Resonance Imaging Scans Research Articles

Raidionics: an open software for pre- and postoperative central nervous system tumor segmentation and standardized reporting

For patients suffering from central nervous system tumors, prognosis estimation, treatment decisions, and postoperative assessments are made from the analysis of a set of magnetic resonance (MR) scans. Currently, the lack of open tools for standardized and automatic tumor segmentation and generation of clinical reports, incorporating relevant tumor characteristics, leads to potential risks from inherent decisions’ subjectivity. To tackle this problem, the proposed Raidionics open-source software has been developed, offering both a user-friendly graphical user interface and stable processing backend. The software includes preoperative segmentation models for each of the most common tumor types (i.e., glioblastomas, lower grade gliomas, meningiomas, and metastases), together with one early postoperative glioblastoma segmentation model. Preoperative segmentation performances were quite homogeneous across the four different brain tumor types, with an average Dice around 85% and patient-wise recall and precision around 95%. Postoperatively, performances were lower with an average Dice of 41%. Overall, the generation of a standardized clinical report, including the tumor segmentation and features computation, requires about ten minutes on a regular laptop. The proposed Raidionics software is the first open solution enabling an easy use of state-of-the-art segmentation models for all major tumor types, including preoperative and postsurgical standardized reports.

A state-of-the-art review on deep learning for estimating eloquent cortex from resting-state fMRI.

Deep learning algorithms have greatly improved our ability to estimate eloquent cortex regions from resting-state brain scans for patients about to undergo neurosurgery. The use of deep learning has the potential to fully automate functional mapping of cortex in this context. We present a highly focused state-of-the-art review on current technology for estimating eloquent cortex from resting-state functional magnetic resonance scans and identify potential paths to meet this goal in the future.

Melanin-targeted [18F]-PFPN PET imaging may shed light for clear cell sarcoma.

Intracytoplasmic melanin pigment is a characteristic of clear cell sarcoma (CCS), which is a particularly deadly type of soft-tissue sarcoma. [18F]-N-(2-(diethylamino)ethyl)-5-(2-(2-(2-fluoroethoxy)ethoxy)ethoxy)picolinamide ([18F]-PFPN) is a positron emission tomography (PET) probe characterized by high melanin affinity. Therefore, this study aimed to investigate the feasibility of melanin-targeted [18F]-PFPN PET in patients with CCS. This prospective single-centre study recruited patients with pathologically confirmed CCS. [18F]-FDG PET/computed tomography and [18F]-PFPN PET/magnetic resonance imaging scans were performed within 1week of each other. The lesion numbers and [18F]-FDG and [18F]-PFPN PET parameters (maximum standardized uptake value [SUVmax], mean standardized uptake value [SUVmean], metabolic/melanotic tumour volume [MTV/MLTV], and total lesion glycolysis/melanin [TLG/TLM]) were collected. Three patients with CCS were recruited and received PET imaging. A total of 56 lesions were detected on [18F]-PFPN PET, including primary tumour and distant metastases. Identical lesions were not detected on [18F]-PFPN and [18F]-FDG PET. Twelve lesions (12/39, 30.77%) on [18F]-FDG imaging were missed on [18F]-PFPN, and 20 lesions (20/47,42.55%) on [18F]-PFPN imaging were missed on [18F]-FDG. In quantitative analysis, the [18F]-FDG SUVmean (4.60 ± 3.24) was higher than the [18F]-PFPN SUVmean (3.0 ± 2.63) in all lesions (P = 0.01). No significant correlations were found between the SUVmax, SUVmean, MLTV/MTV, and TLM/TLG values of [18F]-PFPN and [18F]-FDG (P > 0.05). Melanin-targeted [18F]-PFPN PET imaging is feasible for the diagnosis of CCS. Different imaging features were displayed on [18F]-PFPN and [18F]-FDG PET imaging, demonstrating the complementary role of the tracers. Combined use of the two imaging modalities would be preferred in patients with CCS. NCT05963035.

