MR-guided focused ultrasound therapy of extra-abdominal desmoid tumors: a multicenter retrospective study of 105 patients.

OBJECTIVE: To assess the safety and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment extra-abdominal desmoids. METHODS: A total of 105 patients with desmoid fibromatosis (79 females, 26 males; 35 ± 14 years) were treated with MRgFUS between 2011 and 2021 in three centers. Total and viable tumors were evaluated per patient at last follow-up after treatment. Response and progression-free survival (PFS) were assessed with (modified) response evaluation criteria in solid tumors (RECIST v.1.1 and mRECIST). Change in Numerical Rating Scale (NRS) pain and 36-item Short Form Health Survey (SF-36) scores were compared. Treatment-related adverse events were recorded. RESULTS: The median initial tumor volume was 114 mL (IQR 314 mL). After MRgFUS, median total and viable tumor volume decreased to 51 mL (95% CI: 30-71 mL, n = 101, p < 0.0001) and 29 mL (95% CI: 17-57 mL, n = 88, p < 0.0001), respectively, at last follow-up (median: 15 months, 95% CI: 11-20 months). Based on total tumor measurements (RECIST), 86% (95% CI: 75-93%) had at least stable disease or better at last follow-up, but 50% (95% CI: 38-62%) of remaining viable nodules (mRECIST) progressed within the tumor. Median PFS was reached at 17 and 13 months for total and viable tumors, respectively. NRS decreased from 6 (IQR 3) to 3 (IQR 4) (p < 0.001). SF-36 scores improved (physical health (41 (IQR 15) to 46 (IQR 12); p = 0.05, and mental health (49 (IQR 17) to 53 (IQR 9); p = 0.02)). Complications occurred in 36%, most commonly 1st/2nd degree skin burns. CONCLUSION: MRgFUS reduced tumor volume, reduced pain, and improved quality of life in this series of 105 patients with extra-abdominal desmoid fibromatosis. CLINICAL RELEVANCE STATEMENT: Imaging-guided ablation is being increasingly used as an alternative to surgery, radiation, and medical therapy for the treatment of desmoid fibromatosis. MR-guided high-intensity focused ultrasound is an incisionless ablation technique that can be used to reduce tumor burden effectively and safely. KEY POINTS: • Desmoid fibromatosis was treated with MR-guided high-intensity focused ultrasound in 105 patients. • MR-guided focused ultrasound ablation reduced tumor volume and pain and improved quality of life. • MR-guided focused ultrasound is a treatment option for patients with extra-abdominal desmoid tumors.

Update on musculoskeletal applications of magnetic resonance-guided focused ultrasound.

Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive, incisionless, radiation-free technology used to ablate tissue deep within the body. This technique has gained increased popularity following FDA approval for treatment of pain related to bone metastases and limited approval for treatment of osteoid osteoma. MRgFUS delivers superior visualization of soft tissue targets in unlimited imaging planes and precision in targeting and delivery of thermal dose which is all provided during real-time monitoring using MR thermometry. This paper provides an overview of the common musculoskeletal applications of MRgFUS along with updates on clinical outcomes and discussion of future applications.

Acetabular cartilage delamination: performance of MRI using arthroscopy as the standard of reference.

BACKGROUND: Femoroacetabular impingement (FAI) frequently leads to acetabular chondral delamination. Early identification and treatment of these cases is crucial to prevent further damage to the hip. PURPOSE: To evaluate the accuracy of morphological signs of cartilage acetabular delamination in non-arthrographic magnetic resonance imaging (MRI) using intra-articular arthroscopic findings in patients undergoing FAI surgery. MATERIAL AND METHODS: All hip MRI scans were assessed individually by three independent radiologists. Images were assessed for signs of delamination including the presence of a linear area of bright signal intensity along the acetabular subchondral bone and an area of darker tissue at the surface of the acetabular cartilage. All FAI patients underwent surgery; arthroscopy served as the standard of reference. RESULTS: The mean age of participants was 36.1±10.9 years with 36 (48.6%) women. In the FAI group, arthroscopic surgery showed acetabular chondral delamination in 37 hips. In all hips (including the controls), MRI signs of acetabular cartilage delamination showed an average sensitivity across the three raters of 73.0% with a specificity of 71.0%. In a separate analysis of only the FAI patients, a slightly higher sensitivity (77.7%) but lower specificity (66.7%) was demonstrated. The interrater reliability showed a moderate agreement (average [k]) across the raters (0.450). CONCLUSION: Performance of non-arthrographic MRI in diagnosing acetabular chondral delamination showed good results, yet inter-observer reproducibility among different radiologists was only moderate. Our results suggest that an increased level of awareness, for signs of delamination using MRI, will be helpful for detecting chondral delamination in patients with a history of FAI.

