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Harmsen MJ, Trommelen LM, de Leeuw RA, Tellum T, Juffermans LJM, Griffioen AW, Thomassin-Naggara I, Van den Bosch T, Huirne JAF. Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022. [PMID: 36370446 DOI: 10.1002/uog.26117] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 06/02/2023]
Abstract
The uterine junctional zone is the subendometrial area in the myometrium that contributes to peristalsis and aids in spermatozoa and blastocyst transport. Alterations in the appearance of the junctional zone on transvaginal sonography (TVS) or magnetic resonance imaging (MRI) are associated with adenomyosis. The lack of standardization of description of its appearance and ill-defined boundaries on both histology and imaging hamper understanding of the junctional zone and limit its role in the diagnosis of adenomyosis. The objectives of this review were to investigate the accordance in definition of the junctional zone across different diagnostic approaches and to examine how imaging findings can be linked to histological findings in the context of diagnosis of adenomyosis. A comprehensive literature review was conducted of articles describing the appearance on imaging and the histological structure of the uterine junctional zone. Our review suggests that the junctional zone is distinguished from the middle and outer myometrium by gradual changes in smooth-muscle cell density, extracellular space, connective tissue, water content and vascular properties. However, while the signal intensity from the junctional zone to the middle myometrium changes abruptly on MRI, the histopathological changes are gradual and its border may be difficult or impossible to distinguish on two-dimensional TVS. Moreover, the thickness of the junctional zone measured on MRI is larger than that measured on TVS. Thus, these two imaging modalities reflect this zone differently. Although a thickened junctional zone is often used to diagnose adenomyosis on MRI, the presence of adenomyosis can be described more accurately as interruptions of the junctional zone by endometrial tissue, which leads to direct signs on imaging such as subendometrial lines and buds on two- and three-dimensional TVS or bright foci on MRI. The histopathological criteria for diagnosis are based on enlargement of the uterus with severe adenomyosis, and might not reflect its early stages. Clinicians should be aware that findings on MRI cannot be extrapolated readily to ultrasound. An understanding of this is necessary when investigating the uterine junctional zone as a functional unit and the association between visualization of direct features of adenomyosis in the junctional zone and clinical symptoms. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M J Harmsen
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - L M Trommelen
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - R A de Leeuw
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - T Tellum
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - L J M Juffermans
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - A W Griffioen
- Angiogenesis Laboratory, Department of Medical Oncology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Thomassin-Naggara
- Department of Diagnostic and Interventional Imaging (IRIS), Sorbonne Université, Assistance Publique Hopitaux de Paris, Paris, France
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - J A F Huirne
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Wang X, Li S, Lin X, Lu Y, Mao C, Ye Z, Li X, Koh TS, Liu J, Liu J, Ma X, Cheng J, Ning G, Yan Z, Hou Z. Evaluation of tracer kinetic parameters in cervical cancer using dynamic contrast-enhanced MRI as biomarkers in terms of biological relevance, diagnostic performance and inter-center variability. Front Oncol 2022; 12:958219. [PMID: 36324571 PMCID: PMC9620719 DOI: 10.3389/fonc.2022.958219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives This study assessed the clinical value of parameters derived from dynamic contrast-enhanced (DCE) MRI with respect to correlation with angiogenesis and proliferation of cervical cancer, performance of diagnosis and reproducibility of DCE-MRI parameters across MRI scanners. Materials and Methods A total of 113 patients with cervical carcinoma from two centers were included in this retrospective study. The DCE data were centralized and processed using five tracer kinetic models (TKMs) (Tofts, Ex-Tofts, ATH, SC, and DP), yielding the following parameters: volume transfer constant (Ktrans), extravascular extracellular volume (Ve), fractional volume of vascular space (Vp), blood flow (Fp), and permeability surface area product (PS). CD34 counts and Ki-67 PI (proliferation index) of cervical cancer and normal cervix tissue were obtained using immunohistochemical staining in Center 1. Results CD34 count and Ki-67 PI in cervical cancer were significantly higher than in normal cervix tissue (p<0.05). Parameter Ve from each TKM was significantly smaller in cervical cancer tissue than in normal cervix tissue (p<0.05), indicating the higher proliferation of cervical cancer cells. Ve of each TKM attained the largest AUC to diagnose cervical cancer. The distributions of DCE parameters for both cervical cancer and normal cervix tissue were not significantly different between two centers (P>0.05). Conclusion Parameter Ve was similar to the expression of Ki-67 in revealing the proliferation of tissue cells, attained good performance in diagnosis of cervical cancer, and demonstrated consistent findings on measured values across centers.
