Routine Brain Magnetic Resonance Imaging Research Articles

Expert consensus on the clinical practice of neonatal brain magnetic resonance imaging.

In recent years, magnetic resonance imaging (MRI) has been widely used in evaluating neonatal brain development, diagnosing neonatal brain injury, and predicting neurodevelopmental prognosis. Based on current research evidence and clinical experience in China and overseas, the Neonatologist Society of Chinese Medical Doctor Association has developed a consensus on the indications and standardized clinical process of neonatal brain MRI. The consensus has the following main points. (1) Brain MRI should be performed for neonates suspected of hypoxic-ischemic encephalopathy, intracranial infection, stroke and unexplained convulsions; brain MRI is not considered a routine in the management of preterm infants, but it should be performed for further evaluation when cranial ultrasound finds evidence of brain injury; as for extremely preterm or extremely low birth weight infants without abnormal ultrasound findings, it is recommended that they should undergo MRI examination at term equivalent age once. (2) Neonates should undergo MRI examination in a non-sedated state if possible. (3) During MRI examination, vital signs should be closely monitored to ensure safety; the necessity of MRI examination should be strictly evaluated for critically ill neonates, and magnetic resonance compatible incubator and ventilator can be used. (4) At present, 1.5 T or 3.0 T equipment can be used for neonatal brain MRI examination, and the special coil for the neonatal head should be used to improve signal-to-noise ratio; routine neonatal brain MRI sequences should at least include axial T1 weighted image (T1WI), axial T2 weighted imaging (T2WI), diffusion-weighted imaging, and sagittal T1WI or T2WI. (5) It is recommended to use a structured and graded reporting system, and reports by at least two reviewers and multi-center collaboration are recommended to increase the reliability of the report.

Considerations for the real‐world management of ARIA from the aducanumab phase 3 studies EMERGE and ENGAGE

AbstractBackgroundAmyloid‐related imaging abnormalities (ARIA), a spectrum of imaging findings detected on brain magnetic resonance imaging (MRI), are associated with the investigational use of amyloid‐targeting monoclonal antibodies, including aducanumab, in patients with Alzheimer’s disease (AD). EMERGE (NCT02484547) and ENGAGE (NCT02477800) were Phase 3 studies that evaluated the efficacy and safety of aducanumab in patients with early AD.MethodsARIA risk minimization included dose titration, routine brain MRI monitoring, ad hoc MRI testing as clinically indicated, and among patients who developed ARIA, possible dose suspension or permanent discontinuation. The criteria for dose suspension or discontinuation were based on the radiographic severity of ARIA and presentation of clinical symptoms. On detection of an ARIA episode, follow‐up MRIs were conducted approximately every 4 weeks to document radiographic resolution of ARIA‐edema (ARIA‐E) or stabilization of ARIA‐hemorrhage (ARIA‐H), which refers to brain microhemorrhages and localized superficial siderosis.ResultsThe integrated data set from EMERGE and ENGAGE consisted of 3285 participants (aducanumab treated, n=2198; placebo treated, n=1087). In the 10‐mg/kg group (n=1029 with ≥1 postbaseline MRI), ARIA‐E was the most common adverse event (35.2%), with a higher incidence in apolipoprotein ε4 carriers compared with noncarriers (43.0% versus 20.3%, respectively). Radiographic severity of ARIA‐E was characterized as mild (30.1%), moderate (57.7%), or severe (12.2%). ARIA‐E typically occurred within the first 32 weeks of treatment with aducanumab and were mostly asymptomatic (74.0%). Among participants who reported symptoms in the setting of ARIA, the majority of symptoms during ARIA were characterized as mild (67.7%) or moderate (28.3); the most common symptoms were headache (46.6%), confusion (14.6%), dizziness (10.7%), and nausea (7.8%). ARIA‐E were transient but recurred in 10.6% of participants in the 10‐mg/kg group. ARIA‐H microhemorrhage and superficial siderosis were typically asymptomatic and more common in participants who had ARIA‐E (40.3% and 38.7%, respectively), compared with participants without ARIA‐E (7.6% and 1.6%, respectively). In participants with ARIA‐E and ARIA‐H, these events frequently overlapped temporally. There were no fatal events due to ARIA.ConclusionsARIA are mostly asymptomatic; evidence supports the use of routine brain MRI to monitor for events in clinical practice.

