Evaluation of an Ultra-Short MRI Protocol for Cerebral Staging Examinations in Melanoma Patients

Purpose Due to its high sensitivity and lack of radiation, MRI is often used to stage cerebral tumors in patients. In contrast, the relatively long examination times and the limited availability of MRI slots at the clinic might delay these examinations. The aim of this study was to compare an ultra-short MRI protocol with the routinely used standard protocol. Materials and Methods Cerebral MRI of 147 patients with malignant melanoma were evaluated retrospectively, whereby only two sequences (FLAIR images and contrast-enhanced T1 MPR images) were evaluated in one group and images from the whole examination were available for the second group, including five sequences (DWI, T2 TSE, FLAIR, native and contrast-enhanced T1 TSE, and contrast-enhanced T1 MPR). The results of the two groups were compared and tested to determine whether the ultra-short approach was inferior to the full examination. Results 13.6 % of the patients had cerebral metastases. Overall, 73 metastases were detected: 60 were located supratentorially and 13 infratentorially. Concerning the detection of cerebral metastases, the ultra-short MRI examination, involving only a FLAIR and a contrast-enhanced T1 MPR sequence, was not inferior to the full MRI protocol in general (p = 0.017) and separated by location for supratentorial (p = 0.026) and infratentorial (p = 0.001) metastases. Conclusion For staging purposes, a focused, ultra-short MRI protocol is not inferior to a standard MRI examination. This might open up opportunities for faster staging processes and a more efficient use of the often-restricted MRI capacities. Key Points Citation Format

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Contrast-free MRI Protocol for Pituitary Assessment in Children with Growth or Puberty Disorders: A Practical Approach.

10.21203/rs.3.rs-266238/v1 ◽

2021 ◽

Author(s):

Marta Michali-Stolarska ◽

Andrzej Tukiendorf ◽

Jagoda Jacków-Nowicka ◽

Anna Zacharzewska-Gondek ◽

Joanna Chrzanowska ◽

...

Keyword(s):

P Value ◽

Contrast Administration ◽

Post Contrast ◽

Mri Examination ◽

Contrast Enhanced ◽

Mri Protocol ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft ◽

Sensitivity Specificity ◽

Administration Methods

Abstract Objectives Most of the pituitary MRI examinations in children with growth or puberty disorders (GPD) might not require gadolinium-based contrast agent (GBCA) administration. Methods Retrospective re-analysis of contrast-enhanced 567 pituitary MRIs of children with GPD. Two sets of sequences were created from each MRI examination: Set1 - common sequences without contrast administration and Set2 - common pre- and post-contrast sequences. The differences in the visibility of pituitary lesions between sets were statistically analyzed. Results The overall frequency of Rathke's cleft cysts was 11.6%, ectopic posterior pituitary 3.5% and microadenomas 0.9%. Lesions visible without contrast administration accounted for 85% of cases, while lesions diagnosed only after contrast injection accounted for 0.18% of all patients. Statistical analysis showed the advantage of antero-posterior (AP) pituitary dimension over other criteria in determining the appropriateness of using contrast in pituitary MRIs. The AP dimension was the most significant factor in logistic regression analysis: OR=2.23, 95%CI, 1.35-3.71, p-value=0.002 and in ROC analysis: AUC:72.9% with cut-off value 7.5 mm, with sensitivity/specificity rates: 69.2%/73.5%. Conclusions In most cases, the use of GBCA in pituitary MRI in children with GPD is unnecessary. The additional advantages of GBCA omission include: shortening the time of MRI examination and of general anesthesia.

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Pearls and Pitfalls of Contrast-Enhanced Mammography

Journal of Breast Imaging ◽

10.1093/jbi/wby013 ◽

2019 ◽

Vol 1 (1) ◽

pp. 64-72 ◽

Cited By ~ 4

Author(s):

Jordana Phillips ◽

Valerie J Fein-Zachary ◽

Priscilla J Slanetz

Keyword(s):

Imaging Modality ◽

Breast Mri ◽

Successful Implementation ◽

Newly Diagnosed ◽

Disease Extent ◽

Diagnostic Problem Solving ◽

Contrast Enhanced ◽

Comparable Performance ◽

Mri Protocol ◽

Monitoring Response

Abstract Contrast-enhanced mammography (CEM) is a promising new imaging modality that uses a dual-energy acquisition to provide both morphologic and vascular assessment of breast lesions. Although no official BI-RADS lexicon exists, interpretation entails using the mammographic BI-RADS lexicon in combination with that for breast MRI. CEM has comparable performance to breast MRI, with sensitivity of 93–100% and specificity of 80–94%. Currently FDA approved for diagnostic imaging, this technology can be helpful in determining disease extent in patients with newly diagnosed breast malignancy, monitoring response to neoadjuvant therapy, identifying mammographically occult malignancies, and diagnostic problem-solving. Studies are ongoing about its role in screening, especially in women with dense breasts or at elevated risk. There are some challenges to successful implementation into practice, but overall, patients tolerate the study well, and exam times are less than the full breast MRI protocol.