EVOLVE: Learning volume-adaptive phases for fast 3D magnetic resonance scan and image reconstruction

Compared with 2D Magnetic Resonance Imaging (MRI), 3D MRI is more powerful for generating high resolution images and visualizing small anatomical structures. However, 3D MRI acquisition is much more time-consuming due to the significantly larger number of phase encoding steps, which is directly proportional to the acquisition time. This paper proposes to select a volume-adaptive small subset of phases to accelerate 3D MRI scans and accurately reconstruct 3D images from the corresponding undersampled 3D k-space data. To avoid the delays caused by computationally expensive yet high-performance volume-adaptive phase selection, we propose a strategy of selecting multiple phases based on sampled slices from the volume during idle time within the repetition time (TR). To enhance the performance of phase selection, we propose a novel three-directional cross-attention phase selection network. Additionally, to improve the reconstruction performance, we introduce a three-directional slice-wise volume reconstruction. To the best of our knowledge, the proposed method, which we called EVOLVE (learning volume-adaptive phases), is the first work that learns volume-adaptive phases for fast 3D MRI. The extensive experimental results on a large-scale 3D MRI dataset at various acceleration factors demonstrate the substantial performance improvement in terms of image reconstruction achieved by using the EVOLVE method for phase selection compared to traditional learning free 3D MRI phase selection methods.

Deep learning-based recurrence detector on magnetic resonance scans in nasopharyngeal carcinoma: A multicenter study

ObjectivesAccuracy in the detection of recurrent nasopharyngeal carcinoma (NPC) on follow-up magnetic resonance (MR) scans needs to be improved. Material and methodsA total of 5 035 follow-up MR scans from 5 035 survivors with treated NPC between April 2007 and July 2020 were retrospectively collected from three cancer centers for developing and evaluating the deep learning (DL) model MODERN (MR-based Deep learning model for dEtecting Recurrent Nasopharyngeal carcinoma). In a reader study with 220 scans, the accuracy of two radiologists in detecting recurrence on scans with vs without MODERN was evaluated. The performance was measured using the area under the receiver operating characteristic curve (ROC-AUC) and accuracy with a 95% confidence interval (CI). ResultsMODERN exhibited sound performance in the validation cohort (internal: ROC-AUC, 0.88, 95% CI, 0.86–0.90; external 1: ROC-AUC, 0.88, 95% CI, 0.86–0.90; external 2: ROC-AUC, 0.85, 95% CI, 0.82–0.88). In a reader study, MODERN alone achieved reliable accuracy compared to that of radiologists (MODERN: 84.1%, 95% CI, 79.3%–88.9%; competent: 80.9%, 95% CI, 75.7%–86.1%, P < 0.001; expert: 85.9%, 95% CI, 81.3%–90.5%, P < 0.001). The accuracy of radiologists was boosted by the MODERN score (competent with MODERN score: 84.6%, 95% CI, 79.8%–89.3%, P < 0.001; expert with MODERN score: 87.7%, 95% CI, 83.4%–92.1%, P < 0.001). ConclusionWe developed a DL model for recurrence detection with reliable performance. Computer-human collaboration has the potential to refine the workflow in interpreting surveillant MR scans among patients with treated NPC.

Detection Rates and Trends of Asymptomatic Unruptured Intracranial Aneurysms From 2005 to 2019.

