MRI Results Research Articles

Fecal occult blood is associated with an increased risk of cerebral small vessel disease in elderly patients

Background and purposeStudies have shown that fecal occult blood is associated with an increased risk of ischemic stroke, but the relationship between fecal occult blood and cerebral small vessel disease (CSVD) remains largely unknown. This study aimed to identify predictors for CSVD, with fecal occult blood and its proxies as potential influencing factors in elderly patients. MethodPatients aged 65 years or older with various chronic diseases were enrolled. The presence of CSVD was evaluated by brain MRI results. Fecal occult blood was measured by fecal immunochemical test. Logistic regression analysis was used for the association between the presence of fecal occult blood and the risk of CSVD. ResultsLogistic regression analysis indicated that a prevalence of positive fecal occult blood was related to CSVD (Model 1, adjusted OR=1.63, 95% CI: 1.15–2.29, P=0.006). We subsequently grouped all subjects as positive fecal occult blood (259, 16.48%) and negative fecal occult blood (1313, 83.52%), and logistic regression analysis indicated that a prevalence of CSVD was related to positive fecal occult blood (Model 2, adjusted OR=1.50, 95% CI: 1.08–2.08, P=0.015). In addition, the ratios of lacunes (67.18% vs. 53.85%, P<0.001) and enlarged perivascular spaces (43.63% vs. 34.42%, P=0.005) were higher in patients with positive fecal occult blood than in controls. ConclusionsThe presence of fecal occult blood is probably related to the risk of CSVD in elderly patients and could be used as a screening tool for CSVD in elderly populations.

Smartphone tests quantify lower extremities dysfunction in multiple sclerosis.

Increasing shortage of neurologists compounded by the global aging of the population have translated into suboptimal care of patients with chronic neurological diseases. While some patients might benefit from expanding telemedicine, monitoring neurological disability via telemedicine is challenging. Smartphone technologies represent an attractive tool for remote, self-administered neurological assessment. To address this need, we have developed a suite of smartphone tests, called neurological functional test suite (NeuFun-TS), designed to replicate traditional neurological examination. The aim of this study was to assess the ability of two NeuFun-TS tests-short walk and foot tapping-to quantify motor functions of lower extremities as assessed by a neurologist. A cohort of 108 multiple sclerosis (MS) patients received a full neurological examination, imaging of the brain, and completed the NeuFun-TS smartphone tests. The neurological exam was digitalized using the NeurEx™ platform, providing calculation of traditional disability scales, as well as quantification of lower extremities-specific disability. We assessed unilateral correlations of 28 digital biomarkers generated from the NeuFun-TS tests with disability and MRI outcomes and developed machine learning models that predict physical disability. Model performance was tested in an independent validation cohort. NeuFun-TS-derived digital biomarkers correlated strongly with traditional outcomes related to gait and lower extremities functions (e.g., Spearman ρ > 0.8). As expected, the correlation with global disability outcomes was weaker, but still highly significant (e.g., ρ 0.46-0.65; p < 0.001 for EDSS). Digital biomarkers also correlated with semi-quantitative imaging outcomes capturing locations that can affect lower extremity functions (e.g., ρ ~ 0.4 for atrophy of medulla). Reliable digital outcomes with high test-retest values showed stronger correlation with disability outcomes. Combining strong, reliable digital features using machine learning resulted in models that outperformed predictive power of best individual digital biomarkers in an independent validation cohort. NeuFun-TS tests provide reliable digital biomarkers of lower extremity motor functions.

RADIOMICS APPLICATIONS IN NON-CONTRAST CINE CARDIAC MAGNETIC RESONANCE IMAGING IN THE DETECTION OF LEFT VENTRICULAR POSTINFARCTION CARDIOSCLEROSIS

BACKGROUND: Size and localization, as well as clear differentiation between intact tissue and infarcted area, are important for clinical diagnosis and precision medicine. This work is based on the study of radiomics features capable of differentiating areas of infarcted and distant tissue from the infarct area using data from non-contrast cine cardiac MRI imaging. AIM: Evaluation of the possibilities and informativeness of radiomics analysis in detection of postinfarction areas of the left ventricular myocardium in patients with ischemic cardiomyopathy by contrast-free cine cardiac MRI images. MATHERIALS AND METHODS: The results of contrast enhancement cardiac MRI with of 33 patients undergoing surgical treatment for ischemic cardiomyopathy were analyzed. Texture analysis was performed on 66 sections of cine cardiac MRI images, and 105 texture characteristics were determined for each of them. Cardiac MRI was performed according to the standard technique on a Vantage Titan (Toshiba) 1.5 T. Texture analysis was performed using 3D slicer-version 5.2.2 software, SlicerRadiomics RESULTS: Collinearity diagrams of the features were constructed. We also identified the features with zero importance and established the importance of the features using the gradient boosting algorithm. In addition, the cumulative importance of the features as a function of their total number was estimated. Using the method of identifying features with low importance, we identified the parameters with the lowest importance that do not affect the indicated total level. Using the method of identifying features with a single value, we did not find features with a single unique value. In addition, ROC curve for Lasso logistic regression (Se =57.14% Sp=71.43%, AUC=0.76) was generated based on the results of the analysis. The main result of this study is the identification of radiomics features able to characterize the areas corresponding to postinfarction cardiosclerosis and intact LV wall on the basis of cine cardiac MRI images. CONCLUSION: This study has shown that the use of radiomics analysis on contrast-free cine cardiac MRI images is a promising approach to identify areas corresponding to myocardial infarction and intact wall and could potentially be used as to identify areas of postinfarction cardiosclerosis in patients with ischemic cardiomyopathy without the use of contrast agents.