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Affiliation(s)
- Xue Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shujian Li
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianhui Lin
- Department of Pathology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Lu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chuanwan Mao
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhijun Ye
- Department of Radiology, The Second Affiliated Hospital of Sichuan University, Chengdu, China
| | - Xuesheng Li
- Department of Radiology, The Second Affiliated Hospital of Sichuan University, Chengdu, China
| | - Tong-San Koh
- Department of Oncologic Imaging, National Cancer Center, Singapore, Singapore
- The department of Jiangsu Key Laboratory of Medical Optics, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Jie Liu
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingjing Liu
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyue Ma
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Ning
- Department of Radiology, The Second Affiliated Hospital of Sichuan University, Chengdu, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zujun Hou
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- *Correspondence: Zujun Hou,
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Angelopoulos K, Palmér M, Gull B, Lundqvist N, Kopelia L, Hellström M, Leonhardt H. Computed tomography contrast enhancement pattern of the uterus in premenopausal women in relation to menstrual cycle and hormonal contraception. Acta Radiol 2021; 62:1257-1262. [PMID: 32927957 PMCID: PMC8392783 DOI: 10.1177/0284185120958404] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are different types of computed tomography (CT) contrast enhancement patterns of the uterus. It is not known whether these are hormonally dependent. PURPOSE To assess the relationship between these patterns and the menstrual cycle in non-users of hormonal contraception, and the possible impact of hormonal contraception. MATERIAL AND METHODS Prospective observational study of abdominal CT scans of 53 premenopausal women of whom 28 were non-users and 25 users of hormonal contraception. The non-users were divided according to menstrual cycle phase: follicular (n = 12); ovulatory (n = 1); and luteal (n = 12). The pattern and intensity of contrast enhancement of the uterine myometrium were assessed. RESULTS The dominant pattern of contrast enhancement of the myometrium was the diffuse homogeneous type in both non-users and users. The intensity of the enhancement measured in Hounsfield units (HU) was higher in the follicular phase (median 102, range 73-130) compared to the luteal phase in non-users (median 92, range 57-130); however this was not statistically significant (P = 0.2). The HU values observed in users (median 95, range 45-160) were at the same levels compared to those of the luteal phase in non-users. CONCLUSION The dominant pattern of contrast enhancement in the portal venous phase of the myometrium in fertile ages is the diffuse homogeneous type and is independent of menstrual cycle phase or the use of hormonal contraception. However, these factors seem to play a role in the intensity of contrast enhancement, with a tendency of higher HU values in the follicular phase of non-users.
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Affiliation(s)
| | - Magnus Palmér
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Berit Gull
- Department of Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Lundqvist
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Kopelia
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mikael Hellström
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Henrik Leonhardt
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Julie L, Ikram D, Mailyn PL, Augustin L, Afef B, Joevin S, Bentoumi I, Cuenod CA, Daniel B. A free time point model for dynamic contrast enhanced exploration. Magn Reson Imaging 2021; 80:39-49. [PMID: 33905829 DOI: 10.1016/j.mri.2021.04.005] [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: 01/20/2021] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
Dynamic-Contrast-Enhanced (DCE) Imaging has been widely studied to characterize microcirculatory disorders associated with various diseases. Although numerous studies have demonstrated its diagnostic interest, the physiological interpretation using pharmacokinetic models often remains debatable. Indeed, to be interpretable, a model must provide, at first instance, an accurate description of the DCE data. However, the evaluation and optimization of this accuracy remain rather limited in DCE. Here we established a non-linear Free-Time-Point-Hermite (FTPH) data-description model designed to fit DCE data accurately. Its performance was evaluated on data generated using two contrasting pharmacokinetic microcirculatory hypotheses (MH). The accuracy of data description of the models was evaluated by calculating the mean squared error (QE) from initial and assessed tissue impulse responses. Then, FTPH assessments were provided to blinded observers to evaluate if these assessments allowed observers to identify MH in their data. Regardless of the initial pharmacokinetic model used for data generation, QE was lower than 3% for the noise-free datasets and increased up to 10% for a signal-to-noise-ratio (SNR) of 20. Under SNR = 20, the sensitivity and specificity of the MH identification were over 80%. The performance of the FTPH model was higher than that of the B-Spline model used as a reference. The accuracy of the FTPH model regardless of the initial MH provided an opportunity to have a reference to check the accuracy of other pharmacokinetic models.