The trend in detection rates of asymptomatic unruptured intracranial aneurysms (UIAs) on brain computed tomography angiography/magnetic resonance angiography (CTA/MRA) is not well established. Our objective was to evaluate time trends in asymptomatic UIA detection rates on brain CTA/MRA between 2005 and 2019. We conducted a retrospective study of all brain computed tomography/magnetic resonance scans (n = 288 336 scans in 130 621 patients) performed between January 2005 and December 2019 at a tertiary referral hospital. Patients who underwent brain CTA/MRA examinations were included (n = 81 261 scans in 48 037 patients). The annual detection rate of new UIA cases was calculated based on the first brain CTA/MRA imaging. Detection rates were compared between three periods and across different age groups. The number of first CTA/MRA examinations increased significantly from 2005 to 2009 (n = 12 190 patients) to 2010-2014 (n = 14 969 patients) and 2015-2019 (n = 20 878 patients) ( P < .001). The UIA detection rate also increased significantly from 1.7% in 2005-2009 to 2.5% in 2010-2014 and 3.4% in 2015-2019 ( P < .001). The UIA detection rate increased significantly from 2010-2014 to 2015-2019 (relative risk [RR], 1.33; 95% CI, 1.17-1.51), particularly in patients aged 60-69 years (RR, 1.29; 95% CI, 1.01-1.63), 70-79 years (RR, 1.71; 95% CI, 1.30-2.25), and >79 years (RR, 2.33; 95% CI, 1.56-3.47). Furthermore, the detection rate of <5-mm UIAs increased from 2010-2014 to 2015-2019 (RR, 1.51; 95% CI, 1.28-1.77). The detection rate of asymptomatic UIAs, particularly in elderly patients, has increased significantly over the past 15 years, coinciding with the increased use of CTA/MRA imaging. Furthermore, the size of the identified UIAs has decreased. These findings raise concerns about the management strategies for UIAs, indicating the need for further research.

Evaluation of myocardial strain in patients with subclinical hypertrophic cardiomyopathy and subclinical Hypertensive Heart Disease using Cardiac magnetic resonance feature tracking.

The evaluation of cardiac magnetic resonance feature tracking may have great diagnostic value in hypertrophic cardiomyopathy and hypertensive heart disease. Exploring the diagnostic and clinical research value of cardiac magnetic resonance feature tracks in evaluation of myocardium deformation in patients with subclinical hypertrophic cardiomyopathy(SHCM)and subclinical hypertensive heart disease(SHHD). Cardiovascular Magnetic Resonance (CMR) scans were performed on a 1.5 T MR scanner in 33 patients with SHCM, 31 patients with SHHD, and 27 controls(NS). The CMR image post-processing software was used to analyze the characteristics of routine cardiac function, different global and regional myocardial strain in each group. Analysis of variance (ANOVA) was used to compare age, blood pressure, heart rate, routine cardiac function, body mass index (BMI), as well as the strain between different segments within each of the three groups. Once a significant difference was detected, a least significant difference (LSD) comparison would be performed. The diagnostic efficacy of different parameters in differentiating SHHD from SHCM was evaluated through receiver operating characteristic (ROC) curve analysis, and the best cut-off value was determined. There was no statistical difference among three groups (P>0.05) in routine cardiac function while significant statistical differences were found in the global myocardial strain parameters and the peak strain parameters of some segments (especially basal segments) (P < 0.05). The global radial peak strain (GRPS) was most effective (AUC = 0.885, 95% CI: 0.085-0.971, P<0.001) with a sensitivity and specificity of 84% and 88% at a cut-off value of 40.105, contributing to distinguishing SHCM from SHHD group. Cardiac magnetic resonance feature tracking could detect left ventricular deformation in patients with SHCM and SHHD group. The abnormality of strain has important research value for subclinical diagnosis and clinical evaluation.

Pentoxifylline and Vitamin E Can Restrict Radiation Necrosis via Vascular Pathways, Experimental Study in an Animal Model

