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Oca Pernas R, Fernández Cantón G. Direct MR arthrography without image guidance: a practical guide, joint-by-joint. Skeletal Radiol 2024:10.1007/s00256-024-04709-0. [PMID: 38801542 DOI: 10.1007/s00256-024-04709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
Direct MR arthrography (dMRA) is a fundamental technique in diagnosing pathology in major peripheral joints, allowing for precise evaluation of intra-articular structures. Although injection guidance is typically performed using imaging techniques such as ultrasound or fluoroscopy, puncture via anatomical landmarks may be useful in certain circumstances where it has been proven to be a safe and effective procedure. This paper describes the indications and injection technique of dMRA, joint by joint, focusing on the different technical details, from the most common locations, like the shoulder or hip, to those with more restricted clinical indications, such as the wrist, knee, elbow, or ankle. The most relevant anatomical landmarks are detailed for each joint, aiding in the intra-articular introduction of diluted contrast, highlighting the most accessible trajectories and structures to avoid when inserting the needle. Additionally, tips are provided to facilitate proper joint distension. With all this information, this paper aims to serve as a suitable reference guide for performing dMRA without image guidance if needed.
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Affiliation(s)
- Roque Oca Pernas
- Osakidetza - Basque Health Service, MRI Department, OSATEK, Osatek Deusto, Luis Power, 18, 48014, Bilbao, Spain.
- Department of Radiology, Mutualia, Bilbao, Spain.
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Donalisio M, Egea M, Dunet V, Omoumi P, Mourad C. Arachnoiditis ossificans. Skeletal Radiol 2024; 53:1019-1021. [PMID: 37851082 DOI: 10.1007/s00256-023-04465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Massimo Donalisio
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, VD, Switzerland.
| | - Michael Egea
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, VD, Switzerland
| | - Vincent Dunet
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, VD, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, VD, Switzerland
| | - Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, VD, Switzerland
- Department of Radiology, Lebanese Hospital Geitaoui - UMC, Geitaoui Street, 1709, Beirut, Lebanon
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3
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Jiang J, Miao L, Zhang L, Shi Z, Zhang H, Wen X, Hu S, Xu L, Gong L, Li M. Assessing the Feasibility of Simplifying the Scanning Protocol for Spinal Metastases With Vertebral Compression Fractures Using Only the Dixon T2-Weighted Sequence. J Comput Assist Tomogr 2024:00004728-990000000-00307. [PMID: 38595136 DOI: 10.1097/rct.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Conventional imaging protocols, including sagittal T1-weighted imaging (T1WI) and water-only T2-weighted imaging (T2WI), are time consuming when screening for spinal metastases with vertebral compression fractures (VCFs). In this study, we aimed to assess the accuracy of using only the Dixon T2-weighted sequence in the diagnosis of spinal metastases with VCFs to determine its suitability as a simplified protocol for this task. METHODS This retrospective study included 27 patients diagnosed with spinal metastases and VCFs. Qualitative analysis was performed separately by two musculoskeletal radiologists, who independently performed diagnostic evaluations of each vertebra using both conventional and simplified protocols. McNemar's test was then used to compare the differences in diagnostic results, and Cohen's kappa coefficient was used to assess interobserver and interprotocol agreement. Diagnostic performance values for both protocols, including sensitivity, specificity, and area under the curve, were then determined based on the reference standard. Quantitative image analysis was performed randomly for 30 metastases on T1WI and fat-only T2WI to measure the signal intensity, signal-to-noise ratio, and contrast-to-noise ratio. RESULTS The diagnosis of VCFs by both radiologists was in full agreement with the reference standard. The classification of spinal metastases and diagnostic performance values determined by both radiologists were not significantly different between the two protocols (all P > 0.05), and the consistency between observers and protocols was excellent (κ = 0.973-0.991). The contrast-to-noise ratio of fat-only T2WI was significantly higher than that of T1WI (P < 0.001). CONCLUSIONS The Dixon T2-weighted sequence alone performed well in diagnosing spinal metastases with VCFs, performing no worse than the conventional protocol (T1WI and water-only T2WI). This suggests that the Dixon T2-weighted sequence alone can serve as a simplified protocol for the diagnosis of spinal metastases with VCFs, thereby avoiding the need for more intricate scanning procedures.