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Affiliation(s)
- Levebvre Julie
- Université de Paris, PARCC, INSERM, Paris F-75015, France
| | - Djebali Ikram
- Université de Paris, PARCC, INSERM, Paris F-75015, France
| | | | | | | | - Sourdon Joevin
- Université de Paris, PARCC, INSERM, Paris F-75015, France.
| | - Isma Bentoumi
- Université de Paris, PARCC, INSERM, Paris F-75015, France
| | - Charles-André Cuenod
- Université de Paris, PARCC, INSERM, Paris F-75015, France; Service Radiologie, AP-HP, Hôpital Européen Georges Pompidou, F-75015, France.
| | - Balvay Daniel
- Université de Paris, PARCC, INSERM, Paris F-75015, France; Université de Paris, Plateforme d'Imageries du Vivant, F-75015, France.
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5
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A Comparative Study of Two-Compartment Exchange Models for Dynamic Contrast-Enhanced MRI in Characterizing Uterine Cervical Carcinoma. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:3168416. [PMID: 31897081 PMCID: PMC6925719 DOI: 10.1155/2019/3168416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
A variety of tracer kinetic methods have been employed to assess tumor angiogenesis. The Standard two-Compartment model (SC) used in cervix carcinoma was less frequent, and Adiabatic Approximation to the Tissue Homogeneity (AATH) and Distributed Parameter (DP) model are lacking. This study compares two-compartment exchange models (2CXM) (AATH, SC, and DP) for determining dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters in cervical cancer, with the aim of investigating the potential of various parameters derived from 2CXM for tumor diagnosis and exploring the possible relationship between these parameters in patients with cervix cancer. Parameters (tissue blood flow, Fp; tissue blood volume, Vp; interstitial volume, Ve; and vascular permeability, PS) for regions of interest (ROI) of cervix lesions and normal cervix tissue were estimated by AATH, SC, and DP models in 36 patients with cervix cancer and 17 healthy subjects. All parameters showed significant differences between lesions and normal tissue with a P value less than 0.05, except for PS from the AATH model, Fp from the SC model, and Vp from the DP model. Parameter Ve from the AATH model had the largest AUC (r = 0.85). Parameters Fp and Vp from SC and DP models and Ve and PS from AATH and DP models were highly correlated, respectively, (r > 0.8) in cervix lesions. Cervix cancer was found to have a very unusual microcirculation pattern, with over-growth of cancer cells but without evident development of angiogenesis. Ve has the best performance in identifying cervix cancer. Most physiological parameters derived from AATH, SC, and DP models are linearly correlated in cervix cancer.
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6
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Brix G, Salehi Ravesh M, Griebel J. Two-compartment modeling of tissue microcirculation revisited. Med Phys 2017; 44:1809-1822. [DOI: 10.1002/mp.12196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Gunnar Brix
- Department of Medical Radiation Protection; Federal Office for Radiation Protection; Ingolstädter Landstraße 1 D-85764 Oberschleissheim Germany
| | - Mona Salehi Ravesh
- Department of Congenital Heart Disease and Pediatric Cardiology; University Hospital Schleswig-Holstein; Arnold-Heller-Straße 3 D-24105 Kiel Germany
| | - Jürgen Griebel
- Department of Medical Radiation Protection; Federal Office for Radiation Protection; Ingolstädter Landstraße 1 D-85764 Oberschleissheim Germany
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Meylaerts LJ, Wijnen L, Bazot M, Grieten M, Ombelet W, Vandersteen M. Perfusion of the uterine junctional zone in nulliparous and primiparous women assessed by DCE-MRI, as a function of menstrual cycle and hormonal contraception. Magn Reson Imaging 2017; 38:101-111. [PMID: 28065695 DOI: 10.1016/j.mri.2016.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the perfusion parameters of inner and outer myometrium in healthy nulliparous and primiparous women who are and who are not currently using hormonal contraceptives by means of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIAL AND METHODS We performed pelvic 1.5T DCE-MRI on 98 women: 18 nulliparous non-users, 30 nulliparous users, 12 primiparous non-users and 38 primiparous users of hormonal contraception (mean age respectively 26.4, 25.8, 30.23 and 28.18years). The nulliparous non-users underwent DCE-MRI investigations during their follicular, ovulatory and luteal phase. Perfusion parameters (iAUC/volume, Ktrans, Kep and Ve) were assessed in the anterior and posterior junctional zone (JZ), outer myometrium and cervix. RESULTS In nulliparous non-users, the mean Ktrans and iAUC/volume showed a decrease from follicular to luteal phase (0.82 vs 0.55min-1 for Ktrans, p=0/027 and 1.28 vs 0.68 for iAUC/volume, p<0.001). The anterior JZ demonstrated lower Ktrans (p=0.050) and higher Kep (p=0.012), in nulliparous non-users, lower Ktrans in nulliparous users (p<0.001) and lower Ve in primiparous users (p=0.012) than the anterior outer myometrium. Ktrans at the anterior and posterior JZ wall in nulliparous users was lower than in non-users (p=0.001 and p=0.013) and Ve at the anterior JZ wall in primiparous users was lower than in non-users (p=0.044). CONCLUSION This study provides data on normal perfusion parameters of inner and outer myometrium, which may be potentially useful in assisted reproductive therapy.
