Deep Learning Reconstruction of Accelerated MRI: False-Positive Cartilage Delamination Inserted in MRI Arthrography Under Traction.

OBJECTIVES: The radiological imaging industry is developing and starting to offer a range of novel artificial intelligence software solutions for clinical radiology. Deep learning reconstruction of magnetic resonance imaging data seems to allow for the acceleration and undersampling of imaging data. Resulting reduced acquisition times would lead to greater machine utility and to greater cost-efficiency of machine operations. MATERIALS AND METHODS: Our case shows images from magnetic resonance arthrography under traction of the right hip joint from a 30-year-old, otherwise healthy, male patient. RESULTS: The undersampled image data when reconstructed by a deep learning tool can contain false-positive cartilage delamination and false-positive diffuse cartilage defects. CONCLUSIONS: In the future, precision of this novel technology will have to be put to thorough testing. Bias of systems, in particular created by the choice of training data, will have to be part of those assessments.

Ability of ChatGPT to generate competent radiology reports for distal radius fracture by use of RSNA template items and integrated AO classifier.

The amount of acquired radiology imaging studies grows worldwide at a rapid pace. Novel information technology tools for radiologists promise an increase of reporting quality and as well quantity at the same time. Automated text report drafting is one branch of this development. We defined for the present study in total 9 cases of distal radius fracture. Command files structured according to a template of the Radiological Society of North America (RSNA) and to Arbeitsgemeinschaft Osteosynthese (AO) classifiers were given as input to the natural language processing tool ChatGPT. ChatGPT was tasked with drafting an appropriate radiology report. A parameter study (n = 5 iterations) was performed. An overall high appraisal of ChatGPT radiology report quality was obtained in a score card based assessment. ChatGPT demonstrates the capability to adjust output files in response to minor changes in input command files. Existing shortcomings were found in technical terminology and medical interpretation of findings. Text drafting tools might well support work of radiologists in the future. They would allow a radiologist to focus time on the observation of image details and patient pathology. ChatGPT can be considered a substantial step forward towards that aim.

Accuracy of magnetic resonance imaging in assessing knee cartilage changes over time in patients with osteoarthritis: A systematic review.

Magnetic resonance imaging (MRI) is a technique useful for the diagnosis of cartilage damage due to high sensitivity to identify subchondral bone abnormalities and full-thickness cartilage lesions. The lack of a study on knee cartilage changes over time in patients with osteoarthritis (OA) by MRI technique led us to investigate the accuracy of MRI in identifying knee cartilage changes over time in patients with OA in a systematic review. In the present systematic review, started from the beginning of 2020 in one of the University Hospitals in Iran, the databases of CINAHL, Ovid, Elsevier, Scopus, PubMed, Science Direct, and Web of Science were searched using the keywords MRI, OA, Cartilage Lesion, Imaging Techniques. A total of 169 articles were retrieved in the initial search, and after reviewing the titles, abstracts, and full-texts, finally, seven were enrolled in the systematic review. Review of the selected papers showed that a total of 1091 subjects were studied, of which 355 were males. The results of all the studies, except one, indicated the high accuracy of MRI to identify knee cartilage changes over time. MRI technique can show cartilage changes with high accuracy in patients with knee OA over time. We proved the potential of MRI to identify articular cartilage injuries in patients with OA and its importance to the evaluation of articular cartilage lesions along with other available techniques.

Diagnostic Imaging of Diabetic Foot Disorders.

Plain, weight-bearing radiography is the preferred first-line imaging. Dependent on the suspected pathology, further imaging is indicated. In a soft tissue infection, an abscess has to be excluded, for example, with ultrasound. Osteomyelitis has a typical triad including osteolysis, periosteal reaction, and bone destruction in radiography, but signs are often delayed. MRI is the gold standard for diagnosis of osteomyelitis with high intensity in T2-weighted and STIR images and intermediate to decreased reticulated hazy intensity in T1-weighted images. In comparison, bone marrow edema is also bright on the T2-weighted image but the T1-weighted image has a confluent low intensity.

Noncontrast-enhanced 3-Tesla MRI using surface coil as a complementary test for assessment of distribution and depth of locoregional cutaneous metastases of malignant melanoma.