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Affiliation(s)
| | - Lei Miao
- From the Departments of Diagnostic Radiology
| | - Li Zhang
- From the Departments of Diagnostic Radiology
| | - Zhuo Shi
- From the Departments of Diagnostic Radiology
| | | | - Xin Wen
- From the Departments of Diagnostic Radiology
| | - Sijie Hu
- From the Departments of Diagnostic Radiology
| | | | - Lihua Gong
- Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Li
- From the Departments of Diagnostic Radiology
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Zandee van Rilland ED, Yoon SY, Garner HW, Ni Mhuircheartaigh J, Wu JS. Does the presence of macroscopic intralesional fat exclude malignancy? An analysis of 613 histologically proven malignant bone lesions. Eur Radiol 2024:10.1007/s00330-024-10687-7. [PMID: 38488967 DOI: 10.1007/s00330-024-10687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/15/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To determine if macroscopic intralesional fat detected in bone lesions on CT by Hounsfield unit (HU) measurement and on MRI by macroscopic assessment excludes malignancy. MATERIALS AND METHODS All consecutive CT-guided core needle biopsies (CNB) of non-spinal bone lesions performed at a tertiary center between December 2005 and September 2021 were reviewed. Demographic and histopathology data were recorded. All cases with malignant histopathology were selected, and imaging studies were reviewed. Two independent readers performed CT HU measurements on all bone lesions using a circular region of interest (ROI) to quantitate intralesional fat density (mean HU < -30). MRI images were reviewed to qualitatively assess for macroscopic intralesional fat signal in a subset of patients. Inter-reader agreement was assessed with Cronbach's alpha and intraclass correlation coefficient. RESULTS In 613 patients (mean age 62.9 years (range 19-95 years), 47.6% female), CT scans from the CNB of 613 malignant bone lesions were reviewed, and 212 cases had additional MRI images. Only 3 cases (0.5%) demonstrated macroscopic intralesional fat on either CT or MRI. One case demonstrated macroscopic intralesional fat density on CT in a case of metastatic prostate cancer. Two cases demonstrated macroscopic intralesional fat signal on MRI in cases of chondrosarcoma and osteosarcoma. Inter-reader agreement was excellent (Cronbach's alpha, 0.95-0.98; intraclass correlation coefficient, 0.90-0.97). CONCLUSION Malignant lesions rarely contain macroscopic intralesional fat on CT or MRI. While CT is effective in detecting macroscopic intralesional fat in primarily lytic lesions, MRI may be better for the assessment of heterogenous and infiltrative lesions with mixed lytic and sclerotic components. CLINICAL RELEVANCE STATEMENT Macroscopic intralesional fat is rarely seen in malignant bone tumors and its presence can help to guide the diagnostic workup of bone lesions. KEY POINTS • Presence of macroscopic intralesional fat in bone lesions has been widely theorized as a sign of benignity, but there is limited supporting evidence in the literature. • CT and MRI are effective in evaluating for macroscopic intralesional fat in malignant bone lesions with excellent inter-reader agreement. • Macroscopic intralesional fat is rarely seen in malignant bone lesions.