Radiation necrosis (RN) is a long-term side effect of Gamma Knife stereotactic radiosurgery that may require surgical intervention. Pentoxifylline and vitamin E have previously been shown to be effective in the treatment of RN in the published literature, but there are no data on the prophylactic use of these molecules or, more importantly, whether prophylaxis is required. The iatrogenic RN model included 50 Sprague-Dawley rats of both sexes. There were 7 treatment subgroups established. Gamma-Plan 8.32 was used to plan after magnetic resonance scans were performed in a specially designed frame. The injection doses used in the treatment groups were vitamin E (30mg/kg/day in a single dose) and pentoxifylline (50mg/kg/day in 2 doses). Control magnetic resonance scans were performed at the end of a 16-week treatment, and the subjects were decapitated for pathological evaluations. The intensity of hypoxia - inducible factor 1α immunoreactivity is statistically significantly lower in the therapeutic vitamin E, prophylactic pentoxifylline and vitamin E, and therapeutic pentoxifylline and vitamin E groups than in the other groups. Similarly, the intensity of vascular endothelial growth factor immunoreactivity was reduced in the therapeutic vitamin E and prophylactic pentoxifylline and vitamin E treatment modality groups.When compared with other groups, the therapeutic pentoxifylline group had significantly fewer vascular endothelial growth factor-immunoreactive cells in the perinecrotic area, with an accompanying decreased contrast enhancement pattern. Both vitamin E and pentoxifylline are effective for the treatment and/or restriction of RN, either alone or in combination. The use of these molecules as a preventive measure did not outperform the therapeutic treatment.

20Ne(α,p)23Na studied to constrain type Ia nucleosynthesis

The 20Ne(α,p)23Na reaction rate is important in determining the final abundances of various nuclei produced in type Ia supernovae. Previously, the ground state cross section was calculated from time reversal reaction experiments using detailed balance. The reaction rates extracted from these studies do not consider contributions from the population of excited states, and therefore, are only estimates. A resonance scan, populating both the ground and first excited states, was performed for the 20Ne(α,p)23Na reaction, measuring between 2.9 and 5 MeV center of mass energies at the Nuclear Science Lab at the University of Notre Dame. Data analysis is underway and preliminary results show substantial contribution from the excited state reaction.

Artifacts in magnetic resonance imaging of the head and neck: Unwanted effects caused by implant-supported restorations fabricated with different alloys

Implant-supported restorations may cause artifacts in magnetic resonance imaging (MRI) of the head and neck area. However, the effect of different alloys remains unclear. The purpose of this in vitro study was to assess artifacts in head and neck MRI caused by implant-supported restorations with different alloys. Three dry mandibles were prepared to receive bilateral dental implants at the second premolar and second molar sites. Different alloy combinations were evaluated: titanium implants+cobalt chromium restorations; titanium-zirconium implants+cobalt chromium restorations; and zirconia implants+ceramic restorations. Specimens were imaged by using a 3-Tesla magnetic resonance scanner system (Achieva 3.0T TX; Philips GmbH) with a turbo-spin-echo sequence. Scan protocols were adjusted to optimize metal artifact reduction and shorten scan time. Artifact volumes were assessed and statistically analyzed by using the Kruskal-Wallis and Spearman tests (α=.05). A statistically significant difference was found among artifact volume caused by different materials (P=.002). The presence of titanium alloy was correlated with the artifact volume (r=-.87). Artifacts were greater for titanium and fewer for titanium-zirconium alloys, whereas zirconia implants found only minimal artifacts. The dimension of artifacts produced by implant-supported restorations varied according to the material.

Comparison of ligamentum flavum thickness between central and lateral lesions in a patient with central lumbar spinal canal stenosis.

Thickened ligamentum flavum has been considered as a major cause of central lumbar spinal canal stenosis (CLSCS). Previous studies have demonstrated that ligamentum flavum thickness (LFT) is correlated with aging, degenerative spinal stenosis, and disc degeneration. Thus, hypertrophy of the ligamentum flavum is a major cause of CLSCS, and measurement of LFT has been considered a morphologic parameter in the diagnosis of CLSCS. To our knowledge, comparison of LFT between central and lateral lesions has not been reported. In addition, no research has analyzed best clinical cutoff values of central ligament flavum thickness (CLFT) and lateral ligament flavum thickness (LLFT). This study aimed to compare CLFT with LLFT in patients with CLSCS and further compare the CLFT and LLFT findings between the 2 groups to analyze LFT variation. Both CLFT and LLFT samples were collected from 101 participants with CLSCS and from 103 participants in the control group who underwent lumbar magnetic resonance imaging without evidence of CLSCS. Axial T2-weighted lumbar magnetic resonance scans were acquired at the L4 to 5 facet joint level from each participant. Average CLFT value was 2.25 ± 0.51 mm in the control group and 4.02 ± 0.74 mm in the CLSCS group. Average LLFT value was 2.50 ± 0.51 mm in the control group and 3.38 ± 0.66 mm in the CLSCS group. CLSCS patients had significantly higher CLFT and LLFT (both P < .001). Regarding the validity of both CLFT and LLFT as predictors of CLSCS, a receiver operating characteristic estimation revealed that the most suitable cutoff value for CLFT was 3.10 mm, with sensitivity of 95.0%, specificity of 94.2%, and an area under the curve of 0.97. The best cut-off value of LLFT was 2.92 mm, with sensitivity of 78.2%, specificity of 77.7%, and area under the curve of 0.87. We have 4 important new findings: The mean CLFT is significantly lower than that of the mean LLFT in the normal control group; CLFT and LLFT are both significantly associated with CLSCS; Increase rate of CLFT is faster than that of LLFT in the CLSCS group; and CLFT is a more sensitive measurement parameter to predict CLSCS than LLFT.

