The magnetization transfer characteristics of human breast tissues: an in vitro NMR study

Magnetization Transfer MRI of Breast Cancer in the Community Setting: Reproducibility and Preliminary Results in Neoadjuvant Therapy

Repeatability and reproducibility of magnetization transfer magnetic resonance imaging of the breast, and the ability of this technique to assess the response of locally advanced breast cancer to neoadjuvant therapy (NAT), are determined. Reproducibility scans at 3 different 3 T scanners, including 2 scanners in community imaging centers, found a 16.3% difference (n = 3) in magnetization transfer ratio (MTR) in healthy breast fibroglandular tissue. Repeatability scans (n = 10) found a difference of ∼8.1% in the MTR measurement of fibroglandular tissue between the 2 measurements. Thus, MTR is repeatable and reproducible in the breast and can be integrated into community imaging clinics. Serial magnetization transfer magnetic resonance imaging performed at longitudinal time points during NAT indicated no significant change in average tumoral MTR during treatment. However, histogram analysis indicated an increase in the dispersion of MTR values of the tumor during NAT, as quantified by higher standard deviation (P = .005), higher full width at half maximum (P = .02), and lower kurtosis (P = .02). Patients' stratification into those with pathological complete response (pCR; n = 6) at the conclusion of NAT and those with residual disease (n = 9) showed wider distribution of tumor MTR values in patients who achieved pCR after 2-4 cycles of NAT, as quantified by higher standard deviation (P = .02), higher full width at half maximum (P = .03), and lower kurtosis (P = .03). Thus, MTR can be used as an imaging metric to assess response to breast NAT.

Translating preclinical MRI methods to clinical oncology

The complexity of modern in vivo magnetic resonance imaging (MRI) methods in oncology has dramatically changed in the last 10 years. The field has long since moved passed its (unparalleled) ability to form images with exquisite soft-tissue contrast and morphology, allowing for the enhanced identification of primary tumors and metastatic disease. Currently, it is not uncommon to acquire images related to blood flow, cellularity, and macromolecular content in the clinical setting. The acquisition of images related to metabolism, hypoxia, pH, and tissue stiffness are also becoming common. All of these techniques have had some component of their invention, development, refinement, validation, and initial applications in the preclinical setting using in vivo animal models of cancer. In this review, we discuss the genesis of quantitative MRI methods that have been successfully translated from preclinical research and developed into clinical applications. These include methods that interrogate perfusion, diffusion, pH, hypoxia, macromolecular content, and tissue mechanical properties for improving detection, staging, and response monitoring of cancer. For each of these techniques, we summarize the 1) underlying biological mechanism(s); 2) preclinical applications; 3) available repeatability and reproducibility data; 4) clinical applications; and 5) limitations of the technique. We conclude with a discussion of lessons learned from translating MRI methods from the preclinical to clinical setting, and a presentation of four fundamental problems in cancer imaging that, if solved, would result in a profound improvement in the lives of oncology patients. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1377-1392.

Quantitative Magnetization Transfer Imaging of the Breast at 3.0 T: Reproducibility in Healthy Volunteers

Quantitative magnetization transfer magnetic resonance imaging provides a means for indirectly detecting changes in the macromolecular content of tissue noninvasively. A potential application is the diagnosis and assessment of treatment response in breast cancer; however, before quantitative magnetization transfer imaging can be reliably used in such settings, the technique's reproducibility in healthy breast tissue must be established. Thus, this study aims to establish the reproducibility of the measurement of the macromolecular-to-free water proton pool size ratio (PSR) in healthy fibroglandular (FG) breast tissue. Thirteen women with no history of breast disease were scanned twice within a single scanning session, with repositioning between scans. Eleven women had appreciable FG tissue for test–retest measurements. Mean PSR values for the FG tissue ranged from 9.5% to 16.7%. The absolute value of the difference between 2 mean PSR measurements for each volunteer ranged from 0.1% to 2.1%. The 95% confidence interval for the mean difference was ±0.75%, and the repeatability value was 2.39%. These results indicate that the expected measurement variability would be ±0.75% for a cohort of a similar size and would be ±2.39% for an individual, suggesting that future studies of change in PSR in patients with breast cancer are feasible.

Equivalent cross-relaxation rate imaging positively correlates with pathological grade and cell density of adipocytic tumors

OBJECTIVE

Equivalent cross-relaxation rate imaging (ECRI) is an MRI technique used to evaluate qualitative changes in protein-water interactions. We aimed to prospectively evaluate the utility of ECRI for classification of adipocytic tumors.

