Routine MRI Research Articles

Diagnostic value of three-dimensional cube fluid attenuated inversion recovery imaging and its axial MIP reconstruction in multiple sclerosis

BackgroundMagnetic resonance imaging is regarded as one of the most important markers for multiple sclerosis. It can detect lesions in order to establish dissemination in time and space, which would aid in the diagnosis. Two-dimensional FLAIR is a standard sequence in MS routine imaging because it suppresses cerebrospinal fluid signal, increasing contrast between lesions and CSF and improving white matter lesion detection. Newer 3D FLAIR sequences are expected to offer even more benefits, such as improved MS lesions detection and higher resolution due to thinner slice thickness. We aimed to compare the role of 3D Cube FLAIR imaging (versus standard 2D FLAIR) in the assessment of white matter lesions in MS patients, as well as to test the convenience of using maximum intensity projection (MIP) on 3D FLAIR images for faster and easier evaluation.ResultsThis study included 160 MS patients. A 1.5 T routine brain MRI scan was performed, which included a 2D FLAIR sequence, followed by a 3D-FLAIR sequence. All images were analyzed after 3D-FLAIR images were reformatted into axial MIP images. Lesions were counted in each sequence and classified into supra-tentorial (periventricular, deep white matter, and juxta-cortical), and infra-tentorial lesions, with the relative comparison of lesions numbers on 3D-FLAIR and MIP versus 2D-FLAIR expressed as a percentage increase or decrease. 3D FLAIR can significantly improve MS lesion detection in all areas of the brain when compared with 2D FLAIR results. At 2 mm reformatting, there is no difference in MS lesion detection between sagittal 3D FLAIR and axial MIP reconstruction, implying that the MIP algorithm can be used to simplify lesion detection by reducing the number of images while maintaining the same level of reliability.Conclusion3D FLAIR sequences should be added to conventional 2D FLAIR sequences in the MRI protocol when MS is suspected.

Can CHA2DS2-VASc and HAS-BLED Foresee the Presence of Cerebral Microbleeds, Lacunar and Non-Lacunar Infarcts in Elderly Patients With Atrial Fibrillation? Data From Strat-AF Study.

Anticoagulants reduce embolic risk in atrial fibrillation (AF), despite increasing hemorrhagic risk. In this context, validity of congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke, vascular disease, age 65–74 years and sex category (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS–BLED) scales, used to respectively evaluate thrombotic and hemorrhagic risks, is incomplete. In patients with AF, brain MRI has led to the increased detection of “asymptomatic” brain changes, particularly those related to small vessel disease, which also represent the pathologic substrate of intracranial hemorrhage, and silent brain infarcts, which are considered risk factors for ischemic stroke. Routine brain MRI in asymptomatic patients with AF is not yet recommended. Our aim was to test predictive ability of risk stratification scales on the presence of cerebral microbleeds, lacunar, and non-lacunar infarcts in 170 elderly patients with AF on oral anticoagulants. Ad hoc developed R algorithms were used to evaluate CHA2DS2-VASc and HAS–BLED sensitivity and specificity on the prediction of cerebrovascular lesions: (1) Maintaining original items' weights; (2) augmenting weights' range; (3) adding cognitive, motor, and depressive scores. Accuracy was poor for each outcome considering both scales either in phase 1 or phase 2. Accuracy was never improved by the addition of cognitive scores. The addition of motor and depressive scores to CHA2DS2-VASc improved accuracy for non-lacunar infarcts (sensitivity = 0.70, specificity = 0.85), and sensitivity for lacunar–infarcts (sensitivity = 0.74, specificity = 0.61). Our results are a very first step toward the attempt to identify those elderly patients with AF who would benefit most from brain MRI in risk stratification.

LGI1 antibody-associated encephalitis without evidence of inflammation in CSF and brain MRI.

This study aimed to explore the frequency and distinct characteristics of adult patients with LGI1 antibody-associated encephalitis in the absence of inflammatory abnormalities in both routine CSF analysis and brain MRI. We conducted a retrospective study of adult patients with antibodies targeting LGI1 and then screened patients with no evidence of inflammation in brain MRI and normal results in routine CSF analysis, including white blood cell count, protein concentration, IgG, and oligoclonal bands. Among 80 patients with LGI1 antibody-associated encephalitis in our center, 31 (38.8%) fulfilled the screening criteria. For these patients, the onset age was 57.0 ± 14.7years, and 19 (61.3%) were female. Viral prodrome occurred in 5 patients (16.1%). Faciobrachial dystonic seizures (FBDS) were the most predominant symptom (38.7%), followed by seizure onset (22.6%) and memory deficits (19.4%). The sensitivity of antibody detection in serum was higher than CSF (96.8% vs. 48.4%, p < 0.001). Most patients (30/31, 96.8%) benefited from the first-line immunotherapy, and 23 patients (74.2%) achieved complete recovery, yet 3 patients (9.7%) had clinical relapses in 2-year follow-up after discharge. The patients had a higher prevalence of females (61.9% vs. 26.7%, p = 0.003) and were more frequently associated with FBDS during the disease course (38.7% vs. 10.2%, p = 0.004). However, there was no difference in treatment outcomes and recurrence ratio between the two groups (p = 0.144 and p = 0.515). Moreover, we divided all 80 patients into four groups according to antibody titer levels in serum and CSF at the time of diagnosis, respectively. WBC and protein concentrations in CSF showed no difference among the four groups. The absence of evidence of inflammation in routine CSF analysis and brain MRI did not rule out anti-LGI1 associated encephalitis. FBDS and the subacute onset of cognitive dysfunction should push forward with autoantibody testing for patients even without inflammatory abnormalities. The routine inflammatory indicators in CSF seemed to be unrelated to antibody titer levels.

