Clinical utility, reproducibility, and radiologist acceptance of ILD-RADS.

PURPOSE: To investigate the clinical utility, reproducibility, and radiologists' acceptance of the Interstitial Lung Disease Imaging-Reporting and Data System (ILD-RADS). METHOD: In this single-institutional retrospective study, three radiologists independently reviewed the chest high-resolution CT (HRCT) scans of 111 consecutive patients diagnosed with ILDs. They assessed the HRCT pulmonary features using the ILD-RADS template and assigned an ILD-RADS category (1-4) to each scan based on the identified imaging pattern. Patients were classified into idiopathic pulmonary fibrosis (IPF) (n = 14) and non-IPF ILD (n = 97) groups based on clinical diagnoses determined by multidisciplinary discussion. Association between ILD-RADS categories and clinical diagnoses was assessed using the Chi-square test for trend. Reproducibility was evaluated using kappa (k) scores, and radiologists' acceptance of the ILD-RADS was evaluated with a questionnaire. RESULTS: We found a significant association between the ILD-RADS categories and patients' clinical diagnoses (P ≤ 0.0001) for the three readers, with a trend toward increased assignment of ILD-RADS-1 to IPF patients (50 %-57.1 %), and ILD-RADS-4 to non-IPF patients (46.4 %-49.5 %). The ILD-RADS categories showed excellent intra-reader agreement (k = 0.873) and moderate inter-reader agreement (k = 0.440). ILD-RADS-1 and -4 categories showed the highest inter-reader agreement (k = 0.681 and 0.481, respectively). Radiologists gave a positive response to using the ILD-RADS in daily practice. CONCLUSIONS: The clinical utility of the ILD-RADS was demonstrated by the significant association between the ILD-RADS categories and patients' clinical diagnoses, particularly the ILD-RADS-1 and -4 categories. Excellent intra-reader and moderate inter-reader reproducibility was observed. ILD-RADS has the potential to be widely accepted for standardized HRCT reporting among radiologists.

Impact of Adding Mean Apparent Diffusion Coefficient (ADCmean) Measurements to O-RADS MRI Scoring For Adnexal Lesions Characterization: A Combined O-RADS MRI/ADCmean Approach.

RATIONALE AND OBJECTIVES: Evaluate the impact of adding mean apparent diffusion coefficient (ADCmean) measurements to the Ovarian-Adnexal Imaging Reporting and Data System MRI (O-RADS MRI) scoring for adnexal lesion characterization using a combined O-RADS MRI/ADCmean reading approach. MATERIALS AND METHODS: This prospective study included 90 women who underwent pelvic MRI for adnexal lesions diagnosis and characterization. Two readers scored the adnexal lesions using the O-RADS MRI scoring independently and in consensus. A third reader calculated ADCmean measurements. The final diagnoses were determined by histo-pathology (n = 77) or follow-up imaging (n = 13). Areas under the curves (AUCs) and diagnostic performance metrics were calculated for the O-RADS MRI scoring, ADCmean, and combined O-RADS MRI/ADCmean thresholds. P-value <0.05 was significant. RESULTS: 116 adnexal lesions (71 benign, 45 malignant) were analyzed. The optimal thresholds to predict malignant adnexal lesions were O-RADS MRI score >3 and ADCmean value ≤1.08 × 10-3 mm2/s (AUC 0.926 and 0.823; sensitivity 97.7% and 95.5%; specificity 87.3% and 68%; positive predictive value (PPV) 83% and 66.2%; positive likelihood ratio (PLR) 7.7 and 3.08, respectively). Compared to the O-RADS MRI scoring, a combined threshold of O-RADS MRI >3/ADCmean ≤1.08 × 10-3 mm2/s, yielded a reduction of false positives, a significant increase in the specificity (97.1%, p = 0.005), PPV (95.4%, p = 0.002), and PLR (33.1, p <0.0001), and non-significant change in the AUC (0.953, p = 0.252), and sensitivity (93.3%, p = 0.467). CONCLUSION: The diagnostic performance of O-RADS MRI scoring to characterize adnexal lesions could be improved by adding the ADCmean values through reducing false positives, increasing specificity, and maintaining good sensitivity.

Diagnostic accuracy and discriminative power of biparametric versus multiparametric MRI in predicting muscle-invasive bladder cancer.

