Search

Background: In the realm of breast cancer diagnosis and treatment, accurately discerning molecular subtypes is of paramount importance, especially when aiming to avoid invasive tests. The updated guidelines for diagnosing and treating HER2 positive advanced breast cancer, as presented at the 2021 National Breast Cancer Conference and the Annual Meeting of the Chinese Society of Clinical Oncology, highlight the significance of this approach. A new generation of drug-antibody combinations has emerged, expanding the array of treatment options for HER2 positive advanced breast cancer and significantly improving patient survival rates. Triple-negative breast cancer (TNBC), on the other hand, may indicate survival outcomes following multi-agent adjuvant chemotherapy. DISCO is a more recent DCE MRI technique that has achieved high spatial and temporal resolution and minimized image artifacts in cases like malignant focal liver lesions, enhanced focal breast lesions, and intracranial aneurysms., Objective: To employ the method mentioned above to differentiate between triple-negative and non-triple-negative as well as HER2 positive and HER2 negative cancer lesions, and to assess the value of quantitative and semi-quantitative parameters in molecularly typing breast cancer., Methods: All participants were scanned with a 3.0-T MR scanner (GE SIGNA™ Premier) using a 16-channel phased-array body coil. Each participant underwent a DISCO DCE-MRI with a scan time of approximately 1 minute and 40 seconds. The ROIs were outlined with the GenIQ software, avoiding regions with blood vessels, susceptibility artifacts, hemorrhage, and necrosis. We evaluated four quantitative parameters (K trans , k ep , v e , v p ) and four semi-quantitative parameters (TTP, MAX Conc, AUC, MAX Slope). The carcinomas were segregated into respective subgroups (HER2+ vs HER2-, TNBC vs non-TNBC, HER2+ vs TNBC) and we compared the eight parameters across these groups. The AUC of the models was compared using DeLong's test as per the ROC analysis., Results: We analyzed a total of 96 female patients, revealing significant differences in the semi-quantitative parameters such as TTP, MAX Conc, AUC, and MAX Slope among different groups. HER2-positive versus HER2-negative exhibited significant differences in quantitative parameters (Ktrans: 0.22 min-1 vs. 0.43 min-1, kep: 0.11 min-1 vs. 0.35 min-1, vp: 0.01 vs. 0.04, all P < 0.05). TNBC versus non-TNBC revealed statistical variations in quantitative parameters (Ktrans: 1.03 min-1 vs. 0.15 min-1, kep: 0.61 min-1 vs. 0.19 min-1, vp: 0.18 vs. 0.01, all P < 0.05). Additionally, HER2-positive compared to TNBC demonstrated significant differences in quantitative parameters (Ktrans: 0.22 min-1 vs. 1.03 min-1, kep: 0.11 min-1 vs. 0.61 min-1, vp: 0.01 vs. 0.18, all P < 0.05). As per ROC analysis, Ktrans, kep, vp, TTP, and MAX Conc effectively differentiated TNBC from non-TNBC, with TTP being the strongest determinant for TNBC. Furthermore, these parameters successfully distinguished between HER2 positive and HER2 negative, with kep being particularly effective in identifying HER2. Importantly, Ktrans, kep, vp, TTP, and MAX Conc were effective in discriminating HER2 positive from TNBC, with kep and TTP exhibiting notable efficacy in this context., Conclusion: Our study suggests that DISCO DCE-MRI derived parameters could serve as reliable quantitative biomarkers for differentiating between TNBC and HER2 positive breast cancer., Competing Interests: Authors DP and DW were employed by company General Electric Healthcare. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Haodong, Jianguo, Pylypenko, Weiqiang, Sheng, Jie and Haige.)

