scholarly journals Magnetic Resonance Imaging Grading of Pituitary Macroadenoma- SIPAP Classification Revisited.

2021 ◽  
Author(s):  
Shayan Sirat Maheen Anwar ◽  
Kiran Hilal ◽  
Anam Khan ◽  
Asra Ahmad
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pituitary Adenomas ◽  
Tumour Size ◽  
P Value ◽  
Kappa Statistics ◽  
Pituitary Macroadenoma ◽  
Resonance Imaging ◽  
Tumour Delineation ◽  
Significant Difference

Abstract BACKGROUNDMagnetic resonance imaging (MRI) is regarded as the modality of choice in diagnosis of pituitary adenomas. Since surgery is the first line therapy for all pituitary adenomas with exception of prolactinoma, simple and reproducible MRI classification based on major directions of tumour growth is an essential tool providing the exact road map for right surgical approach and maximum safe resection.SIPAP MRI classification for pituitary adenomas is derived from KNOSP-STEINER classification of parasellar growth, to which has been added grading for superior, inferior, anterior and posterior tumour extension.We, therefore, propose to incorporate SIPAP classification in routine reporting template of pituitary adenomas, for ideal radiological description of tumour delineation, relationship to juxtasellar structures, and tumour size, hence facilitating greater success rate in surgical and subsequent clinical management.METHODSTwo radiologists retrospectively reviewed imaging of 49 patients with biopsy-proven pituitary macroadenoma and graded according to SIPAP classification. Study was conducted at Aga Khan University Hospital from 1st July 2019 to 30th June 2020. Data was analyzed using Stata version 15. Interobserver variability was calculated using Cohen’s Kappa. Comparison between grading before and after treatment was performed by Chi-square test. P values <0.05 were considered statistically significant.RESULTSSixty three percent patients were male and 37% female. Overall, maximum preoperative and postoperative volume was 71.82 cm3 and 49.50 cm3 respectively, with significant difference in pre and post-operative volumes (14.1±17.7 vs. 4.5±10.4, p-value <0.001). Length showed most significant difference pre and post-operatively (2.4±1.1 vs. 1.3±1.1, p-value <0.001). Individual tumour extensions according to SIPAP for pre- and post-operative grading showed significant difference (p-value <0.001), except for anterior extension. For suprasellar extension, 67.3% patients had pre-operative grade 3 and 63.3% had post-operative grade 0. For infrasellar extension, 51.0% had pre-operative grade 2 and 71.4% had post-operative grade 0. Anterior, posterior and parasellar extensions showed increased frequency in grade 0 in post-operative stage compared to pre-operative. Substantial inter-observer agreement was achieved for Superior, Inferior, Anterior and Posterior extent with all Kappa statistics values above 0.7 (p-value <0.001).CONCLUSIONWe propose incorporating simple and objective SIPAP classification in routine MR reporting for ideal pituitary tumour delineation, relationship to juxtasellar structures and tumour size.

scholarly journals Clinical and Pathological Attributes of Hepatocellular Carcinoma Showing Lack of Restricted Diffusion on Magnetic Resonance Imaging

2021 ◽  
Author(s):  
Dearada Wancharoenrung ◽  
Kamonwon Cattapan ◽  
Thitinan Chulroek ◽  
Hamed Kordbacheh ◽  
Martina Cecconi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hepatocellular Carcinoma ◽  
Magnetic Resonance ◽  
Survival Rates ◽  
Restricted Diffusion ◽  
P Value ◽  
Resonance Imaging ◽  
Arterial Enhancement ◽  
Significant Difference ◽  
Poorly Differentiated

