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Objective: To compare four different methods for the quantitative assessment of dorsal scaphoid displacement in patients with scapholunate ligament tears., Methods: A total of 160 consecutive patients who underwent CT arthrography to evaluate a suspected scapholunate ligament tear were prospectively included in this study approved by the local ethics committee. MR images were available for 65 of these patients. Two readers independently evaluated the dorsal scaphoid displacement on conventional radiographs with the dorsal tangential line (DTL) method, the posterior radioscaphoid angle (PRSA) on both CT and MR, and the radioscaphoid congruency ratio on MR. These measurements were compared in groups of patients with and without scapholunate ligament tears., Results: The measurement interobserver agreement was considered excellent for the DTL and the PRSA on CT (ICC = 0.93 and 0.88, respectively), good for the PRSA (ICC = 0.65) on MR, and moderate for the RSCR (ICC = 0.49). There was a significant increase in the values of DTL and PRSA on CT between patients with normal and ruptured SLIL (p < 0.0001). The same tendency was seen on MR-based methods, but these differences were only significant for one reader. The only method that allowed the differentiation between patients with normal and partially ruptured SLIL was the PRSA on CT. PRSA on CT yielded the best diagnostic performance for SLIL rupture (a sensitivity and a specificity of 70-82% and 70-72%)., Conclusion: DTL on standard radiographs and the PRSA on CT are the most consistent imaging indicators of SDD with an excellent interobserver reproducibility., Key Points: • Dorsal scaphoid displacement is an important prognostic factor in patients with scapholunate instability. • Quantitative assessment of dorsal scaphoid displacement can be performed on conventional radiographs and CT with an excellent reproducibility. • The posterior radioscaphoid angle on CT yielded the best diagnostic performance for the identification of scapholunate ligament tears and the only method allowing differentiation between patients with normal and partially torn ligaments., (© 2022. The Author(s), under exclusive licence to European Society of Radiology.)

Brain regions located between the right fusiform face area (FFA) in the middle fusiform gyrus and the temporal pole may play a critical role in human face identity recognition but their investigation is limited by a large signal drop-out in functional magnetic resonance imaging (fMRI). Here we report an original case who is suddenly unable to recognize the identity of faces when electrically stimulated on a focal location inside this intermediate region of the right anterior fusiform gyrus. The reliable transient identity recognition deficit occurs without any change of percept, even during nonverbal face tasks (i.e., pointing out the famous face picture among three options; matching pictures of unfamiliar or familiar faces for their identities), and without difficulty at recognizing visual objects or famous written names. The effective contact is associated with the largest frequency-tagged electrophysiological signals of face-selectivity and of familiar and unfamiliar face identity recognition. This extensive multimodal investigation points to the right anterior fusiform gyrus as a critical hub of the human cortical face network, between posterior ventral occipito-temporal face-selective regions directly connected to low-level visual cortex, the medial temporal lobe involved in generic memory encoding, and ventral anterior temporal lobe regions holding semantic associations to people's identity., Competing Interests: Declaration of Competing Interest The authors declare no potential conflict of interest., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: This observational CMR study aims to characterize left-ventricular (LV) damage, which may be specifically attributed to COVID-19 and is distant in time from the acute phase, through serial CMR performed during the first year in patients with no prior cardiac disease., Methods: This study included consecutive patients without any prior history of cardiac disease but with a peak troponin-Ic > 50 ng/ml at the time of the first COVID-wave. All had a CMR in the first months after the acute phase, and some had an additional CMR at the end of the first year to monitor LV function, remodeling, and abnormalities evocative of myositis and myocarditis - i.e., increased T1/T2 relaxation times, increased extracellular volume (ECV), and delayed contrast enhancement., Results: Nineteen consecutively admitted COVID-19 patients (17 men, median age 66 [57-71] years) were included. Eight (42%) had hypertension, six (32%) were obese, and 16 (84%) had suffered an acute respiratory distress syndrome. The 1 st CMR, recorded at a median 3.2 [interquartile range: 2.6-3.9] months from the troponin peak, showed (1) LV concentric remodeling in 12 patients (63%), (2) myocardial tissue abnormalities in 11 (58%), including 9 increased myocardial ECVs, and (3) 14 (74%) increased ECVs from shoulder skeletal muscles. The 2 nd CMR, obtained at 11.1 [11.0-11.7] months from the troponin peak in 13 patients, showed unchanged LV function and remodeling but a return to normal or below the normal range for all ECVs of the myocardium and skeletal muscles., Conclusion: Many patients with no history of cardiac disease but for whom an increase in blood troponin-Ic ascertained COVID-19 induced myocardial damage exhibited signs of persistent extracellular edema at a median 3-months from the troponin peak, affecting the myocardium and skeletal muscles, which resolved within a one-year time frame. Associations with long-COVID symptoms need to be investigated on a larger scale now., Clinical Trial Registration: NCT04753762 on the ClinicalTrials.gov site., Competing Interests: The 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 © 2022 Filippetti, Pace, Louis, Mandry, Goehringer, Rocher, Jay, Selton-Suty, Hossu, Huttin and Marie.)

Background: Psychogenic non epileptic seizures (PNES) are a frequent, disabling and costly disorder for which there is no consensual caring. They are considered as a dissociative disorder and they share many common characteristics with post-traumatic stress disorder (PTSD). Nevertheless, their pathophysiology is still unclear. In this study, we plan to obtain new data comparing functional brain activity of participants suffering from PNES, from PTSD and healthy controls via functional brain MRI during resting state and under emotional visual stimulation. The protocol presented hereunder describes an observational study with no direct treatment implication. Nevertheless, it could lead to a better understanding of PNES and to identifying targets for specialised cares of post-traumatic or dissociative disorders, like repetitive transcranial magnetic stimulation., Methods & Analysis: This is a prospective, single-centre, interventional, non-randomized, open, controlled and exploratory clinical study. It will involve 75 adult French, right-handed women in 3 groups, either suffering from PNES or PTSD, or healthy controls. An informed consent will be signed by each participant. All of them will be given psychiatric tests to assess dissociation and alexithymia, psychopathological profile and history, and emotional recognition. Each participant will undergo a functional brain MRI. We will record anatomical images and five functional imaging sequences including emotional periodic oscillatory stimulation, standard emotional stimulation, Go / No Go task under emotional stimulation, and resting state. Analysis will include a descriptive analysis of all participants and the treatment for functional magnetic resonance imaging images of each sequence., Registration, Ethics & Dissemination: This study was approved the regional Protection of Persons Committee under the reference 16.10.01 and by the French National Medical Security Agency under the reference 2016-A01295-46. The protocol and results will be published in peer-reviewed academic medical journals and disseminated to research teams, databases, specialised media and concerned patients' organisations., Competing Interests: The authors have declared that no competing interests exist.

The assessment of gliomas by 18 F-FDOPA PET imaging as an adjunct to MRI showed high performance by combining static and dynamic features to noninvasively predict the isocitrate dehydrogenase (IDH) mutations and the 1p/19q codeletion, which the World Health Organization classified as significant parameters in 2016. The current study evaluated whether other 18 F-FDOPA PET radiomics features further improve performance and the contributions of each of these features to performance. Methods: Our study included 72 retrospectively selected, newly diagnosed glioma patients with 18 F-FDOPA PET dynamic acquisitions. A set of 114 features, including conventional static features and dynamic features, as well as other radiomics features, were extracted and machine-learning models trained to predict IDH mutations and the 1p/19q codeletion. Models were based on a machine-learning algorithm built from stable, relevant, and uncorrelated features selected by hierarchic clustering followed by a bootstrapped feature selection process. Models were assessed by comparing area under the curve using a nested cross-validation approach. Feature importance was assessed using Shapley additive explanations values. Results: The best models were able to predict IDH mutations (logistic regression with L2 regularization) and the 1p/19q codeletion (support vector machine with radial basis function kernel) with an area under the curve of 0.831 (95% CI, 0.790-0.873) and 0.724 (95% CI, 0.669-0.782), respectively. For the prediction of IDH mutations, dynamic features were the most important features in the model (time to peak, 35.5%). In contrast, other radiomics features were the most useful for predicting the 1p/19q codeletion (up to 14.5% of importance for the small-zone low-gray-level emphasis). Conclusion: 18 F-FDOPA PET is an effective tool for the noninvasive prediction of glioma molecular parameters using a full set of amino-acid PET radiomics features. The contribution of each feature set shows the importance of systematically integrating dynamic acquisition for prediction of the IDH mutations as well as developing the use of radiomics features in routine practice for prediction of the 1p/19q codeletion., (© 2022 by the Society of Nuclear Medicine and Molecular Imaging.)

