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Madhu B, Robinson SP, Howe FA, Griffiths JR. Effect of Gd-DTPA-BMA on choline signals of HT29 tumors detected by in vivo1H MRS. J Magn Reson Imaging 2008; 28:1201-8. [DOI: 10.1002/jmri.21577] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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152
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Hsieh TJ, Li CW, Chuang HY, Liu GC, Wang CK. Longitudinally Monitoring Chemotherapy Effect of Malignant Musculoskeletal Tumors With In Vivo Proton Magnetic Resonance Spectroscopy. J Comput Assist Tomogr 2008; 32:987-94. [DOI: 10.1097/rct.0b013e31815b9ce9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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153
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Sharma U, Sah RG, Jagannathan NR. Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) in Breast Cancer. MAGNETIC RESONANCE INSIGHTS 2008. [DOI: 10.4137/mri.s991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Breast cancer is a major health problem in women and early detection is of prime importance. Breast magnetic resonance imaging (MRI) provides both physical and physiologic tissue features that are useful in discriminating malignant from benign lesions. Contrast enhanced MRI is valuable for diagnosis of small tumors in dense breast and the structural and kinetic parameters improved the specificity of diagnosing benign from malignant lesions. It is a complimentary modality for preoperative staging, to follow response to therapy, to detect recurrences and for screening high risk women. Diffusion, perfusion and MR elastography have been applied to breast lesion characterization and show promise. In-vivo MR spectroscopy (MRS) is a valuable method to obtain the biochemical status of normal and diseased tissues. Malignant tissues contain high concentration of choline containing compounds that can be used as a biochemical marker. MRS helps to increase the specificity of MRI in lesions larger than 1cm and to monitor the tumor response. Various MR techniques show promise primarily as adjunct to the existing standard detection techniques, and its acceptability as a screening method will increase if specificity can be improved. This review presents the progress made in different MRI and MRS techniques in beast cancer management.
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Affiliation(s)
- Uma Sharma
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi–-110029, India
| | - Rani Gupta Sah
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi–-110029, India
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154
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Geraghty PR, van den Bosch MAAJ, Spielman DM, Hunjan S, Birdwell RL, Fong KJ, Stables LA, Zakhour M, Herfkens RJ, Ikeda DM. MRI and (1)H MRS of the breast: presence of a choline peak as malignancy marker is related to K21 value of the tumor in patients with invasive ductal carcinoma. Breast J 2008; 14:574-80. [PMID: 19000051 DOI: 10.1111/j.1524-4741.2008.00650.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To assess which specific morphologic features, enhancement patterns, or pharmacokinetic parameters on breast Magnetic Resonance Imaging (MRI) could predict a false-negative outcome of Proton MR Spectroscopy ((1)H MRS) exam in patients with invasive breast cancer. Sixteen patients with invasive ductal carcinoma of the breast were prospectively included and underwent both, contrast-enhanced breast MRI and (1)H MRS examination of the breast. The MR images were reviewed and the lesions morphologic features, enhancement patterns and pharmacokinetic parameters (k21-value) were scored according to the ACR BI-RADS-MRI lexicon criteria. For the in vivo MRS studies, each spectrum was evaluated for the presence of choline based on consensus reading. Breast MRI and (1)H MRS data were compared to histopathologic findings. In vivo (1)H MRS detected a choline peak in 14/16 (88%) cancers. A false-negative (1)H MRS study occurred in 2/16 (14%) cancer patients. K21 values differed between both groups: the 14 choline positive cancers had k21 values ranging from 0.01 to 0.20/second (mean 0.083/second), whereas the two choline-negative cancers showed k21 values of 0.03 and 0.05/second, respectively (mean 0.040/second). Also enhancement kinetics did differ between both groups; typically both cancers that were choline-negative showed a late phase plateau (100%), whereas this was only shown in 5/14 (36%) of the choline positive cases. There was no difference between both groups with regard to morphologic features on MRI. This study showed that false-negative (1)H MRS examinations do occur in breast cancer patients, and that the presence of a choline peak on (1)H MRS as malignancy marker is related to the k21 value of the invasive tumor being imaged.
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Affiliation(s)
- Patricia R Geraghty
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305-5488, USA
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155
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Tozaki M, Sakamoto M, Oyama Y, O'uchi T, Kawano N, Suzuki T, Yamashiro N, Ozaki S, Sakamoto N, Higa K, Abe S, Ogawa T, Fukuma E. Monitoring of early response to neoadjuvant chemotherapy in breast cancer with (1)H MR spectroscopy: comparison to sequential 2-[18F]-fluorodeoxyglucose positron emission tomography. J Magn Reson Imaging 2008; 28:420-7. [PMID: 18666159 DOI: 10.1002/jmri.21454] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess the efficacy of (1)H MR spectroscopy (MRS) to evaluate early responses to neoadjuvant chemotherapy in breast cancer patients, as compared to that of the standardized uptake value (SUV) in (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET). MATERIALS AND METHODS This retrospective study included seven patients with breast cancer who had both single-voxel (1)H MRS and PET/computed tomography (CT) acquired before, during, and after neoadjuvant chemotherapy. RESULTS The averages of the Choline (Cho) integral value and peak SUV before chemotherapy were 2.5 (range, 1.2-5.3) and 7.5 (range, 1.9-19), respectively. Three cases became negative for both Cho and peak SUV after two cycles of chemotherapy, and one patient became negative before surgery. In the remaining three patients, the curves of both values paralleled the time course of chemotherapy treatment. The difference between Cho and peak SUV before, during, and after chemotherapy was r = 0.65 (P = 0.12), r = 0.80 (P = 0.03), and r = 0.99 (P < 0.001), respectively. The reduction rate (RR) of both values after chemotherapy was also correlated (r = 0.84, P = 0.02). CONCLUSION A change in the Cho integral value is well correlated with that of peak SUV in the time course of neoadjuvant chemotherapy; thus, breast (1)H MRS is thought to be an alternative to sequential (18)F-FDG PET.
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156
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Marcus CD, Ladam-Marcus V, Cucu C, Bouché O, Lucas L, Hoeffel C. Imaging techniques to evaluate the response to treatment in oncology: current standards and perspectives. Crit Rev Oncol Hematol 2008; 72:217-38. [PMID: 18760935 DOI: 10.1016/j.critrevonc.2008.07.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 07/04/2008] [Accepted: 07/17/2008] [Indexed: 02/07/2023] Open
Abstract
Response evaluation in solid tumours currently uses radiological imaging techniques to measure changes under treatment. Imaging requires a well-defined anatomical lesion to be viewed and relies on the measurement of a reduction in tumour size during treatment as the basis for presumed clinical benefit. However, with the development of anti-angiogenesis agents, anatomical imaging has became inappropriate as certain tumours would not reduce in size. Functional studies are therefore necessary and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), DCE-computed tomography (CT) and DCE-ultrasonography (US) are currently being evaluated for monitoring treatments. Diffusion-weighted MR imaging (DW-MRI) and magnetic resonance spectroscopy (MRS) are also capable of detecting changes in cell density and metabolite content within tumours. In this article, we review anatomical and functional criteria currently used for monitoring therapy. We review the published data on DCE-MRI, DCE-CT, DCE-US, DW-MRI and MRS. This literature review covers the following area: basic principles of the technique, clinical studies, reproducibility and repeatability, limits and perspectives in monitoring therapy. Anatomical criteria such as response evaluation criteria in solid tumours (RECIST) will require adaptation to employ not only new tools but also different complementary techniques such as functional imaging in order to monitor therapeutic effects of conventional and new anti-cancer agents.
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Affiliation(s)
- C D Marcus
- Department of Radiology, Robert-Debre Hospital, University of Reims, France.
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Abstract
Molecular imaging of tumor metabolism has gained considerable interest, since preclinical studies have indicated a close relationship between the activation of various oncogenes and alterations of cellular metabolism. Furthermore, several clinical trials have shown that metabolic imaging can significantly impact patient management by improving tumor staging, restaging, radiation treatment planning, and monitoring of tumor response to therapy. In this review, we summarize recent data on the molecular mechanisms underlying the increased metabolic activity of cancer cells and discuss imaging techniques for studies of tumor glucose, lipid, and amino acid metabolism.
