1
|
Nasr P, Forsgren M, Balkhed W, Jönsson C, Dahlström N, Simonsson C, Cai S, Cederborg A, Henriksson M, Stjernman H, Rejler M, Sjögren D, Cedersund G, Bartholomä W, Rydén I, Lundberg P, Kechagias S, Leinhard OD, Ekstedt M. A rapid, non-invasive, clinical surveillance for CachExia, sarcopenia, portal hypertension, and hepatocellular carcinoma in end-stage liver disease: the ACCESS-ESLD study protocol. BMC Gastroenterol 2023; 23:454. [PMID: 38129794 PMCID: PMC10734181 DOI: 10.1186/s12876-023-03093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Liver cirrhosis, the advanced stage of many chronic liver diseases, is associated with escalated risks of liver-related complications like decompensation and hepatocellular carcinoma (HCC). Morbidity and mortality in cirrhosis patients are linked to portal hypertension, sarcopenia, and hepatocellular carcinoma. Although conventional cirrhosis management centered on treating complications, contemporary approaches prioritize preemptive measures. This study aims to formulate novel blood- and imaging-centric methodologies for monitoring liver cirrhosis patients. METHODS In this prospective study, 150 liver cirrhosis patients will be enrolled from three Swedish liver clinics. Their conditions will be assessed through extensive blood-based markers and magnetic resonance imaging (MRI). The MRI protocol encompasses body composition profile with Muscle Assement Score, portal flow assessment, magnet resonance elastography, and a abbreviated MRI for HCC screening. Evaluation of lifestyle, muscular strength, physical performance, body composition, and quality of life will be conducted. Additionally, DNA, serum, and plasma biobanking will facilitate future investigations. DISCUSSION The anticipated outcomes involve the identification and validation of non-invasive blood- and imaging-oriented biomarkers, enhancing the care paradigm for liver cirrhosis patients. Notably, the temporal evolution of these biomarkers will be crucial for understanding dynamic changes. TRIAL REGISTRATION Clinicaltrials.gov, registration identifier NCT05502198. Registered on 16 August 2022. Link: https://classic. CLINICALTRIALS gov/ct2/show/NCT05502198 .
Collapse
Affiliation(s)
- Patrik Nasr
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Wallenberg Centre for Molecular Medicine, Linköping University, Linköping, Sweden
| | - Mikael Forsgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- AMRA Medical AB, Linköping, Sweden
| | - Wile Balkhed
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Cecilia Jönsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nils Dahlström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Christian Simonsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Shan Cai
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Anna Cederborg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Stjernman
- Department of Internal Medicine, Ryhov Hospital Jönköping, Jönköping, Sweden
| | - Martin Rejler
- Department of Medicine, Höglandssjukhuset Eksjö, Region Jönköping County Council, Jönköping, Sweden
- The Jönköping Academy for Improvement of Health and Welfare, Hälsohögskolan, Jönköping University, Jönköping, Sweden
| | - Daniel Sjögren
- Department of Medicine, Höglandssjukhuset Eksjö, Region Jönköping County Council, Jönköping, Sweden
| | - Gunnar Cedersund
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- School of Medical Sciences and Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Wolf Bartholomä
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Ingvar Rydén
- Department of Research, Region Kalmar County, Kalmar, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Stergios Kechagias
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- AMRA Medical AB, Linköping, Sweden
| | - Mattias Ekstedt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| |
Collapse
|
2
|
Mezrich JL, Weinreb JC. Financial and medicolegal implications of focused/fast abdominopelvic MRI exams. Abdom Radiol (NY) 2022; 47:471-474. [PMID: 34713311 DOI: 10.1007/s00261-021-03328-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Abbreviated MRI offers significant advantages in terms of MRI throughput, patient tolerance and expediency, and is being utilized for a variety of abdominopelvic imaging applications. However questions abound with respect to financial and medicolegal treatment of these relatively new protocols. METHODS A review of the relevant literature was performed. RESULTS There is no Current Procedural Terminology code for a "limited" MRI study, but it may not be appropriate to bill an abbreviated study the same as a more comprehensive study. With respect to medicolegal concerns, the risk of liability when missing or misinterpreting medically significant findings due to use of an abbreviated scan will turn on whether abbreviated MRI has become the standard of care. CONCLUSION In light of these ambiguities, it would behoove abdominopelvic imagers to advocate for their professional and subspecialty organizations to issue practice parameters/guidelines with respect to the utilization of abbreviated MRI protocols, and for the subspecialty to bill these abbreviated scans at objectively reasonable rates.