Purpose: This study aimed to compare 123I-FP-CIT SPECT imaging obtained from a 360° cadmium-zinc-telluride (CZT) camera with different focus configurations and from a conventional Anger camera., Methods: This prospective study (NCT03980418) included patients referred to 123I-FP-CIT SPECT imaging who consecutively underwent a 30-minute acquisition on a conventional camera immediately followed by two 15-minute acquisitions on the 360°-CZT camera with, respectively, striatum and brain focus and reconstruction parameters to give equivalent contrast ratios, albeit with higher spatial resolution for the CZT camera. Tomographic count sensitivities were calculated. The images were analyzed through visual, according to 5 independent physicians, and automatic semiquantitative analyses., Results: Ninety-two patients were included in this study. The 360°-CZT camera tomographic count sensitivities showed increases of +25% and +18% for striatum and brain focus, respectively, as well as significantly higher quality scores (P ≤ 0.04) in comparison to the conventional camera. The κ scores of consensual visual analysis were 0.80 and 0.85, and correlation coefficients of semiquantitative analysis for striatum uptakes were 0.75 and 0.76 for the comparisons of images obtained with the 2 cameras, with striatum and brain focus, respectively, for the CZT camera. Advanced age was the single predictor of discordant cases (10/92 [11%]) showing systematically abnormal scans with the conventional camera, potentially as a result of partial volume effect., Conclusions: Irrespective of focus mode, this high-sensitivity 360°-CZT camera provides concordant 123I-FP-CIT SPECT results when compared with a conventional camera, but with shorter acquisition times, higher image quality, and few discordant cases possibly explained by its higher spatial resolution., Competing Interests: Conflicts of interest and sources of funding: Financial support was provided by Nancyclotep Imaging Platform. The authors declare no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Pretreatment ischemic location may be an important determinant for functional outcome prediction in acute ischemic stroke. In total, 143 anterior circulation ischemic stroke patients in the THRACE study were included. Ischemic lesions were semi-automatically segmented on pretreatment diffusion-weighted imaging and registered on brain atlases. The percentage of ischemic tissue in each atlas-segmented region was calculated. Statistical models with logistic regression and support vector machine were built to analyze the predictors of functional outcome. The investigated parameters included: age, baseline National Institutes of Health Stroke Scale score, and lesional volume (three-parameter model), together with the ischemic percentage in each atlas-segmented region (four-parameter model). The support vector machine with radial basis functions outperformed logistic regression in prediction accuracy. The support vector machine three-parameter model demonstrated an area under the curve of 0.77, while the four-parameter model achieved a higher area under the curve (0.82). Regions with marked impacts on outcome prediction were the uncinate fasciculus, postcentral gyrus, putamen, middle occipital gyrus, supramarginal gyrus, and posterior corona radiata in the left hemisphere; and the uncinate fasciculus, paracentral lobule, temporal pole, hippocampus, inferior occipital gyrus, middle temporal gyrus, pallidum, and anterior limb of the internal capsule in the right hemisphere. In conclusion, pretreatment ischemic location provided significant prognostic information for functional outcome in ischemic stroke.

Purpose: This study aimed to determine the impact of carbidopa premedication on static, dynamic and radiomics parameters of 18 F-FDOPA PET in brain tumors., Methods: The study included 54 patients, 18 of whom received carbidopa, who underwent 18 F-FDOPA PET for newly diagnosed gliomas. SUV-derived, 105 radiomics features and TTP dynamic parameters were extracted from volumes of interest in healthy brains and tumors. Simulation of the effects of carbidopa on time-activity curves were generated., Results: All static and TTP dynamic parameters were significantly higher in healthy brain regions of premedicated patients (ΔSUV mean = +53%, ΔTTP = +48%, p < 0.001). Furthermore, carbidopa impacted 81% of radiomics features, of which 92% correlated with SUV mean (absolute correlation coefficient ≥ 0.4). In tumors, premedication with carbidopa was an independent predictor of SUV mean (ΔSUV mean = +52%, p < 0.001) and TTP (ΔTTP = +24%, p = 0.025). All parameters were no longer significantly modified by carbidopa premedication when using ratios to healthy brain. Simulated data confirmed that carbidopa leads to higher tumor TTP values, corrected by the ratios., Conclusion: In 18 F-FDOPA PET, carbidopa induces similarly higher SUV and TTP dynamic parameters and similarly impacts SUV-dependent radiomics in healthy brain and tumor regions, which is compensated for by correcting for the tumor-to-healthy-brain ratio. This is a significant advantage for multicentric study harmonization.

Objectives: Identify the most pertinent imaging features for solitary bone tumor characterization using a multimodality approach and propose a systematic evaluation system., Methods: Data from a prospective trial, including 230 participants with histologically confirmed bone tumors, typical "do not touch" lesions, and stable chondral lesions, were retrospectively evaluated. Clinical data, CT, and MR imaging features were analyzed by a musculoskeletal radiologist blinded to the diagnosis using a structured report. The benign-malignant distribution of lesions bearing each image feature evaluated was compared to the benign-malignant distribution in the study sample. Benign and malignant indicators were identified. Two additional readers with different expertise levels independently evaluated the study sample., Results: The sample included 140 men and 90 women (mean age 40.7 ± 18.3 years). The global benign-malignant distribution was 67-33%. Seven imaging features reached the criteria for benign indicators with a mean frequency of benignancy of 94%. Six minor malignant indicators were identified with a mean frequency of malignancy of 60.5%. Finally, three major malignant indicators were identified (Lodwick-Madewell grade III, aggressive periosteal reaction, and suspected metastatic disease) with a mean frequency of malignancy of 82.4%. A bone tumor imaging reporting and data system (BTI-RADS) was proposed. The reproducibility of the BTI-RADS was considered fair (kappa = 0.67) with a mean frequency of malignancy in classes I, II, III, and IV of 0%, 2.2%, 20.1%, and 71%, respectively., Conclusion: BTI-RADS is an evidence-based systematic approach to solitary bone tumor characterization with a fair reproducibility, allowing lesion stratification in classes of increasing malignancy frequency., Trial Registration: Clinical trial number NCT02895633 ., Key Points: • The most pertinent CT and MRI criteria allowing bone tumor characterization were defined and presented. • Lodwick-Madewell grade III, aggressive periosteal reaction, and suspected metastatic disease should be considered major malignant indicators associated with a frequency of malignancy over 75%. • The proposed evidence-based multimodality reporting system stratifies solitary bone tumors in classes with increasing frequencies of malignancy., (© 2021. European Society of Radiology.)

Background: MRI diagnostic criteria of shoulder adhesive capsulitis (AC) are nowadays widely used, but there is little information available on the association between MRI findings and clinical impairment., Purpose: To determine the correlation of MRI findings with the Constant-Murley Score (CMS), pain duration and symptoms at the one-year follow-up in AC patients., Materials and Methods: This monocentric prospective study included 132 patients with a clinical diagnosis of shoulder AC who underwent shoulder MRI. Mean patient age was 54.1 ± 9.3 years, and there were 55 men and 77 women. A radiologist examined all patients and completed the CMS just prior to MRI. Pain duration was assessed along with the signal intensity and measured the maximal thickness of the inferior glenohumeral ligament (IGHL) by two radiologists. Medical record analysis was performed in a sub-group of 49 patients to assess prognosis approximately one year after the MRI examination. Linear regression analysis with the Pearson test and the Fisher exact test were used to determine the association between MRI findings and clinical impairment., Results: There was a significant difference in mean pain duration score (3.8 ± 1.2 versus 3.2 ± 0.9 and 3.8 ± 1.2 versus 3.2 ± 0.9, respectively, for readers 1 and 2) and in mean mobility scores (15.7 ± 8 points versus 19.6 ± 10.1 points and 15.8 ± 8.2 points versus 19.4 ± 10 points, respectively, for readers 1 and 2) in patients with a high IGHL signal compared to those with a low IGHL signal ( p < 0.05). IGHL was thicker in patients with clinical improvement at one-year follow-up compared to those presenting clinical stability or worsening ( p < 0.05)., Conclusions: In patients with shoulder AC, the degree of signal intensity at the IGHL was inversely related to shoulder pain duration and range of motion, and a thickened IGHL indicated a favorable outcome at one-year follow-up.

The physiological mechanism induced by the isocitrate dehydrogenase 1 (IDH1) mutation, associated with better treatment response in gliomas, remains unknown. The aim of this preclinical study was to characterize the IDH1 mutation through in vivo multiparametric MRI and MRS. Multiparametric MRI, including the measurement of blood flow, vascularity, oxygenation, permeability, and in vivo MRS, was performed on a 4.7 T animal MRI system in rat brains grafted with human-derived glioblastoma U87 cell lines expressing or not the IDH1 mutation by the CRISPR/Cas9 method, and secondarily characterized with additional ex vivo HR-MAS and histological analyses. In univariate analyses, compared with IDH1-, IDH1+ tumors exhibited higher vascular density (p < 0.01) and better perfusion (p = 0.02 for cerebral blood flow), but lower vessel permeability (p < 0.01 for time to peak (TTP), p = 0.04 for contrast enhancement) and decreased T 1 map values (p = 0.02). Using linear discriminant analysis, vascular density and TTP values were found to be independent MRI parameters for characterizing the IDH1 mutation (p < 0.01). In vivo MRS and ex vivo HR-MAS analysis showed lower metabolites of tumor aggressiveness for IDH1+ tumors (p < 0.01). Overall, the IDH1 mutation exhibited a higher vascularity on MRI, a lower permeability, and a less aggressive metabolic profile. These MRI features may prove helpful to better pinpoint the physiological mechanisms induced by this mutation., (© 2021 John Wiley & Sons, Ltd.)

