Myocardial delayed enhancement using a single (0.1 mmol/kg) dose of gadobenate dimeglumine : contrast resolution versus intraventricular blood and viable myocardium

This study was done to estimate delayed enhancement (DE) contrast resolution of infarcted myocardium (IM) relative to intraventricular blood (IB) and viable myocardium (VM) using gadobenate dimeglumine (Gd-BOPTA). After approval from the Ethics Committee, we retrospectively evaluated 21 consecutive patients (61 +/- 10 years) with a healed myocardial infarction who underwent 1.5-T magnetic resonance (MR) imaging using an inversion-recovery-prepared turbo gradient-echo sequence 10 minutes after injection of 0.1 mmol/kg of Gd-BOPTA. Signal intensity (SI) was measured in arbitrary units (au) for IM, IB, VM, and outside the patient. Contrast-to-noise ratio (CNR) was calculated for IM to IB and IM to VM. Seven consecutive patients (59 +/- 6 years) with a healed myocardial infarction studied with similar technique but with 0.1 mmol/kg of gadoterate meglumine (Gd-DOTA) served as the control group. The Mann-Whitney U test was used to compare groups. Mean SI of IM was 44 +/- 16 au for Gd-BOPTA and 20 +/- 6 au for Gd-DOTA (p < 0.001), that of IB 35 +/- 15 au and 14 +/- 5 au (p=0.016), and that of VM 7 +/- 3 au and 5 +/- 2 au (p=0.116), respectively. Mean IM to IB CNR was 10 +/- 7 for Gd-BOPTA and 8 +/- 5 for Gd-DOTA (p=0.836), that of IM to VM was 45 +/- 27 and 18 +/- 6, respectively (p=0.012). Gd-BOPTA at 0.1 mmol/kg produced a higher myocardial DE and an IM to VM CNR than a single dose of Gd-DOTA. No significant difference was observed for IM to IB CNR

Less is better? Intraindividual and interindividual comparison between 0.075mmol/kg of gadobenate dimeglumine and 0.1mmol/kg of gadoterate meglumine for cranial MRI

Purpose To retrospectively compare a reduced dose (RD) (0.075 mmol/kg) of gadobenate dimeglumine (RD-gadobenate) with standard single dose (SSD) (0.1 mmol/kg) of gadoterate meglumine (SSD-gadoterate) for cranial MRI. Materials and methods Thirty-one patients (12 males; aged 52 \ub1 16 years) underwent cranial MRI with SSD-gadoterate and repeated the examination with RD-gadobenate after a median interval of 10 months. Signal-to-noise ratio (SNR) was obtained on contrast-enhanced images for enhancing lesions (n = 10) as well as for right and left transverse venous sinuses, internal carotid arteries, and parotid glands. Moreover, a consecutive series of 100 cranial MRI with SSD-gadoterate (49 males; aged 51 \ub1 19 years) was compared with a consecutive series of 100 cranial MRI with RD-gadobenate (45 males; aged 54 \ub1 18 years). Two blinded neuroradiologists (R1, R2) judged contrast enhancement as sufficient, good, or optimal. Wilcoxon, Mann-Whitney, \u3c72, and Cohen \u3ba statistics were used. Results At intraindividual analysis, median SNR ranged 57-88 for SSD-gadoterate and 79-99 for RD-gadobenate, the latter being systematically higher, the difference being significant for both transverse venous sinuses (p 64 0.011), not significant for both internal carotid arteries and both parotid glands, and enhancing lesions (p 0.101). The two series of interindividual analysis were not significantly different for gender/age (p > 0.415). Contrast enhancement was optimal in 59% (R1) and 76% (R2) of patients using RD-gadobenate, in 39% (R1) and 49% (R2) of patients using SSD-gadoterate (p 64 0.016), with substantial reproducibility (\u3ba 65 0.606). Conclusion Both analyses showed an equal or better contrast enhancement when using RD-gadobenate compared to SSD-gadoterate for routine cranial MRI. The high relaxivity of gadobenate allowed for a 25% dose reduction

