Benchmarking Guanidinium Organosulfonate Hydrogen-Bonded Frameworks for Structure Determination of Encapsulated Guests.

Single crystal X-ray diffraction (SCXRD) is arguably the most definitive method for molecular structure determination, but it is often challenged by compounds that are liquids or oils at room temperature or do not form crystals adequate for analysis. Our laboratory previously reported a simple, cost-effective, single-step crystallization method based on guanidinium organosulfonate (GS) hydrogen bonded frameworks for structure determination of a wide range of encapsulated guest molecules, including assignment of the absolute configuration of chiral centers. Herein, we expand on those results and report a head-to-head comparison of the GS method with adamantoid "molecular chaperones", which have been reported to be useful hosts for structure determination. Inclusion compounds limited to only two GS hosts are characterized by low R1 values and Flack parameters, infrequent disorder of the host and guest, and manageable disorder when it does exist. The structures of some target molecules that were not included or resolved using the adamantoid chaperones were successfully included and resolved by the GS hosts, and vice versa. Of the 32 guests attempted by the GS method, 31 inclusion compounds afforded successful guest structure solutions, a 97% success rate. The GS hosts and adamantoid chaperones are complementary with respect to guest inclusion, arguing that both should be employed in the arsenal of methods for structure determination. Furthermore, the low cost of organosulfonate host components promises an accessible route to molecular structure determination for a wide range of users.

Formation, Selective Encapsulation, and Tautomerization Control of Isoindolone Utilizing Guanidinium Sulfonate Frameworks.

Herein we report the use of tetrakis (guanidinium) pyrenetetrasulfonate (G4PYR) and bis (guanidinium) 1,5-napthalene disulfonate (G2NDS) to catalyze the cyclization of 2-cyanobenzamide (1) to isoindolone (2). Moreover, we demonstrate the remarkable selectivity of these guanidinium organosulfonate hosts in encapsulating 2 over 1. By thoroughly investigating the intramolecular cyclization reaction, we determined that guanidinium and the organosulfonate moiety acts as the catalyst in this process. Additionally, 2 is selectively encapsulated, even in mixtures of other structurally similar heterocycles like indole. Furthermore, the tautomeric state of 2 (amino isoindolone (2-A) and imino isoindolinone forms (2-I)) can be controlled by utilizing different guanidinium organosulfonate frameworks.

Supramolecular Mille-Feuille: Adaptive Guest Inclusion in a New Aliphatic Guanidinium Monosulfonate Hydrogen-Bonded Framework.

During the past three decades, the ability of guanidinium arenesulfonate host frameworks to encapsulate a wide range of guests has been amply demonstrated, with more than 700 inclusion compounds realized. Herein, we report crystalline inclusion compounds based on a new aliphatic host, guanidinium cyclohexanemonosulfonate, which surprisingly exhibits four heretofore unobserved architectures, as described by the projection topologies of the organosulfonate residues above and below hydrogen-bonded guanidinium sulfonate sheets. The inclusion compounds adopt a layer motif of guanidinium sulfonate sheets interleaved with guest molecules, resembling a mille-feuille pastry. The aliphatic character of this remarkably simple host, combined with access to greater architectural diversity and adaptability, enables the host framework to accommodate a wide range of guests and promises to expand the utility of guanidinium organosulfonate hosts.

Electrosynthesis of iminophosphoranes and applications in nickel catalysis.

P(v) iminophosphorane compounds are accessed via electrochemical oxidation of commercially available P(iii) phosphines, including mono-, di- and tri-dentate phosphines, as well as chiral phosphines. The reaction uses inexpensive bis(trimethylsilyl)carbodiimide as an efficient and safe aminating reagent. DFT calculations, cyclic voltammetry, and NMR studies provide insight into the reaction mechanism. The proposed mechanism reveals a special case of sequential paired electrolysis. DFT calculations of the frontier orbitals of an iminophosphorane are compared with those of the analogous phosphines and phosphine oxides. X-ray crystallographic studies of the ligands as well as a Ni-coordination complex provide structural insight for these ligands. The utility of these iminophosphoranes as ligands is demonstrated in nickel-catalyzed cross-electrophile couplings including C(sp2)-C(sp3) and C(sp2)-C(sp2) couplings, an electrochemically driven C-N cross-coupling, and a photochemical arylative C(sp3)-H functionalization. In some cases, these new ligands provide improved performance over commonly used sp2-N-based ligands (e.g. 4,4'-di-tert-butyl-2,2'-bipyridine).

