some studies suggest that incorporating plant-based therapies, rich in anti-inflammatory compounds and nutrients, may contribute to alleviating BME and promoting overall bone health. Aims and Objective: The study aims to evaluate the effect of Cissus quadrangularis and Dalbergia sissoo therapy on BME and knee pain associated with degenerative medial compartment knee osteoarthritis (OA). Materials and Methods: This retrospective study examined seven individuals with medial tibial condyle BME associated with medial compartment OA. These patients were treated with initial 10 days of non-steroidal anti-inflammatory drugs along with once-a-day tablet containing C. quadrangularis (500 mg) and D. sissoo (400 mg). Visual analogue scores (VAS) and Oxford knee score (OKS) were noted at the beginning of the therapy and at 12 weeks of completion of therapy. Before treatment, BME (percentage of the medial tibial condyle) and presence/absence of subtle subchondral fracture were diagnosed with T2-weighted magnetic resonance imaging (MRI) images, and subsequently, its resolution was confirmed with a repeat MRI scan at 12 weeks. Results: At the end of 12 weeks of therapy, there was a statistically significant improvement in the mean VAS score (baseline 8.14±0.90 improved to 2.00±0.58 at 12 weeks, [P<0.0001]), OKS (baseline 25.71±1.80 improved to 36.57±1.51 at 12 weeks, [P=0.0001]), and there was statistically significant decrease in mean BME (baseline 37.86±10.35% decreased to 14.29±4.50% at the end of 12 weeks, [P=0.0001]). Conclusion: Our early experience shows that the combination therapy of C. quadrangularis + D. sissoo is effective in relief of pain, improvement in knee function, and resolution of BME associated with medial compartment knee OA. This combination is safe, effective, and well-tolerated by patients’ population.

Prolactinoma Presenting with Secondary Amenorrhoea in a Young Girl

Prolactinoma is the most common secreting pituitary adenoma. It has different clinical presentation in men and women which varies with age. Young women present with menstrual problems, infertility and galactorrhoea, whilst older women and men may present with loss of libido, visual disturbances and in late cases, ith osteoporosis. In approaching a young woman with secondary amenorrhoea, other cuses such as pregnancy, functional hypothalamic amenorrhea, pituitary adenoma, Polycystic Ovarian Syndrome (PCOS) or primary ovarian insufficiency should be ruled out. Prolactinoma can be confirmed in the presence of high serum prolactin level and adenoma on pituitary gland magnetic resonance imaging (MRI). Dopaminergic agonist, cabergoline is efficacious in restoring gonadal and sexual functions by normalising prolactin levels. We presented a case report onan 18-year-old girl who presented with secondary amenorrhoea for six months. On further evaluation she was noted to have galactorrhoea with substantially high prolactin level of 466.9 ng/mL (normal range: 4.0- 23) and the MRI showed a pituitary tumour measuring 1.2 x 1.1 x 1.4 cm. A diagnosis of macroprolactinoma was made and she was managed with cabergoline with gradual dose increment. At 6 months of treatment, her menstrual cycle and serum prolactin had normalised. A repeat MRI pituitary one year later showed reduction in tumour size.

Clinical Utility of Repeat Magnetic Resonance Imaging Studies Among Children With Acute Hematogenous Osteomyelitis.

There is limited guidance for whether repeat magnetic resonance imaging (MRI) studies are clinically impactful among children with acute hematogenous osteomyelitis (AHO) who fail to improve as expected. This study aimed to determine whether repeat MRIs changed management among children with AHO and identify clinical characteristics predictive of which patients benefit from repeat MRIs. Children admitted to a quaternary care pediatric hospital with AHO were identified during a 9-year period. Patients with chronic symptoms, non-hematogenous infections, or significant contributing comorbidities were excluded. Medical records were retrospectively reviewed for all MRIs performed 3 weeks before admission to 24 months after discharge. An MRI was considered clinically impactful if it identified a new infectious process (eg, abscess not seen on the initial MRI) or if it resulted in surgical intervention within 24 hours. Bivariable comparisons of categorical variables were performed, and multivariable logistic regression was used to assess the clinical factors of impactful repeat MRIs. Among the 239 included patients, 41 (17%) had more than 1 MRI performed during their clinical course, the majority of whom (53.7%) had a repeat MRI that impacted care. Patients who underwent repeat MRIs had longer hospitalizations (7 vs. 5 d, P <0.01), were more likely to have C-reactive protein (CRP) levels >20mg/dL (41% vs. 10%, P <0.01), and were more likely to have a delayed transition to oral antimicrobials (8.4 vs. 3.3d, P <0.01). Peak CRP >20mg/dL and prolonged bacteremia were found to be associated with increased odds of having an impactful repeat MRI, with adjusted odds ratios of 3.9 ( P =0.007) and 3.4 ( P =0.03), respectively. When used judiciously among ill children with complicated AHO, repeat MRI can be clinically impactful. Prospective studies are needed to better define which children with AHO benefit from repeat MRI. Level II evidence-this is a retrospective cohort study interested in determining the clinical utility of repeat magnetic resonance imaging studies for children with osteomyelitis.

