Short TI Inversion Recovery Images Research Articles

An MRI-Based Radiomics Nomogram for Differentiation of Benign and Malignant Vertebral Compression Fracture

This study aimed to develop and validate a magnetic resonance imaging (MRI)-based radiomics nomogram combining radiomics signatures and clinical factors to differentiate between benign and malignant vertebral compression fractures (VCFs). A total of 189 patients with benign VCFs (n=112) or malignant VCFs (n=77) were divided into training (n=133) and validation (n=56) cohorts. Radiomics features were extracted from MRI T1-weighted images and short-TI inversion recovery images to develop the radiomics signature, and the Rad score was constructed using least absolute shrinkage and selection operator regression. Demographic and MRI morphological characteristics were assessed to build a clinical factor model using multivariate logistic regression analysis. A radiomics nomogram was constructed based on the Rad score and independent clinical factors. Finally, the diagnostic performance of the radiomics nomogram, clinical model, and radiomics signature was validated using receiver operating characteristic and decision curve analysis (DCA). Six features were used to build a combined radiomics model (combined-RS). Pedicle or posterior element involvement, paraspinal mass, and fluid sign were identified as the most important morphological factors for building the clinical factor model. The radiomics signature was superior to the clinical model in terms of the area under the curve (AUC), accuracy, and specificity. The radiomics nomogram integrating the combined-RS, pedicle or posterior element involvement, paraspinal mass, and fluid sign achieved favorable predictive efficacy, generating AUCs of 0.92 and 0.90 in the training and validation cohorts, respectively. The DCA indicated good clinical usefulness of the radiomics nomogram. The MRI-based radiomics nomogram, combining the radiomics signature and clinical factors, showed favorable predictive efficacy for differentiating benign from malignant VCFs.

Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma

Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma

Automated Differentiation Between Osteoporotic Vertebral Fracture and Malignant Vertebral Fracture on MRI Using a Deep Convolutional Neural Network.

Retrospective study of magnetic resonance imaging (MRI). To assess the ability of a convolutional neural network (CNN) model to differentiate osteoporotic vertebral fractures (OVFs) and malignant vertebral compression fractures (MVFs) using short-TI inversion recovery (STIR) and T1-weighted images (T1WI) and to compare it to the performance of three spine surgeons. Differentiating between OVFs and MVFs is crucial for appropriate clinical staging and treatment planning. However, an accurate diagnosis is sometimes difficult. Recently, CNN modeling-an artificial intelligence technique-has gained popularity in the radiology field. We enrolled 50 patients with OVFs and 47 patients with MVFs who underwent thoracolumbar MRI. Sagittal STIR images and sagittal T1WI were used to train and validate the CNN models. To assess the performance of the CNN, the receiver operating characteristic curve was plotted and the area under the curve was calculated. We also compared the accuracy, sensitivity, and specificity of the diagnosis made by the CNN and three spine surgeons. The area under the curve of receiver operating characteristic curves of the CNN based on STIR images and T1WI were 0.967 and 0.984, respectively. The CNN model based on STIR images showed a performance of 93.8% accuracy, 92.5% sensitivity, and 94.9% specificity. On the other hand, the CNN model based on T1WI showed a performance of 96.4% accuracy, 98.1% sensitivity, and 94.9% specificity. The accuracy and specificity of the CNN using both STIR and T1WI were statistically equal to or better than that of three spine surgeons. There were no significant differences in sensitivity based on both STIR images and T1WI between the CNN and spine surgeons. We successfully differentiated OVFs and MVFs based on MRI with high accuracy using the CNN model, which was statistically equal or superior to that of the spine surgeons.Level of Evidence: 4.

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Traumatic brachial plexopathy in a patient with off‐state Parkinson disease

AbstractThe patient was a 67‐year‐old woman who had an advanced Parkinson disease. She developed flaccid monoplegia with areflexia in the right upper limb after a fall during off‐state. Neurophysiological examinations revealed a neurapraxia in the proximal segment of the peripheral nerves. MRI showed high signal intensity in the right supraclavicular area including the brachial plexus and peripheral tissue on short TI inversion recovery images, which supported the diagnosis of the crush injury. The diagnosis of the traumatic brachial plexopathy was made. By the combination of neurophysiological examination and MRI, more elaborate diagnosis of the traumatic nerve injuries can be made.

