RPS 2211 - Neuroimaging in various diseases

Author Block: M. Elmansy¹, J. M. Morrow¹, S. Shah¹, S. Wastling¹, S. Saleh El-Essawy², E. Helmy², M. G Hanna¹, J. S. Thornton¹, T. A. Yousry¹; ¹London/UK, ²Mansoura/EG
Purpose or Learning Objective: To quantify the cross-sectional area (CSA) of the sciatic and tibial nerves in patients with IBM compared with Charcot-Marie-Tooth disease type IA (CMTIA) and healthy controls using MRI and correlate these nerve measurements with the clinical data and disease scores.
Methods or Background: MRI of the sciatic and tibial nerves was performed at 3T using magnetisation-prepared rapid gradient-echo sequence (MPRAGE) and 2D Dixon. The nerve CSA was measured at the mid-thigh and upper-calf regions by an observer blinded to the diagnosis. The measurements were correlated with clinical parameters.
Results or Findings: 20 patients with IBM, 20 CMT1A patients and 29 healthy controls (age and sex-matched) were studied. Sciatic nerve CSA was significantly enlarged in patients with IBM and CMT1A compared to controls (sciatic nerve mean CSA 62.3±22.9mm (IBM) vs 35.5±9.9mm (controls), p=0.001; and 97.6±35.5 (CMT1A) vs 35.5±9.9mm (controls); p=0.001. Similarly, tibial nerve CSA was also enlarged in IBM and CMT1 patients compared to controls. There was no significant correlation between CSA nerve measurements in patients with IBM and clinical disease scores. However, in CMT1A patients, sciatic nerve CSA correlated positively with age r=0.53-0.65 (p≤0.02) as well as the duration of disease r=0.56-0.61 (p≤0.01).
Conclusion: MRI reveals significant hypertrophy of the sciatic and tibial nerves in patients with IBM and CMT1A compared to controls. This study is the first study to demonstrate and quantify nerve hypertrophy in IBM patients using MRI. Further studies are needed to validate this feature, correlate with neurophysiological evaluation, and assess its diagnostic value.
Limitations: No gross limitations.
Ethics committee approval: Not applicable.
Funding for this study: Not applicable.

Author Block: A. S. C. Verde, J. Ruivo, B. Sousa, A. Oliveira-Maia, F. Cardoso, N. Papanikolaou; Lisbon/PT
Purpose or Learning Objective: Volumetry studies have shown that breast cancer patients undergoing treatment present reduced volumes in the bilateral thalamus, putamen, frontal and temporal lobes, compared with healthy controls (HC). Since cingulum fibers are interconnecting some of these structures, our aim was to identify local fractional anisotropy (FA) changes in patients which may explain the cancer-related cognitive impairment.
Methods or Background: Brain MRI examinations of 32 non-metastatic breast cancer patients - 17 endocrine-treated (ET) and 15 chemotherapy-treated (CT) - were prospectively acquired on a 3T scanner at two timepoints, namely, before (t0) and 6 months after treatment (t1). Additionally, 19 age-matched female HC, from two OpenNeuro datasets, were included in the analysis. A b-value of 1000 s/mm2 and 64 or 128 diffusion encoding directions were used as acquisition parameters for the DTI sequence. For regional-tract analysis, local differences in FA for the bilateral cingulum were quantified between groups by adapting an available MATLAB code.
Results or Findings: Visual analysis of fiber tracking results has depicted local changes in FA, which motivated the cingulum regional analysis. Overall, it was found a bilateral cingulum anisotropy reduction in patients compared with HC, both at t0 and t1. Particularly, there was a point-group interaction, statistically significant after multiple comparisons correction, with patients showing lower FA in the middle of the cingulum compared with HC. No significant differences were found between ET and CT patients.
Conclusion: White-matter integrity loss for the bilateral cingulum in breast cancer patients was shown. This tract belongs to a limbic circuit involved in memory and emotions, which may be associated with symptoms reported by patients.
Limitations: Use of external HC datasets.
Ethics committee approval: MRI acquisitions approved by the local ethics committee.
Funding for this study: BOUNCE project funded by the EU Horizon 2020 research and innovation programme.

Author Block: W. J. Shao, S. Xiang, J. Fang, w. su, Y. Yang, Y. Xiong, J. Li; Kunming/CN
Purpose or Learning Objective: To evaluate the feasibility of amide proton transfer weighted (APTw) in reflecting the pathological changes of brain tissue, cognitive impairment in T2DM rat.
Methods or Background: 48 Sprague-Dawley male rats were divided into control and T2DM groups. Cognitive function was assessed using the Morris water maze experiment. The APTw signal intensity (SI)(%) was measured by APTw . Tau expression was determined using immunofluorescence and Immunohistochemistry. Pearson and Spearman correlation analysis were used to study the relationship between hippocampal APTw SI (%), tau protein expression and cognitive function.
Results or Findings: The escape latency time significantly reduced in the T2DM group. The APTw SI(%) in bilateral hippocampus in T2DM group was significantly higher than that in NC group (P < 0.05). Compared with control group, the expression of t-Tau and p-Tau ser199 increased in T2DM group (P < 0.05). The expression of t-Tau protein was positively correlated with escape latency time (rho = 0.425，P = 0.0486). There was a positive correlation between APTw SI(%) and t-Tau protein expression. APTw SI (%) is negatively correlated with platform crossings times.
Conclusion: T2DM may result in increase the expression of t-Tau and p-Tauser199 protein in hippocampus. The increase of t-Tau protein may be the cause of DACD. MRI APTw technology can be used as an imaging biomarker for the pathological changes of brain parenchyma and cognitive function in T2DM.
Limitations: This study only focuses on amide proton concentration and does not make an in-depth study on pH
Ethics committee approval: All animal experiments conformed to the internationally accepted principles for the care and use of laboratory animals (Kunming Medical University Institutional Review Board, Approval No. kmmu 2020410).
Funding for this study: The Endocrine Clinical Medical Center of Yunnan Province, No. ZX20190202