Objective: To correlate non-restricted diffusion magnetic resonance imaging (MRI) patterns of hepatocellular carcinoma (HCC), with histopathology and clinical outcome.Material and Methods: We retrospectively evaluated pre-treatment MRIs showing non-restricted diffusion HCC lesions (≥1-centimeter), excluding lesions with poor quality/non-available diffusion weighted imaging (DWI). Three radiologists evaluated 37 lesions in 27 patients, for: T1-weighted (T1W)/T2-weighted (T2W) characteristics, arterial enhancement, washout on portal venous/delayed phase, capsular enhancement, intralesional fat component and presence of cirrhosis. Histopathological reports were categorized as: well/moderate/poorly differentiated. Kaplan-Meier survival analysis was calculated for clinical outcome.Results: From a total of 37 lesions, 24 lesions had available pathological grading, which revealed well and moderately differentiated equally (12 lesions each). None of the non-restricted diffusion HCCs were poorly differentiated. Thirty-five of the 37 lesions (94.6%) showed arterial enhancement with washout; 34 lesions (91.9%) were T2W hypo-/isointense, 33 esions (89.2%) were T1W iso-/hyperintense, 19 lesions (51.4%) showed capsular enhancement and 8 lesions (21.6%) had intralesional fat. These findings in the well and moderately differentiated groups were not significantly different (p-value 0.178-1.000). Overall mean-survival was 6.972 years (95% confidence interval (CI); 5.3-8.6). The 1-year, overall survival rate was 83.6% and for 3-years was 67.9%. Mean survival of well and moderately differentiated groups were 6.88 and 7.23 years (95% CI 5.7-8.0 and 4.4-10.1), respectively (p-value=0.319).Conclusion: DWI may help to predict histological grading of HCC and clinical outcome. We found that non-restricted diffusion HCCs were histologically well or moderately differentiated, with no significant difference of imaging findings and survival rates between the two groups. No poorly differentiated lesions were seen in our non-restricted HCC cohort.

scholarly journals Estimation of ventricles size of human brain by Magnetic Resonance Imaging in Nepalese Population: A retrospective study

2020 ◽  
Vol 13 (1) ◽  
pp. 45-50
Author(s):  
Sushma Singh ◽  
Bhoj Raj Sharma ◽  
Urusha Prajapati ◽  
Pujan Sharma ◽  
Manoj Bhatta ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Retrospective Study ◽  
Magnetic Resonance ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
P Value ◽  
Resonance Imaging ◽  
Mean Width ◽  
Significant Difference ◽  
The Mean

Background and Objective: Magnetic resonance imaging (MRI) provides image acquisition of three-dimensional data and measurement in any chosen imaging plane. Objective of this study is to assess the size of ventricles of the brain of normal Nepalese people and establish the range of size of the ventricular system and compute the ventricular dimensions among different age and gender. Materials and methods: This is a cross-sectional retrospective study done at Gandaki Medical College, Pokhara. A total of 106 MRI scan data of healthy individuals were collected over a period of seven months between March to September 2019. Patients ranged between eight and eighty years of age with 58 males and 48 females. Measurements of the mean of bifrontal diameter (BFD), bihemispheric diameter (BHD), third ventricle transverse dimension (TVTD), fourth ventricle antero-posterior dimension (FVAP), fourth ventricle width (FVW), and frontal horn ratio (FHR) were done. Result: The mean of BFD, BHD, TVTD, FVAP, FVW, and FHR were found to be 3.05 ± 0.10 cm, 10.11 ± 0.40 cm, 0.43 ± 0.11 cm, 0.90 ± 0.11 cm, 1.22 ± 0.12 cm, and 0.30 ± 0.01 cm, respectively. The mean width of fourth ventricle in males and females was observed to be 1.23 ± 0.12 cm and 1.19 ± 0.11 cm respectively. There was a significant correlation of TVTD, FVAP, FHR and BFD with age with Pearson correlation coefficient 0.393 (P value <0.01), 0.259 (P value <0.01), 0.34 (P value <0.01), and 0.219 (P value <0.05) respectively. However, BHD and FVW have no correlation with age. Conclusion: Third Ventricle Traverse Dimension, FVP, FVW and FHR show almost similar or slight difference in measurement according to gender. However, BFD shows larger difference in measurement according to gender. Similarly there is no such significant difference according to age in measurement of BFD, BHD, FVAP, FVW and FHR, while TVTD measurement shows slight increased measurement according to age.  

scholarly journals Can diffusion and T2 star-weighted magnetic resonance imaging aid in the diagnosis of ectopic endometrium?

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Mariam Raafat ◽  
Soha H. Talaat ◽  
Salma M. Abdelghaffar ◽  
Engy A. Ali
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Statistical Significance ◽  
P Value ◽  
Large Sample Size ◽  
Resonance Imaging ◽  
Conventional Mri ◽  
Patient Will ◽  
Magnetic Resonance Imaging Mri ◽  
Ectopic Endometrium

