Evaluating the image quality and local tumor invasion of uterine cancer by MUSE DWI with RPG.

Diffusion-weighted imaging (DWI) is widely utilized for evaluating uterine diseases. However, the prevalent technique, single-shot echo planar imaging (ssEPI), is hindered by notable image distortion and low spatial resolution. Therefore, optimizing uterine DWI sequences is vital for improving image quality. To investigate the efficacy of multiplexed sensitivity encoding (MUSE) combined with reverse polarity gradient (RPG) in enhancing uterine DWI quality and assessing local invasion in endometrial and cervical cancer, we included 149 patients. Each patient underwent DWI of the uterus using ssEPI, MUSE, and RPG-MUSE techniques. We compared these three sequences regarding image quality, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), geometric distortion rate (GDR), ADC values, accuracy in determining the extent of cancer invasion, and the Area Under the Curve (AUC) for identifying endometrial cancer and benign endometrial lesions using ADC values. The results indicated that RPG-MUSE DWI had less artifacts than MUSE and ssEPI (P < 0.05). Lesions were more apparent in MUSE and RPG-MUSE sequences compared to ssEPI (P < 0.05), with RPG-MUSE providing clearer lesion edges (P < 0.05). Additionally, RPG-MUSE DWI demonstrated higher SNR and CNR than ssEPI and MUSE (P < 0.05), along with a lower GDR (P < 0.05). The ADC values did not show significant differences among the three sequences (P > 0.05). Furthermore, the AUC of the ROC for detecting endometrial cancer and benign endometrial lesions using ADC values showed no significant differences across the sequences (P = 0.7609, 0.7186, and 0.8706, respectively). When combining each DWI sequence with T2WI for FIGO staging, RPG-MUSE and MUSE exhibited better alignment with pathology findings compared to ssEPI (P < 0.05). Overall, RPG-MUSE DWI showed fewer artifacts, higher SNR and CNR, reduced geometric distortion, and clearer lesion visualization compared to ssEPI and MUSE, leading to a more precise assessment of endometrial and cervical cancer invasion extent.

Comparison of single-shot, FOCUS single-shot, MUSE, and FOCUS MUSE diffusion weighted imaging for pulmonary lesions: A pilot study.

Rationale and objectives: To compare the performance of SS, FOCUS SS, MUSE, and FOCUS MUSE DWI for pulmonary lesions to obtain a better technique for pulmonary DWI imaging. Materials and methods: 44 patients with pulmonary lesions were recruited to perform pulmonary DWI using SS, FOCUS SS, MUSE, and FOCUS MUSE sequences. Then, two radiologists with 12 and 10 years of chest MRI experiences assessed the overall image quality while another two radiologists both with 3 years of experiences evaluated the SNR, DR, and ADC of pulmonary lesions. Using interclass correlation coefficient (ICC) and kappa statistics to assess consistency of readers, Friedman test and Dunn-Bonferroni post hoc were used to calculate the difference between sequences. Mann-Whitney test and ROC curve were used to distinguish malignant from benign lesions. Results: All the assessed variables of the four sequences presented good to excellent intra-/inter-observer consistency. Compared with SS, FOCUS SS and MUSE, FOCUS MUSE demonstrated better image quality, including significantly higher 5-point Likert scale score (P < 0.001) and smaller DR (P < 0.001). SNR was comparable among SS, FOCUS SS, and FOCUS MUSE (P > 0.05) while MUSE presented with significantly higher SNR over them (P < 0.01). ADC of malignant was significantly smaller than that of benign for all the four sequences (P < 0.05). ROC analysis showed relatively better diagnostic performance of FOCUS MUSE (AUC = 0.820) over SS (AUC = 0.748), FOCUS SS (AUC = 0.778), and MUSE (AUC = 0.729) in distinguishing malignant from benign lesions. Conclusion: FOCUS MUSE possessed sufficient SNR and was better over SS, FOUCS SS, and MUSE for characterizing pulmonary lesions.

Role of Multiparametric MRI in the Preoperative Evaluation of Endometrial Carcinoma: A Cross-Sectional Study.

