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Sporadic Creutzfeldt-Jakob disease (sCJD) is a frequent differential diagnostic consideration in patients with rapidly progressive dementia (RPD). Fortunately, in the last 2 decades there has been substantial cumulative improvements in sCJD biomarkers, particularly those based on imaging and cerebrospinal fluid (CSF) interrogation. Brain MRI is a very frequently employed investigation in patients with RPD, often utilized quite early in the evaluation and thereby offering a potentially key role in prompting initial concerns for sCJD. Extant conventional MRI criteria for sCJD diagnosis are relatively stringent, requiring fluid attenuated inversion recovery (FLAIR) or diffusion weighted imaging (DWI) high signal changes in 2 or more cortical regions (excluding frontal) or in both the caudate and putamen. Challenging these conventional criteria, a recent publication described improved sensitivity and unchanged specificity if MRI criteria were arguably less rigorous, requiring DWI high signal changes in only 1 or more of 7 discrete brain regions: frontal, parietal, occipital or temporal cortices, as well as the caudate, putamen or thalamus. The aim of the current study was to test the diagnostic performance of this proposed change in MRI criteria in the Australian context and compare it with conventional criteria, as well as 2 other stringent sets of criteria, predicting that a similar improved sensitivity with unchanged specificity would be observed when the proposed criteria were utilized. Sixty-five definite sCJD cases were compared with 63 age- and sex-matched controls. Radiological review of all MRIs applying the different sets of MRI criteria was undertaken by a blinded neuroradiologist, very experienced in CJD interpretation, with independent assessment of 71 MRIs performed by a second blinded neuroradiologist less experienced in sCJD imaging findings. Our study found the sensitivity of the recently proposed MRI criteria (92.3%) to be comparable to that originally reported (90–95%) and also equivalent to the conventional MRI diagnostic criteria (92.3%), while the specificities were also quite similar between the conventional MRI criteria (87.3%) and proposed criteria (85.7%), with the latter lower than previously reported. Negative predictive values and positive predictive values were also very similar between the conventional and proposed MRI criteria. Other MRI criteria assessed were associated with unacceptably low sensitivity for clinical use. Inter-rater reliability as assessed by intra-class correlation coefficients (ICC) revealed moderate reliability for the conventional and proposed MRI criteria, modestly better in the former and when the frontal lobe was retained versus excluded in comparisons. [ABSTRACT FROM AUTHOR]

Introduction: Neoadjuvant therapy has become standard of care for locally advanced rectal cancer patients. It is correlated with improved clinical and pathological outcomes, including significant tumor downstaging and organ preservation in certain patients. Magnetic resonance imaging (MRI), which has become the standard for pre-operative staging, is also used for clinical and pre-operative restaging following pre-operative treatment. In this meta-analysis, we aimed to evaluate the concordance between restaging MRI (following the completion of neoadjuvant therapy) and postoperative pathology result. Methods: We conducted a meta-analysis following the PRISMA 2020 guidelines. Two independent reviewers searched PubMed and Google Scholar for studies reporting restaging MRI results compared to pathological outcomes. Outcomes included tumor and nodal staging, circumferential resection margin (CRM) and pathological complete response (pCR). Results: Out of 25,000 studies found on the initial search; 33 studies were included. The studies were published between 2005 and 2023 and included 4100 patients (57.14% males). The median age was 62.45 years. The median interval between the conclusion of neoadjuvant treatment and the subsequent restaging MRI was 6 weeks (range 4.14–8.8 weeks). The pooled concordance rates between the restaging MRI and the pathological outcomes for ypT stage and ypN stage were 63.9% (54.5%–73.3%, I2 = 96.02%) and 60.9% (42.9%–78.9%, I2 = 98.96%), respectively. The pooled concordance for predicting pathological complete response was 70.4% (53.6%–87.1%, I2 = 98.21%). As for the circumferential resection margin (CRM), the pooled concordance was 78.2.% (71.6%–84.8%, I2 = 83.76%). Conclusions: Our findings suggest that the concordance rates between restaging MRI and pathological outcomes in rectal cancer patients following neoadjuvant therapy are limited. Caregivers should take these results into consideration when making clinical decisions about these patients. More data should be gathered about the predictive value of MRI after total neoadjuvant therapy as well as immunotherapy in rectal cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players. Design: Retrospective case series. Setting: Professional domestic and international cricket teams over 13 seasons. Participants: Elite Australian cricket players. Independent variables: Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging. Main outcome measures: Incidence, presentation, history, healing, and management. Results: 211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis. Conclusions: LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI. [ABSTRACT FROM AUTHOR]

Objectives : To determine the feasibility of a randomized controlled trial (RCT) examining outdoor walking on knee osteoarthritis (KOA) clinical outcomes and magnetic resonance imaging (MRI) structural changes. Method: This was a 24-week parallel two-arm pilot RCT in Tasmania, Australia. KOA participants were randomized to either a walking plus usual care group or a usual care control group. The walking group trained 3 days/week. The primary outcome was feasibility assessed by changes being required to the study design, recruitment, randomization, program adherence, safety, and retention. Exploratory outcomes were changes in symptoms, physical performance/activity, and MRI measures. Results: Forty participants (mean age 66 years (SD 1.4) and 60% female) were randomized to walking (n = 24) or usual care (n = 16). Simple randomization resulted in a difference in numbers randomized to the two groups. During the study, class sizes were reduced from 10 to 8 participants to improve supervision, and exclusion criteria were added to facilitate program adherence. In the walking group, total program adherence was 70.0% and retention 70.8% at 24 weeks. The walking group had a higher number of mild adverse events and experienced clinically important improvements in symptoms (e.g., visual analogue scale (VAS) knee pain change in the walking group: − 38.7 mm [95% CI − 47.1 to − 30.3] versus usual care group: 4.3 mm [− 4.9 to 13.4]). Conclusions: This study supports the feasibility of a full-scale RCT given acceptable adherence, retention, randomization, and safety, and recruitment challenges have been identified. Large symptomatic benefits support the clinical usefulness of a subsequent trial. Trial registration number: 12618001097235. Key Points • This pilot study is the first to investigate the effects of an outdoor walking program on knee osteoarthritis clinical outcomes and MRI joint structure, and it indicates that a full-scale RCT is feasible. • The outdoor walking program (plus usual care) resulted in large improvements in self-reported knee osteoarthritis symptoms compared to usual care alone. • The study identified recruitment challenges, and the manuscript explores these in more details and provides recommendations for future studies. [ABSTRACT FROM AUTHOR]

To characterise the radiological features of orbital lymphoma subtypes This was a multicentre, retrospective study to analyse radiological and clinical characteristics of orbital lymphoma by histological subtype across two sites within Australia and the United States. A total of eighty-eight patients were included. The most common subtypes were extranodal marginal zone lymphoma [EMZL] (48, 54.5%), follicular lymphoma [FL] (16, 18.2%), and diffuse large B-cell lymphoma [DLBCL] (15, 17.0%). Clinically, significant associations were found between DLBCL and vision change (p <.01), pain (p <.01), extraocular movement limitation (p =.01), and optic neuropathy (p =.01). Radiologically, there was no significant difference between the individual histopathological sub-groups with respect to bone destruction (p =.30), optic nerve involvement (p =.30) and diffuse appearance (p =.84). However, if categorised as either aggressive or indolent, aggressive lymphoma subtypes were significantly more likely to demonstrate globe indentation radiologically than indolent subtypes (Odds Ratio = 5.5, 95% CI: 1.3, 23.3; p =.02). DLBCL was significantly associated with vision change, pain, extraocular movement limitation and optic neuropathy clinically. Aggressive lymphoma subtypes were significantly more likely to demonstrate globe indentation radiologically. Otherwise, there were no significant differences between lymphoma subtypes and radiological findings on MRI and CT. [ABSTRACT FROM AUTHOR]