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Affiliation(s)
- Eddy D Zandee van Rilland
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Sherman 231, Boston, MA, 02215, USA.
| | - Se-Young Yoon
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Sherman 231, Boston, MA, 02215, USA
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Sherman 231, Boston, MA, 02215, USA
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5
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Rodríguez-Laval V, Lumbreras-Fernández B, Aguado-Bueno B, Gómez-León N. Imaging of Multiple Myeloma: Present and Future. J Clin Med 2024; 13:264. [PMID: 38202271 PMCID: PMC10780302 DOI: 10.3390/jcm13010264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Multiple myeloma (MM) is the second most common adult hematologic malignancy, and early intervention increases survival in asymptomatic high-risk patients. Imaging is crucial for the diagnosis and follow-up of MM, as the detection of bone and bone marrow lesions often dictates the decision to start treatment. Low-dose whole-body computed tomography (CT) is the modality of choice for the initial assessment, and dual-energy CT is a developing technique with the potential for detecting non-lytic marrow infiltration and evaluating the response to treatment. Magnetic resonance imaging (MRI) is more sensitive and specific than 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for the detection of small focal lesions and diffuse marrow infiltration. However, FDG-PET/CT is recommended as the modality of choice for follow-up. Recently, diffusion-weighted MRI has become a new technique for the quantitative assessment of disease burden and therapy response. Although not widespread, we address current proposals for structured reporting to promote standardization and diminish variations. This review provides an up-to-date overview of MM imaging, indications, advantages, limitations, and recommended reporting of each technique. We also cover the main differential diagnosis and pitfalls and discuss the ongoing controversies and future directions, such as PET-MRI and artificial intelligence.
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Affiliation(s)
- Víctor Rodríguez-Laval
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
- Department of Medicine, Autonomous University of Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Blanca Lumbreras-Fernández
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
| | - Beatriz Aguado-Bueno
- Department of Hematology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain;
| | - Nieves Gómez-León
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
- Department of Medicine, Autonomous University of Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
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Samet JD, Alizai H, Chalian M, Costelloe C, Deshmukh S, Kalia V, Kamel S, Mhuircheartaigh JN, Saade J, Walker E, Wessell D, Fayad LM. Society of skeletal radiology position paper - recommendations for contrast use in musculoskeletal MRI: when is non-contrast imaging enough? Skeletal Radiol 2024; 53:99-115. [PMID: 37300709 DOI: 10.1007/s00256-023-04367-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
The following White Paper will discuss the appropriateness of gadolinium administration in MRI for musculoskeletal indications. Musculoskeletal radiologists should consider the potential risks involved and practice the judicious use of intravenous contrast, restricting administration to cases where there is demonstrable added value. Specific nuances of when contrast is or is not recommended are discussed in detail and listed in table format. Briefly, contrast is recommended for bone and soft tissue lesions. For infection, contrast is reserved for chronic or complex cases. In rheumatology, contrast is recommended for early detection but not for advanced arthritis. Contrast is not recommended for sports injuries, routine MRI neurography, implants/hardware, or spine imaging, but is helpful in complex and post-operative cases.
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Affiliation(s)
- Jonathan D Samet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Hamza Alizai
- CHOP Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, USA
| | | | | | - Vivek Kalia
- Children's Scottish Rite Hospital, Dallas, USA
| | - Sarah Kamel
- Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Jimmy Saade
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, USA
| | - Eric Walker
- Penn State Health Milton S Hershey Medical Center, Hershey, USA
| | - Daniel Wessell
- Mayo Clinic Jacksonville Campus: Mayo Clinic in Florida, Jacksonville, USA
| | - Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, USA.
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Poon D, Tang C, Vijayanathan S, Mak D. The use of MRI for the imaging of metastatic bone lesions. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2023; 67:271-279. [PMID: 38054411 DOI: 10.23736/s1824-4785.23.03538-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Skeletal metastatic disease accounts for significant overall morbidity in cancer patients. Accurate and accessible imaging forms an integral part of the investigation for patients with suspected or known skeletal metastatic disease; it is considered indispensable in making appropriate oncological treatment decisions. Magnetic resonance imaging (MRI) is a contemporary imaging modality that provides excellent spatial and contrast resolution for bone and soft tissues. Therefore, it is particularly useful for imaging patients suffering from metastatic skeletal disease. This review provides a fundamental overview of the physics and image generation of MRI. The most commonly used MRI sequences in the investigation of metastatic skeletal disease are also discussed. Additionally, a review of the pathophysiological basis of metastatic bone disease is presented, along with an introduction to the interpretation of MRI sequences obtained for metastatic bone disease. Finally, the strengths and drawbacks of MRI are considered in comparison to alternative imaging modalities for the investigation of this common and important oncological complication.