Background: Patient-specific 3-dimensional (3D) computational modelling offers a tailored approach with promising results, but experience using digital-twin fusion on real-time fluoroscopy to guide left atrial appendage closure (LAAC) is unreported., Objectives: To assess whether LAAC guided by fusion of a 3D computational model on real-time fluoroscopy is safe and effective., Methods: We included retrospectively through a multicenter registry all consecutive patients with non-valvular atrial fibrillation (AF) who underwent LAAC guided by artificial intelligence (AI)-enabled computer simulations (FEops, Gent, Belgium) fusion with real-time fluoroscopy. Operators selected the appropriate device size and position in relation to the LAA using FEops HEARTguide™, and a digital twin was provided for image fusion. The primary efficacy endpoint was successful LAAC with the use of a single device, without moderate or greater peri-device leak and/or device related thrombus (DRT) on follow-up imaging. The primary safety endpoint was a composite of major procedural complications including tamponade, stroke, systemic embolism, major bleeding, and device embolization., Results: A total of 106 patients underwent LAAC with an Amulet™ or Watchman FLX™ device using CT-model-fluoroscopy fusion imaging. Device implantation was successful in 100 % of cases. The primary efficacy endpoint was met in 82 patients (89 %). A single-device SINGLE-deployment LAAC procedure was observed in 49 cases (46 %). The primary safety endpoint occurred in 2 patients (1.9 %). After a median follow-up of 405 days, two patients suffered an ischemic stroke and four expired., Conclusions: Fusion of a CT-based 3D computational model on real-time fluoroscopy is a safe and effective approach that may optimize transcatheter LAAC outcomes., Competing Interests: Declaration of competing interest P. Garot is medical director and shareholder of CERC, a CRO dedicated to cardiovascular research. He is proctor for Abbott and has received Advisory/speaker's fees from Abbott, Biosensors, Boston Scientific, Cordis, GE Healthcare, and Terumo outside the submitted work. C. Skurk has received speakers fees from Abiomed and Boston Scientific. A. Gautier has received consulting fees from Abbott, Boston Scientific, GE HealthCare, Medtronic and Terumo outside the submitted work. A.M. Bavo is an employee of FEops. R. Vaillant is an employee of General Electric HealthCare. J. Horvilleur is proctor for Abbott. X. Freixa is proctor for Abbott, Boston Scientific and Lifetech Medical. J. Saw is Consultant and Proctor for Abbott and Boston Scientific. O. De Backer has received institutional research grants and consulting fees from Abbott and Boston Scientific. The other co-authors have nothing to disclose., (Copyright © 2024. Published by Elsevier B.V.)

Rationale and Objectives: To evaluate the performance of virtual MR elastography (vMRE) for predicting microvascular invasion (MVI) in Barcelona Clinic Liver Cancer (BCLC) stage A (≤ 5.0 cm) hepatocellular carcinoma (HCC) and to construct a combined nomogram based on vMRE, multi-b-value DWI models, and clinical-radiological (CR) features., Methods: Consecutive patients with suspected HCC who underwent multi-b-value DWI examinations were prospectively collected. Quantitative parameters from vMRE, mono-exponential, intravoxel incoherent motion, and diffusion kurtosis imaging models were obtained. Multivariate logistic regression was used to identify independent MVI predictors and build prediction models. A combined MRI&#95;Score was constructed using independent quantitative parameters. A visualized nomogram was built based on significant CR features and MRI&#95;Score. The predictive performance of quantitative parameters and models was evaluated., Results: The study included 103 patients (median age: 56 years; range: 35-70 years; 87 males and 16 females). Diffusion-based shear modulus (μ Diff ) exhibited a predictive performance for MVI with area under the curve (AUC) of 0.735. The MRI&#95;Score was developed employing true diffusion coefficient (D), mean kurtosis (MK), and μ Diff . CR model and MRI&#95;Score achieved AUCs of 0.787 and 0.840, respectively. The combined nomogram based on AFP, corona enhancement, tumor capsule, TTPVI, and MRI&#95;Score significantly improved the predictive performance to an AUC of 0.931 (Delong test p < 0.05)., Conclusion: vMRE exhibited great potential for predicting MVI in BCLC stage A HCC. The combined nomogram integrating CR features, vMRE, and quantitative diffusion parameters significantly improved the predictive accuracy and could potentially assist clinicians in identifying appropriate treatment options., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Although neuroimaging investigations have consistently demonstrated that "hyperresponsive" and "hyperconnected" visual cortices may represent the functional substrate of cortical spreading depolarization in patients with migraine with aura, the mechanisms which underpin the brain "tendency" to ignite the cortical spreading depolarization and, consequently, aura phenomenon are still matter of debate. Considering that triggers able to induce aura phenomenon constrain brain to increase global (such as physical activity, stressors and sleep abnormalities) or local (such as bright light visual stimulations) energy demand, a vascular supply unable to satisfy the increased energy requirement could be hypothesized in these patients., Methods: Twenty-three patients with migraine with aura, 25 patients with migraine without aura and 20 healthy controls underwent a 3-Tesla MRI study. Cerebral blood flow and local functional connectivity (regional homogeneity) maps were obtained and registered to the MNI space where 100 cortical regions were derived using a functional local-global normative parcellation. A surrogate estimate of the regional neurovascular coupling for each subject was obtained at each parcel from the correlation coefficient between the z-scored ReHo map and the z-scored cerebral blood flow maps., Results: A significantly higher regional cerebral blood flow across the visual cortex of both hemispheres (i.e. fusiform and lingual gyri) was detected in migraine with aura patients when compared to patients with migraine without aura (p < 0.05, corrected for multiple comparisons). Concomitantly, a significantly reduced neurovascular coupling (p < 0.05, false discovery rate corrected) in the primary visual cortex parcel (VIS-4) of the large-scale visual network was observed in the left hemisphere of patients with migraine with aura (0.23±0.03), compared to both patients with migraine without aura (0.32±0.05) and healthy controls (0.29±0.05)., Conclusions: Visual cortex neurovascular "decoupling" might represent the "link" between the exposure to trigger factors and aura phenomenon ignition. While physiological vascular oversupply may compensate neurovascular demand-supply at rest, it becomes inadequate in case of increased energy demand (e.g. when patients face with trigger factors) paving the way to the aura phenomenon ignition in patients with migraine with aura. Whether preventive treatments may exert their therapeutic activity on migraine with aura restoring the energy demands and cerebral blood flow trade-off within the visual network should be further investigated., (© 2024. The Author(s).)