Background: Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life. Purpose: To explore potential moderators, mediators, and prognostic indicators of the effect of hip arthroscopy and physical therapy on change in 33-item international Hip Outcome Tool (iHOT-33) score for FAI syndrome. Study Design: Cohort study; Level of evidence, 2. Methods: Overall, 99 participants were recruited from the clinics of orthopaedic surgeons and randomly allocated to treatment with hip arthroscopy or physical therapy. Change in iHOT-33 score from baseline to 12 months was the dependent outcome for analyses of moderators, mediators, and prognostic indicators. Variables investigated as potential moderators/prognostic indicators were demographic variables, symptom duration, alpha angle, lateral center-edge angle (LCEA), Hip Osteoarthritis MRI Scoring System (HOAMS) for selected magnetic resonance imaging (MRI) features, and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score. Potential mediators investigated were change in chosen bony morphology measures, HOAMS, and dGEMRIC score from baseline to 12 months. For hip arthroscopy, intraoperative procedures performed (femoral ostectomy ± acetabular ostectomy ± labral repair ± ligamentum teres debridement) and quality of surgery graded by a blinded surgical review panel were investigated for potential association with iHOT-33 change. For physical therapy, fidelity to the physical therapy program was investigated for potential association with iHOT-33 change. Results: A total of 81 participants were included in the final moderator/prognostic indicator analysis and 85 participants in the final mediator analysis after exclusion of those with missing data. No significant moderators or mediators of change in iHOT-33 score from baseline to 12 months were identified. Patients with smaller baseline LCEA (β = −0.82; P =.034), access to private health care (β = 12.91; P =.013), and worse baseline iHOT-33 score (β = −0.48; P <.001) had greater iHOT-33 improvement from baseline to 12 months, irrespective of treatment allocation, and thus were prognostic indicators of treatment response. Unsatisfactory treatment fidelity was associated with worse treatment response (β = −24.27; P =.013) for physical therapy. The quality of surgery and procedures performed were not associated with iHOT-33 change for hip arthroscopy (P =.460-.665 and P =.096-.824, respectively). Conclusion: No moderators or mediators of change in hip-related quality of life were identified for treatment of FAI syndrome with hip arthroscopy or physical therapy in these exploratory analyses. Patients who accessed the Australian private health care system, had smaller LCEAs, and had worse baseline iHOT-33 scores, experienced greater iHOT-33 improvement, irrespective of treatment allocation. [ABSTRACT FROM AUTHOR]

Recognising the need for a national approach for the recommended best practice for the follow-up of implanted cardiac rhythm devices to ensure patient safety, this document has been produced by the Cardiac Society of Australia and New Zealand (CSANZ). It draws on accepted practice standards and guidelines of international electrophysiology bodies. It lays out methodology, frequency, and content of follow-up, including remote monitoring; personnel, including physician, allied health, nursing and industry; paediatric and adult congenital heart patients; and special considerations including magnetic resonance imaging scanning, perioperative management, and hazard alerts. [ABSTRACT FROM AUTHOR]

The CSANZ/RANZCR Position Statement on Cardiac Magnetic Resonance Imaging (CMRI) is intended to support and foster the provision of quality, safe CMRI services in Australia and New Zealand. This document specifically pertains to CMRI in adults, as distinct from general vascular MRI or paediatric imaging, and provides certification and recertification requirements., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: The demographics and geography of Australia and New Zealand (ANZ), with few metropolitan centres and vast, sparsely populated rural areas, represent a challenge to providing equal care to all patients. This study aimed to compare rectal cancer care at rural and urban hospitals in ANZ., Methods: From the Bowel Cancer Outcomes Registry (BCOR, formerly known as the Bi-National Colorectal Cancer Audit; BCCA), rectal cancer patients treated between 2007 and 2020 were compared based on hospital location (urban versus rural). Propensity-score matching was performed to correct for differences in baseline characteristics between groups., Results: A total of 9385 rectal cancer patients were identified from the BCOR: 1329 (14.2%) were treated at rural hospitals and 8056 (85.8%) at urban hospitals. Propensity-score matching resulted in 889 patients in each group, matched for age, ASA score, hospital type (public/private), tumour height from the anal verge, and pre-treatment cT- and cAJCC-stage. Rural patients had fewer pre-treatment MRIs (67.9% versus 74.7%; P = 0.002), and underwent less neoadjuvant therapy (44.7% versus 50.9%; P = 0.01). Rural patients underwent fewer ULARs (39.4% versus 45.6%; P = 0.03), and fewer anastomoses were formed (67.9% versus 74.4%; P = 0.05). CRM rates and postoperative AJCC stages (P = 0.19) were similar between groups (P = 0.87). Fewer rural patients received adjuvant chemotherapy (37.8% versus 43.3%; P = 0.02)., Conclusion: There are significant differences in pre-treatment MRI rates, (neo)adjuvant treatment rates and surgical procedures performed between rectal cancer patients treated at rural and urban hospitals in ANZ, while CRM rates and postoperative AJCC stages are similar., (© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Introduction: Surgical excision of deep infiltrating endometriosis (DIE) is complex and associated with morbidity. Diagnostic imaging plays an important role in the preoperative workup. We sought to determine the utility of single sagittal T2‐weighted MRI motion sequence in the preoperative assessment of pelvic mobility in patients with endometriosis. Methods: An observational study at a single tertiary public referral centre in Australia. Eighty‐one MRI studies from 1 May 2019 to 3 December 2019, were enrolled. Studies were included if they were performed to stage endometriosis, including a T2‐weighted motion series, adequately covering a uterus, cervix and rectum. Fifty‐seven studies met inclusion criteria. The reference standard was a contemporaneous transvaginal ultrasound (TVUS) reporting on pelvic organ mobility. Three subspecialist radiologists were then blindly asked to identify, on the cine loop: rectouterine immobility, superficial endometriosis (pelvic bowel adhesions), rectosigmoid Deep Infiltrating Endometriosis (DIE). Fleiss' Kappa assessed interobserver agreement. Consensus MRI sensitivity and specificity were estimated against the reference standard (TVUS). Results: Median age was 35 years (range 19–51). Forty‐three cases had a contemporaneous TVUS; 14 reporting a sliding sign, 29 with fixed pelves. Interobserver agreement was 'substantial' (k = 0.79) for absent MRI sliding sign and 'almost perfect' (k = 0.90) for absence of DIE. Consensus MRI had 90% sensitivity (95% CI 73–98%) for pelvic immobility at TVUS (absent sliding sign). Interobserver agreement and consensus MRI sensitivity were higher for adhesions and immobility than normal findings. Conclusion: An MRI motion sequence can identify patients with pelvic adhesions and immobility, helping determine surgical difficulty when TVUS is not diagnostic. [ABSTRACT FROM AUTHOR]

