T2* mapping combined with conventional T2-weighted image for prostate cancer detection at 3.0T MRI: a multi-observer study

Rapid high-fidelity T 2 * mapping using single-shot overlapping-echo acquisition and deep learning reconstruction

PURPOSE

To develop and evaluate a single-shot quantitative MRI technique called GRE-MOLED (gradient-echo multiple overlapping-echo detachment) for rapid T 2 * $$ {T}_2^{\ast } $$ mapping.

METHODS

In GRE-MOLED, multiple echoes with different TEs are generated and captured in a single shot of the k-space through MOLED encoding and EPI readout. A deep neural network, trained by synthetic data, was employed for end-to-end parametric mapping from overlapping-echo signals. GRE-MOLED uses pure GRE acquisition with a single echo train to deliver T 2 * $$ {T}_2^{\ast } $$ maps less than 90 ms per slice. The self-registered B₀ information modulated in image phase was utilized for distortion-corrected parametric mapping. The proposed method was evaluated in phantoms, healthy volunteers, and task-based FMRI experiments.

RESULTS

The quantitative results of GRE-MOLED T 2 * $$ {T}_2^{\ast } $$ mapping demonstrated good agreement with those obtained from the multi-echo GRE method (Pearson's correlation coefficient = 0.991 and 0.973 for phantom and in vivo brains, respectively). High intrasubject repeatability (coefficient of variation <1.0%) were also achieved in scan-rescan test. Enabled by deep learning reconstruction, GRE-MOLED showed excellent robustness to geometric distortion, noise, and random subject motion. Compared to the conventional FMRI approach, GRE-MOLED also achieved a higher temporal SNR and BOLD sensitivity in task-based FMRI.

CONCLUSION

GRE-MOLED is a new real-time technique for T 2 * $$ {T}_2^{\ast } $$ quantification with high efficiency and quality, and it has the potential to be a better quantitative BOLD detection method.

The Preoperative Diagnostic Performance of Multi-Parametric Quantitative Assessment in Rectal Carcinoma: A Preliminary Study Using Synthetic Magnetic Resonance Imaging

Objective

Synthetic MRI (SyMRI) can reconstruct different contrast-weighted images(T1, T2, PD) and has shorter scan time, easier post-processing and better reproducibility. Some studies have shown splendid correlation with conventional mapping techniques and no degradation in the quality of syMRI images compared with conventional MRI. It is crucial to select an individualized treatment plan based on the preoperative images of rectal carcinoma (RC). We tried to explore the feasibility of syMRI on T, N stage and extramural vascular invasion (EMVI) of rectal cancer.

Materials and Methods

A total of 100 patients (37 females and 63 males) diagnosed with rectal carcinoma were enrolled. All the patients underwent preoperative pelvic MR examinations including conventional MR sequence and synthetic MRI. Two radiologists evaluated the MRI findings of each rectal carcinoma and EMVI score in consensus. The values for T1, T2 relaxation times and PD value were measured in tumor(ROI-1) and pararectal fat space(ROI-2) and analyzed independently. A receiver operating characteristic (ROC) analysis was performed. Correlations between the T1, T2 and PD values and EMVI score were also evaluated.

Results

Compared with the normal rectal wall, the values of T1 and T2 relaxation times of the tumor were significantly higher (P <0.001). There was no statistically significant difference in the PD value (P >0.05). As for ROI, the ROI of pararectal fat space(ROI-2) had better significance than rectal cancer lesion (ROI-1). T2 value of ROI-1 and T1 value of ROI-2 were higher in the pEMVI positive group than in the negative group (P=0.002 and 0.001) and T1 value of ROI-2 had better performance with an AUC of 0.787, (95% CI:0.693- 0.882). T1 value, T2 value and PD value from ROI-2 were effective for both T and N stage of rectal cancer. High-grade pathological stage had showed higher T1 value (P_{T stage}=0.013,P_{N stage}=0.035), lower T2 value (P_{T stage}=0.025,P_{N stage}=0.034) and lower PD value (P_{T stage}=0.017). We also enrolled the characteristics with P < 0.05 in the combined model which had better diagnostic efficacy. A significant positive correlation was found between the T1 value of pararectal fat space(ROI-2) and EMVI score (r value = 0.519, P<0.001). The T2 value(r=0.213,P=0.049) and PD value(r=0.354,P=0.001) from ROI-1 was correlated with EMVI score. Correlation analysis did not show any significant associations between T2 value of tumor, T2, PD values of pararectal fat space and EMVI scores.

Conclusion

Synthetic MRI can provide multi-parameter quantitative image maps with a easier measurement and slightly shorter acquisition time compared with conventional MRI. The measurement of multi-parametric quantitative values contributes to diagnosing the tumor and evaluating T stage, N stage and EMVI. It has the potential to be used as a preoperative diagnostic and grading technique in rectal carcinoma.