MATERIALS AND METHODS

Institutional Review Board approval was obtained and all patients provided informed consent. Study participants included 40 patients with adipocytic tumors who were diagnosed with lipomas (n=22), atypical lipomatous tissue/well-differentiated liposarcoma (ALT/WDL; n=9), myxoid/round cell liposarcoma (MyL; n=6), and dedifferentiated liposarcoma (DDL; n=3), and 20 control patients for whom subcutaneous fat in the buttock or thigh was analyzed.

RESULTS

Mean ECR values of lipomas, ALT/WDL, and subcutaneous fat were low, and those of MyL and DDL were high. Mean ECR values of MyL and DDL were significantly higher than those of ALT/WDL. The cut-off value was 5.1%. There was a positive correlation between ECR value, pathological grade, and cell density in adipocytic tumors.

CONCLUSION

The ECR value positively correlates with pathological grade and cell density of adipocytic tumors. Our findings suggest that ECRI is a useful method for preoperative evaluation of adipocytic tumors.

Differentiation of malignant and benign breast lesions using magnetization transfer imaging and dynamic contrast-enhanced MRI

PURPOSE

To evaluate feasibility of using magnetization transfer ratio (MTR) in conjunction with dynamic contrast-enhanced MRI (DCE-MRI) for differentiation of benign and malignant breast lesions at 3 Tesla.

MATERIALS AND METHODS

This prospective study was IRB and HIPAA compliant. DCE-MRI scans followed by MT imaging were performed on 41 patients. Regions of interest (ROIs) were drawn on co-registered MTR and DCE postcontrast images for breast structures, including benign lesions (BL) and malignant lesions (ML). Initial enhancement ratio (IER) and delayed enhancement ratio (DER) were calculated, as were normalized MTR, DER, and IER (NMTR, NDER, NIER) values. Diagnostic accuracy analysis was performed.

RESULTS

Mean MTR in ML was lower than in BL (P < 0.05); mean DER and mean IER in ML were significantly higher than in BL (P < 0.01, P < 0.001). NMTR, NDER, and NIER were significantly lower in ML versus BL (P < 0.007, P < 0.001, P < 0.001). IER had highest diagnostic accuracy (77.6%), sensitivity (86.2%), and area under the ROC curve (.879). MTR specificity was 100%. Logistic regression modeling with NMTR and NIER yielded best results for BL versus ML (sensitivity 93.1%, specificity 80%, AUC 0.884, accuracy 83.7%).

CONCLUSION

Isolated quantitative DCE analysis may increase specificity of breast MR for differentiating BL and ML. DCE-MRI with NMTR may produce a robust means of evaluating breast lesions.

Cellular density evaluation for malignant lymphoma using equivalent cross-relaxation rate imaging - initial experience

Objective

Equivalent cross-relaxation rate (ECR) imaging is an MRI technique used to evaluate quantitatively a change in the protein-water interaction. We aimed to evaluate retrospectively the usefulness of ECR imaging for the histologic classification of malignant lymphoma (ML).

Materials and Methods

Institutional Review Board approval was obtained and all patients provided informed consent. The study subjects included 15 patients with untreated ML who were histologically diagnosed with follicular lymphoma (FL; n = 8) or diffuse large B-cell lymphoma (DLBCL; n = 7). All patients underwent ECR imaging and the offset frequency was set at 7 ppm.

Results

The median ECR values were 71% (range; 60.7 to 75.5) in FL and 54% (50.8 to 59.4) in DLBCL (p = 0.001). The median cellular density was 1.5 ± 0.17 × 10⁶ / mm² in FL and 1.0 ± 0.70 × 10⁶ / mm² in DLBCL (p = 0.001). The correlation coefficient between the ECR values and cellular density in ML was 0.88 (p = 0.001). In FL and DLBCL, assuming ECR value cut-off points of 60%, both sensitivity and specificity were 100%.

Conclusion

A strong correlation between ECR and cellular density in ML is demonstrated and the ECR may be a useful technique to differentiate between FL and DLBCL.

