Computer-based automated estimation of breast vascularity and correlation with breast cancer in DCE-MRI images

Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) with gadolinium constitutes one of the most promising protocols for boosting up the sensitivity in breast cancer detection. The aim of this study was twofold: first to design an image processing methodology to estimate the vascularity of the breast region in DCE-MRI images and second to investigate whether the differences in the composition/texture and vascularity of normal, benign and malignant breasts may serve as potential indicators regarding the presence of the disease. Clinical material comprised thirty nine cases examined on a 3.0-T MRI system (SIGNA HDx; GE Healthcare). Vessel segmentation was performed using a custom made modification of the Seeded Region Growing algorithm that was designed in order to identify pixels belonging to the breast vascular network. Two families of features were extracted: first, morphological and textural features from segmented images in order to quantify the extent and the properties of the vascular network; second, textural features from the whole breast region in order to investigate whether the nature of the disease causes statistically important changes in the texture of affected breasts. Results have indicated that: (a) the texture of vessels presents statistically significant differences (p < 0.001) between normal, benign and malignant cases, (b) the texture of the whole breast region for malignant and non-malignant breasts, produced statistically significant differences (p < 0.001), (c) the relative ratios of the texture between the two breasts may be used for the discrimination of non-malignant from malignant patients, and (d) an area under the receiver operating characteristic curve of 0.908 (AUC) was found when features were combined in a logistic regression prediction rule according to ROC analysis.     

The value of ESWAN in diagnosis and differential diagnosis of prostate cancer: Preliminary study

ObjectiveTo evaluate the value of enhanced T2 star-weighted angiography (ESWAN) in diagnosis and differential diagnosis of prostate cancer by comparing the multiple indices of ESWAN in benign prostatic hyperplasia (BPH), prostate cancer (PCa) and the normal peripheral zone (PZ).MethodsTraditional MRI and ESWAN were performed on forty-nine clinically-diagnosed PCa patients, sixty BPH patients, and forty-six normal adult males. The ESWAN indices (magnitude value, phase value, R2* value and T2* value) measured on different regions of interest (ROIs) were analyzed. Additionally, receiver operating characteristic (ROC) analysis was performed to obtain the area under the curve (AUC), sensitivity, specificity, and optimal cut-off points of PCa and BPH, PCa and PZ respectively.ResultsThe magnitude value, phase value, R2* value and T2* value of PZ were 1529.43 ± 254.43, 0.0689 ± 0.1619, 16.57 ± 8.11, 82.75 ± 53.87, respectively; the magnitude value, phase value, R2* value, and T2* value of PCa were 1540.18 ± 338.62, − 0.0176 ± 0.0919, 26.93 ± 11.31, and 45.99 ± 17.43, respectively; the magnitude value, phase value, R2* value, and T2* value of BPH were 1579.49 ± 285.28, 0.0209 ± 0.0839, 20.69 ± 3.95, and 51.56 ± 8.90, respectively. Compared with normal PZ, phase value of PCa was lower (t = − 3.302, P = 0.001), R2* value higher (t = 5.326, P = 0.000), and T2* value lower (t = − 4.570, P = 0.000); compared with BPH, phase value of PCa was lower (t = − 2.261, P = 0.026), R2* value higher (t = 3.988, P = 0.000), and T2* value lower (t = − 2.155, P = 0.033). When PCa and PZ were distinguished, the AUC of magnitude value, phase value, R2* value, and T2* value were respectively 0.539 (P = 0.510), 0.679 (P = 0.0007), 0.811 (P < 0.0001), and 0.762 (P < 0.0001); the diagnosis efficiency of R2* value was higher than that of T2* value (P = 0.037), while the diagnosis efficiency of T2* value was equivalent to phase value (P = 0.256). When PCa was differentiated from BPH, the AUC of magnitude value, phase value, R2* value, and T2* value were 0.518 (P = 0.752), 0.612 (P = 0.039), 0.705 (P = 0.0001), and 0.685 (P = 0.0006), respectively; there was no statistical difference in the diagnostic efficiency of phase value, R2* value, and T2* value.ConclusionsThe phase value, R2* value and T2* value can distinguish PCa and normal PZ, PCa and BPH, so they are valuable for the diagnosis and differential diagnosis of PCa, moreover, the diagnostic efficiency of R2* value is better than other indices.     

