The importance of psoas muscle on low back pain: a single-center study on lumbar spine MRI.

Background: Low back pain (LBP) is the most frequent indication to magnetic resonance imaging (MRI) examinations of the lumbosacral spine. The individual role of soft tissues, including muscles, on LBP is not fully understood and the contribution of each MRI-derived parameter of soft tissues status on the intensity of LBP has not been investigated in detail. Methods: The study design was observational retrospective, single center carried out at a University Hospital. Images were acquired using a using a 1.5 Tesla scanner. Patients completed a symptom questionnaire and rated their pain intensity using the Visual Analogue Scale (VAS). The VAS scores ​​were categorized as mild, moderate, and severe using cutoff values of 3.8 and 5.7, based on the literature. Biometric data, including weight and height, were also recorded to calculate the body mass index (BMI). The ratios between intramuscular fat infiltration and net muscle area were also calculated. Patient sample included 94 patients with LBP underwent MRI of the lumbosacral spine. Results: The stepwise analysis revealed that increasing psoas net area was associated with lower VAS levels (odds ratio [OR]: 0.94: 95% confidence interval [CI]: 0.90-0.98; p=.005), and an increase of one square centimeter of total psoas area resulted in a greater probability of reporting a mild (+1.21%; 95% CI: 0.37, 2.05%) or a moderate VAS (+0.40%; 95% CI: -0.02, 0.82%), Furthermore, a more severe VAS was associated with a higher BMI (OR: 1.13; 95% CI: 1.00-1.27). Conclusion: Our study demonstrates a relationship between LBP and MRI parameters of paravertebral and psoas muscles status. The psoas muscle is extremely important for spine stabilization and is linked to clinical symptoms of patients affected by LBP. These findings could contribute to future studies and improve treatment options in patients with LBP, possibly reducing the impact on disability, quality of life and socioeconomical burden.

Exploring the interplay between paraspinal muscular status and bone health in osteoporosis and fracture risk: a comprehensive literature review on computed tomography (CT) and magnetic resonance imaging (MRI) studies.

Background and Objective: Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine are fundamental non-invasive tools to investigate the status of the bone and soft tissue in vivo. A novel and promising approach is to investigate the quality and quantity of paraspinal muscles even beyond the clinical question. The aim of the present review is to summarize current evidence on CT and MRI about the relationship between paraspinal muscular status and bone health in osteoporosis (OP) and fracture risk. Methods: Literature research was carried out on September 2023 using PubMed, Scopus, and Cochrane databases. Key Content and Findings: Research investigating the intricate interplay between musculature and bone health reveals that degenerating paraspinal muscles, characterized by shrinking and fatty infiltration, are associated with lower bone mineral density (BMD) and the development of OP. Additionally, research indicates that weaker paraspinal muscles are linked to a higher risk of fractures, including those at the spine. Conclusions: The findings suggest that paraspinal muscle health may be a significant factor in identifying individuals at risk for OP and fractures. Further investigation is needed to explore the potential of paraspinal muscles in preventing these conditions.

Retrolabyrinthine approach to the lateral skull base: The value of preoperative temporal bone CT analysis.

PURPOSE: The most used neurosurgical approach to reach cerebellar-pontine angle is the retrosigmoid route. This article describes the presigmoid approach which requires excellent knowledge of the labyrinthine block together with quantitative analysis of temporal bone CT. METHODS: CT-based quantitative measurements were obtained in patients undergoing vestibular neurectomy with a presigmoid approach. Eighteen patients were enrolled, and five measures were taken: Trautmann's area, the petro-clival angle, presigmoid dura length and its angle. The relationship between these measurements and hospitalization days, operating times, and complications was explored. RESULTS: The posterior semicircilar canal (PSC)-sigmoid sinus (SS) distance, presigmoid dura- internal auditory canal (IAC)-PSC angle, and duration of surgery are predictors of complications. Specifically, a PSC-sigmoid sinus distance <11 mm, a dura presig-IAC-PSC angle <14 are associated with the highest risk of complications. CONCLUSION: Preoperative temporal bone CT scan can guide the surgeon through the narrowest areas of the surgical approach. Trautmann's triangle area and petro-clival angle reduction are challenging and can be faced with combined microscopic-endoscopic technique, and with optics angulation-rotation. The retrolabyrinthine approach can enable hearing preservation and minimal cerebellar retraction.