Contralateral Breast Screening with Preoperative MRI: Long-Term Outcomes for Newly Diagnosed Breast Cancer.

Background The diagnostic value of screening the contralateral breast with MRI in patients with newly diagnosed breast cancer is poorly understood. Purpose To assess the impact of MRI for screening the contralateral breast on long-term outcomes in patients with newly diagnosed breast cancer and to determine whether subgroups with unfavorable prognoses would benefit from MRI in terms of survival. Materials and Methods Data on consecutive patients with newly diagnosed breast cancer seen from January 2008 to December 2010 were reviewed retrospectively. Patients with neoadjuvant chemotherapy, previous breast cancer, distant metastasis, absence of contralateral mammography at diagnosis, and no planned surgical treatment were excluded. Groups that did and did not undergo preoperative MRI were compared. Survival analysis was performed using the Kaplan-Meier method for propensity score-matched groups to estimate cause-specific survival (CSS) and overall survival (OS). A marginal Cox proportional hazards model was used to evaluate association of MRI and clinicopathologic variables with OS. Results Of 1846 patients, 1199 fulfilled the inclusion criteria. Median follow-up time was 10 years (range, 0-14 years). The 2:1 matched sample comprised 705 patients (470 in the MRI group and 235 in the no-MRI group); median ages at surgery were 59 years (range, 31-87 years) and 64 years (range, 37-92 years), respectively. MRI depicted contralateral synchronous disease more frequently (27 of 470 patients [5.7%] vs five of 235 patients [2.1%]; P = .047) and was associated with a higher OS (hazard ratio [HR], 2.51; 95% CI: 1.25, 5.06; P = .01). No differences were observed between groups in metachronous disease rate (MRI group: 21 of 470 patients [4.5%]; no-MRI group: 10 of 235 patients [4.3%]; P > .99) or CSS (HR, 1.34; 95% CI: 0.56, 3.21; P = .51). MRI benefit was greater in patients with larger tumor sizes (>2 cm) (HR, 2.58; 95% CI: 1.11, 5.99; P = .03) and histologic grade III tumors (HR, 2.94; 95% CI: 1.18, 7.32; P = .02). Conclusion Routine MRI screening of the contralateral breast after first diagnosis of breast cancer improved overall survival; the most pronounced benefit was found in patients with larger primary tumor size and primary tumors of histologic grade III. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Taourel in this issue.

FV 24 Connectome-based lesion symptom mapping: Disconnection patterns underlying specific aspects of motor impairment after stroke

Introduction: An accurate prediction of motor impairment from lesion information after stroke remains challenging, highlighting the complexity of structure-function relationships. While corticospinal tract (CST) integrity has been shown to correlate with motor impairment after stroke1, far less is known about the functional relevance of cortico-cortical connections for distinct aspects of motor function. Therefore, we investigated whether it is possible to infer distinct aspects of individual motor impairment and identify crucial task-specific connections using connection-based lesion-symptom mapping (CLSM) in acute stroke patients. Methods: Individual disconnectomes were estimated for 114 ischemic stroke patients using lesion masks designed based on routine MRI data and a normative structural connectome 2 . Relative grip strength and four subtests of the Action Research Arm Test 3 were performed to assess movements with varying demands of multi-joint movements, strength and fine-grained control. Nested and cross-validated support vector regressions (SVR) estimated impairment across motor tasks based on CLSM data and CST damage. Results: For each motor task, CLSM-SVR significantly predicted individual motor impairment (p<0.05 permutation testing) with higher or similar accuracy compared to CST-SVR. CLSM and CST-integrity represented largely independent aspects of variance in motor impairment. Permutation testing identified disconnection patterns underlying SVR predictions (Fig. 1). Discussion: Disconnections between ipsilesional subcortical motor areas and bihemispheric cortical motor areas were indicative of impairment across all motor tasks. Movements relying on fine-grained motor control were impacted by ipsilesional motor-temporal, and -prefrontal disconnections. Multi-joint movements involving proximal musculature relied on diverse interhemispheric (pre-)motor-prefrontal and -temporal connections, which may reflect several compensatory ways of motor execution. In summary, lesion-induced cortico-cortical disconnections were associated with distinct aspects of individual motor impairment, highlighting the potential of CLSM to further our understanding of crucial white matter structures in the human motor network.