Study Design: Retrospective Case control Study., Objectives: To analyze the effect of diffuse idiopathic skeletal hyperostosis (DISH) on the occurrence of new thoracolumbar vertebral fragility fractures (VFFs) at different ages., Methods: A retrospective analysis of 564 patients, including 189 patients who presented with new-onset thoracolumbar VFFs and 375 patients without spinal fractures, was performed in 4 age groups (50-59 years, 60-69 years, 70-79 years, and 80+ years). DISH was diagnosed based on computed tomography findings, and the Mata score of each disc space level combined with the maximum number of consecutive ossified segments (MNCOS) for each patient was recorded. Data were compared between the fracture and control groups, and odds ratios (ORs) were calculated for each of the 4 age groups using logistic regression., Results: Both the crude ORs and the adjusted ORs of DISH for VFFs decreased with age, with statistical significance shown in the 50-59 years group (crude OR = 4.373, P = 0.017; adjusted OR = 7.111, P = 0.009) and the 80+ years group (crude OR = 0.462, P = 0.018; adjusted OR = 0.495, P = 0.045). The Mata scores and the MNCOS were significant risk factors for VFFs ( P < 0.05) in the 50-59 years group, but they were protective factors in the 80+ years group, which was more significant in the T11/12-L5/S1 subsegment., Conclusions: The effect of DISH on the occurrence of thoracolumbar VFFs is complex, and in patients above 50 years, it changes from a risk factor to a protective factor with increasing age., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Medical image segmentation is a critical task in healthcare applications, and U-Nets have demonstrated promising results in this domain. We delve into the understudied aspect of receptive field (RF) size and its impact on the U-Net and attention U-Net architectures used for medical imaging segmentation., Approach: We explore several critical elements including the relationship among RF size, characteristics of the region of interest, and model performance, as well as the balance between RF size and computational costs for U-Net and attention U-Net methods for different datasets. We also propose a mathematical notation for representing the theoretical receptive field (TRF) of a given layer in a network and propose two new metrics, namely, the effective receptive field (ERF) rate and the object rate, to quantify the fraction of significantly contributing pixels within the ERF against the TRF area and assessing the relative size of the segmentation object compared with the TRF size, respectively., Results: The results demonstrate that there exists an optimal TRF size that successfully strikes a balance between capturing a wider global context and maintaining computational efficiency, thereby optimizing model performance. Interestingly, a distinct correlation is observed between the data complexity and the required TRF size; segmentation based solely on contrast achieved peak performance even with smaller TRF sizes, whereas more complex segmentation tasks necessitated larger TRFs. Attention U-Net models consistently outperformed their U-Net counterparts, highlighting the value of attention mechanisms regardless of TRF size., Conclusions: These insights present an invaluable resource for developing more efficient U-Net-based architectures for medical imaging and pave the way for future exploration of other segmentation architectures. A tool is also developed, which calculates the TRF for a U-Net (and attention U-Net) model and also suggests an appropriate TRF size for a given model and dataset., (© 2024 The Authors.)

Amplified MRI (aMRI) is a promising new technique that can visualize pulsatile brain tissue motion by amplifying sub-voxel motion in cine MRI data, but it lacks the ability to quantify the sub-voxel motion field in physical units. Here, we introduce a novel post-processing algorithm called 3D quantitative amplified MRI (3D q-aMRI). This algorithm enables the visualization and quantification of pulsatile brain motion. 3D q-aMRI was validated and optimized on a 3D digital phantom and was applied in vivo on healthy volunteers for its ability to accurately measure brain parenchyma and CSF voxel displacement. Simulation results show that 3D q-aMRI can accurately quantify sub-voxel motions in the order of 0.01 of a voxel size. The algorithm hyperparameters were optimized and tested on in vivo data. The repeatability and reproducibility of 3D q-aMRI were shown on six healthy volunteers. The voxel displacement field extracted by 3D q-aMRI is highly correlated with the displacement measurements estimated by phase contrast (PC) MRI. In addition, the voxel displacement profile through the cerebral aqueduct resembled the CSF flow profile reported in previous literature. Differences in brain motion was observed in patients with dementia compared with age-matched healthy controls. In summary, 3D q-aMRI is a promising new technique that can both visualize and quantify pulsatile brain motion. Its ability to accurately quantify sub-voxel motion in physical units holds potential for the assessment of pulsatile brain motion as well as the indirect assessment of CSF homeostasis. While further research is warranted, 3D q-aMRI may provide important diagnostic information for neurological disorders such as Alzheimer's disease.