Primary extraskeletal intradural Ewing sarcoma with acute hemorrhage: a case report and review of the literature

BackgroundSpinal cord tumors present a challenge in diagnosis and treatment due to their varied histopathological characteristics. While Ewing sarcoma is a rare malignant tumor typically originating from skeletal bone, cases of primary intradural extraskeletal Ewing sarcoma are exceptionally rare. The similarity of its presentation to other spinal tumors further complicates its identification and management.Case presentationWe report a case of a 58-year-old Palestinian male with intradural extraskeletal lumbar Ewing sarcoma. The patient initially presented with lower back pain and bilateral S1 radiculopathy, with more severe symptoms on the left side. Magnetic resonance imaging revealed a 7 cm oval-shaped mass with homogeneous contrast enhancement, obstructing the spinal canal from L3/L4 to L5/S1 levels. Initially, a myxopapillary ependymoma was suspected, but the patient’s sensory and motor functions suddenly deteriorated during hospitalization. Repeat magnetic resonance imaging indicated heterogeneous contrast enhancement, indicating acute intratumoral hemorrhage. Consequently, the patient underwent emergent L3–L5 laminotomy, with successful gross total resection of the tumor. Histopathological and immunohistochemical analyses confirmed the diagnosis of intradural extraskeletal Ewing sarcoma. Adjuvant therapy was administered to minimize the risk of local recurrence or distant metastasis. A systematic review of relevant literature, along with retrospective analysis of medical records, operative reports, radiological studies, and histopathological findings of similar cases, was also conducted.ConclusionsIntradural extraskeletal Ewing sarcoma is an infrequently encountered condition in adult patients, emphasizing the importance of considering it in the differential diagnosis of spinal tumors. Surgeons must possess a comprehensive understanding of this rare entity to ensure accurate staging and optimal management, particularly in the early stages when prompt intervention may improve prognosis.

A Rapid MRI Protocol for the Evaluation of Acute Pediatric Musculoskeletal Infections: Eliminating Contrast and Decreasing Anesthesia, Scan Time, and Hospital Length of Stay and Charges.

Acute musculoskeletal infection affects >1 in 6,000 children in the United States annually. Magnetic resonance imaging (MRI) is the gold standard for the diagnosis of musculoskeletal infection, but it traditionally requires contrast and anesthesia for children, delaying management. A rapid MRI protocol involves MRI without anesthesia and with limited non-contrast sequences optimized for fluid detection and diffusion-weighted images to identify abscesses. We hypothesized that a rapid MRI protocol would improve imaging and treatment efficiency for pediatric patients undergoing musculoskeletal infection evaluation without substantially affecting accuracy. This was a single-center, retrospective study of patients undergoing evaluation for musculoskeletal infection before (60 patients in the traditional cohort [TC]) and after (68 patients in the rapid cohort [RC]) implementation of the rapid MRI protocol. Sociodemographic and clinical variables were extracted from electronic health records, and statistical comparisons were performed. The anesthesia rates were 53% for the TC and 4% for the RC, and the contrast administration rates were 88% for the TC and 0% for the RC. The median time to MRI after ordering was 6.5 hours (95% confidence interval [CI], 5.0 to 8.6 hours) for the TC and 2.2 hours (95% CI, 1.4 to 3.6 hours) for the RC (p < 0.01). The median duration of MRI was 63.2 minutes (95% CI, 56.8 to 69.6 minutes) for the TC and 24.0 minutes (95% CI, 21.1 to 29.5 minutes) for the RC (p < 0.01). The median hospital length of stay was 5.3 days (95% CI, 3.7 to 6.9 days) for the TC and 3.7 days (95% CI, 1.9 to 4.1 days) for the RC (p < 0.01). The median hospital charges were $47,309 (95% CI, $39,137 to $58,769) for the TC and $32,824 (95% CI, $22,865 to $45,339) for the RC (p < 0.01). Only 2 positive cases of musculoskeletal infection in the RC were missed on the initial imaging, but these instances were not attributable to the rapid protocol itself. Although 10 of 68 rapid MRI scans resulted in nondiagnostic outcomes due to patient motion, only 6 of 68 required repeat MRI with anesthesia. In patients evaluated for musculoskeletal infection, the rapid MRI protocol eliminated contrast and minimized anesthesia while improving MRI access and decreased scan and interpretation times, hospital length of stay, and hospital charges. The rapid MRI protocol had high sensitivity for diagnosing musculoskeletal infection and a low rate of imaging failure. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case.

