Investigative Radiology最新文献

{"title":"Pharmacokinetics, Excretion, and Organ Distribution of the Novel Gadolinium-Based MRI Contrast Agent Gadoquatrane in Female Cynomolgus Monkeys.","authors":"Clemens Guenther, Thomas Frenzel, Antje Rottmann, Jessica Lohrke, Wiebke Janssen","doi":"10.1097/RLI.0000000000001211","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001211","url":null,"abstract":"<p><strong>Objectives: </strong>Gadoquatrane is a tetrameric, macrocyclic, extracellular gadolinium-based MRI contrast agent with high relaxivity and stability, which is currently in Phase 3 clinical development. The aim of the present study was to characterize the pharmacokinetic profile of gadoquatrane in an animal species closely related to humans and to compare this profile with the profiles of the 2 long-established gadolinium-based contrast agents gadobutrol and gadoterate (Gd-DOTA) or, more precisely, with analogs of these agents. Non-Gd-based lanthanide analogs were used instead of the Gd-based versions to make the 3 co-injected compounds analytically differentiable.</p><p><strong>Materials and methods: </strong>Eight female cynomolgus monkeys were included. Six animals received a single intravenous injection of a mixture containing gadoquatrane, Dy-butrol and Tb-DOTA at the same dose (0.1 mmol lanthanide/kg body weight). Two control animals received placebo. Procedures included collection of blood, excreta, and selected tissue samples up to 58 days post dose. Inductively coupled plasma mass spectrometry was used to measure the concentrations of the lanthanide complexes in all samples. Lanthanide plasma concentrations were fitted to a 3-compartment model to obtain pharmacokinetic parameters. High-performance liquid chromatography connected to inductively coupled plasma mass spectrometry or high-resolution mass spectroscopy was used for metabolite profiling of gadoquatrane.</p><p><strong>Results: </strong>After the injection, gadoquatrane plasma concentrations decreased in 3 phases: a distribution phase (α-phase; half-life: ~3 min), a major elimination phase (β-phase; half-life: ~60 min), and a slow terminal elimination phase (γ-phase; half-life: approximately 25 h). The effective half-life was ~1.0 hour, the total plasma clearance was 0.11 L/kg/h, and the volume of distribution was 0.17 L/kg. Gadoquatrane was rapidly and almost exclusively renally excreted. On average, 97% of the dose (SD: 5.3%) was recovered in urine within the first 24 hours after the injection. Urinary excretion was still ongoing at day 58, albeit in very small quantities (0.01% of dose/day). Only minimal amounts of Gd were detected in organ and tissue samples (<110 ppm dose/g tissue at day 5 and <10 ppm dose/g tissue at day 58). The highest concentration was found in the kidney cortex at day 5 (41 nmol Gd/g tissue). The Gd concentrations in skin and selected brain sections were lower by a factor of 100 or 1000, respectively, at day 5. Gd tissue concentrations declined substantially in all tested tissues between day 5 and day 58. Similar results were obtained for Dy-butrol and Tb-DOTA. Metabolic degradation of gadoquatrane was not observed.</p><p><strong>Conclusions: </strong>Gadoquatrane showed a pharmacokinetic profile very similar to that of macrocyclic comparator products. There were no indications of an increased risk of a prolonged presence of gadolinium in tis","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tolerability and Long-Term Safety of Gadolinium-Based Contrast-Enhanced Interstitial Pedal MR Lymphangiography in Patients With Lymphedema.","authors":"Andreas Henkel, Sergej Geiger, Julia Wagenpfeil, Daniel L Kuetting, Julian A Luetkens, Claus C Pieper","doi":"10.1097/RLI.0000000000001213","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001213","url":null,"abstract":"<p><strong>Objectives: </strong>Contrast-enhanced MR lymphangiography (CE-MRL) with pedal interstitial injection of a gadolinium-based contrast agent is increasingly employed in patients with lymphedema (off-label use). However, data on short-term tolerability and possible long-term adverse effects are limited. This study aimed to report clinical experiences regarding the tolerability and long-term safety of CE-MRL.