SHIP-MR and Radiology: 12 Years of Whole-Body Magnetic Resonance Imaging in a Single Center
Norbert HostenRobin BülowHenry VölzkeMartin DomínCarsten Oliver SchmidtAlexander TeumerTill IttermannMatthias NauckStephan B. FelixMarcus DörrMarcello Ricardo Paulista MarkusUwe VölkerAmro DaboulChristian SchwahnBirte HoltfreterTorsten MündtKarl‐Friedrich KreyStefan KindlerMaria MksoudStefanie SamietzReiner BiffarWolfgang HoffmannThomas KocherJean‐François ChenotAndreas StahlFrank TostNele FriedrichStephanie ZyllaAnke HannemannMartín LotzeJens‐Peter KühnKatrin HegenscheidChristian RosenbergGeorgi I. WassilewStefan FrenzelKatharina WittfeldHans J. GrabeMarie‐Luise Kromrey
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The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented.The current study aims to assess the sensitivity and specifi city of magnetic resonance imaging by reference to arthroscopy in the preoperative diagnosis of knee pathologies. In this retrospective study, pre-operative knee magnetic resonance imaging reports of 70 patients were reviewed by a blinded musculoskeletal radiologist and compared with the respective arthroscopic fi ndings recorded in the operative notes. Pre-operative magnetic resonance imaging demonstrated a sensitivity level of 92.7% and 61.3% and specifi city level of 33.3% and 53.9% in detecting pathologies of the medial and lateral menisci, respectively. With respect to the cases of complete anterior cruciate ligament tear, sensitivity was 76.7% with 92.5% specifi city. On the other hand, magnetic resonance imaging demonstrated 100% sensitivity and 90.7% specifi city in the diagnosis of posterior cruciate ligament partial tear. Relatively better sensitivity in detecting cruciate ligaments pathology and better specifi city in detecting menisci pathology was reported using magnetic resonance imaging. Almost 25% of complete anterior cruciate ligament injuries may remain undetected in preoperative magnetic resonance imaging reports, while they represent the most prevalent knee injury. Magnetic resonance imaging should be used with caution in knee pathology and arthroscopy continues to be the gold standard.
Gold standard (test)
Posterior cruciate ligament
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Objective To evaluate the accuracy of magnetic resonance imaging in assessment of adolescent patients with complex Müllerian anomalies and its contribution towards operative management. Design A retrospective review of magnetic resonance imaging and operative findings. Setting A London teaching hospital that is a tertiary referral centre for complex reproductive tract disorders. Sample All adolescents referred for assessment of complex Müllerian anomalies, from 1996 to 1999, and undergoing both magnetic resonance imaging and surgical assessment. Method In the nine suitable patients magnetic resonance imaging and surgical findings were compared and the role of magnetic resonance imaging in determining the route and type of surgery was evaluated. Main outcome measures Magnetic resonance imaging data on reproductive tract anatomy and surgical findings detailing reproductive tract anatomy. Results There was good correlation of magnetic resonance imaging and operative findings in all cases. The best correlation was with uterine structure. In four cases the magnetic resonance imaging findings were essential for the appropriate choice of the surgical approach and type of procedure. Conclusions Magnetic resonance imaging is a valuable tool in the management of this particular complex group of patients.
Tertiary referral centre
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This study was designed to evaluate prospectively magnetic resonance imaging for the prediction of the circumferential resection margin in rectal cancer to identify in which patient magnetic resonance imaging could accurately assess the circumferential resection margin before surgery and in which patients it could not.During a 17-month period, a preoperative magnetic resonance imaging for the assessment of circumferential resection margin was obtained prospectively in 38 patients with mid or low rectal cancer. The agreement of magnetic resonance imaging and pathologic examination for assessment of circumferential resection margin was analyzed.Overall, magnetic resonance imaging agreed with histologic examination of the circumferential resection margin assessment in 28 patients (73 percent; kappa = 0.47). In all cases of disagreement between magnetic resonance imaging and pathology, magnetic resonance imaging overestimated the circumferential resection margin involvement. For the 11 patients with mid rectal cancer, circumferential resection margin was well predicted by magnetic resonance imaging in all cases (kappa = 1). For 27 patients with low rectal tumor, overall agreement between magnetic resonance imaging and histologic assessment was 63 percent (kappa = 0.35). Agreement was 22 percent (kappa = 0.03) for the 9 patients with low anterior and 83 percent (kappa = 0.67) for the 18 patients with low posterior rectal tumor. Univariate analysis revealed that only low and anterior rectal tumor was risk factor of overestimation of the circumferential resection margin by magnetic resonance imaging.Although magnetic resonance imaging remains the best imaging tool for the preoperative assessment of the circumferential resection margin in patients with rectal cancer, it can overestimate the circumferential resection margin involvement in low and anterior tumor with the risk of overtreating the patients.