Background Endometrial carcinoma (EC) is a major global concern in females throughout the world with increasing incidence in India. Hence, early detection and prompt intervention will reduce morbidity and mortality associated with it. Multiple studies showed a promising role of multiparametric magnetic resonance imaging (mpMRI) in the evaluation and early detection of the disease. In view of the paucity of such studies in the Indian population, we assessed the role of mpMRI in the evaluation of EC by utilizing a 3T MR scanner. Objectives To assess the efficacy of mpMRI in detecting myometrial invasion and locoregional staging in suspected or diagnosed cases of EC. Materials and methods Nineteen cases of EC with mpMRI were included in the study, and 15 of these underwent surgicopathological staging. The preoperative staging was done using the International Federation of Gynecology and Obstetrics (FIGO) 2009 staging system based on mpMRI findings and compared with postoperative FIGO staging. All the data were compiled in a Microsoft Excel (Microsoft® Corp., Redmond, WA) file and analyzed in Statistical Product and Service Solutions (SPSS, version 21.0; IBM SPSS Statistics for Windows, Armonk, NY) using appropriate tools. Results In our study, EC was commonly seen in more than 50-year females with a predominant complaint being postmenopausal bleeding. EC most commonly appeared heterogeneously hyperintense on T2-weighted sequence (T2W) and areas of diffusion restriction on diffusion-weighted imaging (DWI) in all cases. Dynamic contrast-enhanced (DCE) MRI (DCE-MRI) showed mild heterogeneous enhancement in all phases with better delineation of adjacent myometrial infiltration in the equilibrium phase. Diffusion tensor imaging (DTI) parameters had significantly lower values in involved myometrium vis-a-vis uninvolved myometrium. A statistically significant correlation was seen between preoperative mpMRI FIGO staging utilizing T2W, DWI, DCE-MRI, and DTI with surgicopathological FIGO staging. Conclusion mpMRI, particularly T2W, DWI, DCE-MRI, and DTI, yields a significant correlation between MR imaging and histopathological findings in assessing myometrial infiltration and thereby could be helpful in preoperative staging and extent of lymph-nodal dissection.

Cardiac intravoxel incoherent motion diffusion-weighted imaging to assess myocardial microcirculation dysfunction in hypertension.

Background: Myocardial microcirculation dysfunction is the most potent predictor of adverse cardiovascular events in hypertension. The current study aimed to apply intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) to assess hypertension-related microcirculation dysfunction. Methods: In this prospective study, 102 participants were recruited from our hospital and underwent cardiac magnetic resonance (CMR) examination on a 3T scanning system. Hypertensive patients were divided into 3 subgroups based on blood pressure (BP) types. Two experienced CMR radiologists independently analyzed all images, and Bland-Altman analysis was applied to assess intra- and inter-observer reproducibility. Cardiac function indexes and IVIM-DWI parameters were compared between the hypertension and healthy control groups, as well as among the three hypertension subgroups. Results: Totally 62 participants with hypertension and 27 healthy controls were included. 13 participants were excluded for poor quality of IVIM-DWI images. Significantly higher maximal left ventricular wall thickness (10.3±2.0 vs. 8.6±1.4 mm, P<0.001) and left ventricular mass index (49.0±9.1 vs. 42.1±7.5 g/m2, P<0.05) were observed inhypertension group compared with healthy control group. There were significant statistical differences in pseudo diffusion (D*) between them (81.3±16.3 vs. 111.8±18.9 mm2/s, P<0.001), as well as among the three hypertension subgroups (99.4±13.9 vs. 79.7±10.6 vs. 67.1±6.6 mm2/s, P<0.001). Participants with poor quality of IVIM-DWI images had higher heart rates (72.2±10.0 vs. 62.0±8.1 bpm, P<0.001). Conclusions: IVIM-DWI is feasible for quantitatively evaluating myocardial microcirculation dysfunction in hypertension. The D* parameter has a potential value for assessing the severity of microcirculation dysfunction in different BP categories.

Histogram analysis based on intravoxel incoherent motion diffusion-weighted imaging for determining the perineural invasion status of rectal cancer.

Background: Unfortunately, the morphologic magnetic resonance imaging (MRI) is unable to determine perineural invasion (PNI) status. This study applied histogram analysis of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the assessment of PNI status of rectal cancer (RC). Methods: The retrospective analysis enrolled 175 patients with RC confirmed by postoperative pathology in The First Affiliated Hospital of Shandong First Medical University from January 2019 to December 2021. All patients underwent preoperative rectal MRI. Whole-tumor volume histogram features from IVIM-DWI were extracted using open-source software. Univariate analysis and multivariate logistic regression analysis were used to compare the differences in histogram parameters and clinical features between the PNI-positive group and PNI-negative group. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance, while the Delong test was used to compare the area under the curve of the models. Results: The interobserver agreement of the histogram features derived from DWI, including apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), water molecular diffusion heterogeneity index (α), and distributed diffusion coefficient (DDC) were good to excellent. A total of eight histogram features including DWI_maximum, DWI_skewness, D_kurtosis, D_minimum, D_skewness, D*_energy, D*_skewness, and f_minimum were significantly different between the PNI-positive and PNI-negative groups in the univariate analysis (P<0.05); among the clinicoradiologic factors, percentage of rectal wall circumference invasion (PCI) was significantly different between the two groups (P<0.05). Multivariate analysis demonstrated that the values of D*_energy, D*_skewness, and f_minimum differed significantly between the PNI-positive patients and PNI-negative patients (P<0.05), with the independent risk factors being D*_skewness [odds ratio (OR) =1.157; 95% confidence interval (CI): 1.050-1.276; P=0.003] and PCI (OR =11.108, 95% CI: 1.767-69.838; P=0.0002). The area under the curve of the model combining the three histogram features and PCI to assess PNI status in RC was 0.807 (95% CI: 0.741-0.863). The results of the Delong test showed that the combined model was significantly different from each single-parameter model (P<0.05). Conclusions: The combined model constructed on the basis of IVIM-DWI histogram features may help to assess the status of RC PNI.

