T2-weighted Images Research Articles

Machine learning-based assessment of morphometric abnormalities distinguishes bipolar disorder and major depressive disorder.

Bipolar disorder (BD) and major depressive disorder (MDD) have overlapping clinical presentations which may make it difficult for clinicians to distinguish them potentially resulting in misdiagnosis. This study combined structural MRI and machine learning techniques to determine whether regional morphological differences could distinguish patients with BD and MDD. A total of 123 participants, including BD (n = 31), MDD (n = 48), and healthy controls (HC, n = 44), underwent high-resolution 3D T1-weighted imaging. Cortical thickness, surface area, and subcortical volumes were measured using FreeSurfer software. Common and classic machine learning models were utilized to identify distinct morphometric alterations between BD and MDD. Significant morphological differences were observed in both common and distinct brain regions between BD, MDD, and HC. Specifically, abnormalities in the amygdala, thalamus, medial orbitofrontal cortex and fusiform were observed in both BD and MDD compared with HC. Relative to HC, unique differences in BD were identified in the lateral occipital and inferior/middle temporal regions, whereas MDD exhibited differences in nucleus accumbens and middle temporal regions. BD exhibited larger surface area in right middle temporal gyrus and greater right nucleus accumbens volume compared to MDD. The integration of two-stage models, including deep neural network (DNN) and support vector machine (SVM), achieved an accuracy rate of 91.2% in discriminating individuals with BD from MDD. These findings demonstrate that structural MRI combined with machine learning techniques can accurately discriminate individuals with BD from MDD, and provide a foundation supporting the potential of this approach to improve diagnostic accuracy.

Brain tissue integrity in neuromyelitis optica spectrum disorder through T1-w/T2-w ratio, MTR and DTI.

The presence of diffuse brain damage in normal-appearing white matter (NAWM) and gray matter (NAGM) in neuromyelitis optica spectrum disorder (NMOSD) remains controversial. We aimed to address this controversy by applying a multiparametric MRI approach. Additionally, the association between MRI metrics and clinical variables was explored. In this cross-sectional study, we prospectively evaluated aquaporin-4-IgG positive NMOSD patients and healthy controls (HC) matched for age and sex. The clinical variables of interest were collected for each participant. The mean values of T1-w/T2-w ratio, magnetization transfer ratio (MTR), fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were obtained in NAWM, NAGM, as well as in global and hypointense lesion masks. Global lesions refer to those typically associated with aquaporin-4-IgG positive NMOSD. Hypointense lesions were defined as areas of hypointense signal in both T1-w and fluid-attenuated inversion recovery (FLAIR) images. In total, we included 105 participants (59 NMOSD patients and 46 HC). T1-w/T2-w ratio was lower in NAWM of NMOSD patients versus HC (1.83 ± 0.14 vs 1.89 ± 0.14; p = 0.029), while no significant differences were found in NAWM or NAGM across the other metrics: (p range: 0.079 to 0.973). Hypointense lesions showed lower T1-w/T2-w ratio, MTR, and FA, and higher diffusivity metrics as compared to global lesion masks (p < 0.001). T1-w/T2-w ratio in NAWM was inversely correlated with time to start immunosuppressive therapy (r = - 0.278; p = 0.036) and with MD (r = - 0.325; p = 0.014). Microstructural integrity loss seems to be confined to focal tissue damage in NMOSD. Decreased T1-w/T2-w ratio in NAWM may reflect subclinical water accumulation due to astrocyte and blood-brain barrier dysfunction. Hypointense lesions have shown a severe degree of microstructural damage.

Hidden blood loss and risk factors after percutaneous endoscopic transforaminal lumbar interbody fusion

PurposeIn this study, we aimed to assess the occurrence of hidden blood loss (HBL) and its associated risk factors in patients with lumbar degenerative diseases who underwent percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF).MethodsSex, age, height, weight, body mass index, and medical history including hypertension, diabetes, and osteoporosis were recorded. The duration of symptoms, preoperative lumbar subcutaneous fat tissue thickness (measured using midsagittal T2-weighted magnetic resonance imaging), lumbar disc degeneration grade, and other basic patient information were also documented. The levels of fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, and platelet count as well as the pre- and postoperative hematocrit and hemoglobin levels were collected. In addition, the number of fusion levels, surgical time, and intraoperative blood loss were recorded. Total blood loss (TBL) was calculated using the gross formula, and HBL was calculated based on the TBL and visible blood loss. The risk factors were analyzed using single-factor correlation and multivariate linear regression analyses.ResultsOf the 83 patients, there were 42 males and 41 females. Hypertension (P = 0.003), fusion level (P &amp;lt; 0.001), and surgery time (P &amp;lt; 0.001) were significantly correlated with HBL via a single-factor correlation analysis. Multiple linear regression analysis showed that the fusion level (P &amp;lt; 0.001) and surgery time (P &amp;lt; 0.001) were independent risk factors for HBL.ConclusionIn patients with lumbar degenerative diseases treated with Endo-TLIF, HBL accounts for a large proportion of TBL. A large number of fusion segments and prolonged operation time are risk factors for increased perioperative HBL during Endo-TLIF. Increased attention should be paid to the presence of HBL to ensure the safety of perioperative patients.

