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El Haddad J, Charbonneau F, Guillaume J, Clavel G, Chazal T, Poillon G, Tran A, Niro A, Sore R, Litman-Roventa L, Mahe K, Chhour S, Savatovsky J, Lecler A. Reproducibility and accuracy of vessel wall MRI in diagnosing giant cell arteritis: a study with readers of varying expertise. Eur Radiol 2024:10.1007/s00330-023-10567-6. [PMID: 38206404 DOI: 10.1007/s00330-023-10567-6] [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: 11/16/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To evaluate the reproducibility of vessel wall magnetic resonance imaging (VW-MRI) in diagnosing giant cell arteritis (GCA) among groups of radiologists with varying levels of expertise. METHODS This institutional review board-approved retrospective single-center study recruited patients with suspected GCA between December 2014 and September 2021. Patients underwent 3 -T VW-MRI before temporal artery biopsy. Ten radiologists with varying levels of expertise, blinded to all data, evaluated several intracranial and extracranial arteries to assess GCA diagnosis. Interobserver reproducibility and diagnostic performance were evaluated. RESULTS Fifty patients (27 women and 23 men) with a mean age of 75.9 ± 9 years were included. Thirty-one of 50 (62%) had a final diagnosis of GCA.VW-MRI had an almost perfect reproducibility among expert readers (kappa = 0.93; 95% CI 0.77-1) and substantial reproducibility among all readers, junior and non-expert senior readers (kappa = 0.7; 95% CI 0.66-0.73; kappa = 0.67 95% CI 0.59-0.74; kappa = 0.65; 95% CI 0.43-0.88 respectively) when diagnosing GCA. Substantial interobserver agreement was observed for the frontal branch of superficial temporal artery. Moderate interobserver agreement was observed for the superficial temporal artery and its parietal branch, as well as ophthalmic arteries in all groups of readers. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy varied depending on the group of readers. CONCLUSION VW-MRI is a reproducible and accurate imaging modality for detecting GCA, even among less-experienced readers. This study advocates for the use of VW-MRI when diagnosing GCA even in less-experienced centers. CLINICAL RELEVANCE STATEMENT VW-MRI is a reproducible and accurate imaging modality for detecting GCA, even among less-experienced readers, and it could be used as a first-line diagnostic tool for GCA in centers with limited expertise in GCA diagnosis. KEY POINTS • Vessel wall magnetic resonance imaging (VW-MRI) is a reproducible and accurate imaging modality for detecting giant cell arteritis (GCA) in both extracranial and intracranial arteries. • The reproducibility of vessel wall magnetic resonance imaging for giant cell arteritis diagnosis was high among expert readers and moderate among less-experienced readers. • The use of vessel wall magnetic resonance imaging for giant cell arteritis diagnosis can be recommended even in centers with less-experienced readers.
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Affiliation(s)
- Jérôme El Haddad
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France.
| | | | - Jessica Guillaume
- Department of Clinical Research, A. Rothschild Foundation Hospital, Paris, France
| | - Gaëlle Clavel
- Department of Internal Medicine, A. Rothschild Foundation Hospital, Paris, France
| | - Thibaud Chazal
- Department of Internal Medicine, A. Rothschild Foundation Hospital, Paris, France
| | - Guillaume Poillon
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Alexia Tran
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Alexandre Niro
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Rémi Sore
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Luca Litman-Roventa
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Kévin Mahe
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Samantha Chhour
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France.
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Ughi N, Padoan R, Crotti C, Sciascia S, Carrara G, Zanetti A, Rozza D, Monti S, Camellino D, Muratore F, Emmi G, Quartuccio L, Morbelli S, El Aoufy K, Tonolo S, Caporali R, De Vita S, Salvarani C, Cimmino M. The Italian Society of Rheumatology clinical practice guidelines for the management of large vessel vasculitis. Reumatismo 2022; 73. [DOI: 10.4081/reumatismo.2021.1470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: Since of the last publication of last recommendations on primary large-vessel vasculitis (LVV) endorsed by the Italian Society of Rheumatology (SIR) in 2012, new evidence emerged regarding the diagnosis and the treatment with conventional and biologic immunosuppressive drugs. The associated potential change of clinical care supported the need to update the original recommendations. Methods: Using the grading of recommendations assessment, development and evaluation (GRADE)-ADOLOPMENT framework, a systematic literature review was performed to update the evidence supporting the European Alliance of Associations for Rheumatology (EULAR) guidelines on LVV as reference. A multidisciplinary panel of 12 expert clinicians, a trained nurse, and a patients’ representative discussed the recommendation in cooperation with an Evidence Review Team. Sixty-one stakeholders were consulted to externally review and rate the recommendations. Results: Twelve recommendations were formulated. A suspected diagnosis of LVV should be confirmed by imaging or histology. In active GCA or TAK, the prompt commencement of high dose of oral glucocorticoids (40-60 mg prednisone-equivalent per day) is strongly recommended to induce clinical remission. In selected patients with GCA (e.g., refractory or relapsing disease or patients at risk of glucocorticoid related adverse effects) the use of an adjunctive therapy (tocilizumab or methotrexate) is recommended. In all patients diagnosed with TAK, adjunctive therapies, such as conventional synthetic or biological immunosuppressants, should be given in combination with glucocorticoids. Conclusions: The new set of SIR recommendations was formulated in order to provide a guidance on both diagnosis and treatment of patients suspected of or with a definite diagnosis of LVV.