Locoregional and distant metastases account for most cases of morbidity and mortality associated with melanoma. In addition, local recurrences of melanoma might be the onset of disseminated disease. Therefore, precise diagnosis and therapy are warranted to minimize morbidity and increase survival in a subset of patients. However, the correct distribution of the metastatic lesions on the skin is often difficult to estimate. We present the application of noncontrast-enhanced 3-Tesla MRI using surface coil to detect locoregional cutaneous metastases of malignant melanoma on the basis of the topographic assessment of skin lesions. Furthermore, in a systematic review, we summarize the current knowledge about application of MRI in assessment of location, distribution, and depth of cutaneous primary malignant melanoma. MRI might be applied to evaluate the location, distribution, size, and depth of the locoregional cutaneous metastasis of malignant melanoma to identify the optimal cost-effective treatment strategies and monitor their effects.

[Radiosynoviorthesis of the thumb's carpometacarpal joint]. / Radiosynoviorthese des Daumensattelgelenks.

Radiosynoviorthesis (RSO) is an established therapeutic method for the local treatment of pain in aseptic joint inflammation (e.g. arthritis, activated osteoarthritis, synovitis). RSO can be used for the treatment of synovial membrane inflammation of the finger joints such as the thumb's carpometacarpal joint. The beta emitter Erbium-169 (Er-169) is injected into the joint space, which irradiates the inflamed synovialis, thereby leading to fibrosis and obliteration of the pain receptors of the synovial membrane. The chances of success in the treatment of the thumb's carpometacarpal joint by RSO are estimated to be 54-100% within 2-6 weeks after therapy.

Non-contrast-enhanced 3-Tesla Magnetic Resonance Imaging Using Surface-coil and Sonography for Assessment of Hidradenitis Suppurativa Lesions.

Hidradenitis suppurativa has a substantial negative effect on quality of life of affected persons. Diagnosis is based mainly on clinical examination. However, physi-cal examination alone might underestimate disease severity compared with imaging modalities. We report here the application of non-contrast-enhanced 3-Tesla magnetic resonance imaging using surface-coil and sonography for assessment of hidradenitis suppurativa lesions based on topographic assessment of skin lesions. In addition, we review the literature regarding the application of ultrasound and magnetic resonance imaging in hidradenitis suppurativa.

Fibrin sealants in lumbar annuloplasty after endoscopic discectomy as a method to prevent recurrent lumbar disc herniation.

Fibrin sealant as a promising agent for providing scaffold and efficient hemostasis is widely accepted in several specialties. However, the outcome of Fibrin sealants in lumbar annuloplasty after endoscopic discectomy has not been evaluated in patients with disc herniation. The goal of this study was to evaluate the efficacy, response, and probability of future recurrence rates in herniated nucleus pulposus (HNP) with the use of fibrin sealant in conjunction with endoscopic disc surgery. A total of 35 patients (28 men, 7women) were evaluated, including 18 patients who underwent endoscopic discectomy alone and 17 patients that received fibrin sealant at the site of annulus tear and endoscopic discectomy. All patients were followed through both clinical and imaging methods for an average of 10.5 months. Primary outcome measure was defined as lumbar decompression approved by imaging and symptom alleviation after endoscopic spinal discectomy with Visual Analogue Scale (VAS) score ≤ 4 (cut-off point). Median size of annular tearing was significantly lower in the endoscopic discectomy group (median, 3) (minimum, 2; maximum, 5); however, the corresponding factor in the endoscopic discectomy plus fibrin sealant group was significantly larger (median, 6) (minimum, 5; maximum, 10), with P <0.001. Only one patient in the endoscopic discectomy group had an HNP recurrence during follow-up compared to two patients in the endoscopic discectomy plus fibrin sealant group. Due to the temporary effects of fibrin sealant in preventing disc herniation and the observed recurrence rate in both the case and control groups, the results of this study suggest a role of fibrin sealants combined with endoscopic discectomy to prevent early HNP recurrence rate.

Sphenoorbital meningiomas: surgical management and outcome.