Imaging characteristics of hypervascular focal nodular hyperplasia-like lesions in patients with chronic alcoholic liver disease.

Focal nodular hyperplasia (FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse. Although pathologically similar to hepatocellular carcinoma (HCC) lesions, they are benign. As such, it is important to develop methods to distinguish between FNH-like lesions and HCC. To evaluate diagnostically differential radiological findings between FNH-like lesions and HCC. We studied pathologically confirmed FNH-like lesions in 13 patients with alcoholic cirrhosis [10 men and 3 women; mean age: 54.5 ± 12.5 (33-72) years] who were negative for hepatitis-B surface antigen and hepatitis-C virus antibody and underwent dynamic computed tomography (CT) and magnetic resonance imaging (MRI), including superparamagnetic iron oxide (SPIO) and/or gadoxetic acid-enhanced MRI. Seven patients also underwent angiography-assisted CT. The evaluated lesion features included arterial enhancement pattern, washout appearance (low density compared with that of surrounding liver parenchyma), signal intensity on T1-weighted image (T1WI) and T2-weighted image (T2WI), central scar presence, chemical shift on in- and out-of-phase images, and uptake pattern on gadoxetic acid-enhanced MRI hepatobiliary phase and SPIO-enhanced MRI. Eleven patients had multiple small lesions (< 1.5 cm). Radiological features of FNH-like lesions included hypervascularity despite small lesions, lack of "corona-like" enhancement in the late phase on CT during hepatic angiography (CTHA), high-intensity on T1WI, slightly high- or iso-intensity on T2WI, no signal decrease in out-of-phase images, and complete SPIO uptake or incomplete/partial uptake of gadoxetic acid. Pathologically, similar to HCC, FNH-like lesions showed many unpaired arteries and sinusoidal capillarization. Overall, the present study showed that FNH-like lesions have unique radiological findings useful for differential diagnosis. Specifically, SPIO- and/or gadoxetic acid-enhanced MRI and CTHA features might facilitate differential diagnosis of FNH-like lesions and HCC.

Comparative Sensitivity of MRI Indices for Myelin Assessment in Spinal Cord Regions

Background/Objectives: Although multiple magnetic resonance imaging (MRI) indices are known to be sensitive to the noninvasive assessment of myelin integrity, their relative sensitivities have not been directly compared. This study aimed to identify the most sensitive MRI index for characterizing myelin composition in the spinal cord’s gray matter (GM) and white matter (WM). Methods: MRI was performed on a deer’s ex vivo cervical spinal cord. Quantitative indices known to be sensitive to myelin, including the myelin water fraction (MWF), magnetization transfer ratio (MTR), the signal ratio between T1- and T2-weighted images (T1W/T2W), fractional anisotropy (FA), mean diffusivity (MD), electrical conductivity (σ), and T1, T2, and T1ρ relaxation times were calculated. Their mean values were compared using repeated measures analysis of variance (ANOVA) and post hoc Bonferroni tests or Friedman and post hoc Wilcoxon tests to identify differences across GM and WM columns possessing distinct myelin distributions, as revealed by histological analysis. Relationships among the indices were examined using Spearman’s rank-order correlation analysis. Corrected p &lt; 0.05 was considered statistically significant. Results: All indices except σ differed significantly between GM and all WM columns. Two of the three WM columns had significantly different MWF, FA, MD, and T2, whereas one WM column had significantly different MTR, σ, T1, and T1ρ from the others. A significant moderate to very strong correlation was observed among most indices. Conclusions: The sensitivity of MRI indices in distinguishing spinal cord regions varied. A strategic combination of two or more indices may allow the accurate differentiation of spinal cord regions.

Audiovisual Breathing Guidance for Improved Image Quality and Scan Efficiency of T2- and Diffusion-Weighted Liver MRI

