Standard MRI Research Articles

Contrast-enhanced ultrasound (CEUS) can be used to effectively monitor hepatocellular carcinoma (HCC) treatment response to percutaneous ablation and transarterial chemoembolization. Here, we performed a supplementary analysis of a prospective study to evaluate HCC participants treated with yttrium-90 transarterial radioembolization (Y90-TARE). We evaluated the utility of quantifiable parameters obtained from CEUS up to 2 weeks posttreatment for predicting treatment response compared with the standard of care cross-sectional imaging performed 2 to 6 months posttreatment (reference standard). In this IRB-approved, prospective clinical trial, participants with HCC scheduled for Y90-TARE underwent 3 CEUS sessions. These sessions occurred 1 to 4 hours post-Y90-TARE, 1 week, and 2 weeks posttreatment. Each CEUS examination involved a 10-minute infusion of Optison (GE HealthCare) using an Acuson Sequoia 2.0 or a HELX S3000 scanner (Siemens Healthineers) with 6C1 transducer. During each CEUS examination, flash-replenishment sequences were performed at the tumor midline for CEUS replenishment imaging. Changes between baseline and 1 or 2 weeks were used for quantitative analyses. Fractional tumor vascularity (FTV in %), perfusion (in mL/s*mg), peak enhancement (au), and time to peak (TTP in seconds) were calculated offline using Matlab (MathWorks) to quantitatively evaluate TARE response. Two abdominal radiologists read the reference standard MRI or CT obtained post-Y90-TARE and characterized the tumor as nonviable (complete response) or viable (partial response/stable disease). Unpaired t tests were performed to evaluate differences in nonviable versus viable disease. ROC analysis and logistic regression were evaluated to determine diagnostic performance and disease prediction. Final analysis included 38 participants. Of these, 22 had nonviable disease (58%, 22/38) and 16 had viable disease (42%, 16/38). FTV showed a difference between nonviable and viable tumors at 2 weeks post-Y90-TARE (38% ± 24% vs 62% ± 28%, P = 0.008). In addition, there was a statistically significant difference in the change in FTV from immediately post-Y90-TARE to 2 weeks after treatment between participants with viable and nonviable disease (41% ± 31% vs 11% ± 26%, P = 0.006). No significant difference was found between viable and nonviable disease across examinations for any of the other variables (P > 0.13). Quantitative CEUS appears to provide an early indicator of treatment response ∼2 weeks post-Y90-TARE.

ObjectivesMulti-material decomposition (MMD), a key application of dual-energy computed tomography (DECT), has shown potential in musculoskeletal research. This study aimed to compare the diagnostic performance of DECT-based MMD with standard CT and MRI in detecting rotator cuff disease.Materials and methodsThis retrospective study evaluated patients diagnosed with rotator cuff disease who underwent third-generation dual-source DECT and 3.0-T MRI within a 2-week interval between December 2023 and November 2024. Shoulder arthroscopy served as the reference standard. Six readers independently assessed rotator cuff tears and determined the degree of supraspinatus tendon diseases using standard CT, DECT-based MMD and MRI. Area under the curve (AUC), sensitivity, specificity, positive/negative predictive values and accuracy were calculated for the diagnosis of rotator cuff disease. Friedman test was used to analyze the radiologists’ diagnostic confidence across the three image types.ResultsIn total of 103 patients (mean age: 50.0 ± 15.6 years) underwent shoulder arthroscopy. MMD demonstrated a higher average AUC for diagnosing rotator cuff tears (88% vs. 65%, p < 0.001) and supraspinatus tendon disease (86% vs. 63%, p < 0.001) compared to standard CT. Its diagnostic performance for supraspinatus tendon disease (91% vs. 90%, p = 0.35) and full-thickness tears (95% vs. 93%, p = 0.11) was comparable to that of MRI.ConclusionDECT-based MMD demonstrated superior diagnostic performance and reliability for detecting rotator cuff diseases compared to standard CT, with accuracy comparable to that of MRI in detecting supraspinatus tendon tears. DECT-based MMD offers a promising approach for the opportunistic detection of rotator cuff diseases.Critical relevance statementDual energy CT-based multi-material decomposition demonstrated accuracy comparable to that of MRI in detecting supraspinatus tendon tears, and may provide an alternative for patients with contraindications to MRI, facilitating early detection of injuries and accurate diagnosis of rotator cuff diseases.Key PointsDual energy (DE) CT multi-material decomposition (MMD) improves diagnostic performance for rotator cuff tears and supraspinatus tendon injuries.Radiologists with varying experience levels benefited from MMD, with experienced readers achieving MRI-level diagnostic performance.DECT MMD offers a promising alternative for patients with contraindications for MRI.Graphical