Risk factors for healing failure after arthroscopic rotator cuff repair in small to medium-sized tears: a retrospective cohort study.

To identify risk factors for tendon healing failure following arthroscopic rotator cuff repair (ARCR) in patients with small to medium-sized rotator cuff tears (RCTs). A retrospective study was conducted on 320 patients with RCTs who underwent arthroscopic repair between June 2018 and June 2021. All patients had at least 2 years of postoperative follow-up, with MRI scans at the final assessment. Based on MRI results, patients were categorized into the healing success group (Group A: types I-III) or the healing failure group (Group B: types IV-V). Variables associated with rotator cuff healing, including patient characteristics, baseline symptoms, imaging data, and surgery-related factors, were analyzed using univariate and multivariate logistic regression. Healing failure occurred in 54 of the 320 patients (16.9%). Functional status improved significantly across all patients (P < 0.05), irrespective of healing outcomes. Multifactorial analysis identified smoking (OR = 1.931, P = 0.028), diabetes (OR = 3.517, P = 0.038), lower bone mineral density (BMD) (OR = 1.551, P = 0.018), higher fatty infiltration (FI) (OR = 4.025, P = 0.009), and smaller acromiohumeral distance (AHD) (OR = 2.546, P = 0.006) as independent risk factors for healing failure. Smoking, diabetes, lower BMD, higher FI, and smaller AHD are independent risk factors for healing failure following ARCR.

CTNI-17. A PHASE 2 STUDY OF SAFETY AND EFFICACY OF CONCURRENT ACT001 AND RADIATION TREATMENT FOLLOWED BY ACT001 MAINTENANCE THERAPY IN NEWLY DIAGNOSED PEDIATRIC PATIENTS WITH DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG)

Abstract BACKGROUND ACT001, an oral parthenolide derivative targeting NF-κB and STAT3 pathways, has shown activity in preclinical DIPG model and dose-finding study in patients with diffuse midline glioma. We further evaluated safety and activity of ACT001 in newly diagnosed DIPG patients and presented the interim data from exploratory stage of this phase 2 study. METHODS Eligible patients ≥ 5 and ≤ 15 years old were treated with concurrent ACT001 and standard radiation followed by ACT001 single agent treatment in this single arm, open label, multicenter phase 2 study. Tumor lesions were evaluated at baseline, 4 weeks and then every 8 weeks after the end of radiation therapy per RAPNO criteria with ORR as primary endpoint. Interim data analysis was performed when data from approximately 20 efficacy evaluable patients became available during the exploratory stage of this study. RESULTS Among 30 patients enrolled since Sept, 2023, 27 took at least one dose of ACT001 by April 30th, 2024, the data cutoff date (with exception for May 15th as the MRI cutoff date). While 3 patients were quickly taken off study due to a disease progression or consent withdrawal, 17 out of 27 patients finished at least one post-radiation MRI exam whereas MRI results are pending for 7 other patients by this interim analysis. Median age was 8 years old and male to female patient ratio is 17:10. The median LPS score is 70.0. Among 17 efficacy evaluable subjects, 8 patients exhibited partial response (6 confirmed) including one with a deep tumor reduction (-91.7%) noted three months after end of radiation. Among 9 other evaluable patients, 5 and 4 exhibited ongoing stable disease and progressive disease respectively. Subject 05001 was considered PD despite confirmed objective response for the target lesion upon development of new lesions. Two patients withdrew consent after finishing first post-radiation MRI scans despite initial tumor burden reduction which were both close to PR criteria. Patients tolerated concurrent ACT001 and radiation well. In total, 289 TEAE and 184 TRAE events were reported in 23 and 22 patients respectively. There were two ACT001-related grade 3 or 4 adverse events including one grade 4 hemorrhagic tumor necrosis (a SUSAR event and the only ACT001 related SAE) likely due to a therapeutic effect of ACT001 and one clinically insignificant grade 3 decreased lymphocyte count. Most common TRAE were manageable grade 1 or 2 events such as weight loss (15/184), vomiting (71/184), decreased lymphocyte count (13/184) and abdominal bloating (7/184). No study discontinuation occurred due to ACT001 or radiation related TRAEs. Conclusion. Concurrent ACT001 and radiation treatment was well tolerated. Preliminary evidence of anti-tumor activity was shown in about 50% efficacy evaluable DIPG patients. It is worthwhile to explore ACT001 and temozolomide combination in future study based on safety and efficacy signal from DIPG and recurrent GBM studies. The confirmatory stage of this study is in planning to further evaluate the anti-tumor efficacy signal of this NF-κB and STAT3 dual inhibitor.