Context: Adrenal gland imaging is recommended by the current guidelines for the workup of primary aldosteronism (PA). However, its diagnostic performance has not been established in large, multiethnic cohorts of patients who undergo adrenal vein sampling (AVS) and adrenalectomy.Objective: This work aims to assess the diagnostic accuracy of cross-sectional adrenal imaging.Methods: This international multicenter study took place in tertiary referral centers. A total of 1625 PA patients seeking surgical cure were enrolled in an international study involving 19 centers in North America, Europe, Asia, and Australia. Of these, 1311 (81%) had imaging data available and 369 (23%), who received a final diagnosis of surgically cured unilateral PA, were examined. Patients underwent AVS and imaging by computed tomography and/or magnetic resonance imaging. The accuracy of detection of unilateral PA at imaging was estimated by the area under the receiver operator characteristics curve using cure (biochemical and/or full clinical success) as the reference at follow-up after unilateral adrenalectomy.Results: In the cohort of 1311 patients with imaging data available, 34% and 7% of cases showed no detectable or bilateral nodules, respectively. Imaging did not detect the culprit adrenal in 28% of the surgically cured unilateral PA patients. Moreover, the clinical outcome did not differ significantly between the imaging-positive and imaging-negative patients.Conclusion: Cross-sectional imaging did not identify a lateralized cause of disease in around 40% of PA patients and failed to identify the culprit adrenal in more than one-fourth of patients with unilateral PA. [ABSTRACT FROM AUTHOR]

Background: Biomechanical studies have suggested that the Kaplan fibers (KFs) of the iliotibial band play a role in controlling anterolateral rotation of the knee. There is a paucity of clinical information on whether injury to the KF in the setting of anterior cruciate ligament (ACL) rupture contributes to increased rotatory laxity of the knee. Purpose/Hypothesis: The purpose was to evaluate the association among radiological evidence of KF injury, intraoperative arthroscopic findings, and grade of pivot shift at the time of ACL reconstruction (ACLR). It was hypothesized that KF injury would be associated with increased injury to the lateral compartment of the knee and a higher grade of pivot shift. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective magnetic resonance imaging (MRI) analysis was conducted on 267 patients with ACL-injured knees who underwent primary ACLR. Patients who had MRI and surgery within 60 days of injury were included (mean age, 23.6 years); there were 158 (59.2%) male patients. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. Associations were made among MRI findings, intraoperative findings, and grade of pivot shift with the patient examined under anesthesia at the time of ACLR. A comparison was made between patients with and without radiological evidence of KF injury. Results: The prevalence of KF injury was 17.6% (47/267 patients). Arthroscopic evidence of lateral meniscal injury was associated with KF injury (KF intact, 31%; KF injured, 55%; P =.010). The majority of patients in the intact and injured KF groups had a grade 2 pivot shift (75% and 70%, respectively). A minority had grade 3 pivot shift: 5% in the intact group versus 6.4% in the injured group. There was no association between radiological evidence of KF injury and pivot-shift grade (P =.600). Conclusion: In acute ACL injury, KF injuries were not very common (17.6%), and the rate of grade 3 pivot shift was low (5.2%). When present, KF injuries were not associated with a higher-grade pivot shift. However, there was an association between KF injury and lateral meniscal tears identified at the time of ACLR. The role of KFS in controlling anterolateral rotatory laxity in the acute ACL injury in the clinical setting may be less evident when compared with the biomechanical setting. [ABSTRACT FROM AUTHOR]

Introduction: Contrast-enhanced mammography (CEM) and MRI detect 'contrast-only' lesions (COLs) occult on standard breast imaging (ultrasound and conventional mammography). Until recently, MRI was the only reliable method of biopsy. This study presents the first Australian experience with CEM-guided biopsy (CEMBx) and the lessons learnt., Methods: A prospective audit of the first 15 consecutive patients who underwent CEMBx for COLs was performed. Indications for contrast imaging, patient and lesion characteristics, procedural details, radiation dose and pathology data were collected., Results: The 15 women were aged 37-81 years (mean 59 years). Indications for contrast imaging were problem solving (n = 3), moderate risk screening (n = 2), cancer staging (n = 9) and symptoms (n = 1). The COLs were non-mass (n = 14), mass (n = 1) and an enhancing asymmetry (n = 1). For one patient, two lesions were sampled during the same event. All lesions enhanced and were successfully sampled followed by marker clip insertion. Most biopsies (87.5%) were performed with the breast in cranio-caudal compression using a horizontal approach. Procedural duration ranged from 13 to 33 min (mean 22 min). Radiation dose was similar to standard stereotactic biopsy. Post-biopsy hematomas occurred in three patients, none required intervention. Clip displacement occurred in three cases. Core biopsy histopathology results were benign (n = 8), malignant (n = 7) and a borderline breast lesion (BBL) (n = 1). Patient satisfaction rates were high. Imaging follow-up is ongoing., Conclusions: CEMBx is a quick, safe and reliable alternative to MRIBx to sample COLs., (© 2024 The Authors. Journal of Medical Imaging and Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Radiologists.)

Background: Recent biomechanical studies have demonstrated that the Kaplan fibers (KFs) of the iliotibial band play a role in the control of anterolateral rotation of the knee. However, controversy exists regarding whether the KFs are injured in conjunction with anterior cruciate ligament (ACL) injury. Purpose: To establish the prevalence of radiological injury to the KFs in the ACL-injured knee; to evaluate the effect of the time interval between injury and magnetic resonance imaging (MRI) on diagnosis of KF injury; and to assess for any association between KF injury and other qualitative radiological findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Preoperative MRI scans were reviewed for 161 patients with ACL injury. Specific diagnostic criteria were developed and applied to identify KF injury. Chi-square testing was performed to look for associations among KF injury, the time from injury to MRI, and associated radiological knee injuries. Results: Radiological evidence of KF injury was identified in 30 (18.6%) patients. The diagnosis of KF injury was higher in patients who had MRI scans performed within 90 days of injury as compared with ≥90 days after injury (23.7 vs 6.4%; P =.010). Patients with an MRI diagnosis of KF injury had significantly higher rates of lateral meniscal injury (40% vs 18%; P =.007), posteromedial tibial bone marrow edema (73% vs 44%; P =.003), and injury to the lateral collateral ligament (13% vs 3%; P =.019) or medial collateral ligament (23% vs 8%; P =.019). Conclusion: The prevalence of injury to the KF in patients with ACL injury as diagnosed by MRI was relatively low (18.6% of patients). However, the time interval from injury to MRI was relevant to diagnosis, with significantly higher rates of injury identification in patients with early (within 90 days) versus delayed (≥90 days) MRI. KF injury was associated with higher rates of injury to the lateral meniscal and collateral ligaments, as well as posteromedial tibial bone bruising. [ABSTRACT FROM AUTHOR]