To validate a standardized MRI scoring system, tracheal invasion score (T-score) and vascular invasion score (V-score) against CT for detecting tracheal and major-vessel invasion in esophageal cancer, based on imaging obtained after neoadjuvant therapy. Twenty-six patients (mean age 65 years) who underwent both MRI and CT after preoperative therapy and prior to esophagectomy were retrospectively reviewed. Two radiologists independently assigned T- and V-scores on MRI and CT-based T-stage (12th Japanese Classification). Diagnostic performance was measured by the area under the ROC curve (AUC) and κ for inter-reader agreement. Patient-level bootstrap resampling (2000 iterations) compared the combined MRI score-defined as max (T, V)-with CT. MRI yielded higher AUCs than CT for tracheal invasion (0.943-0.990 vs. 0.529-0.706) and vascular invasion (0.878 for both readers). MRI achieved substantial-to-almost-perfect agreement (κ = 0.771-1.000), whereas CT was only moderate (κ = 0.369-0.487). Bootstrap analysis confirmed superior discrimination of the combined MRI score: ΔAUC + 0.19 (-0.05-0.43, p = 0.11) for Reader A and +0.38 (0.07-0.66, p = 0.02) for Reader B. A combined MRI T/V-score provides better accuracy and inter-reader reliability than CT for evaluating critical local invasion, even after preoperative therapy, supporting routine integration of MRI when CT findings are equivocal. Question Determine whether a standardized MRI scoring system for tracheal and vascular invasion improves diagnostic accuracy compared with contrast‑enhanced CT in esophageal cancer. Findings MRI outperforms CT in detecting tracheal and vascular invasion, with higher specificity and superior inter-reader agreement using standardized scoring criteria. Clinical relevance Standardized MRI scoring improves staging accuracy in suspected T4 esophageal cancer, aiding surgical decision-making and helping to avoid unnecessary surgery in inoperable patients as well as incomplete (R1/R2) resections.

MRI Based Intratumoral-Peritumoral Habitat Radiomics for Prediction of Overall Survival in Rhabdomyosarcoma: A Multicenter Study.

Annual whole-body MRI (WB-MRI) is recommended for early cancer detection in individuals with Li-Fraumeni syndrome (LFS). However, there is no agreement on a standardized MRI protocol. This study evaluated the diagnostic performance of different MRI sequences to suggest an optimized protocol for LFS surveillance. In this prospective bicentric study, 113 participants with LFS underwent annual WB-MRI and were included in the analysis. The protocol comprised turbo-spin echo (TSE) T1-weighted and inversion-recovery T2-weighted (TIRM) images of the whole body in coronal orientation, and T2-weighted (HASTE), diffusion-weighted (DWI), and T1-weighted DIXON images (pre- and post-contrast agent administration) from head to thighs in axial orientation. An additional fluid-attenuated inversion recovery (FLAIR) sequence imaged the skull only. Initial clinical interpretation was conducted by staff radiologists. The visibility of reported mass lesions was independently graded in all sequences by three experienced radiologists using a Likert scale. Sequence combinations were compared to inform the design of an optimal MRI protocol. Over 30 months, 189 WB-MRI examinations were performed in 113 participants (mean age 40 years, ±12.7 years [standard deviation], 91 women). 188 mass lesions were detected and confirmed as malignant (n = 38), benign (n = 120) or ambiguous (n = 30). In the multi-reader analysis, all new malignant lesions could have been detected by a combination of cranial FLAIR, whole-body DWI, and whole-body HASTE in the axial direction. A shortened, contrast-agent-free WB-MRI protocol combining cranial FLAIR, WB-HASTE, and WB-DWI promises to be an effective and patient-friendly approach for annual cancer surveillance in LFS. Question Annual whole-body MRI (WB-MRI) is recommended for early cancer detection for individuals with Li-Fraumeni syndrome (LFS), but a standardized sequence protocol has yet to be established. Findings The combination of cranial FLAIR, whole-body HASTE, and whole-body DWI in the axial plane enabled visualization of all newly developed malignant lesions in our study cohort. Clinical relevance A shortened, standardized WB-MRI protocol enables efficient, sensitive early cancer detection in individuals with LFS, minimizing patient burden by reducing examination time and contrast agent use. This approach may improve surveillance participation while enhancing comparability across centers.