Collapse
Affiliation(s)
- Jonathan L Mezrich
- Department of Diagnostic Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA.
| | - Jeffrey C Weinreb
- Department of Diagnostic Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA
| |
Collapse
|
3
|
Hajri R, Ponti A, Meuwly JY, Eminian S, Ledoux JB, Tenisch E, Alamo-Maestre L, Dromain C, Violi NV. Abbreviated MRI for Preoperative Assessment of Breast Cancer: is Maximal Intensity Projection (MIP) of the First Post Contrast Acquisition Subtracted (Fast) Sequence Sufficient for Disease Evaluation? J Cancer Sci Clin Ther 2022; 6:452-459. [PMID: 36938135 PMCID: PMC10022524 DOI: 10.26502/jcsct.5079184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives The aim of this study was to assess the diagnostic performance of abbreviated MRI (AMRI) using the maximal intensity projection (MIP) reconstruction of the first post-contrast acquisition subtracted (FAST) compared with MIP+FAST and full-protocol MRI (fpMRI) for the preoperative assessment of breast cancer (BC) in a biopsy-proven cancer population. Methods In this monocentric retrospective study, two readers consensually assessed two AMRI protocols consisting of MIP reconstruction of the FAST (MIP) and MIP+FAST. 228 patients were included with a breast MRI performed between 2013 and 2014, 207 of them (90.8%) had biopsy-proven cancer with 256 lesions. Data of MIP and MIP+FAST were compared to full-protocol MRI (fpMRI) reading and to the reference standard including 6-month follow-up imaging and pathology as the reference. Results MIP, MIP+FAST and fpMRI demonstrated a per-lesion sensitivity for BC detection of 87.5% (224/256, 95%CI: 82.9-91.3%) and 97.7% (250/256, 95-99.1%) and 98.4% (252/256, 96.1-99.6%), respectively with a statistical difference between MIP compared to MIP+FAST and fpMRI when considering confidence intervals. Per-lesion specificity was not different [MIP: 47.6% (10/21, 25.7-70.2%), MIP+FAST: 52.4% (11/21,29.8-74.3%, fpMRI: 66.7% (14/21, 43-85.4%)]. Conclusion AMRI using only MIP is not accurate for the pre-operative assessment of BC due to lower sensitivity when compared to MIP+FAST and fpMRI. AMRI using the MIP+FAST acquisition in the preoperative setting seems promising as it could be used as the same protocol for both screening and staging in case of positive cases, without need for a recall fpMRI. This needs confirmation with cohort including higher rate of negative cases in order to evaluate the specificity.
Collapse
Affiliation(s)
- Rami Hajri
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Alexandre Ponti
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean-Yves Meuwly
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Sylvain Eminian
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean-Baptiste Ledoux
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
- Centre for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Estelle Tenisch
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Leonor Alamo-Maestre
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Naïk Vietti Violi
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| |
Collapse
|
4
|
Islam GMN, Yadav T, Khera PS, Sureka B, Garg PK, Elhence P, Puranik A, Singh K, Singh S. Abbreviated MRI in patients with suspected acute appendicitis in emergency: a prospective study. Abdom Radiol (NY) 2021; 46:5114-5124. [PMID: 34379149 DOI: 10.1007/s00261-021-03222-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the diagnostic performance of an abbreviated non-contrast MRI protocol in diagnosing acute appendicitis. METHODS Prospectively, a total of 67 consenting consecutive patients with clinical suspicion of acute appendicitis (Alvarado score ≥ 5) were evaluated with an abbreviated three-sequence non-contrast MRI protocol (axial T2WI, coronal T2WI, axial DWI) at a single tertiary care center. MRI was interpreted by two radiologists blinded to the clinical details, other investigations, and outcome of the patients. Diagnostic performance of MRI was determined using either histopathological examination (HPE) results as the reference standard in surgical cases (n = 39), or final clinical diagnosis at discharge and 3-months follow-up in non-operatively managed cases (n = 28). RESULTS Sixty-seven patients comprising 42 males, 25 females including 1 pregnant patient were enrolled (median age 24 years; age range 6-70 years). The median acquisition duration of the MRI protocol was 12.5 min. In the analysis of the complete cohort including both surgical and non-operatively managed cases (n = 67), MRI showed sensitivity of 93.3% (95% CI 81.7-98.6%), specificity of 86.4% (95% CI 65.1-97.1%), and diagnostic accuracy of 91.0% (95% CI 81.5-96.6%) (p < 0.001). In the subset of surgical cases with HPE as the reference standard (n = 39), MRI showed sensitivity of 97.1% (95% CI 84.7-99.9%), specificity of 100% (95% CI 47.8-100%), and diagnostic accuracy of 98% (95% CI 87.5-100%) (p < 0.001). CONCLUSION MRI may be performed to diagnose acute appendicitis or alternative causes of right iliac fossa pain. An abbreviated MRI protocol consisting of only three sequences without IV contrast, patient preparation, or antiperistaltic agents could shorten the examination duration while retaining diagnostic accuracy.