Background: Tertiary lymphoid structures (TLSs) have prognostic value in intrahepatic cholangiocarcinoma (ICC) patients. Noninvasive tool to preoperatively evaluate TLSs is still lacking., Purpose: To explore the association between TLSs status of ICC and preoperative MRI radiomics analysis., Study Type: Retrospective., Subjects: One hundred and ninety-two patients with ICC, divided into training (T = 105), internal validation groups (V1 = 46), and external validation group (V2 = 41)., Sequence: Coronal and axial single-shot fast spin-echo T2-weighted, diffusion-weighted imaging, T1-weighted, and T1WI fat-suppressed spoiled gradient-recall echo LAVA sequence at 3.0 T., Assessment: The VOIs were drawn manually within the visible borders of the tumors using ITK-SNAP version 3.8.0 software in the axial T2WI, DWI, and portal vein phase sequences. Radiomics features were subjected to least absolute shrinkage and selection operator regression to select the associated features of TLSs and construct the radiomics model. Univariate and multivariate analyses were used to identify the clinical radiological variables associated with TLSs. The performances were evaluated by the area under the receiver operator characteristic curve (AUC)., Statistical Tests: Logistic regression analysis, ROC and AUC, Hosmer-Lemeshow test, Kaplan-Meier method with the log-rank test, calibration curves, and decision curve analysis. P < 0.05 was considered statistically significant., Results: The AUCs of arterial phase diffuse hyperenhancement were 0.59 (95% confidence interval [CI], 0.50-0.67), 0.52 (95% CI, 0.43-0.61), and 0.66 (95% CI, 0.52-0.80) in the T, V1, and V2 cohorts. The AUCs of Rad-score were 0.85 (95% CI, 0.77-0.92), 0.81 (95% CI, 0.67-0.94), and 0.84 (95% CI, 0.71-0.96) in the T, V1, and V2 cohorts, respectively. In cohort T, low-risk group showed significantly better median recurrence-free survival (RFS) than that of the high-risk group, which was also confirmed in cohort V1 and V2., Data Conclusion: A preoperative MRI radiomics signature is associated with the intratumoral TLSs status of ICC patients and correlate significantly with RFS., Level of Evidence: 3 TECHNICAL EFFICACY: Stage 2., (© 2023 International Society for Magnetic Resonance in Medicine.)

Objectives: To construct a combined model based on bi-regional quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), as well as clinical-radiological (CR) features for predicting microvascular invasion (MVI) in solitary Barcelona Clinic Liver Cancer (BCLC) stage A hepatocellular carcinoma (HCC), and to assess its ability for stratifying the risk of recurrence after hepatectomy., Methods: Patients with solitary BCLC stage A HCC were prospective collected and randomly divided into training and validation sets. DCE perfusion parameters were obtained both in intra-tumoral region (ITR) and peritumoral region (PTR). Combined DCE perfusion parameters (C DCE ) were constructed to predict MVI. The combined model incorporating C DCE and CR features was developed and evaluated. Kaplan-Meier method was used to investigate the prognostic significance of the model and the survival benefits of different hepatectomy approaches., Results: A total of 133 patients were included. Total blood flow in ITR and arterial fraction in PTR exhibited the best predictive performance for MVI with areas under the curve (AUCs) of 0.790 and 0.792, respectively. C DCE achieved AUCs of 0.868 (training set) and 0.857 (validation set). A combined model integrated with the α-fetoprotein, corona enhancement, two-trait predictor of venous invasion, and C DCE could improve the discrimination ability to AUCs of 0.966 (training set) and 0.937 (validation set). The combined model could stratify the prognosis of HCC patients. Anatomical resection was associated with a better prognosis in the high-risk group (p < 0.05)., Conclusion: The combined model integrating DCE perfusion parameters and CR features could be used for MVI prediction in HCC patients and assist clinical decision-making., Critical Relevance Statement: The combined model incorporating bi-regional DCE-MRI perfusion parameters and CR features predicted MVI preoperatively, which could stratify the risk of recurrence and aid in optimizing treatment strategies., Key Points: Microvascular invasion (MVI) is a significant predictor of prognosis for hepatocellular carcinoma (HCC). Quantitative DCE-MRI could predict MVI in solitary BCLC stage A HCC; the combined model improved performance. The combined model could help stratify the risk of recurrence and aid treatment planning., (© 2024. The Author(s).)

