Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR)

Abstract: Observer-driven pattern recognition is the standard for interpretation of medical images. To achieve global parity in interpretation, semi-quantitative scoring systems have been developed based on observer assessments; these are widely used in scoring coronary artery disease, the arthritides and neurological conditions and for indicating the likelihood of malignancy. However, in an era of machine learning and artificial intelligence, it is increasingly desirable that we extract quantitative biomarkers from medical images that inform on disease detection, characterisation, monitoring and assessment of response to treatment. Quantitation has the potential to provide objective decision-support tools in the management pathway of patients. Despite this, the quantitative potential of imaging remains under-exploited because of variability of the measurement, lack of harmonised systems for data acquisition and analysis, and crucially, a paucity of evidence on how such quantitation potentially affects clinical decision-making and patient outcome. This article reviews the current evidence for the use of semi-quantitative and quantitative biomarkers in clinical settings at various stages of the disease pathway including diagnosis, staging and prognosis, as well as predicting and detecting treatment response. It critically appraises current practice and sets out recommendations for using imaging objectively to drive patient management decisions

What Is Your Radiologic Diagnosis?

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Gadolinium Leakage Into Subarachnoid Space And Cystic Metastases

Subarachnoid space (SAS) and cystic metastatic lesions of brain parenchyma appear hypointense on fluid-attenuated inversion-recovery (FLAIR) and T1-weighted magnetic resonance imaging (MRI) unless there is a hemorrhage or elevated protein content. Otherwise, delayed enhancement and accumulation of contrast media in SAS or cyst of metastases should be considered. We present hyperintense SAS and cystic brain metastases of lung cancer on FLAIR and T1-weighted MRI, respectively, in a patient who had been previously given contrast media for imaging of spinal metastases and had mildly impaired renal functions, and discuss the relevant literature.WoSScopu

Neuromyelitis optica spectrum disorder: a pediatric case report

Neuromyelitis optica spectrum disorder(NMOSD) is an autoimmune demyelinating disorder of the central nervous system that predominantly affects the optic nerves and the spinal cord. Magnetic resonance imaging (MRI) has increasingly important role in differentiating NMOSD from other inflammatory disorders of the central nervous system, particularly multiple sclerosis (MS). Specific antibodies against aquaporin-4(AQP4) were identified and found to be directly responsible for the pathogenesis of the disease. We report on an AQP4 antibody-positive 12-year-old female with radiological findings in her brain MRI. [Med-Science 2017; 6(3.000): 562-6

Prognostic Value of Magnetic Resonance Imaging in Post-Resuscitation Encephalopathy

Objective Prediction of the prognosis of comatose survivors after cardiopulmonary arrest (CPA), so-called post-resuscitation encephalopathy (PRE), relies on neurological examination Findings. Early laboratory indicators of poor prognosis (vegetative state/death) are not sensitive enough. Methods We analyzed the results of magnetic resonance (MR) imaging with fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) in 22 consecutive patients with PRE. Clinical details such as arrest place and anoxia time along with neurological examination findings including items of Glasgow coma scale (GCS) and the Full Outline of UnResponsiveness (FOUR) score were determined. Receiver Operator Characteristics (ROC) curves were produced to determine prognostic yield of the parameters studied. Results Prognosis was classified as 'poor' (Glasgow-Pittsburg Cerebral Performance -CPC-score 4 or 5) in 16 and 'better' (CPC score 1-3) in 6 patients. The lower limit of confidence interval (CI) of the area under the curve (AUC) of the ROC was higher than 0.5 for visual, motor and total scores of GCS and FOUR score. Presence of a lesion pattern of multilobar, or diffuse, cortical involvement, termed as "extensive cortical lesion pattern" in MR imaging was a very good predictor of poor prognosis with an AUC of ROC of 0,937. Sensitivity of GCS motor part score and MR was 87.5% (95% CI: 61.6%-92.6%). Motor part of the FOUR score has a slightly lower sensitivity (68.7% with 95% CI from 41.4% to 88.9%). Incorporating of MR to the motor scores (either GCS or FOUR score) improved sensitivity to 100 % (95% CI: 79.2%-100%). AUC of the ROC was 1.000 (95%CI: 0.844-1.000) for the combination of MR and GCS motor score. Conclusion This study provides the preliminary evidence that MRI, when used in conjunction with a neurological examination, may have potential in terms of predicting outcome in patients with PRE.WoSScopu

Is White Matter Affected in Adolescents with Anorexia Nervosa? A Study Using Magnetization Transfer Imaging

The aim of the study was to assess potential changes in structural integrity of the brain in adolescent patients with Anorexia Nervosa (AN) using the magnetization transfer imaging technique and re-evaluating after nutritional rehabilitation was accomplished. Magnetization transfer ratio (MTR) was used for the detection and quantification of histological changes to the white matter of 9 adolescents diagnosed with AN at diagnosis and after weight gain. Using the MTR technique 6 regions were measured: the pons, left cerebellar hemisphere, amygdala, thalamus, corona radiata and white matter adjacent to the left dorsolateral prefrontal cortex. Scans from the patients with AN were also compared with scans from an age-matched subset of 9 healthy controls. Compared with control subjects, the MTR of participants with AN was no different either at the early stages of diagnosis (p=0.62) or after weight recovery (p=0.81). Similarly, comparison of MTR between patients with AN at diagnoses compared with MTR after weight recovery yielded no statistically significant difference (P=0.33). We conclude that MTR was not able to detect any neuropathological alterations in adolescent patients with AN at either diagnosis or after nutritional recovery and the achievement of weight gain.WoSScopu

Value Of Magnetic Resonance Imaging And Audiology In The Emergency Department In Differential Diagnosis Of Peripheral And Central Vertigo

Objective: Vertigo is a common complaint in the emergency room. Vertigo can be central or peripheral in origin and it is important for an emergency physician to make a correct differential diagnosis. The purpose of our study was to emphasize the role of cranial magnetic resonance imaging (MRI) and audiological tests in differential diagnosis of patients who present with vertigo to the emergency room. Material and Methods: Fifty patients (31 female, 19 male, mean age 50.84 years) with vertigo who were admitted to the Hacettepe University Faculty of Medicine Emergency Room (ER) between 01.10.2004 and 31.01.2005 were included in the study. Physical and neurological examinations of all patients were performed by senior residents and all patients were evaluated by Ear Nose Throat specialists. Audio logic and vestibular tests and MRI with 3T (Tesla) magnetic field power were performed in all patients. Results: Among 29 patients with normal neurological examination, only 3 (10.3%) had lesions on MRI. MRI scans revealed lesions suggesting central vertigo etiology in six (18.2%) patients out of 33 with abnormal audiological test suggesting peripheral vestibulopathy. Conclusion: In conclusion, in our prospective study, urgent cranial MRI technique in patients presenting to the emergency room with vertigo may reveal significant findings regarding the differential diagnosis and concomitant pathologies. However, meticulous neurological examination can exclude central vertigo in the majority of the patients.WoSScopu