Diffusion-Weighted Imaging for Skin Pathologies of the Breast-A Feasibility Study.

Several breast pathologies can affect the skin, and clinical pathways might differ significantly depending on the underlying diagnosis. This study investigates the feasibility of using diffusion-weighted imaging (DWI) to differentiate skin pathologies in breast MRIs. This retrospective study included 88 female patients who underwent diagnostic breast MRI (1.5 or 3T), including DWI. Skin areas were manually segmented, and the apparent diffusion coefficients (ADCs) were compared between different pathologies: inflammatory breast cancer (IBC; n = 5), benign skin inflammation (BSI; n = 11), Paget's disease (PD; n = 3), and skin-involved breast cancer (SIBC; n = 11). Fifty-eight women had healthy skin (H; n = 58). The SIBC group had a significantly lower mean ADC than the BSI and IBC groups. These differences persisted for the first-order features of the ADC (mean, median, maximum, and minimum) only between the SIBC and BSI groups. The mean ADC did not differ significantly between the BSI and IBC groups. Quantitative DWI assessments demonstrated differences between various skin-affecting pathologies, but did not distinguish clearly between all of them. More extensive studies are needed to assess the utility of quantitative DWI in supplementing the diagnostic assessment of skin pathologies in breast imaging.

[Expert recommendations for magnetic resonance imaging of muscle disorders]. / Expertenempfehlung zur Magnetresonanztomographie bei Muskelerkrankungen.

BACKGROUND: Magnetic resonance (MRI) imaging of the skeletal muscles (muscle MRI for short) is increasingly being used in clinical routine for diagnosis and longitudinal assessment of muscle disorders. However, cross-centre standards for measurement protocol and radiological assessment are still lacking. OBJECTIVES: The aim of this expert recommendation is to present standards for the application and interpretation of muscle MRI in hereditary and inflammatory muscle disorders. METHODS: This work was developed in collaboration between neurologists, neuroradiologists, radiologists, neuropaediatricians, neuroscientists and MR physicists from different university hospitals in Germany. The recommendations are based on expert knowledge and a focused literature search. RESULTS: The indications for muscle MRI are explained, including the detection and monitoring of structural tissue changes and oedema in the muscle, as well as the identification of a suitable biopsy site. Recommendations for the examination procedure and selection of appropriate MRI sequences are given. Finally, steps for a structured radiological assessment are presented. CONCLUSIONS: The present work provides concrete recommendations for the indication, implementation and interpretation of muscle MRI in muscle disorders. Furthermore, it provides a possible basis for the standardisation of the measurement protocols at all clinical centres in Germany.

[Expert recommendations for magnetic resonance imaging of muscle disorders]. / Expertenempfehlung zur Magnetresonanztomographie bei Muskelerkrankungen.

BACKGROUND: Magnetic resonance (MRI) imaging of the skeletal muscles (muscle MRI for short) is increasingly being used in clinical routine for diagnosis and longitudinal assessment of muscle disorders. However, cross-centre standards for measurement protocol and radiological assessment are still lacking. OBJECTIVES: The aim of this expert recommendation is to present standards for the application and interpretation of muscle MRI in hereditary and inflammatory muscle disorders. METHODS: This work was developed in collaboration between neurologists, neuroradiologists, radiologists, neuropaediatricians, neuroscientists and MR physicists from different university hospitals in Germany. The recommendations are based on expert knowledge and a focused literature search. RESULTS: The indications for muscle MRI are explained, including the detection and monitoring of structural tissue changes and oedema in the muscle, as well as the identification of a suitable biopsy site. Recommendations for the examination procedure and selection of appropriate MRI sequences are given. Finally, steps for a structured radiological assessment are presented. CONCLUSIONS: The present work provides concrete recommendations for the indication, implementation and interpretation of muscle MRI in muscle disorders. Furthermore, it provides a possible basis for the standardisation of the measurement protocols at all clinical centres in Germany.

Comparison of 3T and 7T magnetic resonance imaging for direct visualization of finger flexor pulley rupture: an ex-vivo study.

