scholarly journals Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI

2018 ◽  
Vol 5 (5) ◽  
pp. e480 ◽  
Author(s):  
Kianush Karimian-Jazi ◽  
Brigitte Wildemann ◽  
Ricarda Diem ◽  
Daniel Schwarz ◽  
Thomas Hielscher ◽  
...  
Keyword(s):  
Diagnostic Value ◽  
Contrast Administration ◽  
Signal Ratio ◽  
T2 Lesions ◽  
Normal Appearing White Matter ◽  
Standardized Protocol ◽  
Contrast Enhanced ◽  
Fluid Attenuated Inversion Recovery ◽  
Cranial Mri

ObjectiveTo assess the diagnostic value of gadolinium (Gd) contrast administration in MRI follow-up examinations of patients with MS if the T2 lesion load is stable.MethodsWe included 100 patients with MS with at least 2 cranial MRI follow-up examinations (mean follow-up time 4.0 ± 2.6 years). MRI was performed at 3 Tesla with a standardized protocol including T2-weighted, fluid-attenuated inversion recovery (FLAIR) and T1-weighted contrast-enhanced sequences. Images were analyzed for T2/FLAIR and contrast-enhancing (CE) lesions by 3 independent neuroradiologists. Isolated Gd-enhancing lesions without correlate in T2 and FLAIR images, and reactivated Gd+ lesions were further assessed for size and signal intensity.ResultsWe identified a total of 343 new T2 lesions and 152 CE lesions in a total of 559 MRI follow-up examinations. New T2/FLAIR lesions were present in 30% of the scans. Of the Gd-enhancing lesions, 145/152 (95.4%) showed a correlate as a new T2/FLAIR lesion. There were 3 enhancing lesions (1.9% of all enhancing lesions) without T2/FLAIR correlate and 4 lesions (2.6%) that exhibited lesion reactivation or persistent enhancement over time. As a predictive factor of enhancement, we found that enhancing lesions had a higher T2 signal ratio (T2 SRlesion/normal-appearing white matter: 3.0 ± 0.1 vs 2.2 ± 0.1, p < 0.001).ConclusionThe likelihood of missing “active lesions” is overall small (1.7%) if T2 lesions are stable compared with the previous MRI examination. Lesion reactivation is rare. Our study indicates that Gd contrast administration might be dispensable in follow-up MRI of patients with MS if no new T2/FLAIR lesions and no new neurologic symptoms are present.

scholarly journals Diagnostic value of gadolinium contrast administration for spinal cord magnetic resonance imaging in multiple sclerosis patients and correlative markers of lesion enhancement

2021 ◽  
Vol 7 (4) ◽  
pp. 205521732110479
Author(s):  
Kianush Karimian-Jazi ◽  
Ulf Neuberger ◽  
Katharina Schregel ◽  
Gianluca Brugnara ◽  
Martin Bendszus ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Diagnostic Value ◽  
Resonance Imaging ◽  
Gadolinium Contrast ◽  
Contrast Administration ◽  
Signal Ratio ◽  
Spine Magnetic Resonance Imaging

Background Magnetic resonance imaging is essential for monitoring people with multiple sclerosis, but the diagnostic value of gadolinium contrast administration in spine magnetic resonance imaging is unclear. Objective To assess the diagnostic value of gadolinium contrast administration in spine magnetic resonance imaging follow-up examinations and identify imaging markers correlating with lesion enhancement. Methods A total of 65 multiple sclerosis patients with at least 2 spinal magnetic resonance imaging follow-up examinations were included. Spine magnetic resonance imaging was performed at 3 Tesla with a standardized protocol (sagittal and axial T2-weighted turbo spin echo and T1-weighted post-contrast sequences). T2 lesion load and enhancing lesions were assessed by two independent neuroradiologists for lesion size, localization, and T2 signal ratio (T2 signallesion/T2 signalnormal appearing spinal cord). Results A total of 68 new spinal T2 lesions and 20 new contrast-enhancing lesions developed during follow-up. All enhancing lesions had a discernable correlate as a new T2 lesion. Lesion enhancement correlated with a higher T2 signal ratio compared to non-enhancing lesions (T2 signal ratio: 2.0 ± 0.4 vs. 1.4 ± 0.2, **** p < 0.001). Receiver operating characteristics analysis showed an optimal cutoff value of signal ratio 1.78 to predict lesion enhancement (82% sensitivity and 97% specificity). Conclusion Gadolinium contrast administration is dispensable in follow-up spine magnetic resonance imaging if no new T2 lesions are present. Probability of enhancement correlates with the T2 signal ratio.