Multiparametric simultaneous hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) incorporating intratumoral and peritumoral regions for grading of glioma.

Background: Preoperative grading gliomas is essential for therapeutic clinical decision-making. Current non-invasive imaging modality for glioma grading were primarily focused on magnetic resonance imaging (MRI) or positron emission tomography (PET) of the tumor region. However, these methods overlook the peritumoral region (PTR) of tumor and cannot take full advantage of the biological information derived from hybrid-imaging. Therefore, we aimed to combine multiparameter from hybrid 18F-fluorodeoxyglucose (18F-FDG) PET/MRI of the solid component and PTR were combined for differentiating high-grade glioma (HGG) from low-grade glioma (LGG). Methods: A total of 76 patients with pathologically confirmed glioma (41 HGG and 35 LGG) who underwent simultaneous 18F-FDG PET, arterial spin labelling (ASL), and diffusion-weighted imaging (DWI) with hybrid PET/MRI were retrospectively enrolled. The relative maximum standardized uptake value (rSUVmax), relative cerebral blood flow (rCBF), and relative minimum apparent diffusion coefficient (rADCmin) for the solid component and PTR at different distances outside tumoral border were compared. Receiver operating characteristic (ROC) curves were applied to assess the grading performance. A nomogram for HGG prediction was constructed. Results: HGGs displayed higher rSUVmax and rCBF but lower rADCmin in the solid component and 5 mm-adjacent PTR, lower rADCmin in 10 mm-adjacent PTR, and higher rCBF in 15- and 20-mm-adjacent PTR. rSUVmax in solid component performed best [area under the curve (AUC) =0.865] as a single parameter for grading. Combination of rSUVmax in the solid component and adjacent 20 mm performed better (AUC =0.881). Integration of all 3 indicators in the solid component and adjacent 20 mm performed the best (AUC =0.928). The nomogram including rSUVmax, rCBF, and rADCmin in the solid component and 5-mm-adjacent PTR predicted HGG with a concordance index (C-index) of 0.906. Conclusions: Multiparametric 18F-FDG PET/MRI from the solid component and PTR performed excellently in differentiating HGGs from LGGs. It can be used as a non-invasive and effective tool for preoperative grade stratification of patients with glioma, and can be considered in clinical practice.

Cortical Network Disruption Is Minimal in Early Stages of Psychosis.

Background and Hypothesis: Schizophrenia is associated with white matter disruption and topological reorganization of cortical connectivity but the trajectory of these changes, from the first psychotic episode to established illness, is poorly understood. Current studies in first-episode psychosis (FEP) patients using diffusion magnetic resonance imaging (dMRI) suggest such disruption may be detectable at the onset of psychosis, but specific results vary widely, and few reports have contextualized their findings with direct comparison to young adults with established illness. Study Design: Diffusion and T1-weighted 7T MR scans were obtained from N = 112 individuals (58 with untreated FEP, 17 with established schizophrenia, 37 healthy controls) recruited from London, Ontario. Voxel- and network-based analyses were used to detect changes in diffusion microstructural parameters. Graph theory metrics were used to probe changes in the cortical network hierarchy and to assess the vulnerability of hub regions to disruption. The analysis was replicated with N = 111 (57 patients, 54 controls) from the Human Connectome Project-Early Psychosis (HCP-EP) dataset. Study Results: Widespread microstructural changes were found in people with established illness, but changes in FEP patients were minimal. Unlike the established illness group, no appreciable topological changes in the cortical network were observed in FEP patients. These results were replicated in the early psychosis patients of the HCP-EP datasets, which were indistinguishable from controls in most metrics. Conclusions: The white matter structural changes observed in established schizophrenia are not a prominent feature in the early stages of this illness.

Predicting tumor invasion depth in gastric cancer: developing and validating multivariate models incorporating preoperative IVIM-DWI parameters and MRI morphological characteristics.