OBJECTIVE: To compare image quality and diagnostic performance of 3T and 7T magnetic resonance imaging (MRI) for direct depiction of finger flexor pulleys A2, A3 and A4 before and after artificial pulley rupture in an ex-vivo model using anatomic preparation as reference. MATERIALS AND METHODS: 30 fingers from 10 human cadavers were examined at 3T and 7T before and after being subjected to iatrogenic pulley rupture. MRI protocols were comparable in duration, both lasting less than 22 min. Two experienced radiologists evaluated the MRIs. Image quality was graded according to a 4-point Likert scale. Anatomic preparation was used as gold standard. RESULTS: In comparison, 7T versus 3T had a sensitivity and specificity for the detection of A2, A3 and A4 pulley lesions with 100% vs. 95%, respectively 98% vs. 100%. In the assessment of A3 pulley lesions sensitivity of 7T was superior to 3T MRI (100% vs. 83%), whereas specificity was lower (95% vs. 100%). Image quality assessed before and after iatrogenic rupture was comparable with 2.74 for 7T and 2.61 for 3T. Visualization of the A3 finger flexor pulley before rupture creation was significantly better for 7 T (p < 0.001). Interobserver variability showed substantial agreement at 3T (κ = 0.80) and almost perfect agreement at 7T (κ = 0.90). CONCLUSION: MRI at 3T allows a comparable diagnostic performance to 7T for direct visualization and characterization of finger flexor pulleys before and after rupture, with superiority of 7T MRI in the visualization of the normal A3 pulley.

Machine Learning-Supported Diagnosis of Small Blue Round Cell Sarcomas Using Targeted RNA Sequencing.

Small blue round cell sarcomas (SBRCSs) are a heterogeneous group of tumors with overlapping morphologic features but markedly varying prognosis. They are characterized by distinct chromosomal alterations, particularly rearrangements leading to gene fusions, whose detection currently represents the most reliable diagnostic marker. Ewing sarcomas are the most common SBRCSs, defined by gene fusions involving EWSR1 and transcription factors of the ETS family, and the most frequent non-EWSR1-rearranged SBRCSs harbor a CIC rearrangement. Unfortunately, currently the identification of CIC::DUX4 translocation events, the most common CIC rearrangement, is challenging. Here, we present a machine-learning approach to support SBRCS diagnosis that relies on gene expression profiles measured via targeted sequencing. The analyses on a curated cohort of 69 soft-tissue tumors showed markedly distinct expression patterns for SBRCS subgroups. A random forest classifier trained on Ewing sarcoma and CIC-rearranged cases predicted probabilities of being CIC-rearranged >0.9 for CIC-rearranged-like sarcomas and <0.6 for other SBRCSs. Testing on a retrospective cohort of 1335 routine diagnostic cases identified 15 candidate CIC-rearranged tumors with a probability >0.75, all of which were supported by expert histopathologic reassessment. Furthermore, the multigene random forest classifier appeared advantageous over using high ETV4 expression alone, previously proposed as a surrogate to identify CIC rearrangement. Taken together, the expression-based classifier can offer valuable support for SBRCS pathologic diagnosis.

Artificial intelligence (AI) in diagnostic imaging. / Künstliche Intelligenz (KI) in der Bildgebenden Diagnostik.

PURPOSE: In the last few years artificial intelligence (AI) has increasingly become a topic of interest, especially in diagnostic imaging. There are two main expected potential benefits: workflow effectiveness and diagnostic support systems, particularly as far as quality assurance is concerned. METHODS: To meet these objectives, it is necessary to define what artificial intelligence in medicine means and to discuss which detailed steps should be fulfilled, e. g., for MSK imaging in the daily routine. In addition, this article provides an overview of what is necessary for an efficient IT-based workflow including the clinical question, the choice of modalities and investigation protocols, structured reports, and clinical classification. This is particularly interesting for potential providers, who are keen to apply new soft skills to support imaging diagnostic processes. RESULTS: The use of AI-supported diagnostic imaging could result in a paradigm shift from a modality-oriented to a clinical problem-oriented workflow. In order to streamline trauma, degeneration, inflammation, and oncology-MSK diagnostic imaging, the potential benefits of AI-based workflow optimization should be taken advantage of. The following article describes a five-point plan combining patient expectations and specialized radiological standards with respect to investigation protocols and reports. Moreover, this AI-based strategy could help to improve interdisciplinary networking, e. g., boards etc., and facilitate the required leap in quality towards "personalized precision medicine" for the patient. According to the global discussion, there is a need to point out that it is not currently realistic to replace doctors with AI. KEY POINTS: · AI as support-system has a paramount clinical impact. · AI in the daily routine could be for work-flow-support (processing) - a physician-replacement is un-realistic yet. · Standardization of work-flow by AI could be an important contribution of quality assurance. CITATION FORMAT: · Braunschweig R, Kildal D, Janka R. Artificial intelligence (AI) in diagnostic imaging . Fortschr Röntgenstr 2024; DOI: 10.1055/a-2208-6487.

