1
|
Behzad S, Tabatabaei SMH, Lu MY, Eibschutz LS, Gholamrezanezhad A. Pitfalls in Interpretive Applications of Artificial Intelligence in Radiology. AJR Am J Roentgenol 2024. [PMID: 39046137 DOI: 10.2214/ajr.24.31493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Interpretive artificial intelligence (AI) tools are poised to change the future of radiology. However, certain pitfalls may pose particular challenges for optimal AI interpretative performance. These include anatomic variants, age-related changes, postoperative changes, medical devices, image artifacts, lack of integration of prior and concurrent imaging examinations and clinical information, as well as the satisfaction-of-search effect. Model training and development should account for such pitfalls, to minimize errors and optimize interpretation accuracy. More broadly, AI algorithms should be exposed to diverse and complex training data sets, to yield a holistic interpretation that considers all relevant information beyond the individual examination. Successful clinical deployment of AI tools will require that radiologist end-users recognize these pitfalls and other limitations of the available models. Furthermore, developers should incorporate explainable AI techniques (e.g., heat maps) into their tools, to improve radiologists' understanding of model outputs and to enable radiologists to provide feedback for guiding continuous learning and iterative refinement. In this article, we provide an overview of common pitfalls that radiologists may encounter when using interpretive AI products in daily practice. We present how such pitfalls lead to AI errors and offer potential strategies that AI developers may use for their mitigation.
Collapse
Affiliation(s)
| | | | - Max Yang Lu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles CA
| | | | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles CA
- Department of Radiology, Los Angeles General Hospital, Los Angeles, CA
| |
Collapse
|
2
|
Nakai H, Takahashi N, Sugi MD, Wellnitz CV, Thompson CP, Kawashima A. Image quality comparison of 1.5T and 3T prostate MRIs of the same post-hip arthroplasty patients: multi-rater assessments including PI-QUAL version 2. Abdom Radiol (NY) 2024:10.1007/s00261-024-04483-6. [PMID: 38980403 DOI: 10.1007/s00261-024-04483-6] [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: 04/15/2024] [Revised: 06/27/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To compare the image quality of 1.5T and 3T prostate MRIs of the same post-hip arthroplasty patients, with a specific focus on the degree of susceptibility artifacts. METHODS This single-center retrospective study included post-hip arthroplasty patients who underwent 1.5T prostate MRIs between 2021 and 2023, as well as comparative 3T prostate MRIs. Three blinded abdominal radiologists retrospectively reviewed their diffusion-weighted imaging (DWI, 50 s/mm2), T2-weighted imaging (T2WI), and dynamic contrast-enhanced imaging (DCE) to evaluate the image quality. The degree of susceptibility artifacts was categorized using a three-point scale, with 3 indicating the least artifact and 1 indicating the most. Image quality was also evaluated using Prostate Imaging Quality (PI-QUAL) version 2. The median of the three raters' scores was compared between 1.5T and 3T prostate MRIs using the Wilcoxon signed-rank test. The inter-rater agreement was evaluated using the multi-rater generalized kappa. RESULTS Twenty pairs of 1.5T and 3T prostate MRI examinations from 20 unique patients were included. The DWI susceptibility artifact score at 1.5T was significantly higher than at 3T (mean score ± standard deviation, 2.80 ± 0.41 vs. 2.35 ± 0.93, p = 0.014). In contrast, no significant differences were observed in the susceptibility artifact scores in T2WI and DCE, or in the PI-QUAL score. The inter-reader agreement in the susceptibility artifact score was moderate (multi-rater generalized kappa: 0.60) in DWI, perfect in T2WI (not applicable), and substantial (0.65) in DCE. The inter-reader agreement was fair (0.27) in the PI-QUAL score. CONCLUSION Using 1.5T scanners may be preferable to reduce susceptibility artifacts from hip prostheses in DWI.
Collapse
Affiliation(s)
| | | | - Mark D Sugi
- Department of Radiology, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Clinton V Wellnitz
- Department of Radiology, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Cole P Thompson
- Department of Radiology, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Akira Kawashima
- Department of Radiology, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
| |
Collapse
|
3
|
Wang Y, Hrovat M, Kolandaivelu A, Gunderman AL, Halperin HR, Schmidt EJ, Chen Y. MR-Safe Cartesian Platform for Active Cardiac Shimming: Preliminary Validation. IEEE Trans Biomed Eng 2024; 71:2131-2142. [PMID: 38315598 PMCID: PMC11246563 DOI: 10.1109/tbme.2024.3362295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Implanted Cardioverter Defibrillators (ICDs) induce a large (100 parts per million) inhomogeneous magnetic field in the magnetic resonance imaging (MRI) scanner which cannot be corrected by the scanner's built-in shim coils, leading to significant image artifacts that can make portions of the heart unreadable. To compensate for the field inhomogeneity, an active shim coil capable of countering the field deviation in user-defined regions was designed that must be optimally placed at patient-specific locations. We aim to develop and evaluate an MR-safe robotic solution for automated shim coil positioning. METHODS We designed and fabricated an MR-safe Cartesian platform that holds the shim coil inside the scanner. The platform consists of three lead screw stages actuated by pneumatic motors, achieving decoupled translations of 140 mm in each direction. The platform is made of plastics and fiberglass with the control electronics placed outside the scanner room, ensuring MR safety. Mechanical modeling was derived to provide design specifications. RESULTS Experiments show that the platform achieves less than 2 mm average motion error and 0.5 mm repeatability in all directions, and reduces the adjustment time from 5 min to a few seconds. Phantom and animal trials were conducted, showing that the proposed system is able to position a heavy shim coil ( kg) for improved ICD artifact suppression. CONCLUSION This robotic platform provides an effective method for reliable shim coil positioning inside the scanner. SIGNIFICANCE This work contributes to improving cardiac MRI quality that could facilitate accurate diagnosis and treatment planning for patients with implanted ICDs.
