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van der Voort A, van der Hoogt KJJ, Wessels R, Schipper RJ, Wesseling J, Sonke GS, Mann RM. Diffusion-weighted imaging in addition to contrast-enhanced MRI in identifying complete response in HER2-positive breast cancer. Eur Radiol 2024:10.1007/s00330-024-10857-7. [PMID: 38967659 DOI: 10.1007/s00330-024-10857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES The aim of this study is to investigate the added value of diffusion-weighted imaging (DWI) to dynamic-contrast enhanced (DCE)-MRI to identify a pathological complete response (pCR) in patients with HER2-positive breast cancer and radiological complete response (rCR). MATERIALS AND METHODS This is a single-center observational study of 102 patients with stage I-III HER2-positive breast cancer and real-world documented rCR on DCE-MRI. Patients were treated between 2015 and 2019. Both 1.5 T/3.0 T single-shot diffusion-weighted echo-planar sequence were used. Post neoadjuvant systemic treatment (NST) diffusion-weighted images were reviewed by two readers for visual evaluation and ADCmean. Discordant cases were resolved in a consensus meeting. pCR of the breast (ypT0/is) was used to calculate the negative predictive value (NPV). Breast pCR-percentages were tested with Fisher's exact test. ADCmean and ∆ADCmean(%) for patients with and without pCR were compared using a Mann-Whitney U-test. RESULTS The NPV for DWI added to DCE is 86% compared to 87% for DCE alone in hormone receptor (HR)-/HER2-positive and 67% compared to 64% in HR-positive/HER2-positive breast cancer. Twenty-seven of 39 non-rCR DWI cases were false positives. In HR-negative/HER2-positive breast cancer the NPV for DCE MRI differs between MRI field strength (1.5 T: 50% vs. 3 T: 81% [p = 0.02]). ADCmean at baseline, post-NST, and ∆ADCmean were similar between patients with and without pCR. CONCLUSION DWI has no clinically relevant effect on the NPV of DCE alone to identify a pCR in early HER2-positive breast cancer. The added value of DWI in HR-positive/HER2-positive breast cancer should be further investigated taken MRI field strength into account. CLINICAL RELEVANCE STATEMENT The residual signal on DWI after neoadjuvant systemic therapy in cases with early HER2-positive breast cancer and no residual pathologic enhancement on DCE-MRI breast should not (yet) be considered in assessing a complete radiologic response. KEY POINTS Radiologic complete response is associated with a pathologic complete response (pCR) in HER2+ breast cancer but further improvement is warranted. No relevant increase in negative predictive value was observed when DWI was added to DCE. Residual signal on DW-images without pathologic enhancement on DCE-MRI, does not indicate a lower chance of pCR.
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Affiliation(s)
- Anna van der Voort
- Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Kay J J van der Hoogt
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ronni Wessels
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Robert-Jan Schipper
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Jelle Wesseling
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
| | - Ritse M Mann
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Bendszus M, Laghi A, Munuera J, Tanenbaum LN, Taouli B, Thoeny HC. MRI Gadolinium-Based Contrast Media: Meeting Radiological, Clinical, and Environmental Needs. J Magn Reson Imaging 2024. [PMID: 38226697 DOI: 10.1002/jmri.29181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are routinely used in magnetic resonance imaging (MRI). They are essential for choosing the most appropriate medical or surgical strategy for patients with serious pathologies, particularly in oncologic, inflammatory, and cardiovascular diseases. However, GBCAs have been associated with an increased risk of nephrogenic systemic fibrosis in patients with renal failure, as well as the possibility of deposition in the brain, bones, and other organs, even in patients with normal renal function. Research is underway to reduce the quantity of gadolinium injected, without compromising image quality and diagnosis. The next generation of GBCAs will enable a reduction in the gadolinium dose administered. Gadopiclenol is the first of this new generation of GBCAs, with high relaxivity, thus having the potential to reduce the gadolinium dose while maintaining good in vivo stability due to its macrocyclic structure. High-stability and high-relaxivity GBCAs will be one of the solutions for reducing the dose of gadolinium to be administered in clinical practice, while the development of new technologies, including optimization of MRI acquisitions, new contrast mechanisms, and artificial intelligence may help reduce the need for GBCAs. Future solutions may involve a combination of next-generation GBCAs and image-processing techniques to optimize diagnosis and treatment planning while minimizing exposure to gadolinium. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Josep Munuera
- Advanced Medical Imaging, Artificial Intelligence, and Imaging-Guided Therapy Research Group, Institut de Recerca Sant Pau - Centre CERCA, Barcelona, Spain
- Diagnostic Imaging Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Harriet C Thoeny
- Department of Diagnostic and Interventional Radiology, Fribourg Cantonal Hospital, Fribourg, Switzerland
- Faculty of Medicine, University of Fribourg, Fribourg, Switzerland
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Puchnin V, Jandaliyeva A, Hurshkainen A, Solomakha G, Nikulin A, Petrova P, Lavrenteva A, Andreychenko A, Shchelokova A. Quadrature transceive wireless coil: Design concept and application for bilateral breast MRI at 1.5 T. Magn Reson Med 2023; 89:1251-1264. [PMID: 36336799 DOI: 10.1002/mrm.29507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Development of a novel quadrature inductively driven transceive wireless coil for breast MRI at 1.5 T. METHODS A quadrature wireless coil (HHMM-coil) design has been developed as a combination of two linearly polarized coils: a pair of 'metasolenoid' coils (MM-coil) and a pair of Helmholtz-type coils (HH-coil). The MM-coil consisted of an array of split-loop resonators. The HH-coil design included two electrically connected flat spirals. All the wireless coils were coupled to a whole-body birdcage coil. The HHMM-coil was studied and compared to the linear coils in terms of transmit and SAR efficiencies via numerical simulations. A prototype of HHMM-coil was built and tested on a 1.5 T scanner in a phantom and healthy volunteer. We also proposed an extended design of the HHMM-coil and compared its performance to a dedicated breast array. RESULTS Numerical simulations of the HHMM-coil with a female voxel model have shown more than a 2.5-fold increase in transmit efficiency and a 1.7-fold enhancement of SAR efficiency compared to the linearly polarized coils. Phantom and in vivo imaging showed good agreement with the numerical simulations. Moreover, the HHMM-coil provided good image quality, visualizing all areas of interest similar to a multichannel breast array with a 32% reduction in signal-to-noise ratio. CONCLUSION The proposed quadrature HHMM-coil allows the B 1 + $$ {\mathrm{B}}_1^{+} $$ -field to be significantly better focused in the region-of-interest compared to the linearly polarized coils. Thus, the HHMM-coil provides high-quality breast imaging on a 1.5 T scanner using a whole-body birdcage coil for transmit and receive.