Brain magnetic resonance imaging without contrast significantly increased serum levels of IL-6, but not IL-10, IL-17A and TGF-β

ABSTRACT Introduction: Magnetic Resonance Imaging (MRI) is a non-invasive imaging modality. However, the effects of MRI on the immune system in the in vivo conditions are yet to be clarified. In this study we explored the effects of routine brain MRI on the protein and mRNA peripheral blood levels of interleukin-6 (IL-6), IL-10, IL-17A and transforming growth factor-beta (TGF-β). Material and methods: 40 subjects, who referred for brain MRI, were entered for evaluating effects of routine brain MRI on the protein and mRNA peripheral blood levels of IL-6, IL-10, IL-17A and TGF-β. Accordingly, peripheral blood were collected before and 3 hours after MRI from the participants. Protein levels of the cytokines were evaluated using ELISA. Also, mRNA levels were analyzed using Real-Time PCR techniques. Results: Brain MRI without contrast led to an increase in protein levels of IL-6 in the peripheral serum, but did not change protein and mRNA levels of IL-10, IL-17A and TGF-β. IL-6 mRNA levels after MRI were higher in the participants with mild anxiety compared to those without anxiety. Conclusion: brain MRI without contrast can induce secretion of IL-6 and may be associated with its functions, such as development of plasma cells or induction of inflammation.

Implementation of the Feed and Swaddle Technique as a Non-Pharmacological Strategy to Conduct Brain Magnetic Resonance Imaging in Very Low Birth Weight Infants

Purpose: Magnetic resonance imaging (MRI) is a useful tool for evaluating brain injury and maturation in preterm infants and often requires sedation to acquire images of sufficient quality. Infant sedation is often associated with adverse events, despite extreme precautions. In this study, the swaddling technique was investigated as an alternative non-pharmacological strategy to obtain brain MRIs of sufficient quality.Methods: We applied the feed and swaddle technique during routine brain MRI as a quality improvement project and compared its morbidity with that of sedation in a historic age-matched group. Seventy-nine very low birth weight infants in the neonatal intensive care unit of Ajou University Hospital (Suwon, Korea) were enrolled. Thirty-two (40.5%) infants were in the feed and swaddling group, and 47 (59.5%) were in the sedation group.Results: The morbidity associated with the cardiopulmonary system (swaddling group vs. sedation group: 53.13% [n=17] vs. 63.83% [n=30], P=0.723) and central nervous system (40.63% [n=13] vs. 29.79% [n=14], P=0.217) were not significantly different between groups. The MRI failure rate was not significantly different (swaddling group vs. sedation group: 12.5% [n=4] vs. 4.3% [n=2], P=0.174). The MRI scanning time was longer in the swaddling group than in the sedation group (76.5±20.3 minutes vs. 61.5±13.6 minutes, P=0.001). Cardiopulmonary adverse events were significantly less common in the swaddling group than in the sedation group (3.13% [n=1] vs. 34.04% [n=16], P=0.002).Conclusion: The success rate of MRI was comparable between the swaddling technique and sedation. Furthermore, despite the drawback of prolonged scan time, cardiopulmonary adverse events are fewer with swaddling than with sedative agents. Therefore, swaddling can be an alternative to sedation or anesthesia when performing neonatal MRI scans.

Clinical Features of Adult-Onset Neuronal Intranuclear Inclusion Disease: A Multi-Centre Study in China