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Affiliation(s)
- L J Meylaerts
- Department of Medical Imaging, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - L Wijnen
- Department of Medical Imaging, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Biomedicine at Hasselt University, Diepenbeek, Belgium
| | - M Bazot
- Department of Radiology, Hôpital Tenon, Paris, France
| | - M Grieten
- Department of Medical Imaging, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - W Ombelet
- Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - M Vandersteen
- Faculty of Medicine and Biomedicine at Hasselt University, Diepenbeek, Belgium
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8
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Rocha TGR, Lopes SCDA, Cassali GD, Ferreira Ê, Veloso ES, Leite EA, Braga FC, Ferreira LAM, Balvay D, Garofalakis A, Oliveira MC, Tavitian B. Evaluation of Antitumor Activity of Long-Circulating and pH-Sensitive Liposomes Containing Ursolic Acid in Animal Models of Breast Tumor and Gliosarcoma. Integr Cancer Ther 2016; 15:512-524. [PMID: 27130721 PMCID: PMC5739155 DOI: 10.1177/1534735416628273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/01/2015] [Accepted: 12/11/2015] [Indexed: 01/05/2023] Open
Abstract
Background Ursolic acid (UA) is a triterpene found in different plant species, possessing antitumor activity, which may be a result of its antiangiogenic effect. However, UA has low water solubility, which limits its use because the bioavailability is impaired. To overcome this inconvenience, we developed long-circulating and pH-sensitive liposomes containing ursolic acid (SpHL-UA). We investigated the antiangiogenic effect of free UA and SpHL-UA in murine brain cancer and human breast tumor models by means of determination of the relative tumor volume, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and histopathological analysis. Methods The animals were treated with dimethyl sulfoxide in 0.9% (w/v) NaCl, free UA, long-circulating and pH-sensitive liposomes without drug (SpHL), or SpHL-UA. The animals were submitted to each treatment by intraperitoneal injection for 5 days. The dose of free UA or SpHL-UA was equal to 23 mg/kg. Results Tumor growth inhibition was not observed in human breast tumor-bearing animals. For murine gliosarcoma-bearing animals, a slight tumor growth inhibition was observed in the groups treated with free UA or SpHL-UA (9% and 15%, respectively). No significant change in any of the parameters evaluated by DCE-MRI for both experimental models could be observed. Nevertheless, the evaluation of the mean values of magnetic resonance parameters of human breast tumor-bearing animals showed evidence of a possible antiangiogenic effect induced by SpHL-UA. Histopathological analysis did not present significant change for any treatment. Conclusion SpHL-UA did not show antiangiogenic activity in a gliosarcoma model and seemed to induce an antiangiogenic effect in the human breast tumor model.
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Affiliation(s)
| | | | | | - Ênio Ferreira
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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9
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Copen WA, Lev MH, Rapalino O. Brain perfusion: computed tomography and magnetic resonance techniques. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:117-135. [PMID: 27432662 DOI: 10.1016/b978-0-444-53485-9.00006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebral perfusion imaging provides assessment of regional microvascular hemodynamics in the living brain, enabling in vivo measurement of a variety of different hemodynamic parameters. Perfusion imaging techniques that are used in the clinical setting usually rely upon X-ray computed tomography (CT) or magnetic resonance imaging (MRI). This chapter reviews CT- and MRI-based perfusion imaging techniques, with attention to image acquisition, clinically relevant aspects of image postprocessing, and fundamental differences between CT- and MRI-based techniques. Correlations with cerebrovascular physiology and potential clinical applications of perfusion imaging are reviewed, focusing upon the two major classes of neurologic disease in which perfusion imaging is most often performed: primary perfusion disorders (including ischemic stroke, transient ischemic attack, and reperfusion syndrome), and brain tumors.