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Affiliation(s)
- Viktor Puchnin
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | | | - Anna Hurshkainen
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Georgiy Solomakha
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Anton Nikulin
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Polina Petrova
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Anna Lavrenteva
- Medical Institute named after Berezin Sergey (MIBS), St. Petersburg, Russia
| | - Anna Andreychenko
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia.,Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Moscow Health Care Department, Moscow, Russia
| | - Alena Shchelokova
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
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Negi PS, Mehta SB, Jena A, Rana P. K trans Calculation Using Reference Method Corrected Native T 10 for Breast Cancer Diagnosis. J Med Phys 2023; 48:19-25. [PMID: 37342602 PMCID: PMC10277302 DOI: 10.4103/jmp.jmp_90_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 06/23/2023] Open
Abstract
Purpose The objective of the study is to use multiple tube phantoms to generate correction factor at different spatial locations for each breast coil cuff to correct the native T10 value in the corresponding spatial location of the breast lesion. The corrected T10 value was used to compute Ktrans and analyze its diagnostic accuracy in the classification of target condition, i.e., breast tumors into malignant and benign. Materials and Methods Both in vitro phantom study (external reference) and patient's studies were acquired on simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) Biograph molecular magnetic resonance (mMR) system using 4 channel mMR breast coil. The spatial correction factors derived using multiple tube phantom were used for a retrospective analysis of dynamic contrast-enhanced (DCE) MRI data of 39 patients with a mean age of 50 years (31-77 years) having 51 enhancing breast lesions. Results Corrected and non-corrected receiver operating characteristic (ROC) curve analysis revealed a mean Ktrans value of 0.64 min-1 and 0.60 min-1, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for non-corrected data were 86.21%, 81.82%, 86.20%, 81.81%, and 84.31%, respectively, and for corrected data were 93.10%, 86.36%, 90%, 90.47%, and 90.20% respectively. The area under curve (AUC) of corrected data was improved to 0.959 (95% confidence interval [CI] 0.862-0.994) from 0.824 (95% CI 0.694-0.918) of non-corrected data, and for NPV, it was improved to 90.47% from 81.81%, respectively. Conclusion T10 values were normalized using multiple tube phantom which was used for computation of Ktrans. We found significant improvement in the diagnostic accuracy of corrected Ktrans values that results in better characterization of breast lesions.
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Affiliation(s)
- Pradeep Singh Negi
- PET Suite (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
- Department of Physics, Vivekananda Global University, Jaipur, Rajasthan, India
| | - Shashi Bhushan Mehta
- PET Suite (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
- Department of Physics, Vivekananda Global University, Jaipur, Rajasthan, India
| | - Amarnath Jena
- PET Suite (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
- Department of Physics, Vivekananda Global University, Jaipur, Rajasthan, India
| | - Prerana Rana
- PET Suite (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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Stern N, Radunsky D, Blumenfeld‐Katzir T, Chechik Y, Solomon C, Ben‐Eliezer N. Mapping of magnetic resonance imaging's transverse relaxation time at low signal-to-noise ratio using Bloch simulations and principal component analysis image denoising. NMR IN BIOMEDICINE 2022; 35:e4807. [PMID: 35899528 PMCID: PMC9787782 DOI: 10.1002/nbm.4807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
High-resolution mapping of magnetic resonance imaging (MRI)'s transverse relaxation time (T2 ) can benefit many clinical applications by offering improved anatomic details, enhancing the ability to probe tissues' microarchitecture, and facilitating the identification of early pathology. Increasing spatial resolutions, however, decreases data's signal-to-noise ratio (SNR), particularly at clinical scan times. This impairs imaging quality, and the accuracy of subsequent radiological interpretation. Recently, principal component analysis (PCA) was employed for denoising diffusion-weighted MR images and was shown to be effective for improving parameter estimation in multiexponential relaxometry. This study combines the Marchenko-Pastur PCA (MP-PCA) signal model with the echo modulation curve (EMC) algorithm for denoising multiecho spin-echo (MESE) MRI data and improving the precision of EMC-generated single T2 relaxation maps. The denoising technique was validated on simulations, phantom scans, and in vivo brain and knee data. MESE scans were performed on a 3-T Siemens scanner. The acquired images were denoised using the MP-PCA algorithm and were then provided as input for the EMC T2 -fitting algorithm. Quantitative analysis of the denoising quality included comparing the standard deviation and coefficient of variation of T2 values, along with gold standard SNR estimation of the phantom scans. The presented denoising technique shows an increase in T2 maps' precision and SNR, while successfully preserving the morphological features of the tissue. Employing MP-PCA denoising as a preprocessing step decreases the noise-related variability of T2 maps produced by the EMC algorithm and thus increases their precision. The proposed method can be useful for a wide range of clinical applications by facilitating earlier detection of pathologies and improving the accuracy of patients' follow-up.
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Affiliation(s)
- Neta Stern
- Department of Biomedical EngineeringTel Aviv UniversityIsrael
| | - Dvir Radunsky
- Department of Biomedical EngineeringTel Aviv UniversityIsrael
| | | | - Yigal Chechik
- Department of OrthopedicsShamir Medical CenterBe'er Ya'akovIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Chen Solomon
- Department of Biomedical EngineeringTel Aviv UniversityIsrael
| | - Noam Ben‐Eliezer
- Department of Biomedical EngineeringTel Aviv UniversityIsrael
- Sagol School of NeuroscienceTel Aviv UniversityIsrael
- Center for Advanced Imaging Innovation and Research (CAIR)New York University School of MedicineNew YorkNew YorkUSA
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Janssen LM, den Dekker BM, Gilhuijs KGA, van Diest PJ, van der Wall E, Elias SG. MRI to assess response after neoadjuvant chemotherapy in breast cancer subtypes: a systematic review and meta-analysis. NPJ Breast Cancer 2022; 8:107. [PMID: 36123365 PMCID: PMC9485124 DOI: 10.1038/s41523-022-00475-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022] Open
Abstract
This meta-analysis aimed to estimate and compare sensitivity, specificity, positive- (PPV) and negative predictive value (NPV) of magnetic resonance imaging (MRI) for predicting pathological complete remission (pCR) after neoadjuvant chemotherapy (NAC) in patients with early-stage breast cancer. We stratified for molecular subtype by immunohistochemistry (IHC) and explored the impact of other factors. Two researchers systematically searched PUBMED and EMBASE to select relevant studies and extract data. For meta-analysis of sensitivity and specificity, we used bivariate random-effects models. Twenty-six included studies contained 4497 patients. There was a significant impact of IHC subtype on post-NAC MRI accuracy (p = 0.0082) for pCR. The pooled sensitivity was 0.67 [95% CI 0.58-0.74] for the HR-/HER2-, 0.65 [95% CI 0.56-0.73] for the HR-/HER2+, 0.55 [95% CI 0.45-0.64] for the HR+/HER2- and 0.60 [95% CI 0.50-0.70] for the HR+/HER2+ subtype. The pooled specificity was 0.85 [95% CI 0.81-0.88] for the HR-/HER2-, 0.81 [95% CI 0.74-0.86] for the HR-/HER2+, 0.88[95% CI 0.84-0.91] for the HR+/HER2- and 0.74 [95% CI 0.63-0.83] for the HR+/HER2+ subtype. The PPV was highest in the HR-/HER2- subtype and lowest in the HR+/HER2- subtype. MRI field strength of 3.0 T was associated with a higher sensitivity compared to 1.5 T (p = 0.00063). The accuracy of MRI for predicting pCR depends on molecular subtype, which should be taken into account in clinical practice. Higher MRI field strength positively impacts accuracy. When intervention trials based on MRI response evaluation are designed, the impact of IHC subtype and field strength on MR accuracy should be considered.