Magnetization transfer enhanced vascular-space-occupancy (MT-VASO) functional MRI

Vascular-space-occupancy (VASO) MRI is a novel technique that uses blood signal nulling to detect blood volume alterations through changes in tissue signal. VASO has relatively low signal to noise ratio (SNR) because only 10-20% of tissue signal remain at the time of blood nulling. Here, it is shown that by adding a magnetization transfer (MT) prepulse it is possible to increase SNR either by attenuating the initial tissue magnetization when the MT pulse is placed before inversion, or, accelerating the recovery process when the pulse is applied after the inversion. To test whether the MT pulse would affect the blood nulling time in VASO, MT effects in blood were measured both ex vivo in a bovine blood phantom and in vivo in human brain. Such effects were found to be sufficiently small (<2.5%) under a saturation power <or= 3 microT, length=500 ms, and frequency offset >or=40 ppm to allow use of the same nulling time. Subsequently, functional MRI experiments using MT-VASO were performed in human visual cortex at 3 Tesla. The relative signal changes in MT-VASO were of the same magnitude as in VASO, while the contrast to noise ratio (CNR) was enhanced by 44+/-12% and 36+/-11% respectively. Therefore, MT-VASO should provide a means for increasing inherently low CNR in VASO experiments while preserving the CBV sensitivity.

Differentiation between benign and malignant breast lesions detected by bilateral dynamic contrast-enhanced MRI: a sensitivity and specificity study

The purpose of this study was to apply an empirical mathematical model (EMM) to kinetic data acquired under a clinical protocol to determine if the sensitivity and specificity can be improved compared with qualitative BI-RADS descriptors of kinetics. 3D DCE-MRI data from 100 patients with 34 benign and 79 malignant lesions were selected for review under an Institutional Review Board (IRB)-approved protocol. The sensitivity and specificity of the delayed phase classification were 91% and 18%, respectively. The EMM was able to accurately fit these curves. There was a statistically significant difference between benign and malignant lesions for several model parameters: the uptake rate, initial slope, signal enhancement ratio, and curvature at the peak enhancement (at most P=0.04). These results demonstrated that EMM analysis provided at least the diagnostic accuracy of the kinetic classifiers described in the BI-RADS lexicon, and offered a few key advantages. It can be used to standardize data from institutions with different dynamic protocols and can provide a more objective classification with continuous variables so that thresholds can be set to achieve desired sensitivity and specificity. This suggests that the EMM may be useful for analysis of routine clinical data.

Effect of acute tryptophan depletion on pre-frontal engagement

BACKGROUND

Serotonin is known to modulate cognitive functioning and has been implicated in the cognitive deficits associated with affective disorders. The present study examined regional brain activation during two tasks that are known to engage the pre-frontal cortex and are performed poorly by patients with depression and bipolar disorder. We tested the hypothesis that acute tryptophan depletion (ATD) would attenuate pre-frontal activation during both tasks.

MATERIALS AND METHODS

Ten healthy right-handed volunteers were studied using functional MRI whilst performing a 2-back verbal working memory task and a phonological verbal fluency task. Subjects were studied in two separate sessions, after either a tryptophan-free or a balanced amino acid drink, in a double-blind design. Task performance and mood were measured online.

RESULTS

Relative to sham depletion, ATD attenuated activation in the right superior frontal gyrus during the 2-back task and in the medial frontal gyrus and precuneus during the verbal fluency task. ATD lowered total plasma tryptophan by 79% but had no significant effect on either task performance or mood.

CONCLUSIONS

The engagement of pre-frontal cortex during verbal working memory and verbal fluency tasks is significantly modulated by central serotonergic activity. The different location of these modulatory effects within the frontal cortex may reflect the engagement of distinct cognitive processes by the respective tasks.

Equivalent cross-relaxation rate imaging for sentinel lymph node biopsy in breast carcinoma

Sentinel lymph node biopsy (SLNB) is an important technique for detecting axillary lymph node metastasis in breast carcinoma patients. However, false-negative results are a problem. Equivalent cross-relaxation rate (ECR) imaging (ECRI) is a measurement method that can be used to quantitatively evaluate a change in the structural organization of lymph nodes by magnetic resonance imaging (MRI). We performed axillary ECRI in an attempt to decrease the false-negative results of SLNB. Regions without metastases showed a higher ECR value. On the other hand, regions with metastases showed a lower ECR value. The ECR images were compared with macroscopic histology images in which the presence or absence of axillary lymph node metastasis could be evaluated. ECRI is a potentially useful method for evaluating the efficacy of SLNB.

Equivalent cross-relaxation rate imaging of breast cancer

PURPOSE

To determine whether equivalent cross-relaxation rate (ECR) imaging is a feasible method for demonstrating breast cancer.

