Comparative evaluation of chest radiography,low-field MRI,the Shwachman-Kulczycki score and pulmonary function tests in patients with cystic fibrosis

The aim of this study was to investigate whether the parenchymal lung damage in patients suffering from cystic fibrosis (CF) can be equivalently quantified by the Chrispin-Norman (CN) scores determined with low-field magnetic resonance imaging (MRI) and conventional chest radiography (CXR). Both scores were correlated with pulmonary function tests (PFT) and the Shwachman-Kulczycki method (SKM). To evaluate the comparability of MRI and CXR for different states of the disease, all scores were applied to patients divided into three age groups. Seventy-three CF patients (mean SKM score: 62 ± 8) with a median age (range) of 14 years (7–32) were included. The mean CN scores determined with both imaging methods were comparable (CXR: 12.1 ± 4.7; MRI: 12.0 ± 4.5) and showed high correlation (P < 0.05, R = 0.97). Only weak correlations were found between imaging, PFT, and SKM. Both imaging modalities revealed significantly more severe disease expression with age, while PFT and SKM failed to detect early signs of disease. We conclude that imaging of the lung in CF patients is capable of detecting subtle and early parenchymal destruction before lung function or clinical scoring is affected. Furthermore, low-field MRI revealed high consistency with chest radiography and may be used for a thorough follow-up while avoiding radiation exposure.     

Comparison of the utility of whole-body MRI with and without contrast-enhanced Quick 3D and double RF fat suppression techniques,conventional whole-body MRI,PET/CT and conventional examination for assessment of recurrence in NSCLC patients

Purpose

The purpose of this study was to compare diagnostic capabilities for assessment of recurrence in non-small cell lung cancer (NSCLC) patients by contrast-enhanced whole-body MRI (CE-WB-MRI) with and without CE-Quick 3D and double RF fat suppression technique (DFS), FDG-PET/CT and conventional radiological examinations.

Materials and methods

A total of 134 pathologically proven and completely resected NSCLC patients (78 males, 56 females; mean age: 72 years) underwent FDG-PET/CT, CE-WB-MRI with and without Quick 3D and DFS at 3 T as well as conventional radiological examinations. The probability of recurrence was assessed with a 5-point scoring system on a per-patient basis, and final diagnosis was made by consensus between two readers. The capability for overall recurrence assessment by all the methods was compared by means of ROC analysis and their sensitivity, specificity and accuracy by means of McNemar's test.

Results

Although areas under the curve did not show any significant differences, specificity (100%) and accuracy (95.5%) of CE-WB-MRI with CE-Quick 3D and DFS were significantly higher than those of FDG-PET/CT (specificity: 93.6%, p = 0.02; accuracy: 89.6%, p = 0.01) and conventional radiological examinations (specificity: 92.7%, p = 0.01; accuracy: 91.0%, p = 0.03). In addition, specificity of CE-WB-MRI without CE-Quick 3D and DFS (100%) was significantly higher than that of FDG-PET/CT (p = 0.02) and conventional radiological examinations (p = 0.01).

Conclusion

Specificity and accuracy of CE-WB-MRI with CE-Quick 3D and DFS for assessment of recurrence in NSCLC patients are at least as high as, or higher than those of others.     

MRI in the investigation of patients with myelopathy thought to be due to multiple sclerosis

The role of cerebral and spinal cord MRI was investigated in 65 patients with myelopathy suspected of having demyelinating disease. Cerebral MRI demonstrated lesions compatible with demyelination in 80% and spinal cord MRI in 68.6%. In 28.5% of our patients brain lesions were present with normal spinal cord images, but in 17% spinal cord lesions were depicted with a normal brain MRI. The combination of the two examinations demonstrated lesions in 97% of the patients. The frequency of coexistent cerebral lesions in patients with spinal cord lesions was over 85% in patients with chronic disease but only 28.5% in patients with acute myelitis.     

Ear pain in patients with oropharynx carcinoma: how MRI contributes to the explanation of a prognostic and predictive symptom

Reflex otalgia is a predictive and prognostic parameter for local control in patients with oropharynx carcinoma. Can a morphologic correlate of this important symptom be detected by MRI? Thirty-six patients were prospectively evaluated by MRI before radical radiotherapy. Sixteen patients had reflex otalgia; 20 did not. The oropharynx and adjacent regions were analyzed. Alteration was defined as effacement of anatomical structures, signal alteration or enhancement after contrast medium administration. The χ²-test was used to compare categorical parameters. In patients with reflex otalgia, alteration of the following structures innervated by the glossopharyngeal nerve were found significantly more often: nasopharynx, hard palate, superior constrictor pharyngis muscle, palatine tonsil, palatopharyngeus muscle, palatoglossus muscle, stylopharyngeus muscle, hyoglossus muscle and preepiglottic space. No difference was found for the muscles of mastication, levator and tensor veli palatini muscles, styloglossus muscle, genioglossus muscle, intrinsic muscles of the tongue, digastric muscles, mucosal surface of the lateral and posterior pharyngeal wall, uvula, valleculae, parapharyngeal space and larynx. An alteration of structures innervated by the glossopharyngeal nerve was visualized on MRI significantly more often when reflex otalgia was present. Involvement of structures innervated by other cranial nerves did not show the same association with ear pain.     