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Affiliation(s)
- L M Janssen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - B M den Dekker
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K G A Gilhuijs
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Wright JL, Rahbar H, Obeng-Gyasi S, Carlos R, Tjoe J, Wolff AC. Overcoming Barriers in Ductal Carcinoma In Situ Management: From Overtreatment to Optimal Treatment. J Clin Oncol 2022; 40:225-230. [PMID: 34813345 PMCID: PMC8760161 DOI: 10.1200/jco.21.01674] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 01/22/2023] Open
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Ishimori Y, Shimanuki T, Kobayashi T, Monma M. Fast B1 Mapping Based on Double-Angle Method with T1 Correction Using Standard Pulse Sequence. J Med Phys 2022; 47:93-98. [PMID: 35548043 PMCID: PMC9084583 DOI: 10.4103/jmp.jmp_78_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/14/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Abstract
Radiofrequency (RF) field (B1) mapping by combining the double-angle method (DAM) and T1 correction was investigated. The signal intensities S1 and S2 acquired by flip angle (FA) α and double FA 2α at short repetition time (TR) were converted to a signal intensity at TR=∞ by T1 correction. Then, these were used for DAM calculation. The T1 values are measured from two different images acquired with different TRs based on the saturation recovery (SR) method preliminarily. The effects of imaging parameters for T1 estimation and measured FA were investigated using CuSO4-doped water phantoms. A two-dimensional gradient echo type echo planar imaging pulse sequence was used. T1 values obtained by the 2-SR method were underestimated compared to the multipoint inversion recovery method. FA error was less than 5% when the appropriate imaging parameters were used. The acquisition time could be shortened to under 25 s by the use of T1-corrected DAM.
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Affiliation(s)
- Yoshiyuki Ishimori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Kashiwa, Japan,Address for correspondence: Dr. Yoshiyuki Ishimori, 4669-2 Ami, Ami-Machi, Inashiki-Gun, Ibaraki 300-0394, Japan. E-mail:
| | - Takeshi Shimanuki
- Department of Radiology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Tomoya Kobayashi
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Kashiwa, Japan
| | - Masahiko Monma
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Kashiwa, Japan
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Frankhouser DE, Dietze E, Mahabal A, Seewaldt VL. Vascularity and Dynamic Contrast-Enhanced Breast Magnetic Resonance Imaging. FRONTIERS IN RADIOLOGY 2021; 1:735567. [PMID: 37492179 PMCID: PMC10364989 DOI: 10.3389/fradi.2021.735567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/11/2021] [Indexed: 07/27/2023]
Abstract
Angiogenesis is a key step in the initiation and progression of an invasive breast cancer. High microvessel density by morphological characterization predicts metastasis and poor survival in women with invasive breast cancers. However, morphologic characterization is subject to variability and only can evaluate a limited portion of an invasive breast cancer. Consequently, breast Magnetic Resonance Imaging (MRI) is currently being evaluated to assess vascularity. Recently, through the new field of radiomics, dynamic contrast enhanced (DCE)-MRI is being used to evaluate vascular density, vascular morphology, and detection of aggressive breast cancer biology. While DCE-MRI is a highly sensitive tool, there are specific features that limit computational evaluation of blood vessels. These include (1) DCE-MRI evaluates gadolinium contrast and does not directly evaluate biology, (2) the resolution of DCE-MRI is insufficient for imaging small blood vessels, and (3) DCE-MRI images are very difficult to co-register. Here we review computational approaches for detection and analysis of blood vessels in DCE-MRI images and present some of the strategies we have developed for co-registry of DCE-MRI images and early detection of vascularization.
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Affiliation(s)
- David E. Frankhouser
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
| | - Eric Dietze
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
| | - Ashish Mahabal
- Department of Astronomy, Division of Physics, Mathematics, and Astronomy, California Institute of Technology (Caltech), Pasadena, CA, United States
| | - Victoria L. Seewaldt
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
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[Need for and predictability of magnetic resonance imaging examinations in patients with implanted neurostimulators]. Schmerz 2021; 36:357-362. [PMID: 34731324 PMCID: PMC9512871 DOI: 10.1007/s00482-021-00598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/30/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Bei steigender Zahl von Magnetresonanztomographie(MRT)-Untersuchungen in der deutschen Gesamtbevölkerung gibt es keine Daten zum Untersuchungsbedarf von Patienten mit implantiertem Neurostimulator in Deutschland. Publizierte Daten aus den USA legen einen hohen Bedarf nahe. Die eingeschränkte MRT-Zulassung der Implantate ist in der täglichen Praxis ein häufiges Problem. Ziel Im Fokus steht der MRT-Bedarf dieser Schmerzpatienten und die Vorhersagbarkeit zum Zeitpunkt der Implantation. Material und Methoden Es erfolgte eine retrospektive Auswertung der Datenbank unseres Klinikinformationssystems. Gesucht wurden alle im Zeitraum November 2011 bis März 2019 in unserem Klinikum angeforderten MRT-Untersuchungen für Patienten mit implantiertem Neurostimulator. Zudem erfolgte ein Abgleich mit den im gleichen Zeitraum durchgeführten Implantationen derartiger Stimulationssysteme. Ergebnisse Es konnten 171 durchgeführte MRT-Untersuchungen und 22 Anforderungen ohne nachfolgende Untersuchung ausgewertet werden. Bei 83 von 294 Patienten, die in unserem Zentrum mit implantierten Neurostimulatoren versorgt wurden, erfolgte mindestens eine MRT-Untersuchung in unserem Klinikum. Wir beobachten eine stetig steigende Nachfrage. In 111 von 171 durchgeführten Untersuchungen (65 %) bestand kein Zusammenhang zwischen der zur Implantation führenden Indikation und der Indikation für die MRT. Eine Vorhersagbarkeit konnte nur bei 43 von 193 MRT-Anforderungen (22 %) unterstellt werden. Diskussion Patienten mit implantiertem Neurostimulator haben auch in Deutschland einen hohen Bedarf an MRT-Diagnostik, welcher zum Zeitpunkt der Implantation nicht vorhersagbar ist. Daher sollten ausschließlich MRT-taugliche Systeme implantiert werden. Die Industrie ist aufgefordert, die Implantate und deren Zulassungen an den Bedarf anzupassen.
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O’Connell AM, Marini TJ, Kawakyu-O’Connor DT. Cone-Beam Breast Computed Tomography: Time for a New Paradigm in Breast Imaging. J Clin Med 2021; 10:jcm10215135. [PMID: 34768656 PMCID: PMC8584471 DOI: 10.3390/jcm10215135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 01/02/2023] Open
Abstract
It is time to reconsider how we image the breast. Although the breast is a 3D structure, we have traditionally used 2D mammography to perform screening and diagnostic imaging. Mammography has been continuously modified and improved, most recently with tomosynthesis and contrast mammography, but it is still using modifications of compression 2D mammography. It is time to consider 3D imaging for this 3D structure. Cone-beam breast computed tomography (CBBCT) is a revolutionary modality that will assist in overcoming the limitations of current imaging for dense breast tissue and overlapping structures. It also allows easy administration of contrast material for functional imaging. With a radiation dose on par with diagnostic mammography, rapid 10 s acquisition, no breast compression, and true high-resolution isotropic imaging, CBBCT has the potential to usher in a new era in breast imaging. These advantages could translate into lower morbidity and mortality from breast cancer.