Abstract Background Endometriosis is a common gynecologic disorder characterized by the implantation of the endometrial tissue ectopically outside the endometrial cavity. It affects about 10% of females at the childbearing period and is estimated to be present up to 20–50% in women complaining of infertility. While laparoscopy is considered the mainstay for diagnosis, magnetic resonance imaging (MRI) is recognized as a useful tool for definitive diagnosis, pre-surgical planning, and determining whether the patient will require multi-specialty involvement. The aim of this study is to evaluate the performance of MRI with the addition of diffusion-weighted imaging (DWI) and T2 star (T2*) to conventional MRI, for the accurate assessment of ectopic endometrium. Results Endometriotic lesions that showed diffusion restriction on DWI were 80.7%, and 96.1% of the endometriotic lesions had signal voids on the T2*W sequence, whereas only 65.4% of the lesions had typical signal intensities on T1WI and T2WI. Diagnostic performance of the MRI examination was improved by the use of the diffusion sequence and better improved by the T2* sequence, compared to the conventional MR protocol sensitivity (SE) = 96.12% and specificity (SP) = 85.7% in T2*-weighted images, SE = 80.7% and SP = 71.4% in DWI, and SE = 65.4% and SP = 71.4% in conventional MRI. P value for conventional MRI was 0.1, which is of no statistical significance (p < 0.05). P value for DWI was 0.016, which is statistically significant (p < 0.05). P value for T2*WI was 0.001, which is more statistically significant (p < 0.05) and could be adequately correlated with laparoscopy. Conclusion DWI and T2* significantly increase MRI diagnostic accuracy by allowing the detection of the hemorrhagic character of the endometriotic lesions. Studies with a large sample size are needed to confirm that they can replace invasive laparoscopy for the diagnosis of endometriosis.

Association between Trigeminal Neuralgia and Multiple Sclerosis: Role of Magnetic Resonance Imaging

2021 ◽  
Vol 15 (6) ◽  
pp. 1927-1930
Author(s):  
Tahir Baig ◽  
Adnan Ahmed ◽  
Atif Hussain ◽  
Rabia Shah ◽  
Muhammad Tahir ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Wilcoxon Test ◽  
P Value ◽  
World Population ◽  
Resonance Imaging ◽  
Affected Side

Background: Trigeminal neuralgia (TN) is a severe neuropathic unilateral facial pain affecting about 30% percent of the world population. Neuropathic pains are considered to be associated with multiple sclerosis (MS).Multiple sclerosis is a chronic inflammatory condition causing demyelination and degeneration of axons in central nervous system. Objective: The objective of the study is to determine role of Magnetic Resonance Imaging to find association between trigeminal neuralgia and multiple sclerosis. Methods: The prospective cohort study was conducted for six months in Radiology Department of Hayatabad Medical Complex, Peshawar from September 2020 to February 2021. Initially 250 patients were screened for multiple sclerosis. The study recruited a total of 35 patients of MS visited neuroradiology department, out of which 26 patients were enrolled in the study. The participants with age of 18 years and onward of both genders with definitive symptoms of TN with MS that is having unilateral TN pain (that is sharp shooting electric pulse like) lasting for up-to 2minutes precipitated with an environmental stimulus were included in the study. The patients (n=6) with bilateral MS with TN and cognitive disturbances (n=3) were excluded from the study. Results: The study recruited a total of 26 participants with MS related TN. The clinical examination didn’t show any difference between the three groups with the p-value less than 0.001. Age at the onset of MS was younger in patients with MS related sensory disturbances compared to other two groups, with p-value less than 0.05. The frequency of the affected side was different in all three groups with the p-value less than 0.05 as tested by Fischer exact test. Trigeminal reflex tests done for different components such as R1 and SP1 showed longer latency periods for the affected side after stimulation and unaffected side after stimulation with the mean of 14.2± 4.4 and 15.3±3.2, 16.3±4.2 and 17.4±5.2ms and p-value less than 0.001 as shown by Wilcoxon test. Conclusion: The study showed significant association between trigeminal neuralgia and multiple sclerosis with the greater efficacy of using MRI as imaging technique to find this association. Keywords: Multiple sclerosis, Magnetic Resonance Imaging, Trigeminal neuralgia

Is multidetector computed tomography comparable to magnetic resonance imaging for assessment of lumbar foraminal stenosis?