Background  In this study we sought to evaluate the contribution of dynamic four-dimensional computed tomography (4DCT) relative to the standard imaging work-up for the identification of the dorsal intercalated segment instability (DISI) in patients with suspected chronic scapholunate instability (SLI). Methods  Forty patients (22 men, 18 women; mean age 46.5 ± 13.1 years) with suspected SLI were evaluated prospectively with radiographs, arthrography, and 4DCT. Based on radiographs and CT arthrography, three groups were defined: positive SLI ( n  = 16), negative SLI ( n  = 19), and questionable SLI ( n  = 5). Two independent readers used 4DCT to evaluate the lunocapitate angle (LCA) (mean, max, coefficient of variation [CV], and range values) during radioulnar deviation. Results  The interobserver variability of the 4DCT variables was deemed excellent (intraclass correlation coefficient = 0.79 to 0.96). Between the three groups, there was no identifiable difference for the LCA mean . The LCA max values were lower in the positive SLI group (88 degrees) than the negative SLI group (102 degrees). The positive SLI group had significantly lower LCA cv (7% vs. 12%, p  = 0.02) and LCA range (18 vs. 27 degrees, p  = 0.01) values than the negative SLI group. The difference in all the LCA parameters between the positive SLI group and the questionable SLI group was not statistically significant. When comparing the negative SLI and questionable SLI groups, the LCA cv ( p  = 0.03) and LCA range ( p  = 0.02) values were also significantly different. The best differentiation between patients with and without SLI was obtained with a LCA cv and LCA range threshold values of 9% (specificity of 63% and sensitivity of 62%) and 20 degrees (specificity of 71% and sensitivity of 63%), respectively. Conclusion  In this study, 4DCT appeared as a quantitative and reproducible relevant tool for the evaluation of DISI deformity in cases of SLI, including for patients presenting with questionable initial radiography findings. Level of evidence  This is a Level III study., Competing Interests: Conflict of Interest P.A.G.T. and A.B. participate on a non-remunerated research contract with TOSHIBA Medical Systems for the development and clinical testing of postprocessing tools for musculoskeletal CT. The remaining authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Thieme. All rights reserved.)

Background: Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders, and death. Left ventricular (LV) replacement myocardial fibrosis, a marker of maladaptive remodeling, has been described in patients with MVP, but the implications of this finding remain scarcely explored. We aimed at assessing the prevalence, pathophysiological and prognostic significance of LV replacement myocardial fibrosis through late gadolinium enhancement (LGE) by cardiac magnetic resonance in patients with MVP., Methods: Four hundred patients (53±15 years of age, 55% male) with MVP (trace to severe MR by echocardiography) from 2 centers, who underwent a comprehensive echocardiography and LGE cardiac magnetic resonance, were included. Correlates of replacement myocardial fibrosis (LGE+), influence of MR degree, and ventricular arrhythmia were assessed. The primary outcome was a composite of cardiovascular events (cardiac death, heart failure, new-onset atrial fibrillation, arterial embolism, and life-threatening ventricular arrhythmia)., Results: Replacement myocardial fibrosis (LGE+) was observed in 110 patients (28%; 91 with myocardial wall including 71 with basal inferolateral wall, 29 with papillary muscle). LGE+ prevalence was 13% in trace-mild MR, 28% in moderate MR, and 37% in severe MR, and was associated with specific features of mitral valve apparatus, more dilated LV and more frequent ventricular arrhythmias (45% versus 26%, P <0.0001). In trace-mild MR, despite the absence of significant volume overload, abnormal LV dilatation was observed in 16% of patients and ventricular arrhythmia in 25%. Correlates of LGE+ in multivariable analysis were LV mass (odds ratio, 1.01 [95% CI, 1.002-1.017], P =0.009) and moderate-severe MR (odds ratio, 2.28 [95% CI, 1.21-4.31], P =0.011). LGE+ was associated with worse 4-year cardiovascular event-free survival (49.6±11.7 in LGE+ versus 73.3±6.5% in LGE-, P <0.0001). In a stepwise multivariable Cox model, MR volume and LGE+ (hazard ratio, 2.6 [1.4-4.9], P =0.002) were associated with poor outcome., Conclusions: LV replacement myocardial fibrosis is frequent in patients with MVP; is associated with mitral valve apparatus alteration, more dilated LV, MR grade, and ventricular arrhythmia; and is independently associated with cardiovascular events. These findings suggest an MVP-related myocardial disease. Last, cardiac magnetic resonance provides additional information to echocardiography in MVP.

Background and Hypothesis: There is no consensus on the optimal endovascular management of the extracranial internal carotid artery steno-occlusive lesion in patients with acute ischemic stroke due to tandem occlusion. We hypothesized that intracranial mechanical thrombectomy plus emergent internal carotid artery stenting (and at least one antiplatelet therapy) is superior to intracranial mechanical thrombectomy alone in patients with acute tandem occlusion., Study Design: TITAN is an investigator-initiated, multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) study. Eligibility requires a diagnosis of acute ischemic stroke, pre-stroke modified Rankin Scale (mRS)≤2 (no upper age limit), National Institutes of Health Stroke Scale (NIHSS)≥6, Alberta Stroke Program Early Computed Tomography Score (ASPECTS)≥6, and tandem occlusion on the initial catheter angiogram. Tandem occlusion is defined as large vessel occlusion (intracranial internal carotid artery , M1 and/or M2 segment) and extracranial severe internal carotid artery stenosis ≥90% (NASCET) or complete occlusion. Patients are randomized in two balanced parallel groups (1:1) to receive either intracranial mechanical thrombectomy plus internal carotid artery stenting (and at least one antiplatelet therapy) or intracranial mechanical thrombectomy alone within 8 h of stroke onset. Up to 432 patients are randomized after tandem occlusion confirmation on angiogram., Study Outcomes: The primary outcome measure is complete reperfusion rate at the end of endovascular procedure, assessed as a modified Thrombolysis in Cerebral Infarction (mTICI) 3, and ≥4 point decrease in NIHSS at 24 h. Secondary outcomes include infarct growth, recurrent clinical ischemic event in the ipsilateral carotid territory, type and dose of antiplatelet therapy used, mRS at 90 (±15) days and 12 (±1) months. Safety outcomes are procedural complications, stent patency, intracerebral hemorrhage, and death. Economics analysis includes health-related quality of life, and costs utility comparison, especially with the need or not of endarterectomy., Discussion: TITAN is the first randomized trial directly comparing two types of treatment in patients with acute ischemic stroke due to anterior circulation tandem occlusion, and especially assessing the safety and efficacy of emergent internal carotid artery stenting associated with at least one antiplatelet therapy in the acute phase of stroke reperfusion., Trial Registration: ClinicalTrials.gov NCT03978988.

Objective: To assess the use of a volumetric image display simulation tool (VDST) for the evaluation of applied radiological neuroanatomy knowledge and spatial understanding of radiotherapy technologist (RTT) undergraduates., Methods: Ninety-two third-year RTT students from three French RTT schools took an examination using software that allows visualization of multiple volumetric image series. To serve as a reference, 77 first- and second-year undergraduates, as well as ten senior neuroradiologists, took the same examination. The test included 13 very-short-answer questions (VSAQ) and 21 exercises in which examinees positioned markers onto preloaded brain MR images from a healthy volunteer. The response time was limited. Each correct answer scored 100 points, with a maximum possible test score of 3,400 (VSAQ = 1,300; marker exercise = 2,100). Answers were marked automatically for the marker positioning exercise and semi-automatically for the VSAQs against prerecorded expected answers., Results: Overall, the mean test score was 1,787 (150-3,300) and the standard deviation was 781. Scores were highly significantly different between all evaluated groups (p < 0.001). The interoperator reproducibility was 0.90. All the evaluated groups could be discriminated by VSAQ, marker, and overall total scores independently (p ≤ 0.0001 to 0.001). The test was able to discriminate between the three schools either by VSAQ scores (p < 0.001 to 0.02) or by overall total score (p < 0.001 to 0.05)., Conclusion: This software is a high-quality evaluation tool for the assessment of radiological neuroanatomy knowledge and spatial understanding in RTT undergraduates., Key Points: • This VDST allows volumetric image analysis of MR studies. • A high reliability test could be created with this tool. • Test scores were strongly associated with the examinee expertise level.

