New clinical opportunities of low-field MRI: heart, lung, body, and musculoskeletal

Feasibility and Usability of Low-Field Magnetic Resonance Imaging for Pediatric Neuroimaging in Low- and Middle-Income Countries: A Qualitative Study

Background

The burden of neurological disorders in low- and middle-income countries (LMICs) may be underestimated due to the limited number of diagnostic imaging devices and trained specialists to operate and interpret scans. Recent advancements in low-field (<100 milliteslas) magnetic resonance imaging (LFMRI) hold significant promise for improving access to pediatric neuroimaging due to the technology's lower costs, portability, and reduced infrastructure and training requirements.

Purpose

Explore user needs and experiences on the training and use of a portable LFMRI for pediatric neuroimaging in LMICs.

Methods

We conducted qualitative interviews with end users of the LFMRI systems across 11 sites in Bangladesh, Ethiopia, Ghana, Malawi, Pakistan, South Africa, Uganda, and Zambia. A semi-structured questionnaire with open-ended questions on usability and feasibility was used to encourage participants to share their experiences and opinions on ease of use, user satisfaction, and integration into local health systems.

Results

Among 46 participants, key challenges were reported in infant positioning, power stability, and internet connectivity. Suggestions included developing reference materials with content and format tailored to local needs and contexts, conducting refresher trainings, and providing education that includes technical and maintenance support crucial for appropriate utilization and implementation sustainability.

Conclusion

This study underscores the importance of incorporating human-centered design principles and user feedback into identifying and resolving usability issues, sharing insights for successful integration of LFMRI within existing health care infrastructures in LMICs, and optimizing LFMRI use for pediatric populations.

MRI-based virtual pathology of the prostate

Prostate cancer poses significant diagnostic challenges, with conventional methods like prostate-specific antigen (PSA) screening and transrectal ultrasound (TRUS)-guided biopsies often leading to overdiagnosis or miss clinically significant cancers. Multiparametric MRI (mpMRI) has emerged as a more reliable tool. However, it is limited by high inter-observer variability and radiologists missing up to 30% of clinically significant cancers. This article summarizes a few of these recent advancements in quantitative MRI techniques that look at the "Virtual Pathology" of the prostate with an aim to enhance prostate cancer detection and characterization. These techniques include T2 relaxation-based techniques such as luminal water imaging, diffusion based such as vascular, extracellular, and restricted diffusion for cytometry in tumors (VERDICT) and restriction spectrum imaging or combined relaxation-diffusion techniques such as hybrid multi-dimensional MRI (HM-MRI), time-dependent diffusion imaging, and diffusion-relaxation correlation spectrum imaging. These methods provide detailed insights into underlying prostate microstructure and tissue composition and have shown improved diagnostic accuracy over conventional MRI. These innovative MRI methods hold potential for augmenting mpMRI, reducing variability in diagnosis, and paving the way for MRI as a 'virtual histology' tool in prostate cancer diagnosis. However, they require further validation in larger multi-center clinical settings and rigorous in-depth radiological-pathology correlation are needed for broader implementation.

Recurrent Biatrial Myxomas in Carney Complex with a Spinal Melanotic Schwannoma: Advocacy for a Rigorous Multidisciplinary Follow-Up

A 31-year-old female patient with a previous history of Carney complex and surgical resection for cardiac myxoma and bilateral adrenalectomy at 18 years old and 10 and 11 years old, respectively, was referred to our department with a diagnosis of recurrent biatrial myxomas incidentally discovered on echography. A magnetic resonance imaging (MRI) confirmed the diagnosis of a tumor protruding into the left ventricle, and the patient underwent a surgical resection of a large left atrial mass and a right-sided atrial small tumor. Diagnosis of bilateral atrial myxomas was confirmed by histologic studies. Postoperative outcome was uneventful, and the patient was discharged at the 7th postoperative day. Few months later, she reported trivial clinical symptoms suspecting a cervical radiculopathy. MRI confirmed the presence of a compressive cervical spinal cord tumoral mass at the C2-3 level leading to perform a surgical exeresis of the tumor. Histology showed a spinal melanotic schwannoma. This case highlights the risk of unexpected ubiquitary tumor locations and the importance of a rigorous transversal multidisciplinary follow-up to prevent severe complications in patients with Carney complex.