Benchmarking Excellence: Evaluating Advanced Breast Carcinoma Care in Pakistan's Largest Cancer Hospital Against the National Institute for Health and Care Excellence (NICE) Guidelines.

Introduction Breast cancer is the most common type of cancer worldwide, and even with all the screening and education, great numbers of diagnoses are made in advanced stages. Additionally, patients in remission always remain at risk of relapse and metastasis. Pakistan has the highest incidence of breast cancer among Asian countries. The purpose of this clinical audit was to compare data from the largest cancer hospital in Pakistan with international standards to provide room for quality improvement. Methods A retrospective review of patients with advanced breast carcinoma over a period of six months was done. Permission was obtained from the Quality Assurance and Patent Safety Department before the commencement of the audit. Standards Data obtained were audited against nine standards of four different categories from the National Institute for Health and Care Excellence (NICE) guidelines on advanced breast carcinoma. Results For the diagnosis and assessment category, for which a target of 100% was set, 99.66% was achieved; for disease monitoring, for which a target of 100% was set, 91.8% was achieved; for systemic disease-modifying therapy, for which the majority was the target, only 1% was achieved; for managing complications, for which a target of 100% was set, 71.8% was achieved. Conclusion Continuous research and breakthrough advancements have made health care an ever-evolving field. Clinical audits like these that compare international standards with local data are beneficial and lead to quality improvement. They highlight issues that may be overlooked otherwise, raise questions that may never be asked, and may inspire prospective research studies. Limitations of the audit were that this clinical audit was conducted outside of the NHS where NICE guidelines are not followed and local guidelines differ from NICE guidelines.

Unraveling Stigmas of Male Breast Carcinoma: A Singular Case of Advanced Metaplastic Breast Carcinoma in a Young Male.

Breast carcinoma in males is a rare and unique condition that differs from breast cancer in females and is typically diagnosed at an advanced stage in older male patients. Late diagnosis is often due to the rarity of male breast carcinoma. Among the various types of breast carcinomas, metaplastic breast carcinoma is one of the rarest kind of breast malignancy and is associated with poorer outcomes. This case report presents a singular case of a young male in his early thirties who presented with a breast lump and was diagnosed with metaplastic breast carcinoma. Breast cancer in males is a topic that is often overlooked and lacks extensive research. However, with an increasing incidence of breast carcinoma in males, including even the rarest forms, such as metaplastic carcinoma, and its occurrence in young patients as highlighted in this case report, it is crucial to initiate more discussions, enhance education, and promote further research in male breast carcinoma. In addition, the psychosocial impacts of the disease should be carefully considered, as men with breast cancer face unique emotional challenges that require attention and support.

Systematic Analysis of Common Factors Impacting Deep Learning Model Generalizability in Liver Segmentation.

Purpose: To investigate the effect of training data type on generalizability of deep learning liver segmentation models. Materials and Methods: This Health Insurance Portability and Accountability Act-compliant retrospective study included 860 MRI and CT abdominal scans obtained between February 2013 and March 2018 and 210 volumes from public datasets. Five single-source models were trained on 100 scans each of T1-weighted fat-suppressed portal venous (dynportal), T1-weighted fat-suppressed precontrast (dynpre), proton density opposed-phase (opposed), single-shot fast spin-echo (ssfse), and T1-weighted non-fat-suppressed (t1nfs) sequence types. A sixth multisource (DeepAll) model was trained on 100 scans consisting of 20 randomly selected scans from each of the five source domains. All models were tested against 18 target domains from unseen vendors, MRI types, and modality (CT). The Dice-Sørensen coefficient (DSC) was used to quantify similarity between manual and model segmentations. Results: Single-source model performance did not degrade significantly against unseen vendor data. Models trained on T1-weighted dynamic data generally performed well on other T1-weighted dynamic data (DSC = 0.848 ± 0.183 [SD]). The opposed model generalized moderately well to all unseen MRI types (DSC = 0.703 ± 0.229). The ssfse model failed to generalize well to any other MRI type (DSC = 0.089 ± 0.153). Dynamic and opposed models generalized moderately well to CT data (DSC = 0.744 ± 0.206), whereas other single-source models performed poorly (DSC = 0.181 ± 0.192). The DeepAll model generalized well across vendor, modality, and MRI type and against externally sourced data. Conclusion: Domain shift in liver segmentation appears to be tied to variations in soft-tissue contrast and can be effectively bridged with diversification of soft-tissue representation in training data.Keywords: Convolutional Neural Network (CNN), Deep Learning Algorithms, Machine Learning Algorithms, Supervised Learning, CT, MRI, Liver Segmentation Supplemental material is available for this article. © RSNA, 2023.