Objectives: To develop and validate a customized variant for fetal biometry of the generic OSAUS score (Objective Structured Assessment of Ultrasound Skills) METHODS: The 5-points OSAUS METHOD grid was elaborated by defining five target skills specific to fetal biometry for each thematic item of the generic score. The level of skills of 43 trainees was prospectively assessed during an ultrasound examination by using this grid. The results of the "novice" level group (experience<10 ultrasounds) were compared to those of the "intermediate" level group (experience≥10 ultrasounds) (I). The reached/non-reached skills ratio within the different items composing the score allowed the identification of priority areas of improvement (II). Previously published distribution and actual distribution of ratings according to the generic pass/fail score were compared (III)., Results: Median scores of "novices" (n=29) and "intermediates" (n=14) groups were statistically different, 1.87 (±0.75) and 3.31 (±0.83) (P=1.85-5), respectively and corresponded to the pre-existing experience (I). A lower ratio of reached skill allowed the identification of "documentation of the examination" item as a priority area of improvement for both groups (II). The relevance of the pass/fail score is consolidated, even if an overlap was observed between novices and intermediates groups (III)., Conclusions: The relevancy and feasibility of using OSAUS scoring method for fetal biometry are supported. In addition, the possibility of comparisons with generic OSAUS remains., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: Mechanical thrombectomy (MT) increases functional independence in patients with acute ischaemic stroke with anterior circulation large vessel occlusion (LVO), and the probability to achieve functional independence decreases by 20% for each 1-hour delay to reperfusion. Therefore, we aim to investigate whether direct angiosuite transfer (DAT) is superior to standard imaging/emergency department-based management in achieving 90-day functional independence in patients presenting with an acute severe neurological deficit likely due to LVO and requiring emergent treatment with MT., Methods and Analysis: DIRECT ANGIO (Effect of DIRECT transfer to ANGIOsuite on functional outcome in patient with severe acute stroke treated with thrombectomy: the randomised DIRECT ANGIO Trial) trial is an investigator-initiated, multicentre, prospective, randomised, open-label, blinded endpoint (PROBE) study. Eligibility requires a patient ≤75 years, pre-stroke modified Rankin Scale (mRS) 0-2, presenting an acute severe neurological deficit and admitted within 5 hours of symptoms onset in an endovascular-capable centre. A total of 208 patients are randomly allocated in a 1:1 ratio to DAT or standard management. The primary outcome is the rate of patients achieving a functional independence, assessed as mRS 0-2 at 90 days. Secondary endpoints include patients presenting confirmed LVO, patients eligible to intravenous thrombolysis alone, patients with intracerebral haemorrhage and stroke-mimics, intrahospital time metrics, early neurological improvement (reduction in National Institutes of Health Stroke Scale by ≥8 points or reaching 0-1 at 24 hours) and mRS overall distribution at 90 days and 12 months. Safety outcomes are death and intracerebral haemorrhage transformation. Medico-economics analyses include health-related quality of life and cost utility assessment., Ethics and Dissemination: The DIRECT ANGIO trial was approved by the ethics committee of Ile de France 1. Study began in April 2020. Results will be published in an international peer-reviewed medical journal., Trial Registration Number: NCT03969511., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To assess the validity and reliability of the posterior radioscaphoid angle (PRSA), an indicator of dorsal displacement of the scaphoid, in distinguishing wrists with and without chronic scapholunate instability (SLI)., Methods: We prospectively evaluated 40 patients (22 men and 18 women; mean age, 46 ± 13 years) with suspected SLI with radiographs and computed tomography arthrography. Based on these data, 3 groups were defined: positive SLI (n = 16), negative SLI (n = 19), and questionable SLI (n = 5). An independent reader measured the PRSA on sagittal computed tomography images using the same procedure., Results: The PRSA median values were significantly lower in the negative SLI group (98°) compared with the positive SLI (110°) and questionable SLI (111°) groups. The difference between the positive SLI and questionable SLI groups was not significant. The best differentiation between patients with and without SLI was obtained with a PRSA threshold value of 103° (specificity of 86% and sensitivity of 79%)., Conclusions: In this preliminary study, PRSA analysis offers a quantitative tool for the evaluation of dorsal scaphoid displacement in cases of SLI, including for patients presenting with questionable initial radiography findings., Type of Study/level of Evidence: Diagnostic II., (Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

OBJECTIVE. The purpose of this study was to evaluate the variation of the posterior radioscaphoid (RS) angle in patients with and without scapholunate ligament (SLL) tears during wrist radioulnar deviation. SUBJECTS AND METHODS. Seventy-three patients with clinically suspected scapholunate instability were prospectively evaluated with 4D CT and CT arthrography from February 2015 to April 2018. The posterior RS angle is formed between the articular surface of the scaphoid fossa of the radius and the most posterior point of the scaphoid in the sagittal plane. Two independent radiologists calculated this angle during radioulnar deviation. Posterior RS angles were correlated with the SLL status and the presence of a scapholunate diastasis on conventional stress radiographs. RESULTS. Readers 1 and 2 found mean posterior RS angles of 99° and 98°, respectively, in patients without and 107° and 111°, respectively, in patients with a scapholunate diastasis. The posterior RS angle amplitude varied 7.6-9.3° in the subgroups studied. The reproducibility of posterior RS angle measurement was considered good (intraclass correlation coefficient, 0.73). Mean posterior RS angles increased 6-10% and 12-14% when patients with an intact SLL were compared with those with partial tears and full tears, respectively ( p < 0.001). These values also increased 8-13% when patients with diastasis were compared with those without ( p < 0.0001). A dynamic acquisition was not necessary to assess this angle, with neutral posterior RS angles yielding a sensitivity of 64% and 72% and specificity of 79% and 94% for the diagnosis of SLL tears by readers 1 and 2, respectively. CONCLUSION. Posterior RS angle tended to increase with the severity of SLL tears and with the presence of scapholunate instability and yielded high sensitivity and specificity for the detection of SLL tears.

Several studies have shown a significant relationship between smelling and olfactory imagery abilities. The primary aim of the present study was to validate a French version of the Vividness of Olfactory Imagery Questionnaire (VOIQ). The secondary aim was to investigate its capability to differentiate individuals with smell loss from healthy individuals. After having elaborated a French translation of the VOIQ (fVOIQ), we evaluated olfactory imagery abilities of 387 French participants who anonymously self-completed the fVOIQ: 121 pathologic individuals (hyposmic and anosmic), 244 normosmic individuals (healthy non-expert), and 22 fragrance experts. Significant split-half reliability as expressed by Spearman correlation coefficients for the global sample, as well as for each group separately, indicated the excellent internal consistency of the fVOIQ. Moreover, results revealed a significant effect of the smelling ability group on fVOIQ score, suggesting that daily olfactory stimulation is fundamental to maintaining the ability to create a vivid image and that severe loss of smell may result in progressive impairment of olfactory imagery. Our fVOIQ and the original English version seemingly have similarly high benefit in differentiating experts and normosmic individuals based on their olfactory imagery ability. Moreover, the fVOIQ seems capable of differentiating individuals with loss of smell from healthy individuals. These findings demonstrate the reliability and validity of the fVOIQ, and its capability to differentiate individuals' smelling ability according to their olfactory imagery ability., Competing Interests: The 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 © 2020 Fantin, Ceyte, Ramdane-Cherif, Jacquot and Hossu.)

Objective: To determine whether hemisphere involvement and infarct location on the Alberta Stroke Program CT Score (ASPECTS) template should serve as predictors of 90-day clinical outcome in patients with acute ischemic stroke with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with mechanical thrombectomy (MT)., Methods: We analyzed data of all consecutive patients included in the Endovascular Treatment in Ischemic Stroke registry between January 1, 2012, and August 31, 2018, who presented with a pretreatment DWI-ASPECTS 0-5 and underwent MT. Multivariable analyses were performed in order to identify the role of infarct location and hemisphere involvement on good outcome defined by a modified Rankin Scale (mRS) score 0-2 at 90 days and on the whole distribution of mRS (shift analysis)., Results: A total of 344 patients with a DWI-ASPECTS 0-5 (median 4, IQR 3-5) were included. Neither infarct location nor hemisphere involvement was found to be an independent predictor of good outcome. Involvement of the M6 region in right-sided strokes (adjusted odds ratio [aOR] 2.6, 99% confidence interval [CI] 1.14-5.8; p = 0.003) and the internal capsule in left-sided strokes (aOR 2.6, 99% CI 0.8-7.9; p < 0.020) independently predicted increased disability on the mRS distribution in the affected subpopulations., Conclusion: Our study suggests that neither hemisphere nor infarct location should be considered as an exclusion criterion for MT in patients with stroke with pretreatment DWI-ASPECTS 0-5. The involvement of specific regions of interest was associated with increased disability. These may provide valuable information regarding stroke management options and neurologic recovery for use of caregivers in the postacute phase., (© 2020 American Academy of Neurology.)