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Affiliation(s)
- Christian Plathow
- Department of Nuclear Medicine, University of Freiburg, Freiburg, Germany
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158
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Lee SC, Huang MQ, Nelson DS, Pickup S, Wehrli S, Adegbola O, Poptani H, Delikatny EJ, Glickson JD. In vivo MRS markers of response to CHOP chemotherapy in the WSU-DLCL2 human diffuse large B-cell lymphoma xenograft. NMR IN BIOMEDICINE 2008; 21:723-733. [PMID: 18384181 DOI: 10.1002/nbm.1250] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
To identify 1H-MRS molecular biomarkers of early clinical therapeutic response in non-Hodgkin's lymphoma, an in vivo longitudinal study was performed on human non-Hodgkin's diffuse large B-cell lymphoma xenografts (WSU-DLCL2) grown in the flanks of female SCID mice. 31P-MRS measurements, which have been demonstrated to be prognostic clinical indices of response (Arias-Mendoza et al. Acad. Radiol. 2004; 11: 368-376) but which provide lower spatial resolution, were included for comparison. The animals received CHOP (cyclophosphamide, hydroxydoxorubicin, oncovin and prednisone) chemotherapy for three 1-week cycles, resulting in stable disease based on tumor volume. Localization of total choline and phosphorus metabolites in vivo was achieved with stimulated echo acquisition mode and image selected in vivo spectroscopy sequences, respectively. Significant decreases in lactate were detected by the selective multiple quantum coherence spectral editing technique after the first cycle of CHOP, whereas total choline and the phosphomonoester/nucleoside triphosphate ratio did not change until the third cycle. Ex vivo extract MRS of tumors corroborated the in vivo results. Histological staining with antibodies to Ki67 revealed a decrease in proliferation rate in CHOP-treated tumors that coincided with the decrease in lactate. This study demonstrates the utility of lactate as an early proliferation-sensitive indicator of therapeutic response in a mouse model of non-Hodgkin's lymphoma and serves as a basis for future clinical implementation of these methods.
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Affiliation(s)
- Seung-Cheol Lee
- Molecular Imaging Laboratory, Department of Radiology, University of Pennsylvania, and NMR Core Facility, Children's Hospital of Philadelphia, Philadelphia, PA 19104-4011, USA
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159
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Nelson MT, Everson LI, Garwood M, Emory T, Bolan PJ. MR Spectroscopy in the diagnosis and treatment of breast cancer. SEMINARS IN BREAST DISEASE 2008; 11:100-105. [PMID: 21490877 PMCID: PMC3073311 DOI: 10.1053/j.sembd.2008.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In vivo proton magnetic resonance spectroscopy ((1)H MRS) is rapidly becoming useful as a clinical tool for diagnosing and characterizing breast cancers. Alterations of the levels of choline-containing metabolites are associated with malignancy. High-field MR scanners at 1.5 T, 3 T, 4 T, and 7 T have been used to evaluate the role of (1)H MRS measurements of total choline containing compounds in patients with breast cancer. This article will review clinical use of MRI/MRS in vivo. Newer developments in high field MR scanning and quantitative MRS may help breast imagers improve sensitivity and specificity in diagnosing and treating breast cancer.
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Affiliation(s)
- Michael T Nelson
- University of Minnesota Medical School, Department of Radiology, Center for Magnetic Resonance Imaging, Minneapolis, MN 55455
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160
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Baek HM, Yu HJ, Chen JH, Nalcioglu O, Su MY. Quantitative correlation between (1)H MRS and dynamic contrast-enhanced MRI of human breast cancer. Magn Reson Imaging 2008; 26:523-31. [PMID: 18060716 PMCID: PMC2653063 DOI: 10.1016/j.mri.2007.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 10/05/2007] [Accepted: 10/08/2007] [Indexed: 11/30/2022]
Abstract
Proton magnetic resonance spectroscopy ((1)H 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 (1)H 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.
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Affiliation(s)
- Hyeon-Man Baek
- John Tu and Thomas Yuen Center for Functional Onco-Imaging, University of California, Irvine, CA 92697-5020, USA.
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161
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Baek HM, Chen JH, Yu HJ, Mehta R, Nalcioglu O, Su MY. Detection of choline signal in human breast lesions with chemical-shift imaging. J Magn Reson Imaging 2008; 27:1114-21. [PMID: 18425841 PMCID: PMC2613433 DOI: 10.1002/jmri.21309] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate the application of MR spectroscopy using chemical-shift imaging (CSI) for characterizing human breast lesions at 1.5T, and to evaluate the diagnostic performance using ROC (receiver operating characteristics) analysis. MATERIALS AND METHODS Thirty-six patients (35-73 years old, mean 52), with 27 malignant and 9 benign lesions, underwent anatomical imaging, dynamic contrast-enhanced MR imaging, and CSI. The ROC analysis was performed and the cutoff point yielding the highest accuracy was found to be a choline (Cho) signal-to-noise ratio (SNR) >3.2. RESULTS The mean Cho SNR was 2.8 +/- 0.8 (range, 1.8-4.3) for the benign group and 5.9 +/- 3.4 (2.1-17.5) for the malignant group (P = 0.01). Based on the criterion of Cho SNR >3.2 as malignant, CSI correctly diagnosed 22 of 27 malignant lesions and 7 of 9 benign lesions, resulting in a sensitivity of 81%, specificity of 78%, and overall accuracy of 81%. If the criterion was set higher at Cho SNR >4.0 the specificity improved to 89% but sensitivity was lowered to 67%. CONCLUSION The ROC analysis presented in this work could be used to set an objective diagnostic criterion depending on preferred emphasis on sensitivity or specificity.
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Affiliation(s)
- Hyeon-Man Baek
- Tu and Yuen Center for Functional Onco-Imaging, University of California, Irvine, California 92697-5020, USA.
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162
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Bartella L, Huang W. Proton (1H) MR spectroscopy of the breast. Radiographics 2008; 27 Suppl 1:S241-52. [PMID: 18180230 DOI: 10.1148/rg.27si075504] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Proton (hydrogen 1) [1H]) magnetic resonance (MR) spectroscopy provides biochemical information about the tissue under investigation. Its diagnostic value in cancer is typically based on the detection of elevated levels of choline compounds, choline being a marker of active tumor. The two main potential clinical applications of 1H MR spectroscopy are (a) as an adjunct to breast MR imaging to improve specificity in differentiating benign from malignant lesions, and (b) for monitoring or even predicting response to treatment in patients undergoing neoadjuvant chemotherapy. Preliminary data are promising, with study results suggesting that 1H MR spectroscopy may decrease the number of benign biopsies recommended on the basis of MR imaging findings and may help predict response as early as 24 hours after the first dose of neoadjuvant chemotherapy. Although several limitations currently exist that make the technique premature for clinical use, further evaluation with larger, preferably multicenter trials is certainly warranted.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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163
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Baek HM, Chen JH, Nalcioglu O, Su MY. Proton MR spectroscopy for monitoring early treatment response of breast cancer to neo-adjuvant chemotherapy. Ann Oncol 2008; 19:1022-4. [PMID: 18372283 DOI: 10.1093/annonc/mdn121] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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164
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Sardanelli F, Fausto A, Podo F. MR spectroscopy of the breast. Radiol Med 2008; 113:56-64. [PMID: 18338127 DOI: 10.1007/s11547-008-0228-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 07/27/2006] [Indexed: 12/16/2022]
Abstract
This literature review assesses the clinical potential of proton ((1)H) magnetic resonance spectroscopy (MRS) of breast lesions. We here illustrate the basic principles of spectrum acquisition for volumes of interest, determined on the basis of dynamic magnetic resonance imaging (MRI) and of MRS postprocessing. We discuss the criteria for interpreting the spectrum with particular reference to the metabolic significance of the peak of total choline containing compounds at 3.2 ppm, a marker that is correlated with malignancy. We then summarise the findings obtained in lesion characterisation (with a possible gain in specificity with respect to dynamic MRI), the assessment of the effects of neoadjuvant chemotherapy and the correlation reported at high-field between the tumour tissue concentration of choline-containing compounds and the presence of lymph node metastases. Lastly, we outline the clinical use of this technique as the final phase of a complete breast MR examination after intravenous administration of paramagnetic contrast material for the dynamic study, with reference to its use by radiologists dedicated to breast imaging.
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Affiliation(s)
- F Sardanelli
- Università degli Studi di Milano, Dipartimento di Scienze Medico-chirurgiche, IRCCS Policlinico San Donato, Servizio di Radiologia, San Donato Milanese, Milano, Italy.
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165
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In vivo monitoring response to chemotherapy of human diffuse large B-cell lymphoma xenografts in SCID mice by 1H and 31P MRS. Acad Radiol 2007; 14:1531-9. [PMID: 18035282 DOI: 10.1016/j.acra.2007.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 07/13/2007] [Accepted: 07/13/2007] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES A reliable noninvasive method for in vivo detection of early therapeutic response of non-Hodgkin's lymphoma (NHL) patients would be of great clinical value. This study evaluates the feasibility of (1)H and (31)P magnetic resonance spectroscopy (MRS) for in vivo detection of response to combination chemotherapy of human diffuse large B-cell lymphoma (DLCL2) xenografts in severe combined immunodeficient (SCID) mice. MATERIALS AND METHODS Combination chemotherapy with cyclophosphamide, hydroxy doxorubicin, Oncovin, prednisone, and bryostatin 1 (CHOPB) was administered to tumor-bearing SCID mice weekly for up to four cycles. Spectroscopic studies were performed before the initiation of treatment and after each cycle of the CHOPB. Proton MRS for detection of lactate and total choline was performed using a selective multiple-quantum-coherence-transfer (Sel-MQC) and a spin-echo-enhanced Sel-MQC (SEE-Sel-MQC) pulse sequence, respectively. Phosphorus-31 MRS using a nonlocalized, single-pulse sequence without proton decoupling was also performed on these animals. RESULTS Significant decreases in lactate and total choline were detected in the DLCL2 tumors after one cycle of CHOPB chemotherapy. The ratio of phosphomonoesters to beta-nucleoside triphosphate (PME/betaNTP, measured by (31)P MRS) significantly decreased in the CHOPB-treated tumors after two cycles of CHOPB. The control tumors did not exhibit any significant changes in either of these metabolites. CONCLUSIONS This study demonstrates that (1)H and (31)P MRS can detect in vivo therapeutic response of NHL tumors and that lactate and choline offer a number of advantages over PMEs as markers of early therapeutic response.