</p><p><strong>Materials and methods: </strong>A total of 168 patients (36 male; mean age 49.1±16.4 y) with clinically diagnosed lymphedema underwent clinically indicated CE-MRL. A total of 8 mL of diluted MR contrast agent (6 mL 1.0 mmol/mL Gadobutrol, 2 mL saline solution) was prepared. After intradermal administration of 0.2 mL local anesthetic, 1 mL of this contrast agent solution was injected intradermally into each interdigital space. To assess tolerability, patients were asked after the examination about their experience regarding remaining motionless during the examination, confinement in the MRI scanner, interdigital contrast injection, and the overall experience [5-point Likert scale (1: very easy/well tolerable, 5: very difficult/intolerable)]. Adverse events were systematically recorded during a clinical follow-up visit (≥3 mo after CE-MRL) through direct patient inquiry and inspection of the injection sites.</p><p><strong>Results: </strong>CE-MRL was technically successful in all cases. Mean clinical follow-up was 36±19 months (range: 3 to 81 mo). The ease of remaining motionless was rated as very easy or mostly easy in 98.2% of cases, the tolerability of confinement in the MRI scanner as well as tolerable or mostly tolerable in 97.6%, the contrast injection in 85.1%, and the overall experience in 97.6%. In addition, 95.8% of patients would recommend CE-MRL under similar conditions. Five patients reported transient irritation of the skin (n=3, 1.8%) and/or light interdigital pain (n=3, 1.8%) for 1 or 2 days at the injection site. No other adverse events were observed.</p><p><strong>Conclusion: </strong>CE-MRL is well tolerated and safe. Intradermal interdigital contrast injection was the most uncomfortable part of the examination, but was still well tolerated by most patients without any long-term adverse events.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and Technological Advances in Magnetic Resonance (Focusing on Imaging Technique and the Gadolinium-Based Contrast Media), Computed Tomography (Focusing on Photon Counting CT), and Ultrasound-State of the Art.","authors":"Val M Runge, Johannes T Heverhagen","doi":"10.1097/RLI.0000000000001210","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001210","url":null,"abstract":"<p><p>Magnetic resonance continues to evolve and advance as a critical imaging modality for disease diagnosis and monitoring. Hardware and software advances continue to propel this modality to the forefront of the field of diagnostic imaging. Next generation MR contrast media, specifically gadolinium chelates with improved relaxivity and stability (relative to the provided contrast effect), have emerged providing a further boost to the field. Concern regarding gadolinium deposition in the body with primarily the weaker gadolinium chelates (which have been now removed from the market, at least in Europe) continues to be at the forefront of clinicians' minds. This has driven renewed interest in possible development of manganese-based contrast media. The development of photon counting CT and its clinical introduction have made possible a further major advance in CT image quality, along with the potential for decreasing radiation dose. The possibility of major clinical advances in thoracic, cardiac, and musculoskeletal imaging were first recognized, with its broader impact - across all organ systems - now also recognized. The utility of routine acquisition (without penalty in time or radiation dose) of full spectral multi-energy data is now also being recognized as an additional major advance made possible by photon counting CT. Artificial intelligence is now being used in the background across most imaging platforms and modalities, making possible further advances in imaging technique and image quality, although this field is nowhere yet near to realizing its full potential. And last, but not least, the field of ultrasound is on the cusp of further major advances in availability (with development of very low-cost systems) and a possible new generation of microbubble contrast media.