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Negi PS, Mehta SB, Jena A. Use of Multiple-Tube Phantom: A Method to Globally Correct Native T1 Relaxation Time Inhomogeneity in Dedicated Molecular Magnetic Resonance Breast Coil. J Med Phys 2021; 46:41-46. [PMID: 34267488 PMCID: PMC8240908 DOI: 10.4103/jmp.jmp_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Native T1 relaxation time (T10) presents an important prerequisite to reliably quantify pharmacokinetic parameter like Ktrans (volume transfer constant). Native T1 value can be varied because of the inhomogeneity in the breast coil, thus influencing the Ktrans measurement. Purpose: The current study aims to design and use a phantom with multiple tubes for both breast cuffs to assess native T1 inhomogeneity across the dedicated molecular magnetic resonance (mMR) breast coil and adopt corrective method to spatially normalize T1 values to improve homogeneity. Materials and Methods: Two phantoms with multiple tubes (19 tubes) specially designed and filled with contrast medium with known T1 value were placed in each mMR breast coil cuff. Native T1 at various spatial locations was calculated applying dual flip angle sequence. Correction factors were derived at various spatial locations as a function of deviation of the native T1 value from phantom and applied to correct the native T1 relaxation time. Results: A statistically significant difference between native T1 values of the right and left anterior (P = 0.0095), middle (P = 0.0081), and posterior (P = 0.0004) parts of the breast coil. No significant difference was seen in the corrected T1 values between anterior (P = 0.402), middle (P = 0.305), and posterior (P = 0.349) aspects of both sides of the breast coil. Conclusion: Inhomogeneity in the native T1 value exists in dedicated mMR breast coil, and significant improvement can be achieved using specially designed external phantom with multiple tubes.
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Affiliation(s)
- Pradeep Singh Negi
- Department of Molecular Imaging and Nuclear Medicine, PET SUITE, Indraprastha Apollo Hospitals, New Delhi, India.,Department of Physics, Vivekananda Global University, Jaipur, Rajasthan, India
| | - Shashi Bhushan Mehta
- Department of Molecular Imaging and Nuclear Medicine, PET SUITE, Indraprastha Apollo Hospitals, New Delhi, India.,Department of Physics, Vivekananda Global University, Jaipur, Rajasthan, India
| | - Amarnath Jena
- Department of Molecular Imaging and Nuclear Medicine, PET SUITE, Indraprastha Apollo Hospitals, New Delhi, India.,Department of Physics, Vivekananda Global University, Jaipur, Rajasthan, India
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3T MRI-Radiomic Approach to Predict for Lymph Node Status in Breast Cancer Patients. Cancers (Basel) 2021; 13:cancers13092228. [PMID: 34066451 PMCID: PMC8124168 DOI: 10.3390/cancers13092228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/11/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Breast cancer is the most common cancer in women worldwide. The axillary lymph node status is one of the main prognostic factors. Currently, the methods to define the lymph node status are invasive and not without sequelae (from biopsy to lymphadenectomy). Radiomics is a new tool, and highly varied, but with high potential that has already shown excellent results in numerous fields of application. In our study, we have developed a classifier validated on a relatively large number of patients, which is able to predict lymph node status using a combination of patients clinical features, primary breast cancer histological features and radiomics features based on 3 Tesla post contrast—MR images. This approach can accurately select breast cancer patients who may avoid unnecessary biopsy and lymphadenectomy in a non-invasive way. Abstract Background: axillary lymph node (LN) status is one of the main breast cancer prognostic factors and it is currently defined by invasive procedures. The aim of this study is to predict LN metastasis combining MRI radiomics features with primary breast tumor histological features and patients’ clinical data. Methods: 99 lesions on pre-treatment contrasted 3T-MRI (DCE). All patients had a histologically proven invasive breast cancer and defined LN status. Patients’ clinical data and tumor histological analysis were previously collected. For each tumor lesion, a semi-automatic segmentation was performed, using the second phase of DCE-MRI. Each segmentation was optimized using a convex-hull algorithm. In addition to the 14 semantics features and a feature ROI volume/convex-hull volume, 242 other quantitative features were extracted. A wrapper selection method selected the 15 most prognostic features (14 quantitative, 1 semantic), used to train the final learning model. The classifier used was the Random Forest. Results: the AUC-classifier was 0.856 (label = positive or negative). The contribution of each feature group was lower performance than the full signature. Conclusions: the combination of patient clinical, histological and radiomics features of primary breast cancer can accurately predict LN status in a non-invasive way.
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Lin L, Hu P, Tong X, Na S, Cao R, Yuan X, Garrett DC, Shi J, Maslov K, Wang LV. High-speed three-dimensional photoacoustic computed tomography for preclinical research and clinical translation. Nat Commun 2021; 12:882. [PMID: 33563996 PMCID: PMC7873071 DOI: 10.1038/s41467-021-21232-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/15/2021] [Indexed: 01/30/2023] Open
Abstract
Photoacoustic computed tomography (PACT) has generated increasing interest for uses in preclinical research and clinical translation. However, the imaging depth, speed, and quality of existing PACT systems have previously limited the potential applications of this technology. To overcome these issues, we developed a three-dimensional photoacoustic computed tomography (3D-PACT) system that features large imaging depth, scalable field of view with isotropic spatial resolution, high imaging speed, and superior image quality. 3D-PACT allows for multipurpose imaging to reveal detailed angiographic information in biological tissues ranging from the rodent brain to the human breast. In the rat brain, we visualize whole brain vasculatures and hemodynamics. In the human breast, an in vivo imaging depth of 4 cm is achieved by scanning the breast within a single breath hold of 10 s. Here, we introduce the 3D-PACT system to provide a unique tool for preclinical research and an appealing prototype for clinical translation.
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Affiliation(s)
- Li Lin
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA
| | - Peng Hu
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA
| | - Xin Tong
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA
| | - Shuai Na
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA
| | - Rui Cao
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA
| | - Xiaoyun Yuan
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA ,grid.12527.330000 0001 0662 3178Present Address: Department of Electronic Engineering, Tsinghua University, Haidian District, Beijing, China
| | - David C. Garrett
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA
| | - Junhui Shi
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA ,Present Address: Zhejiang Lab, China Artificial Intelligence Town, Hangzhou Zhejiang, China
| | - Konstantin Maslov
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA
| | - Lihong V. Wang
- grid.20861.3d0000000107068890Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA USA
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15
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Reply to "Differentiating Benign Lesions From Areas of Malignant Nonmass Enhancement With MRI". AJR Am J Roentgenol 2020; 216:W8. [PMID: 33347354 DOI: 10.2214/ajr.20.24674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Gao Y, Heller SL. Abbreviated and Ultrafast Breast MRI in Clinical Practice. Radiographics 2020; 40:1507-1527. [DOI: 10.1148/rg.2020200006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L. Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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Conti A, Duggento A, Indovina I, Guerrisi M, Toschi N. Radiomics in breast cancer classification and prediction. Semin Cancer Biol 2020; 72:238-250. [PMID: 32371013 DOI: 10.1016/j.semcancer.2020.04.002] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Abstract
Breast Cancer (BC) is the common form of cancer in women. Its diagnosis and screening are usually performed through different imaging modalities such as mammography, magnetic resonance imaging and ultrasound. However, mammography and ultrasound-imaging techniques have limited sensitivity and specificity both in identifying lesions and in differentiating malign from benign lesions, especially in presence of dense breast parenchyma. Due to the higher resolution of magnetic resonance images, MRI represents the method with the higher specificity and sensitivity among all the available tools, in both lesions' identification and diagnosis. However, especially for diagnosis, even MRI has limitations that are only partially solved if combined with mammography. Unfortunately, due to the limits of all these imaging tools, in order to have a certain diagnosis, patients often receive painful and costly bioptics procedures. In this context, several computational approaches have been developed to increase sensitivity, while maintaining the same specificity, in BC diagnosis and screening. Amongst these, radiomics has been increasingly gaining ground in oncology to improve cancer diagnosis, prognosis and treatment. Radiomics derives multiple quantitative features from single or multiple medical imaging modalities, highlighting image traits which are not visible to the naked eye and hence significantly augmenting the discriminatory and predictive potential of medical imaging. This review article aims to summarize the state of the art in radiomics-based BC research. The dominating evidence extracted from the literature points towards a high potential of radiomics in disentangling malignant from benign breast lesions, classifying BC types and grades and also in predicting treatment response and recurrence risk. In the era of personalized medicine, radiomics has the potential to improve diagnosis, prognosis, prediction, monitoring, image-based intervention, and assessment of therapeutic response in BC.