Objective: To compare hip joint effusion-synovitis prevalence in professional ballet dancers with nondancing athletes and to evaluate the relationship between effusion-synovitis and clinical measures and cartilage defects. Design: Case-control study. Setting: Elite ballet and sport. Participants: Forty-nine professional ballet dancers and 49 age-matched and sex-matched athletes. Independent Variables: Group (dancers/athletes), sex, age, years of training, Copenhagen Hip and Groin Outcome Scores (HAGOSs), hip rotation range of motion (ROM), generalized joint hypermobility (GJH), and hip cartilage defect scores. Main Outcome Measures: Hip joint effusion-synovitis (absent, grade 1 = 2-4 mm, grade 2 = >4 mm) scored with 3-Tesla magnetic resonance imaging. Results: Hip joint effusion-synovitis was found in 22 (45%) dancers and 13 (26.5%) athletes (P = 0.06). Grade 2 effusion-synovitis was only found in dancers (n = 8, r = 0.31, P = 0.009). The prevalence of effusion-synovitis was similar in men (n = 11, 26%) and women (n = 24, 43%, P = 0.09). Female dancers with effusion-synovitis had lower HAGOS pain (r = 0.63, P = 0.001) and sports/recreation scores (r = 0.66, P = 0.001) compared with those without effusion-synovitis. The HAGOS scores were not related to effusion-synovitis in male dancers or female and male athletes (P > 0.01 for all). Effusion-synovitis was not related to hip ROM, GJH, or cartilage defect scores (P > 0.05 for all). Conclusions: Hip joint effusion-synovitis was related to higher levels of pain and lower sports/recreation function in female ballet dancers. Effusion-synovitis was not related to hip rotation ROM, GJH or cartilage defects. Larger sized joint effusion-synovitis was exclusively found in dancers. [ABSTRACT FROM AUTHOR]

Objective: To describe the imaging findings in Australian cats and dogs with CNS cryptococcosis., Animals: 23 cases (10 cats; 13 dogs) with CNS cryptococcosis and brain MRI or CT studies available to review., Methods: Retrospective, multi-institutional case series. Brain MRI or CT studies were reviewed by a board-certified radiologist. Imaging findings were described and the differences between cats and dogs explored., Results: Morphologic features were consistent with extra-axial lesions in all (n = 13) dogs and either intra-axial (5/10) or extra-axial (4/10) lesions in cats, with 1 cat having no detectable lesions in low-field brain MRI scans. Meningeal abnormalities were most common, followed by forebrain and cerebellar lesions. Intracranial MRI lesions were typically T2 hyperintense and T1 hypo- to isointense. Four cases had T2 hypointense lesions affecting the brain, sinonasal cavity, or regional lymph nodes. Intracranial CT lesions were mostly soft tissue attenuating. Contrast enhancement was present in all cases with contrast series available, with ring enhancement shown only in cats. Osteolysis was more common in dogs than cats, particularly affecting the cribriform plate. All 13 dogs and many (6/10) cats had at least 1 lesion affecting sinonasal or contiguous tissues, and locoregional lymphadenomegaly was common (7/10 cats; 11/13 dogs)., Clinical Relevance: Imaging lesions in cryptococcal meningoencephalitis were extra-axial in dogs but could be intra-axial or extra-axial in cats. Careful examination for extracranial lesions (sinonasal, retrobulbar, facial soft tissue, tympanic bullae, or locoregional lymph nodes) is important to provide alternative safe biopsy sites. T2 hypointense lesions, while rare, should prompt consideration of cryptococcosis.

The green plum (Buchanania obovata) is a small fruit eaten by Aboriginal people in the northern parts of Australia. The trees grow in remote locations and the fruit has received very little study by Western food science. This study aims to profile and analyse physical characteristics of the green plums as they grow and ripen across multiple locations and harvests. Fruit from four locations, five maturity stages and two harvests were characterised using standard physical measurements, magnetic resonance imaging (MRI), moisture content, titratable acidity, pH, total soluble solids, and ethylene, oxygen and carbon dioxide gas analysis. Results of the physical measurements were analysed with multivariate data analysis using principal component analysis (PCA). This study confirms that the five-stage maturity index has accurately classified the maturity stages in the green plums, how maturity stages can be described with physical parameters and the specific changes that occur between each stage of the maturity process. This study has concluded that green plum is a climacteric fruit and suggest that further studies exploring these characteristics could increase its commercial potential. This report provides valuable characteristics of the green plums as potential products for Indigenous agribusinesses and the food industry. • profiles and analyses of the physical characteristics of green plums as they mature. • magnetic resonance images of green plum maturity stages. • physical measurements analysed using principal component analysis (PCA). • confirms five-stage maturity index has accurately classified the maturity stages. • green plum is a climacteric fruit. [ABSTRACT FROM AUTHOR]

Introduction: An MRI audit substudy was conducted in patients who underwent an MRI prior to treatment in Australia and New Zealand as part of the PETACC-6 trial in locally advanced rectal cancer.Methods: A total of 82 patients from 15 centres had rectal MRI scans reviewed for technique, data included in reports and comparison of reports with blinded central reporting by two experienced radiologists.Results: In total, 82% performed minimum T2 sagittal and T2 axial oblique sequences. The high-resolution T2 sequence parameters varied significantly with only 33% obtaining a voxel size of <1.3 mm3 . The rate of inclusion of relevant findings in the reports was T3 distance in mm 21%, N stage 84%, circumferential resection margin (CRM) status 72%, extramural venous invasion (EMVI) status 29% and distance from the puborectalis sling 17%. In total, 31% reports included all of T stage with T3 substage, N stage and CRM involvement. In total, 17% reports included these 3 findings and EMVI. Eleven reports used a template with 82% of these including the first 3 findings. The agreement with central reporters was T stage 76%, N stage 70%, CRM status 57% and EMVI 16%.Conclusion: There is significant variation in scan quality and low rates of including all relevant findings in rectal MRI reports in the audit. The authors recommend adoption of routine sequences and template reports in both trial settings and routine practice to improve scan technique and adequacy of reports in rectal cancer MRI staging scans across Australia and New Zealand. [ABSTRACT FROM AUTHOR]

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STUDY DESIGN: Cross-sectional, observational study. OBJECTIVES: To investigate the cross-sectional area (CSA) of trunk muscles in professional ballet dancers with and without low back pain (LBP). BACKGROUND: LBP is the most prevalent chronic injury in classical ballet dancers. Research on nondancers has found changes in trunk muscle size and symmetry to be associated with LBP. There are no studies that examine these changes , in ballet dancers. METHODS: Magnetic resonance imaging was performed in 14 male and 17 female dancers. The CSAs of 4 muscles (multifidus, lumbar erector spinae, psoas, and quadratus lumborum) were measured and compared among 3 groups of dancers: those without LBP or hip pain (n = 8), those with LBP only (n = 13), and those with both hip-region pain and LBP (n = 10). RESULTS: Dancers with no pain had larger multifidus muscles compared to those with LBP at L3-5 (P<,024) and those with both hip-region pain and LBP at L3 and L4 on the right side (P<.027). Multifidus CSA was larger on the left side at L4 and L5 in dancers with hip-region pain and LBP compared to those with LBP only (P<.033). Changes in CSA were not related to the side of pain (all, P>.05). The CSAs of the other muscles did not differ between groups. The psoas (P<.0001) and quadratus lumborum (P<.01) muscles were larger in male dancers compared to female dancers. There was a positive correlation between the size of the psoas muscles and the number of years of professional dancing (P = .03). CONCLUSION: In classical ballet dancers, LBP and hip-region pain and LBP are associated with a smaller CSA of the multifidus but not the erector spinae, psoas, or quadratus lumborum muscles. [ABSTRACT FROM AUTHOR]

