scholarly journals Pre-contrast T1-weighted imaging of the spinal cord may be unnecessary in patients with multiple sclerosis

2021 ◽  
Author(s):  
Isabelle Riederer ◽  
Mark Mühlau ◽  
Claus Zimmer ◽  
Magaly Gutbrod-Fernandez ◽  
Nico Sollmann ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Image Quality ◽  
Detection Rate ◽  
List Type ◽  
Diagnostic Confidence ◽  
Post Contrast ◽  
Scan Time ◽  
Spinal Mri

Abstract Objectives Multiple sclerosis (MS) is an inflammatory disease frequently involving the spinal cord, which can be assessed by magnetic resonance imaging (MRI). Here, we hypothesize that pre-contrast T1-w imaging does not add diagnostic value to routine spinal MRI for the follow-up of patients with MS. Methods 3-T MRI scans including pre- and post-contrast T1-w as well as T2-w images of 265 consecutive patients (mean age: 40 ± 13 years, 169 women) with (suspected) MS were analyzed retrospectively. Images were assessed in two separate reading sessions, first excluding and second including pre-contrast T1-w images. Two independent neuroradiologists rated the number of contrast-enhancing (ce) lesions as well as diagnostic confidence (1 = unlikely to 5 = very high), overall image quality, and artifacts. Results were compared using Wilcoxon matched-pairs signed-rank tests and weighted Cohen’s kappa (κ). Results Fifty-six ce lesions were found in 43 patients. There were no significant differences in diagnostic confidence between both readings for both readers (reader 1: p = 0.058; reader 2: p = 0.317). Inter-rater concordance was both moderate regarding artifacts (κ = 0.418) and overall image quality (κ = 0.504). Thirty-one black holes were found in 25 patients with high diagnostic confidence (reader 1: 4.04 ± 0.81; reader 2: 3.80 ± 0.92) and substantial inter-rater concordance (κ = 0.700). Conclusions Availability of pre-contrast T1-w images did not significantly increase diagnostic confidence or detection rate of ce lesions in the spinal cord in patients with MS. Thus, pre-contrast T1-w sequences might be omitted in routine spinal MRI for follow-up exams, however not in special unclear clinical situations in which certainty on contrast enhancement is required. Key Points Availability of pre-contrast T1-w images does not increase diagnostic confidence or detection rate of contrast-enhancing lesions in the spinal cord of MS patients. Excluding pre-contrast T1-w sequences reduces scan time, thus providing more time for other sequences or increasing the patients’ compliance.

Pediatric onset multiple sclerosis: McDonald criteria 2010 and the contribution of spinal cord MRI

2013 ◽  
Vol 19 (10) ◽  
pp. 1330-1335 ◽  
Author(s):  
Hannah-Maria Hummel ◽  
Wolfgang Brück ◽  
Steffi Dreha-Kulaczewski ◽  
Jutta Gärtner ◽  
Jens Wuerfel
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Age At Onset ◽  
Regional Distribution ◽  
Pediatric Multiple Sclerosis ◽  
Mcdonald Criteria ◽  
Spinal Mri ◽  
Magnetic Resonance Imaging Mri ◽  
Pediatric Onset

Background: Diagnostic magnetic resonance imaging (MRI) criteria have not been sufficiently validated in pediatric multiple sclerosis (MS) despite differences in epidemiologic data and clinical disease courses between pediatric and adult MS. Objective: The objective of this paper is to evaluate the diagnostic applicability and validity of the revised McDonald diagnostic criteria 2010 in a large cohort of pediatric-onset MS patients (POMS) and compare them to previously recommended MRI-based classifications. Furthermore, we aimed to investigate the contribution of spinal cord lesions to the revised McDonald criteria 2010. Methods: A cohort of 85 patients with definite MS, age at onset 2.8–18 years, was analyzed in a retrospective multicenter study. Number and regional distribution of T2w and contrast-enhancing T1w lesions at initial and follow-up MRIs were main outcome measures. Results: In 62% of POMS the initial MRI within four weeks after symptom onset was sufficient to diagnose MS according to the revised McDonald criteria 2010. In a subcohort of patients with spinal MRI at first presentation, 10% reached the dissemination in space (DIS) and dissemination in time (DIT) criteria only by the inclusion of contrast-enhancing spinal lesions. Conclusions: The revised McDonald criteria 2010 facilitate the diagnosis of POMS already at first presentation. The addition of a spinal cord MRI was helpful only in selected cases.