2016 ◽  
Vol 58 (2) ◽  
pp. 197-203
Author(s):  
Woo Young Kang ◽  
Joong Mo Ahn ◽  
Joon Woo Lee ◽  
Eugene Lee ◽  
Yun Jung Bae ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Multidetector Computed Tomography ◽  
Excellent Agreement ◽  
Observer Agreement ◽  
Kappa Statistics ◽  
Foraminal Stenosis ◽  
Resonance Imaging ◽  
Lumbar Foraminal Stenosis

Background Both multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are used for assessment of lumbar foraminal stenosis (LFS). Therefore, it is relevant to assess agreement between these imaging modalities. Purpose To determine intermodality, inter-, and intra-observer agreement for assessment of LFS on MDCT and MRI. Material and Methods A total of 120 foramina in 20 patients who visited our institution in January and February 2014 were evaluated by six radiologists with different levels of experience. Radiologists evaluated presence and severity of LFS on sagittal CT and MR images according to a previously published LFS grading system. Intermodality agreement was analyzed by using weighted kappa statistics, while inter- and intra-observer agreement were analyzed by using intraclass correlation coefficients (ICCs) and kappa statistics. Results Overall intermodality agreement was moderate to good (kappa, 0.478–0.765). In particular, two professors and one fellow tended to overestimate the degree of LFS on CT compared with MRI. For inter-observer agreement of all six observers, ICCs indicated excellent agreement for both CT (0.774) and MRI (0.771), while Fleiss’ kappa values showed moderate agreement for CT (0.482) and MRI (0.575). There was better agreement between professors and fellows compared with residents. For intra-observer agreement, ICCs indicated excellent agreement, while kappa values showed good to excellent agreement for both CT and MRI. Conclusion MDCT was comparable to MRI for diagnosis and assessment of LFS, especially for experienced observers. However, there was a tendency to overestimate the degree of LFS on MDCT compared with MRI.

scholarly journals Contrast-enhanced spectral mammography in the radiological assessment of response to neoadjuvant chemotherapy in breast cancer

2021 ◽  
pp. e521
Author(s):  
Anna Grażyńska ◽  
Sofija Antoniuk ◽  
Katarzyna Steinhof-Radwańska
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Tumour Size ◽  
Breast Cancer Diagnosis ◽  
Chemotherapy Response ◽  
Resonance Imaging ◽  
Contrast Enhanced

Accurate morphological assessment and measurement of the residual disease following neoadjuvant chemotherapy are vital for the effective surgical treatment in patients with breast cancer. Neoadjuvant chemotherapy response is measured by RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors), and the classification of the specific therapeutic responses is based on the difference in the tumour size prior to and after chemotherapy. There are currently a few methods of imaging used in the assessment of the neoadjuvant chemotherapy response. Conventional mammography remains the most popular method, whereas magnetic resonance imaging is considered the most effective ones. Nonetheless, the available methods tend to be imperfect and limited, and therefore, new methods are constantly investigated. Contrast-enhanced spectral mammography is a relatively new method used in breast cancer diagnosis, which involves the phenomenon of neoangiogenesis of cancerous tumours, allowing contrast enhancement in the areas of vessel proliferation in the background of the surrounding breast tissue. Contrast-enhanced spectral mammography presents sensitivity similar to magnetic resonance imaging in breast cancer detection, and can be an efficient method used in monitoring neoadjuvant chemotherapy response.

scholarly journals Usefulness of Grayscale Values of Hypoechoic Lesions Matched with Target Lesions Observed on Magnetic Resonance Imaging for the Prediction of Clinically Significant Prostate Cancer

2021 ◽  
Author(s):  
Dong Gyun Kim ◽  
Jeong Woo Yoo ◽  
Kyo Chul Koo ◽  
Byung Ha Chung ◽  
Kwang Suk Lee
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Area Under The Curve ◽  
Imaging Data ◽  
Resonance Imaging ◽  
Scoring Method ◽  
Significant Difference ◽  
Picture Archiving And Communication ◽  
Clinically Significant

Abstract INTRODUCTION: To analyze grayscale values for hypoechoic lesions matched with target lesions evaluated using prebiopsy magnetic resonance imaging (MRI). METHODS We collected data on 420 target lesions in patients who underwent MRI/transrectal ultrasound fusion biopsies. Images of hypoechoic lesions that matched the target lesions on MRI were stored in a picture archiving and communication system, and their grayscale values were estimated using the red/green/blue scoring method through an embedded function. We analyzed imaging data using grayscale values. RESULTS Of the 420 lesions, 261 (62.1%) were prostate cancer lesions. Grayscale ranges (42.6–91.8) were significant predictors of clinically significant prostate cancer (csPC) in multivariable logistic regression analyses. Area under the curve for detecting csPC using grayscale values along with conventional variables was 0.839, which was significantly higher than that for detecting csPC using only conventional variables (0.828; p = 0.036). Subgroup analysis revealed a significant difference for PI-RADS 3 lesions between grayscale values for benign and cancerous lesions (p = 0.008). Grayscale values were the only significant predictive factor (p = 0.005) for csPC. CONCLUSIONS Distribution of grayscale values according to PI-RAD 3 scores was useful, and the grayscale range (42.6–91.8) was an important factor for csPC diagnosis.