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Affiliation(s)
- Daniel Poon
- MSK Imaging, Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Christopher Tang
- MSK Imaging, Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sanjay Vijayanathan
- MSK Imaging, Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Davina Mak
- MSK Imaging, Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK -
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Omoumi P, Mourad C, Ledoux JB, Hilbert T. Morphological assessment of cartilage and osteoarthritis in clinical practice and research: Intermediate-weighted fat-suppressed sequences and beyond. Skeletal Radiol 2023; 52:2185-2198. [PMID: 37154871 PMCID: PMC10509097 DOI: 10.1007/s00256-023-04343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Magnetic resonance imaging (MRI) is widely regarded as the primary modality for the morphological assessment of cartilage and all other joint tissues involved in osteoarthritis. 2D fast spin echo fat-suppressed intermediate-weighted (FSE FS IW) sequences with a TE between 30 and 40ms have stood the test of time and are considered the cornerstone of MRI protocols for clinical practice and trials. These sequences offer a good balance between sensitivity and specificity and provide appropriate contrast and signal within the cartilage as well as between cartilage, articular fluid, and subchondral bone. Additionally, FS IW sequences enable the evaluation of menisci, ligaments, synovitis/effusion, and bone marrow edema-like signal changes. This review article provides a rationale for the use of FSE FS IW sequences in the morphological assessment of cartilage and osteoarthritis, along with a brief overview of other clinically available sequences for this indication. Additionally, the article highlights ongoing research efforts aimed at improving FSE FS IW sequences through 3D acquisitions with enhanced resolution, shortened examination times, and exploring the potential benefits of different magnetic field strengths. While most of the literature on cartilage imaging focuses on the knee, the concepts presented here are applicable to all joints. KEY POINTS: 1. MRI is currently considered the modality of reference for a "whole-joint" morphological assessment of osteoarthritis. 2. Fat-suppressed intermediate-weighted sequences remain the keystone of MRI protocols for the assessment of cartilage morphology, as well as other structures involved in osteoarthritis. 3. Trends for further development in the field of cartilage and joint imaging include 3D FSE imaging, faster acquisition including AI-based acceleration, and synthetic imaging providing multi-contrast sequences.
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Affiliation(s)
- Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui CHU, Achrafieh, Beyrouth, Lebanon
| | - Jean-Baptiste Ledoux
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tom Hilbert
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
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9
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Pace M, Cannella R, Di Stefano V, Lupica A, Alonge P, Morici G, Brighina F, Brancato F, Midiri F, Galia M. Usefulness and Clinical Impact of Whole-Body MRI in Detecting Autoimmune Neuromuscular Disorders. Brain Sci 2023; 13:1500. [PMID: 37891867 PMCID: PMC10605918 DOI: 10.3390/brainsci13101500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Autoimmune neuromuscular diseases are a group of heterogenous pathologies secondary to the activation of the immune system that damage the structures of the peripheric nerve, the neuromuscular junction, or the skeleton muscle. The diagnosis of autoimmune neuromuscular disorders comprises a combination of data from clinical, laboratory, electromyography, imaging exam, and biopsy. Particularly, the whole-body MRI examination in the last two decades has been of great use in the assessment of neuromuscular disorders. MRI provides information about the structures involved and the status of activity of the disease. It can also be used as a biomarker, detect the pattern of specific muscle involvement, and is a useful tool for targeting the optimal muscle site for biopsy. In this work, we summarized the most used technical protocol of whole-body MRI and the role of this imaging technique in autoimmune neuromuscular disorders.