Molecular Flytraps Held Together by Platinum-Platinum Intermetallic Bonds.

Metal-metal bonds have rarely been explored as active elements in supramolecular assemblies despite their unique potential to introduce responsive behavior. In this report, a dynamic molecular container composed of two cyclometalated Pt units is constructed using Pt-Pt bonds. This molecule-the flytrap-has a flexible jaw composed of two [18]crown-6 ethers that can adapt their shape to bind large inorganic cations with sub-micromolar affinity. Along with the spectroscopic and crystallographic characterization of the flytrap, we report its photochemical assembly, which allows the capture of ions and their transport from solution to the solid state. In addition, we have been able to recycle the flytrap to regenerate its starting material due to the reversible nature of the Pt-Pt bond. We believe that other molecular containers and materials for harvesting valuable substrates from solution could be assembled using the advances presented here.

MRI Quantification of Placebo Effect in Nonalcoholic Steatohepatitis Clinical Trials.

Background Several early-phase clinical trials for the treatment of nonalcoholic steatohepatitis (NASH) use liver fat content as measured with the MRI-derived proton density fat fraction (PDFF) for a primary outcome. These trials have shown relative reductions in liver fat content with placebo treatment alone, a phenomenon termed "the placebo effect." This phenomenon confounds the results and limits generalizability to future trials. Purpose To quantify the effect of placebo treatment on change in the absolute PDFF value and to identify variables associated with this observed change. Materials and Methods This is a secondary analysis of prospectively collected data from seven early phase clinical trials that included participants with a diagnosis of NASH based on MRI and/or liver biopsy who received placebo treatment. The primary outcome was a greater than or equal to 30% relative reduction in PDFF after placebo treatment. Normalization of PDFF, relative change in alanine aminotransferase (ALT) level, and normalization of ALT level were also examined. An exploratory linear mixed-effects model was used to estimate an overall change in absolute PDFF and to explore parameters associated with this response. Results A total of 187 participants (median age, 52 years [IQR, 43-60 years]; 114 women) who received placebo treatment were evaluated. A greater than or equal to 30% relative reduction in baseline PDFF was seen in 20% of participants after 12 weeks of placebo treatment (10 of 49), 9% of participants after 16 weeks (two of 22), and 28% of participants after 24 weeks (34 of 122). A repeated-measures linear mixed-effects model estimated a decrease of 2.3 units (median relative reduction of 13%) in absolute PDFF values after 24 weeks of placebo treatment (95% CI: 3.2, 1.4; P < .001). Conclusion In this analysis of 187 participants, a clinically relevant decrease in PDFF was observed with placebo treatment. Based on the study model, assuming an absolute PDFF decrease of approximately 3 units (upper limit of 95% CI) to account for this "placebo effect" in sample size calculations for future clinical trials is suggested. Clinical trial registration nos. NCT01066364, NCT01766713, NCT01963845, NCT02443116, NCT02546609, NCT02316717, and NCT02442687 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Yoon in this issue.

Noncooperative guest binding by metal-free [2 + 2] Schiff-base macrocycles.

Salphen-based [n + n] macrocycles have been widely explored for their unique chemical and topological properties following metal ion coordination. Despite having vastly different reactivity than their coordinated counterparts, fewer studies have focused on metal-free salphen macrocycles. We investigated the binding of [2 + 2] Schiff-base macrocycle host 3, which contains a central 18-crown-6-like cavity and two N2O2 moieties. This macrocycle strongly binds to spherical cationic guests (K11 ≈ 103-104 M-1, DCM/MeCN). The most robust binding was shown for K+ and Na+, followed by Li+ and Rb+. More sterically demanding cationic guests like dibenzylammonium (DBA+) showed almost no binding. The binding pocket in 3 is slightly smaller than 18-crown-6, resulting in binding outside the cavity, which provides a scaffold appropriate for 2 : 1 complexes, where two host molecules sandwich the guest. All host-guest complexes follow a 2 : 1 noncooperative binding model, where each successive binding event is less likely than the previous, unlike coordinated versions of 3, where most binding is 1 : 1.