Background: Fetal biometry quality directly influences obstetrical care relevance. However, obstetrician proficiencies are heterogeneous in particular during initial training., Objectives: To assess the predictive value of OSAUS scale to identify operators with enough command to perform a valid estimation of fetal weight (EFW) (I). This study also assesses OSAUS intra-operator inter-exams variability (II) and pass/fail score relevancy (III)., Methods: Lecturers in Nancy University Hospital assessed trainees' proficiency for EWF systematically and prospectively through OSAUS scale. The trainee assessment was performed right after the one of the senior operator (reference EFW) on three consecutive patients during standard care ultrasounds. To ensure variability in proficiency within the sample, previous practice was taken into account during enrollment ("novices" and "intermediates" for<20 and 20 past exams, respectively). Correlation between mean OSAUS and validity of EFW (a valid EFW was defined by a difference with the reference EWF<0.8 Z-score) and variability between consecutive assessments were assessed., Results: The study population was constituted of 8 "novice" and 8 "intermediate" trainees. Association between OSAUS and EFW validity was significant (P<0.03) (I). Intra-operator inter-exams variability was majored in the "novice" group (coefficients of variation were 25% vs. 10% in "novice" and "intermediate" group respectively) (II). Within the sample, specificity and positive predictive value of a pass/fail score OSAUS>3.5 to predict EFW validity were 77% and 71%, respectively (III)., Conclusion: A 3.5 OSAUS pass/fail score could provide a relevant threshold to estimate operator proficiency in assessing fetal biometry in an autonomous and secure way., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: Pre-eclampsia (PE) and intrauterine growth restriction (IUGR) are two major pregnancy complications, related to chronic uteroplacental hypoperfusion. Nowadays, there is no screening or diagnostic test for uteroplacental vascularisation deficiency in pregnant women. Since 2004, 3 three-imensional power Doppler (3DPD) angiography has been used for the evaluation of uteroplacental vascularisation and three vascular indices are usually calculated: Vascularisation Index (VI), Flow Index (FI) and vascularisation-FI (VFI). A high intraobserver and interobserver reproducibility and a potential interest for placental function study were reported by our team and others.The main objective of our study is to determine differences in 3DPD indices at first trimester between pregnancies defined at their outcome as uncomplicated pregnancy, PE (mild and severe) and IUGR in nulliparous women., Methods and Analysis: This is a national multicentre prospective cohort study conducted in four French maternity units. We expect to include 2200 women in a period of 36 months. The nulliparous pregnant women will be recruited during their first trimester consultation (11-13+6 gestation week (GW)).The 3DPD and uterine artery Doppler acquisition will be included in the current routine 11-13+6 GW ultrasound. Also, additional blood samples will be taken for biomarker analysis (PAPP-A and P1GF) and biological collection. Uteroplacental VIs (FI and VFI) will be measured. For each subgroup (uncomplicated pregnancy, PE and IUGR), mean values in 3DPD indices will be computed and compared using a pairwise t test with a Bonferroni correction p value adjustment., Ethics and Dissemination: The study was approved by the French Ethics Committee, the Comité de Protection des Personnes SUD MEDITERRANEE IV on 13 February 2018 with reference number 17 12 03. The results of this study will be published in a peer-reviewed journal and will be presented at relevant conferences., Trial Registration Number: NCT03342014; Pre-results. PHRCN-16-0567., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although accumulating evidence has demonstrated the benefit of mechanical thrombectomy (MT) in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), it is still unclear how workflow metrics impact the clinical outcomes of this subgroup of patients., Methods: Patients with acute stroke and diffusion-weighted imaging (DWI) ASPECTS ≤5 at baseline, who underwent MT within 6 hours of symptoms onset, were included from a prospectively maintained national multicentric registry between January 1, 2012 to August 31, 2017. The degree of disability was assessed by the modified Rankin Scale (mRS) at 90 days. The primary outcome was functional independence defined as mRS 0 to 2 at 90 days., Results: The study included 291 patients with baseline DWI-ASPECTS ≤5. Good outcome was achieved in 82 (28.2%) patients, and 104 (35.7%) patients died within 90 days. Successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) rate was 75.3%, and median onset to recanalization (OTR) time was 2 268min. Among time-related variables, OTR emerged as the strongest predictor of primary outcome (adjusted OR for every 60 min 0.59, 95% CI 0.44 to 0.77; p<0.001). mTICI 2c-3 independently predicted a good outcome (adjusted OR 1.91, 95% CI 1.004 to 3.6; p=0.049) along with age and baseline DWI-ASPECTS. Recanalization status failed to significantly impact outcome in the DWI-ASPECTS 0-3 subpopulation., Conclusions: Near complete reperfusion (mTICI 2c-3) and OTR are the strongest modifiable outcome predictors in patients with DWI-ASPECTS ≤ 5 treated with MT., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

We performed a prospective study to evaluate the values of dynamic four-dimensional computed tomography in assessing suspected chronic scapholunate instability. Forty patients were evaluated with radiographs, arthrography, and four-dimensional computed tomography. On plain radiographs and computed tomography, we found 16 patients with definite scapholunate instability, five with questionable scapholunate instability, and 19 with absence of scapholunate instability. We used four-dimensional computed tomography to evaluate the size of the scapholunate gap during radioulnar deviation. The mean and maximal values of the gap size were lowest in the patients with absence of scapholunate instability and highest in those with definite scapholunate instability. When comparing the scapholunate gap sizes of the patients with absent and questionable scapholunate instability, the range of the gap sizes was significantly higher in the patients with questionable scapholunate instability. We conclude that four-dimensional computed tomography aids assessment of chronic scapholunate instability, which allows the differentiation between patients without and those with definite or questionable scapholunate instability. Level of evidence: II.

Background: Hippocampal atrophy is associated with cognitive decline. Determining the clinical features associated with hippocampal volume (HV)/atrophy may help in tailoring preventive strategies., Objective: This study was aimed to investigate the association between HV (at visit 2) and vascular status (both at visit 1 and visit 2) in a cohort of individuals aged 60+ with hypertension and without overt cognitive impairment at visit 1 (visit 1 and visit 2 were separated by approximately 8 years)., Methods: Hippocampal volume was estimated in brain MRIs as HV both clinically with the Scheltens' Medial Temporal Atrophy score, and automatically with the Free Surfer Software application. A detailed medical history, somatometric measurements, cognitive tests, leukoaraiosis severity (Fazekas score), vascular parameters including pulse wave velocity, central blood pressure, and carotid artery plaques, as well as several biochemical parameters were also measured., Results: 113 hypertensive patients, 47% male, aged 75.1±5.6 years, participated in both visit 1 and visit 2 of the ADELAHYDE study. Age (β= -0.30) and hypertension duration (β= -0.20) at visit 1 were independently associated with smaller HV at visit 2 (p < 0.05 for all). In addition to these variables, low body mass index (β= 0.18), high MRI Fazekas score (β= -0.20), and low Gröber-Buschke total recall (β= 0.27) were associated with smaller HV at visit 2 (p < 0.05 for all)., Conclusion: In a cohort of older individuals without cognitive impairment at baseline, we described several factors associated with lower HV, of which hypertension duration can potentially be modified.

Context: Variability in 2D ultrasound (US) is related to the acquisition of planes of reference and the positioning of callipers and could be reduced in combining US volume acquisitions and anatomical structures recognition., Objectives: The primary objective is to assess the consistency between 3D measurements (automated and manual) extracted from a fetal US volume with standard 2D US measurements (I). Secondary objectives are to evaluate the feasibility of the use of software to obtain automated measurements of the fetal head, abdomen and femur from US acquisitions (II) and to assess the impact of automation on intraobserver and interobserver reproducibility (III)., Methods and Analysis: 225 fetuses will be measured at 16-30 weeks of gestation. For each fetus, six volumes (two for head, abdomen and thigh, respectively) will be prospectively acquired after performing standard 2D biometry measurements (head and abdominal circumference, femoral length). Each volume will be processed later by both a software and an operator to extract the reference planes and to perform the corresponding measurements. The different sets of measurements will be compared using Bland-Altman plots to assess the agreement between the different processes (I). The feasibility of using the software in clinical practice will be assessed through the failure rate of processing and the score of quality of measurements (II). Interclass correlation coefficients will be used to evaluate the intraobserver and interobserver reproducibility (III)., Ethics and Dissemination: The study and related consent forms were approved by an institutional review board (CPP SUD-EST 3) on 2 October 2018, under reference number 2018-033 B. The study has been registered in https://clinicaltrials.gov registry on 23 January 2019, under the number NCT03812471. This study will enable an improved understanding and dissemination of the potential benefits of 3D automated measurements and is a prerequisite for the design of intention to treat randomised studies assessing their impact., Trial Registration Number: NCT03812471; Pre-results., Competing Interests: Competing interests: The authors CC-V, CR, LR, are part of Philips Research Development. Philips Research is the sponsor of the EPICEA study. The other authors (GAG, GH, CB, OM, MB) are part of CHRU Nancy and have been mandated by Philips Research to design, to set up and to carry out this research., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Knowledge about the mechanisms leading to the establishment of uteroplacental vascularisation is inadequate, and some of what has been thought to be known for decades has recently been challenged by showing that the intervillous space, the major area of maternal-fetal exchange, appears to be perfused by maternal blood at as early as 6 weeks of gestation. The vascular flow then seems relatively constant until 13 weeks when it appears to increase suddenly., Objectives: The principal objective is to quantify the perfusion of the intervillous space by contrast-enhanced ultrasonography (CEUS) during the first-trimester at three different gestational ages (8, 11 and 13 weeks). The secondary objectives are to: (1) describe the indicators of vascularisation of the placenta (intervillous space) and the myometrium at the three gestational ages, measured by CEUS and three-dimensional power Doppler (3DPD) angiography; (2) compare the diagnostic performance of CEUS and 3DPD for the demonstration and quantification of uteroplacental vascularisation and (3) establish a biological collection of placentas to increase knowledge about placental development and functions during pregnancy., Methods and Analysis: This is a prospective, cross-sectional, multicentre and non-randomised open study. We will include 42 women with ongoing pregnancy and divided into three groups of gestational ages (ie, 14 women by per group): 8, 11 and 13 weeks of gestation. 3DPD and then CEUS will be performed and the data about the perfusion kinetics and the 3DPD indices will be calculated and then compared with each other and for each gestational age., Ethics and Dissemination: The appropriate French Ethics Committee Est III approved this study and the related consent forms on 5 April 2016, and the competent authority (Agence Nationale de Sécurité du Médicament et des Produits de Santé) authorised the study on 21 June 2016. The results of this study will be published in a peer-reviewed journal and will be presented at relevant conferences., Trial Registration Numbers: ClinicalTrials.gov registry (NCT02884297); EudraCT registry (2015-005655-27)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Evaluate and compare the image quality and acceptance of a full MBIR algorithm to that of an earlier full IR hybrid algorithm and filtered back projection (FBP)., Methods: Acquisitions were performed with a 320 detector-row CT scanner with seven different dose levels. Images were reconstructed with three algorithms: FBP, full hybrid iterative reconstruction (HIR), and a full model-based iterative reconstruction algorithm (full MBIR). The sensitometry, spatial resolution, image texture, and low-contrast detectability of these algorithms were compared. Subjective analysis of low-contrast detectability was performed. Ten radiologists answered a questionnaire on image quality and confidence in full MBIR images in clinical practice., Results: The contrast-to-noise ratio of full MBIR was significantly higher than in the other algorithms (p < 0.0015). The spatial resolution was also higher with full MBIR at high frequencies (> 0.3 lp/mm). Full MBIR at low dose levels led to better low-contrast detectability and more inserts being identified with a higher confidence (p < 0.0001). Full MBIR was associated with a change in image texture compared to HIR and FBP. Eighty percent of radiologists judged general appearance and texture of full MBIR images worse than HIR. Moreover, compared with HIR, for 50% of radiologists, the diagnostic confidence on full MBIR images was worse. Questionnaire reliability was considered acceptable (Cronbach alpha 0.7)., Conclusion: Compared to conventional iterative reconstruction algorithms, full MBMIR presented a higher image quality and low-contrast detectability and a worse acceptance among radiologists., Key Points: • Full MBIR used led to an overall improvement in image quality compared with FBP and HIR. • Full MBIR leads to image texture change which reduces the confidence in these images among radiologists. • Awareness of the image texture change and improved quality of full MBIR reconstructed images could improve the acceptance of this technique in clinical practice.