Society of Skeletal Radiology- white paper. Guidelines for the diagnostic management of incidental solitary bone lesions on CT and MRI in adults: bone reporting and data system (Bone-RADS).

The purpose of this article is to present algorithms for the diagnostic management of solitary bone lesions incidentally encountered on computed tomography (CT) and magnetic resonance (MRI) in adults. Based on review of the current literature and expert opinion, the Practice Guidelines and Technical Standards Committee of the Society of Skeletal Radiology (SSR) proposes a bone reporting and data system (Bone-RADS) for incidentally encountered solitary bone lesions on CT and MRI with four possible diagnostic management recommendations (Bone-RADS1, leave alone; Bone-RADS2, perform different imaging modality; Bone-RADS3, perform follow-up imaging; Bone-RADS4, biopsy and/or oncologic referral). Two algorithms for CT based on lesion density (lucent or sclerotic/mixed) and two for MRI allow the user to arrive at a specific Bone-RADS management recommendation. Representative cases are provided to illustrate the usability of the algorithms.

Anatomic thermochromic tissue-mimicking phantom of the lumbar spine for pre-clinical evaluation of MR-guided focused ultrasound (MRgFUS) ablation of the facet joint.

OBJECTIVE: To develop a thermochromic tissue-mimicking phantom (TTMP) with an embedded 3D-printed bone mimic of the lumbar spine to evaluate MRgFUS ablation of the facet joint and medial branch nerve. MATERIALS AND METHODS: Multiple 3D-printed materials were selected and characterized by measurements of speed of sound and linear acoustic attenuation coefficient using a through-transmission technique. A 3D model of the lumbar spine was segmented from a de-identified CT scan, and 3D printed. The 3D-printed spine was embedded within a TTMP with thermochromic ink color change setpoint at 60 °C. Multiple high energy sonications were targeted to the facet joints and medial branch nerve anatomical location using an ExAblate MRgFUS system connected to a 3T MR scanner. The phantom was dissected to assess sonication targets and the surrounding structures for color change as compared to the expected region of ablation on MR-thermometry. RESULTS: The measured sound attenuation coefficient and speed of sound of gypsum was 240 Np/m-MHz and 2471 m/s, which is the closest to published values for cortical bone. Following sonication, dissection of the TTMP revealed good concordance between the regions of color change within the phantom and expected areas of ablation on MR-thermometry. No heat deposition was observed in critical areas, including the spinal canal and nerve roots from either color change or MRI. CONCLUSION: Ablated regions in the TTMP correlated well with expected ablations based on MR-thermometry. These findings demonstrate the utility of an anatomic spine phantom in evaluating MRgFUS sonication for facet joint and medial branch nerve ablations.

Musculoskeletal Applications of Magnetic Resonance-Guided Focused Ultrasound.

Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel noninvasive therapy that uses focused sound energy to thermally ablate focal pathology within the body. In the United States, MRgFUS is approved by the Food and Drug Administration for the treatment of uterine fibroids, palliation of painful bone metastases, and thalamotomy for the treatment of essential tremor. However, it has also demonstrated utility for the treatment of a wide range of additional musculoskeletal (MSK) conditions that currently are treated as off-label indications. Advantages of the technology include the lack of ionizing radiation, the completely noninvasive technique, and the precise targeting that offer unprecedented control of the delivery of the thermal dose, as well as real-time monitoring capability with MR thermometry. In this review, we describe the most common MSK applications of MRgFUS: palliation of bone metastases, treatment of osteoid osteomas, desmoid tumors, facet arthropathy, and other developing indications.

Fibroma-like perivascular epithelioid cell tumor: a rare case in a long bone.

