MRI T2 mapping and quantitative ultrasound shear wave elastography in cartilage integrity assessment for juvenile idiopathic arthritis patients

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood that can lead to irreversible cartilage damage, with associated disability and decreased life quality. Shear wave elastography and quantitative MRI mapping can be used to identify early cartilage affection. Purpose To evaluate diagnostic utility of distal femoral cartilage shear wave elastography and MRI T2 mapping in patients with symptomatic knee and investigate their potential clinical significance. Material and methods Twenty patients with knee affection (study group) and 20 volunteers with the same demographic characteristics but without symptomatic knee pain (control group) were included in the study. A total of 80 knee joints of 40 individuals were evaluated. At the medial, intercondylar, and lateral condylar levels, distal femoral cartilage thickness was measured by B-mode ultrasonography and MRI, stiffness was assessed by shear wave elastography, and T2 relaxation time was measured by MRI. Results The medial, intercondylar, and lateral cartilage thickness measurements were similar between the two groups and no statistically significant difference was observed while measured by US (P value 0.653,0.702,0.607) and MRI (P value 0.414, 0.4187, 0.3903). The shear wave velocity values in the study group were significantly higher than in the control group (P value 0.0202). There was a statistically significant difference between the average T2 relaxation time values for the distal femoral cartilage in the study and the control groups (P value 0.0027). SWE results were statistically significant in moderate and high disease activity while T2* revealed statistically significant p values in low as well as moderate and high disease activity; we found the best cutoff values for detection of cases using shear wave elastography velocity ratio (m/sec) about 4.445 with significant p value = 0.02, sensitivity 59.3% and specificity = 70.45%. Conclusion Shear wave elastography and MRI T2 mapping are reliable, non-invasive, and acceptable methods for the assessment of pathologic cartilage. Better diagnostic information of hyaline cartilage can be obtained by adding up an extra sequence called T2 mapping to the routine MRI protocol of knee

The âivy sign scoreâ on FLAIR MR images: Clinical utility following revascularization in pediatric Moyamoya disease

Purpose: The aim was to evaluate post-operative changes in the Ivy sign on unenhanced fluid-attenuated inversion-recovery (FLAIR) following surgical intervention in pediatric Moyamoya disease (MMD) and assess its clinical utility as an indicator of hemodynamic improvement. Patients and methods: Fifteen pediatric patients with MMD were included in this retrospective study. Surgical revascularization had been done in all patients on the cerebral hemisphere with reduced cerebral vascular reserve (CVR); one of them had bilateral surgery (n = 16). FLAIR examinations were reviewed in each patient, pre and post-operative. We compared the pre and post-operative total Ivy score (TIS) for each of the 16 hemispheres and correlated them with the clinical status. Results: FLAIR images depicted the Ivy sign pre-operatively in all 16 hemispheres and a strong positive correlation between the TIS and the grade of clinical hemispheric symptom (p < 0.00001). Following surgery, reduction of the TIS was seen in 13 (81.25%) out of the 16 hemispheres while the TIS remained unchanged in 3 (18.75%) hemispheres. All patients with reduced Ivy signs post-operatively showed improvement of pre-operative clinical symptoms with moderate positive correlation (p = 0.01). Conclusion: A change in the postoperative Ivy sign can be an indicator of effective cerebral reperfusion in MMD. Keywords: Ivy sign score, FLAIR, Moyamoya, Post-operative, Pediatric, Revascularizatio

The role of dynamic contrast enhanced MR imaging in the assessment of inconclusive ovarian masses

Objectives: To evaluate the diagnostic accuracy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in characterization of inconclusive ovarian tumors, with histologic findings as the reference standard. Patients & methods: DCE-MRI was done in 30 patients with 32 complex ovarian masses, prior to surgical excision. We analyzed the following kinetic parameters: enhancement amplitude (EA) in the form of MRE%, time to peak in the form of T max and maximal slope (MS) and correlated them with histopathology. Results: DCE-MRI showed higher overall accuracy (96%) and specificity (100%) than conventional MRI. Malignant masses showed higher MRE% than benign (p = .004) or borderline masses (p = .036). A shorter T max was found in malignant compared to benign (p = .0002) and borderline (p = .049) masses. MS was best at discrimination between benign, borderline and malignant tumors. Finally, Type III curve showed 100% specificity for invasive malignant tumors. Conclusion: DCE-MRI sequence is a helpful adjunct to conventional MRI for discrimination of inconclusive ovarian masses into benign, borderline and invasive malignant tumors