Parotid perfusion in nasopharyngeal carcinoma patients in early-to-intermediate stage after low-dose intensity-modulated radiotherapy: Evaluated by fat-saturated dynamic contrast-enhanced magnetic resonance imaging

PurposeTo investigate parotid perfusion in early-to-intermediate stage after parotid-sparing radiation dose using fat-saturated DCE-MRI, and to verify whether the perfusion alteration was related to radiation dose and the PSV.Methods and MaterialsThirty-two parotid glands from 16 consecutive patients with pathologically proven nasopharyngeal carcinoma treated by IMRT were examined. The parotid glands received a radiation dose of 28.9 ± 3.9 Gy with a PSV of 43.1% ± 13.9%. Perfusion parameters were calculated using time-shifted Brix model from fat-saturated DCE-MRI data before (pre-RT) and in early-to-intermediate stage after (post-RT) IMRT. Paired t-test was used to evaluate perfusion changes, while Pearson's correlation test was used to examine perfusion dependency on radiation dose and PSV. For multiple comparisons Bonferroni correction was applied.ResultsSuccessful fat saturation was achieved in 29 of 32 parotid glands. Compared with pre-RT, the post-RT parotid glands showed significantly higher A, peak enhancement, and wash-in slope, plus a lower K_el, suggesting a mixed effect of increased vascular permeability and acinar loss. Linear regression showed that peak enhancement was positively associated with radiation dose in post-RT parotid glands. K_el and slope were negatively associated with PSV, while time-to-peak was positively associated with PSV significantly.ConclusionsOur results suggest that time-shifted Brix model is feasible for quantifying parotid perfusion using DCE-MRI. The perfusion alterations in early-to-intermediate stage after IMRT might be related to a mixed effect of increased vascular permeability and acinar loss with dose and PSV dependencies.     

Differentiation of myeloma and metastatic cancer in the spine using dynamic contrast-enhanced MRI

Spinal myeloma and metastatic cancer cause similar symptoms and show similar imaging presentations, thus making them difficult to differentiate. In this study, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed to differentiate between 9 myelomas and 22 metastatic cancers that present as focal lesions in the spine. The characteristic DCE parameters, including the peak signal enhancement percentage (SE%), the steepest wash-in SE% during the ascending phase and the wash-out SE%, were calculated by normalizing to the precontrast signal intensity. The two-compartmental pharmacokinetic model was used to obtain K^trans and k_ep. All nine myelomas showed the wash-out DCE pattern. Of the 22 metastatic cancers, 12 showed wash-out, 7 showed plateau, and 3 showed persistent enhancing patterns. The fraction of cases that showed the wash-out pattern was significantly higher in the myeloma group than the metastatic cancer group (9/9 = 100% vs. 12/22 = 55%, P = .03). Compared to the metastatic cancer group, the myeloma group had a higher peak SE% (226% ± 72% vs. 165% ± 60%, P = .044), a higher steepest wash-in SE% (169% ± 51% vs. 111% ± 41%, P = .01), a higher K^trans (0.114 ± 0.036 vs. 0.077 ± 0.028 1/min, P = .016) and a higher k_ep (0.88 ± 0.26 vs. 0.49 ± 0.23 1/min, P = .002). The receiver operating characteristic analysis to differentiate between these two groups showed that the area under the curve was 0.798 for K^trans, 0.864 for k_ep and 0.919 for combined K^trans and k_ep. These results show that DCE-MRI may provide additional information for making differential diagnosis to aid in choosing the optimal subsequent procedures or treatments for spinal lesions.     

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.     

Dynamic contrast-enhanced MRI of gastric cancer: Correlations of the pharmacokinetic parameters with histological type,Lauren classification,and angiogenesis

PurposeTo compare the pharmacokinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in gastric cancers of different histological type and Lauren classification, and to investigate whether DCE-MRI parameters correlate with vascular endothelial growth factor (VEGF) expression levels in gastric cancer.MethodsIncluded were 32 patients with gastric cancer who underwent DCE-MRI of the upper abdomen before tumor resection. DCE-MRI parameters including the volume transfer coefficient (K^trans), reverse reflux rate constant (K_ep), and extracellular extravascular volume fraction (V_e) were calculated from the tumor region. Post-operative specimens were used for determination of histological differentiation (i.e., non-mucinous, mucinous, or signet-ring-cell adenocarcinoma) as well as Lauren classification (intestinal type or diffuse type). VEGF expression was examined for assessing angiogenesis. DCE-MRI parameters with different histological type and Lauren classification were compared using independent samples t-test and analysis of variance, respectively. Correlations between DCE-MRI parameters and VEGF expression grades were tested using Spearman correlation analysis.ResultsAmong gastric adenocarcinomas of three different histological types, mucinous adenocarcinomas showed a higher V_e and lower K^trans than the others (P < 0.01). Between the two Lauren classifications, the diffuse type showed a higher V_e than the intestinal type (P < 0.001). The mean K^trans showed a significantly positive correlation with VEGF (r = 0.762, P < 0.001).ConclusionDCE-MRI permits noninvasive prediction of tumor histological type and Lauren classification and estimation of tumor angiogenesis in gastric cancer. DCE-MRI parameters can be used as imaging biomarkers to predict the biologic aggressiveness of a tumor as well as patient prognosis.     