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dixon-Based Water T1 Mapping for Fat-Corrected Assessment of Hepatic Fibrosis in Chronic Liver Disease.","authors":"Narine Mesropyan, Elizabeth Huaroc Moquillaza, Johannes Chang, Philipp Lutz, Christoph Katemann, Kilian Weiss, Oliver M Weber, Johannes M Peeters, Tatjana Dell, Daniel Kuetting, Claus C Pieper, Can Yueksel, Mariya Doneva, Dimitrios C Karampinos, Julian A Luetkens, Alexander Isaak","doi":"10.1097/RLI.0000000000001212","DOIUrl":"https://doi.org/10.1097/RLI.0000000000001212","url":null,"abstract":"<p><strong>Objectives: </strong>The diagnostic value of conventional T1 mapping for noninvasive assessment of liver fibrosis is limited in the presence of hepatic steatosis. To evaluate the diagnostic value of water T1 (wT1) with continuous inversion-recovery Look-Locker (CIR-LL) method, integrating spiral readout, Dixon, and dictionary-based processing, for the fat-corrected assessment of hepatic fibrosis in patients with chronic liver disease (CLD).</p><p><strong>Materials and methods: </strong>In this prospective study, consecutive participants with CLD underwent liver magnetic resonance imaging (MRI), which included assessment of MR-elastography (MRE)-derived liver stiffness, proton density fat fraction (PDFF), T1 relaxation times using modified Look-Locker inversion recovery (T1-MOLLI) and extracellular volume fraction (ECV), and wT1 relaxation times. MRE served as the reference standard to evaluate the diagnostic performance of MRI-based mapping parameters. Significant fibrosis (≥F2) was defined as MRE-derived liver stiffness >3.66 kPa in patients with PDFF≤5%, or >3.14 kPa in patients with PDFF>5%. Statistical analysis included Student t test, receiver operating characteristic (ROC) analysis, and Spearman correlation coefficient.</p><p><strong>Results: </strong>A total of 81 CLD patients (mean age, 50±14 y; 32 female; 40 patients with PDFF>5%) were included. All measured mapping values were significantly higher in patients with significant fibrosis compared with those without (eg, wT1: 628±82 vs. 546±41 ms, P<0.001). wT1 showed a strong correlation with MRE-derived liver stiffness, outperforming T1-MOLLI and ECV mapping [whole cohort: r=0.67 (wT1) vs. 0.53 (T1-MOLLI) vs. 0.48 (ECV); cohort with PDFF>5%: r=0.69 (wT1) vs. 0.44 (T1) vs. 0.49 (ECV); P<0.05 in each case, respectively]. wT1 had a superior diagnostic performance for the detection of significant fibrosis [whole cohort, area under the curve (AUC): 0.82 (wT1); 0.77 (T1-MOLLI); 0.73 (ECV), P<0.001 in each case; cohort with PDFF>5%, AUC: 0.84, P=0.002 (wT1), 0.70, P=0.04 (T1-MOLLI), 0.70, P=0.04 (ECV)].</p><p><strong>Conclusion: </strong>Compared with T1-MOLLI and ECV mapping, the proposed fat-corrected CIR-LL wT1 method proved to be a more robust marker of hepatic fibrosis in CLD, also in the presence of hepatic steatosis.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relevance of Prostatic Fluid on the Apparent Diffusion Coefficient: An Inversion Recovery Diffusion-Weighted Imaging Investigation.","authors":"Dominika Skwierawska, Sebastian Bickelhaupt, Maximilian Bachl, Rolf Janka, Martina Murr, Felix Gloger, Tristan A Kuder, Moritz Zaiss, Dominique Hadler, Michael Uder, Frederik B Laun","doi":"10.1097/RLI.0000000000001139","DOIUrl":"10.1097/RLI.0000000000001139","url":null,"abstract":"<p><strong>Objectives: </strong>Diffusion-weighted imaging (DWI) is pivotal for prostate magnetic resonance imaging. This is rooted in the generally reduced apparent diffusion coefficient (ADC) observed in prostate cancer in comparison to healthy prostate tissue. This difference originates from microstructural tissue composition changes, including a potentially decreased fluid-containing lumen volume. This study explored the nature of the observed ADC contrast in prostate tissue through inversion recovery-prepared DWI examinations that generated varying levels of fluid suppression.