Preoperative breast MR Imaging in patients with primary breast cancer has the potential to decrease the rate of repeated surgeries

PurposeThe impact of preoperative MRI on re-excisions and mastectomy rate is discussed controversially in the literature. Aim of this study was to evaluate the effect of preoperative breast MRI on the surgical procedure and rate of repeated surgeries.Material and methodsA total of 991 consecutive patients in the years 2009 and 2010 with 1036 primary breast cancers were retrospectively analyzed. Sixty percent (599 patients with 626 cancers) received preoperative breast MRI. Planned surgical procedures before and after MRI and numbers of repeated surgeries in patients with (MR+ ) and without preoperative MRI (MR−) were compared.ResultsThe result of preoperative MRI changed the surgical procedure in 25% (157/626) of the cases. In 81% (127/157), MRI was beneficial for the patients, as otherwise occult carcinomas were removed (n = 122) or further biopsy could be prevented (n = 5). Mastectomy rates did not differ between MR+ and MR- group (39% vs. 39%). On multiple regression analysis, the MR+ group had a lower chance for repeated surgery (p < 0.05).ConclusionPreoperative MRI could lower the chance for repeated surgery in patients with primary breast cancer. The rate of mastectomy did not differ between patients undergoing preoperative MRI and those who did not.     

观察脑肿瘤致大脑运动功能重组患者运动神经网络变化的功能性连接MRI研究

目的 应用功能性连接MR成像(fcMRI)技术,观察中央沟附近脑肿瘤所致功能重组患者运动神经网络的改变,为理解肿瘤所致运动功能重组的机制提供新的实验依据.方法 采用1.5 T MR成像系统,对6名正常志愿者及14例功能MRI(fMRI)显示运动功能重组的中央沟附近脑肿瘤患者行fcMRI.分别得到以正常受试者左和右主运动(M1)区、脑肿瘤患者肿瘤侧半球和非肿瘤侧半球M1区为种子体素(兴趣区)的功能连接图.对与以上种子体素呈明显相关的功能连接区的位置、范围、体积进行评估.将所测数据进行t检验和单向方差分析.结果 fcMRI显示6名正常志愿者单侧M1区的功能连接脑区遍布于双侧大脑半球,包括双侧M1区、双侧辅助运动区(SMA)、双侧运动前区(PMC区)等与运动相关的皮层,左右对称分布.左M1区的功能连接区[(9514.17±186.92)mm3]与右M1区者[(9364.67±382.75)mm3]范围基本一致,二者在体积上差异无统计学意义(P>0.05);肿瘤组fcMRI显示:(1)与肿瘤侧M1区所连接脑区的体积[(11193.14±811.29)mm3]明显大于非肿瘤侧M1区的功能连接区[(6549.86±400.94)mm3](P<0.01).肿瘤组肿瘤侧M1区所连接的脑区与正常对照组单侧M1区的功能连接脑区差异有统计学意义(P<0.01),前者明显扩大(P<0.01),提示肿瘤侧M1区与其他运动相关脑区的功能连接增强.其连接脑区的范围与受累手对指运动时同层面fMRI显示的运动功能重组区范围基本一致.(2)肿瘤组非肿瘤侧M1区的功能连接区的体积与正常组比较,差异有统计学意义(P<0.01),前者有减少的趋势(P<0.01),特别是肿瘤侧半球内,提示非肿瘤侧M1区与对侧半球的功能连接破坏.结论 肿瘤组患者肿瘤侧M1区功能连接区的增多提示运动功能重组可能与运动功能传导路径重组或潜在运动路径补偿性开放有关.fcMRI是一种显示颅内肿瘤所致运动神经网络变化的有效手段.     

Cost-analysis of staging methods for lymph nodes in patients with prostate cancer: MRI with a lymph node-specific contrast agent compared to pelvic lymph node dissection or CT

The aim of this study was to compare the costs of three strategies in patients with prostate cancer in a specific setting: firstly, a strategy including MR lymphography (MRL) in which pelvic lymph node dissection (PLND) is foregone in case of a negative result. The second strategy involves computed tomography (CT) followed by a biopsy or PLND. The third strategy consists of PLND without imaging beforehand. A decision analytic model was constructed. This model represented the diagnostic process for patients with prostate cancer and intermediate or high risk for nodal metastases, comparing the costs of the three strategies. Cost analysis was done from the health care perspective. The model indicated that the expected costs for the MRL strategy were €2,527. The expected costs for the strategy using CT were €3,837 and for PLND €3,994. These results show that potential savings performing MRL instead of CT were €1,310 and €1,467 for PLND. Sensitivity analyses show that variation in costs of PLND was most influential on the costs of all strategies. However, the overall savings pattern did not alter. Average costs of MRL staging in our institution are less than for CT and PLND in staging lymph nodes of patients with prostate cancer and who are intermediate or high risk for nodal metastases.     