scholarly journals Agreement of Magnetic Resonance Imaging With Computed Tomography in the Assessment for Acute Skull Fractures in a Canine and Feline Cadaver Model

2021 ◽  
Vol 8 ◽  
Author(s):  
Silke Hecht ◽  
Kimberly M. Anderson ◽  
Aude Castel ◽  
John F. Griffin ◽  
Adrien-Maxence Hespel ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Head Trauma ◽  
Imaging Modality ◽  
Small Animal ◽  
Skull Fractures ◽  
Resonance Imaging ◽  
Significant Difference ◽  
Mri Sequences

Computed tomography (CT) is the imaging modality of choice to evaluate patients with acute head trauma. However, magnetic resonance imaging (MRI) may be chosen in select cases. The objectives of this study were to evaluate the agreement of MRI with CT in the assessment for presence or absence of acute skull fractures in a canine and feline cadaver model, compare seven different MRI sequences (T1-W, T2-W, T2-FLAIR, PD-W, T2*-W, “SPACE” and “VIBE”), and determine agreement of four different MRI readers with CT data. Pre- and post-trauma CT and MRI studies were performed on 10 canine and 10 feline cadaver heads. Agreement of MRI with CT as to presence or absence of a fracture was determined for 26 individual osseous structures and four anatomic regions (cranium, face, skull base, temporomandibular joint). Overall, there was 93.5% agreement in assessing a fracture as present or absent between MRI and CT, with a significant difference between the pre and post trauma studies (99.4 vs. 87.6%; p &lt; 0.0001; OR 0.042; 95% CI 0.034–0.052). There was no significant difference between dogs and cats. The agreement for the different MRI sequences with CT ranged from 92.6% (T2*-W) to 94.4% (PD-W). There was higher agreement of MRI with CT in the evaluation for fractures of the face than other anatomic regions. Agreement with CT for individual MRI readers ranged from 92.6 to 94.7%. A PD-W sequence should be added to the MR protocol when evaluating the small animal head trauma patient.

scholarly journals Spine and sacroiliac joints on magnetic resonance imaging in patients with early axial spondyloarthritis: prevalence of lesions and association with clinical and disease activity indices from the Italian group of the SPACE study

Reumatismo ◽  
2016 ◽  
Vol 68 (2) ◽  
pp. 72 ◽  
Author(s):  
M. Lorenzin ◽  
A. Ortolan ◽  
P. Frallonardo ◽  
S. Vio ◽  
C. Lacognata ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
X Rays ◽  
Resonance Imaging ◽  
Diagnostic Significance ◽  
Significant Difference ◽  
Spine Mri ◽  
Activity Indices

Our aim was to determine the prevalence of spine and sacroiliac joint (SIJ) lesions on magnetic resonance imaging (MRI) in patients with early axial spondyloarthritis (axSpA) and their correlation with disease activity indices. Sixty patients with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years), attending the SpA-clinic of the Unità Operativa Complessa Reumatologia of Padova [SpondyloArthritis-Caught-Early (SPACE) study], were studied following a protocol including physical examination, questionnaires, laboratory tests, X-rays and spine and SIJ MRI. Positive spine and SIJ MRI and X-rays images were scored independently by 2 readers using the SPARCC method, modified Stoke ankylosing spondylitis spine score and New York criteria. The axial pain and localization of MRI-lesions were referred to 4 sites: cervical/thoracic/lumbar spine and SIJ. All patients were classified into three groups: patients with signs of radiographic sacroiliitis (r-axSpA), patients without signs of r-axSpA but with signs of sacroiliitis on MRI (nr-axSpA MRI SIJ+), patients without signs of sacroiliitis on MRI and X-rays (nr-axSpA MRI SIJ-). The median age at LBP onset was 29.05±8.38 years; 51.6% of patients showed bone marrow edema (BME) in spine-MRI and 56.7% of patients in SIJ-MRI. Signs of enthesitis were found in 55% of patients in the thoracic district. Of the 55% of patients with BME on spine-MRI, 15% presented presented a negative SIJMRI. There was a significant difference between these cohorts with regard to the prevalence of radiographic sacroiliitis, active sacroiliitis on MRI and SPARCC SIJ score. The site of pain correlated statistically with BME lesions in thoracic and buttock districts. Since positive spine-MRI images were observed in absence of sacroiliitis, we can hypothesize that this finding could have a diagnostic significance in axSpA suspected axSpA.

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