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166
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Morse DL, Raghunand N, Sadarangani P, Murthi S, Job C, Day S, Howison C, Gillies RJ. Response of choline metabolites to docetaxel therapy is quantified in vivo by localized (31)P MRS of human breast cancer xenografts and in vitro by high-resolution (31)P NMR spectroscopy of cell extracts. Magn Reson Med 2007; 58:270-80. [PMID: 17654590 DOI: 10.1002/mrm.21333] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Choline-containing compounds (CCCs) are elevated in breast cancer, and detected in vivo by the (1)H MRS total choline (tCho) resonance (3.25 ppm) and the (31)P MRS phosphomonoester (PME) resonance (3.8 ppm). Both the tCho and PME resonances decrease early after initiation of successful therapy. The single major component of these composite resonances, phosphocholine (PCho), also responds to therapy by decreasing. The ability to resolve and quantify PCho in vivo would thus increase the sensitivity of this biomarker for early detection of therapeutic response. Herein, the in vivo resolution and quantification of PCho is reported in human mouse xenograft tumors of the human breast cancer cell lines MCF-7 and MDA-mb-231. Significant decreases in tumor PCho are observed within 2 to 4 d posttreatment with the antimicrotubule drug, docetaxel. To determine whether these decreases are a general tumor response or an intracellular metabolic response, high-resolution NMR spectroscopy was performed on extracts of cells treated with docetaxel. Significant decreases in intracellular PCho and increases in glycerophosphocholine (GPC) were observed. These decreases are coincident with other tumor and cellular responses such as tumor growth delay (TGD), cell-cycle arrest, and modes of cell death such as mitotic catastrophe, necrosis, and apoptosis, with mitotic catastrophe predominating.
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Affiliation(s)
- David L Morse
- The University of Arizona, BIO5 Institute, Arizona Cancer Center, Tucson, Arizona 85724, USA.
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167
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Stanwell P, Mountford C. In Vivo Proton MR Spectroscopy of the Breast. Radiographics 2007; 27 Suppl 1:S253-66. [DOI: 10.1148/rg.27si075519] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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168
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Bartella L, Thakur SB, Morris EA, Dershaw DD, Huang W, Chough E, Cruz MC, Liberman L. Enhancing Nonmass Lesions in the Breast: Evaluation with Proton (H) MR Spectroscopy. Radiology 2007; 245:80-7. [PMID: 17885182 DOI: 10.1148/radiol.2451061639] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To prospectively evaluate the sensitivity and specificity of proton (hydrogen 1 [1H]) magnetic resonance (MR) spectroscopy for diagnosing malignant enhancing nonmass lesions identified at breast MR imaging, with histologic examination as the reference standard. MATERIALS AND METHODS In this HIPAA-compliant, institutional review board-approved study, in which all participants gave written informed consent, proton (1H) MR spectroscopy of the breast was performed in suspicious or biopsy-proved malignant lesions that were 1 cm or larger at MR imaging. Single-voxel proton (1H) MR spectroscopic data were collected. MR spectroscopic findings were defined as positive if the signal-to-noise ratio of the choline resonance peak was 2 or greater and as negative in all other cases. MR spectroscopic results were then compared with histologic findings, and statistical analysis was performed. RESULTS In 32 women (median age, 48.5 years [range, 20-63 years]) with enhancing nonmass lesions, the median lesion size at MR imaging was 2.8 cm (range, 1.2-9.0 cm). At histologic analysis, 12 (37%) of 32 lesions were malignant and 20 (63%) were benign. Positive choline findings were present in 15 of 32 lesions, including all 12 (100%) cancers and three (15%) of 20 benign lesions, giving proton (1H) MR spectroscopy a sensitivity of 100% (95% confidence interval [CI]: 74%, 100%) and a specificity of 85% (95% CI: 62%, 97%) for detection of enhancing nonmass lesions. For 25 lesions with unknown histologic features, proton (1H) MR spectroscopy would have significantly (P<.01) increased the positive predictive value of biopsy from 20% to 63%. If biopsy had been performed for only those lesions with positive choline findings at proton (1H) MR spectroscopy, biopsy might have been avoided for 17 (68%) of 25 lesions, and no cancers would have been missed. CONCLUSION Proton (1H) MR spectroscopy had 100% sensitivity and 85% specificity for the detection of malignancy in enhancing nonmass lesions.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Breast Imaging Section H-118, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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169
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Hu J, Yu Y, Kou Z, Huang W, Jiang Q, Xuan Y, Li T, Sehgal V, Blake C, Haacke EM, Soulen RL. A high spatial resolution 1H magnetic resonance spectroscopic imaging technique for breast cancer with a short echo time. Magn Reson Imaging 2007; 26:360-6. [PMID: 17904326 PMCID: PMC3805364 DOI: 10.1016/j.mri.2007.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 07/16/2007] [Accepted: 07/16/2007] [Indexed: 12/31/2022]
Abstract
The high sensitivity but low specificity of breast MRI has prompted exploration of breast (1)H MRS for breast cancer detection. However, several obstacles still prevent the routine application of in vivo breast (1)H MRS, including poor spatial resolution, long acquisition time associated with conventional multi-voxel MRS imaging (MRSI) techniques, and the difficulty of "extra" lipid suppression in a magnetic field with relatively poor achievable homogeneity compared to the brain. Using a combination of a recently developed echo-filter (EF) suppression technique and an elliptical sampling scheme, we demonstrate the feasibility of overcoming these difficulties. It is robust (the suppression technique is insensitive to magnetic field inhomogeneity), fast (acquisition time of about 12 min) and offers high spatial resolution (up to 0.6 cm(3) per voxel at 1.5 T with a TE of only 60 ms). This approach should be even better at 3 T with higher resolution and/or shorter TE.
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Affiliation(s)
- Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA.
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170
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Vossen JA, Buijs M, Kamel IR. Assessment of tumor response on MR imaging after locoregional therapy. Tech Vasc Interv Radiol 2007; 9:125-32. [PMID: 17561215 DOI: 10.1053/j.tvir.2007.02.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Assessment of tumor response after locoregional therapies is important in determining treatment success and in guiding future therapy. Magnetic resonance imaging plays an important role in evaluating treatment response to new therapies directed toward hepatic lesion treatment. The traditional and accepted criteria to determine tumor response in oncology, namely the Response Evaluation Criteria in Solid Tumors (RECIST) and the European Association for the Study of the Liver (EASL) criteria, use decrease in tumor size and lesion enhancement as an indicator of successful therapy. A more recent evaluation method is the Apparent Diffusion Coefficient (ADC) measured by diffusion-weighted MR imaging. Diffusion-weighted MR imaging and ADC values map the thermally induced motion of water molecules in tissues and thereby are able to provide insight into tumor microstructure. In this article we discuss the role of MR imaging in assessing treatment response after various locoregional therapies. We describe the role of tumor size and lesion enhancement as well as ADC mapping. We also discuss the magnetic resonance imaging findings after radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and radioembolization.
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Affiliation(s)
- Josephina A Vossen
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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171
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Yu B, Burnside ES, Sisney GA, Harter JM, Zhu C, Dhalla AH, Ramanujam N. Feasibility of near-infrared diffuse optical spectroscopy on patients undergoing imageguided core-needle biopsy. OPTICS EXPRESS 2007; 15:7335-7350. [PMID: 19547057 PMCID: PMC2801922 DOI: 10.1364/oe.15.007335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We describe a side-firing fiber optic sensor based on near-infrared spectroscopy for guiding core needle biopsy diagnosis of breast cancer. The sensor is composed of three side firing optical fibers (two source fibers and one detection fiber), providing two source-detector separations. The entire assembly is inserted into a core biopsy needle, allowing for sampling to occur at the biopsy site. A multi-wavelength frequency-domain near-infrared instrument is used to collect diffuse reflectance in the breast tissue through an aperture on the biopsy needle before the tissue is removed for histology. Preliminary in vivo measurements performed on 10 normal or benign breast tissues from 5 women undergoing stereo- or ultrasound-guided core needle biopsy show the ability of the system to determine tissue optical properties and constituent concentrations, which are correlated with breast tissue composition derived from histopathology.