Association between glycemia and outcomes of neonates with hypoxic-ischemic encephalopathy: a systematic review and meta-analysis

ObjectivesThe research aimed to provide the most recent and comprehensive analysis and evidence update comparing outcomes in neonatal encephalopathy (NE) based on different glycemia levels.Patients and methodsA comprehensive search of Cochrane, PubMed, Embase, Web of Science, CNKI, and Wanfang databases was conducted until September 2023. The purpose was to identify research that examined the effects of hyperglycemia, hypoglycemia, and normoglycemia on NE outcomes. The hyperglycemic, normoglycemic and hypoglycemic group were compared. Outcomes measured were mortality, abnormal MRI, hearing or visual unfavorable outcomes, neurodevelopmental delay, cerebral palsy, and all unfavorable outcomes.ResultsThirteen literatures comprising 2,427 participants (1,233 with normoglycemia, 835 with hyperglycemia, and 359 with hypoglycemia) were considered. Pooled analysis showed more overall adverse outcomes, higher mortality and worse hearing or visual outcomes in the hyperglycemic and hypoglycemic group compared to the normoglycemic group. There was no notable distinction found in abnormal MRI and cerebral palsy among all groups. The hypoglycemic group exhibited greater neurodevelopmental delay than normoglycemia.ConclusionsMaintaining normal blood glucose levels in neonates with NE can help reduce the risk of adverse consequences such as hearing and visual impairment.

Correlation between MRI and conventional radiographic findings in evaluation of osteoarthritis.

Objective: To evaluate the diagnostic accuracy of X-rays in detecting osteoarthritis (OA) in comparison to MRI. Study Design: Cross-sectional study. Setting: The Fauji Foundation Hospital, Rawalpindi. Period: August, 2023 to March, 2024. Methods: Total 350 patients consented to clinical interviews, physical examinations, standing radiographs, and MRIs. Standing, semi-flexed posteroanterior radiographs of the knees were obtained with proper alignment to accurately detect joint space narrowing. Manual measurements of joint space width were conducted by a blinded orthopedic surgeon using the Kellgren-Lawrence grading system. Data analysis was performed using SPSS 23, with frequencies, percentages, means, and standard deviations calculated for relevant variables. Diagnostic accuracy was assessed using a 2x2 table. Results: Of the 350 patients, 61.1% were up to 60 years old, and 38.9% were over 60 years old. Among those with positive MRI results, 70.1% also had a positive X-ray, while 29.6% did not. Cohen's Kappa was 0.377, indicating fair to moderate agreement. Sensitivity was 54.3%, specificity 82.4%, positive predictive value 70.1%, and negative predictive value 70.4%, with an overall diagnostic accuracy of 70.3%. Conclusion: X-rays demonstrated high specificity and moderate predictive values, but low sensitivity, suggesting that some OA cases may be missed if relying solely on X-rays.

Profile of Lumbar Spinal Stenosis Patients at Dr. M. Djamil Central Public Hospital from 2018-2022

Background: Lumbar Spinal Stenosis (LSS) is a pathological condition characterized by narrowing of the spinal canal in the lower back. In Indonesia, comprehensive data on LSS is currently unavailable. This study aimed to determine the profile of LSS patients at Dr. M. Djamil Central Public Hospital. Methods: This descriptive cross-sectional study utilized medical record data from 122 LSS patients at Dr. M. Djamil Central Public Hospital between 2018 and 2022, selected via consecutive sampling. Inclusion criteria included age over 18 years and a confirmed LSS diagnosis. Exclusion criteria included incomplete medical records, lack of MRI results, and follow-up visits without treatment. Univariate analysis was performed using SPSS 25.0 to describe patient characteristics, causative factors, symptoms, location of stenosis, and management type. Results: In this study, 122 samples met the inclusion and exclusion criteria. LSS was mainly found in patients aged 60-69 years (33.6%) and in women (59%). Most LSS patients had obesity (BMI category I, 32%). Many LSS patients were housewives (42.62%) and reported light work activity (63.1%). The most common cause of LSS was degenerative factors (59%). The main symptom experienced by LSS patients was lower back pain (94.3%), frequently accompanied by radicular pain (79.5%). The most common location of stenosis was L4-L5 (43.4%). Most LSS patients in this study were managed both conservatively and operatively (70.5%). Conclusion: These findings contribute to a better understanding of LSS prevalence and distribution among patients. Further multicenter studies are needed to establish a comprehensive national LSS profile.