Collapse
|
4
|
De Leon-Benedetti LS, Ramirez-Suarez KI, Otero HJ, Rapp JB, Biko DM, Smith C, Serai SD, Janson C, Shah M, Englehardt G, Fogel M, White AM. How we do it: Cardiac implantable devices are not a contraindication to MRI: time for a paradigm shift. Pediatr Radiol 2024; 54:863-875. [PMID: 38488925 DOI: 10.1007/s00247-024-05902-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Magnetic resonance imaging (MRI) is now an indispensable diagnostic tool in medicine due to its outstanding contrast resolution and absence of radiation exposure, enabling detailed tissue characterization and three-dimensional anatomical representation. This is especially important when evaluating individuals with congenital heart disease (CHD) who frequently require cardiac implantable electrical devices (CIEDs). While MRI safety issues have previously limited its use in patients with CIEDs, new advances have called these limitations into question. However, difficulties persist in the pediatric population due to the continued lack of specific safety data both related to imaging young children and the specific CIED devices they often require. This paper discusses MRI safety considerations related to imaging patients with CIEDs, investigates pediatric-specific problems, and describes thorough methods for safe MRI access, highlighting the significance of specialized institutional guidelines.
Collapse
Affiliation(s)
- Laura S De Leon-Benedetti
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Karen I Ramirez-Suarez
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Christopher Smith
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Christopher Janson
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Maully Shah
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - George Englehardt
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Mark Fogel
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| |
Collapse
|
5
|
Feuerriegel GC, Sutter R. Managing hardware-related metal artifacts in MRI: current and evolving techniques. Skeletal Radiol 2024:10.1007/s00256-024-04624-4. [PMID: 38381196 DOI: 10.1007/s00256-024-04624-4] [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: 11/15/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
Magnetic resonance imaging (MRI) around metal implants has been challenging due to magnetic susceptibility differences between metal implants and adjacent tissues, resulting in image signal loss, geometric distortion, and loss of fat suppression. These artifacts can compromise the diagnostic accuracy and the evaluation of surrounding anatomical structures. As the prevalence of total joint replacements continues to increase in our aging society, there is a need for proper radiological assessment of tissues around metal implants to aid clinical decision-making in the management of post-operative complaints and complications. Various techniques for reducing metal artifacts in musculoskeletal imaging have been explored in recent years. One approach focuses on improving hardware components. High-density multi-channel radiofrequency (RF) coils, parallel imaging techniques, and gradient warping correction enable signal enhancement, image acquisition acceleration, and geometric distortion minimization. In addition, the use of susceptibility-matched implants and low-field MRI helps to reduce magnetic susceptibility differences. The second approach focuses on metal artifact reduction sequences such as view-angle tilting (VAT) and slice-encoding for metal artifact correction (SEMAC). Iterative reconstruction algorithms, deep learning approaches, and post-processing techniques are used to estimate and correct artifact-related errors in reconstructed images. This article reviews recent developments in clinically applicable metal artifact reduction techniques as well as advances in MR hardware. The review provides a better understanding of the basic principles and techniques, as well as an awareness of their limitations, allowing for a more reasoned application of these methods in clinical settings.
Collapse
Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| |
Collapse
|
6
|
Kim D, Collins JD, White JA, Hanneman K, Lee DC, Patel AR, Hu P, Litt H, Weinsaft JW, Davids R, Mukai K, Ng MY, Luetkens JA, Roguin A, Rochitte CE, Woodard PK, Manisty C, Zareba KM, Mont L, Bogun F, Ennis DB, Nazarian S, Webster G, Stojanovska J. SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device. J Cardiovasc Magn Reson 2024; 26:100995. [PMID: 38219955 PMCID: PMC11211236 DOI: 10.1016/j.jocmr.2024.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.