A new diagnostic score to detect osteoporosis in patients undergoing lumbar spine MRI

Objectives: Signal intensity of lumbar-spine at magnetic resonance imaging (MRI) correlates to bone mineral density (BMD). Our aim was to define a quantitative MRI-based score to detect osteoporosis on lumbar-spine MRI. Methods: After Ethics Committee approval, we selected female patients who underwent both lumbar-spine MRI and dual-energy X-ray absorptiometry (DXA) and a reference group of 131 healthy females (20\u201329 years) who underwent lumbar-spine MRI. We measured the intra-vertebral signal-to-noise ratio in L1-L4. We introduced an MRI-based score (M-score), on the model of T-score. M-score diagnostic performance in diagnosing osteoporosis was estimated against DXA using receiver operator characteristic (ROC) analysis. Results: We included 226 patients (median age 65 years), 70 (31 %) being osteoporotic at DXA. MRI signal-to-noise ratio correlated to BMD (r = 120.677, P < 0.001). M-score negatively correlated to T-score (r = 120.682, P < 0.001). Setting a 90 %-specificity, an M-score threshold of 5.5 was found, distinguishing osteoporosis from non-osteoporosis (sensitivity 54 %; ROC AUC 0.844). Thirty-one (14 %) patients had a fragility fracture, with osteoporosis detected in 15 (48 %) according to M-score and eight (26 %) according to T-score (P = 0.016). Conclusions: M-score obtained on lumbar spine MRI is a quantitative method correlating with osteoporosis. Its diagnostic value remains to be demonstrated on a large prospective cohort of patients. Key Points: \u2022 M-score is a quantitative score potentially screening osteoporosis on lumbar-spine MRI;\u2022 This method showed good intra- and inter-reader reproducibility;\u2022 M-score may be used for identifying patients who should undergo DXA

A critical appraisal of the quality of low back pain practice guidelines using the AGREE II tool and comparison with previous evaluations : a EuroAIM initiative

PURPOSE: To assess the methodologic quality of guidelines for the management of low back pain (LBP) and compare their recommendations. METHODS: No ethics committee approval was needed for this systematic review. In March 2017, a systematic search was performed using MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence to find practice guidelines of assessment and management of LBP. The evaluation of guidelines quality was performed independently by four authors using the AGREE II tool, and the results were compared with previous appraisals performed in 2004 and 2009. RESULTS: Of 114 retrieved guidelines, eight were appraised. All except one reached the level of "acceptable" in overall result, with two of them reaching the highest scores. Only two guidelines reached a level of "acceptable" in every domain; the others had at least one domain with low scores. The guidelines had the higher scores (range\u2009=\u200963-94%) on "Scope and purpose" and "Clarity of presentation" (47-89%). "Stakeholder Involvement" has the highest variability between the guidelines results (40-96%). "Rigor of Development" reached an intermediate mean result (34-90%), "Applicability" (42-70%), and "Editorial Independence" (38-85%). Only three guidelines had a radiologist among authors and reached higher scores compared to guidelines without a radiologist among the authors. Compared to previous assessments, low-level guidelines were 53% in 2004, 36% in 2009, and 13% in 2017. CONCLUSIONS: Considering all guidelines, only one had a "low" overall score, while half of them were rated as of "high" quality. Future guidelines might take this into account to improve clinical applicability