Fibroma-like perivascular epithelioid cell (PEComa) tumor is an extremely rare family of mesenchymal tumors composed of cells co-expressing melanocytic and myogenic markers. To date, 13 cases of primary bone PEComa have been reported in the literature and five reported fibroma-like PEComas were found in the soft tissues of patients with tuberous sclerosis (TSC). However, no fibroma-like PEComa has been reported in bone, either sporadic or TSC-associated. Here we report the case of a 22-year-old man with known TSC, who presented for evaluation of an asymptomatic mass in his left fibula diaphysis that had been present for 5 years. He had no activity-related pain, numbness, weakness, or limitations in range of motion. Both 3-T MRI and CT demonstrated a tumor originating from the midshaft middiaphyseal fibula. Axial T1-weighted and fat-saturated T2-weighted fast spin echo images showed a well-defined lesion in the fibula with extension into the surrounding soft tissues. Whole body bone scan was negative for metastasis using technetium-99m. Renal ultrasound was unremarkable with no evidence of angiomyolipoma. Histopathology demonstrated isolated spindle cells in a dense collagenous matrix. By immunohistochemical staining, tumor cells were positive for HMB-45 and MiTF and partially positive for alpha-smooth muscle actin supporting a diagnosis of fibroma-like PEComa of the midshaft fibula. Although fibroma-like PEComa of bone is very rare, a bone tumor in the setting of TSC should raise suspicion for the diagnosis, in particular if histology demonstrates rare epithelioid cells in a densely fibrotic stroma.

Efficacy and safety of magnetic resonance-guided focused ultrasound for the treatment of painful bone metastases: a systematic review and meta-analysis.

OBJECTIVE: To report the safety and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) in the treatment of painful bone metastases through a systematic review and meta-analysis of pain scores before and after MRgFUS treatment and post-treatment adverse events. MATERIALS AND METHODS: A comprehensive literature search of PubMed and Embase databases was performed for studies evaluating the efficacy and/or safety of MRgFUS. The mean difference of pain scores (10-point visual analogue scale or numerical rating scale) between baseline and 1-month/3-month pain scores was collected and analyzed in a pooled meta-analysis. Post-treatment adverse events based on the Common Terminology Criteria for Adverse Events (CTCAE) grading were recorded and the pooled prevalence was calculated. RESULTS: A total of 33 studies published between 2007 and 2019 were collected, resulting in a total sample size of 1082 patients. The majority of the studies were prospective with a reported follow-up period of 3 months. The pooled proportion of patients that achieved pain relief from MRgFUS (complete response or partial response [≥ 2-point improvement of pain score]) was 79% (95% CI 73-83%). The pooled 1-month and 3-month mean difference in pain score were - 3.8 (95% CI - 4.3; - 3.3) and - 4.4 (95% CI - 5.0; - 3.7), respectively. The overall rate of high-grade (CTCAE grade 3 or higher) and low-grade (CTCAE grade 2 or lower) MRgFUS-related adverse events were 0.9% and 5.9%, respectively. CONCLUSION: MRgFUS is an effective procedure that is able to provide significant pain palliation for patients with symptomatic bone metastases with a favorable safety profile.

Principal Component Analysis of Simultaneous PET-MRI Reveals Patterns of Bone-Cartilage Interactions in Osteoarthritis.