INTRODUCTION: Accurate assessment of the depth of tumor invasion in gastric cancer (GC) is vital for the selection of suitable patients for neoadjuvant chemotherapy (NAC). Current problem is that preoperative differentiation between T1-2 and T3-4 stage cases in GC is always highly challenging for radiologists. METHODS: A total of 129 GC patients were divided into training (91 cases) and validation (38 cases) cohorts. Pathology from surgical specimens categorized patients into T1-2 and T3-4 stages. IVIM-DWI and MRI morphological characteristics were evaluated, and a multimodal nomogram was developed. The MRI morphological model, IVIM-DWI model, and combined model were constructed using logistic regression. Their effectiveness was assessed using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC). RESULTS: The combined nomogram, integrating preoperative IVIM-DWI parameters (D value) and MRI morphological characteristics (maximum tumor thickness, extra-serosal invasion), achieved the highest area under the curve (AUC) values of 0.901 and 0.883 in the training and validation cohorts, respectively. No significant difference was observed between the AUCs of the IVIM-DWI and MRI morphological models in either cohort (training: 0.796 vs. 0.835, p = 0.593; validation: 0.794 vs. 0.766, p = 0.79). CONCLUSION: The multimodal nomogram, combining IVIM-DWI parameters and MRI morphological characteristics, emerges as a promising tool for assessing tumor invasion depth in GC, potentially guiding the selection of suitable candidates for neoadjuvant chemotherapy (NAC) treatment.

Quantitative and Radiological Assessment of Post-cardiac-Arrest Comatose Patients with Diffusion-Weighted Magnetic Resonance Imaging.

BACKGROUND: Although magnetic resonance imaging, particularly diffusion-weighted imaging, has increasingly been used as part of a multimodal approach to prognostication in patients who are comatose after cardiac arrest, the performance of quantitative analysis of apparent diffusion coefficient (ADC) maps, as compared to standard radiologist impression, has not been well characterized. This retrospective study evaluated quantitative ADC analysis to the identification of anoxic brain injury by diffusion abnormalities on standard clinical magnetic resonance imaging reports. METHODS: The cohort included 204 previously described comatose patients after cardiac arrest. Clinical outcome was assessed by (1) 3-6 month post-cardiac-arrest cerebral performance category and (2) coma recovery to following commands. Radiological evaluation was obtained from clinical reports and characterized as diffuse, cortex only, deep gray matter structures only, or no anoxic injury. Quantitative analyses of ADC maps were obtained in specific regions of interest (ROIs), whole cortex, and whole brain. A subgroup analysis of 172 was performed after eliminating images with artifacts and preexisting lesions. RESULTS: Radiological assessment outperformed quantitative assessment over all evaluated regions (area under the curve [AUC] 0.80 for radiological interpretation and 0.70 for the occipital region, the best performing ROI, p = 0.011); agreement was substantial for all regions. Radiological assessment still outperformed quantitative analysis in the subgroup analysis, though by smaller margins and with substantial to near-perfect agreement. When assessing for coma recovery only, the difference was no longer significant (AUC 0.83 vs. 0.81 for the occipital region, p = 0.70). CONCLUSIONS: Although quantitative analysis eliminates interrater differences in the interpretation of abnormal diffusion imaging and avoids bias from other prediction modalities, clinical radiologist interpretation has a higher predictive value for outcome. Agreement between radiological and quantitative analysis improved when using high-quality scans and when assessing for coma recovery using following commands. Quantitative assessment may thus be more subject to variability in both clinical management and scan quality than radiological assessment.

Reproducibility of intravoxel incoherent motion quantification in the liver across field strengths and gradient hardware.

PURPOSE: To evaluate reproducibility and interlobar agreement of intravoxel incoherent motion (IVIM) quantification in the liver across field strengths and MR scanners with different gradient hardware. METHODS: Cramer-Rao lower bound optimization was performed to determine optimized monopolar and motion-robust 2D (b-value and first-order motion moment [M1]) IVIM-DWI acquisitions. Eleven healthy volunteers underwent diffusion MRI of the liver, where each optimized acquisition was obtained five times across three MRI scanners. For each data set, IVIM estimates (diffusion coefficient (D), pseudo-diffusion coefficients ( d 1 * $$ {d}_1^{\ast } $$ and d 2 * $$ {d}_2^{\ast } $$ ), blood velocity SDs (Vb1 and Vb2), and perfusion fractions [f1 and f2]) were obtained in the right and left liver lobes using two signal models (pseudo-diffusion and M1-dependent physical) with and without T2 correction (fc1 and fc2) and three fitting techniques (tri-exponential region of interest-based full and segmented fitting and blood velocity SD distribution fitting). Reproducibility and interlobar agreement were compared across methods using within-subject and pairwise coefficients of variation (CVw and CVp), paired sample t-tests, and Bland-Altman analysis. RESULTS: Using a combination of motion-robust 2D (b-M1) data acquisition, M1-dependent physical signal modeling with T2 correction, and blood velocity SD distribution fitting, multiscanner reproducibility with median CVw = 5.09%, 11.3%, 9.20%, 14.2%, and 12.6% for D, Vb1, Vb2, fc1, and fc2, respectively, and interlobar agreement with CVp = 8.14%, 11.9%, 8.50%, 49.9%, and 42.0%, respectively, was achieved. CONCLUSION: Recently proposed advanced IVIM acquisition, signal modeling, and fitting techniques may facilitate reproducible IVIM quantification in the liver, as needed for establishment of IVIM-based quantitative biomarkers for detection, staging, and treatment monitoring of diseases.