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Affiliation(s)
- William A Copen
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Michael H Lev
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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10
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Khalifa F, Soliman A, El-Baz A, Abou El-Ghar M, El-Diasty T, Gimel'farb G, Ouseph R, Dwyer AC. Models and methods for analyzing DCE-MRI: a review. Med Phys 2015; 41:124301. [PMID: 25471985 DOI: 10.1118/1.4898202] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To present a review of most commonly used techniques to analyze dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), discusses their strengths and weaknesses, and outlines recent clinical applications of findings from these approaches. METHODS DCE-MRI allows for noninvasive quantitative analysis of contrast agent (CA) transient in soft tissues. Thus, it is an important and well-established tool to reveal microvasculature and perfusion in various clinical applications. In the last three decades, a host of nonparametric and parametric models and methods have been developed in order to quantify the CA's perfusion into tissue and estimate perfusion-related parameters (indexes) from signal- or concentration-time curves. These indexes are widely used in various clinical applications for the detection, characterization, and therapy monitoring of different diseases. RESULTS Promising theoretical findings and experimental results for the reviewed models and techniques in a variety of clinical applications suggest that DCE-MRI is a clinically relevant imaging modality, which can be used for early diagnosis of different diseases, such as breast and prostate cancer, renal rejection, and liver tumors. CONCLUSIONS Both nonparametric and parametric approaches for DCE-MRI analysis possess the ability to quantify tissue perfusion.
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Affiliation(s)
- Fahmi Khalifa
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292 and Electronics and Communication Engineering Department, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Soliman
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292
| | - Ayman El-Baz
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292
| | - Mohamed Abou El-Ghar
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Tarek El-Diasty
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Georgy Gimel'farb
- Department of Computer Science, University of Auckland, Auckland 1142, New Zealand
| | - Rosemary Ouseph
- Kidney Transplantation-Kidney Disease Center, University of Louisville, Louisville, Kentucky 40202
| | - Amy C Dwyer
- Kidney Transplantation-Kidney Disease Center, University of Louisville, Louisville, Kentucky 40202
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11
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Added Value of Assessing Adnexal Masses with Advanced MRI Techniques. BIOMED RESEARCH INTERNATIONAL 2015; 2015:785206. [PMID: 26413542 PMCID: PMC4564594 DOI: 10.1155/2015/785206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/23/2014] [Accepted: 12/07/2014] [Indexed: 12/16/2022]
Abstract
This review will present the added value of perfusion and diffusion MR sequences to characterize adnexal masses. These two functional MR techniques are readily available in routine clinical practice. We will describe the acquisition parameters and a method of analysis to optimize their added value compared with conventional images. We will then propose a model of interpretation that combines the anatomical and morphological information from conventional MRI sequences with the functional information provided by perfusion and diffusion weighted sequences.
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12
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Rukat T, Walker-Samuel S, Reinsberg SA. Dynamic contrast-enhanced MRI in mice: an investigation of model parameter uncertainties. Magn Reson Med 2015; 73:1979-87. [PMID: 25052296 DOI: 10.1002/mrm.25319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/13/2014] [Accepted: 05/23/2014] [Indexed: 11/08/2022]
Abstract
PURPOSE To establish the experimental factors that dominate the uncertainty of hemodynamic parameters in commonly used pharmacokinetic models. METHODS By fitting simulation results from a multiregion tissue exchange model (Multiple path, Multiple tracer, Indicator Dilution, 4 region), the precision and accuracy of hemodynamic parameters in dynamic contrast-enhanced MRI with four tracer kinetic models is investigated. The impact of various injection rates as well as imprecise knowledge of the arterial input functions is examined. RESULTS Fast injections are beneficial for K(trans) precision within the extended Tofts model and within the two-compartment exchange model but do not affect the other models under investigation. Biases from errors in the arterial input functions are mostly consistent in size and direction for the simple and the extended Tofts model, while they are hardly predictable for the other models. Errors in the hematocrit introduce the greatest loss in parameter accuracy, amounting to an average K(trans) bias of 40% for a 30% overestimation throughout all models. CONCLUSION This simulation study allows the detailed inspection of the isolated impact from various experimental conditions on parameter uncertainty. Because parameter uncertainty comparable to human studies was found, this study represents a validation of preclinical dynamic contrast-enhanced MRI for modeling human tumor physiology.