Magnetic Resonance Sialography and Salivary Gland Scintigraphy of Parotid Glands in Sjögren's Syndrome.

To assess the correlation between conventional magnetic resonance (MR) imaging and MR sialography of parotid glands with salivary gland scintigraphy in patients with Sjögren's syndrome. A retrospective study was conducted on eight patients with Sjögren's syndrome who underwent MR imaging and salivary gland scintigraphy. Conventional MR imaging techniques, such as T1-weighted images (T1WI), T2-weighted images (T2WI), and short TI inversion recovery images (STIR) were used for changes of fat signal in the parotid gland, while the MR sialography were used for ducts dilation of the parotid gland. Regarding scintigraphy, time-activity curves of each parotid gland were analysed. The salivary gland excretion fraction was defined as A (before stimulation test (counts/20 s)) and B (after stimulation test (counts/20 s)). Regarding characteristic appearances of fat signal, the A/B of parotid gland with homogeneous intensity distribution (3.51 ± 0.75) was higher than that with heterogeneous intensity distribution (1.56 ± 0.66, P = 0.001). Regarding MR sialographic stages, the A/B of parotid gland with stage 0 (3.51 ± 0.75) was higher than that with stage 1 (2.03 ± 0.86, P = 0.009) and with stage 2 (1.26 ± 0.25, P = 0.000). The results suggest that MR sialography of the parotid glands is a useful noninvasive tool for evaluating the decrease of salivary gland excretion in patients with Sjögren's syndrome.

Patterns of hippocampal atrophy differ among Alzheimer's disease, amnestic mild cognitive impairment, and late-life depression.

This study investigated whether the characteristic changes in hippocampal atrophy seen in coronal scans are useful for differentiating Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), and major depressive disorder (MDD). Subjects included 58 patients with AD, 33 with aMCI, 20 with MDD, and 22 normal controls, all aged 60 years or older. For each subject, eight coronal short TI inversion recovery images perpendicular to the hippocampal longitudinal axis were obtained. Images were manually measured using the conventional region of interest method of quantitative analysis. The overall trend in the corrected volumes of the hippocampus was AD < aMCI < MDD < normal controls. We found atrophy in all slices in AD, atrophy centred on the hippocampal head in aMCI, and atrophy in the slice of the hippocampal body 12 mm from the amygdala in MDD. The present study suggested that our method of comparing hippocampal atrophy by region may be useful in distinguishing AD, aMCI, MDD, and normal controls.

Diagnostic value of MRI for odontogenic tumours

To evaluate the diagnostic value of MRI for odontogenic tumours. 51 patients with odontogenic tumours were subjected to pre-operative MRI examinations. For tumours with liquid components, i.e. ameloblastomas and keratocystic odontogenic tumours (KCOTs), the signal intensity (SI) uniformity of their cystic components (UΣ) was calculated and then their UΣ values were compared. For tumours with solid components that had been examined using dynamic contrast-enhanced MRI (DCE-MRI), their CImax (maximum contrast index), Tmax (the time when CImax occurred), CIpeak (CImax × 0.90), Tpeak (the time when CIpeak occurred) and CI300 (i.e. the CI observed at 300 s after contrast medium injection) values were determined from CI curves. We then classified the odontogenic tumours according to their DCE-MRI parameters. Significant differences between the UΣ values of the ameloblastomas and KCOT were observed on T1 weighted images, T2 weighted images and short TI inversion recovery images. Depending on their DCE-MRI parameters, we classified the odontogenic tumours into the following five types: Type A, CIpeak > 2.0 and Tpeak < 200 s; Type B, CIpeak < 2.0 and Tpeak < 200 s; Type C, CI300 > 2.0 and Tmax < 600 s; Type D, CI300 > 2.0 and Tmax > 600 s; Type E, CI300 < 2.0 and Tmax > 600 s. Cystic component SI uniformity was found to be useful for differentiating between ameloblastomas and KCOT. However, the DCE-MRI parameters of odontogenic tumours, except for odontogenic fibromas and odontogenic myxomas, contributed little to their differential diagnosis.