Mapping the Neural Basis of Neuroeconomics with Functional Magnetic Resonance Imaging: A Narrative Literature Review.

Neuroeconomics merges neuroscience, economics, and psychology to investigate the neural basis of decision making. Decision making involves assessing outcomes with subjective value, shaped by emotions and experiences, which are crucial in economic decisions. Functional MRI (fMRI) reveals key areas of the brain, including the ventro-medial prefrontal cortex, that are involved in subjective value representation. Collaborative interdisciplinary efforts are essential for advancing the field of neuroeconomics, with implications for clinical interventions and policy design. This review explores subjective value in neuroeconomics, highlighting brain regions identified through fMRI studies.

Posterior Subcutaneous Edema at Lumbar Spine MRI: A Systematic Review.

RATIONALE AND OBJECTIVES: Edema in the subcutaneous soft tissue of the lumbar spine is a frequent incidental finding in spinal magnetic resonance imaging, however, its exact explanation is yet to be determined. The aim of this paper is to provide a systematic literature review on posterior lumbar subcutaneous edema (LSE). MATERIALS AND METHODS: The present systematic literature search was carried out in October 2023 using electronic databases: PubMed, Cochrane library, and Scopus. RESULTS: The current evidence suggests that lumbar edema is correlated with clinical data such as weight and age, and potentially female sex. Moreover, LSE is related to several specific conditions, including both systemic and spinal disorders, such as heart or kidney disorders, as well as low back pain and degenerative and/or inflammatory diseases. CONCLUSION: It is important to be aware that there is an association between LSE and a variety systemic and spinal disorders.

Visceral adiposity in patients with lipomatous hypertrophy of the interatrial septum.

Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign cardiac mass determined by abnormal deposition of adipose tissue in the interatrial septum. The quantitative relationship between LHIS and visceral adiposity has not been explored to date.In this retrospective study, three groups of consecutive patients undergoing CT imaging were enrolled: L + with LHIS, L- without LHIS, and LO- without both LHIS and history of malignancies. Areas of total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and LHIS areas were calculated on CT images. The relationship between LHIS and abdominal fat distribution was investigated with linear regression models. Bonferroni correction was applied to account for multiple testing. Statistical significance was set at 5%. In this study we enrolled a total of 175 subjects: 58 (33.14%) with LHIS (L +), 51(29.14%) without LHIS (L-) and 66 (37.71%) without both LHIS and medical history of malignancies (LO-). VAT (coeff: 105.82; 95% CI 59.37-152.27), SAT (coeff: 74.59; 95% CI 31.63-117.54), and TAT (coeff: 190.37; 95% CI 115.02-265.72), were significantly higher in L + patients. Moreover, VAT (coeff: 24.95; 95% CI 6.94-42.96) and TAT (coeff: 36.58; 95% CI 8.75-64.41) were statistically significant linear predictors for LHIS area. Here, we report a novel association between LHIS and visceral adiposity using a quantitative CT-based imaging approach. The results are of great importance also because they might drive early identification of subjects with LHIS at risk for visceral obesity, and trigger lifestyle interventions aimed at weight loss.

Ten years of gadolinium retention and deposition: ESMRMB-GREC looks backward and forward.

