Resonance Imaging In Patients Research Articles

Whole exome sequencing in young atrial fibrillation patients

Abstract Background Up to 10% of atrial fibrillation (Afib) patients develop the condition in the young age and in the absence of any related risk factors. Recent publications emphasized the importance of genetic testing in this population. However, the yield of the investigation is highly variable and ranges from 1 to 24% precents. Purpose The purpose of this study is to evaluate the prevalence of causative genetic variants in young Afib patients without risk factors and evaluate any structural changes of the heart. Methods We performed whole exome sequencing in 54 young (age of Afib onset less than 65 years) Afib patients without any Afib related risk factors (original cohort). Using ACMG guidelines we performed analysis of 349 previously described cardiomyopathy and arrhythmia associated genes. If a pathogenic (P) or likely pathogenic (LP) variant was found, a cardiac magnetic resonance imaging (CMR) was performed to exclude any structural abnormalities of the heart. We also extracted 107 young Afib patients without any risk factors from UK Biobank (UK Biobank cohort) and performed analysis of the same genes in the subgroup. Results The prevalence of P and LP variants was 24% (13 cases) in the original cohort and 8% (9 cases) in the UK Biobank cohort (p=0.006). We observed variants in cardiac structural and developmental genes only in both cohorts (Table 1 and 2). In the original cohort there were nine (17%) patients with P and LP variant in TTN gene. Moreover, five patients were positive for the same TTN variant NM_001267550.2:c.13696C>T p.(Gln4566Ter). In six (46%) original cohort patients we observed structural changes of the heart on CMR – in five patients there was dilation of one or both ventricles and in one there was increased T1 mapping intensity of septal wall segments. Conclusions 1. There is a high prevalence of pathogenic and likely pathogenic causative genetic variants in young atrial fibrillation patients without any risk factors. 2. All variants are localized in cardiac structural or developmental genes only. 3. There is a high grade of structural changes of the heart observed on cardiac magnetic resonance imaging in patients with monogenic atrial fibrillation.Table 1.WES data in original cohortTable 2.WES data in UK Biobank cohort

Predicting atrial fibrillation risk following embolic stroke of unknown source using cardiac magnetic resonance imaging

Abstract Background Approximately 25% of embolic strokes of unknown source (ESUS) are attributed to undiagnosed atrial fibrillation (AF).1 The European Stroke Organisation (ESO) recommends implantable loop recorder (ILR) monitoring to identify ESUS patients with AF, permit the initiation of anticoagulation and reduce risk of recurrent stroke.2 However, this approach delays treatment and carries significant cost and resource implications. An alternative approach, where early anticoagulation is initiated in the absence of AF has failed to reduce recurrent stroke in four randomised controlled trials (NAVIGATE ESUS, RE-SPECT ESUS, ATTICUS and ARCADIA).3-6 An urgent need exists for new strategies to identify ESUS patients with undiagnosed AF that are at high risk of future thromboembolism. Purpose The primary objective of this study was to produce a substrate-based predictive model for AF in ESUS patients using atrial cardiac magnetic resonance imaging (CMRi). Method The Atrial CARdiac Magnetic resonance imaging in patients with embolic stroke of unknown source without documented AF (CARM-AF) Study is a prospective, multi-centre, observational study. All patients underwent CMRi and ILR insertion for AF detection within 3 months of ESUS. The main inclusion criteria were expected survival >12 months, CHA2DS2VASc≥3 and eGFR >30ml/min. Patients were allocated to the study group if AF >30 seconds was detected by ILR during the first year of follow-up and control group if no AF detected (Figure 1). Univariable analysis was used to identify clinical, echocardiographic and CMR parameters associated with AF diagnosis. Parameters with p<0.2 and no co-linearity were used to develop multivariable logistic regression models for AF prediction. Results From September 2020 to September 2022, 102 patients were enrolled and 91 were included in the final analysis. AF was detected in 17 patients during the first year of follow-up (18.6%). In univariable analysis, patients with AF were more likely to be female (p=0.02), but there were no significant differences in age, race, body mass index (BMI) or CHA2DS2VASc score (p=0.06, 0.272, 0.195, 0.211) between groups. Increased left atrial (LA) volume, surface area and reduced LA ejection fraction were associated with increased risk of AF detection at 1 year (p=0.006, 0.044, 0.008). LA fibrosis and sphericity were not associated with AF (p=0.84, 0.98). Logistic regression models for AF risk prediction were developed using patient, echocardiographic and CMR parameters. A combined model of patient and CMR parameters outperformed assessment of patient characteristics alone, achieving an AUC of 0.85 for predicting AF occurrence (p<0.005). Pseudo R2 of 0.30 (McFadden) indicated excellent model fit (Figure 2). Conclusion CARM-AF is the first study to demonstrate feasibility and utility of CMR imaging to predict AF risk following ESUS. A randomised controlled trial initiating anticoagulation using the developed model is recommended.Study DesignModel Comparison (ROC Curves)