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Validity of high resolution magnetic resonance imaging in detecting giant cell arteritis: a meta-analysis. Eur Radiol 2022; 32:3541-3552. [PMID: 35015125 DOI: 10.1007/s00330-021-08413-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study was designed to evaluate the performance of high-resolution magnetic resonance imaging (HR-MRI) in detecting giant cell arteritis (GCA), evaluate superficial extracranial artery and other MRI abnormalities, and compare three-dimensional (3D) and two-dimensional (2D) techniques. METHODS PubMed, Web of Science, and Cochrane Library were screened up to March 7, 2021, and further selection was performed according to the eligibility criteria. Quality Assessment of Diagnostic Accuracy Studies-2 was used for quality assessment, and heterogeneity assessment and statistical calculations were also performed. RESULTS In total, 1851 records were retrieved from online databases, and 15 studies were finally included. Regarding the performance of HR-MRI, the superficial extracranial artery had 75% sensitivity and 89% specificity, respectively, with an area under the receiver operating characteristic curve (AUC) of 0.91. Positive and negative post-test possibilities were 86% and 20%, respectively, with clinical diagnosis as reference. When referenced with temporal artery biopsy, the sensitivity was 91%, specificity was 78%, AUC was 0.92, and positive and negative post-test possibilities were 78% and 10%, respectively. 3D HR-MRI and 2D HR-MRI had 70% and 72% sensitivity, respectively, and 91% and 84% specificity, respectively. CONCLUSIONS HR-MRI is a valuable imaging modality for GCA diagnosis. It provided high accuracy in the diagnosis of GCA and played a potential role in identifying GCA-related ischemic optic neuropathy. 3D HR-MRI had better specificity than 2D HR-MRI. KEY POINTS HR-MRI helps clinicians to diagnose GCA. Superficial extracranial arteries and other MRI abnormalities can be assessed with HR-MRI. HR-MRI can help in assessing GCA-related optic neuropathy.
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Lecler A, Hage R, Charbonneau F, Vignal C, Sené T, Picard H, Leturcq T, Zuber K, Belangé G, Affortit A, Sadik JC, Savatovsky J, Clavel G. Validation of a multimodal algorithm for diagnosing giant cell arteritis with imaging. Diagn Interv Imaging 2021; 103:103-110. [PMID: 34663548 DOI: 10.1016/j.diii.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study was to identify which combination of imaging modalities should be used to obtain the best diagnostic performance for the non-invasive diagnosis of giant cell arteritis (GCA). MATERIALS AND METHODS This IRB-approved prospective single-center study enrolled participants presenting with a suspected diagnosis of GCA from December 2014 to October 2017. Participants underwent high-resolution 3T magnetic resonance imaging (MRI), temporal and extra-cranial arteries ultrasound and retinal angiography (RA), prior to temporal artery biopsy (TAB). Diagnostic accuracy of each imaging modality alone, then a combination of several imaging modalities, was evaluated. Several algorithms were constructed to test optimal combinations using McNemar test. RESULTS Forty-five participants (24 women, 21 men) with mean age of 75.4 ± 16 (SD) years (range: 59-94 years) were enrolled; of these 43/45 (96%) had ophthalmological symptoms. Diagnosis of GCA was confirmed in 25/45 (56%) patients. Sensitivity and specificity of MRI, ultrasound and RA alone were 100% (25/25; 95% CI: 86-100) and 86% (19/22; 95% CI: 65-97), 88% (22/25; 95% CI: 69-97) and 84% (16/19; 95% CI: 60-97), 94% (15/16; 95% CI: 70-100) and 74% (14/19; 95% CI: 49-91), respectively. Sensitivity, specificity, positive predictive and negative predictive values ranged from 95 to 100% (95% CI: 77-100), 67 to 100% (95% CI: 38-100), 81 to 100% (95% CI: 61-100) and 91 to 100% (95% CI: 59-100) when combining several imaging tests, respectively. The diagnostic algorithm with the overall best diagnostic performance was the one starting with MRI, followed either by ultrasound or RA, yielding 100% sensitivity (22/22; 95% CI: 85-100%) 100% (15/15; 95% CI: 78-100) and 100% accuracy (37/37; 95% CI: 91-100). CONCLUSION The use of MRI as the first imaging examination followed by either ultrasound or RA reaches high degrees of performance for the diagnosis of GCA and is recommended in daily practice.
