Radiologist as a leader in the diagnostic process in patients with prostate cancer

Multiparametric MRI of the prostate gland is a relatively new diagnostic modality which is gathering a growing interest among urologists and radiologists. The second version of the PI-RADS guidelines enabled standardized imaging, evaluation and reporting of prostatic lesions. Nonetheless, since 2015 - when the PI-RADS v.2 was published, numerous questions regarding imaging of the prostate gland have appeared

CT diagnosis of early stroke : the initial approach to the new CAD tool based on multiscale estimation of ischemia

Background: Computer aided diagnosis (CAD) becomes one of the most important diagnostic tools for urgent states in cerebral stroke and other life-threatening conditions where time plays a crucial role. Routine CT is still diagnostically insufficient in hyperacute stage of stroke that is in the therapeutic window for thrombolytic therapy. Authors present computer assistant of early ischemic stroke diagnosis that supports the radiologic interpretations. A new semantic-visualization system of ischemic symptoms applied to noncontrast, routine CT examination was based on multiscale image processing and diagnostic content estimation. Material/Methods: Evaluation of 95 sets of examinations in patients admitted to a hospital with symptoms suggesting stroke was undertaken by four radiologists from two medical centers unaware of the final clinical findings. All of the consecutive cases were considered as having no CT direct signs of hyperacute ischemia. At the first test stage only the CTs performed at the admission were evaluated independently by radiologists. Next, the same early scans were evaluated again with additional use of multiscale computer-assistant of stroke (MulCAS). Computerized suggestion with increased sensitivity to the subtle image manifestations of cerebral ischemia was constructed as additional view representing estimated diagnostic content with enhanced stroke symptoms synchronized to routine CT data preview. Follow-up CT examinations and clinical features confirmed or excluded the diagnosis of stroke constituting 'gold standard' to verify stroke detection performance. Results: Higher AUC (area under curve) values were found for MulCAS -aided radiological diagnosis for all readers and the differences were statistically significant for random readers-random cases parametric and non-parametric DBM MRMC analysis. Sensitivity and specificity of acute stroke detection for the readers was increased by 30% and 4%, respectively. Conclusions: Routine CT completed with proposed method of computer assisted diagnosis provided noticeable better diagnosis efficiency of acute stroke according to the rates and opinions of all test readers. Further research includes fully automatic detection of hypodense regions to complete assisted indications and formulate the suggestions of stroke cases more objectively. Planned prospective studies will let evaluate more accurately the impact of this CAD tool on diagnosis and further treatment in patients suffered from stroke. It is necessary to determine whether this method is possible to be applied widely

Application of probit method for the elastographic evaluation of venous obliterating material after sclerotherapy procedure

Purpose: Status after sclerotherapy constitutes a good clinical model for venous thrombosis with known age. The aim of this study was to compare elastographic parameters of material obliterating the great saphenous vein at 7-21 days after polidocanol sclerotherapy. Material and methods: The study included 60 patients subjected to sclerotherapy due to venous insufficiency (45 women and 15 men, mean age 51.2 ± 14.7 years, range 27-77 years). Elastographic parameters of obliterating material: total area of vessel cross-section (mm2), relative areas (%) covered by tissues with highest, intermediate, and lowest elasticity, were determined 7 ± 1, 14 ± 2, and 21 ± 2 days post-sclerotherapy, respectively. Mean time to partial and complete organisation of the obliterating material was estimated during probit regression analysis. Results: The relative area of vessel cross-section covered by tissues with the lowest elasticity underwent a statistically significant enlargement, either between the first and the second (Z = 6.725, p 21 days, respectively. Conclusions: Ultrasound elastography may accurately reflect the age of venous thrombosis in polidocanol sclerotherapy model. Mixed, fibro-elastic structure of a 14-day-old obliterating material visualised by elastography probably corresponds with chronic thrombus

Comprehensive imaging of stroke – Looking for the gold standard

Background and purpose Stroke is the third cause of death worldwide. In recent decade there has been a marked progress in treatment and prevention of stroke, which was possible largely due to modern neuroimaging techniques. Early radiological confirmation of the diagnosis allows for introduction of fibrinolytic therapy and evaluation of ischaemic penumbra. Material and methods We have analysed clinical and imaging data of 92 patients with early stages of stroke. The sensitivity, specificity and possible influence on the choice of treatment were assessed for different neuroimaging techniques, including diffusion weighted and perfusion imaging in patients with hyperacute and acute stroke. Results A non-contrast computed tomography (CT) allowed for the detection of early ischaemic changes with an overall sensitivity of 38% and 42% in patients in hyperacute phase. In a perfusion CT study the perfusion abnormalities in the area corresponding to the clinical symptoms were present in 79% of patients. The sensitivity of diffusion weighted imaging (DWI) alone was 95% and in conjunction with perfusion MR reached 100%. Conclusions Our study proves that advanced neuroimaging modalities allow for a substantial increase of sensitivity when detecting changes in patients with acute ischaemic strokes and confirming the clinical diagnosis. We believe that MR in combination with DWI should be the imaging methods of choice in diagnosing acute stroke patients. Perfusion adds significant diagnostic value to structural techniques, particularly in clinically ambiguous cases. In cases with a clear clinical picture the data provided by a non-contrast CT study is sufficient for therapeutic decision making

Electromagnetic Exposure of Personnel Involved in Cardiac MRI Examinations in 1.5T, 3T and 7T Scanners