Background: The full clinical spectrum of neuronal intranuclear inclusion disease (NIID) and its relationship with genotype have not been documented. We aimed to identify the clinical, neuroimaging, and genetic features of adult-onset NIID. Methods: An adult-onset NIID registry was launched in multiple centres throughout China. Clinical data, routine brain magnetic resonance imaging, and skin pathologies were evaluated. Arterial spin labelling magnetic resonance imaging and electrophysiological studies were conducted. Repeat-primed and amplicon length polymerase chain reaction were used to screen (GGC)n repeat expansions in the 5’ untranslated region of the NOTCH2NLC gene. Findings: In total, 134 adult-onset patients with NIID (66% female) from 72 clinical centres were included; 23 cases were familial. The mean age of onset was 56·9±9·4 years. The median disease duration was 4 (IQR 2–9) years. Adult-onset NIID was divided into three subtypes based on primary manifestations: dementia-dominant type (n=65), parkinsonism-dominant type (n=19), and episodic neurogenic event-dominant type (n=45). Among the patients, 90·5% presented with mild demyelinating polyneuropathy. All patients presented with high intensities along the corticomedullary junction on diffusion-weighted imaging, and 53·7% of them presented with abnormal hyperintensity in the paravermal area on T2/fluid-attenuated inversion recovery images. Cerebral blood flow in the whole brain was lower and that in globus pallidus was higher in patients with NIID than in healthy controls. (GGC) n repeat number in the 5’-untranslated region of the NOTCH2NLC gene ranged from 82 to 173 repeats. A significant inverse correlation between (GGC) n repeat number and age of onset was observed (r=–0·203, p=0·018). Interpretation: This study provides a novel classification of adult-onset NIID for clinical application. Decreased cerebral perfusion may underpin the pathogenesis of NIID and highlight the potential of perfusion modulation therapy. (GGC) n repeat number was inversely correlated with the age of onset, and the pathogenetic effect may have a cumulative effect. Funding: None Declaration of Interest: We declare no competing interests. Ethical Approval: This study was approved by the Medical Ethics Committee of Beijing Tiantan Hospital, Capital Medical University, and adhered to the principles of the Declaration of Helsinki. Written informed consent was obtained from all individuals or their authorised surrogates at enrolment.

Magnetic resonance tractography based on the constrained spherical deconvolution in patients with gliomas of the optic pathway

Background: The use of magnetic resonance (MR) tractography in neurosurgery is becoming an increasingly common practice for noninvasive imaging of white matter pathways. The most common method of tract reconstruction is the deterministic algorithm of diffusion tensor magnetic resonance imaging (MRI). However, this method of reconstructing pathways has a number of significant limitations. The most important of them are the lack of the possibility of visualizing the intersecting fibers, the complexity of building tracts in the area of perifocal edema and in the immediate vicinity of the tumor borders. The method of MR tractography, based on obtaining a diffusion image with a high angular resolution (High Angular Resolution Diffusion Imaging, HARDI), using the constrained spherical deconvolution (CSD) algorithm for post-processing of data, makes it possible to avoid these disadvantages. Relatively recently, a new algorithm, Single-Shell 3-Tissue CSD (SS3TCSD), has been proposed for processing HARDI data, which has the potential to improve the reconstructing of pathways in the area of perifocal edema or edema-infiltration.Aim: To evaluate the potential of the new SS3TCSD algorithm compared to ST-CSD (Single-Tissue CSD) in the imaging of the optic radiation and visual tracts in patients with gliomas.Materials and methods: Diffusion and routine brain MRI was performed in 10 patients with newly diagnosed cerebral gliomas, followed by reconstruction of the optic radiation and visual tracts. We compared new algorithms for postprocessing MR tractography (ST-CSD and SS3TCSD) in imaging of the optic tract and visual radiation in patients with brain gliomas affecting various parts of the visual system.Results: The SS3T-CSD method showed a lower mean percentage of false positive tracts compared to the ST-CSD method: 19.75% for the SS3T-CSD method and 80.32% for the ST-CSD method in cases of proximity of the tumor to the tracts, 5.27% for the SS3T-CSD method and 25.27% for the STCSD method in cases of reconstructing tracts in healthy white matter.Conclusion: The SS3T-CSD method has a number of advantages over ST-CSD and allows for successful imaging of the optic pathways that have a complex structure and repeatedly change direction along their course.

Cerebral blood flow and acute episodes of Leigh syndrome in neurometabolic disorders.

To investigate cerebral blood flow (CBF) in acute episodes of Leigh syndrome compared with basal state in patients carrying pathogenic mitochondrial disease gene variants responsible for neurometabolic disorders. Arterial spin labelling (ASL) magnetic resonance imaging (MRI) sequences were used to measure CBF in 27 patients with mitochondrial respiratory chain enzyme deficiencies, ascribed to pathogenic variants of reported disease genes who were undergoing either urgent neuroimaging for acute episodes of Leigh syndrome (Group I: 15 MRI, seven females, eight males; mean age 7y; range 7mo-14y) or routine brain MRI (Group II: 15 MRI, eight females, seven males; mean age 5y 2mo; range 2mo-12y). Patients displayed markedly increased CBF in the striatum (2.8-fold greater, p<0.001 [1.05-2.53]) during acute episodes of Leigh syndrome compared to basal conditions. Detection of elevated CBF preceded identification of structural MRI lesions in four out of 15 cases. Our results suggest that increased CBF is an overt hallmark of Leigh syndrome episodes and ASL MRI sequences should facilitate early diagnosis of acute episodes of Leigh syndrome, especially during the first attack in young children, when structural MRI is insufficiently informative.