3D CAIPIRINHA SPACE versus standard 2D TSE for routine knee MRI: a large-scale interchangeability study.

To perform a large-scale interchangeability study comparing 3D controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) sampling perfection with application optimized contrast using different flip angle evolutions (SPACE) TSE with standard 2D TSE for knee MRI. In this prospective study, 250 patients underwent 3 T knee MRI, including a multicontrast 3D CAIPIRINHA SPACE TSE (9:26 min) and a standard 2D TSE protocol (12:14 min). Thirty-three (13%) patients had previous anterior cruciate ligament and/or meniscus surgery. Two radiologists assessed MRIs for image quality and identified pathologies of menisci, ligaments, and cartilage by using a 4-point Likert scale according to the level of diagnostic confidence. Interchangeability of the protocols was tested under the same-reader scenario using a bootstrap percentile confidence interval. Interreader reliability and intermethod concordance were also evaluated. Despite higher image quality and diagnostic confidence for standard 2D TSE compared to 3D CAIPIRINHA SPACE TSE, the protocols were found interchangeable for diagnosing knee abnormalities, except for patellar (6.8% difference; 95% CI: 4.0, 9.6) and trochlear (3.6% difference; 95% CI: 0.8, 6.6) cartilage defects. The interreader reliability was substantial to almost perfect for 2D and 3D MRI (range κ, 0.785-1 and κ, 0.725-0.964, respectively). Intermethod concordance was almost perfect for all diagnoses (range κ, 0.817-0.986). Multicontrast 3D CAIPIRINHA SPACE TSE and standard 2D TSE protocols perform interchangeably for diagnosing knee abnormalities, except for patellofemoral cartilage defects. Despite the radiologist's preference for 2D TSE imaging, a pursuit towards time-saving 3D TSE knee MRI is justified for routine practice. • Multicontrast 3D CAIPIRINHA SPACE and standard 2D TSE protocols perform interchangeably for diagnosing knee abnormalities, except for patellofemoral cartilage defects. • Radiologists are more confident in diagnosing knee abnormalities on 2D TSE than on 3D CAIPIRINHA SPACE TSE MRI. • Despite the radiologist's preference for 2D TSE, a pursuit towards accelerated 3D TSE knee MRI is justified for routine practice.

Combined quantitative T2 mapping and [18F]FDG PET could improve lateralization of mesial temporal lobe epilepsy

ObjectivesTo investigate whether quantitative T2 mapping is complementary to [18F]FDG PET in epileptogenic zone detection, thus improving the lateralization accuracy for drug-resistant mesial temporal lobe epilepsy (MTLE) using hybrid PET/MR.MethodsWe acquired routine structural MRI, T2-weighted FLAIR, whole brain T2 mapping, and [18F]FDG PET in 46 MTLE patients and healthy controls on a hybrid PET/MR scanner, followed with computing voxel-based z-score maps of patients in reference to healthy controls. Asymmetry indexes of the hippocampus were calculated for each imaging modality, which then enter logistic regression models as univariate or multivariate for lateralization. Stereoelectroencephalography (SEEG) recordings and clinical decisions were collected as gold standard.ResultsRoutine structural MRI and T2w-FLAIR lateralized 47.8% (22/46) of MTLE patients, and FDG PET lateralized 84.8% (39/46). T2 mapping combined with [18F]FDG PET improved the lateralization accuracy by correctly lateralizing 95.6% (44/46) of MTLE patients. The asymmetry indexes of hippocampal T2 relaxometry and PET exhibit complementary tendency in detecting individual laterality, especially for MR-negative patients. In the quantitative analysis of z-score maps, the ipsilateral hippocampus had significantly lower SUVR (LTLE, p < 0.001; RTLE, p < 0.001) and higher T2 value (LTLE, p < 0.001; RTLE, p = 0.001) compared to the contralateral hippocampus. In logistic regression models, PET/T2 combination resulted in the highest AUC of 0.943 in predicting lateralization for MR-negative patients, followed by PET (AUC = 0.857) and T2 (AUC = 0.843).ConclusionsThe combination of quantitative T2 mapping and [18F]FDG PET could improve lateralization for temporal lobe epilepsy.Key Points• Quantitative T2 mapping and18F-FDG PET are complementary in the characterization of hippocampal alterations of MR-negative temporal lobe epilepsy patients.• The combination of quantitative T2 and18F-FDG PET obtained from hybrid PET/MR could improve lateralization for temporal lobe epilepsy.

Early neonatal heart rate variability patterns in different subtypes of perinatal hypoxic-ischemic brain injury.