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Affiliation(s)
- Allegra Conti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179, Rome, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Andrea Duggento
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Iole Indovina
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179, Rome, Italy; Department of Medicine and Surgery, Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Maria Guerrisi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, United States.
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Ruiz-Flores L, Whitman GJ, Le-Petross HTC, Hess KR, Parikh JR. Variation in Technical Quality of Breast MRI. Acad Radiol 2020; 27:468-475. [PMID: 31371208 DOI: 10.1016/j.acra.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/20/2019] [Accepted: 07/04/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Breast magnetic resonance imaging (MRI) quality may vary across the United States. Our aim was to investigate the quality of outside breast MRIs presenting for second opinion at a tertiary cancer center following implementation of the American College of Radiology (ACR) Breast MRI Accreditation Program. MATERIALS AND METHODS We retrospectively reviewed the technical quality of the MRI studies of 100 consecutive cases submitted for second opinion in 2013. The image quality was blindly reviewed per ACR Breast MRI Accreditation Program by three fellowship-trained breast radiologists and one breast imaging fellow. RESULTS In total, 88 of the 100 cases were referred from facilities in the United States. Sixty (68%) of the 88 cases had at least one technical deficiency. In 10 cases (11%), more than five different technical deficiencies occurred. The most frequently encountered deficiencies were related to artifacts (74%), with shimming (N = 17) and motion (N = 16) being the most common. In total, 38% of cases (N = 33) had a deficient T2-weighted sequence, mostly due to low signal to noise ratio (N = 25). A total of 27% cases (N = 24) had deficiencies in the delayed phase postcontrast T1-weighted sequence, mainly due to low signal to noise ratio (N = 21) and 23% had deficiencies in the early phase postcontrast T1-weighted sequence, predominantly due to low signal to noise ratio as well. (N = 19). CONCLUSION Our study demonstrates variability of breast MRI quality across the United States. Radiologists should become familiar with the requirements of the ACR breast MRI accreditation program and strive to meet the expected standards in order to enhance patient quality and safety.
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Affiliation(s)
- Lorell Ruiz-Flores
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030.
| | - Gary J Whitman
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
| | - H T Carissa Le-Petross
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay R Parikh
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
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Leithner D, Wengert GJ, Helbich TH, Thakur S, Ochoa-Albiztegui RE, Morris EA, Pinker K. Clinical role of breast MRI now and going forward. Clin Radiol 2018; 73:700-714. [PMID: 29229179 PMCID: PMC6788454 DOI: 10.1016/j.crad.2017.10.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/31/2017] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) is a well-established method in breast imaging, with manifold clinical applications, including the non-invasive differentiation between benign and malignant breast lesions, preoperative staging, detection of scar versus recurrence, implant assessment, and the evaluation of high-risk patients. At present, dynamic contrast-enhanced MRI is the most sensitive imaging technique for breast cancer diagnosis, and provides excellent morphological and to some extent also functional information. To compensate for the limited functional information, and to increase the specificity of MRI while preserving its sensitivity, additional functional parameters such as diffusion-weighted imaging and apparent diffusion coefficient mapping, and MR spectroscopic imaging have been investigated and implemented into the clinical routine. Several additional MRI parameters to capture breast cancer biology are still under investigation. MRI at high and ultra-high field strength and advances in hard- and software may also further improve this imaging technique. This article will review the current clinical role of breast MRI, including multiparametric MRI and abbreviated protocols, and provide an outlook on the future of this technique. In addition, the predictive and prognostic value of MRI as well as the evolving field of radiogenomics will be discussed.
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Affiliation(s)
- D Leithner
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany; Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - G J Wengert
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - T H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - S Thakur
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R E Ochoa-Albiztegui
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Leithner D, Wengert G, Helbich T, Morris E, Pinker K. MRI in the Assessment of BI-RADS® 4 lesions. Top Magn Reson Imaging 2017; 26:191-199. [PMID: 28961568 DOI: 10.1097/rmr.0000000000000138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) lexicon, which is used ubiquitously to standardize reporting of breast magnetic resonance imaging (MRI), provides 7 BI-RADS assessment categories to indicate the level of suspicion of malignancy and guide further management. A BI-RADS category 4 assessment is assigned when an imaging abnormality does not fulfill the typical criteria for malignancy, but is suspicious enough to warrant a recommendation for biopsy. The BI-RADS category 4 assessment covers a wide range of probability of malignancy, from >2 to <95%. MRI is an essential noninvasive technique in breast imaging and the role of MRI in the assessment of ACR BI-RADS 4 lesions is manifold. In lesions classified as suspicious on imaging with mammography, digital breast tomosynthesis, and sonography, MRI can aid in the noninvasive differentiation of benign and malignant lesions and obviate unnecessary breast biopsies. When the suspicion of cancer is confirmed with MRI, concurrent staging of disease for treatment planning can be accomplished. This article will provide a comprehensive overview of the role of breast MRI in the assessment of ACR BI-RADS 4 lesions. In addition, we will discuss strategies to decrease false positives and avoid false negative results when reporting MRI of the breast.
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Affiliation(s)
- Doris Leithner
- *Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany †Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria ‡Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Hahn SY, Ko ES, Han BK, Lim Y, Gu S, Ko EY. Analysis of factors influencing the degree of detectability on diffusion-weighted MRI and diffusion background signals in patients with invasive breast cancer. Medicine (Baltimore) 2016; 95:e4086. [PMID: 27399100 PMCID: PMC5058829 DOI: 10.1097/md.0000000000004086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To determine the factors influencing the degree of detectability of lesions and diffusion background signals on magnetic resonance diffusion-weighted imaging (DWI) in invasive breast cancer.Institutional review board approval was obtained and patient consent was waived. Patients with newly diagnosed invasive ductal carcinoma, who underwent preoperative breast magnetic resonance imaging with DWI were included in this study (n = 167). Lesion detectability on DWI and contrast-enhanced subtracted T1-weighted images, the degree of background parenchymal enhancement (BPE), and diffusion background signal were qualitatively rated. Detectability of lesions on DWI was compared with clinicopathological findings including menopausal status, mammographic density, and molecular subtype of breast cancer. Multivariate linear regression analysis was performed to determine variables independently associated with detectability of lesions on DWI and diffusion background signals.Univariate analysis showed that the detectability of lesions on DWI was significantly associated with lesion size (P = 0.001), diffuse background signal (P < 0.0001), and higher detectability scores for contrast-enhanced T1-weighted subtraction images (P = 0.000). The degree of diffusion background signal was significantly affected by age (P < 0.0001), BPE (P < 0.0001), mammographic density (P = 0.002), and menopausal status (P < 0.0001). On multivariate analysis, the diffusion background signal (P < 0.0001) and histologic grade (P < 0.0001) were correlated with the detectability on DWI of invasive breast cancer. Only BPE was correlated with the amount of diffusion background signal on DWI (P < 0.0001).For invasive breast cancers, detectability on DWI was significantly affected by the diffusion background signal. BPE, menopausal status, menstrual cycle, or mammographic density did not show statistically significant correlation with the diffusion detectability of lesions on DWI.