In 2014, for the first time, visible hyperintensities on unenhanced T1-weighted images in the nucleus dentatus and globus pallidus of the brain were associated with previous Gadolinium-based contrast agent (GBCA) injections and gadolinium deposition in patients with normal renal function. This led to a frenzy of retrospective studies with varying methodologies that the European Society of Magnetic Resonance in Medicine and Biology Gadolinium Research and Educational Committee (ESMRMB-GREC) summarised in 2019. Now, after 10 years, the members of the ESMRMB-GREC look backward and forward and review the current state of knowledge of gadolinium retention and deposition. CLINICAL RELEVANCE STATEMENT: Gadolinium deposition is associated with the use of linear GBCA but no clinical symptoms have been associated with gadolinium deposition. KEY POINTS : • Traces of Gadolinium-based contrast agent-derived gadolinium can be retained in multiple organs for a prolonged time. • Gadolinium deposition is associated with the use of linear Gadolinium-based contrast agents. • No clinical symptoms have been associated with gadolinium deposition.

Use of gadolinium-based contrast agents in multiple sclerosis: a review by the ESMRMB-GREC and ESNR Multiple Sclerosis Working Group.

Magnetic resonance imaging (MRI) is the most sensitive technique for detecting inflammatory demyelinating lesions in multiple sclerosis (MS) and plays a crucial role in diagnosis and monitoring treatment effectiveness, and for predicting the disease course. In clinical practice, detection of MS lesions is mainly based on T2-weighted and contrast-enhanced T1-weighted sequences. Contrast-enhancing lesions (CEL) on T1-weighted sequences are related to (sub)acute inflammation, while new or enlarging T2 lesions reflect the permanent footprint from a previous acute inflammatory demyelinating event. These two types of MRI features provide redundant information, at least in regular monitoring of the disease. Due to the concern of gadolinium deposition after repetitive injections of gadolinium-based contrast agents (GBCAs), scientific organizations and regulatory agencies in Europe and North America have proposed that these contrast agents should be administered only if clinically necessary. In this article, we provide data on the mode of action of GBCAs in MS, the indications of the use of these agents in clinical practice, their value in MS for diagnostic, prognostic, and monitoring purposes, and their use in specific populations (children, pregnant women, and breast-feeders). We discuss imaging strategies that achieve the highest sensitivity for detecting CELs in compliance with the safety regulations established by different regulatory agencies. Finally, we will briefly discuss some alternatives to the use of GBCA for detecting blood-brain barrier disruption in MS lesions. CLINICAL RELEVANCE STATEMENT: Although use of GBCA at diagnostic workup of suspected MS is highly valuable for diagnostic and prognostic purposes, their use in routine monitoring is not mandatory and must be reduced, as detection of disease activity can be based on the identification of new or enlarging lesions on T2-weighted images. KEY POINTS: • Both the EMA and the FDA state that the use of GBCA in medicine should be restricted to clinical scenarios in which the additional information offered by the contrast agent is required. • The use of GBCA is generally recommended in the diagnostic workup in subjects with suspected MS and is generally not necessary for routine monitoring in clinical practice. • Alternative MRI-based approaches for detecting acute focal inflammatory MS lesions are not yet ready to be used in clinical practice.

Neuroradiology of acute pathologies in adults with hematologic malignancies: a pictorial review.

Hematopoietic and lymphoid tumors are a heterogeneous group of diseases including lymphomas, multiple myeloma (MM), and leukemias. These diseases are associated with systemic involvement and various clinical presentations including acute neurological deficits. Adult patients with hematologic malignancies (HM) are at risk for developing a wide array of acute conditions involving the nervous system. HM in adults may present as tumoral masses responsible for mass effect, possibly resulting in acute neurological signs and symptoms caused by tumor growth with compression of central nervous system (CNS) structures. Moreover, as result of the hematologic disease itself or due to systemic treatments, hematologic patients are at risk for vascular pathologies, such as ischemic, thrombotic, and hemorrhagic disorders due to the abnormal coagulation status. The onset of these disorders is often with acute neurologic signs or symptoms. Lastly, it is well known that patients with HM can have impaired function of the immune system. Thus, CNS involvement due to immune-related diseases such as mycotic, parasitic, bacterial, and viral infections linked to immunodeficiency, together with immune reconstitution inflammatory syndrome, are frequently seen in hematologic patients. Knowledge of the etiology and expected CNS imaging findings in patients with HM is of great importance to reach a fast and correct diagnosis and guide treatment choices. In this manuscript, we review the computed tomography (CT) and magnetic resonance findings of these conditions which can be related to the disease itself and/or to their treatments.