Comparison of Cardiac Activated Fibroblast Imaging and Magnetic Resonance Imaging in Patients with COVID-19-Related Myocarditis

Comparison of Cardiac Activated Fibroblast Imaging and Magnetic Resonance Imaging in Patients with COVID-19-Related Myocarditis

Magnetic resonance imaging in patients with immune check point inhibitors induced hypophysitis

Magnetic resonance imaging in patients with immune check point inhibitors induced hypophysitis

Serial Cardiac Magnetic Resonance Imaging in Patients with Mitral Valve Prolapse-A Single-Center Retrospective Registry.

Background: Mitral valve prolapse (MVP) and mitral annular disjunction (MAD) are common valvular abnormalities that have been associated with ventricular arrhythmias (VA). Cardiac magnetic resonance imaging (CMR) has a key role in risk stratification of VA, including assessment of late gadolinium enhancement (LGE). Methods: Single-center retrospective analysis of patients with MVP or MAD who had >1 CMR and >1 24 h Holter registration available. Data are presented in detail, including evolution of VA and presence of LGE over time. Results: A total of twelve patients had repeated CMR and Holter registrations available, of which in four (33%) patients, it was conducted before and after minimal invasive mitral valve repair (MVR). After a median of 4.7 years, four out of eight (50%) patients without surgical intervention had new areas of LGE. New LGE was observed in the papillary muscles and the mid to basal inferolateral wall. In four patients, presenting with syncope or high-risk non-sustained ventricular tachycardia (VT), programmed ventricular stimulation was performed and in two (50%), sustained monomorphic VT was easily inducible. In two patients who underwent MVR, new LGE was observed in the basal inferolateral wall of which one presented with an increased burden of VA. Conclusions: In patients with MVP and MAD, repeat CMR may show new LGE in a small subset of patients, even shortly after MVR. A subgroup of patients who presented with an increase in VA burden showed new LGE upon repeat CMR. VA in patients with MVP and MAD are part of a heterogeneous spectrum that requires further investigation to establish risk stratification strategies.

An Effect of Chronic Negative Stress on Hippocampal Structures and Functional Connectivity in Patients with Depressive Disorder.

Depressive disorder is a mental health disorder with complicated etiopathogenesis. Environmental stress and neurodevelopment combined with other factors contribute to the occurrence of depression. Especially for the depressive disorder with chronic negative stress, it has characteristics of recurrence and poor curative effect because of unclear mechanism. Here, we investigated the hippocampal structures and functional connectivity (FC) according to resting-state functional magnetic resonance imaging in patients with depression who underwent chronic negative stress. A total of 65 patients with depression (34 underwent chronic negative stress and 31 non-underwent chronic negative stress) and 30 healthy controls who did not undergo chronic negative stress were included in the study. The volumes of hippocampal subfields, seed-based FCs between hippocampus and the whole brain voxels, and ROI-wise-based FC between hippocampal subfields were compared among the three groups. In the patients with depression who underwent chronic negative stress, the volumes of right_GC-ML-DG-head, right_CA4-head and right_CA3-head increased, FCs between Temporal_Mid_R, Precuneus_R, Frontal_Sup_R, Temporal_Sup_R, Angular_L, Frontal_Inf_Tri_R, Supp_Motor_Area_R, Precentral_L and hippocampus increased, and FCs between parasubiculum and CA3, and presubiculum and CA1 decreased. When compared to the patients who did not undergo chronic negative stress, the patients who underwent chronic negative stress had larger volumes of right_GC-ML-DG-head and right_CA3-head, higher FCs between Frontal_Sup_R, Frontal_Inf_Tri_R and hippocampus, and lower FCs between presubiculum and CA1. The depression underwent chronic negative stress may experience disrupted hippocampal structures and functional connectivity. It may be one of potential depressive disorder subtypes.