Spontaneous spinal subarachnoid hemorrhage is a rare pathological entity with a variety of presentations depending on the underlying etiology, which often remains cryptogenic. The literature is sparse regarding the most efficacious treatment or management option, and there is no consensus on follow-up time or modalities. Additionally, there are very few reports that include operative videos, which is provided herein. The authors present a case of spontaneous spinal subarachnoid hemorrhage without an underlying etiology in a patient with progressive myelopathy, back pain, and lower-extremity paresthesias. She presented to our institution, and because of progressive worsening of her symptoms and the development of compressive arachnoid cysts, she underwent thoracic laminectomies for evacuation of subdural fluid, fenestration of the arachnoid cysts, and lysis of significant arachnoid adhesions. Her clinical course was further complicated by the recurrence of worsening myelopathy and the development of a large compressive arachnoid cyst with further arachnoiditis. The patient underwent repeat surgical intervention for cyst decompression with an improvement in symptoms. This case highlights the importance of long-term follow-up for these complicated cases with an emphasis on repeat magnetic resonance imaging. Unfortunately, surgical intervention is associated with short-term relief of the symptoms and no significant nonoperative management is available for these patients.

Spontaneous resorption of a C7–T1 intervertebral disc extrusion in a Cavalier King Charles spaniel confirmed via low‐field MRI

AbstractA 4‐year‐old, male, neutered Cavalier King Charles spaniel was referred to the neurology service with a 10‐day history of cervical hyperaesthesia. A low‐field magnetic resonance imaging scan of the cervical spine identified a large C7–T1 intervertebral disc extrusion, resulting in severe spinal cord compression. The patient was treated with conservative therapy (exercise restriction and analgesia for 4 weeks). Repeat magnetic resonance imaging of the cervical spine was performed 4 months after initial presentation, and identified spontaneous resorption of the extruded C7–T1 disc material. There are very few documented cases of spontaneously resorbed cervical intervertebral disc extrusions in canine patients following successful conservative therapy. To the authors’ knowledge, this is the first report of spontaneous resorption of an intervertebral disc extrusion at an unusual C7–T1 location confirmed via follow‐up low‐field magnetic resonance imaging following conservative therapy.

The value of a repeat MRI examination of the sacroiliac joints following an inconclusive initial examination.

Assess the diagnostic utility of repeat sacroiliac joint (SIJ) magnetic resonance imaging (MRI) examinations following an inconclusive initial examination performed for suspected sacroiliitis. Subjects with > 1 SIJ MRI examinations, an inconclusive first scan and at least 6 months interval between scans, were included. All scans were evaluated for the presence of structural/active SIJ lesions as well as any other pathology. Clinical data was extracted from the patients' clinical files, and any missing data was obtained by a telephone interview. Diagnosis and active/structural scores were compared between first and follow-up examinations (t test). Seventy-one subjects were included in the study, 77.4% females, mean age 41.0 ± 15 years, mean time interval between exams 30.4 ± 25.24 months. Twelve subjects performed > 2 scans. In only two subjects (2.81%), both females, MRI diagnosis changed from inconclusive to definite sacroiliitis. None of the subjects with > 2 scans had evidence of sacroiliitis in any of the following MRI examinations. Significant differences were observed between the scores of active SIJ lesion of the first and follow-up MRI (1.51/1.62, p = 0.02) but not for scores of structural lesions (1.22/1.68, p = 0.2). Repeat SIJ MRI when the first MRI is inconclusive for sacroiliitis is more valuable in ruling out than in securing diagnosis of sacroiliitis. We suggest that when MRI findings are inconclusive, decision-making should be based on clinical data.