This study aimed to compare the detection rates and inter-rater agreements of the sagittal T2w-TSE and sagittal short tau inversion recovery (STIR) sequence versus the axial T2w-TSE sequence with full spinal cord coverage in identifying spinal cord lesions in patients with suspected demyelinating diseases and diagnosed multiple sclerosis (MS). 104 patients were prospectively enrolled in this study and underwent MRI, including a sagittal T2w-TSE and STIR sequence, as well as an axial T2w-TSE sequence with full spinal cord coverage. Two experienced neuroradiologists, blinded to clinical parameters, independently evaluated the scans in separate sessions. After blinded readings, raters re-evaluated all sequences to assess if lesions could be retrospectively identified in other sequences. Spinal cord lesions were found in 81 patients. The highest inter-rater reliability was observed for the sagittal T2w-TSE sequence (κ = 0.73, 95%-CI 0.66-0.79), followed by the axial T2w-TSE (κ = 0.71, 95%-CI 0.63-0.79) and the sagittal STIR sequence (κ = 0.65, 95%-CI 0.58-0.73). The axial T2w-TSE sequence demonstrated superior lesion detection rates, identifying significantly more lesions (n = 361) compared to the STIR (n = 293) and T2w-TSE sagittal (n = 224) sequence (p < 0.001). Axial T2w-TSE sequences with full spinal cord coverage provide superior lesion detection compared to sagittal sequences and should be included in standard MRI protocols for MS patients. They may accelerate meeting MRI criteria for MS, improve monitoring of disease progression, and enhance prediction of future disability.

Robust and objective quantification of ophthalmic and retroorbital structures from standard neuroimaging is an accessible but still untapped resource for clinical assessment. Current approaches mostly rely on subjective manual measurements, introducing variability and limiting clinical integration. We developed and validated an automated ocular morphometrics pipeline enabling diagnostic precision through standardised orbital measurements. The presented pipeline consists of: (1) supra-resolution orbital template generation from standard structural MRI, (2) expert-guided segmentation with anatomical landmark annotation, (3) registration-based propagation to individual scans, (4) ocular neuroimaging quality control, and (5) automated extraction of 38 bilateral volumetric and geometric parameters critical for comprehensive ophthalmic and ocular structural morphometry including entire optic nerve sheath volume. We also integrated posterior globe deformation mapping for structural analysis. High-resolution orbital space template generation and subsequent landmark-based segmentation succeeded for all tested T1- and T2-weighted datasets. Ocular morphometrics revealed a substantial and significant physiological asymmetry between the eyes with minimal-to-negligible inter-dataset variations for all orbital parameters and landmarks. The pipeline demonstrated excellent reproducibility with intraclass correlation coefficients exceeding 0.8 for 30/38 metrics. We then established normative ranges from adult datasets to facilitate clinical and research interpretation. Our posterior globe deformation mapping enables sensitive morphological assessment. This pipeline ( https://github.com/Eulenburg-LMU/MReye-Seg ) enables objective, standardised and comprehensive quantification of ophthalmic morphometrics, including total optic nerve sheath volume and posterior globe deformations as potential surrogates for raised intracranial pressure. By minimising measurement variability and processing time, MReye-Seg supports eye researchers and ophthalmologists in achieving diagnostic precision for ocular and retroorbital conditions.