BACKGROUND: Bone-cartilage interactions have been implicated in causing osteoarthritis (OA). PURPOSE: To use [18 F]-NaF PET-MRI to 1) develop automatic image processing code in MatLab to create a model of bone-cartilage interactions and 2) find associations of bone-cartilage interactions with known manifestations of OA. STUDY TYPE: Prospective study aimed to evaluate a data analysis method. POPULATION: Twenty-nine patients with knee pain or joint stiffness. FIELD STRENGTH/SEQUENCE: 3T MRI (GE), 3D CUBE FSE, 3D combined T1 ρ/T2 MAPSS, [18F]-sodium fluoride, SIGNA TOF (OSEM). ASSESSMENT: Correlation between MRI (cartilage) and PET (bone) quantitative parameters, bone-cartilage interactions model described by modes of variation as derived by principal component analysis (PCA), WORMS scoring on cartilage lesions, bone marrow abnormalities, subchondral cysts. STATISTICAL TESTS: Linear regression, Pearson correlation. RESULTS: Mode 1 was a positive predictor of the bone abnormality score (P = 0.0003, P = 0.001, P = 0.0007) and the cartilage lesion score (P = 0.03, P = 0.01, P = 0.02) in the femur, tibia, and patella, respectively. For the cartilage lesion scores, mode 5 was the most important positive predictor in the femur (P = 3.9E-06), and mode 2 were predictors, significant negative predictor in the tibia (P = 0.007). In the patella, mode 1 was a significant positive predictor of the bone abnormality score (P = 0.0007). DATA CONCLUSION: By successfully building an automatic code to create a bone-cartilage interface, we were able to observe dynamic relationships between biochemical changes in the cartilage accompanied with bone remodeling, extended to the whole knee joint instead of simple colocalized observations, shedding light on the interactions that occur between bone and cartilage in OA. Evidence Level: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2020;52:1462-1474.

Diagnostic Performance of CT-Guided Bone Biopsies in Patients with Suspected Osteomyelitis of the Appendicular and Axial Skeleton with a Focus on Clinical and Technical Factors Associated with Positive Microbiology Culture Results.

PURPOSE: To assess diagnostic performance of CT-guided percutaneous needle bone biopsy (CTNBB) in patients with suspected osteomyelitis and analyze whether certain clinical or technical factors were associated with positive microbiology results. MATERIALS AND METHODS: All CTNBBs performed in a single center for suspected osteomyelitis of the appendicular and axial skeleton during 2003-2018 were retrospectively reviewed. Specific inclusion criteria were clinical and radiologic suspicion of osteomyelitis. Standard of reference was defined using outcome of surgical histopathology and microbiology culture and clinical and imaging follow-up. Technical and clinical data (needle size, comorbidities, clinical factors, laboratory values, blood cultures) were collected. Logistic regression was performed to assess associations between technical and clinical data and microbiology biopsy outcome. RESULTS: A total of 142 CTNBBs were included (46.5% female patients; age ± SD 46.10 y ± 22.8), 72 (50.7%) from the appendicular skeleton and 70 (49.3%) from the axial skeleton. CTNBB showed a sensitivity of 42.5% (95% confidence interval [CI], 32.0%-53.6%) in isolating the causative pathogen. A higher rate of positive microbiology results was found in patients with intravenous drug use (odds ratio [OR] = 5.15; 95% CI, 1.2-21.0; P = .022) and elevated white blood cell count ≥ 10 × 109/L (OR = 3.9; 95% CI, 1.62-9.53; P = .002). Fever (≥ 38°C) was another clinical factor associated with positive microbiology results (OR = 3.6; 95% CI, 1.3-9.6; P = .011). CONCLUSIONS: CTNBB had a low sensitivity of 42.5% for isolating the causative pathogen. Rate of positive microbiology samples was significantly higher in patients with IV drug use, elevated white blood cell count, and fever.

Cost-effectiveness analysis of magnetic resonance-guided focused ultrasound ablation for palliation of refractory painful bone metastases.

OBJECTIVE: The aim of this study was to determine if magnetic resonance-guided focused ultrasound (MRgFUS) is cost-effective compared with medication, for refractory pain from bone metastases in the United States. METHODS: We constructed a Markov state transition model using TreeAge Pro software (TreeAge Software, Inc., Williamstown, MA, USA) to model costs, outcomes, and the cost-effectiveness of a treatment strategy using MRgFUS for palliative treatment of painful bone metastases compared with a Medication Only strategy (Figure 1). Model transition state probabilities, costs (in 2018 US$), and effectiveness data (quality-adjusted life-years [QALYs]) were derived from available literature, local expert opinion, and reimbursement patterns at two U.S. tertiary academic medical centers actively performing MRgFUS. Costs and QALYs, discounted at three percent per year, were accumulated each month over a 24-month time horizon. One-way and probabilistic sensitivity analyses were performed. RESULTS: In the base-case analysis, the MRgFUS treatment strategy costs an additional $11,863 over the 2-year time horizon to accumulate additional 0.22 QALYs, equal to a $54,160/QALY ICER, thus making MRgFUS the preferred strategy. One-way sensitivity analyses demonstrate that for the base-case analysis, the crossover point at which Medication Only would instead become the preferred strategy is $23,341 per treatment. Probabilistic sensitivity analyses demonstrate that 67 percent of model iterations supported the conclusion of the base case. CONCLUSIONS: Our model demonstrates that MRgFUS is cost-effective compared with Medication Only for palliation of painful bone metastases for patients with medically refractory metastatic bone pain across a range of sensitivity analyses.