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Affiliation(s)
- Mario Pace
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Vincenzo Di Stefano
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Antonino Lupica
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Paolo Alonge
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Giulio Morici
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Filippo Brighina
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Federica Brancato
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy;
| | - Federico Midiri
- IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso 173, 20161 Milano, Italy;
| | - Massimo Galia
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
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Tanturri de Horatio L, Zadig PK, von Brandis E, Ording Müller LS, Rosendahl K, Avenarius DFM. Whole-body MRI in children and adolescents: Can T2-weighted Dixon fat-only images replace standard T1-weighted images in the assessment of bone marrow? Eur J Radiol 2023; 166:110968. [PMID: 37478654 DOI: 10.1016/j.ejrad.2023.110968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE When performing whole-body MRI for bone marrow assessment in children, optimizing scan time is crucial. The aim was to compare T2 Dixon fat-only and TSE T1-weighted sequences in the assessment of bone marrow high signal areas seen on T2 Dixon water-only in healthy children and adolescents. MATERIALS AND METHODS Whole-body MRIs from 196 healthy children and adolescents aged 6 to 19 years (mean 12.0) were obtained including T2 TSE Dixon and T1 TSE-weighted images. Areas with increased signal on T2 Dixon water-only images were scored using a novel, validated scoring system and classified into "minor" or "major" findings according to size and intensity, where "major" referred to changes easily being misdiagnosed as pathology in a clinical setting. Areas were assessed for low signal on T2 Dixon fat-only images and, after at least three weeks to avoid recall bias, on the T1-weighted sequence by two experienced pediatric radiologists. RESULTS 1250 high signal areas were evaluated on T2 Dixon water-only images. In 1159/1250 (92.7%) low signal was seen on both T2 Dixon fat-only and T1-weighted sequences while in 24 (1.9%) it was not present on either sequence, with an absolute agreement of 94.6%. Discordant findings were found in 67 areas, of which in 18 (1.5%) low signal was visible on T1-weighted images alone and in 49 (3.9%) on T2 Dixon fat-only alone. The overall kappa value between the two sequences was 0.39. The agreement was higher for major as compared to minor findings (kappa values of 0.69 and 0.29, respectively) and higher for the older age groups. CONCLUSION T2 Dixon fat-only can replace T1-weighted sequence on whole-body MRI for bone marrow assessment in children over the age of nine, thus reducing scan time.
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Affiliation(s)
- Laura Tanturri de Horatio
- Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway; Department of Pediatric Radiology, Ospedale Pediatrico Bambino Gesù, 00165 Rome, Italy.
| | - Pia K Zadig
- Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway; Department of Radiology, University Hospital of North-Norway, 9038 Tromsø, Norway
| | - Elisabeth von Brandis
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0372 Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Karen Rosendahl
- Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway; Department of Radiology, University Hospital of North-Norway, 9038 Tromsø, Norway
| | - Derk F M Avenarius
- Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway; Department of Radiology, University Hospital of North-Norway, 9038 Tromsø, Norway
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11
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Tipirneni-Sajja A, Brasher S, Shrestha U, Johnson H, Morin C, Satapathy SK. Quantitative MRI of diffuse liver diseases: techniques and tissue-mimicking phantoms. MAGMA (NEW YORK, N.Y.) 2023; 36:529-551. [PMID: 36515810 DOI: 10.1007/s10334-022-01053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
Quantitative magnetic resonance imaging (MRI) techniques are emerging as non-invasive alternatives to biopsy for assessment of diffuse liver diseases of iron overload, steatosis and fibrosis. For testing and validating the accuracy of these techniques, phantoms are often used as stand-ins to human tissue to mimic diffuse liver pathologies. However, currently, there is no standardization in the preparation of MRI-based liver phantoms for mimicking iron overload, steatosis, fibrosis or a combination of these pathologies as various sizes and types of materials are used to mimic the same liver disease. Liver phantoms that mimic specific MR features of diffuse liver diseases observed in vivo are important for testing and calibrating new MRI techniques and for evaluating signal models to accurately quantify these features. In this study, we review the liver morphology associated with these diffuse diseases, discuss the quantitative MR techniques for assessing these liver pathologies, and comprehensively examine published liver phantom studies and discuss their benefits and limitations.