Collapse
|
5
|
Sun EX, Mandell JC, Weaver MJ, Kimbrell V, Harris MB, Khurana B. Clinical utility of a focused hip MRI for assessing suspected hip fracture in the emergency department. Emerg Radiol 2020; 28:317-325. [PMID: 33175269 DOI: 10.1007/s10140-020-01870-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE A focused hip MRI (FHMR) for the detection of radiographically occult hip fractures was implemented in our emergency department (ED) in 2013. The goal of this study was to assess the clinical utility of this protocol. METHODS We retrospectively reviewed radiology reports of 262 unique patients who underwent 263 FHMR (coronal T1, coronal STIR, axial T2 fat saturated) for suspected hip fracture in the ED from October 2013 to March 2020. Electronic medical records were reviewed for the ED course, follow-up imaging, and clinical management within 90 days. RESULTS Seventy-one patients had one or more fractures identified by FHMR: one-third had proximal femoral fractures; two-third had pelvic fractures. Of these 71 patients, 53 (74%) had radiographically occult fractures, including 14 (20%) with occult proximal femoral fractures; 4 patients had fractures occult on CT. Nineteen patients with a suspected fracture on radiography were found to have no fracture on FHMR. Four fractures not reported on FHMR were later seen on follow-up imaging: these included 1 isolated greater trochanter, 1 additional ischial tuberosity, 1 additional superior pubic ramus, and 1 additional sacrum. All four fractures were treated non-operatively. Muscle/tendon injury was the most common type of injury, seen in 50% (130/262) patients with the most commonly torn tendons being the hamstring (44%; 15/34) followed by gluteus medius tendon (18%; 6/34). A full-hip or pelvis MRI was done after FHMR in only 5 patients, primarily for the purpose of better characterizing findings already identified on FHMR (2 for fracture, 2 for tendon injury, 1 for soft tissue metastasis). Only one of these five studies provided new information: ruling out a previously questioned fracture. Clinical management of the vast majority of patients was based solely on findings from the FHMR. CONCLUSIONS FHMR offers reliable identification of radiographically occult hip fractures and muscle/tendon injuries. The protocol is well trusted in guiding patient management in our ED.
Collapse
Affiliation(s)
- Ellen X Sun
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA.
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Michael J Weaver
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Vera Kimbrell
- Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC, 27710, USA.,Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Mitchel B Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Bharti Khurana
- Trauma Imaging Research and Innovation Center, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| |
Collapse
|
6
|
Ko ES, Morris EA. Abbreviated Magnetic Resonance Imaging for Breast Cancer Screening: Concept, Early Results, and Considerations. Korean J Radiol 2020; 20:533-541. [PMID: 30887736 PMCID: PMC6424827 DOI: 10.3348/kjr.2018.0722] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/27/2018] [Indexed: 12/29/2022] Open
Abstract
Breast magnetic resonance imaging (MRI) has been increasingly utilized, especially in screening for high-risk cases, because of its high sensitivity and superior ability to detect cancers as compared with mammography and ultrasound. Several limitations such as higher cost, longer examination time, longer interpretation time, and low availability have hindered the wider application of MRI, especially for screening of average-risk women. To overcome some of these limitations and increase access to MRI screening, an abbreviated breast MRI protocol has been introduced. Abbreviated breast MRI is becoming popular and challenges the status quo. This review aims to present an overview of abbreviated MRI, discuss the current findings, and introduce ongoing prospective trials.
Collapse
Affiliation(s)
- Eun Sook Ko
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|