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Affiliation(s)
- Bing Yu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708
| | | | - Gale A. Sisney
- Department of Radiology, University of Wisconsin, Madison, WI 53792
| | - Josephine M. Harter
- Department of Pathology and Laboratry Medicine, University of Wisconsin, Madison, WI 53792
| | - Changfang Zhu
- Department of Electricaland Computer Engineering, University of Wisconsin, Madison, WI 53706
| | - Al-Hafeez Dhalla
- Department of Biomedical Engineering, Duke University, Durham, NC 27708
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC 27708
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172
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Behrens S, Laue H, Althaus M, Boehler T, Kuemmerlen B, Hahn HK, Peitgen HO. Computer assistance for MR based diagnosis of breast cancer: present and future challenges. Comput Med Imaging Graph 2007; 31:236-47. [PMID: 17369019 DOI: 10.1016/j.compmedimag.2007.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
MR based methods have gained an important role for the clinical detection and diagnosis of breast cancer. Dynamic contrast-enhanced MRI of the breast has become a robust and successful method, especially for diagnosis of high-risk cases due to its higher sensitivity compared to X-ray mammography. The application of MR based imaging methods depends on various automated image processing routines. The combination of techniques for preprocessing, quantification and visualization of datasets is necessary to achieve fast and solid assessment of valuable parameters for diagnosis. In this paper, different aspects such as registration methods for the reduction of motion artifacts, segmentation issues, as well as morphologic and dynamic lesion analysis will be reviewed with a focus on breast MRI, MR spectroscopy and MR guided biopsies of the breast, their implications and technical challenges from a computer assistance point of view.
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Affiliation(s)
- Sarah Behrens
- MeVis Research, Center for Medical Image Computing, Universitaetsallee 29, 28359 Bremen, Germany.
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173
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Abstract
Imaging has a significant role in diagnosing, treating, and monitoring breast cancer. Advances in this field are having a great impact in the clinical management of this disease. Breast cancer has now become an "outpatient cancer". This article describes the role and advances of imaging in breast cancer.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Breast Imaging Section H-118, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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174
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He Q, Shkarin P, Hooley RJ, Lannin DR, Weinreb JC, Bossuyt VIJ. In vivo MR spectroscopic imaging of polyunsaturated fatty acids (PUFA) in healthy and cancerous breast tissues by selective multiple-quantum coherence transfer (Sel-MQC): A preliminary study. Magn Reson Med 2007; 58:1079-85. [DOI: 10.1002/mrm.21335] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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175
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Xu H, Li X, Yang ZH, Xie JX. In vivo 1H MR spectroscopy in the evaluation of the serial development of hepatocarcinogenesis in an experimental rat model. Acad Radiol 2006; 13:1532-7. [PMID: 17138121 DOI: 10.1016/j.acra.2006.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 08/31/2006] [Accepted: 09/01/2006] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES We used a 1.5-T MR scanner to investigate in vivo hydrogen 1 ((1)H) MRS to evaluate metabolic changes in the hepatocarcinogenesis experimental rat model. MATERIALS AND METHODS Hepatocellular carcinoma (HCC) was induced by diethylnitrosamine in 70 treated rats with 20 normal rats used as controls. Single-voxel (1)H MRS is performed to obtained the relative choline-to-lipid (Cho/lipid) ratio. The liver and tumor tissues are incised for the histologic examination. Based on the histologic result, the progression of hepatocarcinogenesis of the animal model was divided into three stages: fibrosis stage, cirrhosis stage, and HCC stage. The mean (+/-SD) ratio values are calculated and compared at various stages between the treated group and the control group. RESULTS In control group, the calculated mean (+/-SD) Cho/lipid ratio was 0.15 +/- 0.05. With the progression of hepatocarcinogenesis, the Cho/lipid ratio increased significantly, to 0.18 +/- 0.05, 0.24 +/- 0.07, and 0.38 +/- 0.19, respectively. CONCLUSION The (1)H MRS is technically feasible for evaluation of the metabolic changes in the animal model. A significant increase in choline-containing compounds level was observed in the HCC stage in the treated group.
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Affiliation(s)
- Hui Xu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100083, P. R. China
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176
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Glunde K, Serkova NJ. Therapeutic targets and biomarkers identified in cancer choline phospholipid metabolism. Pharmacogenomics 2006; 7:1109-23. [PMID: 17054420 DOI: 10.2217/14622416.7.7.1109] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Choline phospholipid metabolism is altered in a wide variety of cancers. The choline metabolite profile of tumors and cancer cells is characterized by an elevation of phosphocholine and total choline-containing compounds. Noninvasive magnetic resonance spectroscopy can be used to detect this elevation as an endogenous biomarker of cancer, or as a predictive biomarker for monitoring tumor response to novel targeted therapies. The enzymes directly causing this elevation, such as choline kinase, phospholipase C and phospholipase D may provide molecular targets for anticancer therapies. Signal transduction pathways that are activated in cancers, such as those mediated by the receptor tyrosine kinases breakpoint cluster region-abelson (Bcr-Abl), c-KIT or epidermal growth factor receptor (EGFR), correlate with the alterations in choline phospholipid metabolism of cancers, and also offer molecular targets for specific anticancer therapies. This review summarizes recently discovered molecular targets in choline phospholipid metabolism and signal transduction pathways, which may lead to novel anticancer therapies potentially being monitored by magnetic resonance spectroscopy techniques.
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Affiliation(s)
- Kristine Glunde
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, 212 Traylor Building Baltimore, MD 21205, USA.
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177
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Kwock L, Smith JK, Castillo M, Ewend MG, Collichio F, Morris DE, Bouldin TW, Cush S. Clinical role of proton magnetic resonance spectroscopy in oncology: brain, breast, and prostate cancer. Lancet Oncol 2006; 7:859-68. [PMID: 17012048 DOI: 10.1016/s1470-2045(06)70905-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Standardised proton magnetic resonance spectroscopic imaging (MRSI) was initially developed for routine in-situ clinical assessment of human brain tumours, and its use was later extended for examination of prostate and breast cancers. MRSI coupled with both routine and functional MRI techniques provides more detailed information about a tumour's location and extent of its infiltration than any other modality alone. Information obtained by adding MRSI data to anatomical and functional MRI findings aid in clinical management decisions (such as watchful waiting vs immediate intervention). In this Review, we discuss the current status of proton MRSI, with emphasis on its clinical use to map the location and extent of tumour processes for spectroscopic image-guided biopsy procedures and to monitor treatment paradigms for brain, prostate, and breast cancer.
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Affiliation(s)
- Lester Kwock
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
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178
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Bathen TF, Jensen LR, Sitter B, Fjösne HE, Halgunset J, Axelson DE, Gribbestad IS, Lundgren S. MR-determined metabolic phenotype of breast cancer in prediction of lymphatic spread, grade, and hormone status. Breast Cancer Res Treat 2006; 104:181-9. [PMID: 17061040 DOI: 10.1007/s10549-006-9400-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 09/07/2006] [Indexed: 12/25/2022]
Abstract
The purpose of the study was to evaluate the use of metabolic phenotype, described by high-resolution magic angle spinning magnetic resonance spectroscopy (HR MAS MRS), as a tool for prediction of histological grade, hormone status, and axillary lymphatic spread in breast cancer patients. Biopsies from breast cancer (n = 91) and adjacent non-involved tissue (n = 48) were excised from patients (n = 77) during surgery. HR MAS MR spectra of intact samples were acquired. Multivariate models relating spectral data to histological grade, lymphatic spread, and hormone status were designed. The multivariate methods applied were variable reduction by principal component analysis (PCA) or partial least-squares regression-uninformative variable elimination (PLS-UVE), and modelling by PLS, probabilistic neural network (PNN), or cascade correlation neural network. In the end, model verification by prediction of blind samples (n = 12) was performed. Validation of PNN training resulted in sensitivity and specificity ranging from 83 to 100% for all predictions. Verification of models by blind sample testing showed that hormone status was well predicted by both PNN and PLS (11 of 12 correct), lymphatic spread was best predicted by PLS (8 of 12), whereas PLS-UVE PNN was the best approach for predicting grade (9 of 12 correct). MR-determined metabolic phenotype may have a future role as a supplement for clinical decision-making-concerning adjuvant treatment and the adaptation to more individualised treatment protocols.
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Affiliation(s)
- Tone F Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7489 Trondheim, Norway.