018 The breast cancer, early disease: toxicity from therapy with epirubicin regimens ¨ c cardiac assessment and risk evaluation (better-care), cardiovascular magnetic resonance (CMR) sub-study: cycle 1 changes predict late anthracycline cardiotoxicity

IntroductionA growing number of patients are at risk from chronic anthracycline cardiotoxicity (cAC) as a result of improving prognosis of cancer. This is true even at low, adjuvant doses. In...

Dose T2-weighted short TI inversion recovery images on cardiac magnetic resonance reflect disease activity in cardiac involvement of sarcoidosis patients?

Background Cardiac involvement of sarcoidosis (CIS) in progressed and advanced stage increases cardiac events and mortality of systemic sarcoidosis, so early diagnosis and determination of disease activity are needed for treating in CIS. However, evaluating disease activity of CIS remains a major challenge because no single diagnostic test has yet been established with a high accuracy. High signal intensity of T2-weighted short TI inversion recovery images (T2-STIR) on cardiac magnetic resonance (CMR) might be useful technique for investigating myocardial edematous tissue caused by inflammation.We investigated the relationship between high signal intensity of T2-STIR and disease activity in patients with CIS. Methods 38 patients (male/female = 4/34, age 30-78 years) with CIS or suspect of CIS underwent T2-STIR on CMR. We defined CIS activity as follows; worsening cardiac symptoms, abnormal results of serum tests and other imaging findings. Results Eleven of 38 patients (28%) had high signal intensity of T2-STIR. In these patients with high intensity of T2STIR, 8 patients (73%) confirmed CIS activity, and 3 patients (27%) did not. In active CIS patients, 4 patients were treated with corticosteroid, then 3 patients improved cardiac symptoms or disappeared high signal intensity of T2-STIR. In the rest of all 4 patients without corticosteroid therapy showed worsening CIS. Conclusions High signal intensity of T2-STIR reflects disease activity in patient with CIS. Funding Nothing.

Magnetic resonance imaging (MRI) and dynamic MRI evaluation of extranodal non-Hodgkin lymphoma in oral and maxillofacial regions

The purpose of this study was to evaluate the diagnostic value of magnetic resonance imaging (MRI), especially dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), in extranodal non-Hodgkin lymphoma (NHL) of oral and maxillofacial regions. Thirteen cases with extranodal NHL were examined using MRI. T1-weighted images (T1WI) and T2-weighted images (T2WI) or short TI inversion recovery (STIR) images were obtained in all cases. Contrast-enhanced images and DCE-MRI were acquired in 10 and 7 cases, respectively. On DCE-MRIs, we analyzed the parameters as follows: contrast index at maximal contrast enhancement (CImax), maximum contrast index (CI) gain/CImax ratio, and washout ratios (WR(300), WR(600), and WR(900)) at 300, 600, and 900 seconds after contrast medium injection. The signal intensity of all lesions was hypointense to isointense on T1WIs and showed variable contrast enhancement patterns. On T2WIs and STIR images, the signal intensity was isointense to hyperintense in almost all cases. Analysis of DCE-MRI parameters in extranodal NHLs resulted in the identification of 4 types of CI curves according to CImax and WR: (1) CImax greater than 2.0 and WR(900) greater than 40%, (2) CImax greater than 2.0 and WR(900) less than 40%, (3) CImax less than 1.5 and WR(900) greater than 40%, and (4) CImax less than 1.5 and WR(900) greater than 40%. The signal intensities on MRI were not specific to extranodal NHL and resembled those of other tumor types. When CImax was less than 1.5 or WR900 was less than 40%, these parameters contributed to diagnosis in extranodal NHLs.