</p><p><strong>Materials and methods: </strong>This institutional review board-approved, single-center, prospective study was conducted from 2023 to 2024; all participants underwent magnetic resonance imaging including DWI with b-values of 50 and 800 s/mm 2 at 16 inversion times (TI; 60-4000 milliseconds). The measured ADC was interpreted with a 2-compartment model (compartments: tissue and fluid). Descriptive statistics were computed for all analyzed parameters.</p><p><strong>Results: </strong>Twelve healthy male volunteers (45 ± 17 years) and 1 patient with prostate adenocarcinoma (66 years) were evaluated. The ADC map appearance depended heavily on the TI, and we observed a feature-rich ADC(TI) curve. The ADC in the transition zone (TZ) of healthy volunteers increased between TI = 60 milliseconds and approximately 1100 milliseconds, then dropped drastically before increasing again, stabilizing at a very high TI. This effect was greatly reduced in the patient's prostate cancer lesion. The 2-compartment model described this behavior well. After the inversion, tissue magnetization recovers faster, decreasing its signal contribution in absolute terms and resulting in an increase in the ADC. At the tipping point, the total magnetization is zero at b = 0, when the positive tissue magnetization and still-inverted fluid magnetization cancel out. A small diffusion encoding leads to a positive signal, thus generating an infinite ADC. After the tipping point, the fluid magnetization remains negative and thereby reduces the ADC.</p><p><strong>Conclusions: </strong>Prostate fluid appears to contribute significantly to prostate ADCs. Its contribution could be adjusted by choosing an appropriate inversion recovery preparation, potentially enhancing contrast for prostate cancer lesions.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"357-368"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic Intraepithelial Neoplasia Revealed by Diffusion-Tensor MRI.","authors":"Carlos Bilreiro, Francisca F Fernandes, Rui V Simões, Rafael Henriques, Cristina Chavarrías, Andrada Ianus, Mireia Castillo-Martin, Tânia Carvalho, Celso Matos, Noam Shemesh","doi":"10.1097/RLI.0000000000001142","DOIUrl":"10.1097/RLI.0000000000001142","url":null,"abstract":"<p><strong>Objectives: </strong>Detecting premalignant lesions for pancreatic ductal adenocarcinoma, mainly pancreatic intraepithelial neoplasia (PanIN), is critical for early diagnosis and for understanding PanIN biology. Based on PanIN's histology, we hypothesized that diffusion tensor imaging (DTI) and T2* could detect PanIN.</p><p><strong>Materials and methods: </strong>DTI was explored for the detection and characterization of PanIN in genetically engineered mice (KC, KPC). Following in vivo DTI, ex vivo ultrahigh-field (16.4 T) MR microscopy using DTI, T2* was performed with histological validation. Sources of MR contrasts and histological features were investigated, including histological scoring for disease burden (lesion span) and severity (adjusted score). To test if findings in mice can be translated to humans, human pancreas specimens were imaged.</p><p><strong>Results: </strong>DTI detected PanIN and pancreatic ductal adenocarcinoma in vivo (6 KPC, 4 KC, 6 controls) with high discriminative ability: fractional anisotropy (FA) and radial diffusivity with area under the curve = 0.983 (95% confidence interval: 0.932-1.000); mean diffusivity and axial diffusivity (AD) with area under the curve = 1 (95% confidence interval: 1.000-1.000). MR microscopy with histological correlation (20 KC/KPC; 5 controls) revealed that sources of MR contrasts likely arise from microarchitectural signatures: high FA, AD in fibrotic areas surrounding lesions, high diffusivities within cysts, and high T2* within lesions' stroma. The strongest histological correlations for lesion span and adjusted score were obtained with AD ( R = 0.708, P < 0.001; R = 0.789, P < 0.001, respectively). Ex vivo observations in 5 human pancreases matched our findings in mice, revealing substantial contrast between PanIN and normal pancreas.</p><p><strong>Conclusions: </strong>DTI and T2* are useful for detecting and characterizing PanIN in genetically engineered mice and in the human pancreas, especially with AD and FA. These are encouraging findings for future clinical applications of pancreatic imaging.