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Affiliation(s)
- Aaryani Tipirneni-Sajja
- Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA.
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Sarah Brasher
- Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA
| | - Utsav Shrestha
- Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA
| | - Hayden Johnson
- Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA
| | - Cara Morin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sanjaya K Satapathy
- Northwell Health Center for Liver Diseases and Transplantation, Northshore University Hospital/Northwell Health, Manhasset, NY, USA
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Garcia-Diez AI, Tomas Batlle X, Perissinotti A, Isern-Kebschull J, Del Amo M, Soler JC, Bartolome A, Bencardino JT. Imaging of the Diabetic Foot. Semin Musculoskelet Radiol 2023; 27:314-326. [PMID: 37230131 DOI: 10.1055/s-0043-1764386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Diabetic foot complications are increasingly prevalent in the world, leading to significant morbidity and driving up associated health care costs. Complex pathophysiology and suboptimal specificity of current imaging modalities have made diagnosis challenging, mainly in the evaluation of superimposed foot infection to underlying arthropathy or other marrow lesions. Recent advances in radiology and nuclear medicine have the potential to streamline the assessment of diabetic foot complications. But we must be aware of the specific strengths and weaknesses of each modality, and their applications. This review offers a comprehensive approach to the spectrum of diabetic foot complications and their imaging appearances in conventional and advanced imaging studies, including optimal technical considerations for each technique. Advanced magnetic resonance imaging (MRI) techniques are highlighted, illustrating their complementary role to conventional MRI, in particular their potential impact in avoiding additional studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Jenny Teresa Bencardino
- Division of Musculoskeletal Radiology, Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Ahlawat S, Debs P, Amini B, Lecouvet FE, Omoumi P, Wessell DE. Clinical Applications and Controversies of Whole-Body MRI: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 220:463-475. [PMID: 36169545 DOI: 10.2214/ajr.22.28229] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Whole-body MRI (WB-MRI) is increasing in clinical acceptance and utilization for a range of indications. WB-MRI is currently an established screening tool for children and adults at high risk of developing malignancy, with the strongest supporting evidence in patients with Li-Fraumeni syndrome. WB-MRI has been added to professional society guidelines for staging disease in patients with certain malignancies including multiple myeloma and has been proposed as a technique to screen for metastatic disease in patients with visceral malignancies including prostate cancer and breast cancer. Emerging data support the utility of WB-MRI in children with malignancies such as Ewing sarcoma, in adults with myxoid liposarcoma, and in pregnant patients with occult or newly detected malignancy. WB-MRI can further help evaluate disease extent and treatment response in patients with nononcologic conditions such as chronic nonbacterial osteomyelitis, myopathy, inflammatory arthritis, and fever of unknown origin. This AJR Expert Panel Narrative Review summarizes available evidence and recommendations supporting the clinical applications of WB-MRI. This article also highlights limitations, barriers, and controversies associated with utilization of WB-MRI in routine clinical practice.