Differential functional change in olfactory bulb and olfactory eloquent areas in Parkinson's disease.

Olfactory dysfunction, or hyposmia, frequently occurs as a prodromal symptom and ongoing sign of Parkinson's disease. Functional MRI is a powerful tool for studying functional changes in the olfactory brain regions in patients with Parkinson's disease. However, existing studies show inconsistent results and no study has measured olfactory functional MRI abnormalities in the human olfactory bulb directly. This is mainly due to the well-known susceptibility artefacts in conventional functional MRI images that affect several key olfactory-eloquent brain regions, and especially the olfactory bulb. In this study, olfactory functional MRI was performed using a recently developed functional MRI approach that can minimize susceptibility artefacts and measure robust functional MRI signals in the human olfactory bulb during olfactory stimulation. Experiments were performed on high magnetic field (7 T) in 24 early (<5 years of parkinsonian symptoms) Parkinson's disease patients and 31 matched healthy controls. Our data showed increased functional MRI signal changes (ΔS/S) in the olfactory bulb in patients with early Parkinson's disease, which correlated with behavioural olfactory measures. Temporally, functional MRI signals in the olfactory bulb returned to the pre-stimulus state earlier after reaching peak amplitude in patients with early Parkinson's disease, implicating a faster olfactory habituation effect. The piriform cortex showed reduced numbers of activated voxels in patients with early Parkinson's disease, which correlated with behavioural olfactory assessment. Several secondary olfactory regions including the orbitofrontal cortex, temporal pole and amygdala exhibited reduced numbers of activated voxels and increased functional MRI signal changes in patients with early Parkinson's disease. Our data also showed that functional MRI results are highly dependent on voxel selection in the functional analysis. In summary, we demonstrate differential spatial and temporal characteristics of olfactory functional MRI signals between the primary and secondary olfactory regions in patients with early Parkinson's disease. These results may assist the development of novel quantitative biomarkers (especially in the early stages of Parkinson's disease) to track and predict disease progression, as well as potential treatment targets for early intervention.

Mechanisms affecting the neutrophil to lymphocyte ratio in heart failure: a prospective CMR study

Abstract Background The neutrophil-to-lymphocyte ratio (NLR) is a simple measure of inflammation defined as the ratio of the neutrophils to lymphocytes as measured in the full blood count. It is well known that patients with heart failure (HF) have elevated levels of pro-inflammatory cytokines. It has been demonstrated in a recent meta-analysis that elevated NLR in heart failure is significantly associated with worse outcomes including all-cause mortality, heart failure readmissions and cardiovascular death. Purpose Given this association between NLR and adverse prognosis in HF, we aim to identify which factors are associated with an elevated NLR. This may help to recognise patients at higher risk and guide management. Methods Patients with newly diagnosed HF and left ventricular ejection fraction &amp;lt;50% on referral echocardiogram were prospectively recruited at the time of referral for cardiovascular magnetic resonance (CMR). Exclusion criteria included prior revascularisation, myocardial infarction, anginal chest pain, congenital heart disease and suspected myocarditis. In one appointment patients (N=599) underwent clinical assessment, medication review, full blood count and CMR. The CMR protocol included quantitative assessment myocardial blood flow at stress and rest, assessment of ischaemic and non-ischaemic fibrosis by late gadolinium enhancement imaging and T1 and T2 mapping. Guideline directed medical therapy was determined by the referring physician. Baseline demographic data, medication and MRI results were recorded for all patients. NLR was calculated from full blood count and split into tertiles. Clinical and CMR parameters were compared between tertiles by analysis of variance and chi squared test. Results See Table 1 The factors which were found to be significantly associated with an elevated NLR were age, atrial fibrillation, NTproBNP, diuretic dose, inducible ischaemia and ischaemic fibrosis. Of note there was no significant difference between groups in terms of guideline directed medical therapy use or other CMR parameters. Conclusion NLR is increasingly recognised as a marker of adverse risk in patients with heart failure. This prospective study of 599 heart failure patients with reduced ejection fraction has identified that an elevated NLR is associated with: 1. Evidence of congestion as evidenced by NTproBNP results and increased diuretic doses. 2. Occult coronary artery disease as shown by greater levels of inducible ischaemia and ischaemic fibrosis. These findings suggest that the adverse prognosis associated with elevated NLR in heart failure may be mediated by worsening congestion and occult coronary artery disease. Importantly there was no association between myocardial inflammation or oedema (measured as native T1 and T2) and NLR. Whether NLR improves with medical therapy of heart failure remains to be established and our findings need to be validated in more varied cohorts of patients with heart failure.