Evaluation of the Presence of Additional Knee Pathology on Magnetic Resonance Imaging in Patients with Chondromalacia Patella

Evaluation of the Presence of Additional Knee Pathology on Magnetic Resonance Imaging in Patients with Chondromalacia Patella

Comparison of vestibular aqueduct visualization on computed tomography and magnetic resonance imaging in patients with Ménière’s disease

BackgroundThe vestibular aqueduct (VA) serves an essential role in homeostasis of the inner ear and pathogenesis of Ménière’s disease (MD). The bony VA can be clearly depicted by high-resolution computed tomography (HRCT), whereas the optimal sequences and parameters for magnetic resonance imaging (MRI) are not yet established. We investigated VA characteristics and potential factors influencing MRI-VA visibility in unilateral MD patients.MethodsOne hundred patients with unilateral MD underwent MRI with three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE) sequence and HRCT evaluation. The imaging variables included MRI-VA and CT-VA visibility, CT-VA morphology and CT-peri-VA pneumatization.ResultsThe most frequent type of MRI-VA and CT-VA visualization was invisible VA and continuous VA, respectively. The MRI-VA visibility was significantly lower than CT-VA visibility. MRI-VA visibility had a weak positive correlation with ipsilateral CT-VA visualization. For the affected side, the MRI-VA visualization was negatively correlated with the incidence of obliterated-shaped CT-VA and positively with that of tubular-shaped CT-VA. MRI-VA visualization was not affected by CT-peri-VA pneumatization.ConclusionIn patients with MD, the VA visualization on 3D-SPACE MRI is poorer than that observed on CT and may be affected by its osseous configuration. These findings may provide a basis for further characterization of VA demonstrated by MRI and its clinical significance.

Changes in Intratumor Blood Flow After Carbon-Ion Radiation Therapy for Early-Stage Breast Cancer

PurposeThis study aimed to quantify the changes in intratumoral blood flow after carbon-ion radiation therapy (CIRT) for early-stage breast cancer and analyze their clinical significance. Patients and MethodsWe included 38 patients with early-stage breast cancer who underwent CIRT. Dynamic imaging was performed using a 3T superconducting magnetic resonance scanner to quantify the washin index (idx), which reflects contrast uptake, and washout idx, which reflects the rate of contrast washout from tumor tissue. The changes in the apparent diffusion coefficient, washin idx, and washout idx were examined before CIRT and at 1 and 3 months after treatment. Clinical factors and imaging features were examined using univariate and receiver operating characteristic curve analyses to identify factors predicting clinical complete response (cCR). ResultsThe median observation period after CIRT was 51 (range: 12-122) months. During the observation period, 31 of the 38 patients achieved cCR, and 22 achieved cCR within 12 months. Tumor size (P < .001), washin idx (P = .043), and washout idx (P < .001) decreased significantly 1-month after CIRT. In contrast, the apparent diffusion coefficient values (P < .001) increased significantly 1-month after CIRT. Univariate analysis suggested that the washin idx after 1 and 3 months of CIRT was associated with cCR by 12 months post-CIRT (P = .028 and .021, respectively). No other parameters were associated with cCR by 12 months post-CIRT. Furthermore, receiver operating characteristic curve analyses showed that the area under the curve values of washin idx after 1 and 3 months of CIRT was 0.78 (specificity 75%, sensitivity 80%) and 0.73 (specificity 75%, sensitivity 71%), respectively. ConclusionTumor changes can be quantified early after CIRT using contrast-enhanced magnetic resonance imaging in patients with breast cancer. Washin idx values 1 and 3 months after CIRT were associated with cCR within 12 months post-CIRT.

Transcranial electrical stimulation during functional magnetic resonance imaging in patients with genetic generalized epilepsy: a pilot and feasibility study.