Bone bruise of the knee associated with the lesions of anterior cruciate ligament and menisci on magnetic resonance imaging

Bone bruise is a common finding in acutely injured knee examined by magnetic resonance (MR). The aim of the study was to determine the association of bone bruise frequency with postinjury lesions of anterior cruciate ligament (ACL) and menisci. Bone bruise involves posttraumatic bone marrow change with hemorrhages, edema and microtrabecular fractures without disruption of adjacent cortices or articular cartilage. MR imaging is a method of choice for detecting bone bruises which can not be seen on conventional radiographic techniques. A representative review of 120 MR examinations for the acute knee trauma was conducted. All the patients were examined within one month of trauma. All MR examinations were performed by using a 0.3T MR unit. Posttraumatic bone bruise was seen in 39 (32.5%) patients out of 120. Three patients had fracture of the cortex, so-called "occult" fracture (not seen on plain radiography). We analyzed only bone bruises without these fractures of the cortex. Bone bruise was associated with the lesion of ACL in 27 (69%) patients. In 28 (72%) patients bone bruise was in combination with the lesion of menisci. Only two patients with bone bruise had neither ACL nor menisci lesions. There were 78 patients without bone bruise but 33 (43%) of them had lesions of ACL and 49 (63%) had lesions of menisci. Bone bruise is best seen in STIR (Short TI Inversion Recovery) images and is very often found in acute knee trauma. Very often it is associated with posttraumatic lesions of ACL and menisci, so attention must be paid to this when bone bruise is seen. The difference in frequency of internal structures of the knee lesions in patients with bone bruise is highly statistically significant as compared to patients with no bone bruise.

Single‐shot steady‐state free precession can detect myocardial edema in patients: A feasibility study

To demonstrate the ability of single-shot, T(2)/T(1) weighted steady-state free precession (SSFP) to detect myocardial edema in patients with an acute myocardial infarction. This study was performed in a series of patients (n = 10) referred for the assessment of acute myocardial infarcts (AMI). Localizers were used to obtain true short axis views of the left ventricle (LV). These views were used to plan and obtain T(2)-weighted STIR (short TI inversion recovery) images of the LV. These slices were then acquired using single-shot dark blood-prepared SSFP with a large (31) number of dummy pulses. Lastly, Contrast agent was injected, and late enhancement (LE) images were acquired. Images were analyzed using a multi-segment model of the heart. SSFP images were compared with STIR images, with STIR images used as the standard of truth for the presence of edema. LE images were used to identify segments which were positive for microvascular obstruction. All techniques were successful in all patients. A total of 312 segments were analyzed. Excluding segments positive for microvascular obstruction, SSFP had a sensitivity/specificity of 80%/89%. Including segments positive for microvascular obstruction, sensitivity/specificity was 71%/88%. On a patient-based analysis, no AMI was missed using SSFP (sensitivity = 100%). Using single-shot SSFP to detect myocardial edema in patients with AMI is feasible with a moderate sensitivity and high specificity.

Magnetic resonance imaging of bone bruising in the acutely injured knee—short-term outcome

AIM: To investigate the short-term outcome and associated injuries of bone bruising in the acutely injured knee. METHOD AND MATERIALS: Thirty patients (age range 17–39 years, mean 28 years) with bone bruising identified on magnetic resonance imaging (MRI) after an acute knee injury were rescanned 12–14 weeks post-injury. The volume of bone bruising was measured on coronal STIR (short TI inversion recovery) images and correlation made with the presence and type of ligamentous and osteochondral injuries. RESULTS: All bone bruises were present on repeat MRI. Twenty of the 30 patients (67%) had associated anterior cruciate ligament (ACL) injuries, seven of the 30 (23%) had collateral ligament injuries and three of the 30 (10%) had no associated ligamentous injuries. Greater than 50% reduction in bone bruise volume was demonstrated at repeat scanning in 24 of the 30 patients (80%) and less than 50% in five of the 30 patients (17%). One patient showed an increase in volume of bone bruising at follow-up. There was no correlation between initial size or size reduction of bone bruising and the presence/absence or type of associated injuries. In 21 patients the bone bruises resolved from the periphery, whilst eight patients showed bone bruises that resolved towards the joint margin, all of whom had associated osteochondral injuries. Of the 30 patients, 17 showed bone bruising that extended to the joint margin, 10 of whom had associated osteochondral injuries on MRI. On clinical review some degree of knee pain was still present in all but one of the patients reviewed. The single patient who reported complete resolution of symptoms was one of the three patients with isolated bone bruising CONCLUSION: Bone bruises persist for at least 12–14 weeks, which is longer than previously quoted. Two discrete patterns of bone bruise resolution have been demonstrated. The size and persistence of bone bruising is not related to the presence or absence or type of associated ligamentous injuries.