Brain Age Prediction of Children Using Routine Brain MR Images via Deep Learning.

Predicting brain age of children accurately and quantitatively can give help in brain development analysis and brain disease diagnosis. Traditional methods to estimate brain age based on 3D magnetic resonance (MR), T1 weighted imaging (T1WI), and diffusion tensor imaging (DTI) need complex preprocessing and extra scanning time, decreasing clinical practice, especially in children. This research aims at proposing an end-to-end AI system based on deep learning to predict the brain age based on routine brain MR imaging. We spent over 5 years enrolling 220 stacked 2D routine clinical brain MR T1-weighted images of healthy children aged 0 to 5 years old and randomly divided those images into training data including 176 subjects and test data including 44 subjects. Data augmentation technology, which includes scaling, image rotation, translation, and gamma correction, was employed to extend the training data. A 10-layer 3D convolutional neural network (CNN) was designed for predicting the brain age of children and it achieved reliable and accurate results on test data with a mean absolute deviation (MAE) of 67.6 days, a root mean squared error (RMSE) of 96.1 days, a mean relative error (MRE) of 8.2%, a correlation coefficient (R) of 0.985, and a coefficient of determination (R2) of 0.971. Specially, the performance on predicting the age of children under 2 years old with a MAE of 28.9 days, a RMSE of 37.0 days, a MRE of 7.8%, a R of 0.983, and a R2 of 0.967 is much better than that over 2 with a MAE of 110.0 days, a RMSE of 133.5 days, a MRE of 8.2%, a R of 0.883, and a R2 of 0.780.

Apparent Diffusion Coefficient Histogram Analysis:Differentiation of Genetic Subtypes of Diffuse Lower-grade Gliomas

Objective To explore the utility of apparent diffusion coefficient(ADC)histogram analysis for differentiating genetic subtypes of diffuse lower-grade gliomas. Methods A total of 55 patients with WHO grade Ⅱ/Ⅲ diffuse lower-grade gliomas who underwent preoperative routine brain magnetic resonance imaging and diffusion weighted imaging in our center were retrospectively evaluated.Among whom there were 14 patients with isocitrate dehydrogenase(IDH)wild-type gliomas(IDH wt group),19 patients with IDH-mutant 1p19q intact gliomas(IDH mut1p19q int group),and 22 patients with IDH-mutant 1p19q co-deleted gliomas(IDH mut1p19q del group).The whole-lesion ADC values derived from histogram analysis(including ADCmean,ADCminimum,ADC5%,ADC10%,ADC25%,ADC50%,ADC75%,ADC90%,ADC95%,ADCmaximum,mode,range,skewness,kurtosis,standard deviation,inhomogeneity,and entrophy)were measured for each patient.All parameters between the different genetic subtypes were compared by using the Student's t test or Mann-Whitney U test.Receiver operating curve(ROC)analysis was used to assess the diagnostic performance of ADC histogram in distinguishing the different genetic subtypes. Results Compared with IDH wt group,the ADC75%(P=0.021),ADC90%(P=0.015),ADC95%(P=0.014),ADCmaximum (P=0.035),range(P=0.009),standard deviation(P=0.001)and inhomogeneity(P=0.001)were significantly lower in IDH mut group;in contrast,the ADCminimum (P=0.031)and kurtosis(P=0.020)of IDH mut group were significantly higher than those in IDH wt group.The ADCmean(P=0.010),ADC5%(P=0.016),ADC10%(P=0.012),ADC25%(P=0.007),ADC50%(P=0.005),ADC75%(P=0.015),and mode(P=0.002)were significantly higher in IDH mut1p19q int group than in IDH mut1p19q del group.Inhomogeneity achieved the highest area under ROC(AUC)(0.811)in differentiating IDH mut gliomas and IDH wt gliomas,with a cutoff value of 0.229;the sensitivity and specificity were 85.7% and 73.2%.The mode achieved the highest AUC(0.744)in differentiating IDH mut1p19q int gliomas and IDH mut1p19q del gliomas,with a cutoff value was 1448.75×10 -6 mm 2/s;the sensitivity and specificity were 57.9% and 90.9%.Conclusion ADC histograms analysis may be helpful to differentiate genetic subtypes in lower-grade gliomas.