This study aims to compare the longitudinal changes in heartrate variability (HRV) during therapeutic hypothermia in neonates with different subtypes of hypoxic-ischemic brain injury. HRV was computed from 1 hour time-epochs q6 hours for the first 48 hours. Primary outcome was brain-injury pattern on MRI at 4(3-5) days. We fitted linear mixed-effect regression models with HRV metric, brain injury subtype and postnatal age. Among 89 term neonates, 40 neonates had abnormal brain MRI (focal infarct 15 (38%), basal-ganglia predominant 8 (20%), watershed-predominant 5 (13%), and mixed pattern 12 (30%)). There was no significant difference in the HRV metrics between neonates with normal MRI, focal infarcts and basal ganglia pattern. At any given postnatal age, the degree of HRV suppression(HRV measure in the brain-injury subtype group/HRV measure in Normal MRI group) was significant in neonates with watershed pattern (SDNN(0.63, p = 0.08), RMSSD(0.74, p = 0.04)) and mixed pattern injury (SDNN (0.64, p < 0.001), RMSSD (0.75, p = 0.02)). HRV suppression was most profound at the postnatal age of 24-30 h in all brain injury subtypes. Neonates with underlying watershed injury with or without basal-ganglia injury demonstrates significant HRV suppression during first 48 hour of hypothermia therapy. Our study suggests that suppression of heartrate variability in neonates during therapeutic hypothermia varies according to the pattern of underlying hypoxic-ischemic brain injury. Neonates with watershed predominant pattern and mixed pattern of brain injury have the most severe suppression of heartrate variability measures. Heartrate variability monitoring may provide early insights into the pattern of hypoxic-ischemic brain injury in neonates undergoing therapeutic hypothermia earlier than routine clinical MRI.

Efficient Radiomics-Based Classification of Multi-Parametric MR Images to Identify Volumetric Habitats and Signatures in Glioblastoma: A Machine Learning Approach.

Simple SummaryGlioblastomas carry a poor prognosis and usually presents with heterogeneous regions in the brain tumor. Multi-parametric MR images can show morphological characteristics. Radiomics features refer to the extraction of a large number of quantitative measurements that describe the geometry, intensity, and texture which were extracted from contrast-enhanced T1-weighted images from anatomical MRI and metabolic features from PET. It also provides a qualitative image interpretation as well as cellular, molecular, and tumor properties. Thus, it derives additional information about the entire tumor volume which is generally of irregular shape and size from routinely evaluated “non-invasive” imaging biomarkers techniques. We demonstrated volumetric habitats and signatures in necrosis, solid tumor, peritumoral tissue, and edema with key biological processes and phenotype features. This provides physicians with key information on how the disease is progressing in the brain and can also give an indication of how well treatment is working.Glioblastoma (GBM) is a fast-growing and aggressive brain tumor of the central nervous system. It encroaches on brain tissue with heterogeneous regions of a necrotic core, solid part, peritumoral tissue, and edema. This study provided qualitative image interpretation in GBM subregions and radiomics features in quantitative usage of image analysis, as well as ratios of these tumor components. The aim of this study was to assess the potential of multi-parametric MR fingerprinting with volumetric tumor phenotype and radiomic features to underlie biological process and prognostic status of patients with cerebral gliomas. Based on efficiently classified and retrieved cerebral multi-parametric MRI, all data were analyzed to derive volume-based data of the entire tumor from local cohorts and The Cancer Imaging Archive (TCIA) cohorts with GBM. Edema was mainly enriched for homeostasis whereas necrosis was associated with texture features. The proportional volume size of the edema was about 1.5 times larger than the size of the solid part tumor. The volume size of the solid part was approximately 0.7 times in the necrosis area. Therefore, the multi-parametric MRI-based radiomics model reveals efficiently classified tumor subregions of GBM and suggests that prognostic radiomic features from routine MRI examination may also be significantly associated with key biological processes as a practical imaging biomarker.

Analysis of the characteristics of MRI T2 value changes of the muscles around the knee joint before and after the race in amateur marathon runners based on T2 mapping

Objective: To evaluate the characteristics of MRI T2 value changes of muscles around the knee joint in amateur marathon athletes based on T2 mapping. Methods: A total of 12 amateur marathon runners (5 males and 7 females) were recruited as the marathon group, aged from 21 to 37(27.5±5.4) years. MRI examination of bilateral knee joint was performed one week before the race, within 12 hours after the race and two months after the race, respectively. Fifteen healthy volunteers (5 males and 10 females) were recruited as the control group, aged from 24 to 27(24.9±1.0) years, and underwent MRI examination of both knee joints. The T2 mapping imaging sequence was used to measure the T2 values of the sartorius, vastus medialis, biceps femoris, semimembranosus, medial head of gastrocnemius and lateral gastrocnemius head on the post-processing platform, and analyzed the marathon group before and after the race. The differences in the T2 value of each muscle of the marathon group before and after the race within 12 hours, before and 2 months after the race, and between the control group and the marathon group before the marathon were analyzed. Results: All subjects had not knee joint pain during the examination. Routine MRI examination showed that there was no obvious abnormality in the shape and signal of the muscles around the knee joint. The T2 value of the semimembranosus [(34.3±2.8) ms vs (35.5±2.5) ms, P=0.008], medial head of gastrocnemius [(34.1±3.4) ms vs (37.7±3.1) ms,P<0.001] and lateral head of gastrocnemius [(35.2±2.9) ms vs (37.2±3.9) ms,P=0.011] increased after the competition compared with that of pre-competition in the marathon group, while the T2 value of the remaining muscles showed no significant difference compared with that of pre-competition(P>0.05). At the follow-up of 2 months, the T2 value of semimembranosus remains higher than before the marathon [(34.3±2.8) ms vs (35.4±2.5) ms,P=0.043], and the T2 value of the medial head of the gastrocnemius and lateral head of gastrocnemius showed no statistically difference compared with pre-competition (P>0.05). Compared with the control group, the T2 value of the lateral head of the gastrocnemius in the marathon group was decreased [(35.3±3.0) ms vs (38.5±4.1) ms,P=0.007]. There was no significant difference in the T2 value of the remaining muscles in the marathon group (P>0.05). Conclusions: After the marathon, the changes in the T2 value of the muscles around the knee joint is reversible. T2 mapping imaging sequence can indirectly reflect the changes of skeletal muscle microstructure to a certain extent.