(1) Background: It has been hypothesised that a significant increase in the use of cardiac magnetic resonance (CMR), for example, when examining COVID-19 convalescents using magnetic resonance imaging (MRI), has an influence the exposure profiles of medical personnel to static magnetic fields (STmf). (2) Methods: Static exposure to STmf (SEmf) was recorded during activities that modelled performing CMR by radiographers. The motion-induced time variability of that exposure (TVEmf) was calculated from SEmf samples. The results were compared with: (i) labour law requirements; (ii) the distribution of vertigo perception probability near MRI magnets; and (iii) the exposure profile when actually performing a head MRI. (3) Results: The exposure profiles of personnel managing 42 CMR scans (modelled using medium (1.5T), high (3T) and ultrahigh (7T) field scanners) were significantly different than when managing a head MRI. The majority of SEmf and TVEmf samples (up to the 95th percentile) were at low vertigo perception probability (SEmf < 500 mT, TVEmf < 600 mT/s), but a small fraction were at medium/high levels; (4) Conclusion: Even under the “normal working conditions” defined for SEmf (STmf < 2T) by labour legislation (Directive 2013/35/EC), increased CMR usage increases vertigo-related hazards experienced by MRI personnel (a re-evaluation of electromagnetic safety hazards is suggested in the case of these or similar changes in work organisation)

Ischaemic background of brain fog in long-haul COVID-19 : a nuclear magnetic resonance spectroscopy-based metabonomic analysis : preliminary results

Purpose: Long-haul COVID-19 is a condition of unknown background occurring in COVID-19 survivors regardless of the severity of the SARS-CoV-2 infection itself. The aim of the study was to evaluate brain changes in patients suffering from variable symptoms of brain fog after COVID-19. Material and methods: Eleven patients hospitalized due to symptoms of severe brain fog, i.e. insomnia, sudden impairment of cognitive function, headache, and depression, and 14 healthy volunteers underwent brain imaging including MR spectroscopy. Results: Routine MR imaging revealed no specific macroscopic changes in keeping with brain fog. Considering that the clinical manifestation of brain fog is transient, the evaluation of the metabolic status of the brain remained the method of choice. The concentration of the major cerebral metabolites, i.e. NAA, Cho, and Cr, remained stable. However, changes in Glx and Lac concentration were observed in MR spectroscopy. Conclusions: Following results along with clinical course of the brain for imply probable ischaemic background of symptoms

Neuroimaging of cerebral venous thrombosis (CVT) : old dilemma and the new diagnostic methods

BACKGROUND: Cerebral venous thrombosis is a relatively uncommon neurologic disorder that is potentially reversible with prompt diagnosis and appropriate medical care. The pathogenesis is multifactorial and the disease may occur at any age. CVT is often associated with nonspecific symptoms. Radiologists play a crucial role in patient care by providing early diagnosis through interpretation of imaging studies. Underdiagnosis or misdiagnosis can increase the risk of severe complications, including hemorrhagic stroke or death. The purpose of this study is to investigate radiological and clinical characteristics of cerebral venous thrombosis (CVT) based on material from 34 patients under care of our hospital. MATERIAL AND METHODS: A total of 34 patients were diagnosed with CVT from August 2009 until March 2015. A clinical and radiological database of patients with final diagnosis of CVT was analyzed. RESULTS: Patient group included 22 women and 12 men at a mean age of 48.7 years (ranging from 27 to 77 years). In the study group 8 patients (23.5%) suffered from hemorrhagic infarction, whereas 16 patients (47%) were diagnosed with venous infarction without hemorrhage. Thirty patients (88%) had transverse sinus thrombosis. CONCLUSIONS: According to our study, CVT was more prevalent in women. Transverse sinus was the most common location. Among all age groups, the highest prevalence was seen in the fifth decade (n=14). Contrast-enhanced CT and MR venography were the most sensitive imaging modalities

Increased brain 1H-MRS glutamate and lactate signals following maximal aerobic capacity exercise in young healthy males: an exploratory study

Physical exercise involves increased neuronal activity of many brain structures, but 1H-MRS investigations on the effects of human brain glutamate (Glu) concentrations on acute exercise have been sparse. Previous studies consistently found increases in brain lactate (Lac) concentrations following graded exercise up to 85% of the predicted maximal heart rate. However, the reported effects on brain concentrations of glutamine and glutamate were not consistent. This study aimed to determine the effect of acute intense graded maximal exercise on 1H-MRS signals related to concentrations of Glu, glutamate+glutamine (Glx), and Lac. Young adult males were randomly divided into two groups and subjected to 1H-MRS when resting (NE) or shortly after cessation of the intense graded exercise intended to pass the anaerobic threshold (E). 1H-MRS spectra were acquired from the large voxel encompassing the occipito-parietal cortex only once. Estimates of Glu, Glx, and Lac concentrations were calculated in institutional units by normalizing to a spectroscopic signal originating from creatine-containing compounds (Cr). Concentrations of Glu, Glx, and Lac were respectively 11%, 12.6%, and 48.5% higher in E than in NE (p < 0.001). The increased brain Lac signal in the exercising group indicated that in our experiment, vigorous exercise resulted in passing the anaerobic threshold and lactate apparently entered the brain. Concomitantly glutamate-related resonance signals from the vicinity of the occipito-parietal cortex were significantly increased; physiological mechanisms underlying these phenomena require further study. Future studies should evaluate whether the normalization rate of these concentrations is a marker of general physical fitness