Differentiation of central gland prostate cancer from benign prostatic hyperplasia using monoexponential and biexponential diffusion-weighted imaging

PurposeTo investigate biexponential apparent diffusion parameters of prostate central gland (CG) cancer, stromal hyperplasia (SH), and glandular hyperplasia (GH) and compare with monoexponential apparent diffusion coefficient (ADC) value for discriminating prostate cancer from benign hyperplasia.Materials and MethodsTwenty-one CG cancer foci, 23 SH and 26 GH nodules in the CG were analyzed in 39 patients (19 with CG cancer, 20 with peripheral zone cancer but no CG cancer) who underwent preoperative conventional DWI (b-value 0, 1000 s/mm²) and a 10 b-value (range 0 to 3000 s/mm²) DWI. All of the cancer and hyperplastic foci on MR images were localized on the basis of histopathologic correlation. The ADC value of the monoexponential DWI, and the fast apparent diffusion coefficient (ADCf), slow apparent diffusion coefficient (ADCs) value and the fraction of ADCf (f) of the biexponential DWI were calculated for all of the lesions. Receiver operating characteristic (ROC) analysis was performed for the differentiation of CG cancer from SH and GH.ResultsThe ADC values (× 10^? 3 mm²/s) were 0.87 ± 0.11, 1.06 ± 0.15, and 1.61 ± 0.27 in CG cancer, SH and GH foci, respectively, and differed significantly, yielding areas under the ROC curve (AUCs) of 1.00 and 0.80 for the differentiation of carcinoma from GH and SH, respectively. The ADCf (× 10^? 3 mm²/s), ADCs (× 10^? 3 mm²/s) and f for cancer were 1.92 ± 0.38, 0.53 ± 0.17, and 47.7 ± 6.1%, respectively, which were lower than the same values for GH (3.43 ± 0.65, 1.12 ± 0.21, 61.1 ± 8.7%) (all p < 0.01). The ADCf and ADCs for cancer were also lower than those for SH (3.11 ± 0.30, 0.79 ± 0.21) (all p < 0.01). The ADCf yielded AUCs (1.00, p > 0.01) that were comparable to those from ADC for the differentiation of cancer from GH, while ADCf yielded higher AUCs (0.92) compared with ADC (p < 0.01) for the differentiation of cancer from SH. ADCs and f revealed AUCs of 0.97 and 0.90, respectively, for the differentiation of cancer from GH, and the ADCs offered relatively lower AUCs (0.68) for differentiating cancer from SH.ConclusionBiexponential DWI could potentially improve the differentiation of prostate cancer in CG, and the ADCf of the biexponential model offers better accuracy than ADC.     

Perfusion of the uterine junctional zone in nulliparous and primiparous women assessed by DCE-MRI,as a function of menstrual cycle and hormonal contraception

PurposeTo evaluate the perfusion parameters of inner and outer myometrium in healthy nulliparous and primiparous women who are and who are not currently using hormonal contraceptives by means of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Material and methodsWe performed pelvic 1.5 T DCE-MRI on 98 women: 18 nulliparous non-users, 30 nulliparous users, 12 primiparous non-users and 38 primiparous users of hormonal contraception (mean age respectively 26.4, 25.8, 30.23 and 28.18 years). The nulliparous non-users underwent DCE-MRI investigations during their follicular, ovulatory and luteal phase. Perfusion parameters (iAUC/volume, Ktrans, Kep and Ve) were assessed in the anterior and posterior junctional zone (JZ), outer myometrium and cervix.ResultsIn nulliparous non-users, the mean Ktrans and iAUC/volume showed a decrease from follicular to luteal phase (0.82 vs 0.55 min^− 1 for Ktrans, p = 0/027 and 1.28 vs 0.68 for iAUC/volume, p < 0.001). The anterior JZ demonstrated lower Ktrans (p = 0.050) and higher Kep (p = 0.012), in nulliparous non-users, lower Ktrans in nulliparous users (p < 0.001) and lower Ve in primiparous users (p = 0.012) than the anterior outer myometrium. Ktrans at the anterior and posterior JZ wall in nulliparous users was lower than in non-users (p = 0.001 and p = 0.013) and Ve at the anterior JZ wall in primiparous users was lower than in non-users (p = 0.044).ConclusionThis study provides data on normal perfusion parameters of inner and outer myometrium, which may be potentially useful in assisted reproductive therapy.     