PURPOSE: Investigate and compare the diagnostic accuracy and discriminative power of biparametric MRI (bp-MRI) and multiparametric MRI (mp-MRI) in predicting muscle-invasive bladder cancer (MIBC) based on Vesical Imaging-Reporting and Data System (VI-RADS) scoring and evaluate potentially influencing factors on both protocols' accuracy. METHOD: This retrospective study included 54 bladder cancer (BC) patients who underwent bladder MRI and histo-pathological assessment. Three readers independently reviewed the MRI studies and assigned a 1-5 score for T2-weighted, diffusion-weighted, and dynamic contrast-enhanced images. Then, bp-MRI and mp-MRI final VI-RADS scores were recorded for each BC. Diagnostic tables, chi-square test, kappa score (k), logistic regression, receiver operating characteristics (ROC) curves, areas under the curves (AUCs), and VI-RADS cut-off values were calculated. A Delong test was performed for ROC curve comparison. A P-value<0.05 was considered significant. RESULTS: In predicting MIBC, bp-MRI and mp-MRI had comparable diagnostic accuracy with insignificant differences for the three readers (P = 0.364,0.718,0.702). Radiologists' experience, and tumors' size and morphology had insignificant effect on bp-MRI accuracy (P = 0.086, 0.392,0.294), respectively. Tumors' size significantly influenced mp-MRI accuracy (P = 0.039). Bp-MRI and mp-MRI had comparable discriminative power with insignificant differences for all readers (P > 0.05). Using VI-RADS > 3 cut-off value improved the discriminative power of bp-MRI. Excellent inter-reader agreement in VI-RADS scoring for bp-MRI (k range, 0.814-0.867) and mp-MRI (k range, 0.787-0.859) was observed. CONCLUSION: Bp-MRI and mp-MRI demonstrated comparable diagnostic accuracy and discriminative power in predicting MIBC. The accuracy of bp-MRI was not influenced by radiologists' experience, or tumors' size and morphology.

Post COVID-19 Head and Neck Mucormycosis: MR Imaging Spectrum and Staging.

OBJECTIVE: To develop a systematic approach for magnetic resonance imaging (MRI) analysis, imaging spectrum, and classification system for the staging of post-COVID-19 head and neck mucormycosis. METHOD: The study included 63 post-COVID-19 patients with pathologically proven mucormycosis who underwent head and neck MR imaging. Three independent radiologists assessed the imaging spectrum of mucormycosis, MRI characteristics of sino-nasal mucormycosis, and extra-sinus extension, and submitted a final staging using a systematic approach and a proposed categorization system. A consensus reading was considered the reference imaging standard. The kappa statistics were used to assess the categorization system's diagnostic reliability. RESULTS: The overall interreader agreement of the MR staging system was very good (k-score = 0.817). MR imaging spectrum involved localized sino-nasal mucormycosis (n = 7 patients, 11.1%), sino-nasal mucormycosis with maxillo-facial soft tissue extension (n = 28 patients, 44.5 %), sino-nasal mucormycosis with maxillo-facial bony extension (n = 7 patients, 11.1%), sino-naso-orbital mucormycosis (n = 13 patients, 20.6%), and sino-nasal mucormycosis with cranium or intracranial extension (n = 8 patients, 12.7%). Extra-sinus extension to the orbit and brain did not have significant association with involvement of the posterior ethmoid/sphenoid sinuses and maxillo-facial regions (p > 0.05). MRI-based staging involved four stages: stage 1 (n = 7, 11.1%); stage 2 (n = 35, 55.6%), and stage 3 (n = 13, 20.6%), and stage 4 (n = 8, 12.7%). Involvement of the bone and MR-based staging were significant predictors of patients' mortality p = 0.012 and 0.033, respectively. CONCLUSION: This study used a diagnostic-reliable staging method to define the imaging spectrum of post-COVID-19 head and neck mucormycosis and identify risk variables for extra-sinus extension.

The validity, reliability, and reviewer acceptance of VI-RADS in assessing muscle invasion by bladder cancer: a multicenter prospective study.