A third of patients with epilepsy continue to have seizures despite receiving adequate antiseizure medication. Transcranial direct current stimulation (tDCS) might be a viable adjunct treatment option, having been shown to reduce epileptic seizures in patients with focal epilepsy. Evidence for the use of tDCS in genetic generalized epilepsy (GGE) is scarce. We aimed to establish the feasibility of applying tDCS during fMRI in patients with GGE to study the acute neuromodulatory effects of tDCS, particularly on sensorimotor network activity. Seven healthy controls and three patients with GGE received tDCS with simultaneous fMRI acquisition while watching a movie. Three tDCS conditions were applied: anodal, cathodal and sham. Periods of 60 s without stimulation were applied between each stimulation condition. Changes in sensorimotor cortex connectivity were evaluated by calculating the mean degree centrality across eight nodes of the sensorimotor cortex defined by the Automated Anatomical Labeling atlas (primary motor cortex (precentral left and right), supplementary motor area (left and right), mid-cingulum (left and right), postcentral gyrus (left and right)), across each of the conditions, for each participant. Simultaneous tDCS-fMRI was well tolerated in both healthy controls and patients without adverse effects. Anodal and cathodal stimulation reduced mean degree centrality of the sensorimotor network (Friedman's ANOVA with Dunn's multiple comparisons test; adjusted p = 0.02 and p = 0.03 respectively). Mean degree connectivity of the sensorimotor network during the sham condition was not different to the rest condition (adjusted p = 0.94). Applying tDCS during fMRI was shown to be feasible and safe in a small group of patients with GGE. Anodal and cathodal stimulation caused a significant reduction in network connectivity of the sensorimotor cortex across participants. This initial research supports the feasibility of using fMRI to guide and understand network modulation by tDCS that might facilitate its clinical application in GGE in the future.

P240: Sarcopenia of the lower limb on Magnetic Resonance Imaging in patients with Diabetes Mellitus – a systematic review

Abstract Introduction Sarcopenia is defined by low measures of muscle quantity and quality and physical performance. Accelerated sarcopenic changes in diabetic patients leads to biomechanical changes in the foot and limb loss. Aim To systematically review the literature on Magnetic Resonance Imaging (MRI) and sarcopenia in the lower limb in patients with diabetes. Methods A literature review was conducted in accordance with PRISMA guidelines. Embase and Medline databases were searched with Ovid interface, as well as Pubmed and Cochrane. The grey literature was also reviewed on ClinicalTrials.gov, WHO international clinical trials registry platform, Cochrane library and the NIHR journals library and ProQuest. The MeSH terms “sarcopenia” AND “diabetes mellitus” AND “magnetic resonance imaging” were employed in the primary search string. The articles were reviewed by two independent reviewers. Results 874 studies were screened. 20 articles were included in the final review. Methods of measurement included cross sectional area measurements, stereological muscle measurements, muscle volume estimation, adipose infiltration, signal intensity cut-off, Goutallier grading, semiquantitative 5-point scale. Reduction in cross-sectional area and volumes and greater intramuscular fat infiltration was noted in patients with diabetes Sarcopenia ++ in Diabetic polyneuropathy (DPN) compared to non-diabetic and diabetic but non-DPN counterparts. MRI findings correlate with neuropathy disability scores and physical tests. Single study using a semi-automated process to measure sarcopenia. Conclusion MRI has its merit in providing accurate and detailed information on skeletal muscle volume and assessment of fat infiltration in muscle. This is relevant to reducing complications associated with changes in the biomechanics of the foot.

PRECISE Version 2: Updated Recommendations for Reporting Prostate Magnetic Resonance Imaging in Patients on Active Surveillance for Prostate Cancer

Background and objectiveThe Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty. MethodsA panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology. Panellists scored 193 statements using a 1–9 agreement scale, where 9 means full agreement. A summary of agreement, uncertainty, or disagreement (derived from the group median score) and consensus (determined using the Interpercentile Range Adjusted for Symmetry method) was calculated for each statement and presented for discussion before individual rescoring. Key findings and limitationsParticipants agreed that MRI scans must meet a minimum image quality standard (median 9) or be given a score of ‘X’ for insufficient quality. The current scan should be compared with both baseline and previous scans (median 9), with the PRECISE score being the maximum from any lesion (median 8). PRECISE 3 (stable MRI) was subdivided into 3-V (visible) and 3-NonV (nonvisible) disease (median 9). Prostate Imaging Reporting and Data System/Likert ≥3 lesions should be measured on T2-weighted imaging, using other sequences to aid in the identification (median 8), and whenever possible, reported pictorially (diagrams, screenshots, or contours; median 9). There was no consensus on how to measure tumour size. More research is needed to determine a significant size increase (median 9). PRECISE 5 was clarified as progression to stage ≥T3a (median 9). Conclusions and clinical implicationsThe updated PRECISE recommendations reflect expert consensus opinion on minimal standards and reporting criteria for prostate MRI in AS. Patient summaryThe Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations are used in clinical practice and research to guide the interpretation and reporting of magnetic resonance imaging for patients on active surveillance for prostate cancer. An international panel has updated these recommendations, clarified the areas of uncertainty, and highlighted the areas for further research.

