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Purpose: For nearly half of patients who undergo Endovascular Thrombectomy following ischemic stroke, successful recanalisation does not guarantee a good outcome. Understanding the underlying tissue changes in the infarct tissue with the help of biomarkers specific to ischemic stroke could offer valuable insights for better treatment and patient management decisions. Using quantitative susceptibility mapping (QSM) MRI to measure cerebral iron concentration, this study aims to track the progression of iron within the infarct lesion after successful reperfusion., Methods: In a prospective study of 87 ischemic stroke patients, successfully reperfused patients underwent MRI scans at 24-to-72 h and 3 months after reperfusion. QSM maps were generated from gradient-echo MRI images. QSM values, measured in parts per billion (ppb), were extracted from ROIs defining the infarct and mirror homolog in the contralateral hemisphere and were compared cross-sectionally and longitudinally., Results: QSM values in the infarct ROIs matched those of the contralateral ROIs at 24-to-72 h, expressed as median (interquartile range) ppb [0.71(-7.67-10.09) vs. 2.20(-10.50-14.05) ppb, p = 0.55], but were higher at 3 months [10.68(-2.30-21.10) vs. -1.27(-12.98-9.82) ppb, p < 0.001]. The infarct QSM values at 3 months were significantly higher than those at 24-to-72 h [10.41(-2.50-18.27) ppb vs. 1.68(-10.36-12.25) ppb, p < 0.001]. Infarct QSM at 24-to-72 h and patient outcome measured at three months did not demonstrate a significant association., Conclusion: Following successful endovascular reperfusion, iron concentration in infarct tissue, as measured by QSM increases over time compared to that in healthy tissue. However, its significance warrants further investigation., Competing Interests: Declarations. Ethics approval: The study was performed in line with the principles of the Declaration of Helsinki. Approval for the study was obtained from The Melbourne Health Human Research Ethics Committee. Consent to participate and consent to publish: Written informed consent was provided by the participants or medical treatment decision-makers before and during the study to continue participating and for the publishing of the results obtained in the study. Competing interests: All the authors do not have financial or non-financial interests to disclose that are directly or indirectly related to this work., (© 2024. The Author(s).)

Purpose: To determine whether change in shoulder position between internal rotation (IR) and external rotation (ER) during magnetic resonance arthrography (MRA) affects previously defined capsular measurements and to determine the utility of rotation in the diagnosis of instability., Methods: A retrospective study was conducted of patients who received a shoulder MRA with humeral IR and ER views. Patients with an arthroscopically confirmed diagnosis of instability and those with clinically stable shoulders, no history of instability, and no MRA findings of instability were identified and compared. Humeral rotation, glenoid retroversion, humeral head subluxation, capsular length, and capsular area using axial sequences of IR and ER views were recorded. Analysis compared IR, ER, and Δ capsular measurements between groups using independent t tests and univariate and multivariate regression., Results: Thirty-one subjects who were diagnosed with instability were included, along with 28 control subjects. Capsular length, capsular area, and humeral subluxations were significantly greater with ER compared with IR views (P < .001, P < .001, P < .001). Patients with instability displayed greater ER capsular length (P = .0006) and ER capsular area (P = .005) relative to controls. Multivariate logistic regression identified age, weight, sex, ER capsular length, and retroversion to be significant predictors of instability. ER capsular length independently predicts instability with 86% sensitivity and 84% specificity. Interobserver reliability using the intraclass correlation coefficient was rated good or excellent on all measurements., Conclusion: Variance in humeral rotation during shoulder MRA significantly affects capsular measurements. Rotational views increase the utility of capsular measurements when assessing for instability, particularly capsular length and capsular area. The implementation of ER positioning enhances the ability to examine capsular changes of the shoulder joint and can assist in the diagnosis of instability., Level of Evidence: III, retrospective comparative study., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Quantitative susceptibility mapping (QSM) of the brain has become highly reproducible and has applications in an expanding array of diseases. To translate QSM from bench to bedside, it is important to automate its reconstruction immediately after data acquisition. In this work, a server system that automatically reconstructs QSM and exchange images with the scanner using the DICOM standard is demonstrated using a multi-site, multi-vendor reproducibility study and a large, single-site, multi-scanner image quality review study in a clinical environment., Methods: A single healthy subject was scanned with a 3D multi-echo gradient echo sequence at nine sites around the world using scanners from three manufacturers. A high-resolution (HiRes, .5 × .5 × 1 mm 3 reconstructed) and standard-resolution (StdRes, .5 × .5 × 3 mm 3 ) protocol was performed. ROI analysis of various white matter and gray matter regions was performed to investigate reproducibility across sites. At one institution, a retrospective multi-scanner image quality review was carried out of all clinical QSM images acquired consecutively in 1 month., Results: Reconstruction times using a GPU were 29 ± 22 seconds (StdRes) and 55 ± 39 seconds (HiRes). ROI standard deviation across sites was below 24 ppb (StdRes) and 17 ppb (HiRes). Correlations between ROI averages across sites were on average .92 (StdRes) and .96 (HiRes). Image quality review of 873 consecutive patients revealed diagnostic or excellent image quality in 96% of patients., Conclusion: Online QSM reconstruction for a variety of sites and scanner platforms with low cross-site ROI standard deviation is demonstrated. Image quality review revealed diagnostic or excellent image quality in 96% of 873 patients., (© 2019 by the American Society of Neuroimaging.)