Structured image diagnosis of vertebral body degeneration and intervertebral disc damage - Binary image criteria and comparison for systematic image analysis for occupational diseases 2108 and 2110. / Strukturierte Bild-Befundung von Wirbelkörperdegeneration und Bandscheibenschäden ­ Binäre Bildkriterien und Vergleichsbilder für die systematische Bildanalyse bei den Berufskrankheiten 2108 und 2110.

BACKGROUND: Job-related limitations of earning capacity are eligible for recognition under social legislation and may be subject to compensation (see Part 1). METHOD: For the recognition of an occupational disease (BK), diagnostic imaging is required as part of the legal determination procedure for occupational diseases 2108/2110 ("occupational disc disease"). The focus is on image criteria on X-ray images and MRI examinations. In a consensus paper under the guidance of the German Social Accident Insurance Institutions from 2005, the characteristic patterns are defined and explained extensively and summarized in typical occupation-related constellations. This article presents representative image examples as a reference system for expert reporting as far as the typical patterns from the consensus paper are concerned. CONCLUSION: In Part 2, comparison images with the typical findings of the vertebral bodies and intervertebral discs according to occupational diseases are systematically presented, explained, and offered as a reference system for expert assessment. The image criteria can be used as "evidence by eye" (Heuck) in the recognition procedure. KEY POINTS: · Occupational diseases are defined by the legislator in the "List of Occupational Diseases".. · For occupational intervertebral disc diseases (OD nos. 2108/2110), constellations of findings are defined.. · Within the scope of diagnostic imaging, a large number of image criteria are used.. · Part 1 explains the basics and the legal background.. · Part 2 provides the image criteria on the basis of "comparison images" as a reference catalog.. CITATION FORMAT: · Braunschweig R, Kildal D, Meyer-Clement M et al. Structured image diagnosis of vertebral body degeneration and intervertebral disc damage - Binary image criteria and comparison for systematic image analysis for occupational diseases 2108 and 2110. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2224-9100.

Modern low-field MRI.

This narrative review explores recent advancements and applications of modern low-field (≤ 1 Tesla) magnetic resonance imaging (MRI) in musculoskeletal radiology. Historically, high-field MRI systems (1.5 T and 3 T) have been the standard in clinical practice due to superior image resolution and signal-to-noise ratio. However, recent technological advancements in low-field MRI offer promising avenues for musculoskeletal imaging. General principles of low-field MRI systems are being introduced, highlighting their strengths and limitations compared to high-field counterparts. Emphasis is placed on advancements in hardware design, including novel magnet configurations, gradient systems, and radiofrequency coils, which have improved image quality and reduced susceptibility artifacts particularly in musculoskeletal imaging. Different clinical applications of modern low-field MRI in musculoskeletal radiology are being discussed. The diagnostic performance of low-field MRI in diagnosing various musculoskeletal pathologies, such as ligament and tendon injuries, osteoarthritis, and cartilage lesions, is being presented. Moreover, the discussion encompasses the cost-effectiveness and accessibility of low-field MRI systems, making them viable options for imaging centers with limited resources or specific patient populations. From a scientific standpoint, the amount of available data regarding musculoskeletal imaging at low-field strengths is limited and often several decades old. This review will give an insight to the existing literature and summarize our own experiences with a modern low-field MRI system over the last 3 years. In conclusion, the narrative review highlights the potential clinical utility, challenges, and future directions of modern low-field MRI, offering valuable insights for radiologists and healthcare professionals seeking to leverage these advancements in their practice.

Highly accelerated, Dixon-based non-contrast MR angiography versus high-pitch CT angiography.