MATERIALS AND METHODS

Fifteen breast cancer patients underwent both ECR imaging, with off-resonance saturation pulses at frequency offsets of 7 and 19 ppm (ECR-7 and ECR-19, respectively) from water resonance, and gadolinium (Gd)-enhanced dynamic magnetic resonance imaging (MRI) of the breast. The mean tumor size was 26.5 mm. The tumor outlines defined by their shape and margin on ECR-7 images were compared with the subtraction images produced by the dynamic study, and the distribution of hyperintensity areas and their shapes on ECR-19 images were assessed. All patients had surgery and pathological findings were compared to ECR images.

RESULTS

The tumor outline of 13/15 (87%) tumors on ECR-7 images was nearly identical to that on subtraction images; ECR-19 images demonstrated the location and degree of fibrosis. The tumor outline of the other two tumors was less clear on ECR-7 images, and internal hyperintensity on ECR-19 images reflected intratumoral fibrotic foci. ECR-7 and -19 imaging findings allowed identification of four distinct tumor types that reflected the tumor growth patterns and their internal structures associated with fibrosis.

CONCLUSION

ECR imaging is a feasible imaging technique for demonstrating breast cancer.

Equivalent cross-relaxation rate imaging in the synthetic copolymer gels and invasive ductal carcinomas of the breast

The values of equivalent cross-relaxation rate (ECR) correlated well with [i] water conditions in various copolymer gels and [ii] nature of malignant cells with regard to nuclear dysplasia and mitotic potential in breast carcinomas. The synthetic copolymer gels composed of any two or three monomers among 2-hydroxyethyl methacrylate (HEMA), glycidyl methacrylate (GMA), N-vinyl-2-pyrrolidinone (N-VP), methyl methacrylate (MMA) and benzyl methacrylate (BMA). The ECR measurement was performed by using an off-resonance saturation pulse under conventional field-echo imaging at frequency within +/- 75 ppm apart from the water resonance frequency. The ECR values were readily to determine and non-time consuming parameter for cross relaxation rate. The ECR values at the frequency offset by 7-ppm (ECR-7) were divided the sample gels two classes, which must correspond to hydrophilic or hydrophobic ones. The sensitivity in the gels was nearly equivalent to the cross-relaxation rate itself. In the breast carcinomas, the ECR-7 correlates with the nature of malignant cells with regard to nuclear dysplasia and mitotic potential. The ECR-7 is better or more accurate than the STR-7 because the SDNRs between carcinoma and glandular tissue increased by approximately 50% on the ECR-7 compared with the STR-7. Thus the ECR values could be a new parameter for malignancy and cell proliferative activity of the breast carcinomas with non-invasive modalities by magnetic resonance imaging.

Saturation transfer ratio imaging in invasive ductal carcinomas of the breast

A prospective study was performed to investigate the correlations between saturation transfer ratio (STR) and histologic parameters of invasive ductal carcinomas in human breast. The histologic parameters investigated were the extent of fibrosis in the intercellular matrix, dysplastic changes of nuclei, and mitotic index. Twenty-seven patients with breast carcinoma were examined using an off-resonance saturation pulse in conjunction with conventional field-echo T(1)-weighted imaging at frequency offsets of 448 Hz and 1200 Hz from water resonance. The values of STR at frequency offset of 1200 Hz (STR(1200)) increased from non-scirrhous carcinoma to scirrhous carcinoma. Although STR(1200) showed correlation with the extent of fibrosis in the intercellular matrix (p<0.01, n = 27), they did not correlate with the dysplastic changes of nuclei or mitotic index. On the other hand, the values of STR at frequency offset of 448 Hz (STR(448)) demonstrated close correlation to dysplastic changes of nuclei and mitotic index (p<0.01, n = 27). STR(1200) correlates with the structural characteristics and STR(448) correlates with the nature of malignant cells with regard to nuclear dysplasia and mitotic potential.

A magnetic field control system for a variable field NMR spectrometer

The magnetic field specifications necessary for use as part of a variable field NMR spectrometer are outlined. Although the widely used commercial magnet systems provide a high degree of temporal field stability and accuracy, they are relatively costly. This publication describes a novel and inexpensive magnet power supply, with field control provided by a Hall effect device. The system has been used successfully to determine in vitro NMR relaxation times and the magnetization transfer characteristics of human thyroid and breast tissues.