Artificial Intelligence to Reduce or Eliminate the Need for Gadolinium-Based Contrast Agents in Brain and Cardiac MRI: A Literature Review.

ABSTRACT: Brain and cardiac MRIs are fundamental noninvasive imaging tools, which can provide important clinical information and can be performed without or with gadolinium-based contrast agents (GBCAs), depending on the clinical indication. It is currently a topic of debate whether it would be feasible to extract information such as standard gadolinium-enhanced MRI while injecting either less or no GBCAs. Artificial intelligence (AI) is a great source of innovation in medical imaging and has been explored as a method to synthesize virtual contrast MR images, potentially yielding similar diagnostic performance without the need to administer GBCAs. If possible, there would be significant benefits, including reduction of costs, acquisition time, and environmental impact with respect to conventional contrast-enhanced MRI examinations. Given its promise, we believe additional research is needed to increase the evidence to make these AI solutions feasible, reliable, and robust enough to be integrated into the clinical framework. Here, we review recent AI studies aimed at reducing or replacing gadolinium in brain and cardiac imaging while maintaining diagnostic image quality.

Innovative quantitative magnetic resonance tools to detect early intervertebral disc degeneration changes: a systematic review.

BACKGROUND CONTEXT: Low back pain (LBP) is the leading cause of disability worldwide, with a tremendous socioeconomic burden. It is mainly caused by intervertebral disc degeneration (IDD), a progressive and age-related process. Due to its ability to accurately characterize intervertebral disc morphology, magnetic resonance imaging (MRI) has been established as one of the most valuable tools in diagnosing IDD. Innovative quantitative MRI (qMRI) techniques able to detect the earliest signs of IDD have been increasingly reported. PURPOSE: To systematically review available reports on the application of novel qMRI techniques to detect early IDD changes. STUDY DESIGN: Systematic literature review. METHODS: A systematic search of PubMed/MEDLINE, Scopus, CINAHL, EMBASE, CENTRAL and Cochrane databases was performed through January 21, 2023. Randomized and nonrandomized studies on innovative qMRI tools able to diagnose early biochemical and architectural IDD changes in patients with or without discogenic LBP were searched. Data on study population, follow-up time (when applicable) and MRI sequence used were recorded. The QUADAS-2 tool was utilized to assess the risk of bias of included studies. RESULTS: A total of 39 articles published between 2005 and 2022 resulted from the search. All novel qMRI techniques showed an increased capacity to detect early IDD changes thanks to the ability to assess subtle alterations of water content, proteoglycan and glycosaminoglycan concentration, and increased levels of catabolic biomarkers compared to conventional MRI. CONCLUSIONS: Innovative qMRI techniques have proven effective in identifying premature IDD changes. Further studies are needed to validate their application in wider populations and confirm their applicability in the clinical setting.

Skin Toxicity After Exposure to Gadolinium-Based Contrast Agents in Normal Renal Function, Using Clinical Approved Doses: Current Status of Preclinical and Clinical Studies.