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Affiliation(s)
- Augustin Lecler
- Department of Radiology, Rothschild Hospital Foundation, 75019 Paris, France.
| | - Rabih Hage
- Department of Ophthalmology, Rothschild Hospital Foundation, 75019 Paris, France
| | | | - Catherine Vignal
- Department of Ophthalmology, Rothschild Hospital Foundation, 75019 Paris, France
| | - Thomas Sené
- Department of Internal Medicine, Rothschild Hospital Foundation, 75019 Paris, France
| | - Hervé Picard
- Clinical Research Unit, Rothschild Hospital Foundation, 75019 Paris, France
| | - Tifenn Leturcq
- Department of Internal Medicine, Rothschild Hospital Foundation, 75019 Paris, France
| | - Kevin Zuber
- Clinical Research Unit, Rothschild Hospital Foundation, 75019 Paris, France
| | - Georges Belangé
- Department of Internal Medicine, Rothschild Hospital Foundation, 75019 Paris, France
| | - Aude Affortit
- Department of Ophthalmology, Rothschild Hospital Foundation, 75019 Paris, France
| | - Jean-Claude Sadik
- Department of Radiology, Rothschild Hospital Foundation, 75019 Paris, France
| | - Julien Savatovsky
- Department of Radiology, Rothschild Hospital Foundation, 75019 Paris, France
| | - Gaëlle Clavel
- Department of Internal Medicine, Rothschild Hospital Foundation, 75019 Paris, France
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Kang Y, Chen Y, Fang J, Huang Y, Wang H, Gong Z, Zhan S, Tan W. Performance of a Flexible 12-Channel Head Coil in Comparison to Commercial 16- And 24-Channel Rigid Head Coils. Magn Reson Med Sci 2021; 21:623-631. [PMID: 34544923 PMCID: PMC9618927 DOI: 10.2463/mrms.mp.2021-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To compare the performance of a 12-channel flexible head coil (HFC12) with commercial 16-channel (HRC16) and 24-channel (HRC24) rigid coils. Methods: The phantom study was performed on a 1.5 T MR scanner with HFC12, HRC16, and HRC24. The SNR and noise correlation matrix of T1WI, T2WI, and diffusion weighted imaging (DWI) were measured. The SNR profiles were created according to the SNR. In addition, 1/g-factors were calculated in different acceleration directions. In the in vivo study, T1WI, T2WI, and DWI were performed in one healthy volunteer with three different coils. The SNR and noise correlation matrix were measured. Results: In the phantom study and in vivo study, the SNR of HFC12 in the transverse, sagittal, and coronal planes was the highest, followed by HRC24, and that of HRC16 was the lowest. The SNR profiles showed that the SNR at the edge of HFC12 was the highest. The mean value of the noise correlation matrix of HFC12 was the highest. The 1/g-factor results showed that HFC12 obtained the best acceleration ability in the head–foot acceleration direction when the reduction factor was set to two. The SNR of HFC12 in most cortices was significantly higher than that of HRC16 and HRC24, except in the occipital cortex. The SNR of HRC24 in the occipital cortex was higher than that of HFC12. Conclusion: The SNR of HFC12 in T1WI, T2WI, and DWI was better than that of the HRC24 and HFC16. The SNR of HFC12 in the cortex was significantly higher than that of the commercial rigid head coil, except in the occipital cortex.