Annual Direct Cost of Dysphagia Associated with Acute Ischemic Stroke in the United States.

BACKGROUND: Dysphagia after acute ischemic stroke is frequent and increases the risk of pneumonia, insertion of feeding tube, hospital length-of-stay and rates of discharge to institutional care. However, the financial impact of dysphagia after acute ischemic stroke is not well understood. METHODS: Estimates were derived from published medical and economic literature to provide a range of estimates for the annual direct hospital cost of dysphagia associated with acute ischemic stroke in the United States. We also estimated the cost savings associated with a hypothetical new therapeutic intervention under a variety of assumptions. RESULTS: The 1-year costs per patient of acute hospital and post hospitalization care were $67,100 to $112,400 in acute ischemic stroke patient with dysphagia and $54,0310 to $51,979.8 in acute ischemic stroke patient without dysphagia in the two models. The estimated incremental cost in United States for ischemic stroke patients with dysphagia was $ 4,610,038,961.13 (95% confidence interval [CI] $3,796,502,674-$5,423,575,248) according to assumptions of Model 1. The estimated incremental cost in United States for ischemic stroke patients with dysphagia was $ 20,114,218,586.23 (95% CI $16564650600.42-$23663786572.04) according to assumptions of Model 2. The cost savings per year with a new therapeutic intervention ranged from $509,444,886.6 to $3,601,651,036 depending upon the magnitude of benefit. CONCLUSION: Our analysis provides additional justification using financial basis for a much larger investment in research and development for treatment of dysphagia associated with ischemic stroke.

Breathing Room: Restoring Free Rotation in a Schiff-Base Macrocycle through Endoperoxide Formation.

Macrocyclization is a popular method for preparing hosts, but it can have unintended effects, like limiting molecular free rotation to yield mixtures of inseparable isomers. We report a [3 + 3] Schiff-base macrocycle (1) with anthracene bridges. Restricted rotation about the phenyl-anthracene bonds leads 1 to exist as a mixture of conformations (1Cs and 1C3v). Macrocycle 1 was photooxidized to tris(endoperoxide) adduct 4, alleviating restricted rotation. These results were supported by spectroscopic, structural, and computational analyses.

Contemporary macrocycles for discrete polymetallic complexes: precise control over structure and function.

The growth of multimetallic clusters and complexes can proceed in the presence of suitable ligands, but often leads to polydisperse structures with poor solubility. As an alternative approach, macrocyclic molecules can anchor the multimetallic complex, directing its formation and stabilizing the resulting product. This approach can provide excellent control over the growth of clusters, and offers a handle to control solubility and other properties of the resulting complexes. In this Tutorial Review, we discuss recent activity (primarily the last two decades) directed at the controlled and reproducible synthesis of multimetallic complexes using macrocyclic ligands. Throughout the review, we focus on the unusual structures that are only accessible by using macrocycles as ligands, and their unique properties.

Clinical impact of the first pass effect on clinical outcomes in patients with near or complete recanalization during mechanical thrombectomy for large vessel ischemic stroke.

BACKGROUND AND PURPOSE: The first pass effect has been reported as a mechanical thrombectomy (MT) success metric in patients with large vessel occlusive stroke. We aimed to compare the clinical and neuroimagign outcomes of patients who had favorable recanalization (mTICI 2c or mTICI 3) achieved in one pass versus those requiring multiple passes. METHODS: In this "real-world" multicenter study, patients with mTICI 2c or 3 recanalization were identified from three prospectively collected stroke databases from January 2016 to December 2019. Clinical outcomes were a favorable functional outcome at 90 days (modified Rankin Scale score 0-2), and the rate of symptomatic intracranial hemorrhage (ICH) any ICH, and 90-day mortality. RESULTS: Favorable recanalization was achieved in 390/664 (59%) of consecutive patients who underwent MT (age 71.2 ± 13.2 years, 188 [48.2%] women). This was achieved after a single thrombectomy pass (n = 290) or multiple thrombectomy passes (n = 100). The rate of favorable clinical outcome was higher (41% vs. 28 %, p = .02) in the first pass group with a continued trend on multivariate analysis that did not reaching statistical significance (OR 1.68 95% confidence interval [CI] 1.0-2.95, p = .07). Similarly, the odds of any ICH were significantly lower (OR 0.56 CI 0.32-0.97, p = .03). A similar trend of favorable clinical outcomes was noticed on subgroup analysis of patients with M1 occlusion (OR 1.81 CI 1.01-3.61, p = .08). CONCLUSION: The first-pass reperfusion was associated with a trend toward favorable clinical outcome and lower rates of ICH. These data suggest that the first-pass effect should be the mechanical thrombectomy procedure goal.

