Guidelines of the Polish Medical Society of radiology for the routinely used MRI protocol in patients with multiple sclerosis.

Magnetic resonance imaging is widely used in diagnosing multiple sclerosis as a basic method for detecting and monitoring the disease. INTRODUCTION: Polish Medical Society of Radiology presents the second version of the recommendations for the routinely conducted MRI in multiple sclerosis, which include new data and practical remarks for radiographers and radiologists. The recommended protocol aims to improve the imaging procedure and, most importantly, to standardize conducting MRI scans in all MRI departments. This is crucial for monitoring the patients with MS, which directly contributes to essential clinical decisions. AIM OF THE GUIDELINES: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system (CNS) with its etiology still unknown. The fundamental requirement of the disease is the CNS destruction process disseminated in time (DIT) and space (DIS). MR imaging detects focal lesions in white and gray matter with high sensitivity and is the best way to assess brain atrophy in MS patients. It is unquestionably the best diagnostic tool to follow-up the clinical course of the disease and treatment of MS patients. However, to achieve a diagnosis based on MRI scans, and follow-up MS patients according to the latest standards, an MRI scan has to meet certain quality criteria that are the subject of this work.

Determination of Non-Invasive Biomarkers for the Assessment of Fibrosis, Steatosis and Hepatic Iron Overload by MR Image Analysis. A Pilot Study.

The reference diagnostic test of fibrosis, steatosis, and hepatic iron overload is liver biopsy, a clear invasive procedure. The main objective of this work was to propose HSA, or human serum albumin, as a biomarker for the assessment of fibrosis and to study non-invasive biomarkers for the assessment of steatosis and hepatic iron overload by means of an MR image acquisition protocol. It was performed on a set of eight subjects to determine fibrosis, steatosis, and hepatic iron overload with four different MRI sequences. We calibrated longitudinal relaxation times (T1 [ms]) with seven human serum albumin (HSA [%]) phantoms, and we studied the relationship between them as this protein is synthesized by the liver, and its concentration decreases in advanced fibrosis. Steatosis was calculated by means of the fat fraction (FF [%]) between fat and water liver signals in "fat-only images" (the subtraction of in-phase [IP] images and out-of-phase [OOP] images) and in "water-only images" (the addition of IP and OOP images). Liver iron concentration (LIC [µmol/g]) was obtained by the transverse relaxation time (T2* [ms]) using Gandon's method with multiple echo times (TE) in T2-weighted IP and OOP images. The preliminary results showed that there is an inverse relationship (r = -0.9662) between the T1 relaxation times (ms) and HSA concentrations (%). Steatosis was determined with FF > 6.4% and when the liver signal was greater than the paravertebral muscles signal, and thus, the liver appeared hyperintense in fat-only images. Hepatic iron overload was detected with LIC > 36 µmol/g, and in these cases, the liver signal was smaller than the paravertebral muscles signal, and thus, the liver behaved as hypointense in IP images.

Motion-corrected free-breathing late gadolinium enhancement combined with a gadolinium contrast agent with a high relaxation rate: an optimized cardiovascular magnetic resonance examination protocol.

OBJECTIVE: This prospective study investigated the feasibility of an optimized cardiovascular magnetic resonance (CMR) examination protocol using the motion-corrected (MOCO), balanced steady-state free precession (bSSFP), phase-sensitive inversion recovery (PSIR) sequence combined with a gadolinium contrast agent with a high relaxation rate in patients who cannot hold their breath. METHODS: Fifty-one patients with heart disease underwent CMR examinations twice and these were performed with different late gadolinium enhancement (LGE) imaging sequences (fast low-angle shot [FLASH] sequence vs. MOCO sequence) and different gadolinium contrast agents (gadopentetate dimeglumine vs. gadobenate dimeglumine) with a 48-hour interval. LGE image quality, total time spent in the whole study, and time taken to perform LGE imaging were compared for the two CMR examinations. RESULTS: LGE images with the MOCO bSSFP PSIR sequence showed significantly higher image quality compared with those with the segmented FLASH PSIR sequence. There was a significant difference between the total scan time for the two examinations and different LGE sequences. CONCLUSIONS: The MOCO bSSFP PSIR sequence effectively improves the quality of LGE images. Changing the CMR scanning protocol by combining the MOCO bSSFP PSIR sequence with a gadolinium contrast agent with a high relaxation rate effectively shortens the scan time.Clinical trial registration number: ChiCTR-ROC-17013978.