Intramolecular zero-quantum-coherence 2D NMR spectroscopy of lipids in the human breast at 7 T

Probing lipids relaxation times in breast cancer using magnetic resonance spectroscopic fingerprinting

OBJECTIVES

To investigate the clinical relevance of the relaxation times of lipids within breast cancer and normal fibroglandular tissue in vivo, using magnetic resonance spectroscopic fingerprinting (MRSF).

METHODS

Twelve patients with biopsy-confirmed breast cancer and 14 healthy controls were prospectively scanned at 3 T using a protocol consisting of diffusion tensor imaging (DTI), MRSF, and dynamic contrast-enhanced (DCE) MRI. Single-voxel MRSF data was recorded from the tumor (patients) - identified using DTI - or normal fibroglandular tissue (controls), in under 20 s. MRSF data was analyzed using in-house software. Linear mixed model analysis was used to compare the relaxation times of lipids in breast cancer VOIs vs. normal fibroglandular tissue.

RESULTS

Seven distinguished lipid metabolite peaks were identified and their relaxation times were recorded. Of them, several exhibited statistically significant changes between controls and patients, with strong significance (p < 10^-3) recorded for several of the lipid resonances at 1.3 ppm (T₁ = 355 ± 17 ms vs. 389 ± 27 ms), 4.1 ppm (T₁ = 255 ± 86 ms vs. 127 ± 33 ms), 5.22 ppm (T₁ = 724 ± 81 ms vs. 516 ± 62 ms), and 5.31 ppm (T₂ = 56 ± 5 ms vs. 44 ± 3.5 ms, respectively).

CONCLUSIONS

The application of MRSF to breast cancer imaging is feasible and achievable in clinically relevant scan time. Further studies are required to verify and comprehend the underling biological mechanism behind the differences in lipid relaxation times in cancer and normal fibroglandular tissue.

KEY POINTS

•The relaxation times of lipids in breast tissue are potential markers for quantitative characterization of the normal fibroglandular tissue and cancer. •Lipid relaxation times can be acquired rapidly in a clinically relevant manner using a single-voxel technique, termed MRSF. •Relaxation times of T₁ at 1.3 ppm, 4.1 ppm, and 5.22 ppm, as well as of T₂ at 5.31 ppm, were significantly different between measurements within breast cancer and the normal fibroglandular tissue.

Fat unsaturation measures in tibial, subcutaneous and breast adipose tissue using short and long TE MRS at 3 T

Fat unsaturation and poly-unsaturation measures can be obtained in vivo with magnetic resonance spectroscopy (MRS) through the olefinic (≈5.4 ppm) and diallylic (≈2.8 ppm) resonances, respectively. Long echo time (TE) MRS sequences have been previously optimized for olefinic/methylene (≈1.3 ppm) or olefinic/methyl (≈0.9 ppm) measures. The objectives of this work, using a Point RESolved Spectroscopy (PRESS) sequence, are to: 1) Investigate olefinic, methyl and methylene resonance decay in subcutaneous, tibial, and breast adipose tissue to determine if a direct comparison of unsaturation measures can be made without correction for T₂ losses. 2) Assess intra-individual fat unsaturation and poly-unsaturation measures in the three adipose tissues. 3) Estimate correction factors for olefinic to methylene ratios to compensate for J-coupling and T₂ relaxation losses that take place when increasing PRESS TE from 40 ms to 200 ms (previously optimized long-TE). 4) Investigate the utility of an inversion recovery for resolving the olefinic resonance from water in adipose tissue. PRESS spectra were acquired from the three adipose regions (breast in female only) in healthy volunteers at 3 T. It was found that olefinic and methyl signal decays faster in breast tissue compared to in tibial bone marrow. Poly-unsaturation measures (diallylic/methylene) differ for tibial bone marrow compared to subcutaneous and breast adipose tissue, with average values of 1.7 ± 0.4, 2.2 ± 0.4, and 2.3 ± 0.8%, respectively. PRESS (TE = 40 ms) with an inversion recovery resolves the olefinic and water resonances in breast tissue with a signal to noise ratio approximately six times greater than that using PRESS with a TE of 200 ms. Stimulated Echo Acquisition Mode (STEAM) with a TE of 20 ms (mixing time of 20 ms) was also combined with IR to resolve the olefinic resonance from that of water is spinal bone marrow.