Minimizing table time in patients with claustrophobia using focused ferumoxytol-enhanced MR angiography (f-FEMRA): a feasibility study

2021 ◽  
Vol 94 (1125) ◽  
pp. 20210430
Author(s):  
Puja Shahrouki ◽  
Kim-Lien Nguyen ◽  
John M. Moriarty ◽  
Adam N. Plotnik ◽  
Takegawa Yoshida ◽  
...  
Keyword(s):  
Image Quality ◽  
Mr Angiography ◽  
Signal To Noise Ratio ◽  
Diagnostic Image Quality ◽  
Diagnostic Confidence ◽  
Motion Artefact ◽  
Scan Time ◽  
Wilcoxon Rank Sum Test ◽  
Significant Difference ◽  
Noise Ratio

Objectives: To assess the feasibility of a rapid, focused ferumoxytol-enhanced MR angiography (f-FEMRA) protocol in patients with claustrophobia. Methods: In this retrospective study, 13 patients with claustrophobia expressed reluctance to undergo conventional MR angiography, but agreed to a trial of up to 10 min in the scanner bore and underwent f-FEMRA. Thirteen matched control patients who underwent gadolinium-enhanced MR angiography (GEMRA) were identified for comparison of diagnostic image quality. For f-FEMRA, the time from localizer image acquisition to completion of the angiographic acquisition was measured. Two radiologists independently scored images on both f-FEMRA and GEMRA for arterial and venous image quality, motion artefact and diagnostic confidence using a 5-point scale, five being best. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the aorta and IVC were measured. The Wilcoxon rank-sum test, one-way ANOVA with Tukey correction and two-tailed t tests were utilized for statistical analyses. Results: All scans were diagnostic and assessed with high confidence (scores ≥ 4). Average scan time for f-FEMRA was 6.27 min (range 3.56 to 10.12 min), with no significant difference between f-FEMRA and GEMRA in diagnostic confidence (4.86 ± 0.24 vs 4.69 ± 0.25, p = 0.13), arterial image quality (4.62 ± 0.57 vs 4.65 ± 0.49, p = 0.78) and motion artefact score (4.58 ± 0.49 vs 4.58 ± 0.28, p > 0.99). f-FEMRA scored significantly better for venous image quality than GEMRA (4.62 ± 0.42 vs 4.19 ± 0.56, p = 0.04). CNR in the IVC was significantly higher for steady-state f-FEMRA than GEMRA regardless of the enhancement phase (p < 0.05). Conclusions: Comprehensive vascular MR imaging of the thorax, abdomen and pelvis can be completed in as little as 5 min within the magnet bore using f-FEMRA, facilitating acceptance by patients with claustrophobia and streamlining workflow. Advances in knowledge: A focused approach to vascular imaging with ferumoxytol can be performed in patients with claustrophobia, limiting time in the magnet bore to 10 min or less, while acquiring fully diagnostic images of the thorax, abdomen and pelvis.

scholarly journals 3D Dixon water-fat LGE imaging with image navigator and compressed sensing in cardiac MRI

2020 ◽  
Author(s):  
Martin Georg Zeilinger ◽  
Marco Wiesmüller ◽  
Christoph Forman ◽  
Michaela Schmidt ◽  
Camila Munoz ◽  
...  
Keyword(s):  
High Resolution ◽  
Image Quality ◽  
Compressed Sensing ◽  
Cardiac Mri ◽  
Three Dimensional ◽  
Fat Suppression ◽  
Diagnostic Confidence ◽  
Pericardial Disease ◽  
Scan Time ◽  
Wilcoxon Rank Sum Test