Central neurodegeneration in Kennedy's disease accompanies peripheral motor dysfunction.

Spinal and bulbar muscular atrophy (SBMA), or Kennedy's disease (KD), is a rare hereditary neuromuscular disorder demonstrating commonalities with amyotrophic lateral sclerosis (ALS). The current study aimed to define functional and central nervous system abnormalities associated with SBMA pathology, their interaction, and to identify novel clinical markers for quantifying disease activity. 27 study participants (12 SBMA; 8 ALS; 7 Control) were recruited. SBMA patients underwent comprehensive motor and sensory functional assessments, and neurophysiological testing. All participants underwent whole-brain structural and diffusion MRI. SBMA patients demonstrated marked peripheral motor and sensory abnormalities across clinical assessments. Increased abnormalities on neurological examination were significantly associated with increased disease duration in SBMA patients (R2 = 0.85, p < 0.01). Widespread juxtacortical axonal degeneration of corticospinal white matter tracts were detected in SBMA patients (premotor; motor; somatosensory; p < 0.05), relative to controls. Increased axial diffusivity was significantly correlated with total neuropathy score in SBMA patients across left premotor (R2 = 0.59, p < 0.01), motor (R2 = 0.63, p < 0.01), and somatosensory (R2 = 0.61, p < 0.01) tracts. The present series has identified involvement of motor and sensory brain regions in SBMA, associated with disease duration and increasing severity of peripheral neuropathy. Quantification of annualized brain MRI together with Total Neuropathy Score may represent a novel approach for clinical monitoring.

White matter changes after Gamma Knife Capsulotomy in patients with intractable obsessive-compulsive disorder.

Background: Anterior capsulotomy is one of the therapeutic options for refractory obsessive-compulsive disorder (OCD). Safety and efficacy of Gamma Knife Capsulotomy (GKC) have been demonstrated in the past. Objective: To characterize changes induced by GKC using a fixel-based analysis (FBA) and possible predictors of efficacy. Methods: Patients with OCD refractory to other therapies underwent bilateral GKC with 120 Gy as a maximum dose on the anterior limb of the internal capsule (ALIC). The clinical outcome was percent reduction in Yale- Brown Obsessive-Compulsive Scale (Y-BOCS). White Matter changes were analyzed using fixel-based analysis (FBA) for fibre density (FD), fibre-bundle cross-section (FC) and the combination of the two (FDC). Results: Seven patients underwent GKC. Median follow-up was 13 months (range 12-58 months). Mean (±SD) decrease in Y-BOCS score at last follow-up was 61 % ± 35 % with five patients considered as responders. FBA showed a symmetric FD reduction in the ALIC with extension to the anterior fronto-thalamic radiation; a reduction of FC along the superior longitudinal fasciculus (SLF) in both hemispheres with a predominance in the left one. Reductions in FDC were detected predominantly in the right hemisphere, with a similar pattern to FD reductions and associated with a positive correlation (p < 0.05) between Y-BOCS reduction and fibres passing in the ventral part. Conclusions: GKC is safe and efficient in reducing OCD severity in selected patients. Changes induced in white matter by GKC extend over the ALIC. Reduction of fibres passing the ventral part of the right sided ALIC correlates with better results.

Superficial Spreading Cervical Squamous Cell Carcinoma Manifesting as Intrauterine Mural Nodules on Magnetic Resonance Imaging.