Detection of multiple myeloma involving the spine: efficacy of fat-suppression and contrast-enhanced MR imaging.

To determine the efficacy of fat-suppressed sequences and contrast-enhanced MR imaging for the detection of focal spinal lesions caused by multiple myeloma, we obtained MR images in 32 patients with newly diagnosed myeloma who had back pain. All patients had biopsy-proved myeloma and had MR imaging at the painful level of the spine. Spin-echo T1-weighted, T2-weighted, and short TI inversion-recovery (STIR) images; dynamic ultrafast low-angle shot (turbo-FLASH) images after IV injection of a bolus of paramagnetic contrast material; and contrast-enhanced T1-weighted images were obtained. We qualitatively compared the signal intensities and contrast enhancement of focal lesions with those of the surrounding vertebral bodies. Multiple lesions were detected in all but two of the 32 patients. On T2-weighted and STIR images, all lesions had homogeneously high signal intensity. On T1-weighted images, the lesions were visible as hypointense areas compared with surrounding bone in all except four patients, in whom the lesions were isointense or hyperintense. All tumor nodules enhanced on turbo-FLASH images obtained in the arterial phase. No additional lesions were seen on STIR or contrast-enhanced images. MR findings resulted in a change in the staging of the disease in one patient and led to prompt treatment in five patients with epidural involvement. MR imaging appears to be helpful in detecting spinal involvement in patients with multiple myeloma. The diagnosis of spinal lesions is best achieved by using either fat-suppressed or T2-weighted images. Although myeloma lesions enhanced in all patients, contrast material appears to be of no value for the detection of additional lesions.

STIR imaging of synthetic vascular graft infection.

Nine patients with suspected prosthetic vascular graft infection were studied with axial spin echo (SE) and short TI inversion recovery (STIR) magnetic resonance imaging. Images were assessed for presence and extent of abnormality. All patients had either surgical (8/9) or bacteriologic (6/9) confirmation of infection. STIR images better defined the extent of infection and had greater fat-fluid contrast than SE images in 6/9 studies. In 3 cases with peri-graft fluid alone, T2-weighted images had slightly greater contrast, although the STIR images were still diagnostic. STIR imaging can offer improved accuracy in evaluation of suspected prosthetic graft infection when used in conjunction with SE techniques.

Effectiveness of the Short TI Inversion Recovery (STIR) sequence in MR imaging of intramedullary spinal lesions

A Short TI Inversion Recovery (STIR) sequence with spin-echo data collection was compared to a conventional cardiac gated long TR spin-echo (SE) sequence for detecting intramedullary signal abnormalities. The cervical ( n = 48), cervico-thoracic ( n = 1), and thoraco-lumbar ( n = 18) spinal cord was imaged in a sagittal plane with a 0.5 T ( n = 61) or 1.5 T ( n = 6) MRI unit in 67 patients with clinical evidence of myelopathy of different etiologies (e.g., multiple sclerosis, trauma, herniated intervertebral disk, spondylosis, etc.). In all patients, ungated double or quadruple echo STIR images (TR 1000–1400 msec, TI 100 msec, TE 30–60 or 30–60–90–120 msec) were compared with cardiac gated long TR (1400–2100 msec), double echo (30–100, 50–100, or 50–150 msec) SE images with first order flow compensation for the second echo. Although STIR images appeared “noisier” than long TR SE images, they showed fewer ghost artifacts. In 55 patients, single or multiple, focal or diffuse, hyperintense areas within the spinal cord were observed on both long TR SE and (magnitude reconstructed) STIR images. Lesion conspicuity was better on the STIR images in 25 patients, better on the SE images in 14 patients, and equal in 16. STIR sequence provides a valuable alternative to gated long TR SE sequence for the MRI investigation of intramedullary spinal lesions.

Magnetic resonance imaging for diagnosis and follow-up of genitourinary, pelvic, and perineal rhabdomyosarcoma.