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Affiliation(s)
- Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Yaeji Lim
- Department of Statistics, Pukyong National University, Busan
| | - Seonhye Gu
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
- Correspondence: Eun Sook Ko, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea (e-mail: )
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Bedair R, Graves MJ, Patterson AJ, McLean MA, Manavaki R, Wallace T, Reid S, Mendichovszky I, Griffiths J, Gilbert FJ. Effect of Radiofrequency Transmit Field Correction on Quantitative Dynamic Contrast-enhanced MR Imaging of the Breast at 3.0 T. Radiology 2016; 279:368-77. [PMID: 26579563 DOI: 10.1148/radiol.2015150920] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the effects of radiofrequency transmit field (B1(+)) correction on (a) the measured T1 relaxation times of normal breast tissue and malignant lesions and (b) the pharmacokinetically derived parameters of malignant breast lesions at 3 T. MATERIALS AND METHODS Ethics approval and informed consent were obtained. Between May 2013 and January 2014, 30 women (median age, 58 years; range, 32-83 years) with invasive ductal carcinoma of at least 10 mm were recruited to undergo dynamic contrast material-enhanced magnetic resonance (MR) imaging before surgery. B1(+) and T1 mapping sequences were performed to determine the effect of B1(+) correction on the native tissue relaxation time (T10) of fat, parenchyma, and malignant lesions in both breasts. Pharmacokinetic parameters were calculated before and after correction for B1(+) variations. Results were correlated with histologic grade by using the Kruskal-Wallis test. RESULTS Measurements showed a mean 37% flip angle difference between the right and left breast, which resulted in a 61% T10 difference in fat and a 41.5% difference in parenchyma between the two breasts. The T1 of lesions in the right breast increased by 58%, whereas that of lesions in the left breast decreased by 30% after B1(+) correction. The whole-tumor transendothelial permeability across the vascular compartment(K(trans)) of lesions in the right breast decreased by 41%, and that of lesions in the left breast increased by 46% after correction. A systematic increase in K(trans) was observed, with significant differences found across the histologic grades (P < .001). The effect size of B1(+) correction on K(trans) calculation was large for lesions in the right breast and moderate for lesions in the left breast (Cohen effect size, d = 0.86 and d = 0.59, respectively). CONCLUSION B1(+) correction demonstrates a substantial effect on the results of quantitative dynamic contrast-enhanced analysis of breast tissue at 3 T, which propagates into the pharmacokinetic analysis of tumors that is dependent on whether the tumor is located in the right or left breast.
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Affiliation(s)
- Reem Bedair
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Martin J Graves
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Andrew J Patterson
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Mary A McLean
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Roido Manavaki
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Tess Wallace
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Scott Reid
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Iosif Mendichovszky
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - John Griffiths
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
| | - Fiona J Gilbert
- From the Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (R.B., M.J.G., R.M., T.W., I.M., F.J.G.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, England (M.J.G., A.J.P., M.A.M.); Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, England (M.A.M., J.G.); and General Electric Company, GE Medical Systems Limited, Chalfont St Giles, England (S.R.)
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von Below C, Daouacher G, Wassberg C, Grzegorek R, Gestblom C, Sörensen J, Ahlström H, Waldén M. Validation of 3 T MRI including diffusion-weighted imaging for nodal staging of newly diagnosed intermediate- and high-risk prostate cancer. Clin Radiol 2016; 71:328-34. [PMID: 26774372 DOI: 10.1016/j.crad.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/13/2015] [Accepted: 12/02/2015] [Indexed: 12/14/2022]
Abstract
AIM To prospectively validate 3 T magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) for preoperative lymph node (LN) staging in a clinical setting, in intermediate- and high-risk prostate cancer (PCa) patients using laparoscopic extended LN dissection (ePLND) as the reference standard. MATERIALS AND METHODS Between August 2011 and May 2013, 40 newly diagnosed intermediate and high-risk PCa patients underwent preoperative LN staging with 3 T MRI DWI using histopathology of ePLND as the reference standard. The sensitivity, specificity, and accuracy of MRI DWI were calculated. A subgroup analysis of proven LN-positive patients was made to investigate differences in PSA, Gleason score, number, and size of LN metastases, estimated risk of LN involvement, and if curative treatment was indicated, between the true-positive and the false-negative groups. RESULTS A total of 728 LN were harvested from six anatomical regions per patient (external, obturator, internal) with a mean number of 18 LNs per patient (range 11-40). Twenty patients had histologically proven LN-positive disease. MRI DWI was true positive in 11 patients, false negative in nine patients, false positive in two patients, and true negative in 18 patients, resulting in 90% specificity, 55% sensitivity, and 72.5% accuracy. The true-positive patients had significantly more involved LNs (mean 6.9 versus 2.7, p=0.017), with larger diameter (mean 12.3 versus 5.2 mm, p=0.048) and fewer were treated with curative intent (six versus nine, p=0.03), compared with the false-negative group. CONCLUSION MRI DWI LN staging has a low sensitivity but high specificity. The true-positive patients have a considerably higher burden of LN metastases compared to false-negative patients.
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Affiliation(s)
- C von Below
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | - G Daouacher
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
| | - C Wassberg
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - R Grzegorek
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
| | - C Gestblom
- Department of Pathology, Central Hospital of Karlstad, Karlstad, Sweden
| | - J Sörensen
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - H Ahlström
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - M Waldén
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
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24
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Menezes GLG, Stehouwer BL, Klomp DWJ, van der Velden TA, van den Bosch MAAJ, Knuttel FM, Boer VO, van der Kemp WJM, Luijten PR, Veldhuis WB. Dynamic contrast-enhanced breast MRI at 7T and 3T: an intra-individual comparison study. SPRINGERPLUS 2016; 5:13. [PMID: 26759752 PMCID: PMC4700043 DOI: 10.1186/s40064-015-1654-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
Abstract
The aim of this study is to compare the current state of lesion identification, the BI-RADS classification and the contrast-enhancement behavior at 7T and 3T breast MRI in the same patient group. Twenty-seven patients with thirty suspicious lesions were selected for this prospective study and underwent both 7T and 3T MRI. All examinations were rated by two radiologists (R1 and R2) independently on image quality, lesion identification and BI-RADS classification. We assessed sensitivity, specificity, NPV and PPV, observer agreement, lesion sizes, and contrast-enhancement-to-noise ratios (CENRs) of mass lesions. Fifteen of seventeen histopathological proven malignant lesions were detected at both field strengths. Image quality of the dynamic series was good at 7T, and excellent at 3T (P = 0.001 for R1 and P = 0.88 for R2). R1 found higher rates of specificity, NPV and PPV at 7T when compared to 3T, while R2 found the same results for sensitivity, specificity, NPV and PPV for both field strengths. The observers showed excellent agreement for BI-RADS categories at 7T (κ = 0.86) and 3T (κ = 0.93). CENRs were higher at 7T (P = 0.015). Lesion sizes were bigger at 7T according to R2 (P = 0.039). Our comparison study shows that 7T MRI allows BI-RADS conform analysis. Technical improvements, such as acquisition of T2w sequences and adjustment of B1+ field inhomogeneity, are still necessary to allow clinical use of 7T breast MRI.
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Affiliation(s)
- Gisela L G Menezes
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Bertine L Stehouwer
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Dennis W J Klomp
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Tijl A van der Velden
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Floortje M Knuttel
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Vincent O Boer
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Wybe J M van der Kemp
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Peter R Luijten
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Abstract
The use of magnetic resonance imaging (MRI) in radiotherapy (RT) planning is rapidly expanding. We review the wide range of image contrast mechanisms available to MRI and the way they are exploited for RT planning. However a number of challenges are also considered: the requirements that MR images are acquired in the RT treatment position, that they are geometrically accurate, that effects of patient motion during the scan are minimized, that tissue markers are clearly demonstrated, that an estimate of electron density can be obtained. These issues are discussed in detail, prior to the consideration of a number of specific clinical applications. This is followed by a brief discussion on the development of real-time MRI-guided RT.