Abstract Objectives To evaluate an image-navigated isotropic high-resolution 3D late gadolinium enhancement (LGE) prototype sequence with compressed sensing and Dixon water-fat separation in a clinical routine setting. Material and methods Forty consecutive patients scheduled for cardiac MRI were enrolled prospectively and examined with 1.5 T MRI. Overall subjective image quality, LGE pattern and extent, diagnostic confidence for detection of LGE, and scan time were evaluated and compared to standard 2D LGE imaging. Robustness of Dixon fat suppression was evaluated for 3D Dixon LGE imaging. For statistical analysis, the non-parametric Wilcoxon rank sum test was performed. Results LGE was rated as ischemic in 9 patients and non-ischemic in 11 patients while it was absent in 20 patients. Image quality and diagnostic confidence were comparable between both techniques (p = 0.67 and p = 0.66, respectively). LGE extent with respect to segmental or transmural myocardial enhancement was identical between 2D and 3D (water-only and in-phase). LGE size was comparable (3D 8.4 ± 7.2 g, 2D 8.7 ± 7.3 g, p = 0.19). Good or excellent fat suppression was achieved in 93% of the 3D LGE datasets. In 6 patients with pericarditis, the 3D sequence with Dixon fat suppression allowed for a better detection of pericardial LGE. Scan duration was significantly longer for 3D imaging (2D median 9:32 min vs. 3D median 10:46 min, p = 0.001). Conclusion The 3D LGE sequence provides comparable LGE detection compared to 2D imaging and seems to be superior in evaluating the extent of pericardial involvement in patients suspected with pericarditis due to the robust Dixon fat suppression. Key Points • Three-dimensional LGE imaging provides high-resolution detection of myocardial scarring. • Robust Dixon water-fat separation aids in the assessment of pericardial disease. • The 2D image navigator technique enables 100% respiratory scan efficacy and permits predictable scan times.

A DTI study of the spinal cord lesion in patients with multiple sclerosis during the follow-up after relapse

2016 ◽  
Vol 116 (2. Vyp. 2) ◽  
pp. 21 ◽  
Author(s):  
S. N. Morozova ◽  
V. V. Bryukhov ◽  
O. V. Trifonova ◽  
E. I. Kremneva ◽  
M. V. Krotenkova
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cord Lesion

CT follow-up in patients with neuroendocrine tumors (NETs): combined radiation and contrast dose reduction

2017 ◽  
Vol 59 (5) ◽  
pp. 517-526 ◽  
Author(s):  
G Böning ◽  
JF Kahn ◽  
D Kaul ◽  
R Rotzinger ◽  
P Freyhardt ◽  
...  
Keyword(s):  
Image Quality ◽  
Contrast Agent ◽  
Dose Reduction ◽  
Neuroendocrine Tumors ◽  
Signal To Noise Ratio ◽  
Low Grade ◽  
Diagnostic Confidence ◽  
Reduction Techniques ◽  
Applied Dose

Background Frequent computed tomography (CT) follow-ups involve significant radiation related risks for patients with low-grade neuroendocrine tumors (NETs). Contrast agent (CA) application is essential for diagnostic evidence and has additional risks especially in patients with limited renal function. Purpose To investigate if a combination of dose and contrast agent (CA) reduction affects image quality and diagnostic evidence in neuroendocrine tumor (NET) patients. Material and Methods A total of 51 NET patients were enrolled in the study and 153 CT scans were analyzed. Patients underwent a baseline CT scan (A = 120 kVp, filtered back projection [FBP]) and two follow-up CTs (B = 120 kVp, adaptive statistical iterative reconstruction [ASIR] 40%; C1 = 100 kVp, ASIR 40%; C2 = 100 kVp, ASIR 60%; the latter two protocols were applied with a 30% reduction in CA volume). We evaluated image quality and applied dose. Results In C1/2, the combination of low kV (100 kVp) with ASIR 40%/60% reduced the mean applied dose significantly by 28% compared to B and by 57% compared to A. Signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR) of tumor to liver/muscle were significantly increased by using C1/2 compared to B and A. With respect to subjective image quality, a slight loss of diagnostic confidence in C1 could be counterbalanced by the higher ASIR blending in C2. Conclusion Combined dose reduction techniques can be used to reduce radiation dose and CA volume without sacrificing image quality and diagnostic confidence in staging CT of NET patients.