OBJECTIVES: The aim of this study was to summarize the current preclinical and clinical evidence on the association between exposure to gadolinium (Gd) compounds and skin toxicity in a setting similar to clinical practice. MATERIALS AND METHODS: A search of MEDLINE and PubMed references from January 2000 to December 2022 was performed using keywords related to gadolinium deposition and its effects on the skin, such as "gadolinium," "gadolinium-based contrast agents," "skin," "deposition," and "toxicity." In addition, cross-referencing was added when appropriate. For preclinical in vitro studies, we included all the studies that analyzed the response of human dermal fibroblasts to exposure to various gadolinium compounds. For preclinical animal studies and clinical studies, we included only those that analyzed animals or patients with preserved renal function (estimated glomerular filtration rate >30 mL/min/1.73 m 2 ), using a dosage of gadolinium-based contrast agents (GBCAs) similar to that commonly applied (0.1 mmol/kg). RESULTS: Forty studies were selected. Preclinical findings suggest that Gd compounds can produce profibrotic responses in the skin in vitro, through the activation and proliferation of dermal fibroblasts and promoting their myofibroblast differentiation. Gadolinium influences the process of collagen production and the collagen content of skin, by increasing the levels of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1. Preclinical animal studies show that Gd can deposit in the skin with higher concentrations when linear GBCAs are applied. However, these deposits decrease over time and are not associated with obvious macroscopic or histological modifications. The clinical relevance of GBCAs in inducing small fiber neuropathy remains to be determined. Clinical studies show that Gd is detectable in the skin and hair of subjects with normal renal function in higher concentrations after intravenous administration of linear compared with macrocyclic GBCA. However, these deposits decrease over time and are not associated with cutaneous or histological modifications. Also, subclinical dermal involvement related to linear GBCA exposure may be detectable on brain MRI. There is no conclusive evidence to support a causal relationship between GBCA administration at the clinical dose and cutaneous manifestations in patients with normal renal function. CONCLUSIONS: Gadolinium can produce profibrotic responses in the skin, especially acting on fibroblasts, as shown by preclinical in vitro studies. Gadolinium deposits are detectable in the skin even in subjects with normal renal function with higher concentrations when linear GBCAs are used, as confirmed by both preclinical animal and human studies. There is no proof to date of a cause-effect relationship between GBCA administration at clinical doses and cutaneous consequences in patients with normal renal function. Multiple factors, yet to be determined, should be considered for sporadic patients with normal renal function who develop clinical skin manifestations temporally related to GBCA administration.

Large language models for structured reporting in radiology: performance of GPT-4, ChatGPT-3.5, Perplexity and Bing.

Structured reporting may improve the radiological workflow and communication among physicians. Artificial intelligence applications in medicine are growing fast. Large language models (LLMs) are recently gaining importance as valuable tools in radiology and are currently being tested for the critical task of structured reporting. We compared four LLMs models in terms of knowledge on structured reporting and templates proposal. LLMs hold a great potential for generating structured reports in radiology but additional formal validations are needed on this topic.

Computed tomography density changes of bone metastases after concomitant denosumab.

OBJECTIVE: To evaluate bone density changes at the level of normal trabecular bone and bone metastases (BMs) after denosumab (DM) treatment in oncologic patients. MATERIALS AND METHODS: We retrospectively evaluated 31 consecutive adult patients with histologically confirmed solid tumors with at least one newly diagnosed bone metastatic lesion detected at CT. Patients received treatment with DM, 120 mg subcutaneous every 28 days for at least 6 months. Bone density was determined at the level of BMs and at the level of normal trabecular bone of lumbar vertebrae using a region of interest (ROI)-based approach. RESULTS: A progressive increase in CT bone density was demonstrated at the level of normal trabecular bone at 6 months (18% ± 5%) and 12 months (23% ± 7%) after the treatment begins. BMs showed a significant increase in CT bone density (p < 0.05) as compared to baseline after 6 months (57% ± 15%) and 12 months (1.06 ± 0.25 times higher) after treatment. CONCLUSION: We have found that long-term treatment with DM increases bone density progressively in oncologic patients. This effect can be observed not only at the level of secondary lesions but also at the level of apparently normal trabecular bone and is more pronounced for osteolytic metastases.