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Affiliation(s)
- Shivani Ahlawat
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Caroline St, 3rd Fl, Baltimore, MD 21287
| | - Patrick Debs
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Caroline St, 3rd Fl, Baltimore, MD 21287
| | - Behrang Amini
- Department of Musculoskeletal Imaging, MD Anderson Cancer Center, Houston, TX
| | - Frédéric E Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Bajaj G, Chhabra A. Bone Marrow Changes and Lesions of Diabetic Foot and Ankle Disease: Conventional and Advanced Magnetic Resonance Imaging. Semin Musculoskelet Radiol 2023; 27:73-90. [PMID: 36868246 DOI: 10.1055/s-0043-1761494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Diabetic foot and ankle complications contribute to substantial mortality and morbidity. Early detection and treatment can lead to better patient outcomes. The primary diagnostic challenge for radiologists is distinguishing Charcot's neuroarthropathy from osteomyelitis. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessing diabetic bone marrow alterations and for identifying diabetic foot complications. Several recent technical advances in MRI, such as the Dixon technique, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have led to improved image quality and increased capability to add more functional and quantitative information.We discuss the bone marrow abnormalities encountered in daily radiologic assessment: osteopenia, reactive bone marrow edema-like signal, insufficiency fractures, Charcot's neuroarthropathy, osteomyelitis, serous marrow atrophy, digital ischemia, and bone infarcts, along with their pathophysiology and the conventional and advanced imaging techniques used for a comprehensive marrow evaluation.
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Affiliation(s)
- Gitanjali Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Avneesh Chhabra
- Department Radiology and Orthopedic Surgery, UT Southwestern, Dallas, Texas.,Johns Hopkins University and Walton Centre for Neuroscience, Liverpool, United Kingdom.,University of Dallas, Irving, Texas
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15
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Mourad C, Cosentino A, Nicod Lalonde M, Omoumi P. Advances in Bone Marrow Imaging: Strengths and Limitations from a Clinical Perspective. Semin Musculoskelet Radiol 2023; 27:3-21. [PMID: 36868241 PMCID: PMC9984270 DOI: 10.1055/s-0043-1761612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Conventional magnetic resonance imaging (MRI) remains the modality of choice to image bone marrow. However, the last few decades have witnessed the emergence and development of novel MRI techniques, such as chemical shift imaging, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and whole-body MRI, as well as spectral computed tomography and nuclear medicine techniques. We summarize the technical bases behind these methods, in relation to the common physiologic and pathologic processes involving the bone marrow. We present the strengths and limitations of these imaging methods and consider their added value compared with conventional imaging in assessing non-neoplastic disorders like septic, rheumatologic, traumatic, and metabolic conditions. The potential usefulness of these methods to differentiate between benign and malignant bone marrow lesions is discussed. Finally, we consider the limitations hampering a more widespread use of these techniques in clinical practice.
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Affiliation(s)
- Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui- CHU, Beyrouth, Lebanon
| | - Aurelio Cosentino
- Department of Radiology, Hôpital Riviera-Chablais, Vaud-Valais, Rennaz, Switzerland
| | - Marie Nicod Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Bai J, Grant K, Hussien A, Kawakyu-O'Connor D. Imaging of metastatic epidural spinal cord compression. FRONTIERS IN RADIOLOGY 2022; 2:962797. [PMID: 37492671 PMCID: PMC10365281 DOI: 10.3389/fradi.2022.962797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/18/2022] [Indexed: 07/27/2023]
Abstract
Metastatic epidural spinal cord compression develops in 5-10% of patients with cancer and is becoming more common as advancement in cancer treatment prolongs survival in patients with cancer (1-3). It represents an oncological emergency as metastatic epidural compression in adjacent neural structures, including the spinal cord and cauda equina, and exiting nerve roots may result in irreversible neurological deficits, pain, and spinal instability. Although management of metastatic epidural spinal cord compression remains palliative, early diagnosis and intervention may improve outcomes by preserving neurological function, stabilizing the vertebral column, and achieving localized tumor and pain control. Imaging serves an essential role in early diagnosis of metastatic epidural spinal cord compression, evaluation of the degree of spinal cord compression and extent of tumor burden, and preoperative planning. This review focuses on imaging features and techniques for diagnosing metastatic epidural spinal cord compression, differential diagnosis, and management guidelines.
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