Differences in advanced radiologic features of glioma subtypes under the 2021 WHO classification of tumors of the central Nervous system.

To evaluate the utility of cerebrospinal fluid (CSF) biomarkers-matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases-1 (TIMP-1), the MMP-9/TIMP-1 ratio, and osteopontin (OPN)-as indicators of blood-brain barrier (BBB) integrity and disease activity in people with relapsing-remitting multiple sclerosis (pwMS), and to assess their changes following autologous hematopoietic stem cell transplantation (aHSCT). CSF samples from pwMS treated with aHSCT (n = 43) and healthy controls (n = 32) were analyzed for MMP-9, TIMP-1, and OPN concentrations using ELISA and electrochemiluminescence assays. Lumbar punctures were performed at baseline and at 1, 2, and 3-5 years post-aHSCT. Biomarker findings were compared with standard CSF parameters, prior treatments, and MRI data. MMP-9/TIMP-1 ratios and OPN levels were significantly elevated in pwMS compared to controls, particularly in those with gadolinium-enhancing lesions or on first-line therapies. Both biomarkers declined significantly after aHSCT and remained low during follow-up. The MMP-9/TIMP-1 ratio showed superior discriminatory capacity and correlated with inflammatory CSF markers. CSF MMP-9/TIMP-1 ratio and OPN are elevated in MS and decrease following aHSCT, reflecting reduced inflammation and restored BBB integrity. These biomarkers may support disease monitoring and therapeutic evaluation.

Multiple sclerosis (MS) is an autoimmune demyelinating disease that attacks myelin. MRI is an important imaging modality for diagnosis and monitoring in MS. However, the current standard MRI protocol for MS lacks sequences capable of detecting molecular changes. To present a saturation-transfer-based MRI protocol, including chemical exchange saturation transfer (CEST) and magnetization transfer indirect spin labeling (MISL) sequences, for quantifying molecular changes and water exchange in the brain of MS patients. Prospective. Fifty-two participants including 31 healthy controls (HC) (18 females and 13 males) and 21 MS patients (18 females and 3 males). 3D inversion-prepared gradient echo T1w, 3D fast spin echo T2w, 3D CUBE CEST and MISL at 3.0 T. Multiple CEST contrasts between HC and MS groups were analyzed using double-step multi-pool Lorentzian fitting (DMPLF) and Lorentzian difference analysis (LDA) to evaluate and compare their diagnostic performance. MISL signals at -20 and -10 ppm were quantified by the normalized signal reduction in cerebrospinal fluid (CSF). T1w MRI was used to quantify brain volumes. Unpaired Student's t-test, receiver operating characteristic (ROC) curve, area under the curve (AUC), and binary logistic regression analysis. p < 0.05 was considered statistically significant. CEST detected decreased signals in the brain of MS patients using both DMPLF and LDA, with DMPLF demonstrating superior performance in differentiating MS from HC (AUC, 0.93; 95% CI: 0.86, 1.00). MS patients showed significantly lower whole brain MISL signals than HCs at both -20 ppm (0.04 ± 0.01 vs. 0.06 ± 0.02) and -10 ppm (0.06 ± 0.02 vs. 0.08 ± 0.02). MS patients showed a significant decrease (-6.57%) in brain tissue and an increase (+20.73%) in CSF volume ratios compared to HCs. The saturation-transfer-based MRI framework can effectively evaluate molecular changes and CSF-tissue water exchange in the brains of MS patients. 2. Stage 3.