Background: People with hip osteoarthritis are typically offered a combination of education and exercise to address muscle atrophy and weakness. Limited evidence exists to assess the efficacy of exercise programs on muscle structure or function in this population. The aim of this study was to evaluate the effects of targeted resistance exercise on gluteal muscle hypertrophy and strength in people with mild-to-moderate hip osteoarthritis., Methods: Twenty-seven participants with radiologically confirmed hip osteoarthritis recruited from a single site of a multi-site, double-blind clinical trial were randomly allocated to receive a 12-week targeted gluteal intervention or sham intervention. Magnetic resonance imaging and hand-held dynamometry were used to determine change in gluteal muscle volume, fatty infiltration and hip muscle strength. For gluteal muscle volume and strength outcomes mixed model analyses of variance (ANOVA) were conducted. A general linear model (ANOVA) analysis with fixed effects parameter estimates was used to assess the impact of sex on gluteal muscle size and strength of the affected limb only. For muscle fat index a mixed method ANOVA was used to assess the differences between groups and over time., Results: In the targeted intervention group, gluteus minimus volume increased from baseline to post-intervention in both limbs (pooled mean difference: 0.06 cm 3 /kg, 95% confidence interval: 0.01 to 0.11) while no change occurred in the sham group (time x group effect: P = 0.025). Gluteus medius, gluteus maximus and tensor fascia lata volume did not change significantly over time. Hip strength (abduction, adduction, flexion, extension, external and internal rotation) improved similarly in both groups (time main effect: P ≤ 0.042). There was a consistent, albeit non-significant, pattern of reduced fatty infiltration after the targeted intervention., Conclusion: Targeted resistance exercise resulted in gluteus minimus hypertrophy, but improvements in hip strength occurred in both groups. Clinicians delivering hip osteoarthritis rehabilitation programs might consider implementing a targeted exercise program to attenuate disease associated changes within gluteal muscles., Trial Registration: Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017., (© 2022. The Author(s).)

Objectives: The aim of this study is to determine the prevalence of abnormal anatomical change present on MRI in elite swimmers' shoulders compared to age-matched controls., Design: Descriptive epidemiological study., Methods: Sixty (aged 16-36 years) elite Australian swimmers and 22 healthy active, age and gender matched controls (aged 16-34 years). All participants completed a demographic, and training load and shoulder pain questionnaire and underwent shoulder MRI. Tests for differences in the population proportion was used for comparison between swimmers dominant and non-dominant shoulders and those of the controls., Results: Subscapularis and supraspinatus tendinopathy was the most common tendon abnormality identified in swimming participants, being reported in at least one shoulder in 48/60 (73 %) and 46/60 (70 %) swimmers, respectively. There was no significant difference between dominant and non-dominant shoulders for either tendinopathy, however, grade 3 tendinopathy was significantly more prevalent in subscapularis than in supraspinatus (P < 0.01). Compared with controls, significantly more abnormalities were reported in swimmers' shoulders in both subscapularis and supraspinatus tendons along with the labrum and acromioclavicular joint. Pathology was not a predictor of current pain., Conclusions: This data confirms that tendon abnormality is the most common finding in elite swimmers' shoulders. Furthermore, that subscapularis tendinopathy is not only as common as supraspinatus but has a greater prevalence of grade 3 tendinopathy. With significant varied abnormalities including tendinopathy being so common in both symptomatic and asymptomatic shoulders of swimming athletes', clinicians should consider imaging findings alongside patient history, symptom presentation and clinical examination in determining their relevance in the presenting condition., (Copyright © 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

The article discusses differential putaminal morphology in Huntington's disease (HD), Alzheimer's disease (AD) and frontotemporal dementia (FTD), diseases with differential clinical dysfunction. Cognitive testing show AD group with poorer performance, and putaminal shape deflation was evident in HD, followed by FTD. The study concluded that differential patterns of putaminal atrophy in HD, FTD and AD suggests putamen to be a suitable clinical biomarker in neurodegenerative disease.

Abstract: Magnetic resonance imaging (MRI), a non-invasive technique, was used to study the soft tissue of live Sydney rock oysters (Saccostrea glomerata). The oysters were farmed in Port Stephens, Australia and the research was carried out during 2008–2011. MRI was performed on a Varian UNITY plus 300MHz spectrometer with a wide bore Oxford magnet system (7.05Tesla) equipped with a Varian Millipede microimaging probe. Relaxation parameters (T 1 and T 2) were found to be dependent on the type of tissue and also reflected seasonal changes in reproductive status of the gonad. The variation in T 1 values of different types of soft tissue was used judiciously to optimise contrast in MR images. The MR images of live oysters revealed anatomical details of the gills and the labial palps that are consistent with the feeding mechanism of bivalves. An empirical equation (y =4.2x +14.9) was derived by traditional methods which describes the relationship between the condition index (y) of oysters and the percentage volume of soft tissue (x). A significant correlation (R2 =0.871, P<0.01, n=5) was obtained between measurements of percentage volume of soft tissue by MRI and the traditional method. Hence, it was concluded that MRI is useful in determining the condition index of live oysters. An interesting observation from MR images was the development of gas bubbles within emersed oysters. Analysis of this gas revealed an elevated concentration of carbon dioxide (2760ppm after 3days of emersion and 6300 ppm after 8days). It was concluded that oysters produce gas bubbles by a physiological process for removing CO2 from soft tissue. The research findings presented here suggest that MRI, due to its non-invasive nature, could prove to be a unique tool for oyster research. [Copyright &y& Elsevier]

The Older Australian Twins Study (OATS) was recently initiated to investigate genetic and environmental factors and their associations and interactions in healthy brain ageing and ageing-related neurocognitive disorders. The study extends the classic MZ-DZ design to include one or two equivalently aged siblings for each twin pair and utilizes the rich resources of the Australian Twin Registry. The study has a number of distinguishing features including comprehensive psychiatric, neuropsychological, cardiovascular, metabolic, and neuroimaging assessments, a longitudinal design and links with a brain donor program. The study measures many behavioral and environmental factors, but in particular lifetime physical and mental activity, physical and psychological trauma, loss of parent early in life, later losses and life events, early-life socioeconomic environment, alcohol and drug use, occupational exposure, and nutrition. It also includes comprehensive cardiovascular assessment, blood biochemistry, genetics and proteomics. The socio-demographic and health data on the first 172 pairs of twins participating in this study are presented. Prevalence of mild cognitive impairment is 12.8% and of dementia 1.5% in the sample. The target sample size is 1000, with at least 400 pairs of twins aged 65-90 years. The cohort will be assessed every two years, with in-depth assessments being repeated. OATS offers an excellent opportunity for collaboration with other similar studies as well as researchers who share the same interests. [ABSTRACT FROM AUTHOR]

Background: Cardiac involvement in systemic sarcoidosis is common; however, current diagnostic tools are imprecise. Recognition of cardiac sarcoidosis (CS) is important as it has a relatively poor prognosis. Gadolinium-enhanced cardiac magnetic resonance imaging (Gad-CMR) is emerging as an excellent technique in determining the presence of and extent to which cardiac muscle is affected by sarcoidosis. Methods: A retrospective analysis was performed on all patients with biopsy-proven systemic sarcoidosis referred for Gad-CMR scanning to evaluate potential cardiac involvement. All patients also underwent an electrocardiogram, Holter monitor and echocardiography. Gallium-67 radionuclide investigation, positron emission tomography and cardiac biopsy were ordered at the discretion of the treating physician. Results: Eleven of the 20 patients had Gad-CMR images supportive of the diagnosis of CS. Eight of these 11 patients met the Japanese Ministry of Health and Welfare (JMHW) criteria for the diagnosis of CS; three abnormal Gad-CME scans consistent with diagnosis of CS were seen in patients who did not meet JMHW criteria. No patients with normal Gad-CMR scan met JMHW criteria for CS. Conclusion: These findings suggest that Gad-CMR is potentially superior to the JMHW criteria in the diagnosis of cardiac sarcoidosis. [ABSTRACT FROM AUTHOR]