The Rubber Band Man: An Unexpected Reason for Breathing Difficulty

A 73-year-old male presented to his physician with difficulty breathing. The patient described a nagging inability to take a deep breath, and his wife noted what appeared to be a mass on his back, that she believed had gotten bigger. He had a notable family history of soft tissues masses in numerous family members. Physical examination revealed non-painful, soft, and movable masses along the inferior edges of both scapulae, consistent with elastofibroma. Pulmonary function testing and cardiac evaluation revealed normal results. The masses remained stable in size across repeat Magnetic Resonance Imaging and were managed conservatively due to their non-impeding nature and lack of cosmetic concerns. This case highlights the importance of considering elastofibroma in patients with soft tissue masses, the significance of their physical symptomatology and the decision-making process involved in selecting appropriate management strategies based on individual patient characteristics and clinical presentations.

Follow-Up Magnetic Resonance Imaging of Sagittal Groove Disease of the Equine Proximal Phalanx Using a Classification System in 29 Non-Racing Sports Horses.

Evolution of magnetic resonance imaging (MRI) findings in horses with sagittal groove disease (SGD) of the proximal phalanx is relatively sparsely described. This retrospective, descriptive, longitudinal study describes the findings of sequential low-field MRI fetlock examinations in horses with SGD of the proximal phalanx using a classification system. Twenty-nine horses were included, predominantly warmbloods used for show jumping (79%). For 29 limbs re-examined during the initial rehabilitation period, classification remained constant (n = 18), increased (n = 2), decreased (n = 7), and fluctuated (n = 2). Notably, two limbs with initial classification 4b (bone oedema-like signal with subchondral microfissure) and one with 4c (bone oedema-like signal with subchondral demineralisation) progressed to classification 5 (incomplete macrofissure/fracture), highlighting their potential as prodromal or imminent fissure pathology. Following conservative (n = 28) and surgical (n = 1) treatment, 86% of the horses re-entered full training and competition with a mean ± sd recovery time of 9.4 ± 4.4 months. In total, 20% of horses in the study subsequently presented for repeat MRI due to recurrent lameness after resuming full work, with classification that was the same (n = 2), increased (n = 2), or decreased (n = 2) compared with the last scan. This study underscores the variability in progression of SGD MRI findings, emphasising the need for further larger-scale research into patterns of progression.

2900. Clinical Utility of Repeat Magnetic Resonance Imaging Studies Among Children with Acute Hematogenous Osteomyelitis

Abstract Background Magnetic resonance imaging (MRI) is the diagnostic study of choice for children with acute hematogenous osteomyelitis (AHO). However, there is limited guidance for whether repeat MRIs are clinically impactful for children with AHO who fail to improve after initial treatment. This study aimed to determine whether repeat MRIs changed clinical management among children with AHO. Methods Children admitted to a quaternary care pediatric hospital with a discharge diagnosis of osteomyelitis were identified during a 9-year period. Patients with chronic symptoms, non-hematogenous infections, or significant contributing comorbidities were excluded. Medical records were retrospectively reviewed for all MRIs performed 3 weeks prior to admission to 24 months after discharge. An MRI was considered clinically impactful if it identified a new infectious process (e.g., abscess not seen on initial MRI) or if it resulted in surgical intervention within 24 hours. Categorical variables were compared using Fisher’s Exact or chi-square tests and continuous with Wilcoxon Rank-Sum tests. Results Among 239 included patients, 41 (17%) had more than 1 MRI performed during clinical care for their AHO. Twenty-nine repeat MRIs occurred during initial hospitalization and 27 during outpatient follow up. Children who underwent repeat inpatient MRIs had longer hospitalizations (9 vs 5 days, P&amp;lt; 0.01) and higher C-reactive protein levels (20 vs 7 mg/dL, P&amp;lt; 0.01), and were more likely to be critically ill (20% vs 6%, P=0.02) or to experience a therapeutic failure (20% vs 3%, P&amp;lt; 0.01). Among repeat inpatient MRIs, 19 (66%) were clinically impactful; 9 (31%) led to repeat surgical procedures and 13 (45%) identified new diagnoses. Repeat outpatient MRIs were more likely to be performed in children with vertebral AHO or multifocal infections (P=0.02). Among repeat outpatient MRIs, 7 (25%) were clinically impactful. Six (22%) led to repeat operative procedures and 3 (11%) identified new diagnoses. Conclusion When used judiciously among ill children with complicated AHO, repeat MRI can be clinically impactful in both the inpatient and outpatient setting. Prospective studies are needed to better define which children with AHO benefit from repeat MRI. Disclosures Julia S. Sanders, MD, OrthoPediatrics Corp: Advisor/Consultant