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Affiliation(s)
- Tammo Rukat
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada; Department of Physics, Humboldt University, Berlin, Germany
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Budzik JF, Lefebvre G, Forzy G, El Rafei M, Chechin D, Cotten A. Study of proximal femoral bone perfusion with 3D T1 dynamic contrast-enhanced MRI: a feasibility study. Eur Radiol 2014; 24:3217-23. [PMID: 25120203 DOI: 10.1007/s00330-014-3340-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/28/2014] [Accepted: 07/10/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this study was to compare measurements of semi-quantitative and pharmacokinetic parameters in areas of red (RBM) and yellow bone marrow (YBM) of the hip, using an in-house high-resolution DCE T1 sequence, and to assess intra- and inter-observer reproducibility of these measurements. METHODS The right hips of 21 adult patients under 50 years of age were studied. Spatial resolution was 1.8 × 1.8 × 1.8 mm(3), and temporal resolution was 13.5 seconds. Two musculoskeletal radiologists independently processed DCE images and measured semi-quantitative and pharmacokinetic parameters in areas of YBM and RBM. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Intra- and inter-observer reproducibility was assessed. RESULTS Area under the curve (AUC) and initial slope (IS) were significantly greater for RBM than for YBM (p < 0.05). K(trans) and kep were also significantly greater for RBM (p < 0.05). There was no significant difference in time to peak between the regions (p < 0.05). SNR, CNR, and intra- and inter-observer reproducibility were all good. CONCLUSIONS DCE study of the whole hip is feasible with high spatial resolution using a 3D T1 sequence. Measures were possible even in low vascularized areas of the femoral head. K(trans), kep, AUC, and IS values were significantly different between red and yellow marrow, whereas TTP values were not. KEY POINTS High-spatial-resolution dynamic contrast-enhanced MRI of hip structures is feasible. Intra- and inter-observer reproducibility is good. Red and yellow bone marrow have different perfusion patterns.
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Affiliation(s)
- Jean-François Budzik
- Service d'Imagerie Médicale, Groupe Hospitalier de l'Institut Catholique de Lille / Faculté Libre de Médecine, 59000, Lille, France,
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Thomassin-Naggara I, Siles P, Balvay D, Cuenod C, Carette M, Bazot M. MR perfusion for pelvic female imaging. Diagn Interv Imaging 2013; 94:1291-8. [DOI: 10.1016/j.diii.2013.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Cuenod C, Balvay D. Perfusion and vascular permeability: Basic concepts and measurement in DCE-CT and DCE-MRI. Diagn Interv Imaging 2013; 94:1187-204. [DOI: 10.1016/j.diii.2013.10.010] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Sourbron SP, Buckley DL. Classic models for dynamic contrast-enhanced MRI. NMR IN BIOMEDICINE 2013; 26:1004-1027. [PMID: 23674304 DOI: 10.1002/nbm.2940] [Citation(s) in RCA: 274] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 06/02/2023]
Abstract
Dynamic contrast-enhanced MRI (DCE-MRI) is a functional MRI method where T1 -weighted MR images are acquired dynamically after bolus injection of a contrast agent. The data can be interpreted in terms of physiological tissue characteristics by applying the principles of tracer-kinetic modelling. In the brain, DCE-MRI enables measurement of cerebral blood flow (CBF), cerebral blood volume (CBV), blood-brain barrier (BBB) permeability-surface area product (PS) and the volume of the interstitium (ve ). These parameters can be combined to form others such as the volume-transfer constant K(trans) , the extraction fraction E and the contrast-agent mean transit times through the intra- and extravascular spaces. A first generation of tracer-kinetic models for DCE-MRI was developed in the early 1990s and has become a standard in many applications. Subsequent improvements in DCE-MRI data quality have driven the development of a second generation of more complex models. They are increasingly used, but it is not always clear how they relate to the models of the first generation or to the model-free deconvolution methods for tissues with intact BBB. This lack of understanding is leading to increasing confusion on when to use which model and how to interpret the parameters. The purpose of this review is to clarify the relation between models of the first and second generations and between model-based and model-free methods. All quantities are defined using a generic terminology to ensure the widest possible scope and to reveal the link between applications in the brain and in other organs.