Abstract: We examined the associations of current alcohol consumption with brain morphometric measures in a healthy, community-dwelling cohort. Cranial T1-weighted 3D-structural MRI scans were obtain in 383 adults (men=211) aged 60–64 years, randomly selected form the larger PATH Through Life study. Voxel-based morphometric analyses were applied to detect regional gray matter and white matter volume changes related to reported weekly alcohol consumption (mean 7.04±8.15 drinks per week). Alcohol consumption in men had a linear association with greater gray matter in bilateral superior and medial frontal gyrus, bilateral middle occipital gyrus, right inferior parietal gyrus, bilateral precentral gyrus, left paracentral gyrus, left uncus and left inferior occipital gyrus, and with lesser white matter in bilateral superior temporal and left parahippocampal gyrus, after adjustment for age, education, total intracranial volume, smoking, hypertension, diabetes and hyperlipidemia. In women, there was no significant linear association between alcohol consumption and total or regional brain volumes. Our results showed a dose-related, sexually dimorphic impact of alcohol on brain tissue volumes independent of cerebrovascular risk factors. These findings are consistent with an inverse-U association between alcohol use and brain morphometry, while suggesting an increased vulnerability of white matter to alcohol-related brain damage. [Copyright &y& Elsevier]

SUMMARY Primary cerebral neuroblastoma is one of a group of highly malignant undifferentiated primitive neuroectodermal tumours arising from germinal matrix cells of the embryonic neural tube. They occur primarily in young children and are extremely rare in adults. They may be multicentric and have often spread throughout the central nervous system at the time of diagnosis. A case of a 16-year-old man is described, and the recent literature is reviewed. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease, characterised by oligodendrocyte death and demyelination. Oligodendrocyte progenitor cells can differentiate into new replacement oligodendrocytes; however, remyelination is insufficient to protect neurons from degeneration in people with MS. We previously reported that 4 weeks of daily low-intensity repetitive transcranial magnetic stimulation (rTMS) in an intermittent theta-burst stimulation (iTBS) pattern increased the number of new myelinating oligodendrocytes in healthy adult mice. This study translates this rTMS protocol and aims to determine its safety and tolerability for people living with MS. We will also perform magnetic resonance imaging (MRI) and symptom assessments as preliminary indicators of myelin addition following rTMS., Methods: Participants (N = 30, aged 18-65 years) will have a diagnosis of relapsing-remitting or secondary progressive MS. ≤2 weeks before the intervention, eligible, consenting participants will complete a physical exam, baseline brain MRI scan and participant-reported MS symptom assessments [questionnaires: Fatigue Severity Scale, Quality of Life (AQoL-8D), Hospital Anxiety and Depression Scale; and smartphone-based measures of cognition (electronic symbol digit modalities test), manual dexterity (pinching test, draw a shape test) and gait (U-Turn test)]. Participants will be pseudo-randomly allocated to rTMS (n=20) or sham (placebo; n=10), stratified by sex. rTMS or sham will be delivered 5 days per week for 4 consecutive weeks (20 sessions, 6 min per day). rTMS will be applied using a 90-mm circular coil at low-intensity (25% maximum stimulator output) in an iTBS pattern. For sham, the coil will be oriented 90° to the scalp, preventing the magnetic field from stimulating the brain. Adverse events will be recorded daily. We will evaluate participant blinding after the first, 10th and final session. After the final session, participants will repeat symptom assessments and brain MRI, for comparison with baseline. Participant-reported assessments will be repeated at 4-month post-allocation follow-up., Discussion: This study will determine whether this rTMS protocol is safe and tolerable for people with MS. MRI and participant-reported symptom assessments will serve as preliminary indications of rTMS efficacy for myelin addition to inform further studies., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001196134 . Registered on 27 August 2019., (© 2022. The Author(s).)

Gadolinium-based contrast agents are used across species to better visualize abnormalities during MRI and are considered generally safe in clinical practice. The aim of this study was to investigate central nervous system (CNS) gadolinium deposition in 11 dogs that had an MRI performed, received 0.22 mL/kg (0.1 mmol/kg) of gadopentetate dimeglumine, and were necropsied on the same hospital admission. The index case was a 5-year-old castrated male Australian Shepherd that presented for ataxia and following MRI developed seizure-like activity that became refractory to anticonvulsant therapy. Gadolinium concentration was quantified in CNS tissues by inductively-coupled plasma mass spectrometry and was 43-fold higher in the index case. These findings suggest the possibility of gadolinium toxicity in select patients., (© 2021 American College of Veterinary Radiology.)