OBJECTIVES: To compare a novel, non-contrast, flow-independent, 3D isotropic magnetic resonance angiography (MRA) sequence that combines respiration compensation, electrocardiogram (ECG)-triggering, undersampling, and Dixon water-fat separation with an ECG-triggered aortic high-pitch computed tomography angiography (CTA) of the aorta. MATERIALS AND METHODS: Twenty-five patients with recent CTA were scheduled for non-contrast MRA on a 3 T MRI. Aortic diameters and cross-sectional areas were measured on MRA and CTA using semiautomatic measurement tools at 11 aortic levels. Image quality was assessed independently by two radiologists on predefined aortic levels, including myocardium, proximal aortic branches, pulmonary veins and arteries, and the inferior (IVC) and superior vena cava (SVC). Image quality was assessed on a 5-point Likert scale. RESULTS: All datasets showed diagnostic image quality. Visual grading was similar for MRA and CTA regarding overall image quality (0.71), systemic arterial image quality (p = 0.07-0.91) and pulmonary artery image quality (p = 0.05). Both readers favored MRA for SVC and IVC, while CTA was preferred for pulmonary veins (all p < 0.05). No significant difference was observed in aortic diameters or cross-sectional areas between native MRA and contrast-enhanced CTA (p = 0.08-0.94). CONCLUSION: The proposed non-contrast MRA enables robust imaging of the aorta, its proximal branches and the pulmonary arteries and great veins with image quality and aortic diameters and cross-sectional areas comparable to that of CTA. Moreover, this technique represents a suitable free-breathing alternative, without the use of contrast agents or ionizing radiation. Therefore, it is especially suitable for patients requiring repetitive imaging.

Structured image diagnosis of vertebral body degeneration and disc damage - Binary image criteria and comparison for systematic image analysis in occupational diseases 2108/2110. / Strukturierte Bild-Befundung von Wirbelkörperdegeneration und Bandscheibenschäden ­ Binäre Bildkriterien und Vergleichs-Bilder für die systematische Bildanalyse bei den Berufskrankheiten 2108 und 2110.

BACKGROUND: Occupationally related limitations of earning capacity can be recognized under social legislation and may be subject to compensation ("reduction in earning capacity"). For this purpose, legislators have defined a list of occupational diseases ("BK list"). Recognition of an occupational disease requires a legal assessment procedure based on a medical appraisal. The aim of the assessment is to prove the "causality" and the "causality giving rise to liability". METHOD: In addition to clinical findings and workplace analyses, imaging methods (projection radiography, MRI) are primarily used to substantiate liability. These methods enable proof of load-conforming damage patterns for occupational diseases 2108/2110 (damage to intervertebral discs). RESULTS AND CONCLUSION: In addition to the legal background, the following review article primarily presents the image criteria for load-conforming damage patterns of the spine. On the basis of the consensus paper on the "Assessment of occupational disc diseases of the lumbar spine", image criteria are assigned to age-atypical grades of findings, and "typical constellations of findings" are defined for vibration (BK 2108) or lifting (BK 2110) loads. The aim of Part 1 is to explain the image criteria of the comparative images presented as image plates in Part 2 and thus to present a reference catalog of findings. KEY STATEMENTS: · Occupational diseases are defined by legislators in the "List of Occupational Diseases".. · For occupational intervertebral disc diseases (BK 2108/2110), constellations of findings are defined.. · In the context of imaging diagnostics, a large number of image criteria are used.. · Part 1 explains the basics.. · Part 2 provides the image criteria on the basis of "comparative images" as a reference catalog.. CITATION FORMAT: · Braunschweig R, Kildal D, Meyer-Clement M et al. Structured image diagnosis of vertebral body degeneration and disc damage - Binary image criteria and comparison for systematic image analysis in occupational diseases 2108/2110. Fortschr Röntgenstr 2024; 196: 347 - 353.

Evaluation of finger cartilage composition in recreational climbers with 7 Tesla T2 mapping magnetic resonance imaging.