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Affiliation(s)
- YingJie Kang
- Department of Radiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine
| | - YiLei Chen
- Department of Radiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine
| | - JieMing Fang
- Department of Diagnostic Radiology, City of Hope Medical Center
| | - YanWen Huang
- Department of Radiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine
| | - Hui Wang
- Department of Radiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine
| | - ZhiGang Gong
- Department of Radiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine
| | - SongHua Zhan
- Department of Radiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine
| | - WenLi Tan
- Department of Radiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine
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Nakai R, Azuma T, Nakaso Y, Sawa S, Demura T. Development of a dynamic imaging method for gravitropism in pea sprouts using clinical magnetic resonance imaging system. PLANT BIOTECHNOLOGY (TOKYO, JAPAN) 2020; 37:437-442. [PMID: 33850431 PMCID: PMC8034701 DOI: 10.5511/plantbiotechnology.20.1020a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/20/2020] [Indexed: 05/17/2023]
Abstract
Although magnetic resonance imaging (MRI) is a useful technique, only a few studies have investigated the dynamic behavior of small subjects using MRI owing to constraints such as experimental space and signal amount. In this study, to acquire high-resolution continuous three-dimensional gravitropism data of pea (Pisum sativum) sprouts, we developed a small-bore MRI signal receiver coil that can be used in a clinical MRI and adjusted the imaging sequence. It was expected that such an arrangement would improve signal sensitivity and improve the signal-to-noise ratio (SNR) of the acquired image. All MRI experiments were performed using a 3.0-T clinical MRI scanner. An SNR comparison using an agarose gel phantom to confirm the improved performance of the small-bore receiver coil and an imaging experiment of pea sprouts exhibiting gravitropism were performed. The SNRs of the images acquired with a standard 32-channel head coil and the new small-bore receiver coil were 5.23±0.90 and 57.75±12.53, respectively. The SNR of the images recorded using the new coil was approximately 11-fold higher than that of the standard coil. In addition, when the accuracy of MR imaging that captures the movement of pea sprout was verified, the difference in position information from the optical image was found to be small and could be used for measurements. These results of this study enable the application of a clinical MRI system for dynamic plant MRI. We believe that this study is a significant first step in the development of plant MRI technique.
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Affiliation(s)
- Ryusuke Nakai
- Kokoro Research Center, Kyoto University, 46 Shimoadachi-cho, Yoshida Sakyo-ku, Kyoto 606-8501, Japan
| | - Takashi Azuma
- Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8397, Japan
| | - Yosuke Nakaso
- Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan
| | - Shinichiro Sawa
- Graduate School of Science and Technology, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto 860-0862, Japan
| | - Taku Demura
- Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, Nara 630-0192, Japan
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Ponte C, Martins-Martinho J, Luqmani RA. Diagnosis of giant cell arteritis. Rheumatology (Oxford) 2020; 59:iii5-iii16. [DOI: 10.1093/rheumatology/kez553] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
GCA is the most common form of primary systemic vasculitis affecting older people. It is considered a clinical emergency because it can lead to irreversible blindness in around 20% of untreated cases. High doses of glucocorticoids should be initiated promptly to prevent disease-related complications; however, glucocorticoids therapy usually results in significant toxicity. Therefore, correct diagnosis is crucial. For many years, temporal artery biopsy has been considered the diagnostic ‘gold standard’ for GCA, but it has many limitations (including low sensitivity). US has proven to be effective for diagnosing GCA and can reliably replace temporal artery biopsy in particular clinical settings. In cases of suspected GCA with large-vessel involvement, other imaging modalities can be used for diagnosis (e.g. CT and PET). Here we review the current evidence for each diagnostic modality and propose an algorithm to diagnose cranial-GCA in a setting with rapid access to high quality US.