Association of MRI findings with intra-articular tumour extension.

Treatment of high-grade limb bone sarcoma that invades a joint requires en bloc extra-articular excision. MRI can demonstrate joint invasion but is frequently inconclusive, and its predictive value is unknown. We evaluated the diagnostic accuracy of direct and indirect radiological signs of intra-articular tumour extension and the performance characteristics of MRI findings of intra-articular tumour extension. We performed a retrospective case-control study of patients who underwent extra-articular excision for sarcoma of the knee, hip, or shoulder from 1 June 2000 to 1 November 2020. Radiologists blinded to the pathology results evaluated preoperative MRI for three direct signs of joint invasion (capsular disruption, cortical breach, cartilage invasion) and indirect signs (e.g. joint effusion, synovial thickening). The discriminatory ability of MRI to detect intra-articular tumour extension was determined by receiver operating characteristic analysis. Overall, 49 patients underwent extra-articular excision. The area under the curve (AUC) ranged from 0.65 to 0.76 for direct signs of joint invasion, and was 0.83 for all three combined. In all, 26 patients had only one to two direct signs of invasion, representing an equivocal result. In these patients, the AUC was 0.63 for joint effusion and 0.85 for synovial thickening. When direct signs and synovial thickening were combined, the AUC was 0.89. MRI provides excellent discrimination for determining intra-articular tumour extension when multiple direct signs of invasion are present. When MRI results are equivocal, assessment of synovial thickening increases MRI's discriminatory ability to predict intra-articular joint extension. These results should be interpreted in the context of the study's limitations. The inclusion of only extra-articular excisions enriched the sample for true positive cases. Direct signs likely varied with tumour histology and location. A larger, prospective study of periarticular bone sarcomas with spatial correlation of histological and radiological findings is needed to validate these results before their adoption in clinical practice.

Synthetic double inversion recovery imaging for rectal cancer T staging evaluation: imaging quality and added value to T2-weighted imaging

ObjectiveTo assess the image quality of synthetic double inversion recovery (SyDIR) imaging and enhance the value of T2-weighted imaging (T2WI) in evaluating T stage for rectal cancer patients.MethodsA total of 112 pathologically confirmed rectal cancer patients were retrospectively selected after undergoing MRI, including synthetic MRI. The image quality of T2WI and SyDIR imaging was compared based on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), overall picture quality, presence of motion artifacts, lesion edge sharpness, and conspicuity. The concordance between MRI and pathological staging results, using T2WI alone and the combination of T2WI and SyDIR for junior and senior radiologists, was assessed using the Kappa test. The area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic efficacy of extramural infiltration in rectal cancer patients.ResultsNo significant differences in imaging quality were observed between conventional T2WI and SyDIR (p = 0.07–0.53). The combination of T2WI and SyDIR notably improved the staging concordance between MRI and pathology for both junior (kappa value from 0.547 to 0.780) and senior radiologists (kappa value from 0.738 to 0.834). In addition, the integration of T2WI and SyDIR increased the AUC for diagnosing extramural infiltration for both junior (from 0.842 to 0.918) and senior radiologists (from 0.917 to 0.938).ConclusionThe combination of T2WI and SyDIR increased the consistency of T staging between MRI and pathology, as well as the diagnostic performance of extramural infiltration, which would benefit treatment selection.Critical relevance statementSyDIR sequence provides additional diagnostic value for T2WI in the T staging of rectal cancer, improving the agreement of T staging between MRI and pathology, as well as the diagnostic performance of extramural infiltration.Key PointsSynthetic double inversion recovery (SyDIR) and T2WI have comparable image quality.SyDIR provides rectal cancer anatomical features for extramural infiltration detections.The combination of T2WI and SyDIR improves the accuracy of T staging in rectal cancer.Graphical

The Utility of a Community-Based Knee Ultrasound in Detecting Meniscal Tears: A Retrospective Analysis in Comparison with MRI.