Purpose: To investigate the safety and value of hyperpolarized (HP) MRI of [1- 13 C]pyruvate in healthy volunteers using deuterium oxide (D 2 O) as a solvent., Methods: Healthy volunteers (n = 5), were injected with HP [1- 13 C]pyruvate dissolved in D 2 O and imaged with a metabolite-specific 3D dual-echo dynamic EPI sequence at 3T at one site (Site 1). Volunteers were monitored following the procedure to assess safety. Image characteristics, including SNR, were compared to data acquired in a separate cohort using water as a solvent (n = 5) at another site (Site 2). The apparent spin-lattice relaxation time (T 1 ) of [1- 13 C]pyruvate was determined both in vitro and in vivo from a mono-exponential fit to the image intensity at each time point of our dynamic data., Results: All volunteers completed the study safely and reported no adverse effects. The use of D 2 O increased the T 1 of [1- 13 C]pyruvate from 66.5 ± 1.6 s to 92.1 ± 5.1 s in vitro, which resulted in an increase in signal by a factor of 1.46 ± 0.03 at the time of injection (90 s after dissolution). The use of D 2 O also increased the apparent relaxation time of [1- 13 C]pyruvate by a factor of 1.4 ± 0.2 in vivo. After adjusting for inter-site SNR differences, the use of D 2 O was shown to increase image SNR by a factor of 2.6 ± 0.2 in humans., Conclusions: HP [1- 13 C]pyruvate in D 2 O is safe for human imaging and provides an increase in T 1 and SNR that may improve image quality., (© 2024 International Society for Magnetic Resonance in Medicine.)

Purpose: To evaluate the role of the magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS) version 2018 features and clinical-pathological factors for predicting the prognosis of alpha-fetoprotein (AFP)-negative (≤ 20 ng/ml) hepatocellular carcinoma (HCC) patients, and to compare with other traditional staging systems., Methods: We retrospectively enrolled 169 patients with AFP-negative HCC who received preoperative MRI and hepatectomy between January 2015 and August 2020 (derivation dataset:validation dataset = 118:51). A prognostic model was constructed using the risk factors identified via Cox regression analysis. Predictive performance and discrimination capability were evaluated and compared with those of two traditional staging systems., Results: Six risk factors, namely the LI-RADS category, blood products in mass, microvascular invasion, tumor size, cirrhosis, and albumin-bilirubin grade, were associated with recurrence-free survival. The prognostic model constructed using these factors achieved C-index of 0.705 and 0.674 in the derivation and validation datasets, respectively. Furthermore, the model performed better in predicting patient prognosis than traditional staging systems. The model effectively stratified patients with AFP-negative HCC into high- and low-risk groups with significantly different outcomes (p < 0.05)., Conclusion: A prognostic model integrating the LI-RADS category, blood products in mass, microvascular invasion, tumor size, cirrhosis, and albumin-bilirubin grade may serve as a valuable tool for refining risk stratification in patients with AFP-negative HCC., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Evaluation of 3D bone morphology of the glenohumeral joint is necessary for pre-surgical planning. Zero echo time (ZTE) magnetic resonance imaging (MRI) provides excellent bone contrast and can potentially be used in place of computed tomography. Segmentation of shoulder anatomy, particularly humeral head and acetabulum, is needed for detailed assessment of each anatomy and for pre-surgical preparation. In this study we compared performance of two popular deep learning models based on Google's DeepLab and U-Net to perform automated segmentation on ZTE MRI of human shoulders. Axial ZTE images of normal shoulders (n=31) acquired at 3-Tesla were annotated for training with a DeepLab and 2D U-Net, and the trained model was validated with testing data (n=13). While both models showed visually satisfactory results for segmenting the humeral bone, U-Net slightly over-estimated while DeepLab under-estimated the segmented area compared to the ground truth. Testing accuracy quantified by Dice score was significantly higher (p<0.05) for U-Net (88%) than DeepLab (81%) for the humeral segmentation. We have also implemented the U-Net model onto an MRI console for a push-button DL segmentation processing. Although this is an early work with limitations, our approach has the potential to improve shoulder MR evaluation hindered by manual post-processing and may provide clinical benefit for quickly visualizing bones of the glenohumeral joint., Competing Interests: Conflicts of Interest: This work was funded by a research grant from General Electric Healthcare. Drs. Carl, Brau, and Fung are employees of General Electric Healthcare.