scholarly journals Clinical Evaluation of an Abbreviated Contrast-Enhanced Whole-Body MRI for Oncologic Follow-Up Imaging

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2368
Author(s):  
Judith Herrmann ◽  
Saif Afat ◽  
Andreas Brendlin ◽  
Maryanna Chaika ◽  
Andreas Lingg ◽  
...  
Keyword(s):  
Image Quality ◽  
Random Order ◽  
Whole Body ◽  
Diagnostic Confidence ◽  
Whole Body Mri ◽  
Institutional Review ◽  
Contrast Enhanced ◽  
Mri Protocol ◽  
Cancer Types

Over the last decades, overall survival for most cancer types has increased due to earlier diagnosis and more effective treatments. Simultaneously, whole-body MRI-(WB-MRI) has gained importance as a radiation free staging alternative to computed tomography. The aim of this study was to evaluate the diagnostic confidence and reproducibility of a novel abbreviated 20-min WB-MRI for oncologic follow-up imaging in patients with melanoma. In total, 24 patients with melanoma were retrospectively included in this institutional review board-approved study. All patients underwent three consecutive staging examinations via WB-MRI in a clinical 3 T MR scanner with an abbreviated 20-min protocol. Three radiologists independently evaluated the images in a blinded, random order regarding image quality (overall image quality, organ-based image quality, sharpness, noise, and artifacts) and regarding its diagnostic confidence on a 5-point-Likert-Scale (5 = excellent). Inter-reader agreement and reproducibility were assessed. Overall image quality and diagnostic confidence were rated to be excellent (median 5, interquartile range [IQR] 5–5). The sharpness of anatomic structures, and the extent of noise and artifacts, as well as the assessment of lymph nodes, liver, bone, and the cutaneous system were rated to be excellent (median 5, IQR 4–5). The image quality of the lung was rated to be good (median 4, IQR 4–5). Therefore, our study demonstrated that the novel accelerated 20-min WB-MRI protocol is feasible, providing high image quality and diagnostic confidence with reliable reproducibility for oncologic follow-up imaging.

scholarly journals Multiple sclerosis lesions in motor tracts from brain to cervical cord: spatial distribution and correlation with disability

Brain ◽  
2020 ◽  
Vol 143 (7) ◽  
pp. 2089-2105 ◽  
Author(s):  
Anne Kerbrat ◽  
Charley Gros ◽  
Atef Badji ◽  
Elise Bannier ◽  
Francesca Galassi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Volume Fraction ◽  
Lesion Volume ◽  
Corticospinal Tracts ◽  
Disability Status ◽  
Relapsing Remitting ◽  
The Brain ◽  
Lesion Frequency

