Combining images and anatomical knowledge to improve automated vein segmentation in MRI.

PURPOSE: To improve the accuracy of automated vein segmentation by combining susceptibility-weighted images (SWI), quantitative susceptibility maps (QSM), and a vein atlas to produce a resultant image called a composite vein image (CV image). METHOD: An atlas was constructed in common space from manually traced MRI images from ten volunteers. The composite vein image was derived for each subject as a weighted sum of three inputs; an SWI image, a QSM image and the vein atlas. The weights for each input and each anatomical location, called template priors, were derived by assessing the accuracy of each input over an independent data set. The accuracy of vein segmentations derived automatically from each of the CV image, SWI, and QSM image sets was assessed by comparison with manual tracings. Three different automated vein segmentation techniques were used, and ten performance metrics evaluated. RESULTS: Vein segmentations using the CV image were comprehensively better than those derived from SWI or QSM images (mean Cohen's d = 1.1). Sixty permutations of performance metric, benchmark image, and automated segmentation technique were evaluated. Vein identification improvements that were both large and significant (Cohen's d > 0.80, p < 0.05) were found in 77% of the permutations, compared to no improvement in 5%. CONCLUSION: The accuracy of automated vein segmentations derived from the composite vein image was overwhelmingly superior to segmentations derived from SWI or QSM alone.

Preoperative staging of rectal cancer.

Preoperative staging is now an essential factor in the multidisciplinary management of rectal cancer because tumor stage is the strongest predictive factor for recurrence. Preoperative staging of rectal cancer can be divided into either local or distant staging. Local staging incorporates the assessment of mural wall invasion, circumferential resection margin involvement, as well as the nodal status for metastasis. Distant staging assesses for evidence of metastatic disease. The aim of this review is to consider the indications and limitations of the current preoperative imaging modalities for rectal cancer staging including clinical examination, endorectal ultrasound, magnetic resonance imaging, computed tomography and positron emission tomography-computed tomography, with respect to local and distant disease.

Sexual Dimorphism of Resting-State Network Connectivity in Healthy Ageing.

OBJECTIVES: The onset of many illnesses is confounded with age and sex. Increasing age is a risk factor for the development of many illnesses, and sexual dimorphism influences brain anatomy, function, and cognition. Here, we examine frequency-specific connectivity in resting-state networks in a large sample (n = 406) of healthy aged adults. METHOD: We quantify frequency-specific connectivity in three resting-state networks known to be implicated in age-related decline: the default mode, dorsal attention, and salience networks, using multiband functional magnetic resonance imaging. Frequency-specific connectivity was quantified in four bands: low (0.015-0.027 Hz), moderately low (0.027-0.073 Hz), moderately high (0.073-0.198 Hz), and high (0.198-0.5 Hz) frequency bands, using mean intensity and spatial extent. Differences in connectivity between the sexes in each of the three networks were examined. RESULTS: Each network showed the largest intensity and spatial extent at low frequencies and smallest extent at high frequencies. Males showed greater connectivity than females in the salience network. Females showed greater connectivity than males in the default mode network. DISCUSSION: Results in this healthy aged cohort are compatible with those obtained in young samples, suggesting that frequency-specific connectivity, and differences between the sexes, are maintained into older age. Our results indicate that sex should be considered as an influencing factor in studies of resting-state connectivity.

The 2005 Australian MRI safety survey.

OBJECTIVE: The purpose of this study was to ascertain current MRI safety practices in Australia regarding permanent pacemakers, temporary pacing wires, cerebral aneurysm clips, implants of unknown MRI safety status, and use of metal detectors, with respect to adherence to published guidelines. MATERIALS AND METHODS: A questionnaire was distributed to more than 100 MRI facilities in Australia. RESULTS: Ninety-two responses, representing 102 MRI systems, were received. Respondents from approximately one in 15 sites were aware they had inadvertently imaged a patient who had a permanent pacemaker (eight patients). One of these episodes led to a death. Use of modified request forms, on which referring physicians are asked for MRI safety information, was incomplete (48/90 facilities). Four facilities deliberately imaged pacemaker patients. Seventy-seven of 89 facilities responded that they do not image patients with temporary pacing wires. Aneurysm clips were accepted by most sites (71/91), and only one site associated with a neurosurgical service refused such patients. Seventy of 71 facilities required written identification of the clip type. Most (77/90) of the sites reported delays due to the unknown MRI safety status of implants. Only four of 92 sites reported routine use of a metal detector. The guidelines of the American College of Radiology and of the Royal Australian and New Zealand College of Radiologists were equally influential (38% each). Only 10 of 90 respondents reported use of external audits of safety processes. CONCLUSION: Ongoing vigilance is required for avoiding MRI of patients with pacemakers, particularly when information from the patient is unreliable or unobtainable. Requiring referring physicians to provide MRI safety information may help to minimize risk.