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Affiliation(s)
- Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Martins-Martinho
- Rheumatology Department, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Yan S, Qian T, Maréchal B, Kober T, Zhang X, Zhu J, Lei J, Li M, Jin Z. Test-retest variability of brain morphometry analysis: an investigation of sequence and coil effects. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:12. [PMID: 32055603 DOI: 10.21037/atm.2019.11.149] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Precise and reliable brain morphometry analysis is critical for clinical and research purposes. The magnetization-prepared rapid gradient echo (MPRAGE), multi-echo MPRAGE (MEMPRAGE) and magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) sequences have all been used to acquire brain structural images, but it is unclear which of these sequences is the most suitable for brain morphometry and whether the number of coil channels (20 or 32) affects scan precision. This study aimed to assess the impact of T1-weighted image acquisition variables (sequence and head coil) on the repeatability of resultant automated volumetric measurements. Methods Twenty-four healthy volunteers underwent back-to-back scanning protocols with three sequences and two different coils (i.e., six scanning conditions in total) presented in a randomized order in a single session. MorphoBox prototype and FreeSurfer were used for brain segmentation. Brain structures were divided into cortical and subcortical regions for more precise analysis. The acquired volume and thickness values were used to calculate test-retest variability (TRV) values. TRV values from the six different combinations were compared for total brain structures, total cortical structures, total subcortical structures, and every single structure. Results The median TRV value for all brain regions was 1.23% with MorphoBox and 3.14% with FreeSurfer. When using FreeSurfer results to compare the six combinations, for total brain structures volume and total cortical structures volume and thickness, the MEMPRAGE-32 channel combination showed significantly lower TRV values than the others (P<0.01). Similar results were observed with MorphoBox. For total subcortical structures, the MP2RAGE-32 channel combination showed the lowest TRV values with both MorphoBox (lower about 0.01% to 0.17%) and FreeSurfer analyses (lower about 0.02% to 0.37%). Conclusions TRV values were generally low, indicating generally high reliability for every region. The MEMPRAGE sequence was the most reliable of the three sequences for total brain structures and cortical structures. However, MP2RAGE was the most reliable for subcortical structures. The 32-channel coil showed better repeatability results than the 20-channel coil.
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Affiliation(s)
- Shuang Yan
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Tianyi Qian
- Department of MR Collaboration, Siemens Healthcare Ltd., Beijing 100102, China
| | - Bénédicte Maréchal
- Department of Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Department of Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Xianchang Zhang
- Department of MR Collaboration, Siemens Healthcare Ltd., Beijing 100102, China
| | - Jinxia Zhu
- Department of MR Collaboration, Siemens Healthcare Ltd., Beijing 100102, China
| | - Jing Lei
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mingli Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Duftner C, Dejaco C, Sepriano A, Falzon L, Schmidt WA, Ramiro S. Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations. RMD Open 2018. [PMID: 29531788 PMCID: PMC5845406 DOI: 10.1136/rmdopen-2017-000612] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives To perform a systematic literature review on imaging techniques for diagnosis, outcome prediction and disease monitoring in large vessel vasculitis (LVV) informing the European League Against Rheumatism recommendations for imaging in LVV. Methods Systematic literature review (until 10 March 2017) of diagnostic and prognostic studies enrolling >20 patients and investigating ultrasound, MRI, CT or positron emission tomography (PET) in patients with suspected and/or established primary LVV. Meta-analyses were conducted, whenever possible, obtaining pooled estimates for sensitivity and specificity by fitting random effects models. Results Forty-three studies were included (39 on giant cell arteritis (GCA), 4 on Takayasu arteritis (TAK)). Ultrasound ('halo' sign) at temporal arteries (8 studies, 605 patients) and MRI of cranial arteries (6 studies, 509 patients) yielded pooled sensitivities of 77% (95% CI 62% to 87%) and 73% (95% CI 57% to 85%), respectively, compared with a clinical diagnosis of GCA. Corresponding specificities were 96% (95% CI 85% to 99%) and 88% (95% CI 81% to 92%). Two studies (93 patients) investigating PET for GCA diagnosis reported sensitivities of 67%-77% and specificities of 66%-100% as compared with clinical diagnosis or temporal artery biopsy. In TAK, one study each evaluated the role of magnetic resonance angiography and CT angiography for diagnostic purposes revealing both a sensitivity and specificity of 100%. Studies on outcome prediction and monitoring disease activity/damage were limited and mainly descriptive. Conclusions Ultrasound and MRI provide a high diagnostic value for cranial GCA. More data on the role of imaging for diagnosis of extracranial large vessel GCA and TAK, as well as for outcome prediction and monitoring in LVV are warranted.
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Affiliation(s)
- Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Dejaco
- Rheumatology Service, South Tyrolean Health Trust, Hospital of Bruneck, Bruneck, Italy.,Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, New York, USA
| | | | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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10
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High-resolution vessel wall MRI for the evaluation of intracranial atherosclerotic disease. Neuroradiology 2017; 59:1193-1202. [PMID: 28942481 DOI: 10.1007/s00234-017-1925-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/11/2017] [Indexed: 01/23/2023]
Abstract
High-resolution vessel wall MRI (vwMRI) of the intracranial arteries is an emerging diagnostic imaging technique with the goal of evaluating vascular pathology. vwMRI sequences have high spatial resolution and directly image the vessel wall by suppressing blood signal. With vwMRI, it is possible to identify distinct morphologic and enhancement patterns of atherosclerosis that can provide important information about stroke etiology and recurrence risk. We present a review of vwMRI research in relation to intracranial atherosclerosis, with a focus on the relationship between ischemic stroke and atherosclerotic plaque T1 post-contrast enhancement or plaque/vessel wall morphology. The goal of this review is to provide readers with the most current understanding of the reliability, incidence, and importance of specific vwMRI findings in intracranial atherosclerosis, to guide their interpretation of vwMRI research, and help inform clinical interpretation of vwMRI. We will also provide a translational perspective on the existing vwMRI literature and insight into future vwMRI research questions and objectives. With increased use of high field strength MRI, powerful gradients, and improved pulse sequences, vwMRI will become standard-of-care in the diagnosis and prognosis of patients with cerebrovascular disease, making a firm grasp of its strengths and weakness important for neuroimagers.