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Ledsam JR, Hodgson R, Moots RJ, Sourbron SP. Modeling DCE-MRI at low temporal resolution: a case study on rheumatoid arthritis. J Magn Reson Imaging 2013; 38:1554-63. [PMID: 23857776 DOI: 10.1002/jmri.24061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 01/10/2013] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To identify the optimal tracer-kinetic modeling strategy for dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data acquired at low temporal resolution. MATERIALS AND METHODS DCE-MRI was performed on 13 patients with rheumatoid arthritis of the hand before and after anti-tumor necrosis factor alpha (TNFα) therapy, using a 3D sequence with a temporal resolution of 13 seconds, imaging for 4 minutes postcontrast injection. Concentration-time curves were extracted from regions of interest (ROIs) in enhancing synovium and fitted to the 3-parameter modified Tofts model (MT) and the 4-parameter two-compartment exchange model (2CXM). To assist the interpretation of the data, the same analysis was applied to simulated data with similar characteristics. RESULTS Both models fitted the data closely, and showed similar therapy effects. The MT plasma volume was significantly lower than with 2CXM, but the differences in permeability and interstitial volume were not significant. 2CXM was less precise than MT, with larger standard deviations relative to the mean in most parameters. The additional perfusion parameter determined with 2CXM did not provide a statistically significant trend due to low precision. CONCLUSION The standard MT model is the optimal modeling strategy at low temporal resolution. Advanced models improve the accuracy and generate an additional parameter, but these benefits are offset by low precision.
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Brandão AC, Silva AO. Diseases of the female pelvis: advances in imaging evaluation. Magn Reson Imaging Clin N Am 2013; 21:447-69. [PMID: 23642562 DOI: 10.1016/j.mric.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Magnetic resonance (MR) imaging has been widely accepted as a powerful imaging modality for the evaluation of the pelvis because of its intrinsic superior soft tissue contrast compared with that of computed tomography. In certain cases, however, the morphologic study provided by MR imaging may not be enough. Functional evaluation with perfusion and diffusion, which allow estimation of the microvascular characteristics and cellularity of the lesions, favors the differentiation of benign from malignant lesions. This article focuses on new magnetic resonance techniques and their contribution to the differentiation and characterization of pelvic pathologies.
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Mohaghegh P, Rockall AG. Imaging strategy for early ovarian cancer: characterization of adnexal masses with conventional and advanced imaging techniques. Radiographics 2013; 32:1751-73. [PMID: 23065168 DOI: 10.1148/rg.326125520] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Early detection of ovarian cancer remains crucial for improving patient survival rates. However, early-stage disease is often asymptomatic, and population screening is currently unproven. Adnexal masses may be incidentally detected, but most are identified at ultrasonography (US) in patients who are symptomatic, and most may be characterized as benign or malignant. Indices are available to estimate the risk of malignancy on the basis of clinical and US findings. However, adnexal masses remain indeterminate in some cases, with some benign lesions demonstrating features of malignancy at US. In these cases, use of magnetic resonance (MR) imaging improves the ability to characterize adnexal masses and reduces the number of indeterminate lesions. Establishing the likelihood of malignancy on the basis of imaging features is important to the preoperative detection of early ovarian cancer and profoundly influences referral and management pathways. Conventional and contrast material-enhanced MR imaging are used to evaluate morphologic features, including lesion complexity, signal intensity, and enhancement of solid areas. At dynamic contrast-enhanced MR imaging with semiquantitative analysis, early enhancement characteristics may help differentiate some complex benign and malignant lesions. Diffusion-weighted imaging has a limited but useful role in evaluating adnexal masses: Those with a hypointense solid area on both diffusion-weighted (b = 1000 sec/mm²) and T2-weighted images are likely benign, whereas those that are hyperintense on diffusion-weighted images (b = 1000 sec/mm²) with intermediate signal intensity on T2-weighted images are likely malignant.