An unusual cause of superficial siderosis of central nervous system: A case report of a vestibular schwannoma

Vestibular schwannomas are relatively common benign tumors that account for 7-8% of all intracranial tumors. There is a limited number of cases of subarachnoid hemorrhage associated with vestibular schwannoma in the literature. The incidence of symptomatic tumor bleeding is historically reported less than 1%. Susceptibility-weighted imaging (SWI) is a relatively new Magnetic Resonance Imaging (MRI) sequence that is highly sensitive to compounds which distort the local magnetic field such as blood products and hemorrhage. We herein report the rare MRI findings of a 53-year-old man with unilateral vestibular schwannoma and hearing loss who was followed for 4 years. Initial diagnosis of the vestibular schwannoma was made on prior conventional MRI. We included SWI sequence in routine brain MRI protocol. During follow-up, SWI demonstrated focal superficial siderosis due to recurrent subarachnoid hemorrhage seen as hypointense blooming artifacts on the middle cerebellar peduncle-pons junction adjacent to the mass. We think that including SWI in routine MRI protocol will contribute to the initial diagnosis of acoustic schwannoma and detection of its complications such as subarachnoid hemorrhage and subsequent superficial siderosis.

Pathological and Incidental Findings in 403 Taiwanese Girls With Central Precocious Puberty at Initial Diagnosis.

Background: Whether girls with central precocious puberty (CPP) should undergo routine brain magnetic resonance imaging (MRI) to identify potential intracranial pathologies is controversial.Aims: To evaluate the brain MRI results of girls with CPP and identify the clinical and endocrine predictors of brain abnormalities.Methods: This retrospective study obtained data from pediatric endocrine clinics at Chang Gung Children's Hospital. From 1997 and 2017, 403 girls were consecutively diagnosed with CPP. After the exclusion of patients with a history of central nervous system (CNS) insults or associated neuropsychiatric symptom or signs, we studied the prevalence of brain abnormalities in 251 girls with CPP who received detailed MRI examinations of the hypothalamus and pituitary area. We also recorded the demographic data of the participants, including the onset of puberty; initial pubertal status; height; weight; uterus and ovary sizes; and basal luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol levels, and the response to GnRH stimulation test.Results: Among the 251 girls with CPP, we observed no brain alterations in 190 (75.70%), abnormalities in the hypothalamic-pituitary (H-P) area in 54 (21.51%), and abnormalities in the non-H-P area in 7 (2.79%). Among the 54 patients that had H-P lesions, we noted pathological findings related to CPP (hypothalamic hamartoma) in only one (0.4%) girl aged below 6 years old. We also identified incidental findings in the other girls with H-P lesions, including non-functioning pituitary microadenomas (12.35%), pituitary pars intermedia cysts (4.38%), Rathke's pouch cysts (1.99%), pituitary hypoplasia (1.59%), and pineal gland cysts (0.8%). The patients that had non-H-P lesions were found to have arachnoid cysts (1.59%), Chiari I malformation (0.4%), prepontine nodule (0.4%), and choroidal fissure cyst (0.4%). Of all the patients with brain lesions, 45 (73.77%) underwent regular MRI follow-up. While none of the H-P and non-H-P lesions showed progression, 19.67% of these regressed during the follow-up. None of the participants exhibited other hormonal abnormalities or underwent surgery.Conclusion: The prevalence of true pathological brain lesions related to CPP in girls without prior symptoms or signs of CNS lesions was low (0.4%). None of the girls with intracranial lesions required further intervention besides the GnRH agonist treatment. These data question the routine use of brain MRI in all girls with CPP, especially in those who are healthy without neurologic symptoms.