Background: Limited studies of multiple sclerosis (MS) exist whereby magnetic resonance imaging (MRI) of the brain with consistent imaging protocols occurs at the same time points as collection of healthy lifestyle measures. The aim of this study was to test the feasibility, acceptability and preliminary efficacy of acquiring MRI data as an objective, diagnostic and prognostic marker of MS, at the same time point as brain-healthy lifestyle measures including diet., Methods: Participants living with relapsing remitting MS partook in one structural MRI scanning session of the brain, completed two online 24-hour dietary recalls and demographic and self-reported lifestyle questionnaires (e.g. self-reported disability, comorbidities, physical activity, smoking status, body mass index (BMI), stress). Measures of central tenancy and level of dispersion were calculated for feasibility and acceptability of the research protocols. Lesion count was determined by one radiologist and volumetric analyses by a data analysis pipeline based on FreeSurfer software suite. Correlations between white matter lesion count, whole brain volume analyses and lifestyle measures were assessed using Spearman's rank-order correlation coefficient., Results: Thirteen female participants were included in the study: eligibility rate 90.6% (29/32), recruitment rate 46.9% (15/32) and compliance rate 87% (13/15). The mean time to complete all required tasks, including MRI acquisition was 115.86 minutes ( ± 23.04), over 4 days. Conversion to usual dietary intake was limited by the small sample. There was one strong, negative correlation between BMI and brain volume (r s  = -0.643, p = 0.018) and one strong, positive correlation between physical activity and brain volume (r s  = 0.670, p = 0.012) that were both statistically significant., Conclusions: Acquiring MRI brain scans at the same time point as lifestyle profiles in adults with MS is both feasible and accepted among adult females living with MS. Quantification of volumetric MRI data support further investigations using semi-automated pipelines among people living with MS, with pre-processing steps identified to increase automated feasibility. This protocol may be used to determine relationships between elements of a brain-healthy lifestyle, including dietary intake, and measures of disease burden and brain health, as assessed by T1-weighted and T2-weighted lesion count and whole brain volume, in an adequately powered sample., Trial Registration: The study protocol was retrospectively registered in the Australia New Zealand Clinical Trials Registry (ACTRN12624000296538)., (© 2024. The Author(s).)

Background: The exceptional capabilities of artificial intelligence (AI) in extracting image information and processing complex models have led to its recognition across various medical fields. With the continuous evolution of AI technologies based on deep learning, particularly the advent of convolutional neural networks (CNNs), AI presents an expanded horizon of applications in lung cancer screening, including lung segmentation, nodule detection, false-positive reduction, nodule classification, and prognosis., Methodology: This review initially analyzes the current status of AI technologies. It then explores the applications of AI in lung cancer screening, including lung segmentation, nodule detection, and classification, and assesses the potential of AI in enhancing the sensitivity of nodule detection and reducing false-positive rates. Finally, it addresses the challenges and future directions of AI in lung cancer screening., Results: AI holds substantial prospects in lung cancer screening. It demonstrates significant potential in improving nodule detection sensitivity, reducing false-positive rates, and classifying nodules, while also showing value in predicting nodule growth and pathological/genetic typing., Conclusions: AI offers a promising supportive approach to lung cancer screening, presenting considerable potential in enhancing nodule detection sensitivity, reducing false-positive rates, and classifying nodules. However, the universality and interpretability of AI results need further enhancement. Future research should focus on the large-scale validation of new deep learning-based algorithms and multi-center studies to improve the efficacy of AI in lung cancer screening., (© 2024 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Aim: To report on the performance characteristics of the 5-ring GE Discovery MI PET/CT systems using the AAPM TG-126 report and compare these results to NEMA NU 2-2012 where applicable., Materials and Methods: TG-126 testing was performed on two GE 5-Rings Discovery MI scanners. Tests performed included spatial resolution, PET/CT image-registration accuracy, sensitivity, count rate performance, accuracy of corrections, image contrast, scatter/attenuation correction, and image uniformity. All acquired data were analyzed using scanner console or free software tools as described by TG-126 and the results were then compared to published NEMA NU 2-2012 values., Results: Both scanners gave similar resolution results for TG-126 and NEMA NU 2-2012 and were within manufacturer specifications. Image-registration accuracy between PET and CT using our clinical protocol showed excellent results with values ≤1 mm. Sensitivity using TG-126 was 19.43 cps/kBq while for NEMA the value was 20.73 cps/kBq. The peak noise-equivalent counting rate was 2174 kcps at 63.1 kBq/mL and is not comparable to NEMA NU 2-2012 due to differences in phantoms and methods used to measure and calculate this parameter. The accuracy of corrections for count losses for TG-126 were expressed in SUV values and found to be within 10% of the expected SUV measurement of 1. Image contrast and scatter/attenuation correction using the TG-126 method gave acceptable results. Image uniformity assessment resulted in values within the recommended ± 5% limits., Conclusion: These results show that the 5-ring GE Discovery MI PET/CT scanner testing using TG-126 is reproducible and has similar results to NEMA NU 2-2012 tests where applicable. We hope these results start to form the basis to compare PET/CT systems using TG-126., (© 2024 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