Nationwide lung function monitoring from infancy in newborn-screened children with cystic fibrosis.

Cystic fibrosis (CF) lung disease starts in infancy and can be assessed for structural lung abnormalities using computed tomography or magnetic resonance scans, or for lung function impairment using multiple breath washout (MBW). However, in infancy these two methods are not well correlated. Trajectories of CF lung disease assessed by MBW in infants and toddlers remain poorly described, which is why we aimed to 1) describe the trajectory of lung function, 2) explore risk factors for progression and 3) explore the real-life effect of lumacaftor/ivacaftor. This was a nationwide observational cohort study (2018-2021) using data collected as part of the routine clinical surveillance programme (including MBW and monthly endo-laryngeal suction sampling for bacterial pathogens) in children born after implementation of newborn screening for CF (May 2016). Lumacaftor/ivacaftor commenced from age 2 years in children homozygous for F508del. Ventilation distribution efficiency (VDE), recently described to have advantages over lung clearance index (LCI), was reported as the primary MBW outcome after z-score calculations based on published reference data. Mixed effect linear regression models were the main statistical analyses performed in this study. 59 children, aged 2-45 months, contributed with 211 MBW occasions (median (interquartile range (IQR)) 3 (2-5) MBW occasions per child) with a median (IQR) follow-up time of 10.8 (5.2-22.3) months. An overall mean annual deterioration rate of -0.50 (95% CI -0.78- -0.22) z-VDE was observed, starting from an estimated mean z-VDE of -1.68 (95% CI -2.15- -1.22) at age 0.0 years (intercept). Pseudomonas aeruginosa "ever" (n=14, MBWs 50) had a significantly worse z-VDE trajectory versus P. aeruginosa "never" (mean difference 0.53 (95% CI 0.16-0.89) per year; p=0.0047) and lumacaftor/ivacaftor treatment (n=22, MBWs 46) significantly improved the trajectory of z-VDE (mean difference 1.72 (95% CI 0.79-2.66) per year; p=0.0004), leading to a stable mean z-VDE trajectory after start of treatment. Infants and toddlers with CF demonstrated progressive deterioration in z-VDE over the first years of life. P. aeruginosa isolation "ever" was associated with an accelerated deterioration in lung function, while lumacaftor/ivacaftor therapy significantly improved and stabilised the trajectory.

Effect of arteriosclerotic intracranial arterial vessel wall enhancement on downstream collateral flow.