Sequelae of Premature Birth in Young Adults

Background and PurposeQualitative studies about the abnormalities appreciated on routine magnetic resonance imaging (MRI) sequences in prematurely born adults are lacking. This article aimed at filling this knowledge gap by (1) qualitatively describing routine imaging findings in prematurely born adults, (2) evaluating measures for routine image interpretation and (3) investigating the impact of perinatal variables related to premature birth.MethodsIn this study two board-certified radiologists assessed T1-weighted and FLAIR-weighted images of 100 prematurely born adults born very preterm (VP <32 weeks) and/or at very low birth weight (VLBW <1500 g) and 106 controls born at full term (FT) (mean age 26.8 ± 0.7 years). The number of white matter lesions (WML) was counted according to localization. Lateral ventricle volume (LVV) was evaluated subjectively and by measurements of Evans’ index (EI) and frontal-occipital-horn ratio (FOHR). Freesurfer-based volumetry served as reference standard. Miscellaneous incidental findings were noted as free text.ResultsThe LVV was increased in 24.7% of VP/VLBW individuals and significantly larger than in FT controls. This was best identified by measurement of FOHR (AUC = 0.928). Ventricular enlargement was predicted by low gestational age (odds ratio: 0.71, 95% CI 0.51–0.98) and presence of neonatal intracranial hemorrhage (odds ratio: 0.26, 95% CI 0.07–0.92). The numbers of deep and periventricular WML were increased while subcortical WMLs were not.ConclusionEnlargement of the LVV and deep and periventricular WMLs are typical sequelae of premature birth that can be appreciated on routine brain MRI. To increase sensitivity of abnormal LVV detection, measurement of FOHR seems feasible in clinical practice.

Altered cerebral perfusion in children with Langerhans cell histiocytosis after chemotherapy.

Children with Langerhans cell histiocytosis (LCH) may develop a wide array of neurological symptoms, but associated cerebral physiologic changes are poorly understood. We examined cerebral hemodynamic properties of pediatric LCH using arterial spin-labeling (ASL) perfusion magnetic resonance imaging (MRI). A retrospective study was performed in 23 children with biopsy-proven LCH. Analysis was performed on routine brain MRI obtained before or after therapy. Region of interest (ROI) methodology was used to determine ASL cerebral blood flow (CBF) (mL/100g/min) in the following bilateral regions: angular gyrus, anterior prefrontal cortex, orbitofrontal cortex, dorsal anterior cingulate cortex, and hippocampus. Quantile (median) regression was performed for each ROI location. CBF patterns were compared between pre- and posttreatment LCH patients as well as with age-matched healthy controls. Significantly reduced CBF was seen in posttreatment children with LCH compared to age-matched controls in angular gyrus (P=.046), anterior prefrontal cortex (P=.039), and dorsal anterior cingulate cortex (P=.023). Further analysis revealed dominant perfusion abnormalities in the right hemisphere. No significant perfusion differences were observed in the hippocampus or orbitofrontal cortex. Perfusion in specific cerebral regions may be consistently reduced in children with LCH, and may represent effects of underlying disease physiology and/or sequelae of chemotherapy. Studies that combine a formal cognitive assessment and hemodynamic data may further provide insight into perfusion deficits associated with the disease and the potential neurotoxic effects in children treated by chemotherapy.

Precocious puberty and Chiari I malformation with syrinx: a case report of an unusual presentation of Costello syndrome

BackgroundCostello syndrome (CS) is a rare RASopathy causing developmental delays, short stature and classically, delayed puberty. We present a patient with CS and central precocious puberty (CPP).Case presentationA female patient with CS presented at 6 years 10 months of age with breast development. CPP was biochemically confirmed at 7 years 1 month of age, no additional pituitary dysfunction was noted and puberty progressed at follow-up. Brain magnetic resonance imaging (MRI) revealed a Chiari I malformation with a syrinx, requiring surgical decompression. The patient was successfully treated with histrelin.ConclusionsAlthough recent publications do not recommend routine brain MRI in girls with isolated CPP over 6 years of age, in those with CS actionable MRI findings are more likely and imaging should be performed. It is unclear whether the cerebral malformation in the patient contributed to CPP or was an incidental syndromic finding.