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179
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Tse GM, Yeung DKY, King AD, Cheung HS, Yang WT. In vivo proton magnetic resonance spectroscopy of breast lesions: an update. Breast Cancer Res Treat 2006; 104:249-55. [PMID: 17051424 DOI: 10.1007/s10549-006-9412-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 09/17/2006] [Indexed: 11/24/2022]
Abstract
In vivo proton magnetic resonance spectroscopy ((1)H-MRS) has been demonstrated to be successful in the differentiation of benign and malignant breast lesions in a non-invasive manner by detecting increased levels of composite choline (Cho) compounds. Currently there is molecular evidence of increased Cho metabolism in breast cancer cells. In breast malignancies, (1)H-MRS achieved a high-overall sensitivity (82%). Most test cases were infiltrating duct carcinoma, but infiltrating lobular, medullary, mucinous and adenoid cystic carcinomas were also positive by (1)H-MRS. Large lesional size is a pre-requisite for (1)H-MRS testing, and technical problems account for some of the false negative results. Another potential of (1)H-MRS is to assess patients' response to neoadjuvant chemotherapy. In ductal carcinoma in situ, the results of (1)H-MRS on the limited number of cases were negative. Most of the assessed benign breast lesions including fibroadenoma, fibrocystic changes, cysts and galactoceles, papilloma, tubular adenoma and phyllodes tumours and were mostly negative by (1)H-MRS, with an overall false positive rate was about 8%. Normal breast tissue was almost always negative by (1)H-MRS, whereas, lactating breast tissue showed positivity with a slightly different spectrum on further analysis. With the clinical use of stronger field MR scanners and better coils, the sensitivity of (1)H-MRS may be further improved. With these improvements, (1)H-MRS may potentially be useful in detection of smaller malignant lesions, characterization of malignant lesions into non-invasive or invasive, and as an invaluable tool in disease progression monitoring.
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Affiliation(s)
- Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
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180
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Abstract
Magnetic resonance imaging (MRI) of the breast is rapidly becoming incorporated into clinical practice. Indications for breast MRI include staging of known breast cancer, monitoring response to chemotherapy, assessing recurrence, problem solving, and high-risk screening. Magnetic resonance spectroscopy is a promising technique that may decrease the number of benign biopsies generated by breast MRI in the clinical setting.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Medical College Of Cornell University, 1275 York Avenue, New York 10021 NY, USA.
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181
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Bartella L, Morris EA, Dershaw DD, Liberman L, Thakur SB, Moskowitz C, Guido J, Huang W. Proton MR Spectroscopy with Choline Peak as Malignancy Marker Improves Positive Predictive Value for Breast Cancer Diagnosis: Preliminary Study. Radiology 2006; 239:686-92. [PMID: 16603660 DOI: 10.1148/radiol.2393051046] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the diagnostic performance of magnetic resonance (MR) spectroscopy in patients with suspicious lesions or biopsy-proved cancers at MR imaging by using histologic findings as the reference standard. MATERIALS AND METHODS After institutional review board approval and informed consent were obtained for this HIPAA-compliant study, breast MR spectroscopy was performed in patients with suspicious or biopsy-proved malignant lesions measuring 1 cm or larger at MR imaging. Single-voxel MR spectroscopy data were collected from a single rectangular volume of interest that encompassed the lesion. MR spectroscopy findings were defined as positive if the signal-to-noise ratio of the choline resonance peak was greater than or equal to 2 and as negative in all other cases. MR spectroscopy findings were then compared with histologic findings. RESULTS A total of 56 patients (age range, 20-77 years) with 57 lesions were imaged. The median lesion size at MR imaging was 2.3 cm (range, 1-15 cm). Histologically, 31 (54%) of 57 lesions were malignant, and 26 (46%) were benign. A choline peak was present in 34 of 57 lesions (including all cancers) and in three of 26 benign lesions, giving MR spectroscopy a sensitivity of 100% and a specificity of 88%. In 40 lesions of unknown histologic type, the use of MR spectroscopy as an adjunct to MR imaging would have significantly (P<.01) increased the positive predictive value of biopsy from 35% to 82%. If biopsy had been performed only on those lesions with a choline peak at MR spectroscopy, biopsy may have been spared in 23 (58%) of 40 lesions, and none of the cancers would have been missed. CONCLUSION Proton MR spectroscopy was successfully incorporated into breast MR imaging studies for lesions measuring 1 cm or larger. This technique may be useful in reducing the number of lesions detected at MR imaging that require biopsy.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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182
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Tardivon AA, Ollivier L, El Khoury C, Thibault F. Monitoring therapeutic efficacy in breast carcinomas. Eur Radiol 2006; 16:2549-58. [PMID: 16733676 DOI: 10.1007/s00330-006-0317-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 04/14/2006] [Accepted: 04/21/2006] [Indexed: 01/08/2023]
Abstract
The aim of imaging during and after neoadjuvant therapy is to document and quantify tumor response: has the tumor size been accurately measured? Certainly, the most exciting information for the oncologists is: can we identify good or nonresponders, and can we predict the pathological response early after the initiation of treatment? This review article will discuss the role and the performance of the different imaging modalities (mammography, ultrasound, magnetic resonance imaging and FDG-PET imaging) for evaluating this therapeutic response. It is important to emphasize that, at this time, clinical examination and conventional imaging (mammography and ultrasound) are the only methods recognized by the international criteria. Magnetic resonance imaging and FDG-PET imaging are very promising for predicting the response early after the initiation of neoadjuvant chemotherapy.
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Affiliation(s)
- Anne A Tardivon
- Department of Radiology, Institut Curie, 26 rue d'Ulm, 75248, Paris, Cedex 05, France.
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183
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Baik HM, Su MY, Yu H, Mehta R, Nalcioglu O. Quantification of Choline-containing Compounds in Malignant Breast Tumors by 1H MR Spectroscopy Using Water as an Internal Reference at 1.5 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2006; 19:96-104. [PMID: 16779565 DOI: 10.1007/s10334-006-0032-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 04/04/2006] [Indexed: 12/23/2022]
Abstract
The quantification of choline-containing compounds (Cho) in breast tumors by proton MR spectroscopy (1H-MRS) has been of great interest because such compounds have been linked to malignancy. In this study, an internal reference method for the absolute quantification of Cho metabolite in malignant breast tumors was presented using a clinical 1.5 T scanner. We performed in vitro measurements to examine the accuracy of absolute quantification using four phantoms of known choline chloride concentrations. There was a high correlation between the calculated concentrations by MRS and the known concentrations (r2 > 0.98). We applied the technique to in vivo breast study conducted on 45 patients with biopsy-confirmed breast cancer. After T1 and T2 relaxation times were corrected, the Cho levels in this work had a range of 0.76-21.20 mmol/kg from 34 MR spectra of 32 patients with malignant breast lesions. This result was rather consistent with the previously published value (i.e., 1.38-10 mmol/kg, Bolan et al. in Magn Reson Med 50:1134-1143, 2003). Therefore, we conclude that the internal method using the fully relaxed water as a reference could be used for quantifying Cho metabolite accurately in breast cancer patients using a clinical 1.5 T scanner.
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Affiliation(s)
- Hyun-Man Baik
- John Tu and Thomas Center for Functional Onco-Imaging, University of Califorinia, Irvine Hall 164, Irvine, CA 92697-5020, USA
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184
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Chen CY, Li CW, Kuo YT, Jaw TS, Wu DK, Jao JC, Hsu JS, Liu GC. Early response of hepatocellular carcinoma to transcatheter arterial chemoembolization: choline levels and MR diffusion constants--initial experience. Radiology 2006; 239:448-56. [PMID: 16569781 DOI: 10.1148/radiol.2392042202] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To prospectively investigate the apparent diffusion coefficient (ADC) and choline levels measured at hydrogen 1 ((1)H) magnetic resonance (MR) spectroscopy, to monitor therapeutic responses of hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS Institutional review board approval was obtained, and all patients and control subjects provided informed consent. Histologically proved large HCCs (>3 cm in diameter) were evaluated in 20 patients (16 men and four women; mean age, 59 years; range, 34-80 years) before TACE and 2-3 days after TACE. A control group of eight adults (five men and three women; mean age, 43 years; range, 24-76 years) with normal livers was examined by using the same protocol. Hepatic choline levels were measured by means of an external phantom replacement method, quantifying the peak at 3.2 ppm at (1)H MR spectroscopy. ADCs were measured for all lesions. A Wilcoxon rank sum test was used to compare absolute choline concentrations and ADCs at baseline between HCCs and normal liver parenchyma. Changes in choline levels and ADCs in the tumors before and after TACE were analyzed by using the Wilcoxon signed rank test. RESULTS The median preoperative choline level in patients with HCC (measured in 18 of the 20 patients) was 4.0 mmol/L (range, 0.0-17.2 mmol/L), which was significantly higher than that in patients with normal livers (n = 8) (median, 1.6 mmol/L; range, 0.0-2.1 mmol/L; P < .01). Among 18 patients with HCC, choline levels decreased significantly from before TACE to after TACE (P < .01). A significant increase in ADC from before TACE to after TACE in the 20 patients with HCC was also found (P < .01). CONCLUSION Hepatic choline levels and ADCs may allow monitoring of therapeutic responses of HCC to TACE although larger, more definitive and quantitative studies with clinical end points are needed.