Abstract Despite important efforts to solve the clinico-radiological paradox, correlation between lesion load and physical disability in patients with multiple sclerosis remains modest. One hypothesis could be that lesion location in corticospinal tracts plays a key role in explaining motor impairment. In this study, we describe the distribution of lesions along the corticospinal tracts from the cortex to the cervical spinal cord in patients with various disease phenotypes and disability status. We also assess the link between lesion load and location within corticospinal tracts, and disability at baseline and 2-year follow-up. We retrospectively included 290 patients (22 clinically isolated syndrome, 198 relapsing remitting, 39 secondary progressive, 31 primary progressive multiple sclerosis) from eight sites. Lesions were segmented on both brain (T2-FLAIR or T2-weighted) and cervical (axial T2- or T2*-weighted) MRI scans. Data were processed using an automated and publicly available pipeline. Brain, brainstem and spinal cord portions of the corticospinal tracts were identified using probabilistic atlases to measure the lesion volume fraction. Lesion frequency maps were produced for each phenotype and disability scores assessed with Expanded Disability Status Scale score and pyramidal functional system score. Results show that lesions were not homogeneously distributed along the corticospinal tracts, with the highest lesion frequency in the corona radiata and between C2 and C4 vertebral levels. The lesion volume fraction in the corticospinal tracts was higher in secondary and primary progressive patients (mean = 3.6 ± 2.7% and 2.9 ± 2.4%), compared to relapsing-remitting patients (1.6 ± 2.1%, both P &lt; 0.0001). Voxel-wise analyses confirmed that lesion frequency was higher in progressive compared to relapsing-remitting patients, with significant bilateral clusters in the spinal cord corticospinal tracts (P &lt; 0.01). The baseline Expanded Disability Status Scale score was associated with lesion volume fraction within the brain (r = 0.31, P &lt; 0.0001), brainstem (r = 0.45, P &lt; 0.0001) and spinal cord (r = 0.57, P &lt; 0.0001) corticospinal tracts. The spinal cord corticospinal tracts lesion volume fraction remained the strongest factor in the multiple linear regression model, independently from cord atrophy. Baseline spinal cord corticospinal tracts lesion volume fraction was also associated with disability progression at 2-year follow-up (P = 0.003). Our results suggest a cumulative effect of lesions within the corticospinal tracts along the brain, brainstem and spinal cord portions to explain physical disability in multiple sclerosis patients, with a predominant impact of intramedullary lesions.

Tailored CT angiography in follow-up after endovascular aneurysm repair (EVAR): combined dose reduction techniques

2018 ◽  
Vol 59 (11) ◽  
pp. 1316-1325 ◽  
Author(s):  
Georg Böning ◽  
Roman A Rotzinger ◽  
Johannes F Kahn ◽  
Patrick Freyhardt ◽  
Diane M Renz ◽  
...  
Keyword(s):  
Image Quality ◽  
Dose Reduction ◽  
Iterative Reconstruction ◽  
Signal To Noise Ratio ◽  
Endovascular Aneurysm Repair ◽  
Diagnostic Confidence ◽  
Diagnostic Quality ◽  
Noise Ratio ◽  
Aneurysm Repair

Background Endovascular aneurysm repair (EVAR) requires lifelong surveillance by computed tomography angiography (CTA). This is attended by a substantial accumulation of radiation exposure. Iterative reconstruction (IR) has been introduced to approach dose reduction. Purpose To evaluate adaptive statistical iterative reconstruction (ASIR) at different levels of tube voltage concerning image quality and dose reduction potential in follow-up post EVAR. Material and Methods One hundred CTAs in 67 patients with EVAR were examined using five protocols: protocol A (n = 40) as biphasic standard using filtered back projection (FBP) at 120 kV; protocols B (n = 40), C (n = 10), and D1 (n = 5) biphasic using ASIR at 120, 100, and 80 kV, respectively; and protocol D2 (n = 5) with a monophasic splitbolus ASIR protocol at 80 kV. Image quality was assessed quantitatively and qualitatively. Applied doses were determined. Results Applied doses in ASIR protocols were significantly lower than FBP standard (up to 75%). Compared to protocol A, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) (e.g. arterial CNR intra-/extra-stent lumen: A = 35.4 ± 13.5, B = 34.2 ± 10.0, C = 29.6 ± 6.8, D1 = 32.1 ± 6.3, D2 = 40.8 ± 23.1) in protocol B were equal and in protocols C and D equal to partially inferior, however not decisive for diagnostic quality. Subjective image quality ratings in all protocols were good to excellent without impairments of diagnostic confidence (A–D2: 5), with high inter-rater agreement (60–100%). Conclusion ASIR contributes to significant dose reduction without decisive impairments of image quality and diagnostic confidence. We recommend an adapted follow-up introducing ASIR and combined low-kV in the long-term surveillance after EVAR.

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