The clinical utility of structural neuroimaging in first-episode psychosis: A systematic review

Australian and US guidelines recommend routine brain imaging, either computed tomography or magnetic resonance imaging, to exclude structural lesions in presentations for first-episode psychosis. The aim of this review was to examine the evidence for the appropriateness and clinical utility of this recommendation by assessing the frequency of abnormal radiological findings in computed tomography and magnetic resonance imaging scans among patients with first-episode psychosis. PubMed and Embase database were searched from inception to April 2018 using appropriate MeSH or Emtree terms. Studies were included in the review if they reported data on computed tomography or magnetic resonance imaging scan findings of individuals with first-episode psychosis. No restriction on the geographical location of the study or the age of participants was applied. We calculated the percentage of abnormal radiological findings in each study, separately by the two diagnostic methods. There were 16 suitable studies published between 1988 and 2017, reporting data on an overall 2312 patients with first-episode psychosis. Most were observational studies with a retrospective design and the majority examined patients with computed tomography. While structural abnormalities were a relatively common finding, these rarely required clinical intervention (range across studies: 0-60.7%; median: 3.5%) and were very rarely the cause of the psychotic symptoms (range: 0-3.3%; median: 0%). Only 2 of the 16 studies concluded that brain imaging should be routinely ordered in first-episode psychosis. There is insufficient evidence to suggest that brain imaging should be routinely ordered for patients presenting with first-episode psychosis without associated neurological or cognitive impairment. The appropriate screening procedure for structural brain lesions is conventional history-taking, mental status and neurological examination. If intracranial pathology is suspected clinically, a magnetic resonance imaging or computed tomography scan should be performed depending on the clinical signs, the acuity and the suspected pathology. National guidelines should reflect evidence-based data.

Magnetic Resonance Imaging of the Brain Using Compressed Sensing- Quality Assessment in Daily Clinical Routine.

To assess the effect of compressed sensing (CS) on image quality and acquisition speed in routine brain magnetic resonance imaging (MRI). During a2-month implementation period of CS, two senior neuroradiologists, one MRI physicist and one application specialist optimized the CS acceleration factor to reduce scan time and improve spatial resolution, while maintaining image quality. Afterwards, two neuroradiologists independently scored image quality on a5-point Likert scale in 3‑dimensional (3D) fluid attenuation inversion recovery (FLAIR), 3D double inversion recovery (DIR), 3D T2, 3D T1, 3D T1 + gadoteric acid, axial T2, axial FLAIR, axial T2*, and 3D arterial time-of-flight MR angiography (art. TOF) sequences acquired during 1 week before (CS-) and after (CS+) the implementation of CS. Time of acquisition was recorded for all sequences. A total of 51CS- and 48CS+ patients were included. The median scan time reduction was 29.3% (range 0.0-58.4%), median voxel size reduction was 10.5% (0.0-33.3%). The CS+ image quality was rated superior for 3D FLAIR (p < 0.001), 3D T2 (p = 0.001), and axial T2* sequences (p = 0.024). For all other sequences, no statistical difference in image quality was observed. Interreader agreement regarding image quality was good for all sequences (weighted Cohen's κ > 0.5). The use of CS saves considerable imaging time while allowing to increase spatial resolution in routine clinical brain MRI without loss in image quality.

The yield of structural magnetic resonance imaging in autism spectrum disorders.

The aim of our study was to assess the yield of routine brain magnetic resonance imaging (MRI) performed at our hospital as part of the diagnostic procedures focused on autism. Our retrospective study involved children who had attended a diagnostic examination focused on autism and underwent brain MRIs between 1998-2015. The International Classification of Diseases, 10th edition was used to make clinical diagnoses. In 489 children (404 boys, 85 girls; mean age 8.0±4.2 years), a diagnosis of a pervasive developmental disorder was confirmed. Forty-five children, where the autism diagnosis was ruled out (but other psychiatric diagnoses found), served as a control group (36 boys, 9 girls; mean age 7.0±2.4 years). We can assume that in such a control group, brain abnormalities might occur at a higher frequency than in truly healthy children which would have the effect of reducing the difference between the groups. MRI pathologies were more common in the autistic (45.4 %) compared to the control group (31.8%) but the difference was significant only at the trend level (P=0.085). Hypoplasia of the corpus callosum (CC) was significantly more common in the autistic vs. the control group (13.7 vs. 0%; P=0.009). In contrast, nonmyelinated areas of white matter were significantly more common in controls (31.8 vs.17.3%; P=0.018). Differences in other parameters were not significant. The occurrence of CC hypoplasia on routine MRI scans could represent a "red flag" for suspicion of autism.