Purpose: Sport climbing may lead to tissue adaptation including finger cartilage before apparent surface damage is detectable. The main aim was to assess finger cartilage composition with T2 mapping in young, active climbers and to compare the results to a non-climbers' collective. A secondary aim was to compare whether differences in cartilage T2 times are observed between older vs. younger volunteers. Methods and materials: 7 Tesla MRI of the fingers Dig.2-4 was performed using a multi-echo spin echo sequence. Manual segmentation of 3 ROIs at the metacarpal heads, 1 ROI at the base phalanx and 1 ROI at the proximal interphalangeal joint was performed. Included were 13 volunteers without history of trauma who are regularly performing climbing activities as a recreational sport (>20 h/month). These were age-matched with 10 control subjects not performing climbing activities. Results: Mean age was 32.4 years for the climbing group and 25.8 years for the controls. Mean T2 values for the 5 different ROIs were 42.2 ± 7.8 msec for climbers and 41.4 ± 6.8 msec for non-climbers. No significant differences were observed for T2 values between both groups. However, higher age had a significant impact on T2 values for all assessed ROIs (higher age 44.2 ± 9.5, younger age 32.9 ± 5.7, p = 0.001). Discussion: This study evaluated the cartilage composition of young, engaged climbers with a T2 mapping MRI technique with the purpose to depict early onset joint changes. No negative impact on cartilage composition due to the sport activity was found, whereas age-related effects on the cartilage seemed to be more prominent.

Cardiac MRI: An Alternative Method to Determine the Left Ventricular Function.

(1) Background: With the conventional contour surface method (KfM) for the evaluation of cardiac function parameters, the papillary muscle is considered to be part of the left ventricular volume. This systematic error can be avoided with a relatively easy-to-implement pixel-based evaluation method (PbM). The objective of this thesis is to compare the KfM and the PbM with regard to their difference due to papillary muscle volume exclusion. (2) Material and Methods: In the retrospective study, 191 cardiac-MR image data sets (126 male, 65 female; median age 51 years; age distribution 20-75 years) were analysed. The left ventricular function parameters: end-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF) and stroke volume (SV) were determined using classical KfW (syngo.via and cvi42 = gold standard) and PbM. Papillary muscle volume was calculated and segmented automatically via cvi42. The time required for evaluation with the PbM was collected. (3) Results: The size of EDV was 177 mL (69-444.5 mL) [average, [minimum-maximum]], ESV was 87 mL (20-361.4 mL), SV was 88 mL and EF was 50% (13-80%) in the pixel-based evaluation. The corresponding values with cvi42 were EDV 193 mL (89-476 mL), ESV 101 mL (34-411 mL), SV 90 mL and EF 45% (12-73%) and syngo.via: EDV 188 mL (74-447 mL), ESV 99 mL (29-358 mL), SV 89 mL (27-176 mL) and EF 47% (13-84%). The comparison between the PbM and KfM showed a negative difference for end-diastolic volume, a negative difference for end-systolic volume and a positive difference for ejection fraction. No difference was seen in stroke volume. The mean papillary muscle volume was calculated to be 14.2 mL. The evaluation with PbM took an average of 2:02 min. (4) Conclusion: PbM is easy and fast to perform for the determination of left ventricular cardiac function. It provides comparable results to the established disc/contour area method in terms of stroke volume and measures "true" left ventricular cardiac function while omitting the papillary muscles. This results in an average 6% higher ejection fraction, which can have a significant influence on therapy decisions.

Effect of Flat-Knitted Medical Compression Stockings on Venous Malformations.

Venous malformations are one of the most common vascular anomalies. Our study aimed to investigate the effect of medical compression stockings of class I and II on the volume of venous malformations. Patients with venous malformations on upper or lower extremities were enrolled. They wore flat-knitted medical compression stockings of class I and II in a randomized order for four weeks each. Magnetic resonance imaging (MRI) and perometry were performed with and without wearing compression stockings. The 12-Item Short Form Survey (SF-12) questionnaire was performed before and after wearing compression stockings for four weeks each. A total of 18 patients completed the evaluations. Both compression classes showed a significant reduction of the volume of the venous malformations in the lesion itself based on MRI in comparison with baseline (both p < 0.001). Measurements taken with perometry did not reveal a significant difference in comparison to baseline (p = 0.09 and p = 0.22). The results of the SF-12 questionnaire demonstrated no significant differences before and after wearing the compression stockings of class I or class II for four weeks or between the two classes of compression therapy. Our results indicate that wearing medical compression stockings of both class I and class II significantly reduces the volume of venous malformation, without compromising the quality of life, while the effect of class II compression stockings on volume reduction was significantly better than that of class I.