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Affiliation(s)
- Pegah Mohaghegh
- Imaging Department, Bart's Cancer Centre, King George V Wing, St Bartholomew's Hospital, Room 6, Ground Floor, West Smithfield, London EC1A 7BE, England
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Daido S, Nakai A, Kido A, Okada T, Kamae T, Fujimoto K, Ito I, Togashi K. Anticholinergic agents result in weaker and shorter suppression of uterine contractility compared with intestinal motion: time course observation with cine MRI. J Magn Reson Imaging 2013; 38:1196-202. [DOI: 10.1002/jmri.24072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 01/14/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sayaka Daido
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Asako Nakai
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tomohisa Okada
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Toshikazu Kamae
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Koji Fujimoto
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Isao Ito
- Department of Respiratory Medicine; Kyoto University Hospital; Kyoto Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
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Brosens I, Pijnenborg R, Benagiano G. Defective myometrial spiral artery remodelling as a cause of major obstetrical syndromes in endometriosis and adenomyosis. Placenta 2013; 34:100-5. [DOI: 10.1016/j.placenta.2012.11.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/17/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022]
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Sourbron SP, Buckley DL. Tracer kinetic modelling in MRI: estimating perfusion and capillary permeability. Phys Med Biol 2011; 57:R1-33. [PMID: 22173205 DOI: 10.1088/0031-9155/57/2/r1] [Citation(s) in RCA: 244] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The tracer-kinetic models developed in the early 1990s for dynamic contrast-enhanced MRI (DCE-MRI) have since become a standard in numerous applications. At the same time, the development of MRI hardware has led to increases in image quality and temporal resolution that reveal the limitations of the early models. This in turn has stimulated an interest in the development and application of a second generation of modelling approaches. They are designed to overcome these limitations and produce additional and more accurate information on tissue status. In particular, models of the second generation enable separate estimates of perfusion and capillary permeability rather than a single parameter K(trans) that represents a combination of the two. A variety of such models has been proposed in the literature, and development in the field has been constrained by a lack of transparency regarding terminology, notations and physiological assumptions. In this review, we provide an overview of these models in a manner that is both physically intuitive and mathematically rigourous. All are derived from common first principles, using concepts and notations from general tracer-kinetic theory. Explicit links to their historical origins are included to allow for a transfer of experience obtained in other fields (PET, SPECT, CT). A classification is presented that reveals the links between all models, and with the models of the first generation. Detailed formulae for all solutions are provided to facilitate implementation. Our aim is to encourage the application of these tools to DCE-MRI by offering researchers a clearer understanding of their assumptions and requirements.
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Affiliation(s)
- S P Sourbron
- Division of Medical Physics, University of Leeds, Leeds, West Yorkshire, UK
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Quantitative dynamic contrast-enhanced MR imaging analysis of complex adnexal masses: a preliminary study. Eur Radiol 2011; 22:738-45. [DOI: 10.1007/s00330-011-2329-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/04/2011] [Accepted: 09/20/2011] [Indexed: 11/25/2022]
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Cuenod CA, Favetto B, Genon-Catalot V, Rozenholc Y, Samson A. Parameter estimation and change-point detection from Dynamic Contrast Enhanced MRI data using stochastic differential equations. Math Biosci 2011; 233:68-76. [DOI: 10.1016/j.mbs.2011.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/15/2011] [Accepted: 06/20/2011] [Indexed: 10/18/2022]
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Sourbron S. Technical aspects of MR perfusion. Eur J Radiol 2010; 76:304-13. [PMID: 20363574 DOI: 10.1016/j.ejrad.2010.02.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 02/23/2010] [Indexed: 12/15/2022]
Abstract
The most common methods for measuring perfusion with MRI are arterial spin labelling (ASL), dynamic susceptibility contrast (DSC-MRI), and T(1)-weighted dynamic contrast enhancement (DCE-MRI). This review focuses on the latter approach, which is by far the most common in the body and produces measures of capillary permeability as well. The aim is to present a concise but complete overview of the technical issues involved in DCE-MRI data acquisition and analysis. For details the reader is referred to the references. The presentation of the topic is essentially generic and focuses on technical aspects that are common to all DCE-MRI measurements. For organ-specific problems and illustrations, we refer to the other papers in this issue. In Section 1 "Theory" the basic quantities are defined, and the physical mechanisms are presented that provide a relation between the hemodynamic parameters and the DCE-MRI signal. Section 2 "Data acquisition" discusses the issues involved in the design of an optimal measurement protocol. Section 3 "Data analysis" summarizes the steps that need to be taken to determine the hemodynamic parameters from the measured data.
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Affiliation(s)
- Steven Sourbron
- Division of Medical Physics, University of Leeds, Worsley Building, Clarendon Way, LS2 9JT Leeds, UK.
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Bazot M, Lafont C, Roussel A, Jarboui L, Nassar-Slaba J, Thomassin-Naggara I. Caractérisation tissulaire IRM du pelvis féminin. ACTA ACUST UNITED AC 2010; 91:453-64. [DOI: 10.1016/s0221-0363(10)70060-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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