Objectives Impaired image quality and long scan times frequently occur in respiratory-triggered sequences in liver magnetic resonance imaging (MRI). We evaluated the impact of an in-bore active breathing guidance (BG) application on image quality and scan time of respiratory-triggered T2-weighted (T2) and diffusion-weighted imaging (DWI) by comparing sequences with standard triggering (T2S and DWIS) and with BG (T2BG and DWIBG). Materials and Methods In this prospective study, random patients with clinical indications for liver MRI underwent 3 T MRI with standard and BG acquisitions. The audiovisual BG application received the respiratory signal from the scanner, and animated breathing instructions were displayed using a mirror and screen behind the MRI bore. Prior to the DWIBG and T2BG acquisition, patients received a short video instruction about MRI with BG. Suitable parameters for desired breathing pattern for T2BG and DWIBG were set individually for each patient based on the patient's physical respiratory ability (ie, 4 seconds breathing followed by 4.5 seconds breath holding). Artifacts, sharpness, lesion conspicuity, and overall image quality were assessed using a Likert scale from 1 (nondiagnostic) to 5 (excellent). Scan time, apparent contrast-to-noise ratio, and apparent signal-to-noise ratio (aSNR) for all sequences were analyzed. Paired t test and Wilcoxon test were used for statistical analysis. Results Thirty-two patients (mean age: 55 ± 13 years, 13 female) were included. T2BG showed less artifacts (4.5 ± 0.7 vs 4.1 ± 0.8, P &lt; 0.001) and better sharpness, lesion conspicuity, and overall image quality (eg, overall image quality 4.6 ± 0.7 vs 4.4 ± 0.7, P = 0.004) compared with T2S. DWIBG demonstrated improved image quality in all categories compared with DWIS (eg, overall image quality 4.5 ± 0.5 vs 4.3 ± 0.5, P = 0.005) and less artifacts (4.1 ± 0.5 vs 3.8 ± 0.7, P = 0.007). Scan times of T2BG (286 ± 23 vs 345 ± 68 seconds, P &lt; 0.001) and DWIBG (160 ± 4 vs 252 ± 70 seconds, P &lt; 0.001) were reduced by 17% and 37%, respectively. aSNR and apparent contrast-to-noise ratio (eg, aSNR: 23.45 ± 11.31 [T2BG] vs 25.84 ± 10.76 [T2S]; P = 0.079) were similar for both sequences for both approaches. Conclusions Active BG for respiratory-triggered liver T2w and DWI sequences led to significant reduction of breathing artifacts, improved image quality, and shorter scan time compared with standard acquisitions.

Association of the Cervical Canal Area With Disability and Progression in People With Multiple Sclerosis.

In multiple sclerosis (MS), brain reserve serves as a protective factor against cognitive impairment. Previous research has suggested a structural counterpart in the spine-spinal cord reserve-seemed to be associated with physical disability. This study aimed to investigate the potential of the cervical canal area (CCaA) as a proxy for spinal cord reserve in a multicentric cohort of people with MS (PwMS). This retrospective, multicentric, longitudinal study included PwMS and healthy controls (HCs) from 9 European MAGNIMS sites. Baseline cervical 3D T1-weighted images were acquired, excluding poor-quality images. CCaA was estimated independently at the C2/C3 and C3/C4 levels. The Expanded Disability Status Scale (EDSS) score was assessed at baseline and 5-year follow-up. We analyzed mean CCaA differences between groups and the association of CCaA with baseline EDSS scores and disability progression using multivariable regression models adjusted for age, sex, spinal cord parenchymal fraction, and cervical cord lesions. After quality check, the cohort included 177 HCs (mean age 39.8 years, 57.6% women) and 428 PwMS (mean age 46.5 years, 60.8% women), comprising 289 people with relapsing MS (PwRMS) and 139 people with progressive MS (PwPMS). No significant differences in CCaA were found between HCs and PwRMS at C2/C3 or C3/C4 levels. Conversely, PwPMS showed a smaller CCaA at the C2/C3 level (210.51 mm2) than HCs (214.62 mm2, estimated mean difference [EMD] -4.11, 95% CI -6.28 to -1.00, p = 0.007) and PwRMS (213.68 mm2, EMD -3.17, 95% CI -5.22 to -0.34, p = 0.026). PwPMS also had a smaller CCaA at C3/C4 (165.16 mm2) than HCs (169.67 mm2, EMD -4.51, 95% CI -5.50 to -1.60, p < 0.001) and PwRMS (169.44 mm2, EMD -3.81, 95% CI -5.22 to -0.34, p < 0.001). At the C3/C4 level, CCaA and baseline EDSS scores were significantly associated (β = -0.13, p < 0.001); in addition, PwMS with clinical worsening at 5-year follow-up displayed a smaller baseline CCaA (worsened vs stable: 167.03 mm2 vs 169.13 mm2, EMD -2.10, 95% CI -3.98 to -023, p = 0.028). CCaA was associated with baseline EDSS scores and clinical worsening in a multicentric MS cohort, suggesting the existence of spinal cord reserve. PwPMS had a smaller CCaA, indicating that reduced spinal cord reserve might be characteristic of progressive MS. Therefore, spinal cord reserve may represent a novel radiologic marker for better understanding physical disability in MS.