Pre-transplant hepatic steatosis (fatty liver) is associated with chronic graft-vs-host disease but not mortality.

Allogeneic-HCT (allo-HCT), while potentially curative, can result in significant complications including graft versus host disease (GVHD). Prior studies suggest that metabolic syndrome may be one risk factor for GVHD. We hypothesized that hepatic steatosis on pre-HCT computed tomography (CT) scans may be a marker for development of GVHD and poor outcomes in allo-HCT. In this retrospective study, we reviewed the pre-HCT CT scans and transplant outcome data of patients who underwent allo-HCT at Duke University Medical Center from 2009 to 2017. The presence of steatosis was confirmed using CT attenuation measurements. We then assessed the association between pre-HCT hepatic steatosis and HCT-related outcomes including GVHD. 80 patients who had pre-HCT CT scans were included in the study. Pre-transplant hepatic steatosis was associated with the development of chronic GVHD (OR 4.2, p = 0.02), but was not associated with acute GVHD (OR 1.3, p = 0.7), non-relapse mortality (p = 0.81) or overall survival (p = 0.74). Based on this single center retrospective study, pre-transplant hepatic steatosis is associated with development of chronic GVHD. Further, prospective study with other imaging modalities including non-contrasted CT scans is needed to determine if this association is reproducible.

The Angiographic Anatomy of the Sphenoidal Segment of the Middle Cerebral Artery and Its Relevance in Mechanical Thrombectomy.

OBJECTIVE: The middle cerebral artery (MCA) is the most commonly treated artery in mechanical thrombectomy stroke trials; however, there is no pragmatic agreement about the segmental anatomy and nomenclature utilized. It results in significant clinical-radiological dissociation and introduces bias in research trials. The purpose of the study is to review and compare angiographic anatomy with microsurgical anatomy literature of the MCA with emphasis on the discrepancy. METHODOLOGY: Consecutive cerebral angiograms between January 2011 and March 2014 were retrospectively reviewed by endovascular surgical neuroradiologists. Information about the anatomy of the sphenoidal segment of the MCA classified as classic and non-classic pattern, the lenticulostriate artery takeoff pattern, and the course angulation of the sphenoidal segment were studied. RESULTS: A total of 500 patients, 886 cerebral angiograms, were reviewed. We found the classic pattern of the main trunk MCA bifurcation and a straight angulation course in less than half of the cases. The lenticulostriate arteries arose not only from the main trunk but also from its divisions in more than half of the cases. CONCLUSION: It is important to corroborate our findings and to develop a pragmatic classification to accurately assess MCA occlusions from the radiological and clinical perspective.

Structural Elucidation of Selective Solvatochromism in a Responsive-at-Metal Cyclometalated Platinum(II) Complex.

We report the synthesis, characterization, and spectroscopic investigations of a new responsive-at-metal cyclometalated platinum(II) complex. With mild chemical oxidants and reductants, it was possible to obtain the same complex in three different oxidation states and each of these complexes was structurally characterized by single-crystal X-ray diffraction. We discovered that the platinum(II) complex displays strong solvatochromism in the solid state, which can be attributed to modulation of Pt⋅⋅⋅Pt interactions that results in switching between optical and photoluminescent states. Incorporating responsive-at-metal species as dynamic components in nanostructured materials might facilitate response amplification, sensing, actuation, or self-healing processes.

The LI-RADS Version 2018 MRI Treatment Response Algorithm: Evaluation of Ablated Hepatocellular Carcinoma.