Quantifying global-brain metabolite level changes with whole-head proton MR spectroscopy at 3 T

Background and purposeTo assess the sensitivity of non-localized, whole-head ¹H-MRS to an individual's serial changes in total-brain NAA, Glx, Cr and Cho concentrations — metabolite metrics often used as surrogate markers in neurological pathologies.Materials and methodsIn this prospective study, four back-to-back (single imaging session) and three serial (successive sessions) non-localizing, ~3 min ¹H-MRS (TE/TR/TI = 5/10⁴/940 ms) scans were performed on 18 healthy young volunteers: 9 women, 9 men: 29.9 ± 7.6 [mean ± standard deviation (SD)] years old. These were analyzed by calculating a within-subject coefficient of variation (CV = SD/mean) to assess intra- and inter-scan repeatability and prediction intervals. This study was Health Insurance Portability and Accountability Act compliant. All subjects gave institutional review board-approved written, informed consent.ResultsThe intra-scan CVs for the NAA, Glx, Cr and Cho were: 3.9 ± 1.8%, 7.3 ± 4.6%, 4.0 ± 3.4% and 2.5 ± 1.6%, and the corresponding inter-scan (longitudinal) values were: 7.0 ± 3.1%, 10.6 ± 5.6%, 7.6 ± 3.5% and 7.0 ± 3.9%. This method is shown to have 80% power to detect changes of 14%, 27%, 26% and 19% between two serial measurements in a given individual.ConclusionsSubject to the assumption that in neurological disorders NAA, Glx, Cr and Cho changes represent brain-only pathology and not muscles, bone marrow, adipose tissue or epithelial cells, this approach enables us to quantify them, thereby adding specificity to the assessment of the total disease load. This will facilitate monitoring diffuse pathologies with faster measurement, more extensive (~90% of the brain) spatial coverage and sensitivity than localized ¹H-MRS.     

Quantitative Dixon MRI sequences to relate muscle atrophy and fatty degeneration with range of motion and muscle force in brachial plexus injury

BackgroundAssessment of muscle atrophy and fatty degeneration in brachial plexus injury (BPI) could yield valuable insight into pathophysiology and could be used to predict clinical outcome. The objective of this study was to quantify and relate fat percentage and cross-sectional area (CSA) of the biceps to range of motion and muscle force of traumatic brachial plexus injury (BPI) patients.MethodsT1-weighted TSE sequence and three-point Dixon images of the affected and non-affected biceps brachii were acquired on a 3 Tesla magnetic resonance scanner to determine the fat percentage, total and contractile CSA of 20 adult BPI patients. Regions of interest were drawn by two independent investigators to determine the inter-observer reliability. Paired Students' t-test and multivariate analysis were used to relate fat percentage, total and contractile CSA to active flexion and biceps muscle force.ResultsThe mean fat percentage 12 ± 5.1% of affected biceps was higher than 6 ± 1.0% of the non-affected biceps (p < 0.001). The mean contractile CSA 8.1 ± 5.1 cm² of the affected biceps was lower than 19.4 ± 4.9 cm² of the non-affected biceps (p < 0.001). The inter-observer reliability was excellent (ICC 0.82 to 0.96). The contractile CSA contributed most to the reduction in active flexion and muscle force.ConclusionQuantitative measurement of fat percentage, total and contractile CSA using three-point Dixon sequences provides an excellent reliability and relates with active flexion and muscle force in BPI.     