Assessment of the Utility of Selected Inflammatory Markers in Correlation with Magnetic Resonance Enterography (MRE) Findings in the Diagnosis of Crohn’s Disease

Crohn’s Disease (CD) is a chronic inflammatory bowel disease affecting the gastrointestinal tract. The search continues for new markers for assessing the activity of CD. Among them, pro-inflammatory and anti-inflammatory cytokines appear promising. We performed the analysis of cytokine concentrations in blood serum using the Bio-Plex Multiplex system (Bio-Rad), and their correlations with radiological parameters were assessed by magnetic resonance enterography (MRE), and fecal calprotectin levels were measured quantitatively by ELISA and clinical evaluation according to the Crohn’s Disease Activity Index (CDAI). Our study found that measuring cytokine serum concentrations can be a valuable tool in the diagnosis and treatment of CD. Positive correlations were reported between contrast enhancement on DCE-MRE and the concentrations of PDGF-BB and RANTES. Also, a positive correlation was found between the delayed-phase of DCE and IL-10 concentration, a strong negative correlation between the delayed-phase of DCE and IL-12 concentration, and a strong positive correlation between the delayed-phase of DCE and RANTES concentrations. A strong positive correlation was also observed between the thickness of the intestinal wall on T2-weighted images and RANTES concentration. Therefore, concentrations of PDGF-BB, RANTES, IL-10 and IL-12 are promising markers of CD activity. The study also demonstrated significant correlations between the severity of disease activity assessed by the CDAI and the concentrations of IL-5, IL-8 and IL-9, as well as positive correlations between the levels of fecal calprotectin and the concentrations of IL-1RA and VEGF. Therefore, the levels of IL-5, IL-8, IL-9, VEGF and IL-1RA may be useful markers in the diagnosis and clinical assessment of disease activity.

Isolated inflammatory involvement of the occipital artery in giant cell arteritis and polymyalgia rheumatica: findings from a retrospective analysis and the critical role of MRI in diagnosis.

Diagnosis of Giant Cell Arteritis (GCA) and Polymyalgia rheumatica (PMR) may be challenging as many patients present with non-specific symptoms. Superficial cranial arteries are predilection sites of inflammatory affection. Ultrasound is typically the diagnostic tool of first choice supplementary to clinical and laboratory examination. Inflammation of temporal arteries can be detected sonographically with high reliability. However, due to the vessel's course and location, occipital arteries evade sonographic detectability. The aim of our study was to evaluate the infestation pattern of superficial cranial arteries in GCA and PMR patients with special focus on the occipital arteries. 90 treatment-naïve patients with clinically and/or histologically proven GCA and/or PMR (51 GCA, 20 PMR, 10 GCA-PMR) were included in the study. All patients underwent contrast-enhanced, fat-suppressed, high-resolution black blood 2D T1-weighted spin echo imaging at 3T MRI. Images were read by three different readers independently. Temporal and occipital arteries were assessed regarding vasculitic affection. Circumferential mural hyperenhancement and thickening of the vessel wall ≥ 600μm was considered positive for vasculitis. 9/90 (10%) of all patients revealed inflammatory changes of the occipital artery only. Prevalence of isolated inflammatory affection of occipital artery was even higher in the GCA subgroup with 7/51 (14%) patients. 14% of GCA patients and 10% of GCA-PMR patients present with signs of inflammation of the occipital artery only. Since the occipital artery is not accessible to routine ultrasound examination, MRI renders incremental value in the diagnosis of GCA and PMR patients.

Case report: Endolymphatic sac tumor with blurred vision

IntroductionEndolymphatic sac tumor (ELST) is a rare neoplasm that exhibits aggressive growth primarily in the endolymphatic capsule and can potentially affect nearby neurovascular structures. The diagnosis of ELST poses challenges due to its low prevalence, gradual progression, and nonspecific symptomatology. It is currently believed that prompt surgical intervention is recommended for endolymphatic sac tumors upon diagnosis. In cases where the lesion is complex or in close proximity to vital blood vessels and nerves, making complete resection challenging, adjuvant therapy may be employed postoperatively. This approach aims to enhance treatment outcomes.Case presentationA case of a 53-year-old male was admitted to the Department of Neurosurgery of Shenzhen People’s Hospital with the main cause of dizziness and blurred vision, and was found to have an occupation in the pontocerebellar angle for about 20 days. Preoperative cranial CT suggested that the temporal bone mastoid was widely damaged with worm-like bone, and some of them showed honeycomb changes. MRI suggested that shadow was seen in the posterior part of the left internal auditory canal, temporal bone mastoid and jugular foramen, with a size of about 28x21x27mm.The T1-weighted image showed low and equal signals, and the T2-weighted image showed equal and slightly low signals in the center with multicompartmental cystic high signals in the margin. The center of the mass strengthened significantly after enhancement. The patient had no other clinical manifestations and no family history. The clinical diagnosis was left-sided pontocerebellar angle occupation - nature to be determined. The occupation was resected microscopically using the distal lateral combined anterior approach to the sigmoid sinus. Due to the extremely rich blood supply of the tumor, the tumor was embedded in the petrous humerus, which was soft and tough, and the surrounding structures were not clearly displayed, making surgical resection extremely difficult. postoperative pathology and immunohistochemistry confirmed that this lesion was an endolymphatic cystic tumor. After surgery, most of the tumor was successfully resected while preserving neurological function well, and the residual tumor was treated with adjuvant gamma knife with good results.ConclusionELST is a rare, low-grade, locally aggressive tumor that is difficult to diagnose early. During the surgery, it was observed that the tumor had a significant blood supply, which made its removal challenging. Preoperative embolization of the tumor’s blood supply artery would facilitate surgical resection and help avoid massive intraoperative bleeding. Complete surgical resection is the treatment of choice, and any remaining tumor remnants can be managed with adjuvant radiotherapy post-surgery, necessitating long-term follow-up to monitor any developments.