Prevalence and type of errors in dual-energy x-ray absorptiometry

Objectives: Pitfalls in dual-energy x-ray absorptiometry (DXA) are common. Our aim was to assess rate and type of errors in DXA examinations/reports, evaluating a consecutive series of DXA images of patients examined elsewhere and later presenting to our institution for a follow-up DXA.Methods: After ethics committee approval, a radiologist retrospectively reviewed all DXA images provided by patients presenting at our institution for a new DXA. Errors were categorized as patient positioning (PP), data analysis (DA), artefacts and/or demographics.Results: Of 2,476 patients, 1,198 had no previous DXA, while 793 had a previous DXA performed in our institution. The remaining 485 (20 %) patients entered the study (38 men and 447 women; mean age \ub1 standard deviation, 68 \ub1 9 years). Previous DXA examinations were performed at a total of 37 centres. Of 485 reports, 451 (93 %) had at least one error out of a total of 558 errors distributed as follows: 441 (79 %) were DA, 66 (12 %) PP, 39 (7 %) artefacts and 12 (2 %) demographics.Conclusions: About 20 % of patients did not undergo DXA at the same institution as previously. More than 90 % of DXA presented at least one error, mainly of DA. International Society for Clinical Densitometry guidelines are very poorly adopted.Key Points: \u2022 More than 90 % of DXA examinations/reports presented one or more errors.\u2022 About 80 % of errors are related to image data analysis.\u2022 Errors in DXA examinations may have potential implications for patients\u2019 management

In vivo assessment of coronary stents with 64-row multidetector computed tomography : Analysis of metal artifacts

Objective: To evaluate stent-induced artifacts by 64-row multi-detector computed tomography (MDCT). Methods: We studied 26 stented patients with MDCT before conventional coronary angiography (CCA). The CT values were measured. Stents were classified as occluded, with significant stenosis, with nonsignificant stenosis, or patent. For the patent stents, mean in-stent and out-stent CT values were compared; stents 3 mm or smaller were compared with stents larger than 3 mm. Multidetector CT was compared with CCA. Results: We analyzed 42 stents. At CCA, 34 stents were patent, 5 were nonsignificantly stenosed, 1 was significantly stenosed, and 2 were occluded. At MDCT, 33 of 34 patent stents, 2 occluded stents, and 1 stent with significant stenosis were correctly diagnosed; nonsignificant stenoses were undetected, 1 patent stent was misdiagnosed as occluded (kappa = 0.727). The out-stent CT value was lower than in-stent CT value both in stents 3 mm or smaller (P = 0.001) and stents larger than 3 mm (P < 0.001). The in-stent CT value of stents 3 mm or smaller was higher (P = 0.011) than that of stents larger than 3 mm. Conclusions: Metal artifacts cause overlooking of nonsignificant stenosis

Prevalence of cerebral aneurysms in patients treated for left cardiac myxoma: A prospective study

Aim To estimate the prevalence of cerebral aneurysms in patients previously treated for left cardiac myxoma (LCM). Materials and methods This prospective institutional review board-approved study included patients treated for LCM. All patients treated at our institution (IRCCS Policlinico San Donato, Italy) were telephoned and those enrolled underwent unenhanced brain magnetic resonance imaging (MRI) using sagittal T1-weighted turbo spin-echo (TSE); axial T2-weighted TSE; axial fluid-attenuated inversion-recovery; axial echo-planar diffusion-weighted; and three-dimensional time-of-flight angiographic sequences. Results Seventy-six patients were telephoned, and data regarding their clinical history since tumor resection were obtained for 49 patients (64%). Four of the 49 (8%) patients were deceased, one due to a cerebral hemorrhage from a ruptured cerebral aneurysm 8 years after tumor resection. One patient had a pacemaker preventing MRI. Of the remaining 44 patients, 31 refused MRI and 13 were enrolled (10 females; mean age 64 years). Three of the 13 (23%; two females; 59-78 years) were diagnosed with a cerebral aneurysm, from 2 mm to 4-5 mm in diameter, involving the right middle cerebral artery (n = 2) or the right internal carotid artery (n = 1). Including the deceased patient, the resulting prevalence was 4/14 (29%). Conclusion From this preliminary study, one-third of patients treated for LCM may present with a cerebral aneurysm. Longitudinal large studies are needed to further clarify this matter

Short-term precision assessment of trabecular bone score and bone mineral density using dual-energy X-ray absorptiometry with different scan modes: an in vivo study