Collapse
Affiliation(s)
- Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - James A White
- Departments of Cardiac Sciences and Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital and Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada
| | - Daniel C Lee
- Department of Medicine (Division of Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amit R Patel
- Cardiovascular Division, University of Virginia, Charlottesville, VA, USA
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Division of Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Rachel Davids
- SHS AM NAM USA DI MR COLLAB ADV-APPS, Siemens Medical Solutions USA, Inc., Chicago, Il, USA
| | - Kanae Mukai
- Salinas Valley Memorial Healthcare System, Ryan Ranch Center for Advanced Diagnostic Imaging, Monterey, CA, USA
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and Faculty of Medicine. Technion - Israel Institute of Technology, Israel
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
| | - Karolina M Zareba
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Lluis Mont
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Webster
- Department of Pediatrics (Cardiology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jadranka Stojanovska
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY, USA
| |
Collapse
|
7
|
Nissan N, Ochoa-Albiztegui RE, Fruchtman H, Gluskin J, Eskreis-Winkler S, Horvat JV, Kosmidou I, Meng A, Pinker K, Jochelson MS. Breast MRI in patients with implantable loop recorder: initial experience. Eur Radiol 2024; 34:155-164. [PMID: 37555957 PMCID: PMC11181953 DOI: 10.1007/s00330-023-10025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/10/2023] [Accepted: 06/13/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES To investigate the feasibility of breast MRI exams and guided biopsies in patients with an implantable loop recorder (ILR) as well as the impact ILRs may have on image interpretation. MATERIALS AND METHODS This retrospective study examined breast MRIs of patients with ILR, from April 2008 to September 2022. Radiological reports and electronic medical records were reviewed for demographic characteristics, safety concerns, and imaging findings. MR images were analyzed and compared statistically for artifact quantification on the various pulse sequences. RESULTS Overall, 40/82,778 (0.049%) MRIs during the study period included ILR. All MRIs were completed without early termination. No patient-related or device-related adverse events occurred. ILRs were most commonly located in the left lower-inner quadrant (64.6%). The main artifact was a signal intensity (SI) void in a dipole formation in the ILR bed with or without areas of peripheral high SI. Artifacts appeared greatest in the cranio-caudal axis (p < 0.001), followed by the anterior-posterior axis (p < 0.001), and then the right-left axis. High peripheral rim-like SI artifacts appeared on the post-contrast and subtracted T1-weighted images, mimicking suspicious enhancement. Artifacts were most prominent on diffusion-weighted (p < 0.001), followed by T2-weighted and T1-weighted images. In eight patients, suspicious findings were found on MRI, resulting in four additional malignant lesions. Of six patients with left breast cancer, the tumor was completely visible in five cases and partially obscured in one. CONCLUSION Breast MRI is feasible and safe among patients with ILR and may provide a significant diagnostic value, albeit with localized, characteristic artifacts. CLINICAL RELEVANCE STATEMENT Indicated breast MRI exams and guided biopsies can be safely performed in patients with implantable loop recorder. Nevertheless, radiologists should be aware of associated limitations including limited assessment of the inner left breast and pseudo-enhancement artifacts. KEY POINTS • Breast MRI in patients with an implantable loop recorder is an infrequent, feasible, and safe procedure. • Despite limited breast visualization of the implantable loop recorder bed and characteristic artifacts, MRI depicted additional lesions in 8/40 (20%) of cases, half of which were malignant. • Breast MRI in patients with an implantable loop recorder should be performed when indicated, taking into consideration typical associated artifacts.
Collapse
Affiliation(s)
- Noam Nissan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Hila Fruchtman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Jill Gluskin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sarah Eskreis-Winkler
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ioanna Kosmidou
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Alicia Meng
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Katja Pinker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| |
Collapse
|
8
|
Barrett T, Lee KL, de Rooij M, Giganti F. Update on Optimization of Prostate MR Imaging Technique and Image Quality. Radiol Clin North Am 2024; 62:1-15. [PMID: 37973236 DOI: 10.1016/j.rcl.2023.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Prostate MR imaging quality has improved dramatically over recent times, driven by advances in hardware, software, and improved functional imaging techniques. MRI now plays a key role in prostate cancer diagnostic work-up, but outcomes of the MRI-directed pathway are heavily dependent on image quality and optimization. MR sequences can be affected by patient-related degradations relating to motion and susceptibility artifacts which may enable only partial mitigation. In this Review, we explore issues relating to prostate MRI acquisition and interpretation, mitigation strategies at a patient and scanner level, PI-QUAL reporting, and future directions in image quality, including artificial intelligence solutions.
Collapse
Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| |
Collapse
|
9
|
Nenoff L, Amstutz F, Murr M, Archibald-Heeren B, Fusella M, Hussein M, Lechner W, Zhang Y, Sharp G, Vasquez Osorio E. Review and recommendations on deformable image registration uncertainties for radiotherapy applications. Phys Med Biol 2023; 68:24TR01. [PMID: 37972540 PMCID: PMC10725576 DOI: 10.1088/1361-6560/ad0d8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
Deformable image registration (DIR) is a versatile tool used in many applications in radiotherapy (RT). DIR algorithms have been implemented in many commercial treatment planning systems providing accessible and easy-to-use solutions. However, the geometric uncertainty of DIR can be large and difficult to quantify, resulting in barriers to clinical practice. Currently, there is no agreement in the RT community on how to quantify these uncertainties and determine thresholds that distinguish a good DIR result from a poor one. This review summarises the current literature on sources of DIR uncertainties and their impact on RT applications. Recommendations are provided on how to handle these uncertainties for patient-specific use, commissioning, and research. Recommendations are also provided for developers and vendors to help users to understand DIR uncertainties and make the application of DIR in RT safer and more reliable.