Background The Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA) is used to assess presumed hepatocellular carcinoma (HCC) after local-regional therapy, but its performance has not been extensively assessed. Purpose To assess the performance of LI-RADS version 2018 TRA in the evaluation of HCC after ablation. Materials and Methods In this retrospective study, patients who underwent ablation therapy for presumed HCC followed by liver transplantation between January 2011 and December 2015 at a single tertiary care center were identified. Lesions were categorized as completely (100%) or incompletely (≤99%) necrotic based on transplant histology. Three radiologists assessed pre- and posttreatment MRI findings using LI-RADS version 2018 and the TRA, respectively. Interreader agreement was assessed by using the Fleiss κ test. Performance characteristics for predicting necrosis category based on LI-RADS treatment response (LR-TR) category (viable or nonviable) were calculated by using generalized mixed-effects models to account for clustering by subject. Results A total of 36 patients (mean age, 58 years ± 5 [standard deviation]; 32 men) with 53 lesions was included. Interreader agreement for pretreatment LI-RADS category was 0.40 (95% confidence interval [CI]: 0.15, 0.67; P < .01) and was lower than the interreader agreement for TRA category (κ = 0.71; 95% CI: 0.59, 0.84; P < .01). After accounting for clustering by subject, sensitivity of tumor necrosis across readers ranged from 40% to 77%, and specificity ranged from 85% to 97% when LR-TR equivocal assessments were treated as nonviable. When LR-TR equivocal assessments were treated as viable, sensitivity of tumor necrosis across readers ranged from 81% to 87%, and specificity ranged from 81% to 85% across readers. Six (11%) of 53 treated lesions were LR-TR equivocal by consensus, with most (five of six) incompletely necrotic at histopathology. Conclusion The Liver Imaging Reporting and Data System treatment response algorithm can be used to predict viable or nonviable hepatocellular carcinoma after ablation. Most ablated lesions rated as treatment response equivocal were incompletely necrotic at histopathology. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Do and Mendiratta-Lala in this issue.

Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain-Barré Syndrome.

Background and objectives: Myasthenia gravis (MG) and Guillain-Barré Syndrome (GBS) are autoimmune neuromuscular disorders that may present as neuromuscular emergencies requiring mechanical ventilation and critical care. Comparative outcomes of these disease processes, once severe enough to require mechanical ventilation, are not known. In this study, we compared the patients requiring mechanical ventilation in terms of in-hospital complications, length of stay, disability, and mortality between these two disease entities at a national level. Materials and Methods: Mechanically ventilated patients with primary diagnosis of MG (n = 6684) and GBS (n = 5834) were identified through retrospective analysis of Nationwide Inpatient Sample (NIS) database for the years 2006 to 2014. Results: Even though mechanically ventilated MG patients were older (61.0 ± 19.1 versus 54.9 ± 20.1 years) and presented with more medical comorbidities, they had lower disease severity on admission, as well as lower in-hospital complications sepsis, pneumonia, and urinary tract infections as compared with GBS patients. In the multivariate analysis, after adjusting for confounders including treatment, GBS patients had significantly higher disability (odds ratio (OR) 15.6, 95% confidence interval (CI) 10.9-22.2) and a longer length of stay (OR 3.48, 95% CI 2.22-5.48). There was no significant difference in mortality between the groups (8.45% MG vs. 10.0% GBS, p = 0.16). Conclusion: Mechanically ventilated GBS patients have higher disease severity at admission along with more in-hospital complications, length of stay, and disability compared with MG patients. Potential explanations for these findings include delay in the diagnosis, poor response to immunotherapy particularly in patients with axonal GBS variant, or longer recovery time after nerve damage.

DIfferential Subsampling With Cartesian Ordering With Respiratory Triggering Versus Conventional Liver Acquisition With Volume Acquisition: A Multiple Reader Preference Study.

OBJECTIVE: The aim of this study was to compare respiratory-triggered DIfferential Subsampling with Cartesian Ordering (rtDISCO) and breath-held Liver Acquisition with Volume Acquisition (LAVA) image quality. METHODS: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective study, 25 subjects underwent T1 imaging with rtDISCO and LAVA before and after intravenous contrast. Three readers scored individual series and side-by-side comparisons for motion and noise. Eight clinical tasks were qualitatively assessed. RESULTS: As individual series, readers rated rtDISCO images as more degraded by motion on both precontrast (mean rtDISCO score, 2.7; LAVA, 1.6; P < 0.001) and postcontrast images (rtDISCO, 2.4; LAVA, 1.8; P < 0.001). Readers preferred LAVA images based on motion on both precontrast (mean preference, -1.2; P < 0.001) and postcontrast images (mean preference, -0.7; P < 0.001) on side-by-side assessment. There was no preference between sequences for 6 of 8 clinical tasks on postcontrast images. CONCLUSIONS: Readers preferred LAVA with respect to motion but not noise; there was no preference in most of the tested clinical tasks.