Superficially spreading cervical squamous cell carcinoma (SCC) is the superficial extension of SCC of the cervix into the uterine lumen, replacing the endometrium. Here, we report a case of superficially spreading cervical SCC manifesting as intrauterine mural nodules with restricted diffusion on magnetic resonance imaging (MRI). A 76-year-old woman with a history of conization presented with a pelvic mass. MRI revealed a large cystic lesion with mural nodules and wall thickening. The nodular lesions and thickened walls showed high signal intensity on diffusion-weighted imaging (DWI) and low signal intensity on apparent diffusion coefficient (ADC) maps. We performed a laparotomy for diagnosis and treatment and suspected that the tumor was of uterine origin. Hysterectomy and bilateral adnexectomy were performed. Histopathological examination revealed superficial spreading of the cervical SCC. Superficially spreading cervical SCC can manifest as intrauterine mural nodules on MRI. DWI is useful for delineating this disease. If mural nodules or endometrial thickening with restricted diffusion are found in the uterine lumen, clinicians should consider the possibility of the superficial spread of cervical SCC.

Characterizing white matter connectome abnormalities in patients with temporal lobe epilepsy using threshold-free network-based statistics.

INTRODUCTION: Emerging evidence illustrates that temporal lobe epilepsy (TLE) involves network disruptions represented by hyperexcitability and other seizure-related neural plasticity. However, these associations are not well-characterized. Our study characterizes the whole brain white matter connectome abnormalities in TLE patients compared to healthy controls (HCs) from the prospective Epilepsy Connectome Project study. Furthermore, we assessed whether aberrant white matter connections are differentially related to cognitive impairment and a history of focal-to-bilateral tonic-clonic (FBTC) seizures. METHODS: Multi-shell connectome MRI data were preprocessed using the DESIGNER guidelines. The IIT Destrieux gray matter atlas was used to derive the 162 × 162 structural connectivity matrices (SCMs) using MRTrix3. ComBat data harmonization was applied to harmonize the SCMs from pre- and post-scanner upgrade acquisitions. Threshold-free network-based statistics were used for statistical analysis of the harmonized SCMs. Cognitive impairment status and FBTC seizure status were then correlated with these findings. RESULTS: We employed connectome measurements from 142 subjects, including 92 patients with TLE (36 males, mean age = 40.1 ± 11.7 years) and 50 HCs (25 males, mean age = 32.6 ± 10.2 years). Our analysis revealed overall significant decreases in cross-sectional area (CSA) of the white matter tract in TLE group compared to controls, indicating decreased white matter tract integrity and connectivity abnormalities in addition to apparent differences in graph theoretic measures of connectivity and network-based statistics. Focal and generalized cognitive impaired TLE patients showcased higher trend-level abnormalities in the white matter connectome via decreased CSA than those with no cognitive impairment. Patients with a positive FBTC seizure history also showed trend-level findings of association via decreased CSA. CONCLUSIONS: Widespread global aberrant white matter connectome changes were observed in TLE patients and characterized by seizure history and cognitive impairment, laying a foundation for future studies to expand on and validate the novel biomarkers and further elucidate TLE's impact on brain plasticity.

Impact of diffusion-weighted imaging on agreement between radiologists and non-radiologist in musculoskeletal tumor imaging using magnetic resonance.

Background: Diffusion-weighted imaging (DWI) is widely used in neuroradiology or abdominal imaging but not yet implemented in the diagnosis of musculoskeletal tumors. Aim: This study aimed to evaluate how including diffusion imaging in the MRI protocol for patients with musculoskeletal tumors affects the agreement between radiologists and non-radiologist. Methods: Thirty-nine patients with musculoskeletal tumors (Ewing sarcoma, osteosarcoma, and benign tumors) consulted at our institution were included. Three raters with different experience levels evaluated examinations blinded to all clinical data. The final diagnosis was determined by consensus. MRI examinations were split into 1) conventional sequences and 2) conventional sequences combined with DWI. We evaluated the presence or absence of diffusion restriction, solid nature, necrosis, deep localization, and diameter >4 cm as known radiological markers of malignancy. Agreement between raters was evaluated using Gwet's AC1 coefficients and interpreted according to Landis and Koch. Results: The lowest agreement was for diffusion restriction in both groups of raters. Agreement among all raters ranged from 0.51 to 0.945, indicating moderate to almost perfect agreement, and 0.772-0.965 among only radiologists indicating substantial to almost perfect agreement. Conclusion: The agreement in evaluating diffusion-weighted MRI sequences was lower than that for conventional MRI sequences, both among radiologists and non-radiologist and among radiologists alone. This indicates that assessing diffusion imaging is more challenging, and experience may impact the agreement.

Assessment of fitting methods and variability of IVIM parameters in muscles of the lumbar spine at rest.

