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Kataoka M, Honda M, Sagawa H, Ohashi A, Sakaguchi R, Hashimoto H, Iima M, Takada M, Nakamoto Y. Ultrafast Dynamic Contrast-Enhanced MRI of the Breast: From Theory to Practice. J Magn Reson Imaging 2024; 60:401-416. [PMID: 38085134 DOI: 10.1002/jmri.29082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 07/13/2024] Open
Abstract
The development of ultrafast dynamic contrast-enhanced (UF-DCE) MRI has occurred in tandem with fast MRI scan techniques, particularly view-sharing and compressed sensing. Understanding the strengths of each technique and optimizing the relevant parameters are essential to their implementation. UF-DCE MRI has now shifted from research protocols to becoming a part of clinical scan protocols for breast cancer. UF-DCE MRI is expected to compensate for the low specificity of abbreviated MRI by adding kinetic information from the upslope of the time-intensity curve. Because kinetic information from UF-DCE MRI is obtained from the shape and timing of the initial upslope, various new kinetic parameters have been proposed. These parameters may be associated with receptor status or prognostic markers for breast cancer. In addition to the diagnosis of malignant lesions, more emphasis has been placed on predicting and evaluating treatment response because hyper-vascularity is linked to the aggressiveness of breast cancers. In clinical practice, it is important to note that breast lesion images obtained from UF-DCE MRI are slightly different from those obtained by conventional DCE MRI in terms of morphology. A major benefit of using UF-DCE MRI is avoidance of the marked or moderate background parenchymal enhancement (BPE) that can obscure the target enhancing lesions. BPE is less prominent in the earlier phases of UF-DCE MRI, which offers better lesion-to-noise contrast. The excellent contrast of early-enhancing vessels provides a key to understanding the detailed pathological structure of tumor-associated vessels. UF-DCE MRI is normally accompanied by a large volume of image data for which automated/artificial intelligence-based processing is expected to be useful. In this review, both the theoretical and practical aspects of UF-DCE MRI are summarized. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Maya Honda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan
- Department of Diagnostic Radiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Hajime Sagawa
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Japan
| | - Akane Ohashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Malmö, Sweden
- Department of Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden
| | - Rena Sakaguchi
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hina Hashimoto
- Department of Human Health Science, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan
- Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan
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Cover KS. Re: The effectiveness of an ultrafast breast MRI protocol in the differentiation of benign and malignant breast lesions. Clin Radiol 2023; 78:872-873. [PMID: 37640580 DOI: 10.1016/j.crad.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Affiliation(s)
- K S Cover
- Postbus 26303, 1100EC, Amsterdam, the Netherlands.
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Kataoka M, Iima M, Miyake KK, Matsumoto Y. Multiparametric imaging of breast cancer: An update of current applications. Diagn Interv Imaging 2022; 103:574-583. [DOI: 10.1016/j.diii.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
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Cover KS. Kim et al. report the first ultrafast MR imaging results applicable to breast cancer screening as their study does not suffer from selection bias towards large lesions. Eur J Radiol 2022; 154:110440. [PMID: 35843013 DOI: 10.1016/j.ejrad.2022.110440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/03/2022]
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Jing X, Wielema M, Cornelissen LJ, van Gent M, Iwema WM, Zheng S, Sijens PE, Oudkerk M, Dorrius MD, van Ooijen PMA. Using deep learning to safely exclude lesions with only ultrafast breast MRI to shorten acquisition and reading time. Eur Radiol 2022; 32:8706-8715. [PMID: 35614363 DOI: 10.1007/s00330-022-08863-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the feasibility of automatically identifying normal scans in ultrafast breast MRI with artificial intelligence (AI) to increase efficiency and reduce workload. METHODS In this retrospective analysis, 837 breast MRI examinations performed on 438 women from April 2016 to October 2019 were included. The left and right breasts in each examination were labelled normal (without suspicious lesions) or abnormal (with suspicious lesions) based on final interpretation. Maximum intensity projection (MIP) images of each breast were then used to train a deep learning model. A high sensitivity threshold was calculated based on the detection trade - off (DET) curve on the validation set. The performance of the model was evaluated by receiver operating characteristic analysis of the independent test set. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with the high sensitivity threshold were calculated. RESULTS The independent test set consisted of 178 examinations of 149 patients (mean age, 44 years ± 14 [standard deviation]). The trained model achieved an AUC of 0.81 (95% CI: 0.75-0.88) on the independent test set. Applying a threshold of 0.25 yielded a sensitivity of 98% (95% CI: 90%; 100%), an NPV of 98% (95% CI: 89%; 100%), a workload reduction of 15.7%, and a scan time reduction of 16.6%. CONCLUSION This deep learning model has a high potential to help identify normal scans in ultrafast breast MRI and thereby reduce radiologists' workload and scan time. KEY POINTS • Deep learning in TWIST may eliminate the necessity of additional sequences for identifying normal breasts during MRI screening. • Workload and scanning time reductions of 15.7% and 16.6%, respectively, could be achieved with the cost of 1 (1 of 55) false negative prediction.