We present a framework for constructing predictive models of cognitive decline from longitudinal MRI examinations, based on mixed effects models and machine learning. We apply the framework to detect conversion from cognitively normal (CN) to mild cognitive impairment (MCI) and from MCI to Alzheimer's disease (AD), using a large collection of subjects sourced from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Aging (AIBL). We extract subcortical segmentation and cortical parcellation from corresponding T1-weighted images using FreeSurfer v.6.0, select bilateral 3D regions of interest relevant to neurodegeneration/dementia, and fit their longitudinal volume trajectories using linear mixed effects models. Features describing these model-based trajectories are then used to train an ensemble of machine learning classifiers to distinguish stable CN from converters to MCI, and stable MCI from converters to AD. On separate test sets the models achieved an average of accuracy/precision/recall score of 69/73/60% for converted to MCI and 75/74/77% for converted to AD, illustrating the framework's ability to extract predictive imaging-based biomarkers from routine T1-weighted MRI acquisitions., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To compare early hip osteoarthritis (OA) features on magnetic resonance imaging (MRI) in high-impact athletes with and without hip and/or groin pain, and to evaluate associations between early hip OA features, the International Hip Outcome Tool (iHOT33) and Copenhagen Hip and Groin Outcome Score (HAGOS)., Design: This case-control study evaluated data of the femoroacetabular impingement and hip osteoarthritis cohort (FORCe). One hundred and eighty-two symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 pain-free high-impact athletes (soccer or Australian football (AF)) without definite radiographic hip OA underwent hip MRI. The Scoring Hip Osteoarthritis with MRI (SHOMRI) method quantified and graded the severity of OA features. Each participant completed the iHOT33 and HAGOS., Results: Hip and/or groin pain was associated with higher total SHOMRI (0-96) (mean difference 1.4, 95% CI: 0.7-2.2), labral score (adjusted incidence rate ratio (aIRR) 1.33, 95% CI: 1.1-1.6). Differences in prevalence of cartilage defects, labral tears and paralabral cysts between symptomatic and pain-free participants were inconclusive. There was a lower prevalence of effusion-synovitis in symptomatic participants when compared to pain-free participants (adjusted odds ratio (aOR) 0.46 (95% CI: 0.3-0.8). Early hip OA features were not associated with iHOT33 or HAGOS., Conclusions: A complex and poorly understood relationship exists between hip and/or groin pain and early hip OA features present on MRI in high-impact athletes without radiographic OA. Hip and/or groin pain was associated with higher SHOMRI and labral scores., (Copyright © 2020 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Objectives: 1) Quantify the intensity of bone marrow oedema (BMO) present in the lumbar vertebrae of asymptomatic elite adult fast bowlers; 2) relate the intensity of BMO to bowling workload and lumbar bone stress injury (LBSI), and; 3) evaluate the utility of MRI screening to reduce the risk of LBSI., Methods: Thirty-eight elite Australian fast bowlers (21.6 ± 3.7 years) completed 48 screening MRI over 3 years. BMO intensity was quantified on MRI retrospectively. Standard practices for bowling workload monitoring and injury diagnosis were followed., Results: Clinically significant BMO (signal intensity ratio ≥ 2.0) was observed in 22 (46%, 95% CI 31-61) screening MRI. These bowlers had a total of 77 (IQR 45-115) days off between seasons, compared to 66 (IQR 41-94) days off for bowlers with a BMO intensity less than 2.0 (p = 0.510). Fifteen bowlers received follow up MRI as part of individualised management based on their screening MRI, of which less than five went on to develop LBSI in the subsequent season. There was no difference in days or balls bowled in the 12 months following screening MRI between those who sustained LBSI and those who did not., Conclusions: BMO is common in asymptomatic bowlers. Identification of high-risk bowlers using screening MRI informs individualised management and may prevent progression to LBSI., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Children born moderate to late preterm (MLP, 32-36 weeks' gestation) account for approximately 85% of all preterm births globally. Compared with children born at term, children born MLP are at increased risk of poor neurodevelopmental outcomes. Despite making up the largest group of preterm children, developmental outcomes of children born MLP are less well studied than in other preterm groups. This study aimed to (1) compare neurodevelopmental, respiratory health and brain magnetic resonance imaging (MRI) outcomes between children born MLP and term at 9 years of age; (2) examine the differences in brain growth trajectory from infancy to 9 years between children born MLP and term; and in children born MLP; (3) examine the relationship between brain development and neurodevelopment at 9 years; and (4) identify risk factors for poorer outcomes at 9 years., Methods and Analysis: The "LaPrem" ( La te Pre term M RI Study) study is a longitudinal cohort study of children born MLP and term controls, born at the Royal Women's Hospital in Melbourne, Australia, between 2010 and 2013. Participants were recruited in the neonatal period and were previously followed up at 2 and 5 years. This 9-year school-age follow-up includes neuropsychology, motor and physical activities, and lung function assessments, as well as brain MRI. Outcomes at 9 years will be compared between birth groups using linear and logistic regressions. Trajectories of brain development will be compared between birth groups using mixed effects models. The relationships between MRI and neurodevelopmental outcomes, as well as other early predictors of poor 9-year outcomes, will be explored using linear and logistic regression., Ethics and Dissemination: This study was approved by the human research ethics committee at the Royal Children's Hospital, Melbourne, Australia. Study outcomes will be disseminated through peer-reviewed publications, conference presentations and social media., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited., Purpose: To determine whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI., Study Design: Case-control study; Level of evidence, 3., Methods: Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury., Results: Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; P = .003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio [AHR], 0.59; P = .02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; P = .025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; P = .001) and a history of ankle injury (AHR, 3.9; P = .032). Older age (AHR, 1.1; P = .013) and a history of CMSI (AHR, 6.7; P = .002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence., Conclusion: A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI.

Objective: Calf complex injuries represent a significant injury burden among Australian Rules athletes. To date, there has been limited research correlating clinical and radiological findings of pathology within the calf. The objective of this study is to determine how accurately magnetic resonance imaging (MRI) findings correlate with clinical measures of calf muscle complex pathology in elite male athletes., Materials and Methods: A prospective cohort study was conducted on Australian rules elite athletes. A cohort of 45 athletes underwent a high-load training session of approximately 10 km of running. Athletes were then assessed by a sports physiotherapist who made a diagnosis of no pathology, delayed onset muscle soreness, strain or other. Subsequently, the athletes underwent MRI of their bilateral calf complexes. Radiologists interpreted the MRI findings and radiological diagnosis were correlated with clinical diagnosis., Results: A total of 90 calf MRIs were performed. Correlation of clinical and radiological diagnosis occurred in 57 cases. Of the 33 cases which did not correlate, there were 4 radiologically significant acute calf strains in clinically asymptomatic athletes, 3 of which involved old scar tissue., Conclusion: MRI may detect clinically insignificant injuries within the calf complex. If an athlete does not have any clinically relevant symptoms, abnormal signal on MRI may represent a different diagnosis to muscle strain. Signal change on MRI proximal to scar tissue may represent reactive oedema. Clinical history and examination should be correlated with radiological findings is recommended when diagnosing calf injury in elite athletes.

Objectives: Single-use commercial surface fiducial markers are used in clinical imaging for a variety of applications. The current study sought to find a new, reliably visible, easily sourced and inexpensive fiducial marker alternative for use with MRI., Design: Five commonly requested MRI sequences were determined (three-dimensional (3D) T1-weighted, T1 coronal, 3D T2-weighted, T2 fat suppressed, proton density), to examine the visibility of 18 items (including a commercial fiducial marker)., Setting: Clinical 3T MRI scanner in an Australian Tertiary Hospital and an Australian University Biomedical Engineering research group., Interventions: 18 marker alternatives were scanned using five common MRI sequences. Images were reformatted to obtain both an image through the mid-height of each marker and a maximum intensity z-projection image over the volume of the marker. Variations in marker intensity were profiled across each visible marker and a visibility rating defined., Main Outcome Measures: Outcome measures were based on quantitative assessment of a clear intensity contrast ratio between the marker and the adjacent tissue and a qualitative assessment of visibility via a 3-point scale., Results: The fish oil capsule, vitamin D capsule, paint ball pellet, soy sauce sushi tube and commercial markers were typically visible to a high quality on all the imaging sequences and demonstrated a clear differential in intensity contrast against the adjacent tissue. Other common items, such as plasticine 'play doh' and a soft 'Jelly baby' sweet, were surprise candidates, demonstrating high-quality visibility and intensity contrast for the 3D T1-weighted sequence., Conclusions: Depending on the basis for referral and MRI sequence chosen, four alternative fiducial markers were determined to be inexpensive, easily sourced and consistently visible. Of these, the vitamin D capsule provided an excellent balance between availability, size, cost, usability and quality of the visualised marker for all the commonly used MRI sequences analysed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

