Pioneers; Purcell, Bloch, Mansfield, Damadian, Lauterbur

In 1946 Edward Purcell (1912-1977) and Felix Bloch (1905-1983) independently discovered Nuclear Magnetic Resonance (NMR) which is the basis for Magnetic Resonace Imaging (MRI).  In 1952 Purcell and Block shared the Nobel Price in Physics for their discovery.

Peter Mansfield (1933–2017) was an English physicist and a Professor at the University of Nottingham shared the 2003 Nobel Prize in Physiology or Medicine with Paul Lauterbur, for discoveries concerning (MRI).  His Echo Planar Imaging (EPI) method allowed later techniques like fMRI, diffusion ,DTI and perfusion to be developed. 

Raymond Damadian (1936-2022) an American physician and inventor of the first MRI machine.  In a 1971 paper in the journal of Science professor Damadian reported that tumors can be detected in vivo by nuclear magnetic resonance because of much longer relaxation times (which means the return of a perturbed system into equilibrium) than normal tissues and suggested that these differences can be used to detect cancers. Damadian perfomed the first full body scan in 1977.

Professor Paul C Lauterbur (1929-2007) was awarded the Nobel Prize in 2003 in Physiology or Medicine for his ground breaking research in the department of Chemistry at Stony Brook University that led to the invention of magnetic resonance imaging.

The above post is dedicated to my colleagues and prominent neuro-radiologists, Drs Don Chakeres, Eric Bourekas, Greg Christoforidis who worked with me during my tenure as Radiology Chairman at Ohio State University and Stathis Gotsis PhD whith whom I collaborated at the University of Illinois in Chicago and who introduced  NMR in Greece. 

Abbreviated Prostatic MRI

Kuhl et published in Radiology findings of their study in which they explored the accuracy of an abbreviated MRI of the prostate.  Multi-parametric contrast-enhanced MR imaging was performed in men with elevated PSA who after negative transrectal US-guided biopsy underwent state-of-the-art, full multiparametric contrast-enhanced MR imaging at 3.0-T that included high-spatial-resolution structural imaging in several planes, diffusion-weighted imaging at 0, 800, 1000, and 1400 mm²/sec, and dynamic contrast-enhanced MR imaging, obtained without endorectal coil within 34 minutes 19 seconds.

One of four radiologists first reviewed only two sequences of the study

 consisting of single-plane (axial) structural imaging (T2-weighted turbo spin-echo and diffusion-weighted imaging), acquired within 8 minutes 45 seconds (referred to as bi-parametric MR imaging), and established a diagnosis; only thereafter, the remaining full multiparametric contrast-enhanced MR images were read. Men with PI-RADS categories 3–5 underwent MR-guided targeted biopsy. Men with PI-RADS categories 1–2 remained in urologic follow-up for at least 2 years, with rebiopsy (transrectal US-guided or transperineal) when appropriate. 

A total of 542 men, aged 65 years with median PSA of 7 ng/mL, were included. Bi-parametric MR imaging helped detect clinically significant prostate cancer in 138 men. Full multi-parametric contrast-enhanced MR imaging allowed detection of one additional clinically significant prostate cancer (a stage pT2a, intermediate-risk cancer with a Gleason score of 3+4) and caused 11 additional false-positive diagnoses. Diagnostic accuracy for detection of clinically significant cancer of bi-parametric MR imaging was 89.1% (483 of 542) was similar to that of full multi-parametric contrast-enhanced MR imaging 87.2% (473 of 542). 

The authors concluded that bi-parametric MR imaging which can be done with two sequences and without contrast injection in less that 9 minutes allows for detection of clinically significant prostate cancer with a rate equivalent to conventional full multi-parametric contrast-enhanced MR imaging protocols.

Preoperative Breast MRI detects additional cancers

A paper by Bae et al published in Radiology indicates that preoperative MRI in women whose breast cancer was detected by ultrasound found additional cancers.

The study was a retrospective review of 374 women, median age, 48 years, with breast cancer detected at screening ultrasound.

Of 374 women, 21 or 5.6% patients were diagnosed with additional cancer.  In premenopausal women with invasive breast cancer and in those with index invasive lobular histologic type had higher incidence of additional cancer detected at MR imaging.  Premenopausal status also put the women at risk.

The authors concluded that preoperative MRI detected additional sites of cancer in women with breast cancer detected at screening ultrasound.

Malpractice Reform does not Affect ED Utilization

Waxman et al report in NEJM their findings regarding the effect legal reform had in the practice of medicine, in three states, Texas, Georgia, and South Carolina, which between 2003 and 2005, enacted legislation that changed the malpractice standard for emergency care to gross negligence.  

Using a 5% random sample of Medicare fee-for-service beneficiaries, they identified all emergency department visits to hospitals in the three reform states and in neighboring (control) states from 1997 through 2011. They compared patient-level outcomes, before and after legislation, in reform states and control states. Outcomes were policy-attributable changes in the use of computed tomography (CT) or magnetic resonance imaging (MRI), per-visit emergency department charges, and the rate of hospital admissions.

For eight of the nine states–outcome combinations tested, they found no reduction in the rates of CT or MRI utilization or hospital admission in any of the three reform states and no reduction in charges in Texas or South Carolina. In Georgia, reform was associated with a 3.6% reduction in per-visit emergency department charges.

They conclude that legislation that substantially changed the malpractice standard for emergency physicians in three states had little effect on the intensity of practice, as measured by imaging rates, average charges, or hospital admission rates.