3D convolutional neural networks for detection and severity staging of meniscus and PFJ cartilage morphological degenerative changes in osteoarthritis and anterior cruciate ligament subjects.

BACKGROUND: Semiquantitative assessment of MRI plays a central role in musculoskeletal research; however, in the clinical setting MRI reports often tend to be subjective and qualitative. Grading schemes utilized in research are not used because they are extraordinarily time-consuming and unfeasible in clinical practice. PURPOSE: To evaluate the ability of deep-learning models to detect and stage severity of meniscus and patellofemoral cartilage lesions in osteoarthritis and anterior cruciate ligament (ACL) subjects. STUDY TYPE: Retrospective study aimed to evaluate a technical development. POPULATION: In all, 1478 MRI studies, including subjects at various stages of osteoarthritis and after ACL injury and reconstruction. FIELD STRENGTH/SEQUENCE: 3T MRI, 3D FSE CUBE. ASSESSMENT: Automatic segmentation of cartilage and meniscus using 2D U-Net, automatic detection, and severity staging of meniscus and cartilage lesion with a 3D convolutional neural network (3D-CNN). STATISTICAL TESTS: Receiver operating characteristic (ROC) curve, specificity and sensitivity, and class accuracy. RESULTS: Sensitivity of 89.81% and specificity of 81.98% for meniscus lesion detection and sensitivity of 80.0% and specificity of 80.27% for cartilage were achieved. The best performances for staging lesion severity were obtained by including demographics factors, achieving accuracies of 80.74%, 78.02%, and 75.00% for normal, small, and complex large lesions, respectively. DATA CONCLUSION: In this study we provide a proof of concept of a fully automated deep-learning pipeline that can identify the presence of meniscal and patellar cartilage lesions. This pipeline has also shown potential in making more in-depth examinations of lesion subjects for multiclass prediction and severity staging. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:400-410.

Factors Predicting Positive Culture in CT-Guided Bone Biopsy Performed for Suspected Osteomyelitis.

OBJECTIVE: The goal of this study was to identify clinical factors and radiographic characteristics associated with positive culture results from bone biopsy in cases of suspected osteomyelitis. MATERIALS AND METHODS: A total of 997 CT-guided bone biopsies were reviewed. We reviewed the images and medical records of 29 cases of suspected osteomyelitis to determine if any of the following factors affected culture results: age, sex, history of diabetes, collection of fluid aspirate at the time of biopsy, recent antibiotic therapy, elevated WBC count, and mean attenuation. RESULTS: Of the 29 CT-guided bone biopsies, 21% yielded positive culture results. We found no significant difference in age, sex, history of diabetes, collection of fluid aspirate at the time of biopsy, recent antibiotic therapy, or elevated WBC count between positive culture and negative culture cases. We did, however, find a significant difference in the mean CT attenuation values of the sampled bone between the two groups: 72.0 ± 41.5 HU (95% CI, 28.4-115.6 HU) among the positive culture group compared with 227.5 ± 198.8 HU (95% CI, 141.4-313.6 HU) among the negative culture group (p = 0.03). CONCLUSION: The rate of positive culture from image-guided core biopsy of suspected osteomyelitis is low. In this study, lower CT attenuation values were associated with a significantly higher rate of positive culture. An attenuation value of 150 HU may serve as a threshold above which biopsy would be expected to have lower utility for obtaining specific microbial culture data.

T2 mapping as a predictor of nonperfused volume in MRgFUS treatment of desmoid tumors.