Collapse
Affiliation(s)
- Lena Nenoff
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, Dresden Germany
- Helmholtz-Zentrum Dresden—Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany
| | - Florian Amstutz
- Department of Physics, ETH Zurich, Switzerland
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Martina Murr
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany
| | | | - Marco Fusella
- Department of Radiation Oncology, Abano Terme Hospital, Italy
| | - Mohammad Hussein
- Metrology for Medical Physics, National Physical Laboratory, Teddington, United Kingdom
| | - Wolfgang Lechner
- Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
| | - Greg Sharp
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
10
|
Choi CE, Chakraborty A, Adzija H, Shamiya Y, Hijazi K, Coyle A, Rizkalla A, Holdsworth DW, Paul A. Metal Organic Framework-Incorporated Three-Dimensional (3D) Bio-Printable Hydrogels to Facilitate Bone Repair: Preparation and In Vitro Bioactivity Analysis. Gels 2023; 9:923. [PMID: 38131909 PMCID: PMC10742699 DOI: 10.3390/gels9120923] [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: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
Hydrogels are three-dimensional (3D) water-swellable polymeric matrices that are used extensively in tissue engineering and drug delivery. Hydrogels can be conformed into any desirable shape using 3D bio-printing, making them suitable for personalized treatment. Among the different 3D bio-printing techniques, digital light processing (DLP)-based printing offers the advantage of quickly fabricating high resolution structures, reducing the chances of cell damage during the printing process. Here, we have used DLP to 3D bio-print biocompatible gelatin methacrylate (GelMA) scaffolds intended for bone repair. GelMA is biocompatible, biodegradable, has integrin binding motifs that promote cell adhesion, and can be crosslinked easily to form hydrogels. However, GelMA on its own is incapable of promoting bone repair and must be supplemented with pharmaceutical molecules or growth factors, which can be toxic or expensive. To overcome this limitation, we introduced zinc-based metal-organic framework (MOF) nanoparticles into GelMA that can promote osteogenic differentiation, providing safer and more affordable alternatives to traditional methods. Incorporation of this nanoparticle into GelMA hydrogel has demonstrated significant improvement across multiple aspects, including bio-printability, and favorable mechanical properties (showing a significant increase in the compressive modulus from 52.14 ± 19.42 kPa to 128.13 ± 19.46 kPa with the addition of ZIF-8 nanoparticles). The designed nanocomposite hydrogels can also sustain drug (vancomycin) release (maximum 87.52 ± 1.6% cumulative amount) and exhibit a remarkable ability to differentiate human adipose-derived mesenchymal stem cells toward the osteogenic lineage. Furthermore, the formulated MOF-integrated nanocomposite hydrogel offers the unique capability to coat metallic implants intended for bone healing. Overall, the remarkable printability and coating ability displayed by the nanocomposite hydrogel presents itself as a promising candidate for drug delivery, cell delivery and bone tissue engineering applications.
Collapse
Affiliation(s)
- Cho-E Choi
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
| | - Aishik Chakraborty
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
- Collaborative Specialization in Musculoskeletal Health Research and Bone and Joint Institute, The University of Western Ontario, London, ON N6A 5B9, Canada
| | - Hailey Adzija
- Department of Chemistry, The University of Western Ontario, London, ON N6A 5B9, Canada
| | - Yasmeen Shamiya
- Department of Chemistry, The University of Western Ontario, London, ON N6A 5B9, Canada
| | - Khaled Hijazi
- Collaborative Specialization in Musculoskeletal Health Research and Bone and Joint Institute, The University of Western Ontario, London, ON N6A 5B9, Canada
- School of Biomedical Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
| | - Ali Coyle
- School of Biomedical Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
| | - Amin Rizkalla
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
- Collaborative Specialization in Musculoskeletal Health Research and Bone and Joint Institute, The University of Western Ontario, London, ON N6A 5B9, Canada
- School of Biomedical Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
- Department of Medical Biophysics, The University of Western Ontario, London, ON N6A 5B9, Canada
- Dentistry, The University of Western Ontario, London, ON N5A 5B9, Canada
| | - David W. Holdsworth
- Department of Medical Biophysics, The University of Western Ontario, London, ON N6A 5B9, Canada
| | - Arghya Paul
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
- Collaborative Specialization in Musculoskeletal Health Research and Bone and Joint Institute, The University of Western Ontario, London, ON N6A 5B9, Canada
- Department of Chemistry, The University of Western Ontario, London, ON N6A 5B9, Canada
- School of Biomedical Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
| |
Collapse
|
11
|
Sacher SE, Koff MF, Tan ET, Burge A, Potter HG. The role of advanced metal artifact reduction MRI in the diagnosis of periprosthetic joint infection. Skeletal Radiol 2023:10.1007/s00256-023-04483-5. [PMID: 37875571 PMCID: PMC11039568 DOI: 10.1007/s00256-023-04483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
Identification and diagnosis of periprosthetic joint infection (PJI) are challenging, requiring a multi-disciplinary approach involving clinical evaluation, laboratory tests, and imaging studies. MRI is advantageous to alternative imaging techniques due to superior soft tissue contrast and absence of ionizing radiation. However, the presence of metallic implants can cause signal loss and artifacts. Metal artifact suppression (MARS) MRI techniques have been developed that mitigate metal artifacts and improve periprosthetic soft tissue visualization. This paper provides a review of the various MARS MRI techniques, their clinical applicability and accuracy in PJI diagnosis and evaluation, and current challenges and future perspectives.