Current and Emerging Magnetic Resonance-Based Techniques for Breast Cancer

Breast cancer is the most commonly diagnosed cancer among women worldwide, and early detection remains a principal factor for improved patient outcomes and reduced mortality. Clinically, magnetic resonance imaging (MRI) techniques are routinely used in determining benign and malignant tumor phenotypes and for monitoring treatment outcomes. Static MRI techniques enable superior structural contrast between adipose and fibroglandular tissues, while dynamic MRI techniques can elucidate functional characteristics of malignant tumors. The preferred clinical procedure-dynamic contrast-enhanced MRI-illuminates the hypervascularity of breast tumors through a gadolinium-based contrast agent; however, accumulation of the potentially toxic contrast agent remains a major limitation of the technique, propelling MRI research toward finding an alternative, noninvasive method. Three such techniques are magnetic resonance spectroscopy, chemical exchange saturation transfer, and non-contrast diffusion weighted imaging. These methods shed light on underlying chemical composition, provide snapshots of tissue metabolism, and more pronouncedly characterize microstructural heterogeneity. This review article outlines the present state of clinical MRI for breast cancer and examines several research techniques that demonstrate capacity for clinical translation. Ultimately, multi-parametric MRI-incorporating one or more of these emerging methods-presently holds the best potential to afford improved specificity and deliver excellent accuracy to clinics for the prediction, detection, and monitoring of breast cancer.

Application of in vivo MR methods in the study of breast cancer metabolism

In the last two decades, various in vivo MR methodologies have been evaluated for their potential in the study of cancer metabolism. During malignant transformation, metabolic alterations occur, leading to morphological and functional changes. Among various MR methods, in vivo MRS has been extensively used in breast cancer to study the metabolism of cells, tissues or whole organs. It provides biochemical information at the metabolite level. Altered choline, phospholipid and energy metabolism has been documented using proton (¹ H), phosphorus (³¹ P) and carbon (¹³ C) isotopes. Increased levels of choline-containing compounds, phosphomonoesters and phosphodiesters in breast cancer, which are indicative of altered choline and phospholipid metabolism, have been reported using in vivo, in vitro and ex vivo NMR studies. These changes are reversed on successful therapy, which depends on the treatment regimen given. Monitoring the various tumor intermediary metabolic pathways using nuclear spin hyperpolarization of ¹³ C-labeled substrates by dynamic nuclear polarization has also been recently reported. Furthermore, the utility of various methods such as diffusion, dynamic contrast and perfusion MRI have also been evaluated to study breast tumor metabolism. Parameters such as tumor volume, apparent diffusion coefficient, volume transfer coefficient and extracellular volume ratio are estimated. These parameters provide information on the changes in tumor microstructure, microenvironment, abnormal vasculature, permeability and grade of the tumor. Such changes seen during cancer progression are due to alterations in the tumor metabolism, leading to changes in cell architecture. Due to architectural changes, the tissue mechanical properties are altered; this can be studied using magnetic resonance elastography, which measures the elastic properties of tissues. Moreover, these structural MRI methods can be used to investigate the effect of therapy-induced changes in tumor characteristics. This review discusses the potential of various in vivo MR methodologies in the study of breast cancer metabolism.

Alteration in lipid composition differentiates breast cancer tissues: a 1H HRMAS NMR metabolomic study

INTRODUCTION

Breast cancer is the most frequent diagnosed cancer among women with a mortality rate of 15% of all cancer related deaths in women. Breast cancer is heterogeneous in nature and produces plethora of metabolites allowing its early detection using molecular diagnostic techniques like magnetic resonance spectroscopy.