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Affiliation(s)
- Maria A Schmidt
- Cancer Research UK Cancer Imaging Centre, Royal Marsden Hospital and the Institute of Cancer Research, Downs Road, Sutton, Surrey, SM2 5PT, UK
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26
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Simultaneous multi-slice readout-segmented echo planar imaging for accelerated diffusion-weighted imaging of the breast. Eur J Radiol 2015; 85:274-278. [PMID: 26547123 DOI: 10.1016/j.ejrad.2015.10.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/11/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Readout-segmented echo planar imaging (rs-EPI) significantly reduces susceptibility artifacts in diffusion-weighted imaging (DWI) of the breast compared to single-shot EPI but is limited by longer scan times. To compensate for this, we tested a new simultaneous multi-slice (SMS) acquisition for accelerated rs-EPI. MATERIALS AND METHODS After approval by the local ethics committee, eight healthy female volunteers (age, 38.9 ± 13.1 years) underwent breast MRI at 3T. Conventional as well as two-fold (2× SMS) and three-fold (3× SMS) slice-accelerated rs-EPI sequences were acquired at b-values of 50 and 800 s/mm(2). Two independent readers analyzed the apparent diffusion coefficient (ADC) in fibroglandular breast parenchyma. The signal-to-noise ratio (SNR) was estimated based on the subtraction method. ADC and SNR were compared between sequences by using the Friedman test. RESULTS The acquisition time was 4:21 min for conventional rs-EPI, 2:35 min for 2× SMS rs-EPI and 1:44 min for 3× SMS rs-EPI. ADC values were similar in all sequences (mean values 1.62 × 10(-3)mm(2)/s, p=0.99). Mean SNR was 27.7-29.6, and no significant differences were found among the sequences (p=0.83). CONCLUSION SMS rs-EPI yields similar ADC values and SNR compared to conventional rs-EPI at markedly reduced scan time. Thus, SMS excitation increases the clinical applicability of rs-EPI for DWI of the breast.
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Rahbar H, Conlin JL, Parsian S, DeMartini WB, Peacock S, Lehman CD, Partridge SC. Suspicious axillary lymph nodes identified on clinical breast MRI in patients newly diagnosed with breast cancer: can quantitative features improve discrimination of malignant from benign? Acad Radiol 2015; 22:430-8. [PMID: 25491740 DOI: 10.1016/j.acra.2014.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/28/2014] [Accepted: 10/31/2014] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES To determine whether quantitative dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance imaging (MRI) features can discriminate malignant from benign axillary lymph nodes (ALNs) identified as suspicious on clinical breast MRI in patients newly diagnosed with breast cancer. MATERIALS AND METHODS After approval from institutional review board, all clinical breast MR examinations performed from March 2006 through January 2010 describing at least one morphologically suspicious ipsilateral ALN in patients with newly diagnosed breast cancer were identified. Each suspicious ALN underwent ultrasound-guided core needle biopsy, and nodes with benign results were subsequently sampled surgically. Quantitative DCE and DW MRI parameters (diameters, volume, enhancement kinetics, and apparent diffusion coefficients [ADC]) were measured for each suspicious ALN and a representative contralateral normal node, and each feature was compared between the ALN groups (normal, benign, and malignant). RESULTS Thirty-four suspicious ALNs (18 malignant and 16 benign) and 34 contralateral normal-appearing ALNs were included. Suspicious malignant and benign nodes exhibited larger size, greater volume, and lower ADCs than normal ALNs (P < .05). Among suspicious ALNs, the only quantitative measure that discriminated between malignant from benign outcome was percent of ALN demonstrating washout kinetics (P = .02). CONCLUSIONS In ALNs deemed morphologically suspicious on breast MRI, quantitative MRI features show little value in identifying those with malignant etiology.
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Caivano R, Villonio A, D' Antuono F, Gioioso M, Rabasco P, Iannelli G, Zandolino A, Lotumolo A, Dinardo G, Macarini L, Guglielmi G, Cammarota A. Diffusion weighted imaging and apparent diffusion coefficient in 3 tesla magnetic resonance imaging of breast lesions. Cancer Invest 2015; 33:159-64. [PMID: 25831024 DOI: 10.3109/07357907.2015.1019674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the utility of diffusion-weighted-imaging (DWI) and apparent-diffusion-coefficient (ADC) in a 3T magnetic-resonance-imaging (MRI) study of breast cancer. In particular, the study aims to classify ADC-values according to histology either for benign or malignant lesions. METHODS 110 Breast MRI with MRI-DWI sequences and quantitative evaluation of the ADC were retrospectively reviewed. Results obtained with MRI-DWI and with biopsy were analyzed and ADC values were compared to histological results. RESULTS MRI showed a 95.5% sensitivity and a 83.7% specificity. The mean ADC values of benign and malignant lesions were 2.06 ± 0.19 and 1.03 ± 0.07 mm(2)/s, respectively (p < .05). CONCLUSIONS DWI and ADC-values could help distinguishing malignant and benign breast masses.
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Fat suppression techniques (STIR vs. SPAIR) on diffusion-weighted imaging of breast lesions at 3.0 T: preliminary experience. Radiol Med 2015; 120:705-13. [PMID: 25665796 DOI: 10.1007/s11547-015-0508-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/19/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this work was to perform a qualitative and quantitative comparison of the performance of two fat suppression techniques on breast diffusion-weighted imaging (DWI). MATERIALS AND METHODS Fifty-one women underwent clinical breast magnetic resonance imaging, including DWI with short TI inversion recovery (STIR) and spectral attenuated inversion recovery (SPAIR). Four were excluded from the analysis due to image artefacts. Rating of fat suppression uniformity and lesion visibility were performed. Agreement between the two sequences was evaluated. Additionally, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) values for normal gland, benign and malignant lesions were compared. Receiver operating characteristic analysis was also performed. RESULTS From the 52 lesions found, 47 were detected by both sequences. DWI-STIR evidenced more homogeneous fat suppression (p = 0.03). Although these lesions were seen with both techniques, DWI-SPAIR evidenced higher score for lesion visibility in nine of them. SNR and CNR were comparable, except for SNR in benign lesions (p < 0.01), which was higher for DWI-SPAIR. Mean ADC values for lesions were similar. ADC for normal fibroglandular tissue was higher when using DWI-STIR (p = 0.006). Sensitivity, specificity, accuracy and area under the curve values were alike: 84.0 % for both; 77.3, 71.4 %; 80.9, 78.3 %; 82.5, 81.3 % for DWI-SPAIR and DWI-STIR, respectively. CONCLUSION DWI-STIR showed superior fat suppression homogeneity. No differences were found for SNR and CNR, except for SNR in benign lesions. ADCs for lesions were comparable. Findings in this study are consistent with previous studies at 1.5 T, meaning that both fat suppression techniques are appropriate for breast DWI at 3.0 T.