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Extended perfusion protocol for MS lesion quantification

Open Medicine ◽

10.1515/med-2020-0100 ◽

2020 ◽

Vol 15 (1) ◽

pp. 520-530

Author(s):

Eleftherios Kontopodis ◽

Kostas Marias ◽

Georgios C. Manikis ◽

Katerina Nikiforaki ◽

Maria Venianaki ◽

...

Keyword(s):

Statistical Analysis ◽

Magnetic Resonance ◽

Goodness Of Fit ◽

Accurate Determination ◽

Acquisition Time ◽

Minimal Extension ◽

Dce Mri ◽

Contrast Enhanced ◽

Demyelinating Lesions ◽

Mri Protocol

AbstractThis study aims to examine a time-extended dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) protocol and report a comparative study with three different pharmacokinetic (PK) models, for accurate determination of subtle blood–brain barrier (BBB) disruption in patients with multiple sclerosis (MS). This time-extended DCE-MRI perfusion protocol, called Snaps, was applied on 24 active demyelinating lesions of 12 MS patients. Statistical analysis was performed for both protocols through three different PK models. The Snaps protocol achieved triple the window time of perfusion observation by extending the magnetic resonance acquisition time by less than 2 min on average for all patients. In addition, the statistical analysis in terms of adj-R2 goodness of fit demonstrated that the Snaps protocol outperformed the conventional DCE-MRI protocol by detecting 49% more pixels on average. The exclusive pixels identified from the Snaps protocol lie in the low ktrans range, potentially reflecting areas with subtle BBB disruption. Finally, the extended Tofts model was found to have the highest fitting accuracy for both analyzed protocols. The previously proposed time-extended DCE protocol, called Snaps, provides additional temporal perfusion information at the expense of a minimal extension of the conventional DCE acquisition time.

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Contribution of advanced MRI to the diagnosis of giant tumefactive perivascular spaces

Acta Radiologica ◽

10.1177/02841851211047240 ◽

2021 ◽

pp. 028418512110472

Author(s):

Veysel Ayyildiz ◽

Ali Koksal ◽

Onur Taydas ◽

Hayri Ogul

Keyword(s):

Mr Spectroscopy ◽

Mr Angiography ◽

Diffusion Tensor ◽

Perivascular Spaces ◽

Cerebral Lesions ◽

Contrast Enhanced ◽

Cerebral Mri ◽

Mri Sequences ◽

Perfusion Mr ◽

Lactate Peak

Background Giant tumefactive perivascular spaces (PVSs) are uncommon benign cystic lesions. They can imitate cystic neoplasms. Purpose To evaluate the contribution of advanced neuro magnetic resonance imaging (MRI) techniques in the diagnosis of giant tumefactive PVSs and to further characterize these unusual cerebral lesions. Material and Methods The MRI scans of patients with tumefactive PVS diagnosed between 2010 and 2019 were retrospectively reviewed. All imaging studies included three plane conventional cerebral MRI sequences as well as precontrast 3D T1 MPRAGE, post-gadolinium 3D T1 acquisitions, sagittal plane 3D T2 SPACE, diffusion-weighted imaging, and time-of-flight (TOF) angiography. Some patients received perfusion MR, MR spectroscopy, diffusion tensor imaging (DTI), and contrast-enhanced TOF MR angiography. Results A perforating vessel was demonstrated in 16 patients (66.7%) by TOF imaging. In four patients, there were intracystic vascular collaterals on contrast-enhanced TOF MR angiography. Septal blooming was observed in four patients in susceptibility-weighted imaging. On perfusion MR, central hyperperfusion was observed in four patients, and peripheral hyperperfusion was observed in one patient. On MR spectroscopy, choline increase was observed in two patients, and there was a lactate peak in three patients, and both a choline increase and lactate peak in one patient. On DTI, there was fiber distortion in five patients and fiber deformation in one patient. Conclusion Advanced MRI techniques and 3D volumetric high-resolution MRI sequences can provide a valuable contribution to the diagnosis and can be successfully used in the management of these lesions.