OBJECTIVES

To evaluate the variation in metabolic profile of breast cancer focusing on lipids as triglycerides (TG) and free fatty acids (FFA) that may alter in malignant breast tissues and lymph nodes from adjacent benign breast tissues by HRMAS ¹H NMR spectroscopy.

METHODS

The ¹H NMR spectra recorded on 173 tissue specimens comprising of breast tumor tissues, adjacent tissues, few lymph nodes and overlying skin tissues obtained from 67 patients suffering from breast cancer. Multivariate statistical analysis was employed to identify metabolites acting as major confounders for differentiation of malignancy.

RESULT

Reduction in lipid content were observed in malignant breast tissues along with a higher fraction of FFA. Four small molecule metabolites e.g., choline containing compounds (Chocc), taurine, glycine, and glutamate were also identified as major confounders. The test set for prediction provided sensitivity and specificity of more than 90% excluding the lymph nodes and skin tissues.

CONCLUSION

Fatty acids composition in breast cancer using in vivo magnetic resonance spectroscopy (MRS) is gaining its importance in clinical settings (Coum et al. in Magn Reson Mater Phys Biol Med 29:1-4, 2016). The present study may help in future for precise evaluation of lipid classification including small molecules as a source of early diagnosis of invasive ductal carcinoma by employing in vivo magnetic resonance spectroscopic methods.

Proton-decoupled carbon magnetic resonance spectroscopy in human calf muscles at 7 T using a multi-channel radiofrequency coil

¹³C magnetic resonance spectroscopy is a viable, non-invasive method to study cell metabolism in skeletal muscles. However, MR sensitivity of ¹³C is inherently low, which can be overcome by applying a higher static magnetic field strength together with radiofrequency coil arrays instead of single loop coils or large volume coils, and ¹H decoupling, which leads to a simplified spectral pattern. ¹H-decoupled ¹³C-MRS requires RF coils which support both, ¹H and ¹³C, Larmor frequencies with sufficient electromagnetic isolation between the pathways of the two frequencies. We present the development, evaluation, and first in vivo measurement with a 7 T 3-channel ¹³C and 4-channel ¹H transceiver array optimized for ¹H-decoupled ¹³C-MRS in the posterior human calf muscles. To ensure minimal cross-coupling between ¹³C and ¹H arrays, several strategies were combined: mutual magnetic flux was minimized by coil geometry, two LCC traps were inserted into each ¹³C element, and band-pass and low-pass filters were integrated along the signal pathways. The developed coil array was successfully tested in phantom and in vivo MR experiments, showing a simplified spectral pattern and increase in signal-to-noise ratio of approximately a factor 2 between non-decoupled and ¹H-decoupled spectra in a glucose phantom and the human calf muscle.

Magnetic resonance spectroscopy detects differential lipid composition in mammary glands on low fat, high animal fat versus high fructose diets

The effects of consumption of different diets on the fatty acid composition in the mammary glands of SV40 T-antigen (Tag) transgenic mice, a well-established model of human triple-negative breast cancer, were investigated with magnetic resonance spectroscopy and spectroscopic imaging. Female C3(1) SV40 Tag transgenic mice (n = 12) were divided into three groups at 4 weeks of age: low fat diet (LFD), high animal fat diet (HAFD), and high fructose diet (HFruD). MRI scans of mammary glands were acquired with a 9.4 T scanner after 8 weeks on the diet. 1H spectra were acquired using point resolved spectroscopy (PRESS) from two 1 mm3 boxes on each side of inguinal mammary gland with no cancers, lymph nodes, or lymph ducts. High spectral and spatial resolution (HiSS) images were also acquired from nine 1-mm slices. A combination of Gaussian and Lorentzian functions was used to fit the spectra. The percentages of poly-unsaturated fatty acids (PUFA), mono-unsaturated fatty acids (MUFA), and saturated fatty acids (SFA) were calculated from each fitted spectrum. Water and fat peak height images (maps) were generated from HiSS data. The results showed that HAFD mice had significantly lower PUFA than both LFD (p < 0.001) and HFruD (p < 0.01) mice. The mammary lipid quantity calculated from 1H spectra was much larger in HAFD mice than in LFD (p = 0.03) but similar to HFruD mice (p = 0.10). The average fat signal intensity over the mammary glands calculated from HiSS fat maps was ~60% higher in HAFD mice than in LFD (p = 0.04) mice. The mean or median of calculated parameters for the HFruD mice were between those for LFD and HAFD mice. Therefore, PRESS spectroscopy and HiSS MRI demonstrated water and fat composition changes in mammary glands due to a Western diet, which was low in potassium, high in sodium, animal fat, and simple carbohydrates. Measurements of PUFA with MRI could be used to evaluate cancer risk, improve cancer detection and diagnosis, and guide preventative therapy.