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Affiliation(s)
- Xueping Jing
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Mirjam Wielema
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Ludo J Cornelissen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Margo van Gent
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Willie M Iwema
- Faculty of Medical Sciences, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands
| | - Sunyi Zheng
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Paul E Sijens
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Faculty of Medical Sciences, University of Groningen and Institute of Diagnostic Accuracy, Wiersmastraat 5, 9713, GH, Groningen, The Netherlands
| | - Monique D Dorrius
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Peter M A van Ooijen
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
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Kataoka M, Honda M, Ohashi A, Yamaguchi K, Mori N, Goto M, Fujioka T, Mori M, Kato Y, Satake H, Iima M, Kubota K. Ultrafast Dynamic Contrast-enhanced MRI of the Breast: How Is It Used? Magn Reson Med Sci 2022; 21:83-94. [PMID: 35228489 PMCID: PMC9199976 DOI: 10.2463/mrms.rev.2021-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Ultrafast dynamic contrast-enhanced (UF-DCE) MRI is a new approach to capture kinetic information in the very early post-contrast period with high temporal resolution while keeping reasonable spatial resolution. The detailed timing and shape of the upslope in the time–intensity curve are analyzed. New kinetic parameters obtained from UF-DCE MRI are useful in differentiating malignant from benign lesions and in evaluating prognostic markers of the breast cancers. Clinically, UF-DCE MRI contributes in identifying hypervascular lesions when the background parenchymal enhancement (BPE) is marked on conventional dynamic MRI. This review starts with the technical aspect of accelerated acquisition. Practical aspects of UF-DCE MRI include identification of target hypervascular lesions from marked BPE and diagnosis of malignant and benign lesions based on new kinetic parameters derived from UF-DCE MRI: maximum slope (MS), time to enhance (TTE), bolus arrival time (BAT), time interval between arterial and venous visualization (AVI), and empirical mathematical model (EMM). The parameters derived from UF-DCE MRI are compared in terms of their diagnostic performance and association with prognostic markers. Pitfalls of UF-DCE MRI in the clinical situation are also covered. Since UF-DCE MRI is an evolving technique, future prospects of UF-DCE MRI are discussed in detail by citing recent evidence. The topic covers prediction of treatment response, multiparametric approach using DWI-derived parameters, evaluation of tumor-related vessels, and application of artificial intelligence for UF-DCE MRI. Along with comprehensive literature review, illustrative clinical cases are used to understand the value of UF-DCE MRI.
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Affiliation(s)
- Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Maya Honda
- Department of Diagnostic Radiology, Kansai Electric Power Hospital
| | - Akane Ohashi
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University hospital
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine
| | - Mariko Goto
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Yutaka Kato
- Department of Radiological Technology, Nagoya University Hospital
| | - Hiroko Satake
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center
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The Additional Value of Ultrafast DCE-MRI to DWI-MRI and 18F-FDG-PET to Detect Occult Primary Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12102826. [PMID: 33007978 PMCID: PMC7600235 DOI: 10.3390/cancers12102826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Patients with cervical lymph node metastasis from squamous cell carcinoma undergo extensive irradiation or surgery of the head and neck with higher treatment morbidity, recurrence rate and lower overall survival than patients with overt primary tumor. In order to enhance treatment efficiency and morbidity reduction, the primary tumor detection accuracy was evaluated by using Ultrafast-Dynamic Contrast-Enhancement (DCE-)MRI in addition to Diffusion-Weighted (DW-)MRI and 18F-FDG-PET/CT imaging. Ultrafast-DCE, with a temporal resolution of 4 s, enabled capturing lesions with increased neoangiogenesis or perfusion compared to normal tissue. The use of Ultra-fast DCE resulted in higher confidence for suspicious locations and high observer agreement. Ultrafast-DCE showed potential to improve detection of unknown primary tumors in addition to DWI and 18F-FDG-PET/CT in patients with cervical squamous cell carcinoma lymph node metastasis. The combined use of ultrafast-DCE, DWI and 18F-FDG-PET/CT yielded highest sensitivity. Abstract To evaluate diagnostic accuracy of qualitative analysis and interobserver agreement of single ultrafast-DCE, DWI or 18F-FDG-PET and the combination of modalities for the detection of unknown primary tumor (UPT) in patients presenting with cervical lymph node metastasis from squamous cell carcinoma (SCC). Between 2014–2019, patients with histologically proven cervical lymph node metastasis of UPT SCC were prospectively included and underwent DWI, ultrafast-DCE, and 18F-FDG-PET/CT. Qualitative assessment was performed by two observers per modality. Interobserver agreement was calculated using the proportion specific agreement. Diagnostic accuracy of combined use of DWI, ultrafast-DCE and 18F-FDG-PET/CT was assessed. Twenty-nine patients were included (20 males. [68%], median age 60 years). Nine (31%) primary tumors remained occult. Ultrafast-DCE added reader confidence for suspicious locations (one additional true positive (5%), 2 decisive true malignant (10%). The per-location analysis showed highest specific positive agreement for ultrafast-DCE (77.6%). The per-location rating showed highest sensitivity (95%, 95%CI = 75.1–99.9, YI = 0.814) when either one of all modalities was scored positive, and 97.4% (95%CI = 93.5–99.3, YI = 0.774) specificity when co-detected on all. The per-patient analysis showed highest sensitivity (100%) for 18F-FDG-PET/CT (YI = 0.222) and either DWI or PET (YI = 0.111). Despite highest trends, no significant differences were found. The per-patient analysis showed highest specific positive agreement when co-detected on all modalities (55.6%, 95%CI = 21.2–86.3, YI = 0.456). Ultrafast-DCE showed potential to improve detection of unknown primary tumors in addition to DWI and 18F-FDG-PET/CT in patients with cervical squamous cell carcinoma lymph node metastasis. The combined use of ultrafast-DCE, DWI and 18F-FDG-PET/CT yielded highest sensitivity.
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