Alexander Isaak

BACKGROUND: Probiotic treatment strategy based on the hygiene hypothesis, such as administration of ova from the non-pathogenic helminth, Trichuris suis, (TSO) has proven safe and effective in autoimmune inflammatory bowel disease. OBJECTIVE: To study the safety and effects of TSO in a second autoimmune disease, multiple sclerosis (MS), we conducted the phase 1 Helminth-induced Immunomodulatory Therapy (HINT 1) study. METHODS: Five subjects with newly diagnosed, treatment-naive relapsing-remitting multiple sclerosis (RRMS) were given 2500 TSO orally every 2 weeks for 3 months in a baseline versus treatment control exploratory trial. RESULTS: The mean number of new gadolinium-enhancing magnetic resonance imaging (MRI) lesions (n-Gd+) fell from 6.6 at baseline to 2.0 at the end of TSO administration, and 2 months after TSO was discontinued, the mean number of n-Gd+ rose to 5.8. No significant adverse effects were observed. In preliminary immunological investigations, increases in the serum level of the cytokines IL-4 and IL-10 were noted in four of the five subjects. CONCLUSION: TSO was well tolerated in the first human study of this novel probiotic in RRMS, and favorable trends were observed in exploratory MRI and immunological assessments. Further investigations will be required to fully explore the safety, effects, and mechanism of action of this immunomodulatory treatment.

Purpose To compare the diagnostic performance of the original Lake Louise criteria (LLC) and the 2018 LLC for the diagnosis of acute myocarditis and simultaneously validate previously reported cutoff values for parametric mapping techniques. Materials and Methods A total of 40 patients with acute myocarditis and 26 control participants underwent cardiac MRI. Cardiac MRI protocol allowed for assessment of T2 signal intensity ratio, early gadolinium enhancement ratio, late gadolinium enhancement, T1 relaxation times, extracellular volume fraction, and T2 relaxation times. The original and the 2018 LLC were assessed, and differences between sensitivities and specificities were calculated with the McNemar test. Results The 2018 LLC yielded a sensitivity of 87.5% (95% confidence interval [CI]: 73.9%, 94.5%) and a specificity of 96.2% (95% CI: 81.1%, 99.3%). The original LLC had a sensitivity of 72.5% (95% CI: 57.2%, 83.9%) and a specificity of 96.2% (95% CI: 81.1%, 99.3%). Sensitivity of the 2018 LLC was significantly higher compared with the sensitivity of original LLC (P = .031). No differences in specificity were observed between both scores (P = .999) Conclusion Multiparametric cardiac MRI has a high diagnostic value for the diagnosis of patients clinically suspected of having acute myocarditis. The 2018 LLC further improve the diagnostic performance of cardiac MRI by increasing its sensitivity. An implementation of the new score into routine diagnostic protocols should be considered. Keywords: Adults, Cardiac, Cardiomyopathies, Heart, Left Ventricle, MR-Imaging © RSNA, 2019 See also the commentary by Gutberlet and Lücke in this issue. Supplemental material is available for this article.

Abstract Computed tomography (CT) and magnetic resonance imaging (MRI) can quantify muscle mass and quality. However, it is still unclear if CT and MRI derived measurements can be used interchangeable. In this prospective study, fifty consecutive participants of a cancer screening program underwent same day low-dose chest CT and MRI. Cross-sectional areas (CSA) of the paraspinal skeletal muscles were obtained. CT and MRI muscle fat infiltration (MFI) were assessed by mean radiodensity in Hounsfield units (HU) and proton density fat fraction (MRI PDFF ), respectively. CSA and MFI were highly correlated between CT and MRI (CSA: r = 0.93, P < 0.001; MFI: r = − 0.90, P < 0.001). Mean CSA was higher in CT compared to MRI (46.6cm 2 versus 43.0cm 2 ; P = 0.05) without significance. Based on MRI PDFF , a linear regression model was established to directly estimate skeletal muscle fat content from CT. Bland–Altman plots showed a difference between measurements of − 0.5 cm 2 to 7.6 cm 2 and − 4.2% to 2.4% regarding measurements of CSA and MFI, respectively. In conclusion, the provided results indicate interchangeability of CT and MRI derived imaging biomarkers of skeletal muscle quantity and quality. Comparable to MRI PDFF , skeletal muscle fat content can be quantified from CT, which might have an impact of analyses in larger cohort studies, particularly in sarcopenia patients.