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MULTIVARIATE MATHEMATICAL MORPHOLOGY FOR DCE-MRI IMAGE ANALYSIS IN ANGIOGENESIS STUDIES

Image Analysis & Stereology ◽

10.5566/ias.1109 ◽

2014 ◽

Vol 34 (1) ◽

pp. 1 ◽

Cited By ~ 3

Author(s):

Guillaume Noyel ◽

Jesus Angulo ◽

Dominique Jeulin ◽

Daniel Balvay ◽

Charles-André Cuenod

Keyword(s):

Noise Reduction ◽

Data Sets ◽

Computer Aided Detection ◽

Segmentation Method ◽

Temporal Segmentation ◽

Dce Mri ◽

Contrast Enhanced ◽

Key Points ◽

Multivariate Images ◽

Spatio Temporal

We propose a new computer aided detection framework for tumours acquired on DCE-MRI (Dynamic Contrast Enhanced Magnetic Resonance Imaging) series on small animals. To perform this approach, we consider DCE-MRI series as multivariate images. A full multivariate segmentation method based on dimensionality reduction, noise filtering, supervised classification and stochastic watershed is explained and tested on several data sets. The two main key-points introduced in this paper are noise reduction preserving contours and spatio temporal segmentation by stochastic watershed. Noise reduction is performed in a special way to select factorial axes of Factor Correspondence Analysis in order to preserves contours. Then a spatio-temporal approach based on stochastic watershed is used to segment tumours. The results obtained are in accordance with the diagnosis of the medical doctors.

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Case Report: Seaweed Bezoar Masquerading as a Malignant Obstruction

Case Reports in Surgery ◽

10.1155/2018/3829271 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

E. C. Abboud ◽

B. Babic

Keyword(s):

Small Bowel ◽

High Sensitivity ◽

Bowel Loop ◽

Asian Woman ◽

Malignant Obstruction ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Risk Patients ◽

High Index Of Suspicion

Bezoars represent a rare cause of small bowel obstruction (SBO). Nonoperative management of bezoars includes use of endoscopy with mechanical or chemical dissolution methods. When obstruction persists, surgical intervention becomes necessary. Here, we present the case of an Asian woman with a SBO secondary to a phytobezoar masquerading as a malignancy. She presented with two days of acute-on-chronic abdominal pain that started after eating seaweed. Initial computed tomography (CT) scan showed a SBO with a jejunal transition point and ill-defined liver lesions, worrisome for a malignant obstruction with liver metastases. Further imaging, however, showed the resolution of these artifacts. Subsequent laparotomy revealed a small bowel loop with copious obstructing seaweed. A distal stricture was palpated, and the involved segment was resected. Intraoperative liver ultrasound was negative, and final pathology revealed benign small intestine with a mild stricture. Given the rarity of bezoar-related obstructions, the diagnosis is often delayed particularly when confounding factors exist such as our patient’s concomitant hepatic findings. Contrast-enhanced CT has a high sensitivity but a lower specificity in identifying bezoars. A high index of suspicion is therefore necessary especially when managing higher risk patients.

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Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

Medical Ultrasonography ◽

10.11152/mu.2013.2066.181.ich ◽

2016 ◽

Vol 18 (1) ◽

pp. 18 ◽

Cited By ~ 12

Author(s):

Sevastiţa Iordache ◽

Mădălin Ionuţ Costache ◽

Carmen Florina Popescu ◽

Costin Teodor Streba ◽

Sergiu Cazacu ◽

...

Keyword(s):

Pancreatic Cancer ◽

Diagnostic Algorithm ◽

High Sensitivity ◽

Clinical Decision ◽

Needle Aspiration ◽

Clinical Tool ◽

Decision Algorithm ◽

Contrast Enhanced ◽

Pancreatic Masses ◽

Sensitivity Specificity

Aims: It is well known that endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has a high sensitivity (over 85%) and specificity (100%) for diagnosis of pancreatic cancer. The aim of the study was to establish a EUS based clinical diagnostic algorithm in patients with pancreatic masses and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS. Material and methods: We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established. Results: For the diagnosis of possible malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed. The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer. Conclusions: The proposed algorithm with sequential use of elastography followed by CEH could be a good clinical tool in the set of patients with negative EUS-FNA results for the differentiation between benign and malignant focal pancreatic masses.