Resection margin
Margin (machine learning)
Surgical oncology
Colorectal Surgery
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Tertiary referral centre
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Study Design. Retrospective chart review of 103 cases. Objectives. To describe the clinical use of magnetic resonance imaging in a pyogenic vertebral osteomyelitis. Summary of Background Data. Long delays in diagnosing pyogenic vertebral osteomyelitis of the spine have been shown in many reports. Magnetic resonance imaging has been advocated as the imaging method of choice in suspected spinal infections. The use, accuracy, and timing of magnetic resonance imaging in pyogenic vertebral osteomyelitis have not been reported in a large series. Methods. In 103 patients with pyogenic vertebral osteomyelitis who underwent magnetic resonance imaging at or before the time of diagnosis, the author reviewed the clinical findings and results of the magnetic resonance imaging, timing with respect to symptom duration and diagnosis, and accuracy of readings in detecting spinal infection. Follow-up magnetic resonance imaging reports also were reviewed. Results. Magnetic resonance imaging appeared to give the correct diagnosis or suggest pyogenic vertebral osteomyelitis as a possible diagnosis in 55% and 36% of cases, respectively, with less than 2 weeks of symptoms. After 2 weeks, the percentages of correct and possible diagnoses of pyogenic vertebral osteomyelitis increased to 76% and 20%, respectively. Magnetic resonance imaging was obtained within 1 month of the start of symptoms in 73% of cases. The diagnosis was made within 1 month in the most cases as well, compared with a 2- to 6-month delay in most series. Follow-up magnetic resonance images often gave impressions of progressive disease, whereas the clinical picture appeared to improve. Conclusions. Magnetic resonance imaging is valuable in suggesting the diagnosis even very early in the clinical course of pyogenic vertebral osteomyelitis. Its use may eliminate significant delays in diagnosis. The use of magnetic resonance imaging in following the therapeutic response remains to be defined.
Vertebral Osteomyelitis
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To assess fistula track healing after infliximab treatment using magnetic resonance imaging.Magnetic resonance imaging and clinical evaluation were performed before and after three infliximab infusions given over a 6-week period. Magnetic resonance images were evaluated for abscesses and fistula tracks. Paired magnetic resonance image examinations were rated 'better', 'unchanged' or 'worse'. Magnetic resonance imaging and clinical outcomes were then compared.Of the 12 referred patients, pre-treatment magnetic resonance imaging detected abscesses in three (two not treated). Of the 10 treated patients, seven had peri-anal fistulas, two of whom also had recto-vaginal fistulas, and three had abdominal wall entero-cutaneous fistulas. After infliximab, four were in remission, one had a response and five were non-responders. One developed a peri-anal abscess. Magnetic resonance imaging improved in six, was unchanged in two and was worse in two. In four of the six with improvement in magnetic resonance imaging, the fistula track resolved, but two of these had clinically persistent entero-cutaneous fistulas. The clinical outcome and magnetic resonance imaging correlated in seven of the 10 patients; in three (two entero-cutaneous and one peri-anal), there was discordance.Magnetic resonance imaging identifies clinically silent sepsis. Fistulas may persist despite clinical remission. Clinical response to infliximab and clinical correlation with magnetic resonance imaging were poor in patients with abdominal entero-cutaneous fistulas.
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Background : Magnetic resonance imaging of the breast is becoming a useful adjunct to mammography and sonography for the detection of breast lesions. However, it is not yet accepted as a routine examination for all breast cancer patients due to the lack of data regarding whether breast magnetic resonance imaging impacts recurrence or survival. This trial examines the use of magnetic resonance imaging for detection of additional lesions in patients with dense breasts and its effect on surgical treatment. Methods : Between November 2011 and November 2012, 51 patients with a confirmed diagnosis of breast cancer and dense breasts underwent bilateral breast magnetic resonance imaging. Cases were reviewed to determine if the breast magnetic resonance imaging detected additional masses, changed the preoperative clinical staging, the operation plan, or prompted additional testing. Results :Magnetic resonance imaging detected 37 additional masses in 19 patients that were not detected by mammography. Cancer occult to mammography was detected by magnetic resonance imaging in one woman. Breast magnetic resonance imaging upstaged the cancer in 7 (13.72%) out of 51 patients. Magnetic resonance imaging impacted surgical treatment in 4(7.84%) out of 51 patients. Conclusions : Magnetic resonance imaging is effective in the identification of additional masses in dense breasts that are not visualized on mammography. Of the 51 patients, 4 (7.84%) who underwent magnetic resonance imaging altered their surgical management due to the magnetic resonance imaging findings. Further studies should be undertaken to show that breast magnetic resonance imaging can change local recurrence and survival.
Breast MRI
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To determine the diagnostic performances of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents we compared them with arthroscopic findings in a consecutive series of pediatric patients (≤16 years old). Stratification effects by patient age and magnetic resonance imaging center were examined. There were 139 lesions diagnosed clinically, 128 diagnosed by magnetic resonance imaging, and 135 diagnosed arthroscopically. There was no significant difference between clinical examination and magnetic resonance imaging with respect to agreement with arthroscopic findings (clinical examination, 70.3%; magnetic resonance imaging, 73.7%), overall sensitivity (clinical examination, 71.2%; magnetic resonance imaging, 72.0%), and overall specificity (clinical examination, 91.5%; magnetic resonance imaging, 93.5%). Stratified analysis by diagnosis revealed significant differences only for sensitivity of lateral discoid meniscus (clinical examination, 88.9%; magnetic resonance imaging, 38.9%) and specificity of medial meniscal tears (clinical examination, 80.7%; magnetic resonance imaging, 92.0%). For magnetic resonance imaging, children younger than 12 years old had significantly lower overall sensitivity (61.7% versus 78.2%) and lower specificity (90.2% versus 95.5%) compared with children 12 to 16 years old. There was no significant effect of magnetic resonance imaging center. In conclusion, selective magnetic resonance imaging does not provide enhanced diagnostic utility over clinical examination, particularly in children, and should be used judiciously in cases where the clinical diagnosis is uncertain and magnetic resonance imaging input will alter the treatment plan.
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