The effect of arteriosclerotic intracranial arterial vessel wall enhancement (IAVWE) on downstream collateral flow found in vessel wall imaging (VWI) is not clear. Regardless of the mechanism underlying IAVWE on VWI, damage to the patient's nervous system caused by IAVWE is likely achieved by affecting downstream cerebral blood flow. The present study aimed to investigate the effect of arteriosclerotic IAVWE on downstream collateral flow. The present study recruited 63 consecutive patients at the Second Hospital of Hebei Medical University from January 2021 to November 2021 with underlying atherosclerotic diseases and unilateral middle cerebral artery (MCA) M1-segment stenosis who underwent an magnetic resonance scan within 3 days of symptom onset. The patients were divided into 4 groups according to IAVWE and the stenosis ratio (Group 1, n = 17; Group 2, n = 19; Group 3, n = 13; Group 4, n = 14), and downstream collateral flow was analyzed using three-dimensional pseudocontinuous arterial spin labeling (3D-pCASL) and RAPID software. The National Institutes of Health Stroke Scale (NIHSS) scores of the patients were also recorded. Two-factor multivariate analysis of variance using Pillai's trace was used as the main statistical method. No statistically significant difference was found in baseline demographic characteristics among the groups. IAVWE, but not the stenosis ratio, had a statistically significant significance on the late-arriving retrograde flow proportion (LARFP), hypoperfusion intensity ratio (HIR), and NIHSS scores ( F = 20.941, P <0.001, Pillai's trace statistic = 0.567). The between-subject effects test showed that IAVWE had a significant effect on the three dependent variables: LARFP ( R2 = 0.088, F = 10.899, P = 0.002), HIR ( R2 = 0.234, F = 29.354, P <0.001), and NIHSS ( R2 = 114.339, F = 33.338, P <0.001). Arteriosclerotic IAVWE significantly reduced downstream collateral flow and affected relevant neurological deficits. It was an independent factor affecting downstream collateral flow and NIHSS scores, which should be a focus of future studies. ChiCTR.org.cn, ChiCTR2100053661.

Analyzing the cortical fine structure as revealed by ex-vivo anatomical MRI.

The human cortex has a rich fiber structure as revealed by myelin-staining of histological slices. Myelin also contributes to the image contrast in Magnetic Resonance Imaging (MRI). Recent advances in Magnetic Resonance (MR) scanner and imaging technology allowed the acquisition of an ex-vivo data set at an isotropic resolution of 100µm. This study focused on a computational analysis of this data set with the aim of bridging between histological knowledge and MRI-based results. This work highlights: (1) the design and implementation of a processing chain that extracts intracortical features from a high-resolution MR image; (2) a demonstration of the correspondence between MRI-based cortical intensity profiles and the myelo-architectonic layering of the cortex; (3) the characterization and classification of four basic myelo-architectonic profile types; (4) the distinction of cortical regions based on myelo-architectonic features; and (5) the segmentation of cortical modules in the entorhinal cortex.

Miniature side-view dual axes confocal endomicroscope for repetitive in vivo imaging.

A side-view dual axes confocal endomicroscope is demonstrated that can be inserted repetitively in hollow organs of genetically engineered mice for in vivo real-time imaging in horizontal and vertical planes. Near infrared (NIR) excitation at λex = 785 nm was used. A monolithic 3-axis parametric resonance scan mirror was fabricated using micro-electro-mechanical systems (MEMS) technology to perform post-objective scanning in the distal end of a 4.19 mm diameter instrument. Torsional and serpentine springs were designed to "switch" the mode of imaging between vertical and horizontal planes by tuning the actuation frequency. This system demonstrated real-time in-vivo images in horizontal and vertical planes with 310 µm depth and 1.75 and 7.5 µm lateral and axial resolution. Individual cells and discrete mucosal structures could be identified.

Diagnosis, Treatment and Prognosis of Mesonephric Adenocarcinoma of the Vagina: A Literature Review and a Case Report.