Background and Purpose- Acute stroke patients with a large ischemic core may still benefit from mechanical thrombectomy (MT), but the predictors of clinical outcome are not well known after MT. We investigated the clinical and imaging factors associated with good outcome and mortality at 90 days in acute stroke patients with a large baseline ischemic core treated with MT. Methods- Data from the multicentric prospective ETIS (Endovascular Treatment in Ischemic Stroke) registry of consecutive acute ischemic stroke patients treated with MT from January 1, 2012, to August 31, 2016, were retrospectively analyzed. Baseline large ischemic core was defined as diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score of ≤5. The degree of disability was assessed by the modified Rankin Scale at 90 days. Outcomes included good outcome (modified Rankin Scale score of ≤2), and mortality (modified Rankin Scale score of 6). Results- Among 216 patients with DWI-Alberta Stroke Program Early CT Score of ≤5 (median DWI volume 77 mL, interquartile range 52-120 mL) treated with MT, good outcome was achieved in 55 (25.4%) patients and 75 (34.7%) died at 90 days. Hemorrhagic transformation was detected in 40 (18.5%) patients within 24 hours post-MT. Older age (adjusted odds ratio [OR] for every 10 years, 0.62; 95% CI, 0.48-0.80; P<0.001) and increased DWI lesional volume (adjusted OR, 0.98; 95% CI, 0.97-0.99; P<0.001) were associated with a lower chance of achieving a good outcome, while successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grades of ≤2b) predicted good outcome (adjusted OR, 4.56; 95% CI, 1.79-11.62; P=0.001). Successful recanalization (OR, 0.46; 95% CI, 0.22-0.97; P=0.042), increased DWI lesional volume (OR, 1.02; 95% CI, 1.01-1.03; P<0.001), age (OR for every 10 years, 1.72; 95% CI, 1.31-2.26; P<0.001), and diabetes mellitus (OR, 3.23; 95% CI, 1.34-7.8; P=0.009) were independent predictors of 90-day mortality. Conclusions- Successful recanalization and baseline DWI lesional volume are the strongest predictors of outcome in stroke patients with a large ischemic core.

Objective: to compare quantitative kinematic 4-D CT parameters between healthy volunteers and pathologic patients (joint stiffness or chronic ankle instability)., Methods: Thirteen healthy volunteers without previous ankle trauma, 18 patients with clinical subtalar joint stiffness and 10 patients with chronic ankle instability diagnosed based on clinical and imaging findings were prospectively evaluated with 4-D CT. This study was approved by the local ethics committee and all patients signed an informed consent. The subtalar joint was evaluated during a prono-supination cycle. Two angles and two distances between the talus and the calcaneus were measured semi-automatically and independently by two readers. Measurement variations were compared in these three different groups., Results: There were statistically significant differences between axial and coronal talocalcaneal angles of healthy volunteers and patients with joint stiffness (p < 0.0001). The best sensitivities and specificities for the identification of subtalar joint stiffness were 92-100% and 74-94%. Mean and maximal posterior calcaneal facet uncovering were significantly lower in patients with chronic ankle instability patients compared to healthy volunteers (p < 0.006) with sensitivities and specificities of 92-95% and 80-92% respectively., Conclusion: Quantitative analysis in 4D CT can provide an objective criteria for the differentiation between healthy volunteers and patients with subtalar joint stiffness and chronic ankle instability., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Endovascular therapy has been shown to be an effective and safe treatment for tandem occlusion. The endovascular therapeutic strategies for tandem occlusions strokes have not been adequately evaluated and the best approach is still controversial. The TITAN (Thrombectomy in TANdem occlusions) registry was a result of a collaborative effort to identify the best therapeutic approach for acute ischemic stroke due to tandem lesion. In this review, we aim to summarize the main findings of the TITAN study and discuss the challenges of treatment for tandem occlusion in the era of endovascular thrombectomy. Methods: A review of the data from the multicenter international observational and non-randomized TITAN registry was performed. The TITAN registry included acute ischemic stroke patients with tandem lesions (proximal intracranial occlusion and cervical carotid artery occlusion or stenosis>90%) who were treated with thrombectomy with or without carotid artery stenting. Results: Prior intravenous thrombolysis and emergent cervical carotid stenting were associated with higher reperfusion (mTICI 2b-3 and mTICI 3) rates at the end of the intervention. Poor outcome did not occur more frequently after stenting than after conservative treatment of the cervical carotid lesion. Emergent carotid stenting with antithrombotic agents and intracranial thrombectomy yielded higher reperfusion rate and good outcome (90 day mRS 0-2) compared to other strategies (carotid artery stenting and thrombectomy without antithrombotic, angioplasty and thrombectomy, or thrombectomy alone). Pretreatment intravenous thrombolysis was not associated with increased risk of hemorrhagic complications. Likewise, periprocedural unfractionated heparin did not modify the efficacy and safety results. Etiology of carotid artery lesion (atherosclerosis vs. dissection) did not emerge as predictor of outcome or recanalization. Conclusion: Emergent stenting of the cervical carotid lesion with antithrombotic agents in conjunction to thrombectomy appears to be the best treatment strategy for acute ischemic strokes with tandem lesions. These findings will be further investigated in the ongoing randomized controlled TITAN trial.

Background and Purpose: A long clot, defined by a low (0-6) clot burden score (CBS) assessed by T2*-MR sequence, is associated with worse clinical outcome after intravenous thrombolysis (IVT) for acute ischemic stroke than is a small clot (CBS, 7-10). The added benefit of mechanical thrombectomy (MT) might be higher in patients with long clot. The aim of this pre-specified post hoc analysis of the THRombectomie des Artères CErebrales (THRACE) trial was to assess the association between T2*-CBS, successful recanalization and clinical outcome., Methods: Of 414 patients randomized in the THRACE trial, 281 patients were included in this analysis. Associations between T2*-CBS and clinical outcome on the modified Rankin Scale (mRS) at 3 months were tested., Results: High T2*-CBS, i.e., small clot, was associated with a shift toward better outcome on the mRS; proportional odds ratio (POR) per point CBS was 1.19 (95% confidence interval [CI], 1.05 to 1.34) in the whole population, 1.34 (95% CI, 1.13 to 1.59) in IVT group, and 1.04 (95% CI, 0.87 to 1.23) in IVTMT group. After adjustment for baseline prognostic variables, the effect of the full scale T2*-CBS was not statistically significant in the whole population and for the IVTMT group but remains significant for the IVT group (POR, 1.32; 95% CI, 1.11 to 1.58)., Conclusion: s A small clot, as assessed using T2*-CBS, is associated with improved outcome and may be used as a prognostic marker. Despite the worst outcome with long clot, the relative benefit of MT over IVT seemed to increase with low T2*-CBS and longer clot.