PIK3CA mutation testing as a valuable molecular surrogate for lipomatosis of the median nerve: clinicopathological and molecular analysis of six cases.

Lipomatosis of peripheral nerves (LPN, also known as fibrolipomatous or lipofibromatous hamartoma of peripheral nerves) is a very rare, benign, intraneural, tumorous lesion that predominantly involves the median nerve but may rarely affect any peripheral nerve. Recently, PIK3CA mutations have been reported in macrodactyly, a rare condition related to LPN, and in other localized lipomatous overgrowth syndromes. In this retrospective study, we report 6 cases of FPN involving the median nerve (4 of them identified among 570 patients with carpal tunnel syndrome who underwent surgical decompression at our center from 2012 to 2022 and two seen in consultation by one of the authors). All cases were diagnosed via biopsy or resection supplemented by MRI. Patients were 4 males and 2 females aged 23 to 60 years (mean 38 years). One patient with bilateral lesions had in addition extensive angiomatosis of the paravertebral region. Histological examination showed an abnormal amount of mature fatty tissue containing disordered fibrous bands, entrapping normal-looking nerve fibers with prominent perineurial and endoneurial fibrosis. Genetic analysis using snapshot assay constructed to detect hotspots mutations in PIK3CA revealed similar PIK3CA mutations (p.H1047R; c.3140A>G) in 5/6 cases (83.3%). Our study represents a further contribution to the literature on LPN and highlights the diagnostic value of PIK3CA mutation testing as surrogate tool in equivocal cases and in those lesions without associated macrodactyly, especially as the biopsy findings of this lesion are essentially nonspecific.

Comparison of Diagnostic Performance and Image Quality between Topup-Corrected and Standard Readout-Segmented Echo-Planar Diffusion-Weighted Imaging for Cholesteatoma Diagnostics.

This study compares the diagnostic performance and image quality of single-shot turbo spin-echo DWI (tseDWI), standard readout-segmented DWI (rsDWI), and a modified rsDWI version (topupDWI) for cholesteatoma diagnostics. Thirty-four patients with newly suspected unilateral cholesteatoma were examined on a 1.5 Tesla MRI scanner. Diagnostic performance was evaluated by calculating and comparing the sensitivity and specificity using histopathological results as the standard of reference. Image quality was independently reviewed by two readers using a 5-point Likert scale evaluating image distortions, susceptibility artifacts, image resolution, lesion conspicuity, and diagnostic confidence. Twenty-five cholesteatomas were histologically confirmed after surgery and originated in the study group. TseDWI showed the highest sensitivity with 96% (95% confidence interval (CI): 88-100%), followed by topupDWI with 92% (95% CI: 81-100%) for both readers. The sensitivity for rsDWI was 76% (95% CI: 59-93%) for reader 1 and 84% (95% CI: 70-98%) for reader 2, respectively. Both tseDWI and topupDWI revealed a specificity of 100% (95% CI: 66-100%) and rsDWI of 89% (95% CI: 52-100%). Both tseDWI and topupDWI showed fewer image distortions and susceptibility artifacts compared to rsDWI. Image resolution was consistently rated best for topupDWI, followed by rsDWI, which both outperformed tseDWI. TopupDWI and tseDWI showed comparable results for lesions' conspicuity and diagnostic confidence, both outperforming rsDWI. Modified readout-segmented DWI using the topup-correction method is preferable to standard rsDWI and may be regarded as an accurate alternative to single-shot turbo spin-echo DWI in cholesteatoma diagnostics.

Dynamic study of the finger interphalangeal joint volar plate-motion analysis with magnetic resonance cinematography and histologic comparison.

OBJECTIVE: We aimed to further improve knowledge about volar plate (VP) motion of the finger proximal interphalangeal joint (PIP), by analyzing the dynamic VP shape during a full range of finger flexion using magnetic resonance cinematography of the fingers (MRCF), and to compare the results with anatomical cross sections from cadaver specimens. MATERIALS AND METHODS: The dynamic sagittal VP shape was visualized with MRCF in a total number of 23 healthy volunteers. The length, angle, and thickness as well as the contact length of the VP to the PIP joint base were measured. Statistical analysis included t-test or rank-sum testing. Anatomical cross sections with differing degrees of PIP joint flexion were obtained from 12 cadaver specimens (fingers) for comparison. RESULTS: Significant positive correlations between PIP joint flexion angle and VP area, length, depth and the VP contact length were found. This matched histologically to fiber rearrangements especially within the loose third VP layer. CONCLUSION: Our study analyzed the full range of motion dynamic VP shape of the PIP joint using MRCF. This contributes to a more precise understanding of the complex interaction of the VP with the PIP joint and may facilitate evaluation of clinical cases such as VP avulsion or pulley rupture.