The prevalence of brain abnormalities in boys with central precocious puberty may be overestimated.

Brain magnetic resonance imaging (MRI) is routinely performed to identify brain lesions in boys with central precocious puberty (CPP). We investigated the prevalence of CPP in Korean boys and the necessity for routine brain MRI examinations. This retrospective cross-sectional study was conducted from April 2003 to December 2016 at a Korean university hospital. Among 151 boys who were diagnosed with CPP, the data of 138 boys who underwent sellar MRI were evaluated. The mean age of the study subjects was 9.51 ± 0.56 years (<8 years [n = 4] and ≥8 years [n = 134]). We excluded patients who had been previously diagnosed with brain tumors and those who did not undergo a sellar MRI because of refusal or the decision of the pediatric endocrinologist. The main outcome measure was the prevalence of intracranial lesions among boys with CPP. Normal sellar MRI findings were observed in 128 of the 138 boys (93%). Mild brain abnormalities were found in 10 boys (7%), while none of the patients had pathological brain lesions. The prevalence (7%) of intracranial lesions among boys who were healthy, did not have neurological symptoms, and were diagnosed with CPP was different from that previously reported. None of the identified lesions necessitated treatment. Although this was a single country study, we found that the previously reported prevalence of brain lesions in boys with CPP is much higher than the prevalence observed in Korea. This study suggests the need to globally reevaluate the prevalence of pathological brain lesions among male pediatric patients with CPP.

Prevalence of Pathological Brain Lesions in Girls with Central Precocious Puberty: Possible Overestimation?

BackgroundBrain magnetic resonance imaging (MRI) is routinely performed to identify brain lesions in girls with central precocious puberty (CPP). We aimed to investigate the prevalence and type of brain lesions among Korean girls with CPP and evaluate the need for routine brain MRI examinations.MethodsThis retrospective cross-sectional study evaluated data on 3,528 girls diagnosed with CPP from April 2003 to December 2016, and identified 317 girls who underwent sellar MRI. Exclusion criteria were patients with a known brain tumor or who did not undergo brain MRI due to refusal or the decision of the pediatric endocrinologist.ResultsNormal sellar MRI findings were observed in 291 of the 317 girls (91.8%). Incidental findings were observed in 26 girls (8.2%). None of the patients had pathological brain lesions.ConclusionThe prevalence of intracranial lesions among girls who were generally healthy and without neurological symptoms but diagnosed with CPP was lower than that previously reported. Furthermore, none of the identified lesions required treatment. It may be prudent to reconsider the routine use of brain MRI to screen all patients with CPP, especially if they are healthy and neurologically asymptomatic, and are girls aged 6–8 years.

Brain magnetic resonance-imaging findings of anti-N-methyl-d-aspartate receptor encephalitis: a cohort follow-up study in Chinese patients

The aim of this report was to assess routine clinical brain magnetic resonance imaging (MRI) and its relation to clinical characteristics and disease prognosis. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients were consecutively recruited from West China Hospital between October 1, 2011 and April 1, 2016. Brain MRI findings of 106 patients were analysed, and outcomes were assessed at 4, 8, and 12months after discharge from the hospital using the modified Rankin scale (mRS). An MRI of the brain was normal in 52/106 (49.1%) patients and abnormal or atypical in 54/106 (50.9%) patients. The initial MRI was abnormal with T2 or fluid-attenuated inversion recovery (FLAIR) hyper-intensity signals in 20/106 (18.9%) patients. There were no statistically significant differences between the MRI findings and clinical presentations (seizure, hypoventilation, loss of consciousness, and tumour) (P>0.05). Patients with normal MRIs were younger than patients with abnormal MRIs (P<0.05). The mean mRS score at the 4-month follow-up was significantly higher in patients with abnormal MRIs than in patients with normal MRIs (P<0.05). Brain MRI abnormalities are typically mild or unrelated to clinical symptoms, which is a clinico-radiological paradox of this type of immune encephalitis. Abnormal MRIs did not affect prognosis evaluated by mRS.