Multicontrast ultrafast MRI brain is increasingly explored to triage acute intracranial emergencies. Since residents are at the forefront of emergency radiology in academic centers, it is critical to understand the suitability of ultrafast MRI for resident trainees. Further, structured radiology reportings have found foothold to communicate to the referring services and it will be beneficial to understand the capability of ultrafast MRI to facilitate such a structured reporting. A retrospective analysis of 104 cases with multicontrast ultrafast MRI was performed in inpatient and emergency settings. Images were assessed independently by blinding to all charts by a second-year diagnostic radiology resident and a board-certified neuroradiology attending with over 20years of experience. Fifteen anatomical variables were evaluated to emulate the structured reporting used in standard MRI brain studies. Clinical summary at discharge served as the reference standard to correlate the presence of acute intracranial emergency on ultrafast MRI. Inter-rater agreements for fifteen imaging variables ranged between 0.33 to 0.74 and Cohen's kappa of 0.92 (p < .001) to triage acute emergency. Percentage agreement for six anatomical landmarks ranged from 98 to 100%. The accuracy to distinguish acute from non-acute conditions was 96.2% for the resident and 99% for the experienced reviewer. Multicontrast ultrafast MRI brain shows promise to triage acute intracranial emergencies with resident-level training. It can facilitate structured analysis of a majority of anatomical landmarks.

To investigate the different regions covered by nasopharyngeal (NPEs) and anterior temporal (anterior temporal electrodes [ATEs]) electrodes in assessing temporal lobe epilepsy, to overcome the limitations of the 10 to 20 electroencephalography (EEG) in diagnosing the basal and mesial temporal regions. EEG data from 229 patients diagnosed with temporal lobe epilepsy were simultaneously analyzed with attached NPEs and ATEs. In case of discrepancies in EEG interpretation, a consensus interpretation was reached among three epilepsy experts. Spike detection was conducted using the Curry9 program for secondary analysis of electric source localization, with source location performed using standard brain MRI data. In total, 2,721 interictal epileptiform discharges (IEDs) from 175 patients were analyzed. Of these, 734 IEDs from 48 patients were detected exclusively with NPEs, while 1,987 IEDs from 127 patients were detected simultaneously by both NPEs and the standard international 10 to 20 electrodes system supplemented with ATEs, respectively. The former IEDs exhibited clustering dipoles in the basal and mesial temporal regions, while the latter were localized solely to the frontotemporal and lateral temporal regions. Nasopharyngeals can identify IEDs in the mesial and basal temporal region that cannot be detected by ATEs. Nasopharyngeals offer additional diagnostic value in regions not confirmed by the existing 10 to 20 EEG electrode system, including those covered by ATE.

ObjectivesTo compare the performance of 3D T1 turbo spin echo (3DT1TSE) and 3D T1 turbo field echo (3DT1TFE) MRI in detecting gadolinium-enhancing lesions in multiple sclerosis (MS).Materials and methodsWe retrospectively analyzed 255 3-T MRIs from MS patients, each including post-contrast 3DT1TSE and 3DT1TFE sequences. Two blinded readers independently assessed enhancing lesions per sequence. A consensus review, incorporating longitudinal imaging and additional sequences, served as the reference standard.ResultsThe consensus identified 70 enhancing lesions in 31 patients. All 70 were visible on 3DT1TSE, while 64 (91%) were detectable on 3DT1TFE. Reader sensitivity was higher for 3DT1TSE (84% and 90%) than 3DT1TFE (45% and 40%) (p < 0.01). Inter-reader agreement was excellent for 3DT1TSE (ICC = 0.90) and moderate for 3DT1TFE (intraclass correlation coefficient = 0.69). Although false positives were more common with 3DT1TSE, they were readily excluded during consensus reading. In six patients, enhancing lesions were detected only on 3DT1TSE, with treatment escalation in two.Conclusion3DT1TSE outperformed 3DT1TFE in sensitivity and reader agreement for enhancing lesion detection in MS. Incorporating 3DT1TSE into standard MRI protocols may improve disease activity assessment and clinical decision-making.Critical relevance statementReplacing 3D gradient-echo with post-contrast 3D T1 turbo spin-echo brain MRI greatly improves the detection of gadolinium-enhancing multiple-sclerosis lesions, boosting diagnostic sensitivity and reader agreement and directly influencing treatment-escalation decisions in routine practice.Key PointsDetecting and enhancing MS lesions is limited by standard 3D T1 turbo field echo (3DT1TFE) MRI.3D T1 turbo spin echo detects significantly more gadolinium-enhancing MS lesions than conventional 3DT1TFE.Greater lesion detection allows more precise activity assessment and optimal treatment management.Graphical