A 79-year-old male was hospitalized due to fatigue, shortness of breath, and recurrent syncopes.He denied symptoms of fever or pain.He had a previous history of asthma.No history of cardiovascular disease was reported, and previous cardiac check-ups were unremarkable (last described left ventricular ejection fraction was 65%).Initial physical examination in the emergency department revealed heart rate of 75 bpm, blood pressure of 101/64 mm Hg, body temperature of 35.6°C, oxygen saturation of 94%, and moderate wheezing on auscultation.On initial blood test, CRP (C-reactive protein) was measured at 13.80 mg/L and high sensitive troponin T at 18.8 ng/L, but leucocyte blood count and NT-proBNP (N-terminal prohormone of brain natriuretic peptide) were normal.Electrocardiogram, chest x-ray, and echocardiography were normal.Patient was referred for contrast-enhanced computed tomography to rule out pneumonia or pulmonary embolism that revealed pulmonary ground-glass peripheral infiltrates in the left upper lobe and discrete pleural and pericardial effusions (Figure 1).Because of the outbreak of coronavirus disease 2019 (COVID-19), a nasopharyngeal swab was performed at admission, real-time reverse transcriptasepolymerase chain reaction assay returned positive for severe acute respiratory syndrome coronavirus 2. Due to respiratory and hemodynamic worsening, the patient was moved to the intensive care unit.Blood tests showed an increase in CRP (64.23 mg/L), leucocyte blood count (14.60 g/L), troponin T (63.5 ng/L), and NT-proBNP (1178.0pg/mL).Cardiac magnetic resonance (CMR) was performed at 1.5 T at day 10 after admission (Figure 2).CMR analysis showed normal left ventricular size (left ventricular end-diastolic volume index: 68 mL/ m 2 ; left ventricular mass index 42 g/m 2 ) and mild systolic dysfunction (left ventricular ejection fraction: 49%) with discrete global hypokinesis, and normal right ventricular volume and function (Movies I and II in the Data Supplement).Pericardial effusion was confirmed, localized mainly around the left ventricular lateral wall (≈10 mm).T2-weighted short TI inversion recovery sequences displayed diffuse interstitial myocardial edema with an increased T2 signal intensity ratio.Presence of diffuse myocardial inflammation was confirmed by T2 mapping (global T2 relaxation times: 62 ms; center-specific cutoff value for acute myocarditis: ≥55.9 ms; global myocardial T2 relaxation time represents a mean value of all 16 heart segments). 1Late-gadolinium enhancement imaging (inversion time by using the Look-Locker technique: 240 ms) was negative for focal myocardial lesions, but prolonged T1 relaxation times could be measured (global T1 relaxation times: 1035 ms; center-specific cutoff value for acute myocarditis: ≥1000 ms; global myocardial T1 relaxation time represents a mean value of all 16 heart segments). 1CMR parameters fulfilled the revised 2018 Lake Louise criteria for the diagnosis of myocarditis. 2Medical treatment

Background Deep learning (DL) reconstructions can enhance image quality while decreasing MRI acquisition time. However, DL reconstruction methods combined with compressed sensing for prostate MRI have not been well studied. Purpose To use an industry-developed DL algorithm to reconstruct low-resolution T2-weighted turbo spin-echo (TSE) prostate MRI scans and compare these with standard sequences. Materials and Methods In this prospective study, participants with suspected prostate cancer underwent prostate MRI with a Cartesian standard-resolution T2-weighted TSE sequence (T2C) and non-Cartesian standard-resolution T2-weighted TSE sequence (T2NC) between August and November 2022. Additionally, a low-resolution Cartesian DL-reconstructed T2-weighted TSE sequence (T2DL) with compressed sensing DL denoising and resolution upscaling reconstruction was acquired. Image sharpness was assessed qualitatively by two readers using a five-point Likert scale (from 1 = nondiagnostic to 5 = excellent) and quantitatively by calculating edge rise distance. The Friedman test and one-way analysis of variance with post hoc Bonferroni and Tukey tests, respectively, were used for group comparisons. Prostate Imaging Reporting and Data System (PI-RADS) score agreement between sequences was compared by using Cohen κ. Results This study included 109 male participants (mean age, 68 years ± 8 [SD]). Acquisition time of T2DL was 36% and 29% lower compared with that of T2C and T2NC (mean duration, 164 seconds ± 20 vs 257 seconds ± 32 and 230 seconds ± 28; P < .001 for both). T2DL showed improved image sharpness compared with standard sequences using both qualitative (median score, 5 [IQR, 4–5] vs 4 [IQR, 3–4] for T2C and 4 [IQR, 3–4] for T2NC; P < .001 for both) and quantitative (mean edge rise distance, 0.75 mm ± 0.39 vs 1.15 mm ± 0.68 for T2C and 0.98 mm ± 0.65 for T2NC; P < .001 and P = .01) methods. PI-RADS score agreement between T2NC and T2DL was excellent (κ range, 0.92–0.94 [95% CI: 0.87, 0.98]). Conclusion DL reconstruction of low-resolution T2-weighted TSE sequences enabled accelerated acquisition times and improved image quality compared with standard acquisitions while showing excellent agreement with conventional sequences for PI-RADS ratings. Clinical trial registration no. NCT05820113 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Turkbey in this issue.