scholarly journals Unusual Presentation of Listerial Myocarditis and the Diagnostic Value of Cardiac Magnetic Resonance

2015 ◽  
Vol 42 (3) ◽  
pp. 255-258 ◽  
Author(s):  
Amit P. Ladani ◽  
Abhishek Biswas ◽  
Nishit Vaghasia ◽  
Thomas Generalovich
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Diagnostic Value ◽  
Magnetic Resonance Images ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Contrast Enhanced ◽  
Treatment Of Arrhythmias

Listeria monocytogenes is an infrequent cause of bacterial myocarditis. Myocarditis without evidence of endocarditis is even rarer. Management in such cases involves early diagnosis, antibiotic therapy, and emergency treatment of arrhythmias. We report the case of a 47-year-old man who presented with features of acute ST-segment-elevation myocardial infarction complicated by ventricular tachycardia that necessitated urgent electrical cardioversion. Contrast-enhanced cardiac magnetic resonance images revealed hypertrophy, necrosis, and a mass that was determined to be an abscess caused by L. monocytogenes. Antibiotic treatment led to resolution of the listerial myocarditis. In addition to reporting our patient's case, we discuss the comparative advantages of cardiac magnetic resonance versus transthoracic echocardiography in characterizing myocarditis, upon presentation and in follow-up evaluation.

Recurrent leukoencephalopathy with microhemorrhages: gradient-echo MRI study diagnostic value in CNS primary angiitis

2008 ◽  
Vol 14 (8) ◽  
pp. 1139-1141 ◽  
Author(s):  
M Arias ◽  
XR Osorio ◽  
D Dapena ◽  
S Arias-Rivas ◽  
F Vázquez
Keyword(s):  
Clinical Course ◽  
Clinical Manifestations ◽  
Diagnostic Value ◽  
Cerebral White Matter ◽  
Fluid Attenuated Inversion Recovery ◽  
Primary Angiitis ◽  
The Central Nervous System ◽  
Cerebral Biopsy ◽  
Mri Study

Diagnosis of primary angiitis of the central nervous system (PACNS) is difficult in relation to variability in its clinical manifestations and absence of specific signs in neuroimaging. A young patient presented with a recurrent encephalopathic clinical course. T2 and fluid-attenuated inversion recovery-magnetic resonance imaging (FLAIR-MRI) showed hyperintense lesions in the cerebral white matter suggesting demyelination. Those lesions decreased or even disappeared after treatment with steroids and immunoglobulins. In echo gradient MRI (T2*-MRI), there were permanent cortical-subcortical petechial hypointense lesions (microhemorrhages). Definite diagnosis was established after cerebral biopsy. Intravenous cyclophosphamide was administrated with no new relapses in more than 18 months of follow-up. In a compatible clinical course, the finding of petechial hemorrhages in T2*-WI could play an important role in early diagnosis of PACNS.

scholarly journals FLAIR MR sequence in the diagnosis and follow-up of low-grade astrocytomas

2005 ◽  
Vol 62 (7-8) ◽  
pp. 525-528 ◽  
Author(s):  
Tatjana Stosic-Opincal ◽  
Mihail Gavrilov ◽  
Srboljub Stosic ◽  
Slobodan Lavrnic ◽  
Vesna Peric ◽  
...  
Keyword(s):  
Spin Echo ◽  
Diagnostic Value ◽  
Inversion Recovery ◽  
Low Grade ◽  
Flair Imaging ◽  
Flair Sequence ◽  
Cystic Component ◽  
Fluid Attenuated Inversion Recovery ◽  
Age Range