In humans, dystrophin mutations cause the X-linked recessive disorder known as Duchenne muscular dystrophy (DMD). These mutations result in skeletal and cardiac muscle damage with mortality increasingly associated with cardiomyopathy. We have identified a novel dystrophin mutation in exon 21 in a line of Australian Labradoodles; affected dogs develop progressive clinical signs including poor weight gain and weight loss, gait abnormalities, exercise intolerance, skeletal muscle atrophy, macroglossa, ptyalism, dysphagia, kyphosis, and a plantigrade stance. Echocardiographic abnormalities include hyperechoic foci in the left ventricular papillary muscles, septal hypokinesis, and decreased left ventricular systolic and diastolic volume and internal diameter. Holter recordings found a Mobitz type II second-degree atrioventricular (AV) block in one affected dog. Analysis of phosphocreatine-to-ATP ratios (PCr/ATP) (obtained via cardiac magnetic resonance imaging and spectroscopy evaluation), found no statistically significant difference in the mean PCr/ATP between groups. Histopathologic skeletal muscle changes included fibrofatty infiltration, myocyte degeneration, necrosis, and regeneration, lymphohistiocytic inflammation, and mineralization; cardiac changes were limited to a focal area of mineralization adjacent to the sinoatrial node in the dog with a second-degree AV block. Due to rapidly progressive clinical signs, a severe phenotype, and potential for cardiac involvement, Australian Labradoodle dystrophinopathy may be a useful model to further study DMD pathogenesis., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To examine the percentage of patients with raised state anxiety levels before undergoing a medical imaging procedure; their attribution of procedural-related anxiety or worry; and sociodemographic, health, and procedural characteristics associated with raised state anxiety levels., Materials and Methods: This prospective cross-sectional study was undertaken in the outpatient medical imaging department at a major public hospital in Australia, with institutional board approval. Adult outpatients undergoing a medical imaging procedure (CT, x-ray, MRI, ultrasound, angiography, or fluoroscopy) completed a preprocedural survey. Anxiety was measured by the short-form state scale of the six-item State-Trait Anxiety Inventory (STAI: Y-6). The number and percentage of participants who reported raised anxiety levels (defined as a STAI: Y-6 score ≥ 33.16) and their attribution of procedural-related anxiety or worry were calculated. Characteristics associated with raised anxiety were examined using multiple logistic regression analysis., Results: Of the 548 (86%) patients who consented to participate, 488 (77%) completed all STAI: Y-6 items. Half of the participants (n = 240; 49%) experienced raised anxiety, and of these, 48% (n = 114) reported feeling most anxious or worried about the possible results. Female gender, imaging modality, medical condition, first time having the procedure, and lower patient-perceived health status were statistically significantly associated with raised anxiety levels., Conclusion: Raised anxiety is common before medical imaging procedures and is mostly attributed to the possible results. Providing increased psychological preparation, particularly to patients with circulatory conditions or neoplasms or those that do not know their medical condition, may help reduce preprocedural anxiety among these subgroups., (Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Introduction: To compare the cost-effectiveness and patient impact between acute magnetic resonance imaging (MRI) management and conventional management in the diagnosis of occult scaphoid fractures in a rural setting., Methods: Consecutive patients presenting to a rural emergency department (ED) with a suspected scaphoid fracture were randomly assigned to either conventional management (6) or acute MRI management (10) (3 patients were excluded from the study analysis). All healthcare costs were compared between the two management groups and potential impacts on the patients' pain, mobility and lifestyle were also measured., Results: There were no significant differences between the two groups at baseline. There was one (10%) scaphoid fracture in the MRI group and none in the conventional group (P = 0.42). A larger proportion of other fractures were diagnosed in the MRI group (20% (2) vs. 16.7% (1), P = 0.87), as well as less clinic attendances (1 (0-2.25) vs. 4 (2.25-5)) and diagnostic services (1 (1-1.25) vs. 2 (1-3)). Median management costs were $485.05 (AUD) (MRI) and $486.90 (AUD) (conventional). The MRI group had better pain and satisfaction scores as well as less time of immobilisation, treatment and time off work., Conclusion: MRI dramatically reduces the amount of unnecessary immobilisation, time of treatment and healthcare usage in a rural setting. The two protocols are suggested to be equivalent financially. When potential societal costs, the amount of unnecessary immobilisation, low prevalence of true fractures and patient satisfaction are considered, acute MRI should be the management technique of choice. Further studies are still required to assess the best method for managing bone bruise within the scaphoid.

Objective: Tinnitus in adults is generally investigated by contrast-enhanced magnetic resonance imaging (MRI) to rule out the diagnosis of acoustic neuroma. Acoustic neuroma is rare in children and, therefore, the role of MRI in children with tinnitus is unclear. This study was undertaken to determine the value of MRI in the investigation of tinnitus in children., Methods: Retrospective study of children younger than 18 years who underwent MRI for the investigation of tinnitus over a 10-year period., Results: Sixty-five patients were identified, but there were only 34 who had also undergone audiologic assessment. Among the 25 patients with normal audiology, MRI abnormalities were present in 9, but these were all thought to be nonspecific. Nine patients had abnormal audiograms and the MRI was abnormal in 4 of these cases, which included 3 children who were found to have multiple sclerosis., Conclusion: Magnetic resonance imaging would appear to be mandatory in the investigation of tinnitus in children who are found to have sensorineural hearing loss, particularly to rule out the diagnosis of multiple sclerosis. Although our study does not support the routine use of MRI in children with normal audiology, the numbers in our series are too small for a conclusive recommendation., (© The Author(s) 2014.)

Background & Aims: There is a need for a scoring system that provides a comprehensive assessment of structural bowel damage, including stricturing lesions, penetrating lesions, and surgical resection, for measuring disease progression. We developed the Lémann Index and assessed its ability to measure cumulative structural bowel damage in patients with Crohn's disease (CD)., Methods: We performed a prospective, multicenter, international, cross-sectional study of patients with CD evaluated at 24 centers in 15 countries. Inclusions were stratified based on CD location and duration. All patients underwent clinical examination and abdominal magnetic resonance imaging analyses. Upper endoscopy, colonoscopy, and pelvic magnetic resonance imaging analyses were performed according to suspected disease locations. The digestive tract was divided into 4 organs and subsequently into segments. For each segment, investigators collected information on previous operations, predefined strictures, and/or penetrating lesions of maximal severity (grades 1-3), and then provided damage evaluations ranging from 0.0 (no lesion) to 10.0 (complete resection). Overall level of organ damage was calculated from the average of segmental damage. Investigators provided a global damage evaluation (from 0.0 to 10.0) using calculated organ damage evaluations. Predicted organ indexes and Lémann Index were constructed using a multiple linear mixed model, showing the best fit with investigator organ and global damage evaluations, respectively. An internal cross-validation was performed using bootstrap methods., Results: Data from 138 patients (24, 115, 92, and 59 with upper tract, small bowel, colon/rectum, and anus CD location, respectively) were analyzed. According to validation, the unbiased correlation coefficients between predicted indexes and investigator damage evaluations were 0.85, 0.98, 0.90, 0.82 for upper tract, small bowel, colon/rectum, anus, respectively, and 0.84 overall., Conclusions: In a cross-sectional study, we assessed the ability of the Lémann Index to measure cumulative structural bowel damage in patients with CD. Provided further successful validation and good sensitivity to change, the index should be used to evaluate progression of CD and efficacy of treatment., (Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: The risk of multiple sclerosis (MS) is dependent on multiple variables, including geographical location. There is increasing interest in the early recognition and treatment of MS in children., Method: Using univariate and multivariate analysis, we determined the clinical and radiological features that were predictive of MS in 88 children from New South Wales, Australia, with a first acute demyelinating syndrome (ADS) who were followed for a minimum of one year. We tested the McDonald, KIDMUS, Callen and Verhey MRI criteria for paediatric MS., Results: After a mean follow-up of 5.2 years, 13/88 (15%) of children had MS. Using multivariate analysis, preceding infection was protective of MS, and corpus callosal lesions, the combined presence of both well and poorly demarcated lesions, and contrast-enhancing lesions on MRI were predictive of MS. The sensitivity and specificity of the respective radiological criteria were McDonald 2005 (69%, 68%), McDonald 2010 (58%, 95%), KIDMUS (8%, 100%), Callen (69%, 85%) and Verhey (62%, 84%). When McDonald 2010 criteria were applied to baseline and serial scans, the sensitivity and specificity was 91% and 93%., Conclusion: Despite the long follow-up, the risk of MS appears lower in New South Wales children compared to previously reported cohorts. Radiological features are more predictive than clinical features in predicting MS. The McDonald 2010 criteria performed well although the dissemination in time criteria on baseline scans is difficult to apply to children with encephalopathy.