Blood oxygenation level dependent magnetic resonance imaging and diffusion weighted MRI imaging for benign and malignant breast cancer discrimination

PurposeThe purpose of this study is to assess Blood oxygenation level dependent Magnetic Resonance Imaging (BOLD-MRI) and Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) in the differentiation of benign and malignant breast lesions.MethodsFifty-nine breast lesions (26 benign and 33 malignant lesions) pathologically proven in 59 patients were included in this retrospective study. As BOLD parameters were estimated basal signal S₀ and the relaxation rate R2*, diffusion and perfusion parameters were derived by DWI (pseudo-diffusion coefficient (Dp), perfusion fraction (fp) and tissue diffusivity (Dt)). Wilcoxon-Mann-Whitney U test and Receiver operating characteristic (ROC) analyses were calculated and area under ROC curve (AUC) was obtained. Moreover, pattern recognition approaches (linear discrimination analysis (LDA), support vector machine, k-nearest neighbours, decision tree) with least absolute shrinkage and selection operator (LASSO) method and leave one out cross validation approach were considered.ResultsA significant discrimination was obtained by the standard deviation value of S0, as BOLD parameter, that reached an AUC of 0.76 with a sensitivity of 65%, a specificity of 85% and an accuracy of 76%. No significant discrimination was obtained considering diffusion and perfusion parameters. Considering LASSO results, the features to use as predictors were all extracted parameters except that the mean value of R2* and the best result was obtained by a LDA that obtained an AUC = 0.83, with a sensitivity of 88%, a specificity of 77% and an accuracy of 83%.ConclusionsGood performance to discriminate benign and malignant lesions could be obtained using BOLD and DWI derived parameters with a LDA classification approach. However, these findings should be proven on larger and several dataset with different MR scanners.     

Values of intravoxel incoherent motion diffusion weighted imaging and dynamic contrast-enhanced MRI in evaluating the activity of sacroiliitis in ankylosing spondylitis of rat model

ObjectiveTo prospectively evaluate the ability of IVIM-DWI and DCE-MRI in detecting early activity of sacroiliitis in rat model of ankylosing spondylitis by comparing with pathological results.Methods20 wistar male rats were induced by bovine proteoglycan combined with complete/incomplete Freund's adjuvant as model group, and 20 healthy male rats were used as the control group. The parameters of IVIM-DWI and DCE-MRI in synovial regions of SIJ were measured respectively at 7th, 12th, 17th, and 22th weeks after the last induction, and the pathological features of SIJ were taken also, further studying the pathological characteristics of sacroiliac region. Independent sample t-test and one-way ANOVA were used for statistical analysis. The prediction parameters and diagnostic efficiency were compared by ROC curve.ResultsThere was no significant difference of image parameters between the model and control groups at the 7th, 12th weeks after the last induction, and there were no positive findings in histopathological examination at the same time. At the 17th week after induction, the f and Fenh%, Senh% between the model and the control groups were statistically significant. At the 22th week, there was a statistically significant increase all the values in model group than those in control group (P < 0.05). Histologic examination confirmed inflmmtorycell infiitrtion at the 17th week and pannus forming of synovium on the surface of cartilage at the 22th week in the model groups. The Fenh%, Senh%, D_slow and f had the moderate diagnostic efficiency and the areas under the curve were 0.77, 0.75, 0.77 and 0.82 respectively. The Senh% demonstrated the highest sensitivity (71.4%) and f demonstrated the highest specificity (95.0%).ConclusionIVIM-DWI and DCE-MRI can be used as the sensitive imaging methods to detect and accurate diagnosis the early activity of sacroiliitis in AS.     

Diffusion configuration of water molecules in diffusion weighted imaging

In the studying of fibers microstructure of brain white matter, many reconstruction methods have been proposed to interpret the diffusion-weighted signal. Those methods can be categorized into model-based and model-free methods. In this paper, the diffusion configuration of water molecules are discussed, and two questions are put forward to analyze the performance of the current algorithms about diffusion configuration. The first question is what the diffusion profile looks like in voxel? The second question is what is the location of fibers in a voxel? As a result, firstly, most of model-based algorithms ignore much information coming from the isotropic diffusion, which will lead to an inaccurate estimation. Secondly, model-free algorithms just provide direction information of fibers, ignore or cannot provide location information of fibers. So unfortunately, neither model-based methods nor model-free methods can resolve those two questions very well. How to resolve those questions is still an open problem, and it may be an interesting direction in the future research.     