[Imaging of muscle injuries in sports medicine]. / Bildgebung von Muskelverletzungen im Sport.

BACKGROUND: Early diagnosis of muscle injuries is indispensable in order to initiate appropriate treatment and to facilitate optimal healing. PURPOSE: The aim of this review is to provide an update on imaging of muscle injuries in sports medicine with a focus on ultrasound and magnetic resonance imaging (MRI) and to present experimental approaches in addition to routine diagnostic procedures. MATERIALS AND METHODS: A PubMed literature search for the years 2012-2022 using the following keywords was performed: muscle, muscle injury, muscle imaging, muscle injury classification, delayed onset muscle soreness, ultrasound, MRI, sodium MRI, potassium MRI, ultra-high-field MRI, injuries of athletes. RESULTS: Imaging is crucial to confirm and assess the extent of sports-related muscle injuries and may help establishing treatment decisions, which directly affect the prognosis. This is of importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be necessary. In addition to established methods such as B­mode ultrasound and 1H­MRI, individual studies show promising approaches to further improve the imaging of muscle injuries in the future. Prior to the integration of contrast-enhanced ultrasound and X­nuclei into clinical routine, additional studies are needed to validate these techniques further. CONCLUSION: B­mode ultrasound represents an easily available, cost-effective modality for the initial diagnosis of muscle injuries. MRI is still considered the reference standard and enables an accurate morphological assessment of the extent of the injury. There are still no imaging approaches available for the objective determination of the optimal point of return to play.

Effects of video-based patient preparation for MRI on clinical processes and patient experience.

PURPOSE: To determine whether video-based informational or relaxational preparation reduces the number of unexpected patient-related events and scan duration more efficiently, and to assess how patients evaluate the interventions. METHODS: We randomized 142 adult patients (mean age: 48 ± 16 years) to three groups. The control group (n = 48, 33.8 %) received standard care. The intervention groups watched an informational (n = 50, 35.2 %) or relaxational (n = 44, 31.0 %) video while awaiting their MRI examination. We recorded scan duration, number of motion artifacts/sequence repetitions, and patient-related incidents (e.g., interruptions, premature termination). Subjective evaluation of the interventions was provided by the patients after MRI completion. RESULTS: Mean scan duration for the control, relaxation, and information group was 39.38 ± 16.62 min, 32.59 ± 11.67 min, and 34.54 ± 11.91 min. Compared to the control group, scan duration was significantly shorter in the relaxation, but not in the information group (relaxation vs control: p =.019; information vs control: p =.082). The information and relaxation group did not differ significantly (p =.704). In 35 (24.6 %) patients, one or more sequences were repeated; incidents occurred in six (4.2 %) patients. Neither the frequency of repeated sequences nor incidents differed between the groups (all p >.239). Patients evaluated both videos very positively; the information video received even better evaluations (all p <.027). CONCLUSION: Additional preparation, especially information, is perceived very positively by patients and at least relaxational preparation may have a positive impact on clinical operations.

Preparing patients according to their individual coping style improves patient experience of magnetic resonance imaging.

MRI-related anxiety is present in 30% of patients and may evoke motion artifacts/failed scans, which impair clinical efficiency. It is unclear how patient anxiety can be countered most effectively. Habitual preferences for coping with stressful situations by focusing or distracting one's attention thereof (coping style) may play a key role in this context. This study aimed to compare the effectiveness of two patient-preparation videos with informational vs. relaxational content and to determine whether the fit between content and coping style affects effectivity. The sample consisted of 142 patients (M = 48.31 ± 15.81 years). Key outcomes were anxiety, and cortisol as a physiological stress marker. When not considering coping style, neither intervention improved the patients' reaction; only patient preparation that matched the patients' coping style was associated with an earlier reduction of anxiety. This suggests that considering individual preferences for patient preparation may be more effective than a one-size-fits-all approach.