Total Bilirubin Level as a Predictor of Suboptimal Image Quality of the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI in Patients with Extrahepatic Bile Duct Cancer

ObjectiveThis study aimed to determine a factor for predicting suboptimal image quality of the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI in patients with extrahepatic bile duct (EHD) cancer before MRI examination.Materials and MethodsWe retrospectively evaluated 259 patients (mean age ± standard deviation: 68.0 ± 8.3 years; 162 male and 97 female) with EHD cancer who underwent gadoxetic acid-enhanced MRI between 2011 and 2017. Patients were divided into a primary analysis set (n = 184) and a validation set (n = 75) based on the diagnosis date of January 2014. Two reviewers assigned the functional liver imaging score (FLIS) to reflect the HBP image quality. The FLIS consists of the sum of three HBP features, each scored on a 0–2 scale: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified into low-FLIS (0–3) or high-FLIS (4–6) groups. Multivariable analysis was performed to determine a predictor of low FLIS using serum biochemical and imaging parameters of cholestasis severity. The optimal cutoff value for predicting low FLIS was obtained using receiver operating characteristic analysis, and validation was performed.ResultsOf the 259 patients, 140 (54.0%) and 119 (46.0%) were classified into the low-FLIS and high-FLIS groups, respectively. In the primary analysis set, total bilirubin was an independent factor associated with low FLIS (adjusted odds ratio per 1-mg/dL increase, 1.62; 95% confidence interval [CI], 1.32–1.98). The optimal cutoff value of total bilirubin for predicting low FLIS was 2.1 mg/dL with a sensitivity of 95.1% (95% CI: 88.9–98.4) and a specificity of 89.0% (95% CI: 80.2–94.9). In the validation set, the total bilirubin cutoff showed a sensitivity of 92.1% (95% CI: 78.6–98.3) and a specificity of 83.8% (95% CI: 68.0–93.8).ConclusionSerum total bilirubin before acquisition of gadoxetic acid-enhanced MRI may help predict suboptimal HBP image quality in patients with EHD cancer.     

64层螺旋CT与1.5 T MRI在慢性阻塞性肺病患者右心功能测定中的临床应用

分别与第1秒用力呼气容积有很好的相关性(rRVEF=0.781,rMM=-0.824).结论 重度COPD患者有严重右心功能损伤,与MRI结果比较,MSCT心功能检查可以正确定量评价右心室容积和功能.     

Quantitative T2 evaluation at 3.0T compared to morphological grading of the lumbar intervertebral disc: a standardized evaluation approach in patients with low back pain

Background

The purpose of our investigation was to compare quantitative T2 relaxation time measurement evaluation of lumbar intervertebral discs with morphological grading in young to middle-aged patients with low back pain, using a standardized region-of-interest evaluation approach.

Patients and methods

Three hundred thirty lumbar discs from 66 patients (mean age, 39 years) with low back pain were examined on a 3.0 T MR unit. Sagittal T1-FSE, sagittal, coronal, and axial T2-weighted FSE for morphological MRI, as well as a multi-echo spin-echo sequence for T2 mapping, were performed. Morphologically, all discs were classified according to Pfirrmann et al. Equally sized rectangular regions of interest (ROIs) for the annulus fibrosus were selected anteriorly and posteriorly in the outermost 20% of the disc. The space between was defined as the nucleus pulposus. To assess the reproducibility of this evaluation, inter- and intraobserver statistics were performed.

Results

The Pfirrmann scoring of 330 discs showed the following results: grade I: six discs (1.8%); grade II: 189 (57.3%); grade III: 96 (29.1%); grade IV: 38 (11.5%); and grade V: one (0.3%). The mean T2 values (in milliseconds) for the anterior and the posterior annulus, and the nucleus pulposus for the respective Pfirrmann groups were: I: 57/30/239; II: 44/67/129; III: 42/51/82; and IV: 42/44/56. The nucleus pulposus T2 values showed a stepwise decrease from Pfirrmann grade I to IV. The posterior annulus showed the highest T2 values in Pfirrmann group II, while the anterior annulus showed relatively constant T2 values in all Pfirrmann groups. The inter- and intraobserver analysis yielded intraclass correlation coefficients (ICC) for average measures in a range from 0.82 (anterior annulus) to 0.99 (nucleus).

Conclusions

Our standardized method of region-specific quantitative T2 relaxation time evaluation seems to be able to characterize different degrees of disc degeneration quantitatively. The reproducibility of our ROI measurements is sufficient to encourage the use of this method in future investigations, particularly for longitudinal studies.