Objective: The objective of this study was to develop an alternative method of non-contrast monitoring of tissue ablation during focused ultrasound treatment. Desmoid tumors are benign but locally aggressive soft tissue tumors that arise from fibroblast cells. Magnetic resonance-guided focused ultrasound (MRgFUS) has emerged as an alternative to conventional therapies, showing promising results in reduction of tumor volume without significant side effects. The gold-standard assessment of the reduction of viable tumor volume post-treatment is non-perfused volume (NPV) and evaluation of NPV is typically performed with post-treatment gadolinium enhanced MR imaging. However, as gadolinium cannot be repeatedly administered during treatments, there is a need for alternative non-contrast monitoring of the tissue to prevent over and under treatment. Methods: Double-echo and multi-echo images were acquired before, during and after the MRgFUS treatment. T2 maps were generated with an exponential fit and T2 maps were compared to post-treatment post-contrast images.Results: In all five MRgFUS treatment sessions, T2 mapping showed excellent qualitative agreement with the post-contrast NPV.Conclusions: T2 mapping may be used to visualize the extent of ablation with focused ultrasound and can be used as a predictor of NPV prior to the administration of contrast during the post-treatment assessment.

The impact of technical parameters on ablation volume during MR-guided focused ultrasound of desmoid tumors.

PURPOSE: Desmoid tumors are benign, locally aggressive soft tissue tumors derived from fibroblasts. Magnetic resonance-guided focused ultrasound (MRgFUS) is a safe and effective treatment for desmoid tumors. The purpose of this study was to retrospectively review the MRgFUS treatments of desmoid tumors at our institution to determine which technical treatment parameters contributed most significantly to the accumulation of thermal dose. MATERIALS AND METHODS: The study protocol was approved by the local IRB. We retrospectively reviewed data from MRgFUS treatments performed in histologically-confirmed desmoid tumors, over a period of 18 months. Sonication parameter means were compared with ANOVA. Mixed effects and linear regression models were used to evaluate the relative contribution of different parameters to thermal dose volume. RESULTS: Nine-hundred thirty-six sonications were reviewed in 13 treatments. Accumulated dose per sonication was greatest for elongated sonications (0.96 cc ± 0.90) compared to short (0.88 ± 0.93 cc) and nominal (0.55 ± 0.70 cc) sonications, p < .001. 65.2% of short sonications resulted in high percentage ablations, compared to 46.0% of nominal and 35.1% of elongated sonications. Standardized beta coefficients (anticipated increased volume in cc per unit) for power, duration, energy and average temperature were 0.006, 0.057, 0.00035 and 0.03, p < .001. Regarding dose efficacy, dose area contributed the greatest to this variability - 50.7% (45.5-54.8%), followed by distance - 16.6% (12.9-20.0%). CONCLUSIONS: A variety of sonication parameters significantly contributed to thermal ablation volume following MRgFUS of desmoid tumors, in reproducible patterns. This work can serve as the basis for future models working toward improved planning for MRgFUS treatments.

Association of weight change with progression of meniscal intrasubstance degeneration over 48 months: Data from the Osteoarthritis Initiative.

OBJECTIVES: To investigate the association of weight change over 48 months with progression of meniscal intrasubstance degeneration (MID). METHODS: We studied 487 subjects with MID at baseline and after 48 months using 3-T MRI with the same protocol (FSE sequences with and without fat suppression). These participants lost weight (≥3%, n = 141), had moderate weight gain (3-10%, n = 77), substantial weight gain (>10%, n = 15) or maintained stable weight (n = 254). Progression of MID to a meniscal tear was assessed using the WORMS grading system and compared among weight change groups using logistic regression. ANOVA and chi-square tests were used to study the differences in subjects' characteristics. RESULTS: Progression of MID increased from weight loss to substantial weight gain (p < 0.001) and was significantly more likely with both moderate weight gain (odds ratio [OR], 4.9; 95% confidence interval [CI] 2.4-8.9) and substantial weight gain (OR, 9.5; 95% CI 3.2-28.5) compared to stable weight. Results were similar in both menisci for moderate weight gain (medial: OR, 6.8; 95% CI 3.5-11.3; lateral: OR, 2.6; 95% CI 1.1-6.6) and substantial weight gain (medial: OR, 21.0; 95% CI 5.1-80.7; lateral: OR, 9.7; 95% CI 0.95-100.2). CONCLUSION: Weight gain is associated with an increased likelihood that meniscal intrasubstance degeneration will progress with the risk increasing with greater weight gain. KEY POINTS: • Subjects who gained weight were more likely to develop meniscal tears. • Greater amount of weight gain was associated with an increasing likelihood of progression. • Prevention of weight gain has health benefits for the meniscus.