Detection of bone metastases using diffusion weighted magnetic resonance imaging: comparison with C-methionine PET and bone scintigraphy

Purpose

We evaluated the ability of diffusion-weighted imaging (DWI) to detect bone metastasis by comparing the results obtained using this modality with those obtained using ¹¹C-methionine (MET) positron emission tomography (PET) and bone scintigraphy.

Materials and methods

This retrospective study involved 29 patients with bone metastasis. DWI was obtained using a single-shot echo planar imaging (EPI) sequence with fat suppression using a short inversion time inversion recovery sequence. The detection capabilities of DWI for bone metastases were compared with those of whole body MET PET (in 19 patients) and 99mTc-methylene diphosphonate bone scintigraphy (in 15 patients).

Results

Among the 19 patients who were diagnosed using DWI and PET, the PET identified 39 bone metastases, while the DWI identified 60 metastases out of 69 metastases revealed with conventional magnetic resonance imaging (MRI). Among the 15 patients who were diagnosed using DWI and bone scintigraphy, the bone scintigraphy identified 18 bone metastases, while the DWI identified 72 metastases out of 78 metastases revealed with conventional MRI. The overall bone metastasis detection rates were 56.5% for PET, 23.1% for bone scintigraphy and 92.3% for DWI.

Conclusion

DWI is a very sensitive method for detecting bone metastasis and is superior to MET PET and bone scintigraphy in terms of its detection capabilities.     

Quantitative correlation between (1)H MRS and dynamic contrast-enhanced MRI of human breast cancer

Proton magnetic resonance spectroscopy (¹H MRS) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) provide functional information, including vascular volume, vascular permeability and choline (Cho) metabolism. In this study, we applied these two imaging modalities to quantitatively characterize 36 malignant breast lesions in 32 patients and analyzed the correlation between them. Cho concentration was quantified by single-voxel ¹H MRS using water as an internal reference. The measured Cho levels ranged from 0.32 to 10.47 mmol/kg, consistent with previously reported values. In 25 mass-type lesions, the Cho concentration was significantly correlated with tumor size (r=.69, P<.0002). In addition, the Cho level was found to be significantly higher in lesions presenting as mass-type lesions compared to non-mass-type diffuse enhancements (P=.035). The enhancement kinetics from tissues covered within each MRS voxel were measured and analyzed with a two-compartmental model to obtain pharmacokinetic parameters K^trans and k_ep. A significant correlation was found between the Cho level and the pharmacokinetic parameter k_ep (r=.62, P<.0001), indicating that tissues with a high Cho level have higher wash-out rates in DCE MRI. The results suggest a correlation between Cho metabolism and angiogenesis activity, which might be explained by the association of Cho with cell replication and angiogenesis required to support tumor growth.     

Prognostic and therapeutic evaluation of nasopharyngeal carcinoma by dynamic contrast-enhanced (DCE), diffusion-weighted (DW) magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS)

Nasopharyngeal carcinoma (NPC) is an aggressive head and neck malignancy, and radiotherapy (with or without chemotherapy) is the primary treatment modality. Reliable tumour assessment during the treatment phase, which can portend the efficacy of radiotherapy and early identification of potential treatment failure in radioresistant disease, has been implicit for better cancer management. Technological advancement in the last decade has fostered the development of functional magnetic resonance imaging (fMRI) techniques into a promising tool for diagnostic and therapeutic assessments in head and neck cancer. Apart from conventional morphological assessment, early detection of the physiological environment by fMRI allows a more thorough investigation in monitoring tumour response. This article discusses the relevant fMRI utilities in NPC as an early prognostic and monitoring tool for treatment. Challenges and future developments of fMRI in radiation oncology are also discussed.     

Magnetic resonance imaging contrast-enhanced relaxometry of breast tumors: an MRI multicenter investigation concerning 100 patients

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using extracellular contrast agents has proved to be useful for the characterization of breast tumors. DCE-MRI has demonstrated a high sensitivity (around 95%) but a rather poor and controversial specificity, varying, according to the different studies, from 45% to 90%. In order to increase (a) the specificity and (b) the robustness of this quantitative approach in multicenter evaluation (five MRI units), a quantitative approach called dynamic relaxometry has been developed. According to the proposed method, the time-dependent longitudinal relaxation rate measured on region of interest of the lesion was calculated during the contrast uptake, after intravenous bolus injection of contrast agent. A specifically developed method was used for fast R(1) measurements. Relaxometry time curves are fitted to the Tofts model allowing the measurement of the parameters describing the enhancement curve (maximum relation rate enhancement, initial, 30-s and 60-s slopes) and the tissue parameters [transfer constant (K(trans) min(-1)) and extracellular extravascular space fraction (v(e))]. Correspondence factorial analysis followed by hierarchical ascendant classification are then performed on the different parameters. Higher K(trans) values were observed in infiltrative ductal carcinomas than in infiltrative lobular carcinomas, in agreement with data published by other groups. Specificity of DCE-MRI has been increased up to 85%, with a sensitivity of 95% with K(trans)/v(e) and enhancement index I (ratio of initial slope by maximum relaxation rate enhancement). A multiparametric data analysis of the calculated parameters opens the way to include quantitative image-based information in new nosologic approaches to breast tumors.     