A novel MRI-based radiomics for preoperative prediction of lymphovascular invasion in rectal cancer.

To develop and validate a clinical-radiomics model for preoperative prediction of lymphovascular invasion (LVI) in rectal cancer. This retrospective study included data from 239 patients with pathologically confirmed rectal adenocarcinoma from two centers, all of whom underwent MRI examinations. Cases from the first center (n = 189) were randomly divided into a training set and an internal validation set at a 7:3 ratio, while cases from the second center (n = 50) constituted the external validation set. The clinical features and MRI imaging characteristics of the patients in the training set were analyzed. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for LVI in rectal cancer, and these risk factors were then used to construct a clinical model. Regions of interest (ROIs) were delineated on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences for feature extraction. After feature reduction and selection, the most strongly correlated features were identified, and their respective regression coefficients were calculated to construct the radiomics model. Finally, a combined clinical-radiomics model was built using a weighted linear combination of features and was visualized as a nomogram. The predictive performance of each model was quantified using receiver operating characteristics (ROC) curves and the area under the curve (AUC) in both training and validation sets, with DeLong analysis being used to compare model performance. Decision curve analysis (DCA) was used to evaluate the clinical utility of each model in the validation sets. In the 239 patients, the combined model outperformed the clinical and radiomics models in predicting LVI in rectal cancer. The combined model showed excellent predictive performance in the training, internal validation, and external validation sets, with AUCs of 0.90 (0.88-0.97), 0.88 (0.78-0.99), and 0.88 (0.78-0.95), respectively. The sensitivity values were 75.9%, 68.8%, and 80.0%, respectively, and the specificity values were 90.3%, 92.7%, and 88.6%. DCA results indicated that the nomogram of the combined model had superior clinical utility compared with the clinical and radiomics models. The clinical-radiomics nomogram serves as a valuable tool for non-invasive preoperative prediction of LVI status in patients with rectal cancer.

Comparative analysis of imaging and pathological features in diagnosis of endometrial carcinosarcoma based on multimodal MRI.

This case report aims to present a rare case of endometrial carcinosarcoma, a highly malignant tumor with a poor prognosis. The primary objective is to describe this unique case's clinical presentation, multimodal magnetic resonance imaging (MRI) features, typical histopathological characteristics and surgical treatment. A detailed analysis of the patient's medical history, preoperative imaging evaluation, and treatment approach was conducted. This case report includes high-resolution images and figures, showcasing MRI scans, surgical treatment, and histopathology slides related to the case. The case report outlines imaging findings of a rare case of endometrial carcinosarcoma. Multimodal imaging such as T1-weighted imaging (T1WI), T2-weighted imaging (T2WI) and multi-b-value diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) scanning could accurately identify the histopathological features of the case. Surgical resection is the best treatment, and preoperative imaging evaluation should be particularly important. This case report highlights endometrial carcinosarcoma's rarity and diagnostic challenges. Multimodal MRI has significant value in diagnosing endometrial carcinosarcoma. This technology not only improves the sensitivity, specificity, and accuracy of diagnosis, but also helps to more accurately evaluate the staging and grading of tumors. By comparing imaging features and pathological results, studies have found that multimodal MRI can clearly show the anatomical structure, pathological nature, and extent of the tumor, with a high degree of consistency with the pathological diagnosis. In particular, when differentiating endometrial carcinosarcoma from low-risk endometrial cancer, multimodal MRI combined with serum carbohydrate antigen 125 (CA125) and E-box binding zinc finger protein 1 (ZEB1) detection can further improve the sensitivity and specificity of differential diagnosis. In addition, research has found that the ADC value of the tumor tissue in different pathological grades is related to the multimodal MRI, which helps to better understand the biological behavior and prognosis of the tumor. In summary, multimodal MRI is an effective diagnostic tool that can provide important evidence for the precise diagnosis and treatment of endometrial carcinosarcoma.

Individualized morphological covariation network aberrance associated with seizure relapse after antiseizure medication withdrawal.