Value of T2 Mapping MRI for Prostate Cancer Detection and Classification

BACKGROUND

Currently, multi-parametric prostate MRI (mpMRI) consists of a qualitative T₂ , diffusion weighted, and dynamic contrast enhanced imaging. Quantification of T₂ imaging might further standardize PCa detection and support artificial intelligence solutions.

PURPOSE

To evaluate the value of T₂ mapping to detect prostate cancer (PCa) and to differentiate PCa aggressiveness.

STUDY TYPE

Retrospective single center cohort study.

POPULATION

Forty-four consecutive patients (mean age 67 years; median PSA 7.9 ng/mL) with mpMRI and verified PCa by subsequent targeted plus systematic MR/ultrasound (US)-fusion biopsy from February 2019 to December 2019.

FIELD STRENGTH/SEQUENCE

Standardized mpMRI at 3 T with an additionally acquired T₂ mapping sequence.

ASSESSMENT

Primary endpoint was the analysis of quantitative T₂ values and contrast differences/ratios (CD/CR) between PCa and benign tissue. Secondary objectives were the correlation between T₂ values, ISUP grade, apparent diffusion coefficient (ADC) value, and PI-RADS, and the evaluation of thresholds for differentiating PCa and clinically significant PCa (csPCa).

STATISTICAL TESTS

Mann-Whitney test, Spearman's rank (r_s ) correlation, receiver operating curves, Youden's index (J), and AUC were performed. Statistical significance was defined as P < 0.05.

RESULTS

Median quantitative T₂ values were significantly lower for PCa in PZ (85 msec) and PCa in TZ (75 msec) compared to benign PZ (141 msec) or TZ (97 msec) (P < 0.001). CD/CR between PCa and benign PZ (51.2/1.77), respectively TZ (19.8/1.29), differed significantly (P < 0.001). The best T₂ -mapping threshold for PCa/csPCa detection was for TZ 81/86 msec (J = 0.929/1.0), and for PZ 110 msec (J = 0.834/0.905). Quantitative T₂ values of PCa did not correlate significantly with the ISUP grade (r_s  = 0.186; P = 0.226), ADC value (r_s  = 0.138; P = 0.372), or PI-RADS (r_s  = 0.132; P = 0.392).

DATA CONCLUSION

Quantitative T₂ values could differentiate PCa in TZ and PZ and might support standardization of mpMRI of the prostate. Different thresholds seem to apply for PZ and TZ lesions. However, in the present study quantitative T₂ values were not able to indicate PCa aggressiveness.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY: Stage 2.

The history of magnetic resonance imaging and its reflections in Acta Radiologica

The first reports in Acta Radiologica on magnetic resonance imaging (MRI) were published in 1984, four years after the first commercial MR scanners became available. For the first two years, all MR papers originated from the USA. Nordic contributions started in 1986, and until 2020, authors from 44 different countries have published MR papers in Acta Radiologica. Papers on MRI have constituted, on average, 30%-40% of all published original articles in Acta Radiologica, with a high of 49% in 2019. The MR papers published since 1984 document tremendous progress in several areas such as magnet and coil design, motion compensation techniques, faster image acquisitions, new image contrast, contrast-enhanced MRI, functional MRI, and image analysis. In this historical review, all of these aspects of MRI are discussed and related to Acta Radiologica papers.

High spectral and spatial resolution MRI of prostate cancer: a pilot study

PURPOSE

High spectral and spatial resolution (HiSS) MRI is a spectroscopic imaging method focusing on water and fat resonances that has good diagnostic utility in breast imaging. The purpose of this work was to assess the feasibility and potential utility of HiSS MRI for the diagnosis of prostate cancer.

METHODS

HiSS MRI was acquired at 3 T from six patients who underwent prostatectomy, yielding a train of 127 phase-coherent gradient echo (GRE) images. In the temporal domain, changes in voxel intensity were analyzed and linear (R) and quadratic (R1, R2) quantifiers of signal logarithm decay were calculated. In the spectral domain, three signal scaling-independent parameters were calculated: water resonance peak width (PW), relative peak asymmetry (PRA), and relative peak distortion from ideal Lorentzian shape (PRD). Seven cancer and five normal tissue regions of interest were identified in correlation with pathology and compared.

RESULTS

HiSS-derived quantifiers, except R2, showed high reproducibility (coefficients of variation, 5%-14%). Spectral domain quantifiers performed better than temporal domain quantifiers, with receiver operator characteristic areas under the curve ranging from of 0.83 to 0.91. For temporal domain parameters, the range was 0.74 to 0.91. Low absolute values of the coefficients of correlation between monoexponential decay markers (R, PW) and resonance shape markers (PRA, PRD) were observed (range, 0.23-0.38).