Cardiac magnetic resonance tissue tracking in right ventricle: Feasibility and normal values

PurposeTo investigate right ventricular (RV) strain in patients without identified cardiac pathology using cardiac magnetic resonance tissue tracking (CMR TT).MethodsA total of 50 consecutive patients with no identified cardiac pathology were analyzed. RV longitudinal and circumferential strain was assessed by CMR TT. The age range was 4–81 years with a median of 32 years (interquartile range, 15 to 56 years).ResultsAnalysis time per patient was < 5 min. The peak longitudinal strain (E_ll) was − 22.11 ± 3.51%. The peak circumferential strains (E_cc) for global, basal, mid-cavity and apical segments were as follows: − 11.69 ± 2.25%, − 11.00 ± 2.45%, − 11.17 ± 3.36%, − 12.90 ± 3.34%. There were significant gender differences in peak E_cc at the base (P = 0.04) and the mid-cavity (P = 0.03) with greater deformation in females than in males. On Bland-Altman analysis, peak E_ll (mean bias, 0.22 ± 1.67; 95% CI − 3.05 to 3.49) and mid-cavity E_cc (mean bias, 0.036 ± 1.75; 95% CI, − 3.39 to 3.47) had the best intra-observer agreement and inter-observer agreement, respectively.ConclusionsRV longitudinal and circumferential strains can be quickly assessed with good intra-observer and inter-observer variability using TT.     

Abnormal lipid metabolism in skeletal muscle tissue of patients with muscular dystrophy: In vitro,high-resolution NMR spectroscopy based observation in early phase of the disease

PurposeQualitative (assignment of lipid components) and quantitative (quantification of lipid components) analysis of lipid components were performed in skeletal muscle tissue of patients with muscular dystrophy in early phase of the disease as compared to control/normal subjects.MethodsProton nuclear magnetic resonance (NMR) spectroscopy based experiment was performed on the lipid extract of skeletal muscle tissue of patients with muscular dystrophy in early phase of the disease and normal individuals for the analysis of lipid components [triglycerides, phospholipids, total cholesterol and unsaturated fatty acids (arachidonic, linolenic and linoleic acid)]. Specimens of muscle tissue were obtained from patients with Duchenne muscular dystrophy (DMD) [n = 11; Age, Mean ± SD; 9.2 ± 1.4 years; all were males], Becker muscular dystrophy (BMD) [n = 12; Age, Mean ± SD; 21.4 ± 5.0 years; all were males], facioscapulohumeral muscular dystrophy (FSHD) [n = 11; Age, Mean ± SD; 23.7 ± 7.5 years; all were males] and limb girdle muscular dystrophy-2B (LGMD-2B) [n = 18; Age, Mean ± SD; 24.2 ± 4.1 years; all were males]. Muscle specimens were also obtained from [n = 30; Mean age ± SD 23.1 ± 6.0 years; all were males] normal/control subjects.ResultsAssigned lipid components in skeletal muscle tissue were triglycerides (TG), phospholipids (PL), total cholesterol (CHOL) and unsaturated fatty acids (arachidonic, linolenic and linoleic acid)]. Quantity of lipid components was observed in skeletal muscle tissue of DMD, BMD, FSHD and LGMD-2B patients as compared to control/normal subjects. TG was significantly elevated in muscle tissue of DMD, BMD and LGMD-2B patients. Increase level of CHOL was found only in muscle of DMD patients. Level of PL was found insignificant for DMD, BMD and LGMD-2B patients. Quantity of TG, PL and CHOL was unaltered in the muscle of patients with FSHD as compared to control/normal subjects. Linoleic acids were significantly reduced in muscle tissue of DMD, BMD, FSHD and LGMD-2B as compared to normal/control individuals.ConclusionsResults clearly indicate alteration of lipid metabolism in patients with muscular dystrophy in early phase of the disease. Moreover, further evaluation is required to understand whether these changes are primary or secondary to muscular dystrophy. In future, these findings may prove an additional and improved approach for the diagnosis of different forms of muscular dystrophy.     

Clinical feasibility of 3D-QALAS – Single breath-hold 3D myocardial T1- and T2-mapping