Men’s Acceptance of Screening for Prostate Cancer with Prostate-specific Antigen, Magnetic Resonance Imaging, and Prostate Biopsy

BackgroundA prerequisite before introducing a screening program is that the screening examinations are acceptable to participants. ObjectiveTo evaluate the acceptance and bother of prostate cancer screening examinations. Design, setting, and participantsThe randomized population-based GÖTEBORG-2 prostate cancer screening trial invited >37 000 men for prostate-specific antigen (PSA) testing followed by magnetic resonance imaging (MRI) in case of elevated PSA and prostate biopsy (targeted and/or systematic) if indicated. Outcome measurements and statistical analysisParticipants were asked to fill out a questionnaire and rate the level of bother associated with each examination (PSA, MRI, and prostate biopsy) on a categorical scale ranging from 1 to 5 (1 = “not at all bothersome” and 5 = “very bothersome”), and to rate their willingness to repeat the examinations, by marking an X on a continuous scale ranging from 0 to 10 (0 = “yes, without any hesitation” and 10 = “no, absolutely not”). Wilcoxon signed rank test was used. Results and limitationsCompliance with MRI was 96% (1790/1872), compliance with biopsy was 89% (810/907), and the response rate to the questionnaire was 75% (608/810). Men who underwent all examinations (n = 577) responded that biopsy was more bothersome than PSA test (p < 0.001) and MRI (p < 0.001). High levels of bother (≥4 out of 5) were reported by 2% (12/577) for PSA test, 8% (46/577) for MRI, and 43% (247/577) for biopsy. Men were more willing to repeat MRI than biopsy (p < 0.001), but the difference was small (median 0.2 [interquartile range 0.1–0.6] vs 0.5 [0.1–2.0]). ConclusionsBiopsies are more bothersome than MRI, but a large majority of men accept to repeat both examinations if necessary. Omitting biopsy for MRI-negative men and shifting to targeted biopsies only will reduce bother for men participating in prostate cancer screening. Patient summaryWe asked men how bothersome they found the prostate-specific antigen (PSA) test, magnetic resonance imaging (MRI), and prostate biopsies. Biopsies were more bothersome than PSA and MRI, but most men were willing to repeat all procedures if necessary.

Early Detection of hyperemia with Magnetic Resonance Fluid Attenuation Inversion Recovery Imaging after Superficial Temporal Artery to Middle Cerebral Artery Anastomosis.

Cerebral hyperperfusion syndrome(CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow, afflicting nearly 30% of patients who have undergone superficial temporal artery(STA)-middle cerebral artery(MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging(MRI) fluid-attenuated inversion recovery(FLAIR) and apparent diffusion coefficient(ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 h after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography(SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Out of a total of 162 patients, 24 individuals(comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but 9 of them showed no significant findings. Among the patients, 10 displayed elevations in both cerebral blood flow(CBF) and cerebral blood volume(CBV), 3 only showed elevation in CBF, and 2 only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.

Recurrent petit mal seizures in Erdheim-Chester disease mimicking an intra-axial brain tumor: illustrative case.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis characterized histologically by foamy histiocytes and Touton giant cells in a background of fibrosis. Bone pain with long bone osteosclerosis is highly specific for ECD. Central nervous system involvement is rare, although dural, hypothalamic, cerebellar, brainstem, and sellar region involvement has been described. A 59-year-old man with a history of ureteral obstruction, medically managed petit mal seizures, and a left temporal lesion followed with serial magnetic resonance imaging (MRI) presented with worsening seizure control. Repeat MRI identified bilateral amygdala region lesions. Gradual growth of the left temporal lesion over 1 year with increasing seizure frequency prompted resection. A non-Langerhans cell histiocytosis with a BRAF V600E mutation was identified on pathology. Imaging findings demonstrated retroperitoneal fibrosis and long bone osteosclerosis with increased fluorodeoxyglucose uptake that, together with the neuropathologic findings, were diagnostic of ECD. This case of biopsy-proven ECD is unique in that the singular symptom was seizures well controlled with medical management in the presence of similarly located bilateral anterior mesial temporal lobe lesions. Although ECD is rare intracranially, its variable imaging presentation, including the potential to mimic seizure-associated medial temporal lobe tumors, emphasizes the need for a wide differential diagnosis.