Diffusion-weighted imaging (DWI) of the spleen in patients with liver cirrhosis and portal hypertension

Objective

The purpose of this study was to assess the influence of liver cirrhosis and portal hypertension on diffusion coefficients of the spleen.

Material and Methods

We retrospectively evaluated 50 patients with liver cirrhosis and 50 patients without any history of liver disease who underwent magnetic resonance imaging of the upper abdomen, including echo planar diffusion-weighted imaging using b values of 50, 300 and 600 mm²/s. Spleen apparent diffusion coefficient (ADC), liver ADC, muscle ADC and normalized spleen ADC (defined as the ratio of spleen ADC to muscle ADC) were compared between cirrhotic patients and patients in the control group and correlated with Child–Pugh stages. Reproducibility was assessed by measuring interclass correlation coefficient (n = 11). Additionally, in eight patients, ADC measurements were performed 1 day before and 3 days after transjugular intrahepatic portosystemic shunt (TIPSS) implantation.

Results

Compared with control subjects, patients with cirrhosis and portal hypertension had significantly higher spleen ADCs (P = .0001). There was a statistically significant correlation between Child–Pugh grade and spleen ADC (Pearson correlation coefficient, observer 1 r = 0.6, P = .0001; observer 2 r = 0.5, P = .0001). After TIPSS implantation, we observed a reduction in spleen ADC values. Spleen ADC measurements showed a high reproducibility (interclass correlation coefficient 0.75, P = .001).

Conclusion

Our data suggest that different stages of liver cirrhosis and portal hypertension correlate with ADC values of the spleen. Furthermore, ADC values of the spleen decrease after TIPSS implantation. Further studies are required to understand the potential clinical values of these observations.     

Intermolecular double quantum coherences (iDQc) and diffusion-weighted imaging (DWI) imaging of the human brain at 1.5 T

To study the sensitivity of intermolecular double quantum coherences (iDQc) imaging contrast to brain microstructure and brain anisotropy, we investigated the iDQC contrast between differently structured areas of the brain according to the strength and the direction of the applied correlation gradient. Thus diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) maps have been obtained. This procedure, which consists of analyzing both iDQc and DWI images at different gradient strength and gradient direction, could be a promising tool for clinical brain investigations performed with higher than 1.5 T magnetic fields.     

Assessment of the link between quantitative biexponential diffusion-weighted imaging and contrast-enhanced MRI in the liver

PurposeTo investigate if intravoxel incoherent motion (IVIM) modeled diffusion-weighted imaging (DWI) can be linked to contrast-enhanced (CE-)MRI in liver parenchyma and liver lesions.MethodsTwenty-five patients underwent IVIM-DWI followed by multiphase CE-MRI using Gd-EOB-DTPA (n = 20) or Gd-DOTA (n = 5) concluded with IVIM-DWI. Diffusion (D_slow), microperfusion (D_fast), its fraction (f_fast), wash-in-rate (R_early) and late-enhancement-rate (R_late) of Gd-EOB-DTPA were calculated voxel-wise for the liver. Parenchyma and lesions were segmented. Pre-contrast IVIM was compared 1) between low, medium and high R_early for parenchyma 2) to post-contrast IVIM substantiated with simulations 3) between low and high R_late per lesion type.ResultsD_fast and f_fast increased (P < 0.001) with 25.6% and 33.8% between low and high R_early of Gd-EOB-DTPA. D_slow decreased (− 15.0%; P < 0.001) with increasing R_early. Gd-DOTA demonstrated similar observations. f_fast (+ 10%; P < 0.001) and D_fast (+ 6.6%; P < 0.001) increased after Gd-EOB-DTPA, while decreasing after Gd-DOTA (− 4.2% and − 5.7%, P < 0.001) and were confirmed by simulations. For focal nodular hyperplasia lesions (n = 5) D_fast and f_fast increased (P < 0.001) with increasing R_late, whereas for hepatocellular carcinoma (n = 4) and adenoma (n = 7) no differences were found.ConclusionMicroperfusion measured by IVIM reflects perfusion in a way resembling CE-MRI. Also IVIM separated intra- and extracellular MR contrast media. This underlines the potential of IVIM in quantitative liver imaging.     