PurposeTo investigate the in-vivo precision and clinical feasibility of 3D-QALAS - a novel method for simultaneous three-dimensional myocardial T1- and T2-mapping.MethodsTen healthy subjects and 23 patients with different cardiac pathologies underwent cardiovascular 3 T MRI examinations including 3D-QALAS, MOLLI and T2-GraSE acquisitions. Precision was investigated in the healthy subjects between independent scans, between dependent scans and as standard deviation of consecutive scans. Clinical feasibility of 3D-QALAS was investigated for native and contrast enhanced myocardium in patients. Data were analyzed using mean value and 95% confidence interval, Pearson correlation, Paired t-tests, intraclass correlation and Bland-Altman analysis.ResultsAverage myocardial relaxation time values and SD from eight repeated acquisitions within the group of healthy subjects were 1178 ± 18.5 ms (1.6%) for T1 with 3D-QALAS, 52.7 ± 1.2 ms (2.3%) for T2 with 3D-QALAS, 1145 ± 10.0 ms (0.9%) for T1 with MOLLI and 49.2 ± 0.8 ms (1.6%) for T2 with GraSE.Myocardial T1 and T2 relaxation times obtained with 3D-QALAS correlated very well with reference methods; MOLLI for T1 (r = 0.994) and T2-GraSE for T2 (r = 0.818) in the 23 patients. Average native/post-contrast myocardial T1 values from the patients were 1166.2 ms/411.8 ms for 3D-QALAS and 1174.4 ms/438.9 ms for MOLLI. Average native myocardial T2 values from the patients were 53.2 ms for 3D-QALAS and 54.4 ms for T2-GraSE.ConclusionsRepeated independent and dependent scans together with the intra-scan repeatability, demonstrated all a very good precision for the 3D-QALAS method in healthy volunteers. This study shows that 3D T1 and T2 mapping in the left ventricle is feasible in one breath hold for patients with different cardiac pathologies using 3D-QALAS.     

Early responses assessment of neoadjuvant chemotherapy in nasopharyngeal carcinoma by serial dynamic contrast-enhanced MR imaging

PurposeTo evaluate the feasibility of utilizing serial dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) prospectively for early prediction of neoadjuvant chemotherapy (NAC) response in nasopharyngeal carcinoma (NPC) patients.Materials and methodsSixty-three advanced NPC patients were recruited and received three DCE-MRI exams before treatment (Pre-Tx), 3 days (Day3-Tx) and 20 days (Day20-Tx) after initiation of chemotherapy (one NAC cycle). Early response to NAC was determined based on the third MRI scan and classified partial response (PR) as responders and stable disease (SD) as non-responders. After intensity-modulated radiotherapy (IMRT), complete response (CR) patients were classified as responders. The kinetic parameters (K^trans, K_ep, v_e, and v_p) derived from extended Tofts' model analysis and their corresponding changes ΔMetrics_(0–X) (X = 3 or 20 days) were compared between the responders and non-responders using the Student's T-test or Mann–Whitney U test.ResultsCompared to the SD group, the PR group after one NAC cycle presented significantly higher mean K^trans values at baseline (P = 0.011) and larger ΔK^trans_(0–3) and ΔK_ep(0–3) values (P = 0.003 and 0.031). For the above parameters, we gained acceptable sensitivity (range: 66.8–75.0%) and specificity (range: 60.0–66.7%) to distinguish the non-responders from the responders and their corresponding diagnosis efficacy (range: 0.703–0.767). The PR group patients after one NAC cycle showed persistent inhibition of tumor perfusion by NAC as explored by DCE-MRI parameters comparing to the SD group (P < 0.05) and presented a higher cure ratio after IMRT than those who did not (83.3% vs. 73.8%).ConclusionsThis primarily DCE-MRI based study showed that the early changes of the kinetic parameters during therapy were potential imaging markers to predicting response right after one NAC cycle for NPC patients.     

Quantification of myocardial oxygenation in heart failure using blood-oxygen-level-dependent T2* magnetic resonance imaging: Comparison with cardiopulmonary exercise test

PurposeQuantification of myocardial oxygenation (MO) in heart failure (HF) has been less than satisfactory. This has necessitated the use of invasive techniques to measure MO directly or to determine the oxygen demand during exercise using the cardiopulmonary exercise (CPX) test. We propose a new quantification method for MO using blood-oxygen-level-dependent (BOLD) myocardial T2* magnetic resonance imaging (M-T2* MRI), and investigate its correlation with CPX results.MethodsThirty patients with refractory HF who underwent cardiac MRI and CPX test for heart transplantation, and 24 healthy, age-matched volunteers as controls were enrolled. M-T2* imaging was performed using a 3-Tesla and multi-echo gradient-echo sequence. M-T2* was calculated by fitting the signal intensity data for the mid-left ventricular septum to a decay curve. M-T2* was measured under room-air (T2*-air) and after inhalation of oxygen for 10 min at a flow rate of 10 L/min (T2*-oxy). MO was defined as the difference between the two values (ΔT2*). Changes in M-T2* at the two conditions and ΔT2* between the two groups were compared. Correlation between ΔT2* and CPX results was analyzed using the Pearson coefficient.ResultsT2*-oxy was significantly greater than T2*-air in patients with HF (29.9 ± 7.3 ms vs. 26.7 ± 6.0 ms, p < 0.001), whereas no such difference was observed in controls (25.5 ± 4.0 ms vs. 25.4 ± 4.4 ms). ΔT2* was significantly greater for patients with HF than for controls (3.2 ± 4.5 ms vs. -0.1 ± 1.3 ms, p < 0.001). A significant correlation between ΔT2* and CPX results (peak VO₂, r = − 0.46, p < 0.05; O₂ pulse, r = − 0.54, p < 0.005) was observed.ConclusionΔT2* is increased T2*-oxy is greater in patients with HF, and is correlated with oxygen metabolism during exercise as measured by the CPX test. Hence, ΔT2* can be used as a surrogate marker of MO instead of CPX test.     