OBJECTIVE: Surgical management of sphenoorbital meningiomas ranges among the most complex of intracranial tumors. We report on our experience of surgical technique, outcome, and tumor recurrence in sphenoorbital meningiomas. METHODS: Between 2003 and 2013, surgical resections for sphenoorbital meningioma were performed in 18 patients (aged 49·6±9·8 years, only women), with two patients operated anew due to tumor recurrence. RESULTS: Main symptom was proptosis (83·3%), followed by diminished visual acuity (38·9%), and dizziness (11·1%). In all patients the lateral orbital wall was resected, whereas the orbital roof and the zygoma were removed according to the extent of their tumorous infiltration. Unroofing of the optic canal was performed in 10 cases (55·6%) and unroofing of the optic foramen in two (11·1%). For reconstruction split calvarian bone and titanium mesh were used in six (33·3%) and seven patients (38·9%), respectively; in one patient both techniques were applied. In five patients (27·8%), no reconstruction was necessary. Complete tumor resection (Simpson grade 1 and 2) was achieved in 14 cases (77·7%). Postoperatively, proptosis improved in all patients. Median follow-up was 39·5±33·3 months (range 1-105) in 16 patients; 2 patients were lost to follow-up. No tumor recurrence was noted in five (27·8%) patients, whereas in nine (50%) patients tumor remnants proved stable over time. Two (11·1%) patients experienced progression of residual tumor, resulting in reoperation after 27 and 109 months, respectively. DISCUSSION: Despite their delicate anatomical relations, surgery of sphenoorbital meningiomas is safe when combining modern techniques.

Preoperative decision making for renal cell carcinoma: cystic morphology in cross-sectional imaging might predict lower malignant potential.

OBJECTIVES: Several histologic studies showed more favorable oncologic outcome for renal cell carcinoma (RCC) with cystic change. However, there is no prognostic tool to judge on cystic RCC preoperatively. We hypothesized, that cystic morphology in cross-sectional imaging predicts lower malignant potential. MATERIALS AND METHODS: From our prospectively conducted oncologic database, we identified 825 patients who underwent surgery for malignant renal tumors between 2001 and 2010. In 348 cases (42%), adequate imaging was available for an independent review by 2 radiologists. We excluded recurrent and synchronous bilateral RCC, familial syndromes, collecting duct carcinoma, and metastases of other origin. For the resulting 319 patients, we compared clinical, pathologic, and survival outcomes. RESULTS: Median age was 63 (19-88) years and 220 (69%) patients were male. Median follow-up was 1.7 (0-9.8) years. Of 319 renal masses, 277 (86.8%) were solid and 42 (13.2%) were cystic. In cystic RCC, median tumor diameter was lower (3 cm vs. 4 cm, P = 0.002) and nephron-sparing surgery was more frequent (69% vs. 41.5%, P = 0.002). None of the patients with cystic RCC and 56 (20.2%) with solid RCC had synchronous systemic disease (P = 0.001). The nuclear grade of cystic RCC was more favorable (P = 0.002). Patients with cystic RCC showed better overall (P = 0.049) and cancer-specific survival (P = 0.027). In a multivariate model, only synchronous metastases, positive R status, and greater tumor diameter were independent risk factors (P ≤ 0.03). CONCLUSIONS: We report the first study to show that cystic morphology in cross-sectional imaging might predict RCC with a lower malignant potential. This insight could allow less invasive treatment strategies in selected patients.

Quantitative T2 mapping of recurrent glioblastoma under bevacizumab improves monitoring for non-enhancing tumor progression and predicts overall survival.