Competing Interests: There are no conflicts of interest.

Background: Optic neuritis in children is an uncommon disorder which usually occurs after a viral illness or vaccination and, less frequently, occurs as a manifestation of a demyelinating disorder. Pediatric optic neuritis usually is bilateral and presents with optic disc edema, recovers rapidly with steroid therapy, and generally has low conversion rate to multiple sclerosis or neuromyelitis optica spectrum disorder. We report the clinical features and treatment outcomes of pediatric optic neuritis in Indian population, for which little data are available., Methods: We reviewed the medical case records of patients with optic neuritis who were younger than 18 years, from 1999 to 2016. All patients were assessed and managed in the Neuro-Ophthalmology Department of Sankara Nethralaya, a unit of Medical Research Foundation and Pediatric Neurology Department of Kanchi Kamakoti-Childs Trust Hospital, Chennai, India., Results: One hundred seventeen eyes of 78 children with mean age of 11.84 (±4.58) years were identified. Forty-two (53.8%) were females and 36 (46.2%) were males. Thirty-nine patients (50%) had bilateral involvement and a similar number had unilateral involvement. Fifty-nine eyes (50.4%) had optic disc edema, 20 eyes (17.1%) had disc pallor, and 38 eyes (32.4%) had normal discs. Of 63 patients who had neuroimaging, 36 had MRI, and 27 underwent computed tomography. Eighty-four eyes (of 59 patients) received steroid therapy according to the protocol of the Optic Neuritis Treatment Trial (ONTT). Thirty-three eyes that were treated with other steroid protocols were excluded from the final visual outcome analyses. Sixty of the 84 eyes (72.3%) recovered visual acuity of 20/40 or better. Visual acuity improvement was statistically significant between initial and final visual acuity (logMAR) in our patients treated with the ONTT protocol (P ≤ 0.001)., Conclusions: Our Indian pediatric population had good visual recovery after steroid treatment for optic neuritis. Profound loss of visual acuity on presentation and bilateral involvement were significantly associated with poor visual outcome.

Intense enhancement of the mitral valve is documented in a MRI examination performed on a patient with rheumatic multi-valvular disease. Patient had the elevated inflammatory markers indicating active inflammatory process. Such hitherto undocumented phenomenon may have important clinical significance in disease evaluation, thus provide a feasible option to document and follow up, active valvular involvement in patients with active rheumatic fever.

Background: Published findings on MRI results in retinoblastoma patients treated with neoadjuvant chemotherapy (NACT) are lacking. The present study evaluates the role of MRI in International Retinoblastoma Staging System (IRSS) stage III retinoblastoma treated with NACT., Methods: 28 consecutive IRSS stage III retinoblastoma patients underwent MRI at baseline and after three cycles of NACT prior to enucleation. MRI films were reviewed retrospectively by an ophthalmic radiologist who was masked to patient outcome. Optic nerves were staged based on their thickness, contrast enhancement and length of involvement on MRI. Response evaluation criteria were based on optic nerve staging and changes in the size of the orbital mass on MRI after NACT., Results: The proposed staging at baseline and after NACT was able to predict event-free-survival (EFS) (p=0.005 and p <0.001, respectively) and overall survival (OS) (p=0.002 and p=0.001, respectively) using the log-rank test for trends. Patients with complete or partial response according to the proposed response evaluation criteria had significantly better EFS (p<0.001) and OS (p=0.024) than those who had stable or progressive disease., Conclusions: The proposed MRI based optic nerve staging system and response evaluation criteria were able to predict EFS and OS at baseline and after NACT.