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11
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de Havenon A, Chung L, Park M, Mossa-Basha M. Intracranial vessel wall MRI: a review of current indications and future applications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0021-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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Abstract
Much progress has been made in the use of imaging as a diagnostic tool in giant cell arteritis (GCA), which assists in the management of patients where the initial diagnosis is unclear. This includes patients with atypical cranial symptoms, or with predominantly systemic, constitutional or limb symptoms. Ultrasound and magnetic resonance imaging are capable of visualising both the cranial and extracranial large vessel circulation, with vessel wall thickening and stenotic lesions being visualised. Computed tomographic angiography is helpful in visualising the aorta for aneurysm complicating GCA but can also detect vessel wall thickening in established large vessel vasculitis. PET-CT is a very sensitive test for early vascular inflammation in extracranial large vessel vasculitis, before aneurysmal or stenotic lesions have developed, of use in the patient with unexplained constitutional symptoms. The place of imaging in the follow-up of GCA is being investigated, and repeated imaging may be useful in select cases. Generally, vascular abnormalities become less defined once glucocorticoid treatment has been started, and therefore, imaging studies must be conducted early as part of a GCA fast-track assessment.
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Affiliation(s)
- Asad Khan
- Department of Rheumatology, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea, Essex, SS0 0RY, UK
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Nestle U, Rischke HC, Eschmann SM, Holl G, Tosch M, Miederer M, Plotkin M, Essler M, Puskas C, Schimek-Jasch T, Duncker-Rohr V, Rühl F, Leifert A, Mix M, Grosu AL, König J, Vach W. Improved inter-observer agreement of an expert review panel in an oncology treatment trial – Insights from a structured interventional process. Eur J Cancer 2015; 51:2525-33. [DOI: 10.1016/j.ejca.2015.07.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/13/2015] [Accepted: 07/26/2015] [Indexed: 11/29/2022]
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Zhang T, Grafendorfer T, Cheng JY, Ning P, Rainey B, Giancola M, Ortman S, Robb FJ, Calderon PD, Hargreaves BA, Lustig M, Scott GC, Pauly JM, Vasanawala SS. A semiflexible 64-channel receive-only phased array for pediatric body MRI at 3T. Magn Reson Med 2015; 76:1015-21. [PMID: 26418283 DOI: 10.1002/mrm.25999] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE To design, construct, and validate a semiflexible 64-channel receive-only phased array for pediatric body MRI at 3T. METHODS A 64-channel receive-only phased array was developed and constructed. The designed flexible coil can easily conform to different patient sizes with nonoverlapping coil elements in the transverse plane. It can cover a field of view of up to 44 × 28 cm(2) and removes the need for coil repositioning for body MRI patients with multiple clinical concerns. The 64-channel coil was compared with a 32-channel standard coil for signal-to-noise ratio and parallel imaging performances on different phantoms. With IRB approval and informed consent/assent, the designed coil was validated on 21 consecutive pediatric patients. RESULTS The pediatric coil provided higher signal-to-noise ratio than the standard coil on different phantoms, with the averaged signal-to-noise ratio gain at least 23% over a depth of 7 cm along the cross-section of phantoms. It also achieved better parallel imaging performance under moderate acceleration factors. Good image quality (average score 4.6 out of 5) was achieved using the developed pediatric coil in the clinical studies. CONCLUSION A 64-channel semiflexible receive-only phased array has been developed and validated to facilitate high quality pediatric body MRI at 3T. Magn Reson Med 76:1015-1021, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Tao Zhang
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | | | - Joseph Y Cheng
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Peigang Ning
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | | | | | | | - Paul D Calderon
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Brian A Hargreaves
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Michael Lustig
- Department of Electrical Engineering, Stanford University, Stanford, California, USA.,Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
| | - Greig C Scott
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - John M Pauly
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
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