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Rahbar H, DeMartini WB, Lee AY, Partridge SC, Peacock S, Lehman CD. Accuracy of 3 T versus 1.5 T breast MRI for pre-operative assessment of extent of disease in newly diagnosed DCIS. Eur J Radiol 2015; 84:611-6. [PMID: 25604909 DOI: 10.1016/j.ejrad.2014.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/06/2014] [Accepted: 12/28/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVES While 3T breast magnetic resonance imaging has increased in use over the past decade, there is little data comparing its use for assessing ductal carcinoma in situ (DCIS) versus 1.5 T. We sought to compare the accuracies of DCIS extent of disease measures on pre-operative 3T versus 1.5 T MRI. METHODS This institutional review board-approved prospective study included 20 patients with ductal carcinoma in situ diagnosed by core needle biopsy (CNB) who underwent pre-operative breast MRI at both 3T (resolution=0.5 mm×0.5 mm×1.3 mm) and 1.5 T (0.85 mm×0.85 mm×1.6 mm). All patients provided informed consent, and the study was HIPPA compliant. Lesion sizes and imaging characteristics (morphologic and kinetic enhancement) were recorded for the 3 T and 1.5 T examinations. Lesion size measures at both field strengths were correlated to final pathology, and imaging characteristics also were compared. RESULTS Of the initial cohort of 20 patients with CNB-diagnosed DCIS, 19 underwent definitive surgery. Median DCIS sizes of these 19 patients were 6mm (range: 0-67 mm) on 3T, 13 mm (0-60 mm) on 1.5 T, and 6mm (0-55 mm) on surgical pathology. Size correlation between MRI and pathology was higher for 3T (Spearman's ρ=0.66, p=0.002) than 1.5 T (ρ=0.36, p=0.13). In 10 women in which a residual area of suspicious enhancement was identified on both field strengths, there was agreement of morphologic description (NME vs. mass) in nine, and no significant difference in dynamic contrast enhanced kinetics at 3T compared to 1.5 T. CONCLUSIONS Pre-operative breast MRI at 3T provided higher correlation with final pathology size of DCIS lesions compared to 1.5 T, and may be more accurate for assessment of disease extent prior to definitive surgery.
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Affiliation(s)
- Habib Rahbar
- University of Washington School of Medicine, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, Seattle, WA 98109-1023, USA.
| | - Wendy B DeMartini
- University of Washington School of Medicine, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, Seattle, WA 98109-1023, USA
| | - Amie Y Lee
- University of Washington School of Medicine, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, Seattle, WA 98109-1023, USA
| | - Savannah C Partridge
- University of Washington School of Medicine, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, Seattle, WA 98109-1023, USA
| | - Sue Peacock
- University of Washington School of Medicine, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, Seattle, WA 98109-1023, USA
| | - Constance D Lehman
- University of Washington School of Medicine, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, Seattle, WA 98109-1023, USA
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Bogner W, Pinker K, Zaric O, Baltzer P, Minarikova L, Porter D, Bago-Horvath Z, Dubsky P, Helbich TH, Trattnig S, Gruber S. Bilateral Diffusion-weighted MR Imaging of Breast Tumors with Submillimeter Resolution Using Readout-segmented Echo-planar Imaging at 7 T. Radiology 2015; 274:74-84. [DOI: 10.1148/radiol.14132340] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vinnicombe SJ, Petralia G. Comprehensive breast MRI: an update. Cancer Imaging 2014. [PMCID: PMC4241981 DOI: 10.1186/1470-7330-14-s1-o39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Breast Cancer Detection Using Double Reading of Unenhanced MRI Including T1-Weighted, T2-Weighted STIR, and Diffusion-Weighted Imaging: A Proof of Concept Study. AJR Am J Roentgenol 2014; 203:674-81. [DOI: 10.2214/ajr.13.11816] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Munley MT, Kagadis GC, McGee KP, Kirov AS, Jang S, Mutic S, Jeraj R, Xing L, Bourland JD. An introduction to molecular imaging in radiation oncology: a report by the AAPM Working Group on Molecular Imaging in Radiation Oncology (WGMIR). Med Phys 2014; 40:101501. [PMID: 24089890 DOI: 10.1118/1.4819818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Molecular imaging is the direct or indirect noninvasive monitoring and recording of the spatial and temporal distribution of in vivo molecular, genetic, and/or cellular processes for biochemical, biological, diagnostic, or therapeutic applications. Molecular images that indicate the presence of malignancy can be acquired using optical, ultrasonic, radiologic, radionuclide, and magnetic resonance techniques. For the radiation oncology physicist in particular, these methods and their roles in molecular imaging of oncologic processes are reviewed with respect to their physical bases and imaging characteristics, including signal intensity, spatial scale, and spatial resolution. Relevant molecular terminology is defined as an educational assist. Current and future clinical applications in oncologic diagnosis and treatment are discussed. National initiatives for the development of basic science and clinical molecular imaging techniques and expertise are reviewed, illustrating research opportunities in as well as the importance of this growing field.
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Affiliation(s)
- Michael T Munley
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
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Yamamoto N, Yoshizako T, Yoshikawa K, Itakura M, Maruyama R, Kitagaki H. Breast 3 T-MR imaging: indication for stereotactic vacuum-assisted breast biopsy. SPRINGERPLUS 2014; 3:481. [PMID: 25932356 PMCID: PMC4409605 DOI: 10.1186/2193-1801-3-481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/26/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study was to assess indications for stereotactic vacuum-assisted breast biopsy (SVAB) evaluated by breast 3 T-magnetic resonance (3 T-MR) imaging in patients showing suspicious microcalcifications on mammography and negative ultrasound (US) findings. METHODS AND MATERIALS Fifty-five patients with 55 breast lesions showing suspicious microcalcifications on mammography and negative US findings underwent preoperative 3 T-MR examination including dynamic MR imaging. All patients underwent SVAB within 1 month of MR imaging. The pathological diagnosis of each breast lesion was made by examining tissues obtained by SVAB or radical/partial mastectomy. 3 T-MR imaging findings were evaluated by using the American College of Radiology Breast Imaging Reporting and Data System Atlas (BI-RADS-MRI) and then were correlated with the histopathological findings. When BI-RADS 4 and 5 MR imaging lesions were assumed to be malignant, the usefulness of 3 T-MR imaging was evaluated for diagnosis of impalpable breast lesions by SVAB among lesions with microcalcification detected by mammography and negative US findings. RESULTS There were 21 malignant lesions, including 5 invasive ductal carcinomas, 16 lesions of ductal carcinoma in situ (DCIS). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 3 T-MR imaging for deciding the indications for SVAB was 90.5%, 97.1%, 95.0%, 94.3%, and 94.5%, respectively. The one-false negative case was a DCIS with small enhancing lesions (0.5 mm). The one false-positive case was ductal adenoma with a linear ductal pattern of enhancement. CONCLUSIONS 3 T-MR imaging may be useful for deciding the indications for SVAB in patients who have breast lesions with microcalcification that are impalpable and are detected by mammography and negative US findings. However, our findings should be considered preliminary and further prospective investigation is required.
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Affiliation(s)
- Nobuko Yamamoto
- Department of Radiology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501 Japan
| | - Takeshi Yoshizako
- Department of Radiology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501 Japan
| | - Kazuaki Yoshikawa
- Department of Radiology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501 Japan
| | - Masayuki Itakura
- Department of Surgery, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501 Japan
| | - Riruke Maruyama
- Department of Pathology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501 Japan
| | - Hajime Kitagaki
- Department of Radiology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501 Japan
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Clinical application of bilateral high temporal and spatial resolution dynamic contrast-enhanced magnetic resonance imaging of the breast at 7 T. Eur Radiol 2013; 24:913-20. [DOI: 10.1007/s00330-013-3075-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/11/2013] [Accepted: 11/03/2013] [Indexed: 12/18/2022]
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