Carotid plaque high-resolution MRI at 3 T: evaluation of a new imaging score for symptomatic plaque assessment

Purpose

To assess the sensitivity and specificity of intra-plaque hemorrhage (IPH), large lipid-rich necrotic core (LR-NC) and ulceration or cap rupture (UCR) for symptomatic carotid plaque characterization and to evaluate a new imaging score [Hemorrhage, Ulceration or cap rupture, Lipid-rich necrotic Core (HULC) score based on the sum of presence/absence of IPH, UCR and LR-NC; range 0–3] for assessment of recently symptomatic carotid plaques.

Material and methods

Twenty-seven recently symptomatic (< 8 weeks) and 36 asymptomatic patients with a carotid plaque thicker than 2 mm were prospectively imaged on a 3-T magnetic resonance (MR) system using high-resolution, multi-contrast MR sequences. Prior to analysis, all images were reviewed to assess image quality of each sequence. Sensitivity and specificity of IPH, LR-NC, UCR and HULC scores were calculated.

Results

Fifty-one patients were analyzed (26 symptomatic carotids and 67 asymptomatic carotids) after exclusion of studies with poor image quality. Sensitivity and specificity for symptomatic carotid plaque was, respectively, 46.1% and 97% for IPH, 84.6% and 73.1% for UCR and 80.7% and 76.1% for LR-NC. A HULC score of 2 or more showed a sensitivity of 73% and a specificity of 92.5%.

Conclusion

At 3 T, intra-plaque hemorrhage is the most specific criterion to characterize symptomatic carotid plaque. The HULC score offers the best compromise between sensitivity and specificity.     

Quantifying liver fibrosis through the application of texture analysis to diffusion weighted imaging

The purpose of this study was to evaluate the potential utility of texture analysis of parametric apparent diffusion coefficient (ADC) maps in quantifying hepatic fibrosis. To this end, using ex vivo murine liver tissues from a dietary model of hepatic fibrosis, an array of texture analysis techniques, including histogram-based, gray-level co-occurrence matrix-based, and gray-level run-length-based features, was used to evaluate correlations with liver fibrosis. Moderate to very strong correlation between several of the texture-based features and both subjective as well as digital image analysis-based assessments of hepatic fibrosis was demonstrated. This rigorous study of texture analysis applied to parametric ADC maps in a liver fibrosis model study demonstrates and validates the potential utility of texture-based features for the noninvasive, quantitative assessment of hepatic fibrosis.     

Optimization and numerical evaluation of multi-compartment diffusion MRI using the spherical mean technique for practical multiple sclerosis imaging

BackgroundThe multi-compartment diffusion MRI using the spherical mean technique (SMT) has been suggested to enhance the pathological specificity to tissue injury in multiple sclerosis (MS) imaging, but its accuracy and precision have not been comprehensively evaluated.MethodsA Cramer-Rao Lower Bound method was used to optimize an SMT protocol for MS imaging. Finite difference computer simulations of spins in packed cylinders were then performed to evaluate the influences of five realistic pathological features in MS lesions: axon diameter, axon density, free water fraction, axonal crossing, dispersion, and undulation.ResultsSMT derived metrics can be biased by some confounds of pathological variations, such as axon size and free water fraction. However, SMT in general provides valuable information to characterize pathological features in MS lesions with a clinically feasible protocol.ConclusionSMT may be used as a practical MS imaging method and should be further improved in clinical MS imaging.     

Water-selective spectral-spatial contrast-enhanced breast MRI for cancer detection in patients with extracapsular and injected free silicone

OBJECTIVE: This study investigates the use of contrast-enhanced, T1-weighted, water-selective spectral-spatial 3D gradient echo magnetic resonance imaging (MRI) with magnetization transfer (3DSSMT) for detecting breast cancer in patients with intraparenchymal silicone. CONCLUSION: Water-selective 3DSSMT provides superior fat and silicone suppression in patients with free silicone as compared with conventional fat saturation. It enables direct, high-quality, high-spatial-resolution, T1-weighted breast MRI of contrast enhancement without the need for subtraction processing and aids diagnosis of cancer in the breast with free silicone.     