Classification of Gliomas and Germinomas of the Basal Ganglia by Transfer Learning.

BackgroundGerm cell tumors (GCTs) are neoplasms derived from reproductive cells, mostly occurring in children and adolescents at 10 to 19 years of age. Intracranial GCTs are classified histologically into germinomas and non-germinomatous germ cell tumors. Germinomas of the basal ganglia are difficult to distinguish based on symptoms or routine MRI images from gliomas, even for experienced neurosurgeons or radiologists. Meanwhile, intracranial germinoma has a lower incidence rate than glioma in children and adults. Therefore, we established a model based on pre-trained ResNet18 with transfer learning to better identify germinomas of the basal ganglia.MethodsThis retrospective study enrolled 73 patients diagnosed with germinoma or glioma of the basal ganglia. Brain lesions were manually segmented based on both T1C and T2 FLAIR sequences. The T1C sequence was used to build the tumor classification model. A 2D convolutional architecture and transfer learning were implemented. ResNet18 from ImageNet was retrained on the MRI images of our cohort. Class activation mapping was applied for the model visualization.ResultsThe model was trained using five-fold cross-validation, achieving a mean AUC of 0.88. By analyzing the class activation map, we found that the model’s attention was focused on the peri-tumoral edema region of gliomas and tumor bulk for germinomas, indicating that differences in these regions may help discriminate these tumors.ConclusionsThis study showed that the T1C-based transfer learning model could accurately distinguish germinomas from gliomas of the basal ganglia preoperatively.

A 78Seconds Complete Brain MRI Examination in Ischemic Stroke: A Prospective Cohort Study.

BackgroundFast 78‐second multicontrast echo‐planar MRI (EPIMix) has shown good diagnostic performance for detecting infarctions at a comprehensive stroke center, but its diagnostic performance has not been evaluated in a prospective study at a primary stroke center.PurposeTo prospectively determine whether EPIMix was noninferior in detecting ischemic lesions compared to routine clinical MRI.Study typeProspective cohort study.PopulationA total of 118 patients with acute MRI and symptoms of ischemic stroke.Field Strength and SequenceA 3 T. EPIMix (echo‐planar based: T1‐FLAIR, T2‐weighted, T2‐FLAIR, T2*, DWI) and routine clinical MRI sequences (T1‐weighted fast spin echo, T2‐weighted PROPELLER, T2‐weighted‐FLAIR fast spin echo, T2* gradient echo echo‐planar, and DWI spin echo echo‐planar).AssessmentThree radiologists, blinded for clinical information, assessed signs of ischemic lesions (DWI↑, ADC↓, and T2/T2‐FLAIR↑) on EPIMix and routine clinical MRI, with disagreements solved in consensus with a fourth reader to establish the reference standard.Statistical testsDiagnostic performance including sensitivity and specificity against the reference standard was evaluated. EPIMix sensitivity was tested for noninferiority compared to the reference standard using Nam's restricted maximum likelihood estimation (RMLE) Score. A P‐value < 0.05 was considered statistically significant.ResultsOf 118 patients (mean age 62 ± 16 years, 58% males), 25% (n = 30) had MRI signs of acute infarcts. EPIMix was noninferior with 97% (95% CI 83–100) sensitivity for reader 1, 100% (95% CI 88–100) sensitivity for reader 2, and 90% (95% CI 88–98) sensitivity for reader 3 vs. 93% (95% CI 78–99) sensitivity for readers 1 and 2 and 90% (95% CI 74–98) for reader 3 on routine clinical MRI. Specificity was 99% (95% CI 94–100) for reader 1, 100% (95% CI 96–100) for reader 2, and 98% (95% CI 92–100) for reader 3 on EPIMix vs. 100% (95% CI 96–100) for all readers on routine clinical MRI.ConclusionEPIMix was noninferior to routine clinical MRI for the diagnosis of acute ischemic stroke.Evidence Level2Technical EfficacyStage 2