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Affiliation(s)
- Chiao-Yun Chen
- Department of Medical Imaging and School of Medical Radiation Technology, Kaohsiung Medical University, 100 Tz You 1st Road, Kaohsiung 807, Taiwan
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185
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Manton DJ, Chaturvedi A, Hubbard A, Lind MJ, Lowry M, Maraveyas A, Pickles MD, Tozer DJ, Turnbull LW. Neoadjuvant chemotherapy in breast cancer: early response prediction with quantitative MR imaging and spectroscopy. Br J Cancer 2006; 94:427-35. [PMID: 16465174 PMCID: PMC2361138 DOI: 10.1038/sj.bjc.6602948] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A prospective study was undertaken in women undergoing neoadjuvant chemotherapy for locally advanced breast cancer in order to determine the ability of quantitative magnetic resonance imaging (MRI) and proton spectroscopy (MRS) to predict ultimate tumour response (percentage decrease in volume) or to detect early response. Magnetic resonance imaging and MRS were carried out before treatment and after the second of six treatment cycles. Pharmacokinetic parameters were derived from T1-weighted dynamic contrast-enhanced MRI, water apparent diffusion coefficient (ADC) was measured, and tissue water : fat peak area ratios and water T2 were measured using unsuppressed one-dimensional proton spectroscopic imaging (30 and 135 ms echo times). Pharmacokinetic parameters and ADC did not detect early response; however, early changes in water : fat ratios and water T2 (after cycle two) demonstrated substantial prognostic efficacy. Larger decreases in water T2 accurately predicted final volume response in 69% of cases (11/16) while maintaining 100% specificity and positive predictive value. Small/absent decreases in water : fat ratios accurately predicted final volume non-response in 50% of cases (3/6) while maintaining 100% sensitivity and negative predictive value. This level of accuracy might permit clinical application where early, accurate prediction of non-response would permit an early change to second-line treatment, thus sparing patients unnecessary toxicity, psychological morbidity and delay of initiation of effective treatment.
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Affiliation(s)
- D J Manton
- The Postgraduate Medical Institute of the University of Hull, Division of Cancer, East Yorkshire, HU6 7RX, UK.
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186
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Abstract
There is evidence in the literature indicating a significant static field inhomogeneity in the human breast. A nonhomogenous field results in line broadening and frequency shifts in MRS and can cause intensity loss and spatial errors in MRI. Thus, there is a clear rationale for determining the regional variations in the static field homogeneity in the breast and providing strategies to correct them. Herein, the nature and extent of the static magnetic field at 3 T were measured in central planes of the human breast using both phase maps and multivoxel MRS techniques. In addition, the effect of first- and high-order shimming and of spatial saturation pulses on the static field inhomogeneity was evaluated. Both the theoretical and the measured field were found to be primarily linear in nature, with a reduction of 300 Hz from the nipple to the chest wall. First-order shimming reduced this inhomogeneity by 65%. Interestingly, the combination of spatial saturation pulses and first-order shimming was more effective than high-order shim alone. Since many clinical scanners do not have either higher-order shim or automated higher shimming algorithms that work in the presence of fat, the suggested combination provides an effective means to correct inhomogeneities in the breast.
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Affiliation(s)
- Nimrod Maril
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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187
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Kumar M, Jagannathan NR, Seenu V, Dwivedi SN, Julka PK, Rath GK. Monitoring the therapeutic response of locally advanced breast cancer patients: Sequential in vivo proton MR spectroscopy study. J Magn Reson Imaging 2006; 24:325-32. [PMID: 16786567 DOI: 10.1002/jmri.20646] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the use of the water-to-fat (W-F) value obtained from in vivo proton ((1)H) MR spectroscopy (MRS) as a response indicator of cytologically confirmed patients with locally advanced breast cancer (LABC), and to monitor the therapeutic response of such patients to neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS Serial (1)H MR spectra were recorded both before and after the completion of chemotherapy in 33 LABC patients (with infiltrating ductal carcinoma (IDC)) at 1.5T. In addition, spectra from normal breast tissues of 28 healthy volunteers were recorded. RESULTS Malignant breast tissues showed elevated W-F values compared to normal breast tissues of controls. Statistically significant higher pretherapy W-F value (P < 0.01) was observed in patients compared to controls. In patients who received NACT resulting in the reduction of the primary tumor size, the W-F value showed a decrease that was statistically significant (P < 0.01). Analysis of the MR data further indicates that the W-F value had no correlation with the menstrual status of the patients. A comparison of pretherapy W-F value with pretherapy tumor volume showed a fair correlation (P = 0.05), while the posttherapy W-F value showed no such correlation with the posttherapy tumor volume. CONCLUSION This study demonstrates that simple, conventional in vivo (1)H MRS is a useful technique for monitoring the therapeutic response of breast cancer patients. The observed trend in the reduction of W-F value provides a noninvasive response indicator to monitor the clinical outcome of locally advanced breast cancer patients to NACT.
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Affiliation(s)
- Mahesh Kumar
- Department of NMR, All India Institute of Medical Sciences, New Delhi, India
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188
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Mountford C, Lean C, Malycha P, Russell P. Proton spectroscopy provides accurate pathology on biopsy and in vivo. J Magn Reson Imaging 2006; 24:459-77. [PMID: 16897689 DOI: 10.1002/jmri.20668] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the last 25 years, MR spectroscopy (MRS) has moved from being a basic research tool into routine clinical use. The spectroscopy method reports on those chemicals that are mobile on the MR time scale. Many of these chemicals reflect specific pathological processes but are complicated by the fact that many chemicals change at one time. There are currently two clinical applications for spectroscopy. The first is in the pathology laboratory, where it can be an adjunct to, and in some cases replacement, for difficult pathologies like Barrett's esophagus and follicular adenoma of the thyroid. The spectroscopy method on a breast biopsy can also report on prognostic indicators, including the potential for spread, from information present in the primary tumor alone. The second application for spectroscopy is in vivo to provide a preoperative diagnosis and this is now achievable for several organs including the prostate. The development of spectroscopy for clinical purposes has relied heavily on the serially-sectioned histopathology to confirm the high accuracy of the method. The combination of in vivo MRI, in vivo MRS, and ex vivo MRS on biopsy samples offers a modality of very high accuracy for preoperative diagnosis and provision of prognostic information for human cancers.
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Affiliation(s)
- Carolyn Mountford
- Institute for Magnetic Resonance Research, University of Sydney, Sydney, New South Wales, Australia.
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189
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Seenu V, Pavan Kumar MN, Sharma U, Gupta SD, Mehta SN, Jagannathan NR. Potential of magnetic resonance spectroscopy to detect metastasis in axillary lymph nodes in breast cancer. Magn Reson Imaging 2005; 23:1005-10. [PMID: 16376185 DOI: 10.1016/j.mri.2005.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 10/18/2005] [Accepted: 10/18/2005] [Indexed: 10/25/2022]
Abstract
Focused pathological evaluation of axillary lymph nodes in breast cancer is gaining importance. Nuclear magnetic resonance (NMR) spectroscopy that assesses the whole of the specimen has the potential in evaluating micrometastases. The biochemical changes associated with breast cancer metastases in axillary nodes by in vitro NMR and its use in the detection of axillary metastases in a clinical setting in comparison with conventional histopathology is presented in this study. Eighty-eight lymph nodes obtained from 30 patients with breast cancer were investigated. Histopathology revealed metastases in 20 nodes from 11 patients, while in vitro NMR spectroscopy revealed metastases in 22 nodes. Out of these 22 nodes, 16 were the same, which showed metastases on histopathology, while 6 nodes have shown metastases only on in vitro magnetic resonance spectroscopy (MRS). These 6 nodes with suspicion of metastases on MRS were subjected to reevaluation with serial sectioning and immunohistochemistry, but no additional metastases were revealed. Forty metabolites could be identified from the MR spectrum of lymph nodes. The levels of the glycerophosphocholine-phosphocholine (GPC-PC), choline, lactate, alanine and uridine diphosphoglucose were elevated significantly in nodes with metastases. In addition, the intensity ratio of GPC-PC/threonine (Thr) was higher in nodes with metastases, and using this as marker, MRS detected the axillary metastases with a sensitivity, specificity and accuracy of 80%, 91% and 88%, respectively. Neoadjuvant chemotherapy (NACT) lowered the concentrations of GPC-PC and GPC-PC/Thr ratio. The accuracy of MRS in detecting metastases was 75% in patients who received NACT (n=9) as compared to 96% in those who did not (n=21). Our results demonstrate the potential of in vitro MRS in characterizing the metabolite profile of the axillary nodes with breast cancer metastases. It detected axillary metastases with reasonable accuracy and can be complementary to histopathological evaluation and immunohistochemistry.