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"397-406"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Contrast-Induced Acute Kidney Injury in Computed Tomography: A 16 Institutional Retrospective Cohort Study.","authors":"Byungjin Choi, Subin Heo, Jennifer S Mcdonald, Sang Hyun Choi, Won-Mook Choi, Jung Bok Lee, Eunyoung Angela Lee, Seong Ho Park, Soobeen Seol, Sujin Gan, Bumhee Park, Hee Jung Choi, Byoung Je Kim, Sang Youl Rhee, Seung Baek Hong, Kyung-Hee Kim, Young Hwan Lee, Seung Soo Kim, Rae Woong Park","doi":"10.1097/RLI.0000000000001141","DOIUrl":"10.1097/RLI.0000000000001141","url":null,"abstract":"<p><strong>Objectives: </strong>Concern about contrast-induced acute kidney injury (CI-AKI) may delay the timely administration of contrast media for computed tomography (CT). The precise causative effect of iodinated contrast media on CI-AKI and its relevant risk factors remains an area of ongoing investigation. Therefore, this study aimed to determine the risk of CI-AKI following contrast-enhanced CT and its predisposing risk factors.</p><p><strong>Materials and methods: </strong>This study employed a 1:1 propensity score matching analysis using electronic medical records gathered between January 2006 and December 2022 from 16 institutions in South Korea. Contrast-enhanced and nonenhanced CT scans in patients aged 18 years and above were matched for baseline estimated glomerular filtration rate (eGFR), demographic characteristics, and clinical variables to assess the risk of CI-AKI. Subgroup analyses were conducted to evaluate any significant risk factors for CI-AKI.</p><p><strong>Results: </strong>A total of 182,170 CT scans with contrast were matched to 182,170 CT scans without contrast. The risk of CI-AKI in the entire study cohort was not statistically significant (odds ratio [OR], 1.036; 95% confidence interval [CI], 0.968-1.109; P = 0.34). Subgroup analyses revealed a significantly higher risk of CI-AKI in patients with eGFR <30 mL/min/1.73m 2 (OR, 1.176; 95% CI, 1.080-1.281; P = 0.011) or eGFR 30-45 mL/min/1.73m 2 (OR, 1.139; 95% CI, 1.043-1.244; P = 0.019), patients diagnosed with chronic kidney disease (OR, 1.215; 95% CI, 1.084-1.361; P = 0.011), and those administered with iso-osmolar contrast media (OR, 1.392; 95% CI, 1.196-1.622; P = 0.011).</p><p><strong>Conclusions: </strong>The risk of CI-AKI following CT was minimal in the general population. However, caution is warranted for patients with chronic kidney disease and eGFR lower than 45 mL/min/1.73m 2 , or those administered with iso-osmolar contrast media.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"376-386"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast-Enhanced Digital Breast Tomosynthesis Compared With Contrast-Enhanced Mammography and Magnetic Resonance Imaging in the Assessment of Breast Lesions: A Pilot Study.","authors":"Paola Clauser, Nina Pötsch, Ambra Santonocito, Francesca Ferrara, Layla Zeitouni, Mathias Hörnig, Michael Weber, Pascal A T Baltzer, Thomas H Helbich","doi":"10.1097/RLI.0000000000001138","DOIUrl":"10.1097/RLI.0000000000001138","url":null,"abstract":"<p><strong>Objectives: </strong>Contrast-enhanced mammography (CEM) is an accurate competitor for contrast-enhanced breast magnetic resonance imaging (CE-MRI), but the examination is limited by the lack of 3D information. Digital breast tomosynthesis (DBT) allows better lesion detection and characterization compared with mammography. The availability of quasi-3D contrast imaging could further improve the performance of CEM. The aim of our analysis was to compare the diagnostic performance of a contrast-enhanced digital breast tomosynthesis prototype (CE-DBTp) to CEM and to CE-MRI.</p><p><strong>Materials and methods: </strong>This prospective study was approved by the ethics committee, and all patients gave written informed consent. Women who presented with suspicious findings on mammography, DBT, or ultrasound were invited to participate in the study. Participants underwent CEM and CE-DBTp of the breast with the suspicious findings as well as bilateral CE-MRI. Histology was used as the standard of reference. Four readers (R1 and R2 non-experienced; R3 and R4 experienced) evaluated the images, blinded to patients' history, previous imaging, and histology. The readers evaluated CEM, CE-DBTp, and CE-MRI in separate sessions and gave a BI-RADS score for each finding. Sensitivity, specificity, lesion conspicuity, and readers' confidence were calculated and compared.