ASPREE-NEURO study protocol: A randomized controlled trial to determine the effect of low-dose aspirin on cerebral microbleeds, white matter hyperintensities, cognition, and stroke in the healthy elderly.

Rationale Cerebral microbleeds seen on brain magnetic resonance imaging are markers of small vessel disease, linked to cognitive dysfunction and increased ischemic and hemorrhagic stroke risk. Observational studies suggest that aspirin use may induce cerebral microbleeds, and associated overt intracranial hemorrhage, but this has not been definitively resolved. Aims ASPREE-NEURO will determine the effect of aspirin on cerebral microbleed development over three years in healthy adults aged 70 years and over, participating in the larger 'ASPirin in Reducing Events in the Elderly (ASPREE)' primary prevention study of aspirin. Sample size Five hundred and fifty-nine participants provide 75% power (two-sided p value of 0.05) to determine an average difference of 0.5 cerebral microbleed per person after three years. Methods and design A multi-center, randomized placebo-controlled trial of 100 mg daily aspirin in participants who have brain magnetic resonance imaging at study entry, one and three years after randomization and who undergo cognitive testing at the same time points. Study outcomes The primary outcome is the number of new cerebral microbleeds on magnetic resonance imaging after three years. Secondary outcomes are the number of new cerebral microbleeds after one year, change in volume of white matter hyperintensity, cognitive function, and stroke. Discussion ASPREE-NEURO will resolve whether aspirin affects the presence and number of cerebral microbleeds, their relationship with cognitive performance, and indicate whether consideration of cerebral microbleeds alters the risk-benefit profile of aspirin in primary prevention for older people. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613001313729.

Recognising pitfalls in assessment of tumours by diffusion-weighted MRI: a pictorial essay.

Diffusion-weighted imaging (DWI) has become an integral part of MRI. Knowledge of the basic principles of DWI and its pitfalls are imperative in the proper application of this technique. We illustrate potential pitfalls of DWI in oncologic imaging.

Detecting lesions after traumatic brain injury using susceptibility weighted imaging: a comparison with fluid-attenuated inversion recovery and correlation with clinical outcome.

The development and utilization of newer neuroimaging modalities provides the capability to more accurately detect the extent of pathology after TBI. The current study examined the ability of susceptibility-weighted imaging (SWI) to detect lesions after TBI as well as the relationship to subsequent clinical outcome. The performance of SWI was compared to that of fluid-attenuated inversion recovery (FLAIR). This study comprised 79 individuals with mild-to-severe TBI, 38 of whom completed neuropsychological tests of attention, working memory, processing speed, memory, and executive functions. SWI was found to quantify a greater lesion volume over the entire brain, specifically in frontal, central, limbic, subcortical gray, and parietal brain regions, than did FLAIR. Moreover, SWI was able to identify TBI-related lesions in almost one third of patients for whom FLAIR was unable to detect any lesions. Greater overall SWI volume, as well as frontal SWI volume, was found to relate to the severity of TBI. Conversely, no association was found between FLAIR lesion volume and injury severity. In addition, there was some evidence that higher lesion volume, for both SWI and FLAIR, were associated with poorer memory as well as processing speed impairment. This study suggests that SWI may provide additional sensitivity in the detection of lesions after TBI. Consequently, this imaging sequence may provide a more accurate representation of the severity of individuals' injuries and their subsequent neuropsychological outcomes.

Evidence-based guideline for the written radiology report: methods, recommendations and implementation challenges.

The written radiology report is the dominant method by which radiologists communicate the results of diagnostic and interventional imaging procedures. It has an important impact on decisions about further investigation and management. Its form and content can be influential in reducing harm to patients and mitigating risk for practitioners but varies markedly with little standardisation in practice. Until now, the Royal Australian and New Zealand College of Radiologists has not had a guideline for the written report. International guidelines on this subject are not evidence based and lack description of development methods. The current guideline seeks to improve the quality of the written report by providing evidence-based recommendations for good practice. The following attributes of the report are addressed by recommendations: Content Clinical information available to the radiologist at the time the report was created Technical details of the procedure Examination quality and limitations Findings (both normal and abnormal) Comparison with previous studies Pathophysiological diagnosis Differential diagnoses Clinical correlation and/or answer to the clinical question Recommendations, particularly for further imaging and other investigations Conclusion/opinion/impression Format Length Format Language Confidence and certainty Clarity Readability Accuracy Communication of discrepancies between an original verbal or written report and the final report Proofreading/editing of own and trainee reports.