Tick-Borne Encephalitis in a 6-Year-Old Patient: A Case Report.

Background: Tick-Borne Encephalitis virus (TBEV) is a positive-sense single-stranded RNA virus belonging to the Flaviviridae family. TBEV transmission typically occurs through infected Ixodes tick bite or by consumption of unpasteurised milk from infected cattle. Case report: We report the clinical, neuroimaging, electroencephalogram (EEG), and laboratory (microbiological tests and spinal tap) data of a 6- year-old boy with Tick-borne encephalitis. Our patient presented with a biphasic course, initially with a myositis-like picture on his first admission to the emergency department, and after a few days with an encephalitic picture, resulting in a second hospitalization. EEG showed focal slow activity, while his brain magnetic resonance imaging (MRI) showed a signal abnormality, which completely resolved on repeat MRI after 3 months. Conclusion: To our knowledge, this is the youngest patient presenting with myositis in the first phase of Tick-borne encephalitis (TBE). In the presence of a biphasic clinical course, with previous myositis, aspecific MRI changes in the thalamic and midbrain regions and an EEG documenting slowed bioelectrical activity should prompt suspicion of TBEV infection.

H - 29 Delivering Culturally Sensitive Neuropsychological Assessment Feedback: a Case Study of Atypical Neurosyphilis.

To demonstrate the neuropsychological correlates of atypical neurosyphilis and the importance of delivering assessment results in a culturally sensitive manner. The patient was a 52-year-old African American male with 12years of education who was raised in a rural, southern town and worked as a delivery driver. He was hospitalized after three weeks of altered mental status, memory loss, and seizures. Electroencephalography (EEG) showed left lateralized periodic discharges. Magnetic resonance imaging (MRI) showed hyperintensities in the left hippocampus and amygdala consistent with limbic encephalitis. Cerebrospinal fluid studies revealed lymphocytic pleocytosis and hypoglycorrhachia. Rapid plasma regain and venereal disease tests were positive for syphilis in serum and CSF. He was initially treated with empiric antibiotics and antiseizures medications with modest improvement. His mental status improved after penicillin treatment, and he was discharged after 14days. Repeat MRI showed cortical atrophy in the left medial frontal lobe and left hippocampus. The patient demonstrated executive dysfunction (e.g., set-loss and source memory errors) and poor performance across verbal and visual memory tasks. He also demonstrated an inaccurate understanding of the possible causes of his illness. Feedback was delivered across two sessions: one session to discuss test results and a second session with the patient and his wife to discuss syphilis as a sexually transmitted infection and address the historical context of syphilis among African American men. Neurosyphilis can present as limbic encephalitis and can mimic autoimmune encephalitis and other infectious diseases. Tailoring assessment feedback to a patient's sociocultural context is vital for encouraging continued treatment.

Clinical Application of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Score for Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer.