Career Trajectory Factors Affecting Gender Diversity in Academic Radiology Department Chairs: Results of a Survey of SCARD Members.

In this survey of academic radiology department chairs, pathways to first chair appointment were similar between men and women in terms of prior professional accomplishments and chair position preparedness. However, women more commonly perceived that their gender negatively affected their career trajectory, and they more frequently reported experiencing overt discrimination and unconscious bias.

Effect of Sonication Duration and Power on Ablation Depth During MR-Guided Focused Ultrasound of Bone.

PURPOSE: To evaluate the effect of differences in sonication duration and power on the size of postcontrast ablation zone following magnetic resonance-guided focused ultrasound (MRgFUS) of bone in a swine femoral bone model. MATERIALS AND METHODS: Experimental procedures received approval from the Institutional Committee on Animal Research. MRgFUS was used to create two thermal lesions in the left femur of six pigs. Each target was subjected to six sonications. 400J of energy was used for each sonication. However, the distal target received the standard sonication duration of 20 seconds (20W), while the proximal target received a longer sonication duration of 40 seconds (10W). MRgFUS lesions were imaged with fat-saturated spoiled gradient echo sequence at 3.0T MRI 10 minutes following the administration of contrast. Maximum three-plane dimensions of the hypoenhanced ablation area were measured. RESULTS: Postcontrast MR images demonstrated ovoid regions of hypoenhancement at each target. The average depth of ablation was significantly greater for the shorter high-power sonications (7.3 mm), compared to the longer lower-power sonications (4.5 mm), P = 0.026. The craniocaudal dimension was also greater for the shorter ablations 26.7 mm compared to the longer sonications 21.0 mm, P = 0.006. CONCLUSION: Contrary to anecdotal clinical experience, this preclinical model suggests that during MRgFUS of bone, standard duration, higher-power sonications resulted in deeper ablation volumes compared to long duration, lower-power sonications. These results suggest that to achieve deeper ablations, if longer sonications are used, then the power should be relatively maintained, for a net energy increase. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2017;46:1418-1422.

Magnetic resonance-guided focused ultrasound treatment of extra-abdominal desmoid tumors: a retrospective multicenter study.

OBJECTIVES: To assess the feasibility, safety and preliminary efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of extra-abdominal desmoid tumours. METHODS: Fifteen patients with desmoid fibromatosis (six males, nine females; age range, 7-66 years) were treated with MRgFUS, with seven patients requiring multiple treatments (25 total treatments). Changes in viable and total tumour volumes were measured after treatment. Efficacy was evaluated using an exact one-sided Wilcoxon test to determine if the median reduction in viable tumour measured immediately after initial treatment exceeded a threshold of 50 % of the targeted volume. Median decrease after treatment of at least two points in numerical rating scale (NRS) worst and average pain scores was tested with an exact one-sided Wilcoxon test. Adverse events were recorded. RESULTS: After initial MRgFUS treatment, median viable targeted tumour volume decreased 63 %, significantly beyond our efficacy threshold (P = 0.0013). Median viable total tumour volume decreased (105 mL [interquartile range {IQR}, 217 mL] to 54 mL [IQR, 92 mL]) and pain improved (worst scores, 7.5 ± 1.9 vs 2.7 ± 2.6, P = 0.027; average scores, 6 ± 2.3 vs 1.3 ± 2, P = 0.021). Skin burn was the most common complication. CONCLUSIONS: MRgFUS significantly and durably reduced viable tumour volume and pain in this series of 15 patients with extra-abdominal desmoid fibromatosis. KEY POINTS: • Retrospective four-centre study shows MRgFUS safely and effectively treats extra-abdominal desmoid tumours • This non-invasive procedure can eradicate viable tumour in some cases • Alternatively, MRgFUS can provide durable control of tumour growth through repeated treatments • Compared to surgery or radiation, MRgFUS has relatively mild side effects.