Intra-articular pathologies detected by magnetic resonance imaging in patients with temporomandibular disorders undergone successful non-surgical treatments

ObjectiveThis study aimed to study on the MRI findings suggesting intra-articular pathologies in patients with temporomandibular disorders (TMD) undergone successful non-surgical treatments, and to discuss on their intra-articular pathological conditions with clinical symptoms. Patients and MethodsOne-hundred eleven TMJs of the consecutive 80 TMD patients were enrolled in this study. These TMJs were classified into the following 3 Groups, Group I: Bilateral 62 TMJs of the 31 patients with masticatory-muscle (MM) symptoms without functional pain, Group II: Affected-side TMJs of the 31 patients with unilateral functional MM pain, Group III: Affected-side TMJs of the 18 patients with unilateral functional TMJ pain. The detection rates of joint effusion (JE), osteoarthritis (OA), and disc displacement (DD) on the MR images were investigated. The correlations of JE, OA, DD, age, and gender were also analyzed. ResultsIn each Group, the detection rates of JE, OA, and DD were more than 70%, and no findings of them were sometimes observed. The detection ratio of moderate/marked JE in Group II was significantly higher among the 3 Groups. The significant correlation of JE, OA, and DD was found, and that of OA and age was also observed. ConclusionsOur results suggest that intra-articular pathologies often occur even in the painless TMJs, and functional TMJ pain sometimes appear even in the TMJs with early-stage OA, which cannot be detected by MRI. Furthermore, the TMJ synovitis occurred in patients with functional MM pain may be more severe than that in the painful TMJ.

Clinical analysis of uterine parameters evaluated by preoperative magnetic resonance imaging in patients treated by hysteroscopic approach with previous cesarean scar defect-related abnormal uterine bleeding: a retrospective cohort study.

As the cesarean delivery rate continues to rise globally, the treatment of previous cesarean scar defects (PCSD) remains challenging. This study aimed to analyze the variables that may influence the clinical cure rate of patients with PCSD-related abnormal uterine bleeding (AUB) as determined by preoperative magnetic resonance imaging (MRI) following hysteroscopic therapy. Women who underwent hysteroscopic surgery for PCSD-related AUB at the Gynecology Department of Third Xiangya Hospital of Central South University from 2018 to 2022 were recruited to this retrospective cohort investigation. A total of 147 patients were enrolled in this study and underwent follow-up over 6 months. The significance of clinical characteristics linked to the clinical cure rate of AUB was examined by logistic regression. There were 64 clinically cured (43.5%) and 83 non-clinically cured (56.5%) patients in the study. There were no significant differences in the age, menstrual duration, gravidity, parity, number of cesarean sections, time since the previous cesarean section, uterus position, width, depth, and thickness of the remaining muscle layer of the defect by MRI T2-weighted images (T2WI) before hysteroscopic surgery between the 2 groups. MRI T2WI of the myometrial thickness adjacent to the defect [P=0.038, odds ratio (OR) =2.095, 95% confidence interval (CI): 1.047-4.261] and the distance from the defect to the external cervical os (P=0.021, OR =2.254, 95% CI: 1.136-4.540) before hysteroscopic surgery are risk factors for the clinical cure rate. The myometrial thickness adjacent to the defect and the distance from the defect to the external cervical os in preoperative MRI are risk factors for clinical cure rate in patients with PCSD-related AUB after hysteroscopic treatment, which is helpful for evaluating the prognosis of disease.

Prediction of antenatal bleeding and preterm deliveries using placental magnetic resonance imaging in patients with placenta previa.