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Affiliation(s)
- Vuthaluru Seenu
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110029, India
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190
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Jordan BF, Black K, Robey IF, Runquist M, Powis G, Gillies RJ. Metabolite changes in HT-29 xenograft tumors following HIF-1alpha inhibition with PX-478 as studied by MR spectroscopy in vivo and ex vivo. NMR IN BIOMEDICINE 2005; 18:430-9. [PMID: 16206237 DOI: 10.1002/nbm.977] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The hypoxia-inducible transcription factor (HIF-1alpha) plays a central role in tumor development. PX-478 is an experimental anti-cancer drug known to inhibit HIF-1alpha in experimental tumors. The purpose of this study was to identify MRS-visible metabolic biomarkers for PX-478 response prior to phase I/II clinical trials. Single-voxel in vivo localized (1)H spectra were obtained from HT-29 tumor xenografts prior and up to 24 h after treatment with a single dose of PX-478. Profiles of water-soluble and lipophilic metabolites were also examined ex vivo with both (1)H and (31)P spectroscopy for peak identification and to interrogate the underlying biochemistry of the response. The total choline (tCho) resonance was significantly decreased in vivo 12 and 24 h following treatment with PX-478 and this was confirmed with high-resolution (1)H and (31)P MRS. In non-aqueous extracts, significant reductions in cardiolipin, PtdEtn (phosphatidylethanolamine) and PtdI (phosphatidylinositol) were seen in response to PX-478. Although there were trends to a decrease in lactate (and lipid) resonances in vivo and ex vivo, these changes were not significant. This is in contrast to inhibition of in vitro glucose consumption and lactate production by PX-478 in HT-29 cells. The significant and robust change in tCho has identified this as a potential (1)H MRS-visible biomarker for drug response in vivo while high-resolution spectroscopy indicated that GPC, PC, myoI, PE, GPE, CL, PtdEtn and PtdI are potential ex vivo response biomarkers.
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Affiliation(s)
- Bénédicte F Jordan
- Department of Biochemistry and Molecular Biophysics, Arizona Cancer Center, Tucson, AZ 85724, USA
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191
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Abstract
Ex vivo and in vivo applications of magnetic resonance spectroscopy have been developed which aid in distinguishing malignant from normal tissues. Studies of breast, colon, cervix, oesophageal and prostate cancer reveal both the successes and failings of present technology. Verification that these non-invasive tests might supplant conventional histology in obtaining spatial diagnostic and chemical prognostic information remains for the time being illusive.
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Affiliation(s)
- Laurence Gluch
- Department of Breast and Endocrine Surgery, Concord Hospital, Sydney, New South Wales, Australia.
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192
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Lindskog M, Spenger C, Klason T, Jarvet J, Gräslund A, Johnsen JI, Ponthan F, Douglas L, Nordell B, Kogner P. Proton magnetic resonance spectroscopy in neuroblastoma: Current status, prospects and limitations. Cancer Lett 2005; 228:247-55. [PMID: 15946794 DOI: 10.1016/j.canlet.2004.12.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 12/10/2004] [Indexed: 10/25/2022]
Abstract
Non-invasive biological information about residual neuroblastoma tumour tissue could allow treatment monitoring without the need for repeated biopsies. Magnetic resonance spectroscopy (MRS) can be performed with standard MR-scanners, providing specific biochemical information from selected tumour regions. By proton 1H-MRS, lipids, certain amino acids and lactate can be detected and their relative concentrations estimated in vivo. Using experimental models of neuroblastoma, we have described the potential of 1H-MRS for the prediction of tumour tissue viability and treatment response. Whereas viable neuroblastoma tissue is dominated by the choline 1H-MRS resonance, cell death as a consequence of spontaneous necrosis or successful treatment with chemotherapy, angiogenesis inhibitors, or NSAIDs is associated with decreased choline content. Therapy-induced neuroblastoma cell death is also associated with enhanced 1H-MRS resonances from mobile lipids and polyunsaturated fatty acids. The mobile lipid/choline ratio correlates significantly with cell death and based on the dynamics of this ratio tumour regression or continued growth (drug resistance) after chemotherapy can be predicted in vivo. The implications of these findings are discussed with focus on the potentials and limitations of introducing 1H-MRS for clinical assessment of treatment response in children with neuroblastoma. Biochemical monitoring of neuroblastoma with 1H-MRS could enable tailoring of individual therapy as well as provide early pharmacodynamic evaluation of novel therapeutic modalities.
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Affiliation(s)
- Magnus Lindskog
- Childhood Cancer Research Unit, Department of Woman and Child Health, Karolinska Institutet, Karolinska Hospital, S-17176 Stockholm, Sweden.
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193
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Abstract
Magnetic resonance spectroscopy (MRS) has been used for more than two decades to interrogate metabolite distributions in living cells and tissues. Techniques have been developed that allow multiple spectra to be obtained simultaneously with individual volume elements as small as 1 uL of tissue (i.e., 1 x 1 x 1 mm(3)). The most common modern applications of in vivo MRS use endogenous signals from (1)H, (31)P, or (23)Na. Important contributions have also been made using exogenous compounds containing (19)F, (13)C, or (17)O. MRS has been used to investigate cardiac and skeletal muscle energetics, neurobiology, and cancer. This review focuses on the latter applications, with specific reference to the measurement of tissue choline, which has proven to be a tumor biomarker that is significantly affected by anticancer therapies.
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Affiliation(s)
- Robert J Gillies
- Arizona Cancer Center, 1515 Campbell Avenue, Tucson, AZ 85724-5024, USA.
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194
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Li CW, Kuo YC, Chen CY, Kuo YT, Chiu YY, She FO, Liu GC. Quantification of choline compounds in human hepatic tumors by proton MR spectroscopy at 3 T. Magn Reson Med 2005; 53:770-6. [PMID: 15799049 DOI: 10.1002/mrm.20412] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The quantification of choline-containing compounds (Cho) in hepatic tumors by (1)H MR spectroscopy (MRS) is of great interest because such compounds have been linked to malignancy. In this study, a practical external phantom replacement method for the absolute quantification of hepatic metabolites is demonstrated. We performed experiments at 3 T using a body coil, and used an external phantom containing choline chloride for calibration. We first tested the quantification strategy to confirm its suitability in vivo using a phantom of known concentration and normal brain tissue. The results obtained after coil loading and T(1) and T(2) effects were corrected for were consistent with the known concentration and previously published values. To demonstrate its feasibility, we applied the technique to liver studies conducted on five normal volunteers and four patients with hepatocellular carcinoma, and one patient (also in the latter group) who had undergone post-transcatheter arterial chemoembolization (TACE). The Cho concentrations in the four patients were estimated to be 3.4, 6.3, 7.4, and 14.0 mM, respectively. These values are substantially higher than those obtained from the healthy volunteers (1.3 +/- 0.9 mM (mean +/- SD)). The results indicate that the proposed method is accurate and requires fewer tedious procedures for MRS; therefore, it may be a promising technique for evaluating response to treatment in liver cancer.
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Affiliation(s)
- Chun-Wei Li
- Faculty of Medical Radiation Technology, College of Health Sciences, 100 Shi-Chuan 1st Road, San Ming District, Kaohsiung City, Taiwan
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195
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Meisamy S, Bolan PJ, Baker EH, Pollema MG, Le CT, Kelcz F, Lechner MC, Luikens BA, Carlson RA, Brandt KR, Amrami KK, Nelson MT, Everson LI, Emory TH, Tuttle TM, Yee D, Garwood M. Adding in Vivo Quantitative1H MR Spectroscopy to Improve Diagnostic Accuracy of Breast MR Imaging: Preliminary Results of Observer Performance Study at 4.0 T. Radiology 2005; 236:465-75. [PMID: 16040903 DOI: 10.1148/radiol.2362040836] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether the addition of in vivo quantitative hydrogen 1 (1H) magnetic resonance (MR) spectroscopy can improve the radiologist's diagnostic accuracy in interpreting breast MR images to distinguish benign from malignant lesions. MATERIALS AND METHODS The study was approved by the institutional review board and, where appropriate, was compliant with the Health Insurance Portability and Accountability Act. All patients provided written informed consent. Fifty-five breast MR imaging cases-one lesion each in 55 patients aged 24-66 years with biopsy-confirmed findings-were retrospectively evaluated by four radiologists. Patients were examined with contrast material-enhanced fat-suppressed T1-weighted 4.0-T MR imaging. The concentration of total choline-containing compounds (tCho) was quantified by using single-voxel 1H MR spectroscopy. For each case, the radiologists were asked to give the percentage probability of malignancy, the Breast Imaging and Reporting Data System category, and a recommendation for patient treatment. Two interpretations were performed for each case: The initial interpretation was based on the lesion's morphologic features and time-signal intensity curve, and the second interpretation was based on the lesion's morphologic features, time-signal intensity curve, and tCho concentration. Receiver operating characteristic (ROC), Wilcoxon signed rank, kappa statistic, and accuracy (based on the area under the ROC curve) analyses were performed. RESULTS Of the 55 lesions evaluated, 35 were invasive carcinomas and 20 were benign. The addition of 1H MR spectroscopy resulted in higher sensitivity, specificity, accuracy, and interobserver agreement for all four radiologists. More specifically, two of the four radiologists achieved a significant improvement in sensitivity (P=.03, P=.03), and all four radiologists achieved a significant improvement in accuracy (P = .01, P = .05, P = .009, P < .001). CONCLUSION Current study results suggest that the addition of quantitative 1H MR spectroscopy to the breast MR imaging examination may help to improve the radiologist's ability to distinguish benign from malignant breast lesions.