CONCLUSION

The feasibility and potential diagnostic utility of HiSS MRI in the prostate at 3 T without an endorectal coil was confirmed. Weak correlation between well-performing markers indicates that complementary information could be leveraged to further improve diagnostic accuracy.

Clinical utility of combined T2-weighted imaging and T2-mapping in the detection of prostate cancer: a multi-observer study

Background

To evaluate the clinical utility of combined T2-weighted imaging and T2-mapping for the detection of prostate cancer.

Methods

Forty patients underwent multiparametric magnetic resonance imaging (mpMRI) and T2-mapping of the prostate. Three readers each reviewed two sets of images: T2-weighted fast spin-echo (FSE) sequence (standard T2), and standard T2 in combination with T2-mapping. Each reader assigned probability scores for malignancy to each zone [peripheral zone (PZ) or transition zone (TZ)]. Inter-observer variability for standard T2 and combined standard T2 with T2-mapping were assessed. Diagnostic accuracy was compared between standard T2 and combined standard T2 with T2-mapping.

Results

There was fair agreement between all three readers for standard T2 [intraclass correlation coefficient (ICC) =0.56] and combined standard T2 with T2-mapping (ICC =0.58). There was no significant difference in the area under the receiver operator characteristics curve for standard T2 compared to combined standard T2 with T2-mapping (0.89 vs. 0.82, P=0.31). Sensitivity (Sn) for combined standard T2 with T2-mapping was significantly higher compared to standard T2 alone (73.0% vs. 49.2%, P=0.006). Specificity (Sp) for combined standard T2 with T2-mapping was borderline significantly lower compared to standard T2 alone (89.3% vs. 94.9%, P=0.05). There was no significant differences between the negative predictive values (NPVs) and positive predictive values (PPVs) (P=0.07, P=0.45).

Conclusions

Combination of T2-weighted imaging and T2-mapping could potentially increase Sn for prostate malignancy compared to T2-weighted imaging alone.

Multi-parametric T2 * magnetic resonance fingerprinting using variable echo times

The use of quantitative imaging biomarkers in the imaging of various disease states, including cancer and neurodegenerative disease, has increased in recent years. T₁ , T₂ , and T₂ * relaxation time constants have been shown to be affected by tissue structure or contrast infusion. Acquiring these biomarkers simultaneously in a multi-parametric acquisition could provide more robust detection of tissue changes in various disease states including neurodegeneration and cancer. Traditional magnetic resonance fingerprinting (MRF) has been shown to provide quick, quantitative mapping of T₁ and T₂ relaxation time constants. In this study, T₂ * relaxation is added to the MRF framework using variable echo times (TE). To demonstrate the feasibility of the method and compare incremental and golden angle spiral rotations, simulated phantom data was fit using the proposed method. Additionally, T₁ /T₂ /T₂ */δf MRF as well as conventional T₁ , T₂ , and T₂ * acquisitions were acquired in agar phantoms and the brains of three healthy volunteers. Golden angle spiral rotation was found to reduce inaccuracy resulting from off resonance effects. Strong correlations were found between conventional and MRF values in the T₁ , T₂ , and T₂ * relaxation time constants of the agar phantoms and healthy volunteers. In this study, T₂ * relaxation has been incorporated into the MRF framework by using variable echo times, while still fitting for T₁ and T₂ relaxation time constants. In addition to fitting these relaxation time constants, a novel method for fitting and correcting off resonance effects has been developed.

Role of quantitative analysis of T2 relaxation time in differentiating benign from malignant breast lesions

Objective To investigate the role of quantitative analysis of T2 relaxation time in the magnetic resonance imaging (MRI) diagnosis of breast cancer. Methods The study enrolled patients with clinical breast masses who were examined using MRI at eight different echo times. The differences in T2 relaxation time of benign and malignant breast lesions were analysed. Results A total of 67 patients (67 breast lesions: 46 malignant, 21 benign) were examined. The mean ± SD T2 relaxation time was significantly lower in the 46 malignant lesions compared with the 21 benign lesions (82.69 ± 15.37 ms versus 95.48 ± 26.51 ms, respectively). The area under the curve was 0.731. Using 79.52 ms as the cut-off between benign and malignant breast lesions, a sensitivity of 85.7% and a specificity of 58.7% were obtained. Conclusions There was a significant difference in T2 relaxation time between benign and malignant breast lesions. The specificity of using T2 relaxation time alone for the differentiation of benign from malignant lesions was not high, but it could constitute a new adjunct in the MRI diagnosis of breast cancer.