While single-shot late gadolinium enhancement (LGE) is useful for imaging patients with arrhythmia and/or dyspnea, it produces low spatial resolution. One approach to improve spatial resolution is to accelerate data acquisition using compressed sensing (CS). Our previous work described a single-shot, multi-inversion time (TI) LGE pulse sequence using radial k-space sampling and CS, but over-regularization resulted in significant image blurring that muted the benefits of data acceleration. The purpose of the present study was to improve the spatial resolution of the single-shot, multi-TI LGE pulse sequence by incorporating view sharing (VS) and k-space weighted contrast (KWIC) filtering into a GRASP-Pro reconstruction. In 24 patients (mean age = 61 ± 16 years; 9/15 females/males), we compared the performance of our improved multi-TI LGE and standard multi-TI LGE, where clinical standard LGE was used as a reference. Two clinical raters independently graded multi-TI images and clinical LGE images visually on a five-point Likert scale (1, nondiagnostic; 3, clinically acceptable; 5, best) for three categories: the conspicuity of myocardium or scar, artifact, and noise. The summed visual score (SVS) was defined as the sum of the three scores. Myocardial scar volume was quantified using the full-width at half-maximum method. The SVS was not significantly different between clinical breath-holding LGE (median 13.5, IQR 1.3) and multi-TI LGE (median 12.5, IQR 1.6) (P = 0.068). The myocardial scar volumes measured from clinical standard LGE and multi-TI LGE were strongly correlated (coefficient of determination, R 2  = 0.99) and in good agreement (mean difference = 0.11%, lower limit of the agreement = -2.13%, upper limit of the agreement = 2.34%). The inter-rater agreement in myocardial scar volume quantification was strong (intraclass correlation coefficient = 0.79). The incorporation of VS and KWIC into GRASP-Pro improved spatial resolution. Our improved 25-fold accelerated, single-shot LGE sequence produces clinically acceptable image quality, multi-TI reconstruction, and accurate myocardial scar volume quantification., (© 2023 The Authors. NMR in Biomedicine published by John Wiley & Sons Ltd.)

Purpose: To analyze the effectiveness of type II endoleaks (T2E) embolization using intra-operative contrast-enhanced ultrasound (CEUS)., Methods: Consecutive patients treated for T2E underwent a standardized protocol with trans-arterial or trans-lumbar access, large volume embolization, onlay fusion, and intra-operative CEUS. Technical success was defined by exclusion of endoleak by CEUS., Results: Twenty-six patients (mean age 81 ± 11 years old; 89% male) were treated. The mean aneurysm sac enlargement was 11 ± 8 mm from T2E diagnosis. Embolization was performed using Onyx® 18 in all patients with adjunctive coils in 13 patients (50%). After the first embolization, CEUS documented residual T2E in 13 patients (50%). Ten patients (38%) had additional embolization, which successfully eradicated the T2E in seven of them. Technical success was 50% after the first embolization attempt and 77% after additional attempts guided by CEUS (P = 0.080). There was no mortality. Median imaging follow-up was 22 months. Among the 20 patients with no residual T2E on completion CEUS, 16 (80%) had sac stabilization and none required additional interventions for T2E. Of the six patients with residual T2Es on CEUS, three had sac stabilization (50%) and one required additional reintervention for T2E. There was one late aortic rupture at 56 months., Conclusion: One in two patients treated by T2E embolization had residual endoleak on intra-operative CEUS after a first embolization attempt, decreasing to one in four patients after multiple attempts. A negative completion CEUS following embolization was associated with higher rates of sac stabilization and no need for additional T2E embolization., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