The clinical discrimination of Parkinson disease (PD) from its mimics can be challenging, especially in the early stages. These mimics include atypical parkinsonian syndromes (APSs), essential tremor, drug-induced parkinsonism, and vascular parkinsonism. Moreover, differential diagnosis of PD is not exclusive; overlapping and coexisting neurodegenerative diseases are common. Most patients with suspected PD undergo standard clinical MRI (including T1- and T2-weighted sequences) as the first imaging examination, with the primary objective to exclude other diseases. Standard MRI can help detect vascular pathologic features in vascular parkinsonism or atrophy patterns in some APSs but is not sensitive for detecting PD. Dopamine transporter imaging remains the neuroimaging reference standard for specific diagnosis of PD: It can be used to detect PD and most APSs but cannot reliably be used to discriminate between them or exclude other findings, including cerebrovascular disease. Emerging MRI biomarkers of PD are nigrosome 1 (N1; the swallow tail sign at susceptibility-weighted imaging) and neuromelanin (at neuromelanin-sensitive MRI). These markers appear abnormal in PD and most APSs yet normal in essential tremor, drug-induced parkinsonism, and vascular parkinsonism. Identifying these challenging markers depends on specific technical parameters and reader experience. Although dopamine transporter imaging remains more accurate for diagnosing PD, the authors discuss how adding N1 or neuromelanin imaging to standard MRI is a practical, cost-effective, and sustainable way to help diagnose PD and PD mimics and select patients for subsequent dopamine transporter imaging.

Evaluation of photon-counting CT-derived attenuation parameters for noninvasive liver fat assessment.

Fully automated measurement of aortic pulse wave velocity from routine cardiac MRI studies.

Sagittal FOCUS-MUSE Diffusion-weighted Imaging MRI Improves the Accuracy of Rectal Cancer Location: A Prospective Observational Study.

Background: Idiopathic Intracranial Hypertension (IIH), or pseudotumor cerebri, is characterized by elevated intracranial pressure without a detectable secondary cause. The condition has an estimated incidence of 0.9 per 100,000 in the general population, rising to 19 per 100,000 among obese women of reproductive age. IIH is associated with significant morbidity, particularly vision loss, if not diagnosed and managed promptly. Methodology: This retrospective case series analyzed five patients evaluated between May 2024 and May 2025 who met the modified Dandy criteria for IIH and underwent standardized MRI and MRV protocols. Patient selection involved the exclusion of secondary intracranial hypertension, and two radiologists independently reviewed images. Results: All patients (100%) exhibited either partial or complete empty Sella, 80% (4/5) showed transverse sinus stenosis, 60% (3/5) had Meckel's cave enlargement; and 60% (3/5) had perioptic CSF space dilation; visual disturbances correlated with perioptic CSF distention. The study highlights the value of neuroimaging biomarkers in confirming IIH, guiding clinical management, and differentiating from secondary causes. However, the limited sample size and single-center scope restrict generalizability. Conclusion: Early radiological identification and intervention are crucial to prevent irreversible complications, emphasizing the need for multi-disciplinary care and further research involving advanced imaging and long-term outcomes.

Assessment of T1 quantification from MP2RAGE using a standardized MRI phantom

Characterization of posterior capsular injury for preoperative planning in closed knee injuries: A narrative review.