MRI is the gold standard for detecting meniscal tears; however, ultrasound may readily detect meniscal changes, obviating the need for MRI. We aim to (1) determine ultrasound sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in detecting meniscal changes, and (2) describe characteristic meniscal changes in US and their prevalence. A retrospective analysis of knee ultrasound scans for the presence of medial and lateral meniscal tears was conducted. Meniscal changes were characterized into five US appearances (cleft, diminutive, cyst, displaced fragment, and extrusion) by the consensus of two musculoskeletal radiologists. Ultrasound findings were then compared to MRI results. In total, 249 patients were included. Ultrasound sensitivity, specificity, PPV, NPV, and accuracy for medial meniscal tears were 79%, 97.3%, 95.3%, 86.6%, and 90%, respectively, and for lateral meniscal tears the ultrasound sensitivity, specificity, PPV, NPV, and accuracy were 63%, 99.5%, 96%, 93%, and 93.6%, respectively. The false negative and false positive rates for medial meniscal tears were 13.4% and 4.7%, respectively, and for the lateral meniscus, the false negative and false positive rates were 6.7% and 3.8%, respectively. Meniscal clefts were the most prevalent appearance in the medial meniscus followed by extrusions. Meniscal extrusions were the most prevalent appearance in the lateral meniscus followed by clefts. Community-based US is highly accurate in the detection of meniscal tears when compared with MRI, making it a valuable diagnostic imaging tool for detecting meniscal tears in a community setting where accessibility to MRI is limited or if there are MRI contraindications.

Using a novel PSMA-PET and PSA-based model to enhance the diagnostic accuracy for clinically significant prostate cancer and avoid unnecessary biopsy in men with PI-RADS ≤ 3 MRI.

The diagnostic evaluation of men with suspected prostate cancer (PCa) yet inconclusive MRI (PI-RADS ≤ 3) presents a common clinical challenge. [68Ga]Ga-labelled prostate-specific membrane antigen ([68Ga]Ga-PSMA) positron emission tomography/computed tomography (PET/CT) has shown promise in identifying clinically significant PCa (csPCa). We aim to establish a diagnostic model incorporating PSMA-PET to enhance the diagnostic process of csPCa in PI-RADS ≤ 3 men. This study retrospective included 151 men with clinical suspicion of PCa and PI-RADS ≤ 3 MRI. All men underwent [68Ga]Ga-PSMA PET/CT scans and ultrasound/MRI/PET fusion-guided biopsies. csPCa was defined as Grade Group ≥ 2. PRIMARY-scores from PSMA-PET scans were evaluated. A diagnostic model incorporating PSMA-PET and prostate-specific antigen (PSA)-derived parameters was developed. The discriminative performance and clinical utility were compared with conventional methods. Internal validation was conducted using a fivefold cross-validation with 1000 iterations. In this PI-RADS ≤ 3 cohort, areas-under-the-curve (AUCs) for detecting csPCa were 0.796 (95%CI, 0.738-0.853), 0.851 (95%CI, 0.783-0.918) and 0.806 (95%CI, 0.742-0.870) for PRIMARY-score, SUVmax and routine clinical PSMA-PET assessment, respectively. The diagnostic model comprising PRIMARY-score, SUVmax and serum free PSA/total PSA (fPSA/tPSA) achieved a significantly higher AUC of 0.906 (95%CI, 0.851-0.961) compared to strategies based on PRIMARY-score or SUVmax (P < 0.05) and markedly superior to conventional strategies typically based on PSA density (P < 0.001). The average fivefold cross-validated AUC with 1000 iterations was 0.878 (95%CI, 0.820-0.954). Theoretically, using a threshold of 21.6%, the model could have prevented 78% of unnecessary biopsies while missing only 7.8% of csPCa cases in this cohort. A novel diagnostic model incorporating PSMA-PET derived metrics-PRIMARY-score and SUVmax-along with serum fPSA/tPSA, has been developed and validated. The integrated model may assist clinical decision-making with enhanced diagnostic accuracy over the individual conventional metrics. It has great potential to reduce unnecessary biopsies for men with PI-RADS ≤ 3 MRI results and warrants further prospective and external evaluations.

Sarcopenia Prevalence in Liver Cirrhosis Patients Using MRI and Handgrip Strength Measurements

Background: Cirrhosis, a leading cause of mortality worldwide, is histologically represented as formation of regenerative nodules encircled by fibrous bands caused by chronic liver injury. Nutritional status in cirrhotic patients is challenging to assess due to fluid accumulation resulting from impaired protein synthesis. Factors such as reduced food intake, malabsorption, and altered macronutrient metabolism negatively impact the nutritional status, leading to sarcopenia. The development of sarcopenia is multifactorial and is linked to lower survival rates. Aim: To assess sarcopenia prevalence in liver cirrhosis patients using MRI and handgrip strength measurements. Discussion: Impaired food intake in liver cirrhosis results from a combination of factors including loss of appetite, hormonal changes, early satiety, ascites, nausea, taste disturbances, and functional dyspepsia. Malabsorption can also occur due to portosystemic shunting, reduced bile production, chronic pancreatitis, and small intestinal bacterial overgrowth, all of which contribute to sarcopenia. It also arises from complex interactions involving impaired glycogen synthesis, inadequate nutrition, disrupted skeletal muscle protein synthesis and underlying hypermetabolism. Conclusion: MRI-based assessments indicate there is a significant occurrence of sarcopenia in individuals with cirrhosis. Our findings reveal that handgrip strength, when correlated with MRI results, is a reliable predictor of sarcopenia in these patients.