Flow versus permeability weighting in estimating the forward volumetric transfer constant (Ktrans) obtained by DCE-MRI with contrast agents of differing molecular sizes

PurposeTo quantify the differential plasma flow- (F_p-) and permeability surface area product per unit mass of tissue- (PS-) weighting in forward volumetric transfer constant (K^trans) estimates by using a low molecular (Gd-DTPA) versus high molecular (Gadomer) weight contrast agent in dynamic contrast enhanced (DCE) MRI.Materials and methodsDCE MRI was performed using a 7T animal scanner in 14 C57BL/6J mice syngeneic for TRAMP tumors, by administering Gd-DTPA (0.9 kD) in eight mice and Gadomer (35 kD) in the remainder. The acquisition time was 10 min with a sampling rate of one image every 2 s. Pharmacokinetic modeling was performed to obtain K^trans by using Extended Tofts model (ETM). In addition, the adiabatic approximation to the tissue homogeneity (AATH) model was employed to obtain the relative contributions of F_p and PS.ResultsThe K^trans values derived from DCE-MRI with Gd-DTPA showed significant correlations with both PS (r² = 0.64, p = 0.009) and F_p (r² = 0.57, p = 0.016), whereas those with Gadomer were found only significantly correlated with PS (r² = 0.96, p = 0.0003) but not with F_p (r² = 0.34, p = 0.111). A voxel-based analysis showed that K^trans approximated PS (< 30% difference) in 78.3% of perfused tumor volume for Gadomer, but only 37.3% for Gd-DTPA.ConclusionsThe differential contributions of F_p and PS in estimating K^trans values vary with the molecular weight of the contrast agent used. The macromolecular contrast agent resulted in K^trans values that were much less dependent on flow. These findings support the use of macromolecular contrast agents for estimating tumor vessel permeability with DCE-MRI.     

Correlation study between intravoxel incoherent motion MRI and dynamic contrast-enhanced MRI in head and neck squamous cell carcinoma: Evaluation in primary tumors and metastatic nodes

ObjectiveTo correlate intravoxel incoherent motion (IVIM) imaging and dynamic contrast-enhanced (DCE) MRI in head and neck squamous cell carcinoma (HNSCC).MethodsForty untreated patients with HNSCC were included retrospectively in the study. Perfusion fraction f, diffusion coefficient D and perfusion-related diffusion coefficient D* were extracted by bi-exponential fitting of IVIM data. Semi-quantitative DCE-MRI parameters, including positive enhancement integral (PEI) and maximum slope of increase (MSI), were calculated. The relationships between all variables were assessed by Spearman's test for correlation.Results27 primary tumors (PTs) and 23 lymph nodes (LNs) were analyzed. The residual sum of squares (RSS), used to assess the fit quality, was significantly different between PTs and LNs, with the last showing lower values. In LNs, D* and the product D* × f were positively related to both nPEI and nMSI, while no significant correlation was found in PTs.ConclusionEvident relationships between D* and D* × f and DCE-MRI perfusion measurements were found in LNs, while no significant association emerged in PTs. This presumably is due to the poorer agreement between the experimental data and curve fitting for PTs, as compared to LNs. Additional work is warranted to improve the reliability of the IVIM parameter estimations in primary HNSCCs.     