Objectives: We estimated the in vivo reproducibility of trabecular bone score (TBS) from dual-energy X-ray absorptiometry (DXA) using different imaging modes to be compared to that of bone mineral density (BMD).Methods: We enrolled 30 patients for each imaging mode: fast-array, array, high definition. Each patient underwent two DXA examinations with in-between repositioning. BMD and TBS were obtained according to the International Society for Clinical Densitometry guidelines. The coefficient of variation (CoV) was calculated as the ratio between root mean square standard deviation and mean, percent least significant change (LSC) as 2.77 7 CoV, reproducibility as the complement to 100 % LSC.Results: Fast-array imaging mode resulted in 0.8 % CoV and 2.1 % LSC for BMD, 1.9 % and 5.3 % for TBS, respectively; array imaging mode resulted in 0.7 % and 2.0 % for BMD, 1.9 % and 5.2 %, for TBS; high-definition imaging mode resulted in 0.7 % and 2.0 %, for BMD; 2.0 % and 5.4 % for TBS, respectively. Reproducibility of TBS (95 %) was significantly lower than that of BMD (98 %) (p < 0.012). Difference in reproducibility among the imaging modes was not significant for either BMD or TBS (p = 0.942).Conclusion: While TBS reproducibility was significantly lower than that of BMD, differences among imaging modes were not significant for both TBS and BMD.Key Points: \u2022 TBS is an emerging tool for assessing BMD.\u2022 TBS reproducibility is lower than that of BMD.\u2022 Differences between imaging modes are not significant for either TBS or BMD

An eight-year prospective controlled study about the safety and diagnostic value of cardiac and non-cardiac 1.5-T MRI in patients with a conventional pacemaker or a conventional implantable cardioverter defibrillator

Objectives: To investigate safety and diagnostic value of 1.5-T MRI in carriers of conventional pacemaker (cPM) or conventional implantable defibrillator (cICD). Methods: We prospectively compared cPM/cICD-carriers undergoing MRI (study group, SG), excluding those device-dependent or implanted <6 weeks before enrolment or prior to 01/01/2000, with cPM/cICD-carriers undergoing chest x-ray, CT or follow-up (reference group, RG). Results: 142 MRI (55 cardiac) were performed in 120 patients with cPM (n=71) or cICD (n=71). In the RG 98 measurements were performed in 95 patients with cPM (n=40) or cICD (n=58). No adverse events were observed. No MRI prolonged/interrupted. All cPM/cICD were correctly reprogrammed after MRI without malfunctions. One temporary communication failure was observed in one cPM-carrier. Immediately after MRI, 12/14 device interrogation parameters did not change significantly (clinically negligible changes of battery voltage and cICD charging time), without significant variations for SG versus RG. Three\u201312 months after MRI, 9/11 device interrogation parameters did not change significantly (clinically negligible changes of battery impedance/voltage). Non-significant changes of three markers of myocardial necrosis. Non-cardiac MRI: 82/87 diagnostic without artefacts; 4/87 diagnostic with artefacts; 1/87 partially diagnostic. Cardiac MRI: in cPM-carriers, 14/15 diagnostic with artefacts, 1/15 partially diagnostic; in cICD-carriers, 9/40 diagnostic with artefacts, 22 partially diagnostic, nine non-diagnostic. Conclusions: A favourable risk-benefit ratio of 1.5-T MRI in cPM/cICD carriers was reported. Key points: \u2022 Cooperation between radiologists and cardiac electrophysiologists allowed safe 1.5-T MRI in cPM/cICD-carriers.\u2022 No adverse events for 142 MRI in 71 cPM-carriers and 71 cICD-carriers.\u2022 Ninety-nine per cent (86/87) of non-cardiac MRI in cPM/cICD-carriers were diagnostic.\u2022 All cPM-carrier cardiac MRIs had artefacts, 14 examinations diagnostic, 1 partially diagnostic.\u2022 Twenty-three per cent (9/40) of cardiac MRI in cICD-carriers were non-diagnostic