</p><p><strong>Results: </strong>We included 84 patients (mean age, 56 years; range, 39-70) with 91 histologically verified breast lesions (27 benign, 64 malignant). The accuracy of the CE-DBTp was high, but significant differences were seen between experienced (both 86.8%) and non-experienced readers (76.9% and 78%, P = 0.021). No differences were found between CEM and CE-DBTp, whereas the accuracy of CE-MRI was higher ( P = 0.002). Sensitivity with CE-DBTp varied (89.1% to 100%) between experienced and non-experienced readers ( P = 0.074), and it was comparable to CEM but lower than CE-MRI ( P = 0.003). Specificity was variable between readers with all modalities. Lesion conspicuity was higher for the CE-DBTp and CE-MRI than for CEM, and confidence was significantly higher with the CE-DBTp than with CEM for one of the readers ( P < 0.001).</p><p><strong>Conclusions: </strong>A high sensitivity and good accuracy were achieved with the CE-DBTp. Lesion conspicuity and readers' confidence were higher with the CE-DBTp compared with CEM. However, CE-MRI had the highest sensitivity and accuracy.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"369-375"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved MR Detection of Optic Nerve Demyelination With MP2RAGE-FLAWS Compared With T 2 -Weighted Fat-Saturated Sequences.","authors":"Randa Aichour, Thibaut Emorine, Nadia Oubaya, Imen Megdiche, Alain Créange, Augustin Lecler, Tobias Kober, Aurélien Massire, Blanche Bapst","doi":"10.1097/RLI.0000000000001140","DOIUrl":"10.1097/RLI.0000000000001140","url":null,"abstract":"<p><strong>Objectives: </strong>Nonenhanced T 1 -w sequences such as magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) and derived fluid and white matter suppression (FLAWS) have demonstrated high performance for detecting brain parenchymal and cervical spine demyelinating lesions in multiple sclerosis. However, their potential for identifying optic nerve (ON) demyelination remains unexplored. The aim of this study was to evaluate the performance of compressed sensing-accelerated (CS) MP2RAGE-FLAWS imaging for detection of ON demyelination lesions compared with T2-w fat-saturated (FS) TSE imaging in a clinical setting.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study of magnetic resonance scans acquired on patients with central nervous system demyelinating disorders between January and December 2022. Inclusion criteria were the acquisition in the same session of a brain CS-MP2RAGE-FLAWS imaging and a combination of axial + coronal T2-w FS orbital sequences. A 4-step radiological analysis-including blinded and consensus readings-assessed ON lesion detection. The reference standard was the final reading session of radiologists using the entire patient file. Sensitivities and specificities of both sequences were computed and compared using McNemar χ 2 tests.</p><p><strong>Results: </strong>Thirty-nine patients (mean age: 43 ± 14 years; 25 women) were analyzed, including 34 with multiple sclerosis, 2 with MOGAD (myelin oligodendrocyte glycoprotein antibody-associated disease), 1 with NMOSD (neuromyelitis optica spectrum disorder), and 2 with indeterminate demyelinating disease. Among the 78 ONs analyzed, 64 lesions were detected with CS-MP2RAGE-FLAWS as opposed to 37 with 2D T2-w FS imaging, corresponding to a total of 41 and 27 affected nerves, respectively. CS-MP2RAGE-FLAWS exhibited higher sensitivity for overall detection of ON lesions compared with 2D T2-w FS imaging (97.5% vs 67.5%, P = 0.001) without reducing the specificity. Improved lesion detectability with CS-MP2RAGE-FLAWS was significant compared with 2D T2-w FS in intraorbital and intracanalicular segments (respectively, 92.3% vs 50% and 96.3% vs 66.7%; P < 0.05). There was no difference in sensitivity ( P = 0.69) or specificity ( P = 0.99) regarding the intracranial segment analysis.