Collapse
Affiliation(s)
- Sara E Sacher
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA.
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Alissa Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA.
| |
Collapse
|
12
|
Xiang J, Lamy J, Lampert R, Peters DC. Balanced Steady-State Free Precession Cine MR Imaging in the Presence of Cardiac Devices: Value of Interleaved Radial Linear Combination Acquisition With Partial Dephasing. J Magn Reson Imaging 2023; 58:782-791. [PMID: 36373998 PMCID: PMC11238270 DOI: 10.1002/jmri.28528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Balanced steady-state free precession (bSSFP) is important in cardiac MRI but suffers from off-resonance artifacts. The interpretation-limiting artifacts in patients with cardiac implants remain an unsolved issue. PURPOSE To develop an interleaved radial linear combination bSSFP (lcSSFP) method with partial dephasing (PD) for improved cardiac cine imaging when implanted cardiovascular devices are present. STUDY TYPE Prospective. PHANTOM AND SUBJECTS Flow phantom adjacent to a pacemaker and 10 healthy volunteers (mean age ± standard deviation: 31.9 ± 2.9 years, 4 females) with a cardioverter-defibrillator (ICD) positioned extracorporeally at the left chest in the prepectoral region. FIELD STRENGTH/SEQUENCE A 3-T, 1) Cartesian bSSFP, 2) Cartesian gradient echo (GRE), 3) Cartesian lcSSFP, and 4) radial lcSSFP cine sequences. ASSESSMENT Flow artifacts mitigation using PD was validated with phantom experiments. Undersampled radial lcSSFP with interleaving across phase-cyclings and cardiac phases (RLC-SSFP), combined with PD, was then employed for achieving improved quality of cine images from left ventricular short-axis view. The image quality in the presence of cardiac devices was qualitatively assessed by three independent raters (1 = worst, 5 = best), regarding five criteria (banding artifacts, streak artifacts, flow artifacts, cavity visibility, and overall image quality). STATISTICAL TESTS Wilcoxon rank-sum test for the five criteria between Cartesian bSSFP cine and RLC-SSFP with PD. Fleiss kappa test for inter-reader agreement. A P value < 0.05 was considered statistically significant. RESULTS Based on simulations and phantom experiments, 60 projections per phase cycling and 1/6 PD were chosen. The in vivo experiments demonstrated significantly reduced banding artifacts (4.8 ± 0.4 vs. 2.7 ± 0.7), fewer streak artifacts (3.7 ± 0.6 vs. 2.6 ± 0.7) and flow artifacts (4.4 ± 0.4 vs. 3.7 ± 0.6), therefore improved cavity visibility (4.1 ± 0.4 vs. 2.9 ± 0.9) and overall quality (4.0 ± 0.4 vs. 2.7 ± 0.7). DATA CONCLUSION RLC-SSFP method with PD may improve cine image quality in subjects with cardiac devices. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 1.
Collapse
Affiliation(s)
- Jie Xiang
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
| | - Jerome Lamy
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Rachel Lampert
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, Connecticut, USA
| | - Dana C. Peters
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| |
Collapse
|
13
|
Fraga Rivas P, de Miguel Criado J, García Del Salto Lorente L, Gutiérrez Velasco L, Quintana Valcarcel P. Patient safety in magnetic resonance imaging. RADIOLOGIA 2023; 65:447-457. [PMID: 37758335 DOI: 10.1016/j.rxeng.2023.01.009] [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: 10/12/2022] [Accepted: 01/29/2023] [Indexed: 10/03/2023]
Abstract
Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging (MRI) study.
Collapse
Affiliation(s)
- P Fraga Rivas
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain.
| | - J de Miguel Criado
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L García Del Salto Lorente
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L Gutiérrez Velasco
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - P Quintana Valcarcel
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| |
Collapse
|
14
|
Xu L, Desjardins B, Witschey WR, Nazarian S. Noninvasive Assessment of Lipomatous Metaplasia as a Substrate for Ventricular Tachycardia in Chronic Infarct. Circ Cardiovasc Imaging 2023; 16:e014399. [PMID: 37526027 PMCID: PMC10528518 DOI: 10.1161/circimaging.123.014399] [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] [Indexed: 08/02/2023]
Abstract
Myocardial lipomatous metaplasia (LM) has been increasingly reported in patients with prior myocardial infarction. Cardiac magnetic resonance and cardiac contrast-enhanced computed tomography have been used to noninvasively detect and quantify myocardial LM in postinfarct patients, and may provide useful information for understanding cardiac mechanics, arrhythmia susceptibility, and prognosis. This review aims to summarize the advantages and disadvantages, clinical applications, and imaging features of different cardiac magnetic resonance sequences and cardiac contrast-enhanced computed tomography for LM detection and quantification. We also briefly summarize LM prevalence in different cohorts of postinfarct patients and review the clinical utility of cardiac imaging in exploring myocardial LM as an arrhythmogenic substrate in patients with prior myocardial infarction.