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Affiliation(s)
- Sina Meisamy
- Department of Radiology, Center for Magnetic Resonance Research Medical School, 2021 Sixth St SE, Minneapolis, MN 55455, USA
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196
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Bolan PJ, Nelson MT, Yee D, Garwood M. Imaging in breast cancer: Magnetic resonance spectroscopy. Breast Cancer Res 2005; 7:149-52. [PMID: 15987466 PMCID: PMC1175074 DOI: 10.1186/bcr1202] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A technique called in vivo magnetic resonance spectroscopy (MRS) can be performed along with magnetic resonance imaging (MRI) to obtain information about the chemical content of breast lesions. This information can be used for several clinical applications, such as monitoring the response to cancer therapies and improving the accuracy of lesion diagnosis. Initial MRS studies of breast cancer show promising results, and a growing number of research groups are incorporating the technique into their breast MRI protocols. This article introduces 1H-MRS of the breast, reviews the literature, discusses current methods and technical issues, and describes applications for treatment monitoring and lesion diagnosis.
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Affiliation(s)
- Patrick J Bolan
- Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael T Nelson
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
- Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Douglas Yee
- Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael Garwood
- Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
- Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA
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197
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Hu J, Vartanian SA, Xuan Y, Latif Z, Soulen RL. An improved 1H magnetic resonance spectroscopic imaging technique for the human breast: preliminary results. Magn Reson Imaging 2005; 23:571-6. [PMID: 15919603 DOI: 10.1016/j.mri.2005.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Accepted: 02/03/2005] [Indexed: 12/28/2022]
Abstract
The high sensitivity but poor specificity of magnetic resonance imaging for detecting breast cancer has stimulated interest in magnetic resonance spectroscopic imaging (MRSI) as a tool to improve specificity and reduce the number of benign biopsies. The challenge of applying 1H MRSI to the diagnosis of cancer in the human breast is the need for robust lipid suppression and a clinically acceptable acquisition time. We present an improved 1H MRSI technique that uses an independently optimized chemical-shift-selective for lipid suppression and weighted elliptical k-space sampling combined with a Hamming filter for improved sampling efficiency.
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Affiliation(s)
- Jiani Hu
- Department of Radiology, MR Center/Concourse, Harper Hospital, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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198
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Meisamy S, Bolan PJ, Baker EH, Bliss RL, Gulbahce E, Everson LI, Nelson MT, Emory TH, Tuttle TM, Yee D, Garwood M. Neoadjuvant chemotherapy of locally advanced breast cancer: predicting response with in vivo (1)H MR spectroscopy--a pilot study at 4 T. Radiology 2004; 233:424-31. [PMID: 15516615 DOI: 10.1148/radiol.2332031285] [Citation(s) in RCA: 274] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine if changes in the concentration of choline-containing compounds (tCho) from before primary systemic therapy (PST) to within 24 hours after the first treatment enable prediction of clinical response in patients with locally advanced breast cancer. MATERIALS AND METHODS Sixteen women with biopsy-confirmed locally advanced breast cancer scheduled to undergo doxorubicin-based PST were recruited. Magnetic resonance (MR) imaging and spectroscopy were performed at 4 T prior to treatment, within 24 hours after the first dose, and after the fourth dose. Lesion size was assessed by using gadolinium-enhanced MR imaging. Lesion tCho concentration was quantified by using single-voxel hydrogen 1 MR spectroscopy. Statistical analysis was performed by using the Pearson correlation coefficient and the Wilcoxon rank sum test. RESULTS Fourteen of 16 patients completed the protocol. In one patient, the level of tCho was not measurable because of unfavorable lesion morphology for MR spectroscopy voxel placement. Of the remaining 13 patients, four had inflammatory breast cancer, six had invasive ductal carcinoma, two had invasive lobular carcinoma, and one had mixed invasive ductal and lobular carcinoma. On the basis of the Response Evaluation Criteria in Solid Tumors, eight of 13 patients had an objective response and five had no response. The change in concentration of tCho from baseline to within 24 hours after the first dose of PST showed significant positive correlation with the change in lesion size (R = 0.79, P = .001). Change in tCho concentration within 24 hours after first dose was significantly different between patients with objective response and those with no response (P = .007). CONCLUSION These results suggest that the change in tCho concentration between baseline and 24 hours after the first dose of PST can serve as an indicator for predicting clinical response to doxorubicin-based chemotherapy in locally advanced breast cancer.
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Affiliation(s)
- Sina Meisamy
- Center for Magnetic Resonance Research, University of Minnesota School of Medicine, 2021 Sixth St SE, Minneapolis, MN 55455, USA
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199
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Sharma U, Mehta A, Seenu V, Jagannathan NR. Biochemical characterization of metastatic lymph nodes of breast cancer patients by in vitro 1H magnetic resonance spectroscopy: a pilot study. Magn Reson Imaging 2004; 22:697-706. [PMID: 15172064 DOI: 10.1016/j.mri.2004.01.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2003] [Accepted: 01/28/2004] [Indexed: 10/26/2022]
Abstract
Using one-dimensional (1D) and two-dimensional (2D) proton nuclear magnetic resonance (NMR) methods, the perchloric acid extract of involved (n = 11) and noninvolved (n = 12) axillary lymph nodes (ALN) of breast cancer patients was investigated. Resonances from 40 metabolites such as lactate (Lac), glucose, several amino acids (alanine, lysine, glutamic acid, glutamine, etc.), nucleotides (adenosine triphosphate, guanosine triphosphate, uridine triphosphate, uridine monophosphate, etc.), membrane metabolites [glycerophosphocholine (GPC), phosphocoline (PC), phosphoethanolamine (PE), choline] were unambiguously assigned in both the involved and noninvolved ALN. The concentration of PC/GPC (p = 0.002) was significantly higher in the involved compared to noninvolved nodes. In addition, the concentration of glycolytic product Lac (p = 0.0001) was also found to be significantly higher in involved nodes. Increased concentration of membrane metabolites PC/GPC may be attributed to increased membrane synthesis in malignant cells and, therefore, suggests the presence of metastatic cells in lymph nodes. The higher concentration of Lac is indicative of the presence of malignant cells that derive energy via anaerobic glycolytic pathway. Present results demonstrate the potentials of in vitro proton NMR in detecting malignant cells in ALN and such studies may have an important bearing in determining the prognosis of breast cancer patients.
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Affiliation(s)
- Uma Sharma
- Department of Nuclear Magnetic Resonance, All India Institute of Medical Sciences, New Delhi 110 029, India
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200
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Stanwell P, Gluch L, Clark D, Tomanek B, Baker L, Giuffrè B, Lean C, Malycha P, Mountford C. Specificity of choline metabolites for in vivo diagnosis of breast cancer using 1H MRS at 1.5�T. Eur Radiol 2004; 15:1037-43. [PMID: 15351906 DOI: 10.1007/s00330-004-2475-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Revised: 05/07/2004] [Accepted: 08/02/2004] [Indexed: 11/24/2022]
Abstract
The purpose was to determine if in vivo proton magnetic resonance spectroscopy ((1)H MRS) at 1.5 T can accurately provide the correct pathology of breast disease. Forty-three asymptomatic volunteers including three lactating mothers were examined and compared with 21 breast cancer patients. Examinations were undertaken at 1.5 T using a purpose-built transmit-receive single breast coil. Single voxel spectroscopy was undertaken using echo times of 135 and 350 ms. The broad composite resonance at 3.2 ppm, which includes contributions from choline, phosphocholine (PC), glycerophosphocholine (GPC), myo-inositol and taurine, was found not to be a unique marker for malignancy providing a diagnostic sensitivity and specificity of 80.0 and 86.0%, respectively. This was due to three of the asymptomatic volunteers and all of the lactating mothers also generating the broad composite resonance at 3.2 ppm. Optimised post-acquisitional processing of the spectra resolved a resonance at 3.22 ppm, consistent with PC, in patients with cancer. In contrast the spectra recorded for three false-positive volunteers, and the three lactating mothers had a resonance centred at 3.28 ppm (possibly taurine, myo-inositol or GPC). This improved the specificity of the test to 100%. Careful referencing of the spectra and post-acquisitional processing intended to optimise spectral resolution of in vivo MR proton spectra from human breast tissue resolves the composite choline resonance. This allows the distinction of patients with malignant disease from volunteers with a sensitivity of 80% and specificity of 100%. Therefore, resolution of the composite choline resonance into its constituent components improves the specificity of the in vivo (1)H MRS method, but does not overcome the problem of 20% false-negatives.
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Affiliation(s)
- Peter Stanwell
- Institute for Magnetic Resonance Research and Department of Magnetic Resonance in Medicine, University of Sydney, Royal North Shore Hospital, St Leonards, NSW, Australia
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