Intravoxel incoherent motion (IVIM) MRI provides insight into tissue diffusion and perfusion. Here, estimates of perfusion fraction ( f ), pseudo-diffusion coefficient ( D * ), and diffusion coefficient ( D ) obtained via different fitting methods are compared to ascertain (1) the optimal analysis strategy for muscles of the lumbar spine and (2) repeatability of IVIM parameters in skeletal muscle at rest. Diffusion-weighted images were acquired in the lumbar spine at rest in 15 healthy participants. Data were fit to the bi-exponential IVIM model to estimate f , D * and D using three variably segmented approaches based on non-linear least squares fitting, and a Bayesian fitting method. Assuming that perfusion and diffusion are temporally stable in skeletal muscle at rest, and spatially uniform within a spinal segment, the optimal analysis strategy was determined as the approach with the lowest temporal or spatial variation and smallest residual between measured and fit data. Inter-session repeatability of IVIM parameters was evaluated in a subset of 11 people. Finally, simulated IVIM signal at varying signal to noise ratio were evaluated to understand precision and bias. Experimental results showed that IVIM parameter values differed depending on the fitting method. A three-step non-linear least squares fitting approach, where D , f , and D * were estimated sequentially, generally yielded the lowest spatial and temporal variation. Solving all parameters simultaneously yielded the lowest residual between measured and fit data, however there was substantial spatial and temporal variability. Results obtained by Bayesian fitting had high spatial and temporal variability in addition to a large residual between measured and fit data. Simulations showed that all fitting methods can fit the IVIM data at signal to noise ratios >35, and that D * was the most challenging to accurately obtain. Overall, this study motivates use of a three-step non-linear least squares fitting strategy to quantify IVIM parameters in skeletal muscle.

Developmental changes in brain structure and function following exposure to oral LSD during adolescence.

LSD is a hallucinogen with complex neurobiological and behavioral effects. Underlying these effects are changes in brain neuroplasticity. This is the first study to follow the developmental changes in brain structure and function following LSD exposure in periadolescence. We hypothesized LSD given during a time of heightened neuroplasticity, particularly in the forebrain, would affect cognitive and emotional behavior and the associated underlying neuroanatomy and neurocircuitry. Female and male mice were given vehicle, single or multiple treatments of 3.3 µg of LSD by oral gavage starting on postnatal day 51. Between postnatal days 90-120 mice were imaged and tested for cognitive and motor behavior. MRI data from voxel-based morphometry, diffusion weighted imaging, and BOLD resting state functional connectivity were registered to a mouse 3D MRI atlas with 139 brain regions providing site-specific differences in global brain structure and functional connectivity between experimental groups. Motor behavior and cognitive performance were unaffected by periadolescent exposure to LSD. Differences across experimental groups in brain volume for any of the 139 brain areas were few in number and not focused on any specific brain region. Multiple exposures to LSD significantly altered gray matter microarchitecture across much of the brain. These changes were primary associated with the thalamus, sensory and motor cortices, and basal ganglia. The forebrain olfactory system and prefrontal cortex and hindbrain cerebellum and brainstem were unaffected. The functional connectivity between forebrain white matter tracts and sensorimotor cortices and hippocampus was reduced with multidose LSD exposure. Does exposure to LSD in late adolescence have lasting effects on brain development? The bulk of our significant findings were seen through changes is DWI values across 74 brain areas in the multi-dose LSD group. The pronounced changes in indices of anisotropy across much of the brain would suggest altered gray matter microarchitecture and neuroplasticity. There was no evidence of LSD having consequential effects on cognitive or motor behavior when animal were evaluated as young adults 90-120 days of age. Neither were there any differences in the volume of specific brain areas between experimental conditions. The reduction in connectivity in forebrain white matter tracts with multidose LSD and consolidation around sensorimotor and hippocampal brain areas requires a battery of tests to understand the consequences of these changes on behavior.

Diffusion-weighted Echo Planar Imaging with Compressed SENSE (EPICS-DWI) for Pancreas Assessment: A Multicenter Study.

PURPOSE: This study aimed to evaluate the feasibility of single-shot echo planar diffusion-weighted imaging with compressed SENSE (EPICS-DWI) for pancreas assessment by comparing with single-shot echo planar DWI with parallel imaging (PI-DWI). METHODS: This multicenter prospective study included 27 consecutive participants with untreated pancreatic ductal adenocarcinoma (PDAC) (15 men; mean age, 67 ± 10 years) who underwent pancreatic protocol MRI including both PI-DWI and EPICS-DWI. Two radiologists independently and randomly reviewed the high b-value DWI images and qualitatively assigned confidence scores for overall image quality, image noise, pancreas conspicuity, and PDAC conspicuity using a 5-point scale. One radiologist measured the PDAC-to-pancreas contrast-to-noise-ratio (CNR) on high b-value DWI images and the apparent diffusion coefficient (ADC) value of PDAC. Qualitative and quantitative parameters were compared between PI-DWI and EPICS-DWI using the Wilcoxon signed-rank test. RESULTS: The confidence scores for overall image quality (P < 0.001 in both radiologists) and image noise (P < 0.001 in both radiologists) were higher in EPICS-DWI than in PI-DWI. The pancreas conspicuity was better in EPICS-DWI than in PI-DWI in one of the radiologists (P = 0.02 and 0.06). The PDAC conspicuity was comparable between PI-DWI and EPICS-DWI (P > 0.99 in both radiologists). The PDAC-to-pancreas CNR was higher in EPICS-DWI than in PI-DWI (P = 0.02), while the ADC value of PDAC in PI-DWI was not significantly different compared to that in EPICS-DWI (P = 0.48). CONCLUSION: The image quality and PDAC-to-pancreas CNR was improved in EPICS-DWI compared to PI-DWI. However, the conspicuity and ADC value of PDAC were comparable between PI-DWI and EPICS-DWI.