Collapse
Affiliation(s)
- Lingyu Xu
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Benoit Desjardins
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Walter R. Witschey
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Saman Nazarian
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA
| |
Collapse
|
15
|
Miękisiak G. Failed Back Surgery Syndrome: No Longer a Surgeon's Defeat-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1255. [PMID: 37512066 PMCID: PMC10384667 DOI: 10.3390/medicina59071255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
The introduction of the term Persistent Spinal Pain Syndrome (PSPS-T1/2), replacing the older term Failed Back Surgery Syndrome (FBSS), has significantly influenced our approach to diagnosing and treating post-surgical spinal pain. This comprehensive review discusses this change and its effects on patient care. Various diagnostic methods are employed to elucidate the underlying causes of back pain, and this information is critical in guiding treatment decisions. The management of PSPS-T1/2 involves both causative treatments, which directly address the root cause of pain, and symptomatic treatments, which focus on managing the symptoms of pain and improving overall function. The importance of a multidisciplinary and holistic approach is emphasized in the treatment of PSPS-T1/2. This approach is patient-centered and treatment plans are customized to individual patient needs and circumstances. The review concludes with a reflection on the impact of the new PSPS nomenclature on the perception and management of post-surgical spinal pain.
Collapse
Affiliation(s)
- Grzegorz Miękisiak
- Institute of Medicine, University of Opole, 45-040 Opole, Poland
- Vratislavia Medica Hospital, 51-134 Wrocław, Poland
| |
Collapse
|
16
|
Frush DP, Callahan MJ, Coley BD, Nadel HR, Guillerman RP. Comparison of the different imaging modalities used to image pediatric oncology patients: A COG diagnostic imaging committee/SPR oncology committee white paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30298. [PMID: 37025033 PMCID: PMC10652359 DOI: 10.1002/pbc.30298] [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: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
Diagnostic imaging is essential in the diagnosis and management, including surveillance, of known or suspected cancer in children. The independent and combined roles of the various modalities, consisting of radiography, fluoroscopy, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine (NM), are both prescribed through protocols but also function in caring for complications that may occur during or subsequent to treatment such as infection, bleeding, or organ compromise. Use of a specific imaging modality may be based on situational circumstances such as a brain CT or MR for a new onset seizure, chest CT for respiratory signs or symptoms, or US for gross hematuria. However, in many situations, there are competing choices that do not easily lend themselves to a formulaic approach as options; these situations depend on the contributions of a variety of factors based on a combination of the clinical scenario and the strengths and limitations of the imaging modalities. Therefore, an improved understanding of the potential influence of the imaging decision pathways in pediatric cancer care can come from comparison among the individual diagnostic imaging modalities. The purpose of the following material to is to provide such a comparison. To do this, pediatric imaging content experts for the individual modalities of radiography and fluoroscopy, US, CT, MRI, and NM will discuss the individual modality strengths and limitations.
Collapse
Affiliation(s)
- Donald P. Frush
- Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710
| | - Michael J. Callahan
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Brian D. Coley
- Division of Radiology and Medical Imaging, 3333 Burnet Avenue MLC 15017., Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - Helen R. Nadel
- Pediatric Radiology, Lucile Packard Children’s Hospital at Stanford, Stanford University School of Medicine, 725 Welch Rd, MC 5913, Palo Alto, CA 94304
| | - R. Paul Guillerman
- Department of Radiology, Texas Children’s Hospital, 6701 Fannin Street, Suite 470, Houston, TX 77030
| |
Collapse
|
17
|
Mastrangelo A, Olivares P, Giambuzzi I, Muratori M, Alamanni F, Bartorelli AL. Diagnosis and treatment of a left atrial myxoma originating from an atrial septal defect closure device: a case report. Eur Heart J Case Rep 2023; 7:ytad258. [PMID: 37323531 PMCID: PMC10267617 DOI: 10.1093/ehjcr/ytad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/01/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
Background Ostium secundum atrial septal defect (osASD) is a common congenital heart disease and transcatheter closure is the preferred treatment. Late device-related complications include thrombosis and infective endocarditis (IE). Cardiac tumours are exceedingly rare. The aetiology of a mass attached to an osASD closure device can be challenging to diagnose. Case summary A 74-year-old man with atrial fibrillation was hospitalized for evaluating a left atrial mass discovered incidentally 4 months earlier. The mass was attached to the left disc of an osASD closure device implanted 3 years before. No shrinkage of the mass was observed despite optimal intensity of anticoagulation. We describe the diagnostic workup and management of the mass that at surgery turned out to be a myxoma. Discussion A left atrial mass attached to an osASD closure device raises the suspect of device-related complications. Poor endothelialisation may promote device thrombosis or IE. Cardiac tumours (CT) are rare, and myxoma is the most common primary CT in adults. Although no clear relationship exists between the implantation of an osASD closure device and a myxoma, the development of this tumour is a possible occurrence. Echocardiography and cardiovascular magnetic resonance play a key role in the differential diagnosis between a thrombus and a myxoma, usually identifying distinctive mass features. Nevertheless, sometimes non-invasive imaging may be inconclusive, and surgery is necessary to make a definitive diagnosis.