</p><p><strong>Conclusions: </strong>CS-MP2RAGE-FLAWS sequence improves ON lesion detection compared with conventional 2D T2-w FS, especially in the intraorbital segment, while simultaneously providing whole-brain and cervical spinal cord imaging at no additional time cost.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"387-396"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating Glioma Recurrence and Pseudoprogression by APTw CEST MRI.","authors":"Kianush Karimian-Jazi, Noah Enbergs, Evgeny Golubtsov, Katharina Schregel, Johannes Ungermann, Hannah Fels-Palesandro, Daniel Schwarz, Volker Sturm, Julius M Kernbach, David Batra, Franziska M Ippen, Irada Pflüger, Nikolaus von Knebel Doeberitz, Sabine Heiland, Lukas Bunse, Michael Platten, Frank Winkler, Wolfgang Wick, Daniel Paech, Martin Bendszus, Michael O Breckwoldt","doi":"10.1097/RLI.0000000000001145","DOIUrl":"10.1097/RLI.0000000000001145","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Recurrent glioma is highly treatment resistant due to its metabolic, cellular, and molecular heterogeneity and invasiveness. Tumor monitoring by conventional MRI has shortcomings to assess these key glioma characteristics. Recent studies introduced chemical exchange saturation transfer for metabolic imaging in oncology and assessed its diagnostic value for newly diagnosed glioma. This prospective study investigates amide proton transfer-weighted (APTw) MRI at 3 T as an imaging biomarker to elucidate the molecular heterogeneity and invasion patterns of recurrent glioma in comparison to pseudoprogression (PsPD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We performed a monocenter, prospective trial and screened 371 glioma patients who received tumor monitoring between August 2021 and March 2024 at our institution. The study included IDH wildtype astrocytoma and IDH mutant astrocytoma and oligodendroglioma, graded according to the WHO 2021 classification. Patients had received clinical standard of care treatment including surgical resection and radiochemotherapy prior to study inclusion. Patients were monitored by 3 monthly MRI follow-up imaging, and response assessment was performed according to the RANO criteria. Within this cohort, we identified 30 patients who presented with recurrent glioma and 12 patients with PsPD. In addition to standard anatomical sequences (FLAIR and T1-w Gd-enhanced sequences), MRI included APTw imaging. After sequence co-registration, semiautomated segmentation was performed of the FLAIR lesion, CE lesion, resection cavity, and the contralateral normal-appearing white matter, and APTw signals were quantified in these regions of interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;APTw values were highest in solid, Gd-enhancing tumor parts as compared with the nonenhancing FLAIR lesion (APTw: 1.99% vs 1.36%, P = 0.001), whereas there were no detectable APTw alterations in the normal-appearing white matter (APTw: 0.005%, P &lt; 0.001 compared with FLAIR). Patients with progressive disease had higher APTw levels compared with patients with PsPD (APTw: 1.99% vs 1.26%, P = 0.008). Chemical exchange saturation transfer identified heterogeneity within the FLAIR lesion that was not detectable by conventional sequences. There were also focal APTw signal peaks within contrast enhancing lesions as putative metabolic hotspots within recurrent glioma. The resection cavity developed an APTw increase at recurrence that was not detectable prior to recurrence nor in patients with PsPD (APTw before recurrence: 0.6% vs 2.68% at recurrence, P = 0.03).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our study shows that APTw imaging can differentiate PD and PsPD. We identify previously undetectable imaging patterns during glioma recurrence, which include alterations within resection cavity associated with disease progression. Our work highlights the clinical potential of APTw imaging for glioma monitoring and further establishes it ","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"414-422"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}