Abstract P3-01-09: Mri in the pre-operative workup of breast cancer patients

Abstract PurposeThe utility of pre-operative MRI (preop MRI) for patients with a new breast cancer diagnosis is controversial. Recently there has been increased use of routine MRI during preoperative workup to evaluate for areas necessitating additional biopsy and planning of operative resection extent; however, these practices carry the risk of delaying treatment, and subjecting patients to unnecessary biopsies and overly extensive resections. Triple negative breast cancer (TNBC) is more difficult to detect on mammography compared to non-TNBC, and patients with TNBC do not receive the chemoprevention benefits of adjuvant endocrine therapy; preop breast MRI to detect mammographically occult foci of disease may therefore be more relevant for patients with TNBC. MethodsOutcomes were evaluated for TNBC patients treated in the prospectively-maintained database of an academic cancer program in a metropolitan city of the Northeast, 1998-2018. ResultsOf 428 TNBC cases, 35.7% (153) had pre-op MRI. 43.6% (61) of 140 TNBC cases ≤50 years old had pre-op MRI compared to 31.9% of 288 TNBC cases &amp;gt;50 years old (p=0.016). There were no differences in race, or stage at presentation between those who had pre-op MRI and those who did not. 34% (52) of pre-op MRI TNBC cases underwent additional biopsies versus 0.43% (1) of TNBC patients who did not have pre-op MRI (p&amp;lt;0.0001). Average time to treatment was 29.5 days for pre-op MRI TNBC cases compared to 25 days for TNBC patients who did not have pre-op MRI (p=0.0026). 9.8% (15) of pre-op MRI TNBC cases underwent re-excisions versus 17.7% (41) of TNBC patients who did not have pre-op MRI (p=0.076). Of those who had mastectomies, patients who had pre-op MRI were more likely to have bilateral mastectomies (21.6% (33) pre-op MRI TNBC v 12.9% (30) of TNBC patients who did not have pre-op MRI (p=0.0471)). Five-year overall survival was no different between patients who had pre-op MRI and those who did not (95.2% vs 95.3% respectively; p=0.79). Among patients undergoing breast conserving surgery, there were no significant differences in the rates of local recurrence between patients that had preop MRI compared to those that did not (13.1% vs 9.1% p=0.392). ConclusionOur data demonstrated that preop MRI in TNBC patients was associated with additional biopsies, more extensive breast surgery, and longer time to treatment. Preop MRI had no impact on survival or local recurrence among patients undergoing breast conserving surgery. Citation Format: Solange Bayard, Genevieve Fasano, Yalei Chen, Jennifer Marti, Rache Simmons, Alexander Swistel, Michelle Drotman, Melissa Davis, Lisa Newman. Mri in the pre-operative workup of breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-01-09.

Surgical outcomes of spinal osteochondroma in children: A multicentre observational study

BackgroundSpinal osteochondroma (or exostosis) is a rare benign tumour whose clinical manifestations are delayed due to their slow growth and location. Few studies have addressed the characteristics and the diagnostic and therapeutic peculiarities of spinal osteochondroma in children. The objective of this multicentre observational study was to assess the outcomes of a cohort of children after surgery for spinal osteochondroma. HypothesisSurgical excision of spinal osteochondroma in children is not followed by complications or recurrences. Material and MethodsWe included consecutive children who had surgery between 2010 and 2018 at any of eight participating centres to remove spinal osteochondromas. The cause, clinical manifestations, and location of the lesions were collected. The surgical outcomes were evaluated after at least 2 years’ follow-up. ResultsWe identified 22 patients who had surgery to remove 26 spinal osteochondromas at a mean age of 12.8±2.6 years. Among them, 7 had a solitary osteochondroma (SO group) and 15 had hereditary multiple osteochondromas (HMO group). At diagnosis, 72% of patients had clinical signs (spinal pain, n=4; one or more lumps, n=5; and neurological manifestations, n=3). In the HMO group, the diagnosis was made during routine MRI screening for tumours involving the spinal canal. Most osteochondromas involved the cervical spine (n=13), with no difference between the two groups (p=0.9). The lamina was the most common location but 54% of the tumours were growing within the canal (92% in the HMO group). After a mean follow-up of 5.2±4.4 years, no patients had experienced any recurrences or complications related to the disease or treatment. DiscussionSurgical excision of spinal osteochondromas in children is effective, with no medium-term recurrences. Our results also confirm the low peri-operative morbidity, even when the canal is involved, and the absence of any effect at last follow-up on spinal alignment. All patients with neurological manifestations at diagnosis made a full recovery. Level of evidenceIV, retrospective observational cohort study.