Collapse
Affiliation(s)
| | - Paolo Olivares
- Department of Interventional Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Istituto Clinico Sant’Ambrogio, Via Privata Val Vigezzo 5, 20149 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | | |
Collapse
|
18
|
Oliver AA, Koons EK, Trester PS, Kleinow JE, Jonsgaard RS, Vercnocke AJ, Bilgin C, Kadirvel R, Leng S, Lu A, Dragomir-Daescu D, Kallmes DF. Medical Imaging Compatibility of Magnesium- and Iron-Based Bioresorbable Flow Diverters. AJNR Am J Neuroradiol 2023; 44:668-674. [PMID: 37169543 PMCID: PMC10249688 DOI: 10.3174/ajnr.a7873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Bioresorbable flow diverters are under development to mitigate complications associated with conventional flow-diverter technology. One proposed advantage is the ability to reduce metal-induced artifacts in follow-up medical imaging. In the current work, the medical imaging compatibility of magnesium- and iron-based bioresorbable flow diverters is assessed relative to an FDA-approved control in phantom models. MATERIALS AND METHODS Bioresorbable flow diverters, primarily composed of braided magnesium or antiferromagnetic iron alloy wires, were compared with an FDA-approved control flow diverter. The devices were assessed for MR imaging safety in terms of magnetically induced force and radiofrequency heating using 1.5T, 3T, and 7T field strength clinical scanners. The devices were deployed in phantom models, and metal-induced image artifacts were assessed in the 3 MR imaging scanners and a clinical CT scanner following clinical scan protocols; device visibility was assessed under fluoroscopy. RESULTS The magnesium-based bioresorbable flow diverter, iron-based bioresorbable flow diverter, and the control device all demonstrated MR imaging safety in terms of magnetically induced force and radiofrequency heating at all 3 field strengths. The bioresorbable flow diverters did not elicit excessive MR imaging artifacts at any field strength relative to the control. Furthermore, the bioresorbable flow diverters appeared to reduce blooming artifacts in CT relative to the control. The iron-based bioresorbable flow diverter and control device were visible under standard fluoroscopy. CONCLUSIONS We have demonstrated the baseline medical imaging compatibility of magnesium and antiferromagnetic iron alloy bioresorbable flow diverters. Future work will evaluate the medical imaging characteristics of the bioresorbable flow diverters in large-animal models.
Collapse
Affiliation(s)
- A A Oliver
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
- Physiology and Biomedical Engineering (A.A.O., D.D.-D.)
| | - E K Koons
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - P S Trester
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - J E Kleinow
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - R S Jonsgaard
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - A J Vercnocke
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - C Bilgin
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - R Kadirvel
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
- Neurosurgery (R.K.), Mayo Clinic, Rochester, Minnesota
| | - S Leng
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - A Lu
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - D Dragomir-Daescu
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Physiology and Biomedical Engineering (A.A.O., D.D.-D.)
| | - D F Kallmes
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| |
Collapse
|
19
|
Vuorinen AM, Lehmonen L, Karvonen J, Holmström M, Kivistö S, Kaasalainen T. Reducing cardiac implantable electronic device-induced artefacts in cardiac magnetic resonance imaging. Eur Radiol 2023; 33:1229-1242. [PMID: 36029346 PMCID: PMC9889467 DOI: 10.1007/s00330-022-09059-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Cardiac implantable electronic device (CIED)-induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raising the ipsilateral arm to the generator during CMR scanning may reduce the CIED-induced image artefacts. We assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in CMR. METHODS We included all clinically indicated CMRs performed on patients with normal cardiac anatomy and a permanent CIED with endocardial pacing leads between November 2011 and October 2019 in our institution (n = 171). We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts. RESULTS Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. In patients with a right-sided pacemaker, the median percentage of artefact-free segments in short-axis balanced steady-state free precession LGE was 93.8% (IQR 9.4%, n = 53) compared with 78.1% (IQR 20.3%, n = 58) for left-sided pacemaker (p < 0.001). In patients with a left-sided implantable cardioverter-defibrillator, the median percentage of artefact-free segments reached 87.5% (IQR 6.3%, n = 9) using arm-raised imaging, which fell to 62.5% (IQR 34.4%, n = 9) using arm-down imaging in spoiled gradient echo short-axis cine (p = 0.02). CONCLUSIONS Arm-raised imaging represents a straightforward method to reduce CMR artefacts in patients with left-sided generators and can be used alongside other image quality improvement methods. Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality. KEY POINTS • Cardiac implantable electronic device (CIED)-induced metal artefacts may significantly diminish the diagnostic value of an MRI, particularly in cardiac MRIs. • Raising the ipsilateral arm relative to the CIED generator is a cost-free, straightforward method to significantly reduce CIED-induced artefacts on cardiac MRIs in patients with a left-sided generator. • Right-sided generator implantation reduces artefacts compared with left-sided implantation and could be considered in CIED patients requiring subsequent cardiac MRIs to ensure adequate image quality in the future.