BACKGROUND: Anti-angiogenic treatment in recurrent glioblastoma patients suppresses contrast enhancement and reduces vasogenic edema while non-enhancing tumor progression is common. Thus, the importance of T2-weighted imaging is increasing. We therefore quantified T2 relaxation times, which are the basis for the image contrast on T2-weighted images. METHODS: Conventional and quantitative MRI procedures were performed on 18 patients with recurrent glioblastoma before treatment with bevacizumab and every 8 weeks thereafter until further tumor progression. We segmented the tumor on conventional MRI into 3 subvolumes: enhancing tumor, non-enhancing tumor, and edema. Using coregistered quantitative maps, we followed changes in T2 relaxation time in each subvolume. Moreover, we generated differential T2 maps by a voxelwise subtraction using the first T2 map under bevacizumab as reference. RESULTS: Visually segmented areas of tumor and edema did not differ in T2 relaxation times. Non-enhancing tumor volume did not decrease after commencement of bevacizumab treatment but strikingly increased at progression. Differential T2 maps clearly showed non-enhancing tumor progression in previously normal brain. T2 relaxation times decreased under bevacizumab without re-increasing at tumor progression. A decrease of <26 ms in the enhancing tumor following exposure to bevacizumab was associated with longer overall survival. CONCLUSIONS: Combining quantitative MRI and tumor segmentation improves monitoring of glioblastoma patients under bevacizumab. The degree of change in T2 relaxation time under bevacizumab may be an early response parameter predictive of overall survival. The sustained decrease in T2 relaxation times toward values of healthy tissue masks progressive tumor on conventional T2-weighted images. Therefore, quantitative T2 relaxation times may detect non-enhancing progression better than conventional T2-weighted imaging.

Preoperative tumor studies using MRI or CT in patients with clinically suspected insulinoma.

PURPOSE: Insulinomas are rare tumors that originate from the islet cells of the pancreas. The aims of this study were to localize insulinomas preoperatively using CT and/or MRI in correlation with postoperative pathological results. PATIENTS AND METHODS: Between December 2001 and June 2010, 27 consecutive patients with clinically suspected insulinoma were surgically treated in our university hospital. Preoperative CT (14 of 27 patients) and MRI studies (14 of 27 patients, one patient had both MRI and CT), operation reports, intraoperative ultrasonography reports, and pathological diagnoses were analyzed retrospectively. For each lesion, images were analyzed based on the presence of enhancement or the characteristics of signal intensities. Pathologic correlation was available for all the lesions. RESULTS: The female: male ratio was 2.9, with a mean age of 47.5 years (range 12-82) . Preoperative tumor localization was achieved by means of MRI and CT. A focal pancreatic lesion, which was hypointense on T(1)-weighted sequences, was detected on all the MR images (14 of 27 patients; 100%). These lesions were isointense (4 cases) to slightly hyperintense (10 of 14 cases) on T(2)-weighted sequences. In T(1)-weighted fat-suppressed contrast-enhanced sequences, there were two types of enhancement: homogeneously hyperintense lesions (in 10 of 14 cases) or peripherally hyper-, centrally isointense (in 4 of 14 cases). On all the CT images (14 of 27 patients), there was no detectable lesion on precontrast series; on arterial series in 13 of 14 patients (arterial series has not been done in one patient), lesions enhanced hypervascular in contrast to the rest of the pancreas with a mean enhancement of 147 HU (range 113-248) and 95 HU (range 65-141), respectively. On venous series in 13 of 14 patients (venous series has not been done in one patient), there was an enhanced lesion in contrast to the rest of the pancreas with a mean enhancement of 110 HU (range 91-151) and 86 HU (range 65-137), respectively. Intraoperative ultrasonography was performed in 11 of 27 patients to localize the tumor, which correlated with the results of the mentioned preoperative studies. Tumor size ranged from 9 × 11 to 31 × 37 mm. Enucleation was carried out in 14 patients, Whipple in 5, segmental resection in 3 and left distal pancreatectomy in 5 patients. The mortality rate was 0. Pathological findings were insulinoma or neuroendocrine tumors in 26 of 27 cases. One patient had a pathological finding of chronic pancreatic disease with intraepithelial neoplasia (grade 1A). CONCLUSION: We conclude that the preoperative localization of insulinoma in clinically suspected patients can be made on the basis of MRI and/or CT studies. A hallmark lesion is hypointense in T(1)-weighted sequences, homogeneously or peripherally hyperintense in T(1)-weighted fat-suppressed contrast-enhanced sequence using MRI (100% of cases) or/and a hypervascular enhanced lesion on arterial (100% of CT studies) and on venous series using CT (66.7% of CT studies).