The locus coeruleus-norepinephrine system is thought to be involved in the clinical effects of vagus nerve stimulation. This system is known to prevent seizure development and induce long-term plastic changes, particularly with the release of norepinephrine in the hippocampus. However, the requisites to become responder to the therapy and the mechanisms of action are still under investigation. Using MRI, we assessed the structural and functional characteristics of the locus coeruleus and microstructural properties of locus coeruleus-hippocampus white matter tracts in patients with drug-resistant epilepsy responding or not to the therapy. Twenty-three drug-resistant epileptic patients with cervical vagus nerve stimulation were recruited for this pilot study, including 13 responders or partial responders and 10 non-responders. A dedicated structural MRI acquisition allowed in vivo localization of the locus coeruleus and computation of its contrast (an accepted marker of LC integrity). Locus coeruleus activity was estimated using functional MRI during an auditory oddball task. Finally, multi-shell diffusion MRI was used to estimate the structural properties of locus coeruleus-hippocampus tracts. These characteristics were compared between responders/partial responders and non-responders and their association with therapy duration was also explored. In patients with a better response to the therapy, trends toward a lower activity and a higher contrast were found in the left medial and right caudal portions of the locus coeruleus, respectively. An increased locus coeruleus contrast, bilaterally over its medial portions, correlated with duration of the treatment. Finally, a higher integrity of locus coeruleus-hippocampus connections was found in patients with a better response to the treatment. These new insights into the neurobiology of vagus nerve stimulation may provide novel markers of the response to the treatment and may reflect neuroplasticity effects occurring in the brain following the implantation., Competing Interests: AB was an employee of Synergia Medical SA. The firm was not involved in the study design, data collection and analysis, interpretation of the data, the writing of the article, or the decision to submit it for publication. GD was employed by General Electric Healthcare. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Berger, Beckers, Joris, Duchêne, Danthine, Delinte, Cakiroglu, Sherif, Morrison, Sánchez, Macq, Dricot, Vandewalle and El Tahry.)

Acoustic beam shaping with high degrees of freedom is critical for applications such as ultrasound imaging, acoustic manipulation, and stimulation. However, the ability to fully control the acoustic pressure profile over its propagation path has not yet been achieved. Here, we demonstrate an acoustic diffraction-resistant adaptive profile technology (ADAPT) that can generate a propagation-invariant beam with an arbitrarily desired profile. By leveraging wave number modulation and beam multiplexing, we develop a general framework for creating a highly flexible acoustic beam with a linear array ultrasonic transducer. The designed acoustic beam can also maintain the beam profile in lossy material by compensating for attenuation. We show that shear wave elasticity imaging is an important modality that can benefit from ADAPT for evaluating tissue mechanical properties. Together, ADAPT overcomes the existing limitation of acoustic beam shaping and can be applied to various fields, such as medicine, biology, and material science.

Purpose: To compare the efficacy of radiomics models via five machine learning algorithms in predicting the histological grade of hepatocellular carcinoma (HCC) before surgery and to develop the most stable model to classify high-risk HCC patients., Methods: Contrast-enhanced computed tomography (CECT) images of 175 HCC patients before surgery were analysed, and radiomics features were extracted from CECT images (including arterial and portal phases). Five machine learning models, including Bayes, random forest (RF), k-nearest neighbors (KNN), logistic regression (LR), and support vector machine (SVM), were applied to establish the model. The stability of the five models was weighed by the relative standard deviation (RSD), and the lowest RSD value was chosen as the most stable model to predict the histological grade of HCC. The area under the curve (AUC) and Delong tests were devoted to assessing the predictive efficacy of the models., Results: High-grade HCC accounted for 28.57% (50/175) of the 175 patients. The RSD value of AUC via the RF machine learning model was the lowest (2.3%), followed by Bayes (3.2%), KNN (6.4%), SVM (8.7%) and LR (31.3%). In addition, the RF model (AUC = 0.995) was better than the other four models in the training set (p < 0.05), as well as obtained good predictive performance in the test set (AUC = 0.837)., Conclusion: Among the five machine learning models, the RF-based radiomics model was the most stable and performed excellently in identifying high histological grade of HCC., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Hippocampal volume (HV) is a key imaging marker to improve Alzheimer's disease risk prediction. However, longitudinal studies are rare, and hippocampus may also be implicated in the subtle aging-related cognitive decline observed in dementia-free individuals. Our aim was to determine whether HV, measured by manual or automatic segmentation, is associated with dementia risk and cognitive decline in participants with and without incident dementia., Methods: At baseline, 510 dementia-free participants from the French longitudinal ESPRIT cohort underwent magnetic resonance imaging. HV was measured by manual and by automatic segmentation (FreeSurfer 6.0). The presence of dementia and cognitive functions were investigated at each follow-up (2, 4, 7, 10, 12, and 15 years). Cox proportional hazards models and linear mixed models were used to assess the association of HV with dementia risk and with cognitive decline, respectively., Results: During the 15-years follow-up, 42 participants developed dementia. Reduced HV (regardless of the measurement method) was significantly associated with higher dementia risk and cognitive decline in the whole sample. However, only the automatically measured HV was associated with cognitive decline in dementia-free participants., Conclusion: These results suggest that HV can be used to predict the long-term risk of dementia but also cognitive decline in a dementia-free population. This raises the question of the relevance of HV measurement as an early marker of dementia in the general population., (Copyright © 2023 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)