This study intents to detect graphical network features associated with seizure relapse following antiseizure medication (ASM) withdrawal. Twenty-four patients remaining seizure-free (SF-group) and 22 experiencing seizure relapse (SR-group) following ASM withdrawal as well as 46 matched healthy participants (Control) were included. Individualized morphological similarity network was constructed using T1-weighted images, and graphic metrics were compared between groups. Relative to the Control, the SF-group exhibited lower local efficiency, while the SR-group displayed lower global and local efficiency and longer characteristic path length. Both patient groups displayed reduced centrality in certain subcortical and cortical nodes than the Control, with a more pronounced reduction in the SR-group. Additionally, the SR-group exhibited lower centrality of the right pallidum than the SF-group. Decreased subcortical-cortical connectivity was found in both patient groups than the Control, with a more extensive decrease in the SR-group. Furthermore, an edge connecting the right pallidum and left middle temporal gyrus exhibited decreased connectivity in the SR-group than in the SF-group. A weaker small-worldization network upon medication withdrawal, potentially underpinned by node decentralization and subcortical-cortical decoupling, may elevate the risk of seizure relapse.

Differentiating Liver Metastases from Primary Liver Cancer: A Retrospective Study of Imaging and Pathological Features in Patients with Histopathological Confirmation

Background and Objectives: This study aimed to identify and analyze imaging and pathological features that differentiate liver metastases from primary liver cancer in patients with histopathological confirmation, and to evaluate the diagnostic accuracy of imaging modalities. Materials and Methods: This retrospective study included 137 patients who underwent liver biopsy or resection between 2016 and 2024, comprising 126 patients with liver metastases and 11 patients with primary liver cancer (hepatocellular carcinoma). Imaging features on contrast-enhanced MRI were evaluated, including lesion number, size, margins, enhancement patterns, presence of capsule, T1/T2 signal characteristics, diffusion-weighted imaging (DWI) signal, and portal vein thrombosis. Laboratory data such as liver function tests and alpha-fetoprotein (AFP) levels were collected. Pathological features recorded included tumor differentiation, vascular invasion, necrosis, and fibrosis. Statistical analyses were performed using chi-squared tests, t-tests, and logistic regression, with a significance level of p &lt; 0.05. The diagnostic accuracy of imaging features was assessed using receiver operating characteristic (ROC) curve analysis. Results: Liver metastases were more likely to present as multiple lesions (82.5% vs. 27.3%, p &lt; 0.001), had irregular margins (78.6% vs. 36.4%, p = 0.002), rim enhancement (74.6% vs. 18.2%, p &lt; 0.001), and were hypointense on T1-weighted images (85.7% vs. 45.5%, p = 0.004). Primary liver cancers were more likely to be solitary (72.7% vs. 17.5%, p &lt; 0.001), have smooth margins (63.6% vs. 21.4%, p = 0.002), exhibit arterial phase hyperenhancement (81.8% vs. 23.8%, p &lt; 0.001), and portal venous washout (72.7% vs. 19.0%, p &lt; 0.001). Vascular invasion was more common in primary liver cancer (45.5% vs. 11.1%, p = 0.01). AFP levels &gt; 400 ng/mL were significantly associated with primary liver cancer (63.6% vs. 4.8%, p &lt; 0.001). ROC curve analysis showed that a combination of imaging features had an area under the curve (AUC) of 0.91 for differentiating the two entities. Conclusions: Imaging features such as lesion number, margin characteristics, enhancement patterns, T1/T2 signal characteristics, and portal venous washout, along with pathological features like vascular invasion and AFP levels, can effectively differentiate liver metastases from primary liver cancer. The diagnostic accuracy of imaging is high when multiple features are combined.

The MRI-based vertebral bone quality score is a predictor of pedicle screw loosening following instrumented posterior lumbar fusion

Objective: To investigate the predictive ability of the MRI-based vertebral bone quality (VBQ) score for pedicle screw loosening following instrumented transforaminal lumbar interbody fusion (TLIF). Methods: Data from patients who have received one or two-level instrumented TLIF from February 2014 to March 2015 were retrospectively collected. Pedicle screw loosening was diagnosed when the radiolucent zone around the screw exceeded 1 mm in plain radiographs. The T1-weighted MRI sagittal images were used for calculation of the VBQ score. The score was calculated with the median signal intensity value of L1 to L4 divided by the signal intensity value of cerebrospinal fluid at the L3 level. Univariate analysis and multivariate binary logistic regression analysis were performed. Receiver operating characteristic curve analysis assessed the predictive ability of the VBQ score on screw loosening. Results: Among the included 211 patients, 75 of them (35.55%) had pedicle screw loosening at the 24 month follow-up. Multivariable logistic regression analyses demonstrated that higher VBQ score (OR: 27.887 ± 0.514 ,95% CI: 10.189–76.326), male sex (female to male 0.323 ± 0.483, 0.126–0.833), and longer fusion length (2.578 ± 0.545, 1.166–5.701) were significant influencing factors for pedicle screw loosening. The VBQ score significantly predicted screw loosening with an accuracy of 78.9%. Conclusions: A higher VBQ score was an independent risk factor for pedicle screw loosening following instrumented TLIF. The MRI-based VBQ score showed good predictive ability for screw loosening and could be used as an alternative option for preoperative bone quality evaluation.

Clinical feasibility of MRI-guided in-bore prostate biopsies at 0.55T.