OBJECTIVE: To assess diagnostic validity and reliability of VI-RADS in predicting muscle invasion by bladder cancer (BCa) and evaluate reviewer acceptance of VI-RADS for clinical routine. METHODS: A prospective multicenter study enrolled 331 patients with suspected/untreated BCa who underwent preoperative multiparametric MRI examination (mp-MRI) of the urinary bladder. Four experienced radiologists independently evaluated all mp-MRI using VI-RADS. The diagnostic validity of VI-RADS for predicting muscle invasion by BCa was calculated using histopathology of the first transurethral resection bladder tumor (TURBT) and second TURBT as the reference standards. The kappa statistics (κ) were applied to assess the interreader agreement (IRA). Reviewer acceptance was evaluated with questionnaires. RESULTS: The risk of muscle invasion in VI-RADS 2, 3, 4, and 5 after the first and second TURBT was 21.8%, 45.8%, 69.6%, and 96.4% and 24.4%, 58.3%, 87%, and 99.2%, respectively. The overall diagnostic validity of VI-RADS was high. The optimal cut-off value for predicting muscle invasion after first TURBT was > VI-RADS 3 (sensitivity = 84.1% and specificity = 92.3%), and after second TURBT was > VI-RADS 2 (sensitivity = 89.9% and specificity = 90.1%). VI-RADS categorization showed a very good IRA (κ = 0.93). Reviewers fully agreed with the statement, "The application of structured reporting of bladder tumor should be encouraged" (score = 20). CONCLUSIONS: VI-RADS showed high diagnostic validity and reliability for predicting muscle invasion by BCa, especially VI-RADS 4 and 5. However, VI-RADS 2 and 3 require further modifications to enhance their diagnostic validity. VI-RADS is highly encouraged to be used in daily practice. KEY POINTS: • VI-RADS showed high diagnostic validity and reliability in predicting BCa muscle invasion, especially VI-RADS 4 and 5. • In VI-RADS 2 and 3, we observed a notable percentage of BCa with muscle invasion and this would require further modifications to enhance the diagnostic validity for these scores. • Overall VI-RADS is well-accepted by radiologists who recommend it for daily practice.

Neuroanatomical MRI study: reference values for the measurements of brainstem, cerebellar vermis, and peduncles.

OBJECTIVES: To set age-specific normal reference values for brainstem, cerebellar vermis, and peduncles measurements and characterize values' variations according to gender, age, and age by gender interaction. METHODS: 565 normal brain magnetic resonance examinations with normal anatomy and signal intensity of the supra- and infratentorial structures were categorized into six age groups (infant, child, adolescent, young adult, middle-age adult, and old aged adults). Patients with congenital malformations, gross pathology of the supra- or infratentorial brain, brain volume loss, developmental delay, metabolic disorders, and neuropsychological disorders (n = 2.839) were excluded. On midsagittal T1 weighted and axial T2 weighted images specific linear diameters and ratios of the brainstem, cerebellar vermis, and peduncles were attained. Two observers assessed a random sample of 100 subjects to evaluate the inter- and intraobserver reproducibility. Intraclass correlation coefficients, means ± standard deviation, one and two-way analysis of variance tests were used in the statistical analysis. RESULTS: Good to excellent inter- and intraobserver measurements' reproducibility were observed, except for the transverse diameter of the midbrain, the anteroposterior diameter of the medulla oblongata at the pontomedullary and cervicomedullary junctions, cerebellar vermis anteroposterior diameter, and thickness of the superior cerebellar peduncle. Age-specific mean values of the investigated measurements were established. A significant gender-related variation was recorded in the anteroposterior diameter of the basis pontis (p = 0.044), the anteroposterior diameter of the medulla oblongata at the cervicomedullary junction (p = 0.044), and cerebellar vermis height (p = 0.018). A significant age-related change was detected in all measurements except the tectal ratio. Age by gender interaction had a statistically significant effect on the tectal ratio, inferior, and middle cerebellar peduncles' thickness (p = 0.001, 0.022, and 0.028, respectively). CONCLUSION: This study provides age-specific normal mean values for various linear dimensions and ratios of the posterior fossa structures with documentation of measurements' variability according to gender, age, and their interaction. ADVANCES IN KNOWLEDGE: It provides a valuable reference in the clinical practice for easier differentiation between physiological and pathological conditions of the posterior fossa structures especially various neurodegenerative diseases and congenital anomalies.