This study aimed to clarify associations between subacute hematoma on placental magnetic resonance imaging (MRI), antenatal bleeding, and preterm deliveries in patients with placenta previa (PP) without placenta accreta spectrum (PAS). This retrospective study investigated 78 consecutive patients with PP (median age, 34.5years; interquartile range [IQR], 31-37years) who underwent placental MRI in the third trimester. Patients with PAS detected intraoperatively or pathologically were excluded. Two radiologists evaluated the presence of subacute hematomas and their locations on placental MRI. We examined associations between presence of subacute hematoma and antenatal bleeding, emergency cesarean section (CS), hysterectomy, gestational age (GA) at delivery, birth weight, and amount of blood loss at CS. We also examined the association between perinatal outcome and subacute hematoma location: marginal, retro-placental, or intra-placental. Inter-observer agreement for the detection of subacute hematoma was calculated using kappa analysis. Subacute hematomas were identified on MRI in 39 of the 78 patients (50.0%). Antenatal bleeding and emergency CS were more prevalent in patients with subacute hematoma on MRI (20 patients [51.3%] and 18patients [46.2%], respectively) than in patients without (7 patients [17.9%], Fisher's exact test, p = 0.004 and 7patients [17.9%], p = 0.014, respectively). GA at delivery was significantly lower in patients with subacute hematoma (median 36w3d, IQR 35w4d-37w1d) than in patients without (median 37w1d, IQR 36w4d-37w2d; Mann-Whitney test: p = 0.048). Marginal hematoma was significantly associated with antenatal bleeding and emergency CS. Inter-observer agreement for the presence of subacute hematoma was moderate (κ = 0.573). Subacute hematoma on placental MRI was associated with antenatal bleeding, emergency CS and shorter GA at delivery in patients with PP. Marginal hematoma was also associated with antenatal bleeding and emergency CS. Placental MRI appears useful for predicting antenatal bleeding and preterm delivery in patients with PP.

Radiological Analysis of Cerebrospinal Fluid Dynamics at the Craniovertebral Junction Using Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging in Patients with Cervical Spinal Canal Stenosis

ObjectiveSpondylotic changes in the cervical spine cause degeneration, leading to cervical spinal canal stenosis. This stenotic change can affect cerebrospinal fluid (CSF) dynamics by compressing the dural sac and reducing space in the subarachnoid space. We examined CSF dynamics at the craniovertebral junction (CVJ) using time-spatial labeling inversion pulse magnetic resonance imaging (Time-SLIP MRI) in patients with cervical spinal canal stenosis. MethodsThe maximum longitudinal movement of the CSF at the CVJ was measured as length of motion (LOM) in the Time-SLIP MR image of 56 patients. The sum of ventral and dorsal LOM was defined as the total LOM. Patients were classified into three groups depending on their spinal sagittal MRI findings: control (n=27, Kang classification grades 0 and 1), stenosis (n=14, Kang classification grade 2), and severe stenosis (n=15, Kang classification grade 3). ResultsTime-SLIP MRI revealed pulsatile movement of the CSF at the CVJ. The mean total, ventral, and dorsal LOM was 14.2 ± 9, 8.1 ± 5.7, and 3.8 ± 2.9 mm, respectively. The ventral LOM was significantly larger than the dorsal LOM. The total LOM was significantly smaller in the severe stenosis group (6.1 ± 3.4 mm) than in the control (16.0 ± 8.4 mm) or stenosis (11 ± 5.4 mm) groups (p < 0.001, Kruskal–Wallis H-test). In five patients, postoperative total LOM was improved after adequate decompression surgery. ConclusionsThis study demonstrates that CSF dynamics at the CVJ are influenced by cervical spinal canal stenosis. Time-SLIP MRI is useful for evaluating CSF dynamics at the CVJ in patients with spinal canal stenosis.

Abstract TP147: Assessment of Inter-Rater Reliability of Fazekas Scoring on Magnetic Resonance Imaging in Patients With Sickle Cell Disease

Background: White matter disease is a common phenomenon in patients with sickle cell disease, that has been linked to cognitive impairment. However, there is no standardized approach for quantification of the cerebral disease burden. The Fazekas score is widely used to quantify the burden of white matter disease in chronic small vessel disease. However, its utility in sickle cell disease has not yet been established. We aimed to assess its, interrater reliability in this patient population. Methods: A patient cohort was compiled for the purpose of a research ethics board (REB) approved retrospective study of consecutive adult patients with sickle cell disease, each of whom underwent MRI/MRA between the year 2017 and 2019. All MRI/MRA studies were performed on 3-Tesla MRI. Two neuroradiologists independently assessed the axial FLAIR MRI brain sequence, for all patients, with the sole focus of assigning a Fazekas score (0-3) to each study, as a means of quantifying the burden of ischemic white matter lesions. The neuroradiologists were blinded to the scoring assigned by their counterpart and to the clinical information. Cohen’s weighted Kappa was used as a measure of agreement between readers. Results: Ninety patients with a median age of 31 and 45/90 (50%) women were included. The expected agreement was 74.65%, with an observed agreement of 94.44% between readers, with a weighted Kappa of 0.7808. Conclusion: On the basis of this study, there is good inter-rater reliability of Fazekas scoring on axial FLAIR MRI brain sequence in patients with sickle cell disease, even though the underlying pathophysiology of white matter lesions in this patient population might vary compared to individuals with chronic small vessel disease. The Fazekas is a promising measure that could easily be integrated in systematic evaluation of cerebrovascular lesions of adults with sickle cell disease.