Purpose: To evaluate the impact of hormonal therapy on MRI characteristics of desmoid-type fibromatosis on T1-weighted, T2-weighted fat-saturated and post-contrast sequences., Materials and Methods: Nineteen patients with histologically-proven desmoid-type fibromatosis were prospectively followed up on MR imaging. Eight patients underwent hormonal therapy and 11 were only surveyed. Change in tumor size during follow-up was analyzed according to RECIST. Signal intensity on T1-weighted, T2-weighted fat-saturated and T1-weighted fat-saturated post-contrast images was graded from 0 to 5 using adjacent normal muscle as reference. Findings were compared with tumor growth and treatment option., Results: There were seven men and 12 women with a mean age of 42.2±16.4 (SD) years (range: 18 - 64 years) yielding twenty-six follow-up periods: eight of tumor progression and 18 of tumor stability/regression (some tumors exhibited more than one behavior type). Hormonal therapy was associated with tumor stability or regression (P=0.0207). There was a significant reduction in enhancement among treated patients with stable/regressing disease (P=0.049). The mean variation in enhancement grade was -1.3±1.2 in these patients. All successfully treated patients presented a reduction in enhancement. Lesions with marked low enhancement or very low signal on T2-weighted images were rare in progressing lesions (0% and 13%)., Conclusion: Hormonal therapy has an impact on desmoid-type fibromatosis signal characteristics reducing lesion enhancement., (Copyright © 2018 Soci showét showé françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the feasibility and reproducibility of artificial intelligence software (Smartplanes ® ) to automatically identify the transthalamic plane from 3D ultrasound volumes and to measure the biparietal diameter (BPD) and head circumference (HC) in fetus., Material and Methods: Thirty fetuses were evaluated at 17-30 weeks' gestation. For each fetus two three-dimensional (3D) volumes of the fetal head along with one conventional two-dimensional (2D) image of the transthalamic plane were prospectively acquired. The Smartplanes ® software identified the transthalamic plane from the 3D volumes and performed BPD and HC measurements automatically (3D auto). Two experienced sonographers also measured BPD and HC from 2D images and from the 3D volumes. Measurements were compared using Bland-Altman plots. Interclass correlation coefficient (ICC) was used to evaluate intra- and interobserver reproducibility., Results: For each series of measurements, intra- and interobserver reproducibility rates were high with ICC values>0.98. The 95% confidence intervals between the BPD measurements were 2mm (3D versus 2D) and 4mm (3D auto versus 2D) and the HC measurements were 7.5mm (3D versus 2D) and 11mm (3D auto versus 2D)., Conclusion: Fetal head measurements obtained automatically by Smartplanes ® software from 3D volumes show good agreement with those obtained by two experienced sonographers from conventional 2D images and 3D volumes. The reproducibility of these measurements is similar to that observed by experienced sonographers., (Copyright © 2018 Soci showét showé françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Objective: The purpose of this study was to evaluate the diagnostic performance of quantitative perfusion parameters in 3-T MRI for benign-malignant differentiation in musculoskeletal tumors., Subjects and Methods: Ninety-five patients with histologically proven musculoskeletal tumors were prospectively included in this study. All patients underwent 3-T contrast-enhanced perfusion MRI with T1 mapping. The extended Tofts pharmacokinetic model was used to obtain four semiquantitative and four quantitative perfusion parameters for each tumor. Two radiologists evaluated all images and manually placed the ROIs in consensus., Results: The 95 patients had 57 (59%) benign and 38 (41%) malignant tumors. Thirty-seven (39%) were bone and 58 (61%) were soft-tissue tumors. No significant differences were found in the perfusion parameters of benign and malignant tumors (p = 0.105-0.609). The best performance for benign-malignant differentiation was found for fractional volume of the extravascular extracellular space, which yielded 79% and 38% sensitivity and specificity. When soft-tissue tumors were considered, the transfer constant from plasma to the extravascular extracellular space exhibited a significant difference (p = 0.028) and had 79% and 27% sensitivity and specificity., Conclusion: Quantitative perfusion MRI had fair sensitivity and poor specificity for benign-malignant differentiation, which was similar to that obtained with semiquantitative parameters.

Surgical laparoscopic procedures in the retroperitoneal and supramesocolic spaces are increasingly frequent. There is a high risk of iatrogenic intraoperative injury of the retroperitoneal lymphatic structures during these procedures. A precise understanding of the anatomy of the thoracic duct (TD) and the cisterna chyli (CC) is essential for safe surgical procedures in this area. However, routine imaging procedures rarely and often incorrectly visualize the CC. The objective of this study was to evaluate the feasibility of a retrograde injection of the TD to fill the CC with a contrast agent in 16 human cadavers. Both magnetic resonance lymphography (MRI) and computed tomography (CT) studies could be performed on the same anatomical specimen, using a contrast medium which hardened, allowing gross dissection. MRI and CT detectability were evaluated, and imaging results were compared with the anatomical dissection. The CC of 12/16 cadavers were successfully injected, and four were unsuccessful due to technical difficulties, showing the effectiveness of the method. This technique can improve understanding of the anatomy of the TD and CC and provides an original option to study the complex anatomy of these structures by correlating precise cadaveric dissections with cross-sectional imaging., (© 2018 Anatomical Society.)

We report the case of a patient (MB, young female human subject) who systematically experienced confusion between perceived facial identities specifically when electrically stimulated inside the lateral section of the right fusiform gyrus. In the presence of a face stimulus (an experimenter or a photograph), intracerebral electrical stimulation in this region generated a perceptual hallucination of an individual facial part integrated within the whole perceived face, i.e., facial palinopsia. In the presence of a distracting stimulus (visual scene or object picture), the patient also experienced an individual face percept superimposed on the non-face stimulus. The stimulation site evoking this category-selective transient palinopsia was localized in a region showing highly selective responses to faces both with functional magnetic resonance imaging ("Fusiform Face Area", "FFA") and intracerebral electrophysiological recordings during fast periodic visual stimulation (FPVS). Importantly, the largest electrophysiological response to fast periodic changes of facial identity was also found at this location. Altogether, these observations suggest that the face-selective right lateral fusiform gyrus plays a role in generating vivid percepts of individual faces, supporting the active role of this region in individual face representation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate by cardiac magnetic resonance imaging (MRI) the impact of microvascular obstruction (MVO) on regional left ventricular (LV) wall characteristics and local remodeling after acute myocardial infarction (AMI)., Materials and Methods: In all, 114 AMI patients underwent cardiac MRI at 3T within 2-4 days (baseline) and at 6 months (follow-up) after reperfusion. Late gadolinium enhancement and cine sequences were performed. The impact of MVO (ie, presence and extent) on regional wall thickening (WT, %), end-diastolic wall thickness (EDWT, mm), and local cavity change (mm) of LV were quantitatively analyzed. Local cavity change, calculated as surface-to-surface distance from registered endocardial surface meshes of cine imaging datasets acquired initially and at follow-up, was used to assess local remodeling., Results: MVO was detected in 69 patients (60.5%). WT was significantly lower when MVO was present (P < 0.05); and it was inversely related to MVO transmural extent (P < 0.0001). WT improvement was significantly worsened when MVO was present in segments with infarct transmural extent exceeding 50%. Significant wall thinning occurred at follow-up in segments with infarct transmural extent >75% with further thinning by MVO presence; and EDWT decreased with increasing MVO transmural extent (P < 0.0001). LV cavity shrank in patients without MVO, whereas it dilated in those with MVO. Local cavity changes were not significantly different by a region-to-region analysis throughout the LV within each group (P = 0.57 and 0.74, respectively)., Conclusion: MVO has a significant adverse effect on LV wall characteristics and LV remodeling. Postinfarct remodeling seems to be globally mediated rather than locally mediated during the first 6 months., Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:499-510., (© 2017 International Society for Magnetic Resonance in Medicine.)

Rationale and Objectives: This study aimed to determine the value of dual-energy thoracic radiography in the diagnosis of pneumothorax considering the reader's experience., Materials and Methods: Forty patients with a suspected pneumothorax, imaged with dual-energy chest radiographs, were divided into two groups: those with pneumothorax as the final diagnosis (n = 19) and those without (n = 21). The images were analyzed by 36 readers (5 interns, 16 residents, 15 senior physicians) for the presence or absence of pneumothorax during three readout sessions at 2-week intervals: standard images alone (session 1), dual-energy images with bone subtraction alone (session 2), and a combination of the two (session 3)., Results: The number of correct responses increased 13.3% between sessions 1 and 2 (P < .001) and 9.4% between sessions 1 and 3 (P < .001). The mean sensitivity for pneumothorax detection was higher in sessions 2 (82%) and 3 (79%) compared to session 1 (70%). There was no statistically significant difference in specificity between the sessions. The number of correct responses for small volume pneumothoraces was higher in sessions 2 (10.6 ± 1.8) and 3 (10.1 ± 2.0) than in session 1 (8.9 ± 2.3), with a statistically significant difference between sessions 1 and 2 (P = .002) and between sessions 1 and 3 (P = .048)., Conclusion: Bone subtracted dual-energy thoracic radiographs improve the detection sensitivity of pneumothorax, including in cases of small pneumothoraces, regardless of the reader's level or expertise., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

The objective of this study was to develop a simple and useful injection protocol for imaging cadaveric vascularization and dissection. Mixtures of contrast agent and cast product should provide adequate contrast for two types of ex vivo imaging (MRI and CT) and should harden to allow gross dissection of the injected structures. We tested the most popular contrast agents and cast products, and selected the optimal mixture composition based on their availability and ease of use. All mixtures were first tested in vitro to adjust dilution parameters of each contrast agent and to fine-tune MR imaging acquisition sequences. Mixtures were then injected in 24 pig livers and one human pancreas for MR and computed tomography (CT) imaging before anatomical dissection. Colorized latex, gadobutrol and barite mixture met the above objective. Mixtures composed of copper sulfate (CuSO 4 ) gadoxetic acid (for MRI) and iodine (for CT) gave an inhomogeneous signal or extravasation of the contrast agent. Agar did not harden sufficiently for gross dissection but appears useful for CT and magnetic resonance imaging (MRI) studies without dissection. Silicone was very hard to inject but achieved the goals of the study. Resin is particularly difficult to use but could replace latex as an alternative for corrosion instead of dissection. This injection protocol allows CT and MRI images to be obtained of cadaveric vascularization and anatomical casts in the same anatomic specimen. Post-imaging processing software allow easy 3D reconstruction of complex anatomical structures using this technique. Applications are numerous, e.g. surgical training, teaching methods, postmortem anatomic studies, pathologic studies, and forensic diagnoses., (© 2017 Anatomical Society.)