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Diagnosis and t-staging of gastric cancer: comparison of standard computed tomography and computed-tomographic pneumogastrography

Vestnik of Russian military medical Academy ◽

10.17816/brmma70384 ◽

2021 ◽

Vol 23 (2) ◽

pp. 99-106

Author(s):

Inna D. Amelina ◽

Lev N. Shevkunov ◽

Aleksey M. Karachun ◽

Alexander E. Mikhnin ◽

Denis V. Nesterov

Keyword(s):

Gastric Cancer ◽

Computed Tomography ◽

Three Dimensional ◽

High Sensitivity ◽

Subtotal Resection ◽

Standard Protocol ◽

Computed Tomographic ◽

T Stage ◽

Significant Difference ◽

Virtual Gastroscopy

The advantages of computed tomographic pneumogastrography with the possibility of three-dimensional visualization and virtual gastroscopy in diagnosing gastric cancer are considered. The study included 479 patients with histologically diagnosed gastric cancer who were treated at the National Medical Research Center of Oncology named after N.N. Petrov from 2011 to 2018. 232 patients received preoperative chemotherapy. All patients underwent surgery: 70 in the volume of endoscopic dissection, 40 proximal subtotal resection, 166 distal subtotal resection, 203 gastrectomy. All patients at the preoperative stage underwent staging computed tomography on a 64-slice X-ray computed tomograph: 208 patients underwent computed tomography according to the standard protocol without targeted preparation of the stomach for the study, 271 patients with targeted preparation of the stomach for the study according to the computed tomographic pneumogastrography protocol. The sensitivity of the computed tomography in assessing the T-stage was assessed by comparison with pathomorphological data. Of the 208 patients who underwent computed tomography according to the standard protocol, a gastric cancer was detected in 111 (53.4%), out of 271 patients who underwent computed tomography pneumogastrography, a gastric cancer was detected in 267 (98.52%), which is a statistically significant difference in comparing computed tomography methods (Pearson, 144.223, df = 1; p 0.001). There are statistically significant differences when comparing computed tomography according to the standard protocol and computed tomographic pneumogastrography in detecting gastric cancer for all tumor categories: T/yT1 8.2 and 94.4% (Pearson, 99.205, df = 1; p 0.001), T/yT2 47.8 and 100% (Pearson, 24.681, df = 1; p 0.001), T/yT3 72.3 and 100% (Pearson, 33.114, df = 1; p 0.001), T/yT4 90.0 and 100% (Pearson, 4.789, df = 1; p = 0.029) respectively. There are also statistically significant differences when comparing the sensitivity of computed tomography according to the standard protocol and computed tomographic pneumogastrography in determining tumor invasion for all tumor categories: T/yT1 0 and 69.4% (Pearson, 67.880, df = 1; p 0.001), T/yT2 26.1 and 71.1% (Pearson, 11.666, df = 1; p 0.001), T/yT3 32.9 and 84.6% (Pearson, 54.900, df = 1; p 0.001), T/yT4 73.3 and 95.7% (Pearson, 7.916, df = 1; p = 0.005) respectively. In general, the sensitivity of the computed tomography according to the standard protocol for determining the T-stage of gastric cancer was 28.4%, computed tomographic pneumogastrography 77.1% (Pearson, 113.505, df = 1; p 0.001). Computed tomographic pneumogastrography with the possibility of three-dimensional visualization and virtual gastroscopy significantly increases the indicators of the effectiveness of diagnosing gastric cancer both early forms (category T1) and with deeper invasion (categories T2T4), demonstrates high sensitivity in determining T/yT-stages.

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Identification of patients with hemoglobin SS/Sβ0 thalassemia disease and pain crises within electronic health records

Blood Advances ◽

10.1182/bloodadvances.2018017541 ◽

2018 ◽

Vol 2 (11) ◽

pp. 1172-1179 ◽

Cited By ~ 2

Author(s):

Ashima Singh ◽

Javier Mora ◽

Julie A. Panepinto

Keyword(s):

Electronic Health Records ◽

Acute Care ◽

Sensitivity And Specificity ◽

Data Model ◽

High Sensitivity ◽

Common Data Model ◽

Health Records ◽

Key Points ◽

Electronic Health

Key Points The algorithms have high sensitivity and specificity to identify patients with hemoglobin SS/Sβ0 thalassemia and acute care pain encounters. Codes conforming to common data model are provided to facilitate adoption of algorithms and standardize definitions for EHR-based research.

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