Collapse
Affiliation(s)
- Aino-Maija Vuorinen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Lauri Lehmonen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Jarkko Karvonen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Sari Kivistö
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Touko Kaasalainen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| |
Collapse
|
20
|
Aparisi Gómez MP, Bazzocchi A, Simoni P, Inarejos Clemente EJ. Postsurgical Evaluation of the Pediatric Foot and Ankle. Semin Musculoskelet Radiol 2022; 26:755-776. [PMID: 36791743 DOI: 10.1055/s-0042-1760244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the role of imaging in surgical planning and postsurgical assessment. The types of pathology analyzed from this perspective are congenital pathology, neuromuscular disorders, osteochondral lesions, fractures and infection, ligament injuries, and tumors.We address the most common pitfalls of postsurgical imaging of the ankle and foot in children. With some exceptions, postsurgical follow-up focuses on clinical assessment, with imaging follow-up only needed in patients where complications are suspected or symptoms recur. Postoperative assessment of the foot and ankle in children and adolescents requires knowing the indications for surgery and the most common types of interventions, along with their imaging characteristics. The radiologist needs to be aware of the normal sequence of development of structures and how to select adequate imaging techniques to assess anatomy at various stages or in different postsurgical scenarios.
Collapse
Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology. IMSKE, València, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Simoni
- Diagnostic Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | |
Collapse
|
21
|
Sautter M, Sautter N, Shellock FG. Near field communication (NFC) device: Evaluation of MRI issues. Magn Reson Imaging 2022; 92:82-87. [DOI: 10.1016/j.mri.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/21/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
|
22
|
Henkelmann J, Henkelmann R, Denecke T, Zajonz D, Roth A, Sabri O, Purz S. Simultaneous 18F-FDG-PET/MRI for the detection of periprosthetic joint infections after knee or hip arthroplasty: a prospective feasibility study. INTERNATIONAL ORTHOPAEDICS 2022; 46:1921-1928. [PMID: 35635553 PMCID: PMC9372014 DOI: 10.1007/s00264-022-05445-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/14/2022] [Indexed: 10/26/2022]
Abstract
Abstract
Purpose
This study investigated the diagnostic value of simultaneous 18F-fluordeoxyglucose positron emission tomography/magnetic resonance imaging (PET/MRI) in suspected periprosthetic joint infection (PJI) of the hip and knee.
Methods
Sixteen prostheses from 13 patients with suspected PJI were prospectively examined using PET/MRI. Image datasets were evaluated in consensus by a radiologist and a nuclear physician for the overall diagnosis of ‘PJI’ (yes/no) and its anatomical involvement, such as the periprosthetic bone margin, bone marrow, and soft tissue. The imaging results were compared with the reference standard obtained from surgical or biopsy specimens and subjected to statistical analysis.
Results
Using the reference standard, ten out of the 13 prostheses (ten hips, threes knees) were diagnosed with PJI. Using PET/MRI, every patient with PJI was correctly diagnosed (sensitivity, 100%; specificity, 100%). Considering the anatomical regions, the sensitivity and specificity were 57% and 50% in the periprosthetic bone margin, 75% and 33% in the bone marrow, and 100% and 100% in the soft tissue.
Conclusion
PET/MRI can be reliably used for the diagnosis of PJI. However, assessment of the periprosthetic bone remains difficult due to the presence of artefacts. Thus, currently, this modality is unlikely to be recommended in clinical practice.
Collapse
|
23
|
Bone and Joint Infections: The Role of Imaging in Tailoring Diagnosis to Improve Patients' Care. J Pers Med 2021; 11:jpm11121317. [PMID: 34945789 PMCID: PMC8709091 DOI: 10.3390/jpm11121317] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
Imaging is needed for the diagnosis of bone and joint infections, determining the severity and extent of disease, planning biopsy, and monitoring the response to treatment. Some radiological features are pathognomonic of bone and joint infections for each modality used. However, imaging diagnosis of these infections is challenging because of several overlaps with non-infectious etiologies. Interventional radiology is generally needed to verify the diagnosis and to identify the microorganism involved in the infectious process through imaging-guided biopsy. This narrative review aims to summarize the radiological features of the commonest orthopedic infections, the indications and the limits of different modalities in the diagnostic strategy as well as to outline recent findings that may facilitate diagnosis.
Collapse
|