Magnetic resonance (MR) imaging, ultrasound, and computed tomography (CT) were performed for diagnosis and follow-up of rhabdomyosarcoma (RMS) arising from the genitourinary tract in five children, pelvic musculature in one, and the perineum in three others. MR imaging performed at 1.0 T included the following: spin-density-, T1-, and T2-weighted images in all nine patients; gadopentatate dimeglumine (Gd-DTPA)-enhanced T1-weighted images in five; and short TI inversion recovery (STIR) images in two children. Longitudinal T1-weighted images were of additional help in localizing the primary tumor at diagnosis and detecting local spread. Residual or recurrent disease within the bladder was best detected by spin-density images. Gd-DTPA enhancement improved contrast in two studies, but paramagnetic artifacts obscured intravesical lesions in three other studies. STIR images disclosed pelvic and retroperitoneal lymphadenopathy. MR imaging is recommended as the key method of diagnosis and follow-up of pelvic RMS.

Detection of Lymphomatous Bone Marrow Involvement With Magnetic Resonance Imaging

Abstract We reviewed magnetic resonance (MR) staging examinations of 98 patients with malignant lymphoma who failed other therapy and were under evaluation for bone marrow transplantation. MR scan results were compared with blind posterior iliac crest aspirations and biopsies. Images of vertebral, pelvic, and femoral marrow were obtained using a standard T1-weighted, short repetition time (TR), short time to echo (TE) (TR700/TE22), spin-echo (T1-SE) method in 92 patients and short TI inversion recovery (STIR) technique (TR1,500/TE36/TI100) in all. On standard T1-SE sequence, normal marrow is bright due to the predominance of marrow fat, and tumor is dark. With STIR images, water containing tumor has a very high signal intensity in a dark (fat suppressed) background. Thirteen patients had positive MR scans and marrow biopsies, whereas 49 had negative MR scans and biopsies. Of 36 discordant MR/histology results, 10 had positive biopsies and negative MR exams; eight of these had microscopic infiltration (less than or equal to 5%) with tumor. MR detected marrow tumor either in the crests or elsewhere in 25 of 75 (33%) patients with negative study biopsies. We could confirm marrow involvement in 15 of these 25 (60%) by clinical methods. Therefore, up to one third of the patients evaluated with routine biopsies may have occult marrow tumor detectable by MR exam. In patients with negative marrow biopsies, especially those with Hodgkin's disease or intermediate to high-grade non-Hodgkin's lymphomas, MR scans found focal lesions distant from the crests. Biopsy better detected lower grade microscopic involvement. We conclude that optimal marrow staging of lymphoma patients incorporates both biopsy and MR imaging.

Detection of lymphomatous bone marrow involvement with magnetic resonance imaging [see comments

We reviewed magnetic resonance (MR) staging examinations of 98 patients with malignant lymphoma who failed other therapy and were under evaluation for bone marrow transplantation. MR scan results were compared with blind posterior iliac crest aspirations and biopsies. Images of vertebral, pelvic, and femoral marrow were obtained using a standard T1-weighted, short repetition time (TR), short time to echo (TE) (TR700/TE22), spin-echo (T1-SE) method in 92 patients and short TI inversion recovery (STIR) technique (TR1,500/TE36/TI100) in all. On standard T1-SE sequence, normal marrow is bright due to the predominance of marrow fat, and tumor is dark. With STIR images, water containing tumor has a very high signal intensity in a dark (fat suppressed) background. Thirteen patients had positive MR scans and marrow biopsies, whereas 49 had negative MR scans and biopsies. Of 36 discordant MR/histology results, 10 had positive biopsies and negative MR exams; eight of these had microscopic infiltration (less than or equal to 5%) with tumor. MR detected marrow tumor either in the crests or elsewhere in 25 of 75 (33%) patients with negative study biopsies. We could confirm marrow involvement in 15 of these 25 (60%) by clinical methods. Therefore, up to one third of the patients evaluated with routine biopsies may have occult marrow tumor detectable by MR exam. In patients with negative marrow biopsies, especially those with Hodgkin's disease or intermediate to high-grade non-Hodgkin's lymphomas, MR scans found focal lesions distant from the crests. Biopsy better detected lower grade microscopic involvement. We conclude that optimal marrow staging of lymphoma patients incorporates both biopsy and MR imaging.