Author Block: P. Swaminathan, N. Hamzah, N. Mohd Ramli, V. Narayanan, T. Li Kuo, K. Rahmat; Kuala Lumpur/MY
Purpose or Learning Objective: DTI can detect changes of microstructural brain damage in mTBI, however subtle changes in recovery process remains a challenge. NODDI measures orientation dispersion index (ODI), neurite density index (NDI) and isotropic volume fraction (ISOVF) which may elucidate the process in mTBI recovery.
Methods or Background: 56 mTBI and 19 healthy controls (HC) were recruited. Neuropsychological assessment battery screening module (S-NAB) performance were assessed 2 weeks post-trauma and at 3 months. The mTBI group was then divided into recovered (REC; S-NAB ≥85) and non-recovered (NREC; S-NAB <85), whereby domains affected were mainly attention and language. DTI and NODDI were done at 3 months. Using tract-based spatial statistics (TBSS), DTI and NODDI parameters were obtained for 50 white matter tracts (WMTs). Data was analysed using SPSS.
Results or Findings: NODDI demonstrated significant changes (p<0.050) in multiple WMTs. Significantly lower NDI was demonstrated in REC (0.4260, 0.4034) vs NREC (0.4540, 0.4389) in both cingulate gyri suggestive of ongoing reparative process in the still-recovering NREC WMTs. Significantly higher ISOVF was seen in REC (0.0716, 0.1349) than NREC (0.0526, 0.0983) in the right external capsule and left fornix/stria terminalis, which may represent increased CSF surrounding healed WMTs. No significant difference between REC and NREC was found in DTI.
Conclusion: NODDI detected more microstructural WMT changes than DTI at 3 months. We postulate that at three months post-mTBI, there is concurrent axonal degeneration and astrogliosis following trauma, which was more abundant in the NREC group. The significantly affected WMTs are comparable to tracts seen in previous studies on mTBI.
Limitations: Significant number of participants whom defaulted.
Ethics committee approval: Medical Research Ethics Committee of the University of Malaya Medical Centre (MREC No. 2018315-6133).
Funding for this study: Malaysian Ministry of Science, Technology and Innovation (MOSTI) Flagship Program Project No. FP0911F001

Author Block: N. Sharma; Gwalior/IN
Purpose or Learning Objective: Aim of our study was to evaluate the role of hippocampal volumetry and T2 Relaxometry in MTLE and compare the relative value of visual assessment, hippocampal volumetry, and T2 relaxometry individually and in combinations.
Methods or Background: This was one-year tertiary care teaching hospital-based case-control study. MRI analysis was done in 40 non-epileptic controls and 40 patients with intractable epilepsy on 1.5T scanner. Visual assessment and hippocampal volumetry were done on oblique coronal IR/T2W and oblique coronal FLAIR images, respectively. T2 relaxation times were measured using 16-echo Carr-Purcell-Meiboom-Gill sequence. All cases were correlated with EEG findings for lateralisation of the epileptic focus.
Results or Findings: The study showed that the highest percentage of MTLE cases were seen in patients with seizures onset in a group of 11-20 years of age and no sex predilection was noted (M:F= 1.5:1). Mean right and left hippocampal volume of 2.19 cm3 and 2.10 cm3 (P-value of <0.001) were found in the cases of study, which was decreased compared to control. T2 relaxation time was increased in MTLE cases (P-value of <0.001). Two other parameters hippocampal volume ratio (HVR) and hippocampal volume difference (HVD) were included in study to detect unilateral cases of mesial temporal sclerosis.
Conclusion: There was an increase in the sensitivity of detection of mesial temporal sclerosis in epilepsy patients on including quantitative methods like T2 relaxometry and hippocampal volumetry with conventional MRI. Use of quantitative methods leads to early diagnosis and helps treatment.
Limitations: Manual error
Ethics committee approval: I have taken approval from Member Secretary, Institutional ethics committee, Assam Medical College, Dibrugarh dated 21/09/2019. (I am unable to attach the same approval as there is no such option available for attachment)
Funding for this study: No funding is given for our study.

Author Block: C. Deniel, T. Le Corroller, D. Guenoun, P. Champsaur; Marseille/FR
Purpose or Learning Objective: To evaluate the possibility and accuracy of the medial calcaneal nerve assessment using ultra sound examination. Secondary objective was to define anatomical landmarks to facilitate the medial calcaneal nerve study for non musculoskeletal specialised radiologists.
Methods or Background: This study was first undertaken in eight cadaveric specimens then followed by high resolution ultrasonographic examination of 20 healthy volunteers (40 legs) by a fellow musculoskeletal radiologist. The location and course of the medial calcaneal nerve was depicted, as well as its relationship to the adjacent anatomic structures.
Results or Findings: High resolution ultrasonography permitted effective study of the medial calcaneal nerve throughout its course. The medial calcaneal nerve mainly branches from the tibial nerve. The level at which it branches is highly variable with a mean distance from the medial malleolus tip of 14.1mm (range -7 75). More distally, at the level of the medial calcaneal side, it ends close to the abductor hallucis muscle with a mean distance of 1.28mm (range 0 2.8).
Conclusion: The medial calcaneal nerve study is achievable using high resolution ultrasonography. The definition of easy to use anatomical landmarks allows physicians to routinely explore the MCN as a differential diagnosis for heel pain.
Limitations: Only a short number of cadavers were included. We did not analyse intra- or inter-observer differences.
Ethics committee approval: All healthy volunteers gave their written consent.
Funding for this study: No funds were received for this study