Magnetic resonance imaging classification in a percutaneous needle injury rat model of intervertebral disc degeneration

BackgroundDuring the development of disease-modifying intervertebral disc degeneration (IDD) drugs, the rat model of IDD is frequently used for disease progression assessment. The aim of this study was to describe a magnetic resonance (MRI) scoring system for the assessment of different disc conditions in puncture-induced IDD, allowing standardization and comparison of results obtained by different investigators.MethodsA total of 36 Sprague-Dawley rats were utilized in the present study. The animals were divided into two groups: a sham group and an IDD group caused by puncture. The rats in the IDD group were subsequently divided into six categories based on time frames, with five rats in each category. The sham group was divided into two sub-groups (n = 3) for 28 and 56 days, respectively. T2-weighted images of rats consecutively studied with MRI of the coccygeal discs were classified according to the time course using the corresponding histological data. Additional scoring of the micro-CT was employed to identify the progression of bone destruction of the rat model of IDD.ResultsA comparison of the MRI results between the sham group and the IDD group revealed a significant reduction in NP height, area, T2WI value, and DHI in the latter group (P < 0.05). The micro-CT results demonstrated that following acupuncture, there was a notable decline in the BV, Tb.N, and height of the coccygeal vertebra, while the BS/BV and Tb.Sp exhibited a significant increase (P < 0.05). The histological results were analogous to the MRI results, indicating a progressive exacerbation of IDD and a corresponding increase in NP score (P < 0.05). The results of the MRI were found to be consistent with those of the micro-CT and histological analyses (P < 0.05). The results of the study demonstrate a robust correlation between MRI analysis and histological findings. Live animals are employed for MRI analysis to improve experiment comparability. The reliability of the MRI scoring system ensures assessment of disease progression in live animals, while promoting cost savings and animal welfare by avoiding the sacrifice of animals at different times.ConclusionsThe described scoring paradigm has quantitatively been found to differentiate IDD disease progression in an in vivo rat model. Hence, we suggest employing it to evaluate the rat IDD model and assess the effects of treatments in this model.

An exploratory study of functional brain activity associated with gross motor function improvement in children with unilateral cerebral palsy

ABSTRACT Purpose Identify relations of gross motor function and primary motor cortex (M1) functional activity pre and post gross motor interventions for children with unilateral cerebral palsy (UCP). Methods Thirteen children with UCP completed a gross motor intervention. Pre/post-intervention functional MRI outcomes included the laterality index (LI), activation volume, and spatial overlap of M1 activation during active ankle dorsiflexion. Advanced gross motor function (Challenge) was assessed pre/post-intervention, and 2–6 months later. Bivariate correlations and linear regression assessed relations between neuroimaging and motor function. Results Mean pre-intervention M1 activity was contralateral during dominant (LI = +0.85, SD 0.21) but variable during the affected (LI = +0.43, SD 0.57) ankle dorsiflexion. Changes in motor function and neuroimaging outcomes were not significantly associated. However, smaller affected ankle activation and less spatial overlap between ankle activations pre-intervention predicted Challenge improvements post-intervention (adjusted R2 = 0.74, p = .001.) Conclusions This exploratory study identified pre-intervention neuroimaging predictors of post-intervention improvements in advanced gross motor function.

Fetal MRI findings, etiology, and outcome in prenatally diagnosed schizencephaly.