Cardiac MRI e-prime predicts myocardial late gadolinium enhancement and diastolic dysfunction in hypertrophic cardiomyopathy

BackgroundMyocardial fibrosis leads to diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM). ObjectivesTo evaluate a manual method of measuring mitral annular relaxation velocity (termed cardiac MRI e′) as a measure of diastolic dysfunction on routine cardiac MRI and its relationship with myocardial late-gadolinium enhancement (LGE) and feature tracking measures of diastolic dysfunction in patients with HCM. MethodsCMR e′, feature tracking measures of diastolic function, left atrial, left ventricular (LV) parameters and LGE were retrospectively measured in 75 patients with HCM (mean age, 54.7 years ± 15.3, 54 men). Multivariate regression and partial Spearman correlations were performed. ResultsCardiac MRI e′ measures correlated with LGE (r = 0.49, P < 0.001) and multiple feature tracking measures of diastolic function, adjusted for patient demographics, left atrial and left ventricular parameters. Cardiac MRI e′ measures were independently predictive of LGE ≥ 10% (mean total cardiac MRI e′: LGE < 10% vs LGE ≥ 10% was 3.5 cm/s vs. 1.7 cm/s, P < 0.001). Superior CMR e′ had an AUC of 0.79 [95%CI 0.66–0.92, P < 0.0001]) in predicting patients with LGE ≥ 10% and a cutoff of 1.7 cm/s resulted in a sensitivity and specificity of 81.0% and 78.0% respectively. ConclusionCardiac MRI e′ is a manual measure of LV diastolic dysfunction acquired on routine cardiac MRI without specialized software and is an independent predictor of LGE ≥ 10% and diastolic dysfunction in HCM.

UTILITY OF APPARENT DIFFUSION COEFFICIENTS WITH DIFFUSIONWEIGHTED MRI IN DIFFERENTIATING BENIGN AND MALIGNANT BONE LESIONS

OBJECTIVE:To evaluate the usefulness of diffusion-weightedMRIwith apparent diffusion co-efcients(ADC) cut-off value indifferentiatingbenignandmalignantbonelesions. MATERIALSAND METHODS: 58 patients with suspected bone tumours based on clinical examination and plain radiographs were included in the current study. They were subjected to routine MRI examination with inclusion of diffusion-weighted imaging, followed by histopathology for nal diagnosis.Allthe lesionswere assessed to see the presence of diffusion restriction if any. ADC values (mean, minimum and maximum) were obtained by two observers individually. Interobserver measurement and the ADC values in benign and malignant lesions were calculated. Receiver operating characteristic (ROC) analysis was done to determine optimal cut-off ADC values in distinguishing benign and malignant bone lesions. RESULTS: Of 58 lesions, there were 28 benign lesions and 30malignant lesions. Diffusion restriction was noted in 83.3% ofmalignant lesions whereas 57.1% of benign lesions did not show diffusion restriction. There were higher mean, minimum and maximum ADC values in benign lesions when compared with malignant lesions. With cut-off value of minimumADC as 0.92 x 10-3 mm2/sec to differentiate malignant and benign lesions, the sensitivity of 79% and specicity of 64% was obtained. CONCLUSIONS: DWIis useful in differentiating between benign and malignant lesions with diffusion restriction favoring malignancy. Higher mean, minimumandmaximumADCvalues are seen in benign lesions as compared tomalignant lesions. Even though, there isslight overlap inADCvalues of bothbenignandmalignantlesions,ADCvalueshelpintheirdifferentiation.

Standalone portable xenon-129 hyperpolariser for multicentre clinical magnetic resonance imaging of the lungs.

ObjectivesDesign and build a portable xenon-129 (129Xe) hyperpolariser for clinically accessible 129Xe lung MRI.MethodsThe polariser system consists of six main functional components: (i) a laser diode array and optics; (ii) a B0 coil assembly; (iii) an oven containing an optical cell; (iv) NMR and optical spectrometers; (v) a gas-handling manifold; and (vi) a cryostat within a permanent magnet. All components run without external utilities such as compressed air or three-phase electricity, and require just three mains sockets for operation. The system can be manually transported in a lightweight van and rapidly installed on a small estates footprint in a hospital setting.ResultsThe polariser routinely provides polarised 129Xe for routine clinical lung MRI. To test the concept of portability and rapid deployment, it was transported 200 km, installed at a hospital with no previous experience with the technology and 129Xe MR images of a diagnostic quality were acquired the day after system transport and installation.ConclusionThis portable 129Xe hyperpolariser system could form the basis of a cost-effective platform for wider clinical dissemination and multicentre evaluation of 129Xe lung MR imaging.Advances in knowledgeOur work successfully demonstrates the feasibility of multicentre clinical 129Xe MRI with a portable hyperpolariser system.

Analysis on the MRI and BAEP Results of Neonatal Brain With Different Levels of Bilirubin.