In-bore MRI-guided biopsy allows direct visualization of suspicious lesions, biopsy needles, and trajectories, allowing accurate sampling when MRI-ultrasound fusion biopsy is not feasible. However, its use has been limited. Wide-bore, lower-field, and lower-cost scanners could help address these issues, but their feasibility for prostate biopsy is unknown. The purpose of our study was to evaluate the feasibility of in-bore MRI-guided prostate biopsy using a large-bore (80cm), 0.55T scanner. Nineteen participants (68 ± 10 years) with suspected prostate cancer (PCa) were recruited for this Institutional Review Board (IRB) approved study (May 2023 -October 2024). Prebiopsy diagnostic scans and intra-procedural T2-weighted images were used for lesion localization. PSA levels, lesion sizes, cancer detection rates, positive core volume percentage, ISUP (International Society of Urological Pathology) grade groups (GG), positive volume cores, skin to target distances, and procedure durations were reported. Seventeen participants underwent biopsies (four transrectal, thirteen percutaneous). Two participants were excluded. Twenty lesions (mean size 1.9 ± 1.2cm) were biopsied which showed various GG cancers (GG1, GG2, GG3, GG4, and GG5), with positive cores ranging from 10 to 100%. 20% of the lesions were benign. Compared to previous biopsies, 22.2% (2/9) had new cancer detections, 22.2% (2/9) showed a GG upgrade, and 33.3% (3/9) had increased positive core volume, while 11.1% (1/9) showed no upgrade and 11.1% (1/9) had benign findings. Among biopsy-naïve participants, 75% (6/8) had cancer detected, and 25% (2/8) had benign findings. One new cancer was detected near a hip prosthesis due to reduced imaging artifacts. Average total procedure time was 77 ± 21min for transrectal and 74 ± 22min for percutaneous biopsies, with times to first core at 45 ± 15 and 53 ± 14min, respectively. Identifying and accurately targeting suspicious prostate lesions is feasible using a 0.55T MRI scanner.

Deep learning MRI models for the differential diagnosis of tumefactive demyelination versus IDH-wildtype glioblastoma.

Diagnosis of tumefactive demyelination can be challenging. The diagnosis of indeterminate brain lesions on MRI often requires tissue confirmation via brain biopsy. Noninvasive methods for accurate diagnosis of tumor and non-tumor etiologies allows for tailored therapy, optimal tumor control, and a reduced risk of iatrogenic morbidity and mortality. Tumefactive demyelination has imaging features that mimic isocitrate dehydrogenase-wildtype glioblastoma (IDHwt GBM). We hypothesized that deep learning applied to postcontrast T1-weighted (T1C) and T2-weighted (T2) MRI images can discriminate tumefactive demyelination from IDHwt GBM. Patients with tumefactive demyelination (n=144) and IDHwt GBM (n=455) were identified by clinical registries. A 3D DenseNet121 architecture was used to develop models to differentiate tumefactive demyelination and IDHwt GBM using both T1C and T2 MRI images, as well as only T1C and only T2 images. A three-stage design was used: (i) model development and internal validation via five-fold cross validation using a sex-, age-, and MRI technology-matched set of tumefactive demyelination and IDHwt GBM, (ii) validation of model specificity on independent IDHwt GBM, and (iii) prospective validation on tumefactive demyelination and IDHwt GBM. Stratified AUCs were used to evaluate model performance stratified by sex, age at diagnosis, MRI scanner strength, and MRI acquisition. The deep learning model developed using both T1C and T2 images had a prospective validation area under the receiver operator characteristic curve (AUC) of 88% (95% CI: 0.82 - 0.95). In the prospective validation stage, a model score threshold of 0.28 resulted in 91% sensitivity of correctly classifying tumefactive demyelination and 80% specificity (correctly classifying IDHwt GBM). Stratified AUCs demonstrated that model performance may be improved if thresholds were chosen stratified by age and MRI acquisition. MRI images can provide the basis for applying deep learning models to aid in the differential diagnosis of brain lesions. Further validation is needed to evaluate how well the model generalizes across institutions, patient populations, and technology, and to evaluate optimal thresholds for classification. Next steps also should incorporate additional tumor etiologies such as CNS lymphoma and brain metastases. AUC = area under the receiver operator characteristic curve; CNS = central nervous system; CNSIDD = central nervous system inflammatory demyelinating disease; FeTS = federated tumor segmentation; GBM = glioblastoma; IDHwt = isocitrate dehydrogenase wildtype; IHC = immunohistochemistry; MOGAD = myelin oligodendrocyte glycoprotein antibody associated disorder; MS = multiple sclerosis; NMOSD = neuromyelitis optica spectrum disorder; wt = wildtype.

T1 mapping using MP2RAGE in degenerative cervical myelopathy: a longitudinal study.