Objective: We aimed to characterize the association between pretreatment lesional volume measured on diffusion-weighted images and functional outcome, and estimate the impact on thrombectomy efficacy for ischemic stroke with anterior proximal intracranial arterial occlusion., Methods: Anterior circulation ischemic stroke patients who had pretreatment diffusion-weighted imaging in the THRACE study were included. Lesional volume was semiautomatically segmented. Logistic regression was applied to model clinical outcome as a function of lesional volume. Outcomes included functional independence (modified Rankin Scale [mRS] 0-2), degree of disability (ordinal mRS 0-6), and mortality at 3 months., Results: Of 298 included patients, with median lesional volume 17.2ml (interquartile range [IQR], 9.2-51.8) and median mRS 2 (IQR, 1-4), 51.0% achieved functional independence. Increased lesional volume was an independent predictor for a lower probability of functional independence (odds ratio [OR], 0.90 [95% confidence interval {CI}, 0.81-0.99] per 10ml; p < 0.001), a less favorable degree of disability (common OR, 0.86 [95% CI, 0.81-0.90] per 10ml; p < 0.001), and a higher mortality rate (OR, 1.21 [95% CI, 1.08-1.37] per 10ml; p < 0.001). For additional thrombectomy, the number of patients needed to treat to achieve functional independence in 1 patient increased with lesional volume (10 for a volume of 80ml; 15 for 135ml). No significant treatment-by-dichotomized volume interaction for functional independence and mortality was observed., Interpretation: Pretreatment lesional volume is an independent predictor for functional outcome in acute ischemic stroke with proximal intracranial occlusion. The clinical benefit of adding mechanical thrombectomy to thrombolysis decreased with the increase of lesional volume. Ann Neurol 2018;83:178-185., (© 2018 American Neurological Association.)

Mild cognitive impairment and Alzheimer's dementia involve a grey matter disease, quantifiable by 18 F-Fluorodeoxyglucose positron emission tomography (FDG-PET), but also white matter damage, evidenced by diffusion tensor magnetic resonance imaging (DTI), which may play an additional pathogenic role. This study aimed to determine whether such DTI and PET variations are also interrelated in a high-risk population of older hypertensive patients with only subjective memory complaints (SMC). Sixty older hypertensive patients (75 ± 5 years) with SMC were referred to DTI and FDG-PET brain imaging, executive and memory tests, as well as peripheral and central blood pressure (BP) measurements. Mean apparent diffusion coefficient (ADC mean ) was determined in overall white matter and correlated with the grey matter distribution of the metabolic rate of glucose (CMRGlc) using whole-brain voxel-based analyses of FDG-PET images. ADC mean was variable between individuals, ranging from 0.82 to 1.01.10 - 3  mm 2  sec - 1 , and mainly in relation with CMRGlc of areas involved in Alzheimer's disease such as internal temporal areas, posterior associative junctions, posterior cingulum but also insulo-opercular areas (global correlation coefficient: - 0.577, p  < 0.001). Both the ADC mean and CMRGlc of the interrelated grey matter areas were additionally and concordantly linked to the results of executive and memory tests and to systolic central BP (all p  < 0.05). Altogether, our findings show that cross-sectional variations in overall white brain matter are linked to the metabolism of Alzheimer-like cortical areas and to cognitive performance in older hypertensive patients with only subjective memory complaints. Additional relationships with central BP strengthen the hypothesis of a contributing pathogenic role of hypertension.

Purpose: To evaluate the impact of coil design and motion-resistant sequences on the quality of sacroiliac magnetic resonance imaging (MRI) examination in patients with spondyloarthropathy., Patients and Methods: One hundred and twenty-one patients with suspected sacroiliitis and referred for MRI of the sacroiliac joints were retrospectively evaluated with MRI at 3-Tesla. There were 78 women and 43 men with a mean age of 36.7±11.5 (SD) years (range: 15.8-78.4 years). Conventional and motion-resistant fat-saturated fast-spin echo T2-weighted sequences were performed with two different coils. Image quality was subjectively evaluated by two independent readers (R1 and R2) using a four-point scale. Confidence in the identification of bone marrow edema pattern (BMEP) was also evaluated subjectively using a three-point scale., Results: Phased array body coil yielded improved image quality compared to surface coil (14.1 to 30.4% for R1 and 14.6 to 25.7% for R2; P<0.0001). The impact of the sequence type on quality was also statistically significant (P=0.0046). BMEP was identified in 40 patients and best inter-reader agreement was obtained using the combination of phased-array body coil with motion-resistant T2-weighted sequence (kappa 0.990). The smallest number of indeterminate BMEP zones was seen on MRI set acquired with the phased-array body coil and motion-resistant T2-weighted sequence., Conclusion: Phased array body coil and motion-resistant T2-weighted sequences perform better than surface coil and conventional T2-weighted sequences for the evaluation of sacroiliac joints, increasing confidence in the identification of BMEP., (Copyright © 2017 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the feasibility and potential clinical applicability of speckle-tracking sonography for the dynamic evaluation of the scapholunate diastasis during stress manoeuvres., Material and Methods: Two readers used speckle tracking sonography to evaluate scapholunate diastasis during a clenching fist manoeuver in 30 normal wrists. Scapholunate peak strain, mean scapholunate diastasis and the diastasis variation coefficient were analysed. IRB exemption was granted for this study. Conventional and stress wrist radiographs of 26 patients with and without a scapholunate ligament tear were retrospectively analysed to ascertain the range of variation in scapholunate diastasis., Results: Speckle-tracking parameters in normal wrists were similar between the two readers (p  > 0.2061). The maximal scapholunate peak strain during stress was relatively low (<0.34-0.47 mm). The normal radiographic diastasis amplitude was similar to maximal strain peak values in normal volunteers (0.49 ± 0.51 mm). The radiographic diastasis amplitude in cases of scapholunate ligament tears was 1.48 ± 0.78 mm, which was higher than the 95% confidence interval of the scapholunate gap peak strain., Conclusion: Speckle-tracking sonography could represent an interesting alternative for stress evaluation of the scapholunate ligament in patients with scapholunate diastasis., Key Points: • Speckle-tracking sonography can assess scapholunate diastasis under stress testing. • Scapholunate gap shows little variation under stress in healthy volunteers. • Scapholunate gap measurements are influenced by grip strength. • Sex and BMI have a significant influence on strain measurements.

Objective: The objective of our study was to evaluate the diagnostic performance of qualitative 3-T proton MR spectroscopy ( 1 H-MRS) for the characterization of musculoskeletal neoplasms., Subjects and Methods: Proton MRS studies of 74 patients (76 lesions) with a histologically confirmed musculoskeletal neoplasm or neoplasms were prospectively included in this study. All studies were performed using a 3-T MRI scanner. Spectra were analyzed with conventional MRI software provided by the fabricant and with dedicated independent MRS software. Spectra were evaluated visually for the presence or absence of a choline peak at 3.2 ppm. The presence of a choline peak was considered indicative of malignancy. The influences of tumor origin and spectral quality on diagnostic performance were considered., Results: Diagnostic performance was similar with both software used (κ = 0.97). Qualitative 1 H-MRS failed to differentiate benign from malignant bone tumors regardless of the application of quality criteria (best sensitivity and specificity, 50.0% and 61.5%, respectively). Diagnostic performance was better with soft-tissue lesions, but the specificity remained low (best sensitivity and specificity, 82.4% and 64.3%, respectively). The application of spectral quality criteria for the evaluation of soft-tissue tumors led to the exclusion of 35.4% of the evaluated spectra., Conclusion: Qualitative 3-T 1 H-MRS cannot be used to characterize bone tumors. This technique has good sensitivity but poor specificity for the characterization of soft-tissue lesions.

Objectives: To assess cardiac and vascular adaptations in long-distance male triathletes and the influence of an increased training volume on these parameters., Design: Case-control study using long-distance male triathletes (Tri) (n=12) and an age-matched cohort of sedentary volunteers (Ctrl)., Methods: All participants gave an informed consent and underwent a Cardiovascular Magnetic Resonance imaging (CMR) exam to measure left and right ventricle functional parameters, and aortic parameters (surface, strain, compliance, pulse wave velocity). This exam was repeated in the triathletes' group after an increased training volume of at least 2h/week for six weeks., Results: Compared to control volunteers, triathletes presented at baseline a typical pattern of athlete's heart (higher end-diastolic, end-systolic and stroke volumes index, p≤0.009, and lower cardiac rate, p=0.015) but similar vascular characteristics except a trend towards an enlarged ascending aorta (surface 942±106 vs 812±127mm 2 , p=0.058). Between the two visits, the triathletes increased their weekly training time from 9.67±2.43 (Tri1) to 12.15±3.01h (Tri2): no modifications were found regarding cardiac parameters, but compliance and distensibility of the ascending aorta increased, from 2.60 to 3.34mm 2 /mmHg (p=0.028) and from 3.36 to 4.40×10 -3 mmHg -1 (p=0.048) respectively., Conclusions: Using CMR, we showed that vascular characteristics of the ascending aorta may vary along the sport season in endurance athletes. This remodelling could be considered as a physiological adaptation, but could eventually lead to an adverse vascular remodelling., (Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)