The dorsomedial and dorsolateral prefrontal cortices (dmPFC and dlPFC) together support cognitive control, with dmPFC responsible for monitoring performance and dlPFC responsible for adjusting behavior. The dlPFC contains a topographic organization that reflects complexity of control demands, with more anterior regions guiding increasingly abstract processing. Recent evidence for a similar gradient within dmPFC suggests the possibility of parallel, hierarchical organization. Here, we measured connectivity between functional nodes of dmPFC and dlPFC using resting-state functional magnetic resonance imaging in humans. We found a posterior-to-anterior connectivity gradient; posterior dmPFC maximally connected to posterior dlPFC and anterior dmPFC maximally connected to anterior dlPFC. This parallel topographic pattern replicated across three independent datasets collected on different scanners, within individual participants, and through both point-to-point and voxelwise analyses. We posit a model of cognitive control characterized by hierarchical interactions--whose level depends on current environmental demands--between functional subdivisions of medial and lateral PFC.

Visceral pain processing is abnormal in a majority of irritable bowel syndrome (IBS) patients. Aberrant endogenous nociceptive modulation and anticipation are possible underlying mechanisms investigated in the current study. Twelve IBS patients and 12 matched healthy controls underwent brain fMRI scanning during the following randomised stimuli: sham and painful rectal distensions by barostat without and with simultaneous activation of endogenous descending nociceptive inhibition using ice water immersion of the foot for heterotopic stimulation. Heterotopic stimulation decreased rectal pain scores from 3.7+/-0.2 to 3.1+/-0.3 (mean+/-SE, scale 0-5) in controls (p<0.01), but not significantly in IBS. Controls differed from IBS patients in showing significantly greater activation bilaterally in the anterior insula, SII and putamen during rectal stimulation alone compared to rectal plus heterotopic stimulation. Greater activation during rectal plus heterotopic versus rectal stimulation was seen bilaterally in SI and the right superior temporal gyrus in controls and in the right inferior lobule and bilaterally in the superior temporal gyrus in IBS. Rectal pain scores were similarly low during sham stimulation in both groups, but brain activation patterns differed. In conclusion, IBS patients showed dysfunctional endogenous inhibition of pain and concomitant aberrant activation of brain areas involved in pain processing and integration. Anticipation of rectal pain was associated with different brain activation patterns in IBS involving multiple interoceptive, homeostatic, associative and emotional areas, even though pain scores were similar during sham distension. The aberrant activation of endogenous pain inhibition appears to involve circuitry relating to anticipation as well as pain processing itself.

Functional neuroimaging studies of numerical cognition have repeatedly associated activation of the intraparietal sulcus (IPS) with number processing. During number comparison, the IPS has been found to be modulated by the numerical distance. This has lead to the contention that the IPS houses the internal representation of numerical magnitude. However, this theory has been challenged by the argument that IPS activation may reflect domain-general response selection. In the present study, we used the numerical size congruity paradigm to further elucidate the role played by the IPS in number comparison. In an event-related, functional magnetic resonance imaging (fMRI) study, participants judged which of two number words was numerically larger. In addition to the numerical distance, physical stimulus size was varied such that physical size and numerical magnitude were either (a) congruent (e.g., numerically smaller number printed in smaller font) or (b) incongruent (e.g., numerically larger number printed in smaller font). This allowed for the study of both the main effects and the interaction of numerical distance and stimulus congruency. A main effect of numerical distance was found in bilateral regions of the IPS. However, these parietal areas were not significantly modulated by congruency or the interaction of distance and congruency. Instead, the main effect of congruency and an interaction of distance and congruency were observed in anterior cingulate and prefrontal cortices. These findings suggest some degree of independence between the processing of numerical distance and size congruity, lending support for the hypothesis that distance effects in IPS reflect the underlying representation of numerical magnitude.

Working memory was evaluated after normal sleep, and at 24 and 35 h of sleep deprivation (SD) in 26 healthy young adults to examine the neural correlates of inter-individual differences in performance. The extent of performance decline was not significantly different between the two SD test periods although there was greater variability in performance at SD35. In both SD sessions, there was reduced task-related activation (relative to normal sleep) in both superior parietal regions and the left thalamus. Activation of the left parietal and left frontal regions after normal sleep was negatively correlated with performance accuracy decline from normal sleep to SD24 thus differentiating persons who maintained working memory performance following SD from those who were vulnerable to its effects.