Comparison of left ventricular deformation abnormalities by echocardiography with cardiac magnetic resonance imaging in patients with acute myocarditis and preserved left ventricular ejection fraction.

Cardiac magnetic resonance imaging (cMRI) represents the gold standard to detect myocarditis. Left ventricular (LV) deformation imaging provides additional diagnostic options presumably exceeding conventional transthoracic echocardiography (TTE). The present study aimed to analyze the feasibility to detect myocarditis in patients (pts) with preserved LV ejection fraction (LVEF) by TTE compared to cMRI. It has been hypothesized that the number of pathological findings by deformation imaging correspond to findings in cMRI. Between January 2018 and February 2020 102 pts with acute myocarditis according to the modified Lake Louise criteria and early gadolinium enhancement (EGE) by cMRI were identified at the department of cardiology at the University Hospital Leipzig. Twenty-six pts were included in this retrospective comparative study based on specific selection criteria. Twelve pts with normal cMRI served as a control group. LV deformation was analyzed by global and regional longitudinal strain (GLS, rLS), global and regional circumferential and radial strain (GCS, rCS, GRS, rRS), and LV rotation (including layer strain analysis). All parameters were compared to findings of edema, inflammation, and fibrosis by cMRI according to Lake Louise criteria. All pts with acute myocarditis diagnosed by cMRI showed pathological findings in TTE. Especially rCS and LV rotation analyzed by regional layer strain exhibit a high concordance with pathological findings in cMRI. In controls no LV deformation abnormalities were documented. Mean values of GLS, GRS, and GCS were not significantly different between pts with acute myocarditis and controls. This retrospective analysis documents the feasibility of detecting regional deformation abnormalities by echocardiography in patients with acute myocarditis confirmed by cMRI. The detection of pathological findings due to myocarditis requires the determination of regional deformation parameters, particularly rCS and LV rotation. The assessment of global strain values does not appear to be of critical value.

Kiosk 11R-TA-04 - Assessment of Sub Clinical Left Ventricular Ischemia Using Oxygen Sensitive Cardiovascular Magnetic Resonance Imaging in Patients with Systemic Sclerosis

Kiosk 11R-TA-04 - Assessment of Sub Clinical Left Ventricular Ischemia Using Oxygen Sensitive Cardiovascular Magnetic Resonance Imaging in Patients with Systemic Sclerosis

Magnetic resonance imaging in patients with implanted cardiac electrotherapy devices: a statement from experts of the Polish Medical Society of Radiology, the Polish Society of Cardiology, and the Polish Society of Electroradiology.

The year 2023 marks 60 years since the first pacemaker was implanted in Poland. The number of implantable cardiac electrotherapy devices (CIEDs), including pacemakers, cardioverter-defibrillators, and resynchronization therapy systems, has been systematically increasing in the subsequent decades. It is estimated that nearly 500,000 Poles have an implanted cardiac electrotherapy device, making optimal diagnostic imaging with the use of magnetic resonance imaging (MRI) a clinically and epidemiologically important issue. MRI has become a gold diagnostic standard in many disease states. In this situation, it is believed that 50-70% of patients who have a cardiac electrotherapy device may have indications for an MRI examination later in life. For many years, an implanted cardiac electrotherapy device was considered a definite contraindication to MRI. However, MRI has become possible in most patients with CIED if certain procedures and precautions are followed. In these guidelines, we describe the basic rules that should be followed in order to perform a safe MRI examination in patients with different CIEDs. Despite all the risks and organizational factors described in the text, it seems that for many MRI departments, MRI in patients with CIEDs is achievable and should be implemented immediately. A second important issue is the need for dedicated financial support for these procedures from public health insurance.