Mesonephric adenocarcinoma (MA) of the vagina is a rare tumor that arises from mesonephric remnants (Wolffian) in the female genital tract. It is a neoplasm with no significant evidence about its diagnosis, treatment, follow-up and prognosis. Systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including observational prospective and retrospective studies, case series and case reports. We collected data regarding studies related to diagnosis and treatment options evaluating the following aspects: study design, population, treatment type, rate of surgical complications and fertility outcome. We further included a case report of laparoscopic management of MA with pictorial assays. Thirteen cases of MA of the vagina are available in the literature, including our case report. The median age at diagnosis was 52 years old; the majority of patients reported vaginal bleeding as a symptom (38%); and ultrasound, followed by a magnetic resonance and CT scan were the diagnostic tools most used. In 54% of the cases, a surgical biopsy was performed, and 92% of the patients underwent upfront surgery with an open access or vaginal resection except one case fully managed by minimally invasive surgery. Most of the patients (68%) received adjuvant treatment with chemotherapy or radiotherapy or a combination of them. The mean follow-up period was 6 years. Despite the rarity of this cancer and bizarre location, a minimally invasive approach seems feasible after multidisciplinary evaluation. According to the rarity of this tumor, any future case and follow-up data must be reported in the literature in order to enlarge the knowledge about it.

The Metabolic Vulnerability Index: A Novel Marker for Mortality Prediction in Heart Failure

BackgroundInflammation and protein energy malnutrition are associated with heart failure (HF) mortality. The metabolic vulnerability index (MVX) is derived from markers of inflammation and malnutrition and measured by nuclear magnetic resonance spectroscopy. MVX has not been examined in HF. ObjectivesThe authors sought to examine the prognostic value of MVX in patients with HF. MethodsThe authors prospectively assembled a population-based cohort of patients with HF from 2003 to 2012 and measured MVX scores with a nuclear magnetic resonance scan from plasma collected at enrollment. Patients were divided into 4 MVX score groups and followed until March 31, 2021. ResultsThe authors studied 1,382 patients (median age: 78 years; 48% women). The median MVX score was 64.6. Patients with higher MVX were older, more likely to be male, have atrial fibrillation, and have a higher Meta-analysis Global Group in Chronic Heart Failure score. Higher MVX was associated with mortality independent of Meta-analysis Global Group in Chronic Heart Failure score, ejection fraction, and other prognostic biomarkers. Compared to those with the lowest MVX, the HRs for MVX groups 2, 3, and 4 were 1.1 (95% CI: 0.9-1.4), 1.5 (95% CI: 1.2-1.9), and 1.5 (95% CI: 1.2-1.9), respectively (Ptrend < 0.001). Measures of model improvement document the added value of MVX in HF for classifying the risk of death beyond the Meta-analysis Global Group in Chronic Heart Failure score and other biomarkers. ConclusionsIn this HF community cohort, MVX was strongly associated with mortality independently of established clinical factors and improved mortality risk classification beyond clinically validated markers. These data underscore the potential of MVX to stratify risk in HF.

Distribution of modic changes and its relation with age, sex and body mass index in Iranian population

BackgroundSuspected as a cause of low back pain (LBP), Modic changes (MCs) have received increasing attention in spine research and care. Knowledge of MCs based on the general population, which may provide an important clinical reference is limited. Moreover, fewer studies have examined whether MCs are related to other structural features of LBP, such as age, gender and body mass index (BMI). The aim of present study was to determine the prevalence and clinical distribution of MCs in patients with LBP and to explore the related factors such as age, gender and BMI. MethodA total of 159 adult subjects (74 males [46.2%] and 85 females [53.5%]) were enrolled in the study (Mean age: 46.15 ± 10.36) and scanned with 1.5 T Magnetic Resonance Scanner. Age, gender, disk degeneration, herniation, involved segments, Lumbar lordosis (LL) angle, Sacral sloop (SS), MCs, and endplate concave angle (ECA) were recorded. Disk degeneration was graded using a Pfirrmann scale. MCs were classified into Type I (MCI), type II (MC II), type III (MCIII). ResultsThere were a total of 13 patients (8.2%) with MCI, 145 patients (91.2%) with MC II, and 1 patient (0.6%) with MCIII. Among all patients, the L4/L5 lumbar level was most likely to suffer MCs (56.0%). Greater age [odds ratio (OR) = 2.44 for each 10-year increase] and BMI (OR = 1.07) were associated with the presence of MCs. Logistic regression showed that age, LL, L5/S1 segment lordosis angle, and L5 upper and lower ECA were related with different types of MCs. The OR values were A = 1.08, L = 0.88, D = 1.12, E = 0.88, O = 1.10, respectively (A means age, L means L5/S1 segment lordosis angle, D and E means L5 upper and lower ECA and O means Lumbar lordosis). ConclusionType II MCs are predominant, mostly occur in lower lumbar region. Age, LL, and L5 ECA were associated with type II MCs. L5 Lower concave angle and LL were the most relevant factors for different types.