BackgroundTo explore whether there is abnormality of neonatal brains' MRI and BAEP with different bilirubin levels, and to provide an objective basis for early diagnosis on the bilirubin induced subclinical damage on brains.MethodsTo retrospectively analyze the clinical data of 103 neonatal patients, to conduct routine brain MRI examination and BAEP testing, and to analyze BAEP and MRI image results of the neonatal patients, who were divided into three groups based on the levels of total serum bilirubin concentration (TSB): 16 cases in mild group (TSB: 0.0–229.0 ěmol/L), 49 cases in moderate group (TSB: 229.0–342.0 ěmol/L), and 38 cases in severe group (TSB ≥ 342.0 ěmol/L).ResultsWe found the following: A. Comparison of the bilirubin value of the different group: The bilirubin value of the mild group is 171.99 ± 33.50 ěmol/L, the moderate group is 293.98 ± 32.09 ěmol/L, and the severe group is 375.59 ± 34.25 ěmol/L. The comparison of bilirubin values of the three groups of neonates (p < 0.01) indicates the difference is statistically significant (p < 0.01). B. The weight value of the <2,500 g group is 2.04 ± 0.21 and the ≥2,500 g group is 3.39 ± 0.46; the weight comparison of the two groups indicates that the difference is statistically significant (p < 0.01). C. Comparison of the abnormal MRI of the different groups: The brain MRI result's abnormal ratio of the mild group is 31.25%, the moderate group is 16.33%, and the severe group is 21.05%, but the comparison of brain MRI results of the three neonates groups indicates that the difference is not statistically significant (p > 0.05). D. Comparison of abnormal MRI signal values of globus pallidus on T1WI in different groups: 1. The comparison of normal group signal values with that of mild group (p < 0.05), with that of moderate group, and with that of severe group (p < 0.01) indicates that the difference is statistically significant.ConclusionAt low level of bilirubin, central nervous system damage may also occur and can be detected as abnormality by MRI and BAEP. Meanwhile, MRI and BAEP can also provide early abnormal information for the judgment of central nervous system damage of the children with NHB who have no acute bilirubin encephalopathy (ABE) clinical features, and provide clues for early treatment and early intervention.

Muscle weakness is associated with non-contractile muscle tissue of the vastus medialis muscle in knee osteoarthritis

BackgroundQuadriceps weakness is assumed to be associated with compositional properties of the vastus medialis muscle in patients with knee osteoarthritis (OA).MethodsThe aim was to determine the association of non-contractile muscle tissue in the vastus medialis muscle, measured with routine MRI, with muscle extensor strength in patients with knee OA. Sagittal T1-weighted 3T MRI of 94 patients with knee OA, routinely acquired in clinical practice were used for analysis. Using the MRI’s, the amount of non-contractile muscle tissue in the vastus medialis muscle was measured, expressed as a percentage of (non)-contractile tissue, dichotomized into a low and a high non-contractile percentage group. Muscle strength was assessed by isokinetic measurement of knee extensors and by conduction of the Get-Up and Go (GUG) test. In regression analyses, associations of percentage of non-contractile muscle tissue with muscle strength and GUG time were determined and controlled for sex, age, BMI and radiographic severity.ResultsA high percentage of non-contractile muscle tissue (> 11.2%) was associated with lower muscle strength (B = -0.25, P = 0.006) and with longer GUG time (B = 1.09, P = 0.021). These associations were specifically confounded by sex and BMI, because these two variables decreased the regression coefficient (B) with > 10%.ConclusionsA high percentage of non-contractile muscle tissue in the vastus medialis muscle measured by clinical T1-weighted 3T MRI is associated with muscle weakness. The association is confounded by sex and BMI. Non-contractile muscle tissue seems to be an important compositional property of the vastus medialis muscle underlying quadriceps weakness.

Longitudinal white matter hyperintensity changes and cognitive decline in patients with minor stroke

Background and objectiveAs reported, both minor stroke and white matter hyperintensities (WMHs) are associated with an increased risk of cognitive impairment and dementia. The underlying factors for dynamic changes in WMH volume and cognitive performances in patients with minor stroke remain poorly understood. A 2-year longitudinal study was designed to investigate the factors associated with the changes in white matter hyperintensity (WMH) volume on brain MRI and cognitive decline in patients with minor stroke.MethodsA group of eligible patients with minor ischemic stroke was recruited in a row. At the initial and 2-year follow-up visits, all the participants underwent routine examinations, multimodal MRI, and cognitive assessment. Using a lesion prediction algorithm tool, we were able to automate the measurement of the change in WMH volume. During the 2-year follow-up, cognitive function was evaluated using Telephone Interview for Cognitive Status-Modified (TICS-m). Participants’ demographic, clinical, and therapeutic data were collected and statistically analyzed. Regression analyses were used to test the relationships between risk factors and changes in WMH volume and cognitive decline.ResultsFinally, we followed up with 225/261 participants for 2 years, with a mean age of 65.67 ± 10.73 years (65.6% men). WMH volume was observed to be increased in 113 patients, decreased in 74 patients, and remained stable in 58 patients. Patients with WMH progression were more often had a history of hypertension (p = 0.006) and a higher CSVD burden both at baseline and follow-up visit (p < 0.05). Longitudinally, the proportion of patients taking antihypertension medications on a regular basis in the regression group was higher than in the stable group (p = 0.01). When compared to the stable group, the presence of lacunes (OR 9.931, 95% CI 1.597–61.77, p = 0.014) was a stronger predictor of progression in WMH volume. 87 subjects (38.6%) displayed incident cognitive impairment. The progression of WMH volume was a significant risk factor for cognitive decline (p < 0.001).ConclusionsThe longitudinal change of WMH is dynamic. The regressive WMH volume was associated with the use of antihypertensive medications on a regular basis. The presence of lacunes at the initial visit of the study was a stronger predictor of WMH progression. The progression of WMH volume could be useful in predicting cognitive decline in patients with minor stroke.