Schizencephaly is a rare brain anomaly which is increasingly detected in utero. There are limited data on the etiology and outcomes in fetal schizencephaly to guide workup and counselling. We aim to determine the associated imaging findings, etiology, and outcomes in schizencephaly detected in utero. This retrospective cohort study included 22 fetuses with a total of 34 schizencephaly defects identified by keyword search of fetal MRI reports from 1996-2022 followed by image review. Follow-up fetal and postnatal imaging, when available, were reviewed. Data on demographics, etiology, and outcomes were extracted from the electronic medical record. The schizencephaly defect was open in 28/34, most common in the MCA territory (23/34), and commonly involved the frontal (16/34) lobe. Additional intracranial abnormalities were seen in all fetuses including other cortical malformations (CM, 13/22), abnormal posterior fossa (12/22), abnormal corpus callosum (10/20), and intraparenchymal hemorrhage (9/22).The cause of schizencephaly was classified as secondary (as evidenced by intraparenchymal hemorrhage at schizencephaly, monochorionic twin gestation, infection, or maternal/placental risk factor) in 64% (14/22), potentially genetic in 9% (2/22), and unknown in 27% (6/22). Among those liveborn (n=8), the following outcomes were observed: postnatal death (1/8), tube feeding (1/7), shunted hydrocephalus (1/7), epilepsy (4/7). Among those >1 year of age, cerebral palsy (4/5) and speech delay or intellectual disability (3/5) were common. CM remote from schizencephaly was associated with epilepsy (p=0.03). On postnatal imaging, open defects often involuted (8/11) and there were high rates of new/additional findings (4/6). In this cohort, fetal schizencephaly was always associated with additional intracranial abnormalities. In most cases, there was evidence that schizencephaly was likely secondary to prior injury. Imaging characteristics may provide clues regarding neurodevelopmental outcome. Postnatal imaging is crucial in assessing evolution as well as for detection of additional abnormalities. ICH = intracranial hemorrhage; CM = cortical malformation; VM = ventriculomegaly; DGN = deep grey nuclei; SP = septum pellucidum; IPH = intraparenchymal hemorrhage; CC = corpus callosum; PMG = polymicrogyria; PVNH = periventricular nodular heterotopia; TTTS = twin-twin transfusion syndrome; GA = gestational age; CP = cerebral palsy.

Magnetic Resonance Imaging in Evaluation of Cystic Renal Masses Using Bosniak Classification Version 2019

Abstract Background Cystic renal lesions are very commonly encountered at abdominal imaging. Most lesions are asymptomatic and incidentally found. When a confident diagnosis cannot be rendered, incidental renal masses are considered indeterminate and typically are furtherly evaluated with CT or MRI using Bosniak classification that is specifically designed to evaluate them. Objective To assess MRI in evaluation of cystic renal masses using Bosniak classification version 2019 to stratify the risk of malignancy in correlation to histo-pathological analysis. Patients and Methods This was a cross sectional study that included 60 patients who were diagnosed to have cystic renal lesion either outpatients or referred from the urology department at Ain Shams University Hospitals to the radiodiagnosis department For pelvi-abdominal MRI examination. An acceptance from the ethical committee of the Radiology Department and the ethical Committee of faculty of medicine - Ain Shams University hospitals was obtained to use the data stared on PACs system With the patient’s consent waived. All patients gone through MR assessment utilizing 1.5 T machine (inginea Philips). Results From our study simple renal cyst (bosniak I) were the most common benign lesion and Cystic renal masses classified as Bosniak IV were the most common malignant lesion. After exclusion of benign causes 17 cases were included in histopathology. Clear cell Renal cell carcinomas were the most common finding and we correlate Histopathology with MRI results and It shows high significant relation between Bosniak classification and histopathology. Conclusion Bosniak classification version 2019 has high sensitivity and specifity in correlation to histopathology.

Magnetic Resonance Imaging MRI versus Color Doppler Ultrasound for Assessment of Placenta Accreta Spectrum Disorders

Abstract Background As placenta previa and placenta accreta are the two most common causes of postpartum hemorrhage, early and accurate diagnosis, preoperative assessment, and intraoperative management are crucial for a successful outcome. However, risk assessment of intraoperative massive hemorrhage in patients with placenta previa and accreta is challenging in clinical practice. Aim of the Work To compare the sensitivity and accuracy of MRI versus color Doppler US in the diagnosis of morbidly adherent placenta in women with placenta previa accreta spectrum. Subjects and Methods This was a cohort prospective study was done in cases was recruited from the pregnant women attending outpatient clinic or emergency department at Ain Shams University Maternity Hospital. The study was include 62 pregnant women. Results The final US results shows that from the 90 studied patients; 25 patients have no presence of accreta (37.8%) and 65 patients have presence of accreta (72.2%). The final MRI results shows that from the 90 studied patients; 35 patients have no presence of accreta (38.9%) and 55 patients have presence of accreta (61.1%). there was statistically significant increase in the percentage of patients with history of thyroidectomy and IUD removal laparoscopic in patients with placenta accreta (7.5% and 7.5%; respectively) than patients without placenta accreta (0.0% and 0.0%; respectively) with p-value = 0.049 and 0.049; respectively. there was statistically significant increase in the percentage of accuracy of MRI results (73.3%) than ultrasound results (58.9%). Conclusion Regarding to our results we concluded that ultrasound can detect patients with placenta accreta with sensitivity of 92.5%, specificity of 32.0% and overall accuracy of 58.9% while MRI can detect patients with placenta accreta with sensitivity of 100.0%, specificity of 52.0% and overall accuracy of 73.3%, there was statistically significant increase in the percentage of accuracy of MRI results (73.3%) than ultrasound results (58.9%) with p-value &amp;lt;0.001.