Aim. To evaluate the sensitivity of fluid-attenuated inversion recovery (FLAIR) sequence in the diagnosis and follow-up of the patients with low-grade astrocytomas compared with T2-weighted (T2W) sequence. Methods. Twenty-four patients with biopsy- confirmed low-grade astrocytoma (age range, 15-66 years) underwent T1- weighted (T1W), T2W and FLAIR imaging with a superconducting unit 1.0 T. FLAIR images were qualitatively evaluated by comparison with T2W images by the three experienced neuroradiologists. To evaluate the diagnostic value of FLAIR, the neuroradiologists individually assessed the possibilities of the detection of lesions, as well as the possibilities of the differentiation of tumor from the surrounding edema on FLAIR vs. T2W images. Every examiner ranked FLAIR sequence vs. T2W in three degrees: worse, equal and better. Results. The comparison of FLAIR with T2W spin-echo (SE) images with regard to the detection of the lesions showed that 82.8% of FLAIR studies were superior, 17.2% were of similar diagnostic value, and none was inferior to the T2W images. The comparison of images with regard to the differentiation of tumor boundaries vs. surrounding edema showed that 92.5% of FLAIR studies were superior, 7.5% were of similar diagnostic value, and none was inferior to the T2W images. Conclusion. Our results were similar to the previous studies' results concerning the advantages of FLAIR sequence in the diagnosis of low grade astrocytomas over T2W sequence. FLAIR was better at showing different tumor components, and at distinguishing CSF from the cystic component, and the postoperative cavity, compared with T2W images. Our conclusion was that FLAIR could be routinely used in the evaluation and follow-up of low-grade astrocytomas.

scholarly journals Reduced Blood Flow in Normal White Matter Predicts Development of Leukoaraiosis

2015 ◽  
Vol 35 (10) ◽  
pp. 1610-1615 ◽  
Author(s):  
Manya Bernbaum ◽  
Bijoy K Menon ◽  
Gordon Fick ◽  
Eric E Smith ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Blood Flow ◽  
White Matter ◽  
Imaging Study ◽  
Subsequent Development ◽  
Minor Stroke ◽  
Normal Appearing White Matter ◽  
Fluid Attenuated Inversion Recovery ◽  
Ischemic Attack ◽  
Normal White Matter

The purpose of this study was to investigate whether low cerebral blood flow (CBF) is associated with subsequent development of white matter hyperintensities (WMH). Patients were included from a longitudinal magnetic resonance (MR) imaging study of minor stroke/transient ischemic attack patients. Images were co-registered and new WMH at 18 months were identified by comparing follow-up imaging with baseline fluid-attenuated inversion recovery (FLAIR). Regions-of-interest (ROIs) were placed on FLAIR images in one of three categories: (1) WMH seen at both baseline and follow-up imaging, (2) new WMH seen only on follow-up imaging, and (3) regions of normal-appearing white matter at both time points. Registered CBF maps at baseline were used to measure CBF in the ROIs. A multivariable model was developed using mixed-effects logistic regression to determine the effect of baseline CBF on the development on new WMH. Forty patients were included. Mean age was 61 ± 11 years, 30% were female. Low baseline CBF, female sex, and presence of diabetes were independently associated with the presence of new WMH on follow-up imaging. The odds of having new WMH on follow-up imaging reduces by 0.61 (95% confidence interval = 0.57 to 0.65) for each 1 mL/100 g per minute increase in baseline CBF. We conclude that regions of white matter with low CBF develop new WMH on follow-up imaging.

scholarly journals The Diagnostic Value of Contrast-enhanced 2D Mammography in Everyday Clinical use

2021 ◽  
Author(s):  
Lidewij Neeter ◽  
Frank Raat ◽  
Stephanie Meens-Koreman ◽  
Rogier van Stiphout ◽  
Steffie Timmermans ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Diagnostic Value ◽  
Low Energy ◽  
Response Monitoring ◽  
Full Field ◽  
Full Field Digital Mammography ◽  
Contrast Enhanced ◽  
One Year ◽  
Histopathological Results

Abstract Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system.We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination , for all readers independently as well as combined. Breast cancer was diagnosed in 23% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3% to 87.6% (p<0.0001), specificity from 87.8% to 94.6% (p=0.0146). AUC increased from 0.872 to 0.957 (p=0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.

scholarly journals The diagnostic value of contrast-enhanced 2D mammography in everyday clinical use

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
L. M. F. H. Neeter ◽  
H. P. J. Raat ◽  
S. D. Meens-Koreman ◽  
R. S. A. van Stiphout ◽  
S. M. E. C. Timmermans ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Diagnostic Value ◽  
Low Energy ◽  
Response Monitoring ◽  
Full Field ◽  
Full Field Digital Mammography ◽  
Contrast Enhanced ◽  
One Year ◽  
Histopathological Results

AbstractContrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.

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