MR elastography of hepatocellular carcinoma: Correlation of tumor stiffness with histopathology features—Preliminary findings

PurposeTo determine if tumor stiffness by MR Elastography (MRE) is associated with hepatocellular carcinoma (HCC) pathologic features.Material and methodsA retrospective review was undertaken of all patients with pathologically confirmed HCC who underwent MRE prior to loco-regional therapy, surgical resection or transplant between 1/1/2007 to 12/31/2015. An independent observer measured tumor stiffness (kilopascals, kPa) by drawing regions of interest (ROI) covering the HCC and in the case of HCCs with non-enhancing/necrotic components, only the solid portion was included in the ROI. HCC tumor grade (WHO criteria), vascular invasion and tumor encapsulation were assessed from retrievable pathology specimens by an expert hepatobiliary pathologist. Tumor stiffness was compared by tumor grade, size, presence of capsule and vascular invasion using Student's t-test (or Exact Mann-Whitney test).Results21 patients were identified who had pathologically confirmed HCCs and tumor MRE data. 17 patients (81.0%) had underlying chronic liver disease. The mean ± SD tumor size (cm) was 5.3 ± 3.9 cm. The mean ± SD tumor stiffness was 5.9 ± 1.4 kPa. Tumors were graded as well differentiated (N = 2), moderately differentiated (N = 11) and poorly differentiated (N = 8). There was a trend toward increased tumor stiffness in well/moderately differentiated HCCs (6.5 ± 1.2 kPa; N = 13) compared to poorly differentiated HCCs (4.9 ± 1.2 kPa; N = 8) (p < 0.01). There was no significant correlation between tumor stiffness and liver stiffness or tumor size. There was no significant difference in tumor stiffness by presence or etiology of chronic liver disease, vascular invasion or tumor encapsulation.ConclusionPreliminary data suggest that tumor stiffness by MRE may be able to differentiate HCC tumor grade.     

Structure relates to elastic recoil and functional role in quadriceps tendon and patellar ligament

Tendons and ligaments have similar but slightly different structure and composition. Crimps of tendons and ligaments are morphological structures related to the elastic functional properties of these connective tissues. Aim of this study was to investigate the morphological arrangement of collagen fibres, fibrils and crimping pattern of suprapatellar (rectus femoris tendon-RFT and vastus intermedius tendon-VIT) and infrapatellar connective tissues (patellar ligament-PL) to relate their structural aspects to their common function role of leg extension. RFT, VIT and PL were removed from knees of Sprague–Dawley rats and light and electron microscopy (TEM and SEM) performed. Sagittal sections showed that collagen array and crimping pattern were similar in RFT and PL but differed from VIT. Morphometric analysis confirmed that crimp number was about the same in RFT and PL (5.4 ± 1.4 and 6.1 ± 2.8 respectively), but it was almost three times higher in VIT (14.5 ± 4.7). Similarly crimp top angle in RFT and PL (141.5 ± 15.0° and 146.2 ± 12.2° respectively) was significantly higher than in VIT (122.3 ± 14.8°) and the crimp base length was more than twice as wide in RFT (75.5 ± 22.6 μm) and PL (72.3 ± 28.9 μm) than in VIT (36 ± 14.1 μm). The smaller, fewer and most crimped crimps in VIT show that this tendon has a greater elastic recoil and responds to higher forces as among quadriceps muscles the vastus intermedius belly contributes the most during knee extension. By contrast, RFT acting as a “stopper” tendon also plays a ligament role by limiting an excessive flexion of the joint during postural rest position of the knee.     

MR visible localization device for radiographic-pathologic correlation of surgical specimens

PurposeThe detection of small parenchymal hepatic lesions identified by preoperative imaging remains a challenge for traditional pathologic methods in large specimens. We developed a magnetic resonance imaging (MRI) compatible localization device for imaging of surgical specimens aimed to improve identification and localization of hepatic lesions ex vivo.Materials and methodsThe device consists of two stationary and one removable MR-visible grids lined with silicone gel, creating an orthogonal 3D matrix for lesion localization. To test the device, five specimens of swine liver with a random number of lesions created by microwave ablation were imaged on a 3 T MR scanner. Two readers independently evaluated lesion coordinates and size, which were then correlated with sectioning guided by MR imaging.ResultsAll lesions (n = 38) were detected at/very close to the expected localization. Inter-reader agreement of lesion localization was almost perfect (0.92). The lesion size estimated by MRI matched macroscopic lesion size in cut specimen (± 2 mm) in 34 and 35, respectively, out of 38 lesions.ConclusionUse of this MR compatible device for ex vivo imaging proved feasible for detection and three-dimensional localization of liver lesions, and has potential to play an important role in the ex vivo examination of surgical specimens in which pathologic correlation is clinically important.