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord (SC) dysfunction. In routine clinical practice, SC changes are well depicted using conventional MRI, especially T2-weighted imaging. However, this modality usually fails to provide satisfactory clinico-radiological correlations. In this context we assessed the potential value of quantitative changes measured with a T1 MP2RAGE sequence. 18 patients diagnosed with chronic onset of DCM and 17 healthy controls (HC) were enrolled in the study. Clinical presentation was assessed using the modified Japanese Orthopaedic Association (mJOA) scale. Sagittal cervical SC T2-w 3D SPACE imaging and T1 MP2RAGE mapping were performed at baseline and 3-months postoperatively. Data were processed using Matlab and the SC Toolbox. mJOA score increased from 13.3 ± 2.1 preoperatively to 14.4 ± 1.9 at follow-up (p = 0.027). Site of maximum compression (Cmax) was at C3-C4 cervical levels in 4 patients, C4-C5 in 8 patients, C5-C6 in 5 patients and C6-C7 in 1 patient. SC compression was multi-level in 7 patients and single-level in 11 patients. T2-w hyperintensity was present in 15 patients. Mean SC T1 values in the whole SC in the DCM group at baseline showed significant difference as compared to mean SC T1 values in HC group (962.2 ± 62 vs. 924.9 ± 34 ms, respectively (p < 0.0001)) but no differences could be observed between baseline and 3-month follow-up (962.4 ± 59 ms (p = 0.86)). Z-scores at baseline were - 0.05 ± 1 for mild, 1.2 ± 1.9 for moderate and 2.5 ± 1.2 for severe. Mean baseline and 3-month follow-up SC T1 values were weakly but significantly correlated to preoperative (R2 = 0.33 (p = 0.013) and postoperative mJOA (R2 = 0.29 (p = 0.024). Baseline T1 value at C2 level was significantly correlated with mJOA at 3-month follow-up (p = 0.048). T1-MP2RAGE mapping in patients with DCM demonstrated both focal and diffuse cervical SC alteration. It could thus be a biomarker for patients with DCM managed surgically.

Multinodular and Vacuolating Neuronal Tumors of the Cerebrum: A Systematic Review of the Literature.

Multinodular and vacuolating neuronal tumors (MVNTs) of the cerebrum are rare, seizure-related, low-grade tumors of the central nervous system that usually affect young adults. First described by Huse etal. in 2013, these neoplasms are usually located within the deep cortical ribbon and the superficial white matter and have a characteristic cytoarchitecture of cells with neuronal and glial differentiation that form multiple nodules with conspicuous vacuolation. Because of their benign nature and indolent clinical course, radiologically based differentiation from other entities is of paramount importance to avoid unnecessary surgical intervention. To the best of our knowledge, our study represents the first systematic review in the literature aiming to delineate the characteristics of MVNTs regarding epidemiology, clinical manifestation, histopathology, imaging, and management. PubMed/MEDLINE and SCOPUS databases were systematically investigated for MVNT cases until November 2023. The search yielded 29 case reports comprising 41 patients with a mean age of 32.6 years and 7 case series with 164 patients. MVNTs were most commonly located in the supratentorial compartment, affecting the temporal, frontal, or parietal lobes. Their most frequent initial clinical manifestation was either seizures or headaches. On conventional magnetic resonance imaging techniques, they usually appear hypointense in T1-weighted images and hyperintense in T2-weighted and fluid-attenuated inversion recovery images and lack perilesional edema or postcontrast enhancement. MVNTs do not seem to change size or recur, even after partial resection of the tumor, indicating their indolent course, and, thus, surveillance with serial magnetic resonance imaging is the most appropriate management technique for these lesions.

Early-Life Adversity Predicts Markers of Aging-Related Neuroinflammation, Neurodegeneration, and Cognitive Impairment in Women.

Despite the overwhelming evidence for profound and longstanding effects of early-life stress (ELS) on inflammation, brain structure, and molecular aging, its impact on human brain aging and risk for neurodegenerative disease is poorly understood. We examined the impact of ELS severity in interaction with age on blood-based markers of neuroinflammation and neurodegeneration, brain volumes, and cognitive function in middle-aged women. We recruited 179 women (aged 30-60 years) with and without ELS exposure before the onset of puberty. Using Simoa technology, we assessed blood-based markers of neuroinflammation and neurodegeneration, including serum concentrations of glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL). We further obtained T1-weighted and T2-weighted magnetic resonance images to assess brain volumes and we assessed cognitive performance sensitive to early impairments associated with the development of dementia, using the Cambridge Neuropsychological Automated Test Battery. We used generalized additive models to examine nonlinear interaction effects of ELS severity and age on these outcomes. Analyses revealed significant nonlinear interaction effects of ELS severity and age on NfL and GFAP serum concentrations, total and subcortical gray matter volume loss, increased third ventricular volume, and cognitive impairment. These findings suggest that ELS profoundly exacerbates peripheral, neurostructural, and cognitive markers of brain aging. Our results are critical for the development of novel early prevention strategies that target the impact of developmental stress on the brain to mitigate aging-related neurological diseases. ANN NEUROL 2025.