Breast Tissue Metabolism by Magnetic Resonance Spectroscopy

Metabolic alterations are known to occur with oncogenesis and tumor progression. During malignant transformation, the metabolism of cells and tissues is altered. Cancer metabolism can be studied using advanced technologies that detect both metabolites and metabolic activities. Identification, characterization, and quantification of metabolites (metabolomics) are important for metabolic analysis and are usually done by nuclear magnetic resonance (NMR) or by mass spectrometry. In contrast to the magnetic resonance imaging that is used to monitor the tumor morphology during progression of the disease and during therapy, in vivo NMR spectroscopy is used to study and monitor tumor metabolism of cells/tissues by detection of various biochemicals or metabolites involved in various metabolic pathways. Several in vivo, in vitro and ex vivo NMR studies using ¹H and ³¹P magnetic resonance spectroscopy (MRS) nuclei have documented increased levels of total choline containing compounds, phosphomonoesters and phosphodiesters in human breast cancer tissues, which is indicative of altered choline and phospholipid metabolism. These levels get reversed with successful treatment. Another method that increases the sensitivity of substrate detection by using nuclear spin hyperpolarization of ¹³C-lableled substrates by dynamic nuclear polarization has revived a great interest in the study of cancer metabolism. This review discusses breast tissue metabolism studied by various NMR/MRS methods.

High-sensitivity, broadband-decoupled (13) C MR spectroscopy in humans at 7T using two-dimensional heteronuclear single-quantum coherence

PURPOSE

Carbon-13 ((13) C) magnetic resonance spectroscopy (MRS) has an intrinsically low NMR sensitivity that often leads to large acquisition volumes or long scan times. While the use of higher magnetic fields can overcome the sensitivity limitations, high radiofrequency (RF) power deposition associated with proton-decoupling limits the achievable gain. Two-dimensional (2D) heteronuclear single quantum coherence (HSQC) MRS is a method that uses the high chemical specificity of (13) C MRS while retaining the high sensitivity of (1) H detection. Due to the 2D nature of the method, proton-decoupled (13) C MR spectra can be obtained without the use of high-powered decoupling pulses.

METHODS

A novel three-dimensional (3D) localized 2D HSQC method based on 3D STEAM localization is presented and implemented at 7T. The low RF power deposition of the method allows TR variation along the indirect dimension which, in combination with controlled aliasing, leads to an acceleration of 11.8 relative to a standard 2D NMR acquisition.

RESULTS

Artifact-free, high-quality and high-sensitivity 2D HSQC spectra were obtained for all subjects in 19 min from a small (9 mL) volume placed in the leg adipose tissue. Complete proton decoupling was achieved along the indirect (13) C dimension despite the absence of broadband proton-decoupling pulses. The high chemical specificity along the indirect (13) C dimension allowed the detection of 19 unique resonances from which the lipids could be characterized in terms of saturation and omega-6/omega-3 fatty acid ratio.

CONCLUSION

It has been demonstrated that high-quality 2D HSQC NMR spectra can be acquired from human adipose tissue at 7T. The HSQC method is methodologically simple and robust and is flexible regarding trade-offs between temporal and spectral resolution. 2D HSQC has a strong potential to become a default method in natural-abundance or (13) C-enriched studies of human metabolism in vivo.