Using fMR adaptation, we studied the effects of aging on the neural processing of passively viewed naturalistic pictures composed of a prominent object against a background scene. Spatially distinct neural regions showing specific patterns of adaptation to objects, background scenes, and contextual integration (binding) were identified in young adults. Older adults did not show adaptation responses corresponding to binding in the medial-temporal areas. They also showed an adaptation deficit for objects whereby their lateral occipital complex (LOC) did not adapt to repeated objects in the context of a changing background. The LOC could be activated, however, when objects were presented without a background. Moreover, the adaptation deficit for objects viewed against backgrounds was reversed when elderly subjects were asked to attend to objects while viewing these complex pictures. These findings suggest that the elderly have difficulty with simultaneous processing of objects and backgrounds that, in turn, could contribute to deficient contextual binding.

We investigated the extent of hemodynamic recovery following the paired presentation of either identical or different faces at two different inter-stimulus intervals (ISI). Signal recovery was consistently better at an ISI of 6 sec compared to 3 sec. Significantly less signal recovery was associated with identical faces compared to different faces in bilateral mid-fusiform and right prefrontal regions but not in the calcarine and posterior fusiform regions. Repetition suppression effects contributed significantly to incomplete signal recovery in a region-specific manner. Simulations using empirically derived data suggest that experiments with shorter ISI (average 4.5-6.0 sec) are as sensitive as experiments with intermediate ISI (average 9 sec) in detecting response differences if experimental duration is equivalent. However, designs using intermediate ISI may be more appropriate if the expected difference in responses is small and if the number of suitable stimuli is limited., (Copyright 2003 Wiley-Liss, Inc.)

Printed word frequency can modulate retrieval effort in a task requiring associative semantic judgment. Event-related fMRI, while avoiding stimulus order predictability, is in theory statistically less powerful than block designs. We compared one event-related and two block designs that evaluated the same semantic judgment task and found that similar brain regions demonstrated the word frequency effect. Although the responses were lower in amplitude, event-related fMRI was able to detect the word frequency effect to a comparable degree compared to the block designs. The detection of a frequency effect with the event-related design also suggests that stimulus-order predictability may not be as serious a concern in block designs as might be supposed., (Copyright 2003 Wiley-Liss, Inc.)

We determined the reproducibility of both the direction and the effect size of the word frequency effect (WFE) as it relates to associative semantic judgments. Sixteen volunteers were scanned twice. At the group level of analysis, signal change and voxel counting could both reproducibly detect the existence of a WFE. However, signal change data showed less intersession variation, particularly in the left inferior frontal gyrus. The effect size of WFE was well reproduced only with signal change measurements. In consideration of the signal change data, statistical threshold did not have a major effect on the detection or determination of the effect size. In general, while the direction of the WFE was reasonably reproducible at the individual level, the effect size was far less well reproduced. These findings suggest that with existing techniques, fMRI may be used to track changes in brain activation stemming from improvement in language proficiency at the group level but not at the individual level.

The blood-brain barrier (BBB) presents a significant challenge for targeted drug delivery. A proposed method to improve drug delivery across the BBB is focused ultrasound (fUS), which delivers ultrasound waves to a targeted location in the brain and is hypothesized to open the BBB. Furthermore, stem cell-derived exosomes have been suggested as a possible anti-inflammatory molecule that may have neural benefits, if able to pass the BBB. In the present study, transcranial low-intensity focused ultrasound (LIFU), without the use of intravenous microbubbles, was assessed for both (1) its ability to influence the BBB, as well as (2) its ability to increase the localization of intravenously administered small molecules to a specific region in the brain. In vivo rat studies were conducted with a rodent-customized 2 MHz LIFU probe (peak pressure = 1.5 MPa), and injection of labeled stem cell-derived exosomes. The results suggested that LIFU (without microbubbles) did not appear to open the BBB after exposure times of 20, 40, or 60 min; instead, there appeared to be an increase in transcytosis of the dextran tracer. Furthermore, the imaging results of the exosome study showed an increase in exosome localization in the right hippocampus following 60 min of targeted LIFU.