Clinical significance of possible HLA biomarkers in axial spondyloarthritis beyond HLA-B27 positivity.

The aim of this study is to compare four forms of axial spondyloarthritis (axSpA): non-radiographic axial spondyloarthritis (nr-axSpA), ankylosing spondylitis (AS), non-radiographic axial psoriatic arthritis (nr-axPsA) and radiographic axial psoriatic arthritis (r-axPsA). In a cross-sectional retrospective study, gender difference, human leukocyte antigen (HLA) typing, laboratory C-reactive protein (CRP) and erythrocyte sedimentation (SE) values, and radiographic and magnetic resonance scans were analyzed. One hundred and thirty-seven patients were included in the study: 45 AS, 51 nr-axSpA, 32 r-axPsA and 9 nr-axPsA; 74 women and 63 men. Most of the gender, laboratory and radiological findings confirmed the results of previously conducted studies about each group of the investigated axSpA. The key findings of our study are the newly detected findings of HLA typing beyond HLA-27 positivity: HLA-DR16 in AS, HLA-DR11 in nr-axSpA, HLA-B13, HLA-B57, HLA-Cw12 and HLA-DR7 in r-axPsA, and HLA-B18 in nr-axPsA. Our study also confirmed some of the results of previously conducted studies on predominant genes of HLA typing in axSpA: HLA-B27 in AS, HLA-B39 and HLA-Cw6 in r-axPsA, and HLA-Cw7 in nr-axPsA. Important conclusions about the nr-axPsA group cannot be drawn because of the very small number of subjects included in this group of axSpA. Our results suggest that the newly detected HLA typing findings beyond HLA-B27 positivity could be possible biomarkers of early detection of axSpA, but further studies on larger samples are needed.

Role of Cardiac Magnetic Resonance Imaging and TroponinT in Definitive Diagnosis of Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA).

It is unknown whether the degree of high-sensitivity troponin T (hsTropT) elevation in patients with suspected myocardial infarction without obstructive coronary arteries (MINOCA) presentations can help predict the likelihood of an abnormal cardiac magnetic resonance (CMR) scan. In this study we describe the diagnostic utility of CMR in patients with MINOCA and assesses the effect of peak hsTropT levels at presentation on CMR diagnostic yield. Records of consecutive patients (n= 1407) referred for CMR at a tertiary referral hospital between January 2016 and September 2021 were reviewed. A total of 70 patients met the criteria of MINOCA including ischemic chest pain, elevated peak hsTropT, and nonobstructive coronary artery disease (< 50% stenosis). The peak hsTropT levels within 72 hours of admission were identified. CMR images were generated using a 3.0 T Siemens scanner. Predictors of having an abnormal CMR were evaluated. CMR established a diagnosis in 71% (n= 50) of patients, with the most common CMR diagnosis being myopericarditis (n= 27; 39%). Time to CMR was an independent predictor of a normal CMR scan (odds ratio, 0.98; 95% confidence interval, 0.97-0.999). Peak hsTropT had a high diagnostic accuracy for identifying patients with an abnormal CMR scan (area under the receiver operator characteristic curve, 0.81; P < 0.001). The optimal hsTropT cutoff was 166 ng/L, with 72% sensitivity and specificity. A troponin value ≥ 166 ng/L was independently predictive of an abnormal CMR scan (odds ratio, 4.76; 95% confidence interval, 1.32-17.11). HsTropT and early CMR imaging are independently predictive of an abnormal CMR scan in patients with MINOCA. Additionally, the use of a hsTropT cutoff provides incremental predictive value to clinical parameters and time to CMR scanning in determining an abnormal scan.