The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) score has been developed to standardise prostate magnetic resonance imaging (MRI) reporting in men on active surveillance (AS) for prostate cancer (PCa). To evaluate the feasibility of PRECISE scoring and assess its diagnostic accuracy. All PCa patients on AS with a baseline MRI and at least one follow-up MRI scan between January 2008 and September 2022 at a single tertiary referral centre were included in a database. The follow-up protocol of the Prostate Cancer International Active Surveillance (PRIAS) study was used. All scans were retrospectively re-reported by a dedicated uroradiologist and appointed a Prostate Imaging Reporting and Data System (version 2.1) and PRECISE score. Clinically significant progression was defined by histopathological upgrading (on biopsy or radical prostatectomy) to grade group ≥3 and/or evolution to T3 stage. A survival analysis was performed to assess differential progression-free survival (PFS) according to the PRECISE score. A total of 188 patients were included for an analysis with a total of 358 repeat MRI scans and 144 repeat biopsies. The median follow-up was 46 mo (interquartile range 21-74). Radiological progression (PRECISE 4-5) had sensitivity, specificity, negative predictive value, and positive predictive value of, respectively, 78%, 70%, 90%, and 49% for clinically significant progression. Four-year PFS was 91% for PRECISE 1-3 versus 66% for PRECISE 4-5 (p<0.001). In total, 137 patients underwent a confirmation MRI scan within 18 mo after diagnosis. Four-year PFS in this group was 81% for PRECISE 1-3 versus 43% for PRECISE 4-5 (p<0.001). Limitations include retrospective design and no strict adherence to AS protocol. Implementation of PRECISE scoring for PCa patients on AS is feasible and offers a prognostic value. Patients with PRECISE score 4-5 on confirmation MRI within 18 mo after diagnosis have a three-fold higher risk of clinically significant progression after 4 yr. Patients with low-risk prostate cancer can be followed up carefully. In this study, we evaluate the standardised reporting of repeat magnetic resonance imaging scans (using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation [PRECISE] recommendations). PRECISE scoring is feasible and helps identify patients in need of further treatment.

RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults.

The Response Assessment in Neuro-Oncology (RANO) criteria for high-grade gliomas (RANO-HGG) and low-grade gliomas (RANO-LGG) were developed to improve reliability of response assessment in glioma trials. Over time, some limitations of these criteria were identified, and challenges emerged regarding integrating features of the modified RANO (mRANO) or the immunotherapy RANO (iRANO) criteria. Informed by data from studies evaluating the different criteria, updates to the RANO criteria are proposed (RANO 2.0). We recommend a standard set of criteria for both high- and low-grade gliomas, to be used for all trials regardless of the treatment modalities being evaluated. In the newly diagnosed setting, the postradiotherapy magnetic resonance imaging (MRI), rather than the postsurgical MRI, will be used as the baseline for comparison with subsequent scans. Since the incidence of pseudoprogression is high in the 12 weeks after radiotherapy, continuation of treatment and confirmation of progression during this period with a repeat MRI, or histopathologic evidence of unequivocal recurrent tumor, are required to define tumor progression. However, confirmation scans are not mandatory after this period nor for the evaluation of treatment for recurrent tumors. For treatments with a high likelihood of pseudoprogression, mandatory confirmation of progression with a repeat MRI is highly recommended. The primary measurement remains the maximum cross-sectional area of tumor (two-dimensional) but volumetric measurements are an option. For IDH wild-type glioblastoma, the nonenhancing disease will no longer be evaluated except when assessing response to antiangiogenic agents. In IDH-mutated tumors with a significant nonenhancing component, clinical trials may require evaluating both the enhancing and nonenhancing tumor components for response assessment. The revised RANO 2.0 criteria refine response assessment in gliomas.

Adaptive Training: A New Method to Improve the Image Quality of Abdominal Magnetic Resonance Imaging.

In abdominal magnetic resonance imaging (MRI), the late hepatic arterial phase is particularly important for the diagnosis of hepatocellular carcinoma (HCC). However, poor patient compliance with breath-hold imaging acquisition protocols and the administration of the liverspecific contrast agent gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) increases the motion artifacts that degrade the quality of the images making it more difficult to interpret the images. This study aimed to evaluate the role of adaptive respiratory training in improving the quality of the MRI by reducing the motion artifacts and improving the signal intensity from the regions of interest (ROI) in the late hepatic arterial phase. A total of 120 patients who underwent an abdominal MRI between 2021 to 2022 to assess for the liver disease were included in the study. These patients were divided into two groups: the experimental group and the control group. The patients in the experimental group received adaptive training. The incidence of motion artifacts and the signal intensity in the late hepatic arterial phase within the abdominal aorta, hepatic artery, splenic artery, and hepatic parenchyma between the experimental group and the control group were compared. The incidence of motion artifacts in the experimental group was significantly reduced by 28.3% (p = 0.001, Chi-square value = 12.079). In the late hepatic arterial phase, the signal intensity of the abdominal aorta, the hepatic artery, the splenic artery, and the hepatic parenchyma increased by 7.3%, 27.4%, 29.5%, and 6.9%, respectively. Adaptive respiratory training reduced the incidence of motion artifacts and improved the signal intensity for various ROI. The improved image quality could potentially facilitate image interpretation and reduce the number of repeat MRI scans.