Comprehensive assessment of postoperative recurrence and survival in patients with cervical cancer.

BACKGROUND: The prediction of postoperative recurrence and survival in cervical cancer patients has been a major clinical challenge. The combination of clinical parameters, inflammatory markers, intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), and MRI-derived radiomics is expected to support the prediction of recurrence-free survival (RFS), disease-free survival (DFS), tumor-specific survival (CSS), and overall survival (OS) of cervical cancer patients after surgery. METHODS: A retrospective analysis of 181 cervical cancer patients with continuous follow-up was completed. The parameters of IVIM-DWI and radiomics were measured, analyzed, and screened. The LASSO regularization was used to calculate the radiomics score (Rad-score). Multivariate Cox regression analysis was used to construct nomogram models for predicting postoperative RFS, DFS, CSS, and OS in cervical cancer patients, with internal and external validation. RESULTS: Clinical stage, parametrial infiltration, internal irradiation, D-value, and Rad-score were independent prognostic factors for RFS; Squamous cell carcinoma antigen, internal irradiation, D-value, f-value and Rad-score were independent prognostic factors for DFS; Maximum tumor diameter, lymph node metastasis, platelets, D-value and Rad-score were independent prognostic factors for CSS; Lymph node metastasis, systemic inflammation response index, D-value and Rad-score were independent prognostic factors for OS. The AUCs of each model predicting RFS, DFS, CSS, and OS at 1, 3, and 5 years were 0.985, 0.929, 0.910 and 0.833, 0.818, 0.816 and 0.832, 0.863, 0.891 and 0.804, 0.812, 0.870, respectively. CONCLUSIONS: Nomograms based on clinical and imaging parameters showed high clinical value in predicting postoperative RFS, DFS, CSS, and OS of cervical cancer patients and can be used as prognostic markers.

Ischemic core volume is associated with hemorrhagic transformation post endovascular thrombectomy.

INTRODUCTION: Symtomatic hemorrhagic transformation(sHT) was defined as any intracerebral hemorrhage that combined with clinical deterioration. While recent studies showed low rates of sHT in large core ischemic strokes treated with endovascular thrombectomy (EVT), the specific impact of core size on overall hemorrhagic transformation (HT) remains unclear. We aim to investigate the relationship between ischemic core size and development of HT post thrombectomy. METHODS: This prospective study enrolled acute ischemic stroke (AIS) patients with anterior large vessel occlusion undergoing EVT who had baseline MRI from 2017-2019. Pre-EVT Arterial Spin Labeling (ASL) and Diffusion-Weighted Imaging (DWI) scans were performed for volume calculations. Primary outcome was HT assessed within 72 hours post EVT. Multivariable logistic regression was used to analyze the associations between baseline DWI and ASL volumes and HT occurrence. Discriminative ability for HT was compared using receiver operating curve analysis (c-statistic). RESULTS: We included 101 patients (median age: 64 [IQR 56-74] years, baseline NIHSS 13 [IQR 9-16]). Median DWI and ASL volume were 21.0 ml [IQR 8.3-47.2] and 105ml [59.5-172.9], respectively. 36.8% recieved intravenous thrombolysis before EVT. HT occurred in 36.6% of patients, including 16.8% with sHT. Baseline DWI volume was independently associated with HT (OR=1.030, 95% CI 1.008 to 1.053, P=0.009), while ASL volume wasn't statistically significant(P=0.330). The DWI model was superior to ASL model in predicting HT within 72 hours (c-statistic, 0.787).Neither DWI (P=0.149) nor ASL volume (P=0.834) effectively indicated sHT. CONCLUSIONS: DWI-based ischemic core volume correlates significantly with HT within 72 hours post successful thrombectomy. This highlights the potential clinical utility of DWI in guiding treatment decisions for this population.