The role of high-resolution imaging in the evaluation of nanosystems for bioactive encapsulation and targeted nanotherapy

Nanotechnology has already started to significantly impact many industries and scientific fields including biotechnology, pharmaceutics, food technology and semiconductors. Nanotechnology-based tools and devices, including high-resolution imaging techniques, enable characterization and manipulation of materials at the nanolevel and further elucidate nanoscale phenomena and equip us with the ability to fabricate novel materials and structures. One of the most promising impacts of nanotechnology is in the area of nanotherapy. Employing nanosystems such as dendrimers, nanoliposomes, niosomes, nanotubes, emulsions and quantum dots, nanotherapy leads toward the concept of personalized medicine and the potential for early diagnoses coupled with efficient targeted therapy. The development of smart targeted nanocarriers that can deliver bioactives at a controlled rate directly to the designated cells and tissues will provide better efficacy and reduced side effects. Nanocarriers improve the solubility of bioactives and allow for the delivery of not only small-molecule drugs but also the delivery of nucleic acids and proteins. This review will focus on nanoscale bioactive delivery and targeting mechanisms and the role of high-resolution imaging techniques in the evaluation and development of nanocarriers.     

Isotropic proton-density-weighted high-resolution MRI for volume measurement of reconstructed orbital fractures--a comparison with multislice CT

Objective

The cause of enophthalmos as a late complication after orbital reconstruction is poorly investigated. Multislice CT (MSCT) is usually employed for its assessment, in spite of limitations regarding soft tissue depiction/imaging, as well as the implication of radiation and production of artifacts. Magnetic resonance imaging (MRI) has been shown to be a valuable alternative. The aim of this study was to establish a bony and soft tissue orbital volume calculation method based on different high-resolution MRI sequences compared to MSCT.

Materials and Methods

Thirty-seven patients were included in this prospective study investigating the origin of enophthalmos present 3–4 months after complex orbital reconstruction. Morphological and dimensional changes of the orbit, eye globes, extraocular muscles and fat content were investigated 3–4 months after surgery. To assess the site and size of bony and soft tissue changes in the traumatized orbits, we used MSCT and MR images as well as corresponding 3-D reconstructions.

Results

All enophthalmic orbits revealed a significant bony volume increase compared to the contralateral side as well as a reduced sagittal eye projection. Mean orbital volume enlargements of 1.0 cm³ lead to 0.93 mm enophthalmos (P<.05). Hardly any fatty atrophy could be depicted by the different MRI techniques.

Conclusions

For soft tissue depiction of the orbit, MRI was superior to MSCT. Particularly, proton density weighting proved to be the best sequence for soft tissue volume segmentation, allowing determination of the cause and degree of posttraumatic enophthalmos in reconstructed orbits.     

Combination of integrated dynamic shimming and readout-segmented echo planar imaging for diffusion weighted MRI of the head and neck region at 3 Tesla

PurposeTo evaluate the performance of combined integrated slice-by-slice shimming and readout-segmented EPI (irsEPI) for diffusion-weighted MR imaging (DWI) of the neck at 3 Tesla.MethodsThis study was approved by the local ethics committee. An anthropometric phantom of the head/neck region incorporating compartments with different diffusivities was constructed. In vivo measurements were performed in 10 healthy volunteers. DWI of the phantom and volunteers was performed on a 3 Tesla MR scanner using single shot EPI (sEPI), a prototype single shot EPI with integrated slice-by-slice shimming (iEPI), readout segmented EPI (rsEPI) and a prototype readout segmented EPI with integrated shimming irsEPI. Apparent diffusion coefficients (ADC) and spatial distortions of phantom compartments were quantified. For phantom and volunteer measurements, the presence of geometric distortions, signal losses, ghosting artifacts as well as overall image quality were visually assessed on a 4-point scale by two radiologists in consensus. In addition, failure of fat saturation was assessed in volunteer data.ResultsQuantification of ADC within the phantom compartments was comparable using the different EPI techniques without significant variations. Using irsEPI, spatial distortions in phase-encoding direction were markedly reduced compared to iEPI, rsEPI and especially sEPI. irsEPI yielded significantly better overall image quality compared to sEPI, iEPI and rsEPI in phantom data as well as volunteer measurements. Markedly reduced geometric distortions and signal loss as well as better fat saturation were observed using irsEPI.ConclusionThe use of irsEPI significantly improves image quality and reduces artifacts caused by magnetic field inhomogeneities in EPI based DWI of the head/neck at 3 Tesla.     

Importance of the (nabla) D term in frequency-resolved optical diffusion imaging

The effects of the approximation DD=0 that is often used in frequency-resolved optical diffusion imaging are examined. It is shown that this approximation can affect the performance of integral-equation-based approaches to optical diffusion imaging, such as the Born iterative method and the distorted Born iterative method. The approximation introduces errors into the calculation of data used in simulations, which can lead to misleading evaluations of reconstruction algorithms. Numerical calculations show the magnitude of these effects and the appearance of artifacts in reconstructed images when conventional inversion algorithms are applied to more accurately calculated data.